“Hello Ivy this is Sally from the Women Studies division calling to congratulate your being awarded the Lancy scholarship. Tomorrow we would like to present this to you at our Spring Celebration Event. If you have any questions give me a call at…”

I received this voicemail somewhere in between giving high doses of morphine for the moans of my patients’ family members, and giving therapeutic breathing techniques to Keith. “For tomorrow they will pull that tube and you will not make it if we can’t control the anxiety with your mind. I can’t give you sedation when you are not on the breathing machine.”

In my mind I can hear them say, “If you nurse half as good as you bullshit you will do well.”

Pain is subjective. Comfort is subjective. Comfort Care is subjective and is guided by ones mores and ethics. She appears comfortable to me, but this is taking to long. I count her respirations—50. Even though we all agree she looks like she is asleep, this is taking to long—16 days. This could be seen as discomfort—bolus. As I push the morphine I am reminded of something Lisa said, or was it me, I don’t remember, I will ask her later. “Sometimes I wonder if it is you or me that I am medicating,” right now I know it is not her but You. “Are you sure there is not anything more we could do?” he not so subtlety asks me to give her a lethal dose. Listen, I have blurred my boundaries with her today. I have given her enough; we just need to follow her. Later I recognize all the contradiction in what I just said, I tried to give her that dose without technically giving her that dose and she did not die. Now I recognize my defeat, lack of control, and I step humbly and feeling a bit guilty back again into my place, following her.

Sometimes I wonder if it is you or me that I am medicating.
She has pursed her lips and is breathing rapidly,
morphine slips under her tongue.

Sometimes I wonder if it is you or me that I am medicating.
“Do you think I made the wrong decision?”
She made this decision, not you, you are only her voice.

Sometimes I wonder if it is you or me that I am medicating.
“Do you remember that patient we took care of? Don’t ever let me become like that” she says,
not knowing the black cotton Webb
covering her head and noosing her neck.

As for those struggling with moral distress I believe a litany is of need.
A LITANY FOR SURVIVAL

For those of us who live at the shoreline
standing upon the constant edges of decision
crucial and alone
for those of us who cannot indulge
the passing dreams of choice
who love in doorways coming and going
in the hours between dawns
looking inward and outward
at once before and after
seeking a now that can breed
futures
like bread in our children's mouths
so their dreams will not reflect
the death of ours:

For those of us
who were imprinted with fear
like a faint line in the center of our foreheads
learning to be afraid with our mother's milk
for by this weapon
this illusion of some safety to be found
the heavy-footed hoped to silence us
For all of us
this instant and this triumph
We were never meant to survive.

And when the sun rises we are afraid
it might not remain
when the sun sets we are afraid
it might not rise in the morning
when our stomachs are full we are afraid
of indigestion
when our stomachs are empty we are afraid
we may never eat again
when we are loved we are afraid
love will vanish
when we are alone we are afraid
love will never return
and when we speak we are afraid
our words will not be heard
nor welcomed
but when we are silent
we are still afraid

So it is better to speak
remembering
we were never meant to survive
- Audre Lorde, The Black Unicorn

Often pain is the price we pay to speak the truth. Sometimes that pain comes with the unacceptance by the others, (ruffling feathers, and rocking the all to comfortable boats people live in) fact of the matter is people don't like truth for its blunt edge and rawness. We don't like to be broken from of illusions, our control, our agenda and especially our ego. But this does not negate the obligation that we as each other's keepers have to one another. It isn't about you, it is about the patient...who is in fact a person...a human, somebody’s lover, mother, father, sister, brother, best friend, soul mate; and deep down they are you.

'Language is a body of suffering and when you take up language you take up the suffering too.' Nothing is as simple as it seems, so much is neither good nor bad, but always a blend of truths."

Don't be quite, we need loud souls willing to wake us from our sleep.
The route word for passion is to suffer.

The Color Purple,
Ivy