Ben Avuyah

Welcome to the Pardess.

Sunday, July 10, 2005

Katie Remembered

I know this feeling all too well, I’m being rescued again, and no doubt the intentions are good, how could they not be? Someone is trying to help me find my way.

It’s my own fault, truth be told, I’ve slipped and allowed someone close to me to know my doubts. As a result I have been given an article cut out of some leading Jewish newspaper, authored by a well known Rabbi, who has, by no small chance, finally discovered the true nature of the world, why bad things happen to good people, and everything in between.

There was a time in my life when I would have simply read the article, absorbed the information, and filed it appropriately in my brain along with Jewish ethics, culture, rules and ritual; all part of the growing database of this here proudly educated Jew; but since meeting Katie, simple explanations have not sufficed.

I won’t be so bold as to say my spiritual life was flawless before fate had our paths cross. I had my doubts about specific doctrines or rituals, but surely human error in interpreting the divine was accountable.

And I was not so far removed from reality, even back in those days, as to be uncomfortably aware of my own strangeness; walking through the halls of the hospital with my Yarmulke on, in a completely gentile community. People often turned to look at me for a second too long or whispered in hushed voices as I came by. I was something of an anomaly but… wasn’t it a fair trade?

Did I not have the ancient wisdom of God’s chosen people in my grasp? Were the secrets of the universe not at my fingertips while everyone around me fumbled in the darkness, groping for spirituality in the wastelands outside of clear cut orthodoxy?

I wore my faith like a protective cloak, held tightly around my psyche, perpetually warming me to the idea that I was far better off than my surrounding companions. I was above them; leading an existence based on pure directives from the source of all that was and all that would ever be.

How odd I must have seemed to them. So different and yet exuding such powerful confidence. Such self assurance. It must have come across in introduction as I gripped attending physician Dr. Gregory Petrovich’s hand, looked him in the eye and told him, yes, I was ready for the work ahead, because he nodded with appreciation and welcomed me wholeheartedly. I studied his face as he motioned for an elderly nurse to come over and meet me.
I judged him to be in his late fifties, early sixties. His hair had receded to a point of widows peak midway on his forehead and was salt and pepper at the temples. His face was craggy, his teeth terrible and darkened, and his stalwart torso spoke to me of Russian ancestry and a youth of physical labor. He was rumored to be amongst the most brilliant and dedicated of the collective staff.
“Molly”, he said with a light accent, his tongue refusing to part with the last remnants of a his Slavic roots, “this is Ben, he will be joining us for the next six weeks.”
“Pleasure to meet you, Molly.”
She took my hand lightly and did not address me. She looked at me.
No.
She took me in. She assessed me then as if determining my worth by her own careful examination, judging whether or not I had the right stuff for the task ahead..
Molly must have been mid sixties, and old fashioned to boot. She still wore a nurses hat; an accoutrement long since left behind by the profession. From beneath it flowed straight white hair, carefully arranged , and sharp blue eyes.

I had heard of her through rumors and gossip. Some said she had been a young nurse in Vietnam, others claimed she was a Nun who had later become a nurse. I don’t know why legends cluster about some people, but I do know what made Molly so exceptional. She was one of those rare people who had found her calling. It was evident in everything she did. This was where she belonged in life. This was her appointed task. I can’t say what she gathered from looking me over, but I saw in her Divine providence, God must have meant for her to be here.

I had barely had a chance to put my books down in a corner of the unit when the buzz of secretaries and orderlies informed me that we had been alerted to trauma. Dr. Petrovich tossed me a gown.

“Get ready”, he said and stalked off to arrange the armamentarium of medicines and devices on a cart that Molly wheeled to the first curtain.

He needn’t have told me twice, I had at my disposal all the energy and stupidity of youth.

“What’s your next rotation”, my roommate had asked me the night before.

“Burn Unit”, I had replied matter of factly, not bothering to look up from my studies.

“Are you ready” ? he asked smugly, already having been there and back.

What the …? didn’t he see me reading the goddamned chapter for the fifth time?

Of course I was ready. My whole life was about being ready.

As I finished donning my protective gown, a stretcher bearing Katie Janson burst through the double doors.

Now, in all likelihood, my erstwhile reader, you’ve never seen a burn victim before, and neither had I. I was not prepared at that time nor will I ever be, and I will not cavalierly turn that fate over to you without warning.

Take from me now a word of caution and advice. Go somewhere else, find yourself an errand, read a bit of politics, go socialize at the office cooler.

If you have a gentle heart this is not for you, dear reader, why, even after several years of studying the most destructive forms of disease, it was not for me. I froze there in my tracks like a statue, struck dumb by the sight of something writhing on that stretcher that could only be qualified as human based on it’s past history. A barely audible whimper emanated from between it’s cracked and swollen lips. It was a gritty hollow sound, pushed from the burnt trachea it grated like a guttural consonant that could not escape the throat.

Even all these years later I am still agonized by the fact that my first reaction was not compassion, but horror. Horror at the…the thing that kept it’s charred and blistered hands stretched directly out in front of it as if still in the act of warding off the searing flames. Fingers blackened and charred through and through and sheets of skin hanging from extremities, it was almost too much to bear. There was no hair on the disfigured head, and the eyes were blistered shut. But, God help us all, if you looked closely enough, it was still a little girl.

Petrovich snapped me out of it.

“Ben, we need you”

I came back. One foot moved then the other. Medical knowledge replaced panic and fear. I joined in with Molly placing wet cloth over Katie’s charred body. The dissociated, calculating, medical part of my mind began its assessment. 90% full thickness burns…I calculated fluid loss rates and recalled infection statistics. I noted that Katie Janson was still too hot to touch.

Molly began speaking into the nub of what was formerly an ear.
“Katie, your safe now, your in the Hospital, and we are going to take care of you”

“I need a central line for fluid management”, Petrovich said, as cool as a cucumber, “And I don’t like the way the airway looks”, he noted pulling charred substances off her swollen tongue with a gloved finger.

“Were going to intubate right now.”

And so the battle for life began. We fought it for Katie without complaint, without coffee breaks, and with a vigor that only accompanies those moments in life where survival is at stake.

We plied her with antibiotics and poured in fluids, we monitored her breathing and electrolytes. We doused her with pain medications and paralyzed her with muscle relaxants so that she wouldn’t buck the ventilator. We performed emergency escharotomy surgery to save her arms and legs from the tight burn tissue that threatened to cut off her circulation.

We each prayed to our own Gods that long night and as day broke and the first rays of light beamed gently through the window, they were answered.

“Pulse and Blood Pressure stable for the past few hours,” I told Petrovich without need. He could have delegated responsibilities for patient care, but he had stayed by the bedside all night.

“Her airway is looking better,” he said, “let’s let her breath on her own…Molly, we’re going to extubate.”

We gathered about the bedside as Petrovich withdrew the tube and Molly turned off the slow drip of paralytic agent.

For a moment we waited in silence and then Molly bent closer still and talked to the gruesomely burnt tissue and open fissures that was once the face of a little girl.

“Katie”

Now Molly could easily be classified as elderly, and the nights tolls showed themselves in her voice, but she persisted.

“Katie breathe, baby, you need to take a breath.”

It wasn’t hokey.
It didn’t feel artificial.
Molly with her gray hair and steely eyes had that demeanor about her. She had talked people back from the brink before and she would do so again right before our very eyes.


“Breathe, Katie, you can do it.”

It started as a slow rumble, a grating noise deep in her chest that carried out to her throat and past her lips. Her chest moved with the effort, but the unmistakable rasp of air continued to flow.

“Breathe Katie”

She was doing it. By God ! She was really doing it. It was going to be the miracle story of the year. No one is supposed to be able to live through a burn like that. Especially not nine year old girls. The odds against are astronomical, and yet before our eyes Katie Janson thumbed her nose at statistics and bucked the tables listed in every textbook. Her will to survive was a force more powerful than science had yet calculated.

I actually heard myself laugh out loud before I gave myself permission to do so. I was glad for it though, because it was contagious.

Petrovich forgot himself in a brief moment of celebration and smiled wide enough for me appreciate the archaic state of Russian dentistry.

Even Molly allowed the skin in the corner of her eyes to crinkle.

Secretaries at desks and orderlies with brooms, stopped to take notice and move a little closer to the joy of one little girl the grim reaper would not claim this day.

We were men and women of medicine and science and we took a moment to revel in our own glory.

Petrovich slapped me on the back hard enough to assure me that I would not even have survived kindergarten in the former Soviet Union, and we savored the realization of the night’s hard earned rewards together.

But Molly leaned ever closer and was thus the first to notice that something was wrong, terribly wrong.

Katie’s breathing did not rise and fall with a normal tempo of respiration but continued steadily in a pitch that now began to rise in tone.


Molly looked confused at first and that got our attention, but as the pitch grew Katie’s fingers curled into fists holding the sheets, taught burnt skin cracking open over all her knuckles.

The noise she was making got louder.

Molly blinked twice.

“My God… she’s screaming…she’s screaming.”

As the last of the paralytic medicines faded from her blood stream, Katie’s eyes fluttered open revealing unseeing globes of pure white scalded tissue. She looked about frantically trying to ascertain her whereabouts. And now her cry for help was evident to all, filling the unit with the pain of a child trapped by fire

You see, dear reader, estimates had been made, and chances taken. We had to paralyze Katie for the breathing tube, and… without her reactions to guide us, take a guess as to how much medicine would be enough to take away the pain and not kill her in the process.

Gregory Petrovich, twenty year veteran of the Burn Unit, took a step back and turned a paler shade of Belarus as the shrill scream permeated the room.

“Morphine,” he said, his voice cracking.

Even Molly was too slow for him and he snapped his fingers in impatience, “Morphine !”

I, for my small part, fumbled the vial over to Molly to inject, and am thankful to this day that I didn’t drop it.

Katie’s scream trailed off as she lost consciousness and a single tear traced the aged lines on Molly’s face.

Dr. Petrovich was silent as he replaced the breathing tube. His face was stone.

How long had Katie been trapped in her own body, screaming in pain?

Did she ever know that she was in the hospital, or without sight or hearing, had she, in her own mind, been trapped in the building that killed the rest of her family all this time, screaming frantically for help.


No one had the heart to voice these questions. We busied ourselves with the medicine, but the brief moment of optimism had come and gone all too quickly. Katie’s vitals now fluttered dangerously. Her electrolytes became difficult to control, and with every passing hour she seemed worse.

We fought the good fight that day, and paid credence to neither fatigue or mounting despair. I ran laboratory tests back and forth, but the news kept on getting worse, dehydration, acidemia, electrolyte imbalance.

We all took turns talking to Katie now…Hang in there…Don’t give up…Your going to make it.
But Katie’s will to live was slipping away, I suppose she had grown tired of screaming for someone to help her, grown tired of waiting to be rescued, and her body could simply not overcome the damage done.


When Dr. Petrovich pronounced Katie dead that afternoon, I couldn’t help but cry a little. He covered her over with a sheet and walked over to Molly to put an arm around her shoulder.

Low man on the totem pole I knew my task before it was given to me and I found Katie’s Aunt resting on a chair in the waiting room. I woke her gently out of her slumber. And she looked at me with growing apprehension. My face must have said it all for she burst into tears immediately.

I had no prior training but I instinctively lied through my teeth.

“She didn’t suffer,” I said, “She was comfortable until she passed on.”

To this day, I don’t think she heard a word I said, the way she wept. She was inconsolable.

I stayed with her a while to comfort her.

On the table next to her was a picture of Katie. I picked it up. Blond hair, blue eyes, very middle America looking…and oh my…what a smile.

I try to remember her that way.


That night I avoided roommates and human contact. It had been 36 hours of hell and I longed for my bed. I took off my Yarmulke and put it on my night table. I stared at it feeling betrayal of the deepest sort.

Could I pretend to be spiritually satisfied with dietary and prayer laws of the utmost specifics, when I couldn’t begin to fathom the most basic tenets of Gods relationship and responsibility to human beings.

What kind of sick joke had been perpetrated on me, to be told that I could walk around with this funny hat and have the answers, when my most enlightened moment occurred to me this instant, as I understood that I didn’t know a goddamned thing.

What role could Katie’s suffering have played in God’s great cosmic plan ? And if it did have a role then what does that make God ?

I still believed though…despite the days events I still believed, hell, maybe I needed to believe, and I prayed that Katie had gone to a better place, away from pain; but I didn’t see how that would be likely given how little concern God had shown her in this world.

Thirty six hours of standing on my feet and fighting to keep my eyes open, and now lying comfortably in bed and… sleep would not come.

Now I sit here, many years later, with this article on my desk, getting ready to read about the harmony of our universe and how our benevolent God is watching over all of us. And that’s fine, I have an open mind, and I am ready to understand if a rational case can be made.

But before the answer must come the question, and I must remember this first brick that fell out of the previously impenetrable façade of orthodoxy that had been erected for me in Yeshiva. I have to remember the first time I realized that the answer was lacking, and needed, and nowhere to be found.

I’m going to read this article now, but I had to remember Katie first…

37 Comments:

At 7:37 PM, Blogger Jewish Atheist said...

Wow. I'm so sorry for Katie and her family and for you.

 
At 1:55 AM, Blogger Orthoprax said...

Man, you brought tears to my eyes with this one. You said it all so well I just have nothing to add.

 
At 3:24 AM, Blogger The Hedyot said...

Incredibly powerful.

May we all be spared such suffering.

 
At 5:49 AM, Blogger Ben Avuyah said...

JA, Orthoprax, and Hedyot,

Thank you very much for comming by to comment. I was worried that this post was going to be too much for people to handle, and I am very happy that you were all able to take something from it.

 
At 7:42 AM, Blogger Mis-nagid said...

I couldn't breath while I read that.

 
At 10:30 AM, Blogger David said...

I was blown away.

 
At 4:29 PM, Blogger Ben Avuyah said...

Mis-Nagid and David,
Thank you both for comming by to read and post a comment, I appreciate them.

 
At 4:49 PM, Blogger Twice a Heretic said...

What an important story. Thank you for sharing it. I'm speechless.

 
At 7:15 PM, Blogger Ben Avuyah said...

Thanks for stopping by, twiceaheretic, I just read your post on the rabbinic view of aids, and I see we agree on the low level of likelihood that any type of benevolent superbeing is running the show down here, something I intend to explore further in my next post...

 
At 7:44 PM, Blogger Avi said...

Okay. As you yourself said, you dont know anything or something like that. You dont think that if God exists he cant figure things out? Yes I know that there are those who are going to going to phoo phoo my answer and make light of it. But maybe, just maybe God ( if he exists ) is one step ahead of us. My wife once read in an article ( typical womens magazine ) that a schizophrenic mother once put her baby in the oven and turned on the gas. What did that poor innocent baby do to deserve such a fate? She finally calmed herself down. How did she rationalize something like that? She said to herself that perhaps that baby was the soul of a temporarily resseructed nazi, who pushed people into the gas chambers. I dont know and neither do you. You have two choices, believe that God ( again if he exists ) knows what he is doing and is one step ahead of us, or believe in a random universe, with no rhyme or reason. I am as confused as you are ( probably even more) but I put my trust with God.

 
At 9:45 PM, Blogger RabBipolar said...

Ben Avuyah,

Your writing gives me a little more faith in mankind.

This is Godwrestling at its finest.

 
At 11:14 PM, Blogger Balabusta in Blue Jeans said...

I had just finished laughing over your haircut, and then I went on to this. Now I'm sitting here crying a little, for Katie and for you.

That was hard to read. I imagine it was hard to write. I think I may understand the name of your blog a little better now.

 
At 6:18 AM, Blogger Ben Avuyah said...

Thank you all for commenting,

Avi, I don’t know where to start, why would god ressurect a Nazi ? Only then to have it’s mother burn it as a baby ? Doesn’t God have his own oven in the lower levels somewhere ?

I just don’t know how to begin to show you how you are grasping at straws to make a vision of God that doesn’t fit, work….

RabBipolar,

Thanks for stopping by and good luck with your blog !

B In BlueJ,

Thanks for understanding.

 
At 7:57 AM, Blogger Enigma4U said...

Ben,

Your tragically beautiful post was hard to read, and it will resonate within me for the rest of the day, at least.

Human beings have an overwhelming need to make sense of the cruel and senseless events we all are witness to on a daily basis, especially when seeing horrendous suffering of innocent children. Religion fails miserably at providing answers, yet the faithful continue to cling to the idea that God has a plan which we, small as we are, are unable to comprehend, and continue to send their prayers to a cruel and merciless God in hopes of appeasing him.

Call me a dreamer, but I am hoping for a future world where random tragedies are not explained by magic and religion is but a relic of humankind's history.

 
At 10:51 AM, Blogger Ben Avuyah said...

Enigma,

Amen, and well spoken !

You're not alone, I share the same dream.

 
At 11:02 AM, Blogger Avi said...

I just don’t know how to begin to show you how you are grasping at straws to make a vision of God that doesn’t fit, work….

Grasping at straws? I find the world too perfect, working too much in harmony to believe that it came about by sheer random luck of physics. I am not ready to throw away what little belief of God that I have. And for that matter, what makes you think that you have to understand everything? People throughout history have always suffered. Perhaps for all we know God has a very special reward for those who suffer in silence, and maintain their belief in him. You didn't have to throw away everything in order to be a doctor. I know plenty of doctors who wear their yarmulkas and still practice medecine. You chose to throw it away, not because of Katie but because you wanted to. I too chose to throw some of it away, because there are things that I dont understand. My shortcoming. We all make our own decisions and use an excuse for why we do it.

 
At 1:24 PM, Blogger Ben Avuyah said...

Avi,
You missed the point of the post, it’s not, as you stated, “that we don’t understand some things”, it’s that we pretend to understand everything down to the minutia of how to wash our hands and tie our shoelaces. When in fact Judaism is completely lost when it comes to the most basic ideas of God and his relationship to us.

It’s like claiming to be an expert nuclear physicist, and then wrinkling your forehead in dismay and saying, “Numbers, math, science….hmmm I’d never thought about those.”

 
At 7:32 PM, Blogger Avi said...

it’s that we pretend to understand everything down to the minutia of how to wash our hands and tie our shoelaces. When in fact Judaism is completely lost when it comes to the most basic ideas of God and his relationship to us.

Now you have come to the crux of the problem. As I have often said before, in my opinion the rabbis have hijacked Judaism. Who are these characters who write laws for me to obey? The rabbis did not have " nevuah" and did not even begin to imagine life in the 20th century. They wrote laws in the dark ages for the dark ages.

 
At 8:06 PM, Blogger Godol Hador said...

Holy crap Ben. You should write a novel. I assume that was actually true?

 
At 11:42 PM, Blogger Ben Avuyah said...

Hi Godol, I like the pants...

Yes it is a true stroy, but I have fictionalized it. The names are changed, of course, and I squeezed the time frame into one 36 hour shift. "Katie" in real life actually hung on for several days. She awoke from pain medicines more than once in severe pain and disorientation. And there was not one person in the Unit who was not devestated by the sad story of her last days and her death. Even for hardened hospital staff, used to working with burn victims, "Katie's" case was exceptionaly painful.
For me, it was truly the first time I realized something had not been covered in my Yeshiva studies...Yes, I was that naive.

 
At 8:00 AM, Blogger Godol Hador said...

But death is not a new concept, even horrible painful death. Hundred of thousands of people die every day, young and old, some peacefully, many horribly. Its a sad story, it kept me awake last night and the Rebbetzin wouldn't even read it, but it shouldn't really affect your religiosity. I guess one cannot judge until one is in that situation.

Also, your writing is excellent, but I edited your article, and now it reads even better. Could be a short story. Maybe we should go into publishing? I could be your editor.

 
At 11:15 AM, Blogger Ben Avuyah said...

Hi Godol,

Sorry to hear my story kept you up at night, and it was a probably a wise move on the Rebetzin's part to avoid it altogether.

Your right that death, and painful death, have been around for a long time. But that just makes it easier to ignore the issue's that they raise about God, until one is uncomfortably confronted with them first hand.

Thank you for the compliments on my writing, I really appreciate them, and I would love to see how you have edited that story. Feel free to email it to me. benavuyah@hushmail.com

Little do you realize you are dangling in front of me the holy grail of publishing. I have tried before and found it quite difficult. I think you truly need a contact on the inside of a publishing company to be successful… but I don't think I will ever stop trying.

 
At 10:32 AM, Blogger respondingtojblogs said...

Powerful stuff and well written. There is nothing more to say.

 
At 2:34 PM, Blogger smoo said...

I find it amazing that nowhere along the way did any doctor think to let her die peacefully (through pain killers). The Hippocratic oath says to do no harm. What exactly are they doing by keeping someone, so far gone, alive? To what end? To show how amazing and heroic they are? (Recall "We were men and women of medicine and science and we took a moment to revel in our own glory".) To get credit for ‘saving’ a life? What kind of life would this severely disfigured girl have? What kind of extended pain have the doctors saved for her? Does anyone stop to consider the emotional damage that this girl would forever endure? Isn’t psychological torture just as bad as physical? So, how is saving her, doing no harm?

In Halacha, it takes a really educated person to make the tough decisions of leniency in the face of challenging matters. It’s easy to be Machmir (stringent) because you err on the side of caution, so you don’t have to think or worry about the consequences. Isn’t this what the doctors are doing by choosing to continually do everything in medicines power to ‘save’ Katie? Who would be brave enough to make the ‘tough’ decision to realize the futility of their efforts and to end the suffering?

Putting aside my emotions and trying to deal with this objectively I could counter with the following objections: Who determines the criteria for what is acceptable suffering on the way to recovery? (Recall "No one is supposed to be able to live through a burn like that. Especially not nine year old girls. The odds against are astronomical")
What if different doctors have different expectations for recovery and different success rates? What if the patient or parent views life differently and would prefer to live in permanent pain and disfigurement? Sometimes patients surprise us and do better than expected. What right do we have to deny them that opportunity?

I hope never to be asked to deal with these situations but I am curious what your response is from a doctor's perspective.

 
At 1:50 PM, Blogger Ben Avuyah said...

Interesting questions smoo,
I suggest an interesting video for you to watch, It is a story about a man named Dax Cowart, we were all required to watch it during training.
He survived severe burns, but throughout his treatment, begged to die.

Now he is a very succesful buisness man, and leads a life that he says he is happy with (his is very disfigured) however he still very sincerely objects that his request to die was denied.

It is a very interesting and provocative video, you should watch it, it may help to solidify the way you feel about end of life issue, or for that matter may open up another can of worms.....

 
At 2:14 PM, Blogger smoo said...

Thanks for the response. Where would i find this video? Library? Internet?

 
At 9:19 AM, Blogger Ben Avuyah said...

Smoo,

It's been a long time since I have seen it. It's certainly not going to be at blockbuster, but you might find it in a medical library. Or perhaps it's floating around some of the internet file sharing sights...

 
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