Beyond All Understanding

The nurses are all in Room 21, the room we use for the most serious cases—the cardiac arrests, heart attacks, trauma. They are all prepared, the cardiac monitor, resuscitation equipment ready. It is 0530, the time to try to simply coast to the end of the night shift, coming at 0700. Did someone forget to tell me, the emergency department doctor, what was coming?

James, aka Ohio prisoner #548672, is 300 pounds and African American. Although in cardiac arrest with CPR in progress, he is, by regulation, shackled securely to the EMS gurney. My paramedic friend Ryan, recently back from Iraq and with whom I have recently lost touch, tells me they have had little evidence of heart activity despite having shocked James several times and given powerful intravenous doses of epinephrine. James was found down in his cell; it has been close to an hour processing him out of the prison and rushing him to Room 21.

Ryan breathes for James, squeezing the bag, forcing oxygen into James’s lungs. Ryan and I served together as volunteer fire-fighters/ EMTs. I am proud to serve as his EMS medical director.

We get a lot of prisoners in the emergency department from the two large institutions in our county. I have a good relationship with the corrections officers, perhaps because they have seen me over the years treat their orange jump-suited charges with the same respect and concern I have shown them and their families when they have been ill or hurt. It is gratifying to overhear them tell prisoners, "You got Doc Cotton, he’ll take good care of you." That makes me feel like a good Quaker and emergency physician. I remember stitching up one 25-year-old prisoner’s face after he "slipped" in the shower. Stitching is time to chat; he tells me he has been studying to be a heavy equipment operator when he gets out, driving multi-ton bulldozers that could take out a city block in no time. The corrections officers laugh when I advise my patient to get that very prominent four-letter word tattoo removed from his forehead before he applies for a job. I tell him as a prospective employer I certainly would feel a little uncomfortable putting so much destructive bulldozing power in the hands of someone with that word tattooed and shouting so loudly from his face.

There is nothing to be done for James. His heart activity is a flat straight line. We stop efforts at 0552. I thank the nurses and the EMTs for their hard work—especially the EMTs, as it certainly was hard bringing in a very overweight James. They say their backs are okay.

We tidy up Room 21. There is no family waiting across the hall this time.

I ask Ryan how his injury, sustained when a suicide bomber attacked his transport in Iraq, is doing. Ryan deserves recognition, so I announce to our team that Ryan is back from Iraq and that he was injured there. One of the nurses who opposes the war as much as I do thanks Ryan for his service.

Catching up with Ryan alone in the hall, it seems things have not gone well since his return from the suicide attack. Fortunately, no one save the attacker was killed in his transport. We talk about what it feels like to know someone wanted to kill you so badly that they were willing to blow themselves up. Ryan’s PTSD has cost him his wife and many friends, and he was let go from the volunteer fire department where we worked together. He was such an enthusiastic kid that we all called him "Opie," as he was as young and eager as his namesake from the television show Mayberry R.F.D. I tell Ryan that I also have PTSD, which I developed after the death of a five-year-old entrusted to my care. PTSD hurts; it takes over everything. I am sure I had a less severe case; I feel better now, and I hope he will. I was able, sometimes, to let people care for me, but other times I was hostile, difficult to work with, and unreachable. Some of the nurses here now can vouch for these facts. I tell Ryan that to me, he is the enthusiastic young Opie of seven years ago. I hope Ryan remains stationed in our area and we shall talk many times.

When I report James’s death to the coroner, I see that he was serving life for serial rape. I go back to Room 21 and spend a quiet minute with him. What darkness he must have lived in, what darkness he brought to others. I remember working as a medic in Cleveland’s east side, and hearing the horrible "n-word" that so many poor African American mothers called their own children, that the children and teens called each other. Did James’ darkness start there? Or was he another innocent person wrongfully convicted, with only a hurried public defender to speak for him? At any rate, his life sentence is over.

Driving home, I listen to Bob Dylan’s words: "The answer my friend, is blowin’ in the wind." I remember being in Quaker gatherings singing that as a child, my mother playing Peter, Paul and Mary’s version in our home.

In the evening, during a beautiful early spring, my wife and I watch our one-year-old granddaughter explore our yard for her first time. I hold Gracie and put her shoe back on for her.

To folks who ask me what do Quakers believe, I tell them I am not sure what we believe, but that I hope we ask the right questions together. For 350 years we have asked questions together, listened to the wind in each other’s words and in each other’s silence. In meeting for worship I sometimes feel that peace "which passeth all understanding" (Philippians 4:7) or the all-knowing quiet compassionate smile of Buddha. I hold James, Ryan, my wife Toye, Gracie, all our children and grandchildren, James’s victims, the nurses and all our patients, my parents and siblings, everyone, even myself, in the Light.

Brad Cotton

Brad Cotton, convenor of Circleville (Ohio) Worship Group, has worked for 32 years as a paramedic and emergency department RN and physician.