Put to death in the flesh, Christ was brought to life in the spirit. In it he also went to preach to the spirits in prison, who had once been disobedient while God patiently waited in the days of Noah during the building of the ark, in which a few persons, eight in all, were saved through water.
—1 Peter 3:18-20
. . . Whilst my physicians by their love are grown
Cosmographers, and I their map, who lie
Flat on this bed, that by them may be shown
That this is my south-west discovery,
Per fretum febris, by these straits to die,
I joy, that in these straits I see my west;
For, though their currents yield return to none,
What shall my west hurt me? As west and east
In all flat maps (and I am one) are one,
So death doth touch the resurrection . . .
—John Donne, “Hymn to God, My God, in My Sickness”
Because of the hospital shows that saturate early afternoon TV and routinely break in on evening viewing very few of us need to be educated regarding what an Intensive Care Unit looks like and what goes on there. Everyone in these shows acts according to the definition of ICU as a kind of sacral reality: the doctors and nurses are on the borderline between panic and focused frenzy, and the patients, with or without a backstory, are quite literally in a life or death situation. There are deaths, because the show has to be real. Deaths are an emotional release, while also playing the role of angst-seeders that will pay off down the line when some splendid doctor will have to go the way of guilt and fragility to become the even more extraordinary man or woman that they were meant to be.
But mostly there are razor-edge saves; patients pull-through, or rather are pulled-through by one of the beautiful people—perhaps by the struggling heroine disappointed in love; maybe by the badboy who only appears to be a knave; or the one nerd, the necessary complement to the beautiful people, who up until this unrepeatable and decisive moment has always cracked under pressure. Whatever stragglers there might have been with respect to the ICU as a spectacle before the moment of our contemporary plague, who either because of their almost impossible purity of never having watched TV, and/or their even more impossible good luck as to never have visited someone in the ICU, these halcyon days are gone.
The daily and hourly reporting on COVID-19 has definitively put an end to that innocence. Whether through computer, phone, or TV, we have all become familiar with the number of overall cases and death counts in our own region, state, country, and worldwide. We have come to know the number of seriously ill patients admitted to the ICU and worry with the newscasters whether there are enough beds and especially whether there are enough ventilators. Most of us have come to appreciate the ventilator as our final mechanical stand against an insidious enemy who not only does not play fair, but plays with us, making us wheeze, then backs off, and just when our guard is down it comes back to maliciously take all air from our lungs and all fluency from our blood.
Death is on the airwaves and constantly circulating in our own speech, just about all of our actions, whether our isolation, social distancing, or wearing masks, our hand-washing, and our donning latex or non-latex gloves, are prophylactics against a death that could come from anywhere or anyone. Yet, it is possible, maybe even probable, that the process of dying, which is always my dying, is occluded.
We are not adducing here the moralization that sooner or later in a plague-like situation we become narcotized and inured to death. We are talking of how our virtues of attention to the death that is all around us—our genuine dismay at the loss and suffering of others, and our human desire to grieve the dead and be consoled in a gathering (religious or otherwise)—connive to prevent us from seeing what dying is. Dying is the greatest of all passions in which an irreplaceable perspective on life disappears from the world, and we could say with Wittgenstein a world disappears.
It is tempting to explain our inability to imagine death from the dying person’s point of view by suggesting the cause is that we have essentially been banished from the ICU and thereby can no longer experience in an intense way the death of a loved one. Perhaps nearer the truth, however, is that we have grown the carapace of the practical: this is a fight which we are all in and all galvanized, even as we have our heroes, first the “health-care workers” and then the “essential workers,” which latter designation has managed to upgrade the one-time invisible people responsible for the food supply chain, from meatpackers and truckers to grocery store workers. Meanwhile, all of us are vesting our hopes in vaccines and medicines that will either prevent or treat the more severe symptoms of COVID-19 and indulging ourselves a little in who the victors are going to be in the race towards the panaceas.
Will it be the Americans we hope? How likely the Brits? Maybe it will be the Chinese? Maybe even the Cubans? In any event, we want the virus to stop wreaking havoc, and are willing to do what we can and more. A contemplative attitude towards an individual person’s very particular dying is a luxury that we as a society cannot afford. Yet, thereby we find ourselves ironically outside this very real death that has undone so many.
I certainly would include myself among those who for the most part have been preoccupied with being occupied by COVID-19. Yet, if that sense of the call for information on all fronts and action on some has generally characterized my response, it has not characterized it entirely. The simple reason is that recently I was seriously ill.
Now, for the record, I neither have had nor currently have COVID-19. Still, in the period in which the virus was incubating I did have a harrowing and life-altering experience in a six-day sojourn in the ICU. Perhaps this stint gives me some notion of what a first-person perspective on dying looks like as death begins to figure as the alien element in one’s biography; a climactic event that, on the one hand, seems to be generated within one’s life and, on the other hand, seems to have nothing to do with it since it simply ends the story rather than being the end of the story.
On the surface, my visitation was less accidental than that of the COVID-19 patient. A catheterization procedure on December 6 of last year revealed that I had 11 major arterial blockages. On December 9 I had quintuple bypass surgery and ended up in the ICU for six days that overall I would very much like to forget. Of course, there was something comical about it all. While I was obviously fairly seriously ill in 2019, and perhaps the previous year also, my heart had been given the all-clear. There were no markers for cardiovascular disease. I was not overweight, ate well, had good blood pressure, low cholesterol, and a strong low heart rate that my physician admired as indicating some lingering indications of physical prowess that quite frankly I glowed in.
Best (or worst) of all I had five EKGs over the span of the last five years and passed each with flying colors. So I am surprised to be in hospital being prepped for surgery, maybe shocked. I have only vague recollections of the visits of family and friends in the weekend prior to the surgery. What is seared in my memory, however, is the surgeon’s drawing on the whiteboard in my hospital room which showed in detail where the blockages were. I confess that pride swelled a little to realize that I was so gravely ill. At the same time, it felt strangely comfortable that the surgeon could draw, as if drawing qualified a person to take another’s heart out, even if I have been inclined to believe before then—and maybe even now—that heart surgery represents the unlikely marriage of the cleaving skills of a butcher and the fine motor skills of the seamstress who cuts and sews.
I awoke in the evening after early morning surgery on December 9 a different person than I arrived in the hospital. Here was the ICU, the bed high and hard, packed with inputs and outputs, white and militant in its mission to save you, the glass divider between rooms covered by curtains, the opening out onto the central area where nurses were busy at the computers and nurses assistants coming and going, professionally trying to make people comfortable and occasionally being abused for doing so. It was an environment stripe clean of anything that might remind one of the home you came from and the bric-a-brac that is part of your enfleshment.
Though lights went on and off, and by some accounts, this ICU was distinguished from its competition in that there were windows that would leave natural light in, being there was to experience neither dark nor light, but leaching of light into a kind of permanent crepuscular that seemed to discount one even more. In its extreme cleanliness and obscure light I found not only that I could not process as much as I normally could, but also I could not feel as much as I normally could. I was aware enough to know that I was less.
My family and close friends visited. So did the hospital chaplain, and a priest friend. I had no grounds for complaint. I was in the warm embrace of more than ample human kindness. Truth be told, however, the embrace could not raise me from less-ness that I felt I was, or the loneliness that penetrated me to the bone. I was a flattened, indefinitely spread-out version of who I had been less than a week ago, a kind of abject to evoke Simone Weil and also Julia Kristeva who invokes her.
In the ICU I had hallucinations, presumably brought on by drugs, of highly stylized murders in black and white. The visuals were not particularly graphic; I kept seeing silhouettes, as if in Parisian set pieces, in which the blows were given by one beautiful elongated shape on another equally beautifully elongated shape were like ballet. Even in the experience it was never clear whether the show was meant to be meaningful or not; it was simply spectacle, the kind of reality that the Tibetan Book of the Dead associates with the bardo, the in-between state after death in which you experience the hungry ghosts.
The ICU is particularly memorable for the two crisis events, the first in which I went into atrial fibrillation that the medical staff seemed not to be able to get under control, the second when I had to be taken off morphine, which I did not appear to handle well, and felt pain so unutterable that it seemed to scrape me from the bone of the world. I do not know whether I was dying, and looking back maybe I was sicker when much younger I came down two years in a row with septicemia. Still, I never felt so lost, so much like one in Sheol beyond rescue.
Yet, all of this provided background to the two other events that countered, the one punctiliar, the other durational and abiding. In that indefinite moment when my heart would not beat as it was supposed to there was more hopelessness than fear, something like an experience of absolute abandonment despite the fact that I had a loving family member with me in the ICU almost all the time. That was until I stopped feeling abandoned, as if the extremity itself was a notice of a presence incredibly human and yet more.
I do not think my hopes rose with regard to my recovery, but I did recall what 1 Peter 3 suggests about Christ being among the dead, accompanied by the gloss of Nicholas of Cusa of the dead being insensate and uncomprehending of the world and themselves. I would be lying if I denied that I could not help thinking of Balthasar’s mystagogical reflection on Good Friday and Holy Saturday when Christ descends to Sheol to be in solidarity with the dead and take on their affliction and their deadness. Whether or not what Hans Urs von Balthasar has written is too graphic for an experience that from start to finish was inchoate is a fair question.
In any event, it seemed to me that in the mode of abjection I was being held up, or at least not permitted to fall further. Returning to this image of thinning which captures much of what I experienced in the ICU, I think of the biblical image of being spread out like parchment which plays a major role in a sermon that serves as both companion and backdrop of John Donne’s great poem “Hymn to God, My God, in My Sickness.” Donne speaks of the self before death being spread out as if a map, only to give it an ingenious turn. To spread the map or parchment out over a globe—which I take to be the world commensurate to the self—means that the edges of the map join. Thus east meets west, and presumably north meets south. This means for Donne that death meets life, the lowest point of the cross meets resurrection.
The second experience was different and had to do with the way I was treated during my entire six days in the ICU by nurse assistants, more than the nurses and the doctors. For it was they who tended to me in my reduced state and did so without abhorrence. They were tender and loving and entirely without disgust when it came to smells, waste, and fluids. They were ministers of acceptance of the failure of our bodies and thus lovers of them. I felt nothing less than they were the glorifiers of the bodies that are far more than vehicles for something else, the real thing, whatever that might be. It would be a travesty to say that they were truly professional. Nor would I do them justice to call them heroes. Most of them were Christians of some sort, perhaps even a few unreconstructed Catholics like myself. What I experienced in them was nothing less than Christ.
They were icons of Christ who is the icon of the loving Father of creation. Perhaps no one quite so conspicuously filled the role as a 42 born-again Christian who was male. Over the course of six days in bits and drabs he gave me his life story. The clear intent was not to convert me, but to remind me of my depressed humanity. In some respects, it was the dismal and infinitely dismissible story of conversion from alcohol and drugs of youth, from being homeless and living rough under a bridge, from stealing from family and friends, of being in jail until the point he discovered and accepted Jesus and was forgiven. This time this old and American story rang entirely true, not because of the words, but how he touched me. He held me as I would hope Christ would hold anyone at or near the hour of their death. I took it that he was doing it in Christ’s stead. In any event, all I could do was says yes to what I felt was a moment of witness that I had done nothing to deserve.
What of this is transitive of these two ICU experiences with regard to those many thousands of patients in ICUs in the State and all over the world? I think all of it, not simply because the ICU is still the ICU whether we are talking about COVID-19 patients or other seriously ill people. Laid bare is the paradox of dying as inevitable yet a riddle. It has to be so, and yet we cannot but ask why, and when we grow exhausted with the big why, we come up with the smaller qualified why, why now? To die in the ICU is marked equally by knowingness and bafflement. It is also essentially to die alone, whether others are there or not. The presence of others is a salve, and a site of remembrance. Yet, dying still seems to be a useless passion, something that happens to you alone which, nonetheless, you cannot own.
We are right to cry out in the current crisis that it is unbearably sad how many die alone. If you are Catholic your sadness has a theological warrant, since a person passes from earthly community into the communion of saints. But dying in the ICU with our technology shown up to be as fragile as ourselves is not only to experience a riddle, but a mystery, and for a Christian a holy mystery. Dying, whether in the ICU or not, whether of COVID-19 or not, is for the Christian the gathering event of encounter with a holy reality that is the promise of making whole again or perhaps for the first time.
I have no doubt that one of the experiences to be had in dying in the ICU or elsewhere, of COVID-19 or some of the many other ailments that obstruct our immortality, is that there will be a moment of transparency that sums up and perhaps judges the value of one’s life. Someday I might be that person. But my own experience leads me to believe that dying disclosures the mystery of the foul rag and bone of the self meeting its infinitely gracious Other who is absolutely familiar with the apparent boundlessness of death and yet whose span of love and life is infinite rather than boundless. A Christian might rise to a kind of Chestertonian humor to see the joke in that. The truth, however, is not about the survival of something of you, or something special and spiritual in you, but this broken body which becomes beautiful in rhyming with the Eucharistic Body of our Lord.
Transitive too to the ICU is the miracle of solicitude and tenderness that is shown hour by hour by nurse assistants and nurses to the COVID-19 patients laid low and lingering in a haze in which time is eclipsed. Paradoxically, it is precisely in those times when our bodies have most betrayed us and will not be tethered to our wills that all of our customized Platonism and Cartesianism goes by the board. We no longer have a body, we are our bodies. The ICU is not a school, but were it one, it might be the place that we are taught that our bodies, our vulnerability and animality, are our true glory.
Of course, Christ has taught us that lesson, but apparently not one which we wanted to listen to as we define and solve our problems and create the technical means to solve them, until suddenly we recognize no limit. The way in which a nurse’s aid or a nurse touches the bodies of our loved ones in the ICU tells them and us that we have been and are loved and that the wounds and failures of our bodies mark us as holy. In a sense, they mark us for resurrection. And it is Christ who does the marking.