Disarray

Although it's just the three of us this year, plus Beau, it isn't all that different from the past few years. Daniele would spend part of the 25th with us and last year, just Christmas Eve. We had to trace further back to get a sense of our family as we once celebrated Christmas. The memories fuse together with little to distinguish one year from the next. Once the presents were ripped open, the day was always a peaceful one, just us reading the books we received, eating the big midday meal, napping, and, when the kids got older, going to a matinee movie.

I returned in November to a house in disarray due to a total kitchen and bath makeover, the kitchen's contents strewn all over the dining room and living room. Within the chaos, Mike cooked up some remarkably good dinners with just a skillet and hot plate. He is one resourceful homemaker. Anyway, I only have myself to blame as I chose to go forward with a project I had been planning the two years before Daniele's death.

Being back in the Twin Cities brings reminders of her that are inescapable. As I travel about town, I acknowledge the people and places connected with her -- a kind of emotional-visual brief embrace -- followed by a letting go. It's like walking a line between remembrance and the moment, leaning one way and then the other.

My boys are doing well, all things considered. Jon just recorded seven of his finger-style guitar compositions in a professional recording studio. You can hear them soon on MySpace. Michael is writing more poems than he has in years. Now he sends them off to magazines or "zines" run by people several decades his junior. Many pieces were "in the drawer" and he's polished and edited them. He has more to say now than ever.

We decided to get out of town for Christmas, spending three days in the North Shore at the end of the Gunflint Trail, an hour's paddle (in the summer, that is) from the Canadian border. We occupied a cabin flush with sauna, jacuzzi, and deer hanging around our picture window. (They were paid in feed supplied by the lodge.)

The ski trails wend their way through pine, birch, and spruce forests along a tall ridge of snow-covered granite. There was no sun at all -- just a light continuous dusting of snow. I'm not sure I am ever happier than being alone in the woods, herring-boning up and gliding down the hills on my cross country skis.

Thanks to you all for your love, words of wisdom and encouragement, thoughts and prayers.

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Here is my most recently written Alaska narrative. I did not finish it when I came home due to all the tasks at hand with the remodel. The work I do there is so meaningful to me and has helped me get through these early months of grieving.

In mid-November I returned to Noatak, one of the eleven bush villages we service. This is the place where I described the aftermath of an adolescent boy's suicide by gunshot last January. This time I brought my own tale of loss.

I spoke of it first to C., the health aide whose 13-year-old foster brother shot himself last December. She was the one who had found him with his face half gone. She reacted calmly to my news. Suicide touches everyone here. Because it is not shocking, people respond with an air of resigned empathy when they are given the news. They understand what it's about.

I bore up well until the third day of the village visit.

The day began with home visits to elders whose mobility is impaired. We entered the first house just after the old man had taken his shot of insulin. This meant we had to wait patiently while he finished his breakfast mush to ensure he did not become hypoglycemic. After describing his concern about his cough, he spit a sizable blood-tinged specimen into the garbage can. Diagnostically speaking, it doesn't get better than that in the absence of X-ray machines and scanners. But now it was too late to visit an elderly woman with breathing problems, since people with appointments were lining up in the clinic waiting room on the other side of town.

The father of my friend from Kotzebue came in with vomiting and a 20-pound weight loss. He'd already been seen a couple of times in our bush hospital without a diagnosis. So I decided to arrange for a direct admission to the Native hospital in Anchorage for an extensive evaluation. First, however, I had to convince the internist on call there that I had good reason to bypass our local hospital.

When I reached the on-call doctor, a sassy Aussie, she said he should go to our regional hospital for a third go-round instead of a direct flight to Anchorage. After a few volleys back and forth, I gave up and said goodbye. I called our hospital and discovered he would have to wait a month for the barium swallow study she recommended he get first. I called her back to make a final plea. She said, "Well, if you had been listening to me, then you would know I wanted him to come here for the swallow study." My anger sparked and I said, "I suspect I may not have understood what you were communicating to me." I could feel my mood shifting in that moment from equanimity to fragility.

I started tearing up while examining an 84-year-old man after he told me his foster daughter was caring for him. Her two-year-old child gave him enormous pleasure. He tries to teach the little one Eskimo words but she usually replies in English because her mom does not know Inupiak. He was a very vigorous man for his age, still ice fishing despite his immobile left shoulder. He showed me how he uses his right arm to do all the real work of digging the hole in the ice with an upward and then downward movement diagonally across his body.

A seventeen-year-old young woman came in for her first prenatal exam. She had to quit sports because of a school rule against participation while pregnant. This seemed to be her main regret about her unplanned pregnancy. The father of the child listened quietly with gleaming eyes as I used the doppler to amplify the baby's heart sounds -- whoosh, whoosh at about 150 beats a minute. The father lived in a different village, and no one seemed to know where this incipient little family would settle. The grandparents will have to do a dance -- indirectly, Inupiat style -- to see who has the honors and responsibility. Some young people perform admirably as young parents, while others want to party and rely on older extended family members to take care of their children. These two struck me as responsible.

The elderly foster mother of the boy who shot himself last December came in for problems related to a pharyngeal cancer diagnosed last February. Our visit last January had centered on her grief and feelings of guilt because she did not sense her son's intention to kill himself. She had complained at the time of an earache, the sole symptom of her cancer.

Now she was suffering from post-radiation dry mouth and vertigo. I watched her daughter help her ever so gently onto the exam table so she could do her vertigo exercises there instead of on the bed at home, where it was logistically more difficult. I was moved by how tenderly her daughter arranged her mother's body on the table.

After the clinic closed, I tried to email Mike. I was feeling emotionally raw and needed to let off a little steam. The internet was down, so I called him on the company's dime. My voice seized up with emotion and with the effort to suppress tears. There is a 1-second delay that makes communication frustrating even while discussing mundane topics like the weather. We had to pause after completing a thought or we tripped over each others' words. I have a terrible habit normally of interrupting Mike so the delay was exacerbating our usual conversational dynamic.

We relived our regrets. "I could feel her going down," said Mike, referring to the aftermath of the second failed fistula repair in July when I was in Alaska. "I couldn't cross the bridge to keep her from spinning away. I sympathized. I tried to be her friend. I feel like a failure as a parent."

And I said, "The feeling of responsibility and the loss of control to act on it -- what a terrible duality."

"You know, I gave the children over to God four years ago," Mike said. "I just decided I couldn't be responsible for them anymore. I was feeling neurotic -- always on the hot seat to come up with a winning strategy. It brought me comfort. It freed me to be a person, not Daniele's spiritual adviser." I said I did not know he had done that -- our religious views were like two Venn diagrams barely overlapping over the years.

"It all ended catastrophically. For my faith and optimism. I am angry every day -- at God, Daniele, people from the church, friends. I spent five years praying to God to save my daughter. And it didn't work. She's dead and gone. That case is solved. That case is closed."

He said now he was redefining God as a force who is suffering with us instead of saving us. The anger in his voice transmitted well despite the distance.

"Our friends mean well but nothing they say can really help. No one can understand what we are going through. Some days I think I can never be friends with old friends again." He talked about our dear friends Mab and Larry, who had taken him and Jon out for pizza a few days before. He and Jon felt like they had to climb out of their bad moods to be good company. And it wasn't worth the pain. Some days it just cannot be done well.

Mike lamented the fact that Jon delimits our family constellation to the three of us. "The Berubes are his brothers" -- referring to our neighbors and the sons of pastor Ned and his wife, Susan, of Christ Community Church where Mike and Jon had gone to church for many years. "They bring comfort and annoyance like any biological brothers."

We both agreed that we want to embrace our close friends as family. But we understand that it is a more challenging notion for our introverted 21-year-old son who didn't grow up with accessible extended family members. Mike says he wishes Jon could accept the love of others more easily.

The conversation swings back to Daniele. We wonder aloud again if we should have pushed her harder to get help. I remind him that over the years it was like rats pushing a a bar for treats. After a while we just gave up. No treats.

He countered: "It was your optimism over the years that kept her going. I was the one who withdrew. The helper in me had come to a halt."

We acknowledged our fear of her. We did not want her to get mad at us. She had the power to break our hearts -- to slam the door in our faces. So we tread lightly. It did not matter. She slammed it anyway and forever.

As I feel ourselves hurtling down the emotional vortex, I feel impelled to pull us back out. I remind him of all our beliefs that are positive and true -- our essential blamelessness.

I remind him of all the wonderful letters, calls, and visits from friends who were amazed by our courage throughout the first few weeks. Did we not go to her posthumous 25th birthday party at her favorite punk bar on Minneapolis' West Bank two days after her funeral to celebrate her life and support her friends? And what about the foundation we established for suicide prevention? We were making good on the awfulness.

I speak of the opportunity to grow from this, to put the experience into the "soul bank."

Mike argues, "I can't put it in. Brave? Isn't it dishonest to pretend that we have accepted and transcended this? Premature?"

I argue back. "But you have -- you spoke the truth about how difficult she was, how she would have been an adolescent suicide but for all the negotiations, decisions, compromises we made while she lived under our roof. She was a wild child, a Zombie girl -- with her volatile negativity and marvelous creativity and authenticity." I remind him about how strong we have been in these mere TEN weeks since her death.

Mike relents: "You did not give up on her -- always expecting her to become independent despite the difficulties. When she talked about going on social security disability after her first overdose in 2004, you said no way. You showed confidence in her -- that she could make it on her own -- which was exactly what she wanted and needed."

But then he says, with an air of defeat, "What's the use of all our consciousness?"

I have no answer. Today. I only know that helping others is keeping me sane no matter what I think about from day to day.

By the time we got off the phone it was well past the time I was supposed to do the second home visit. I was sitting in a puddle of tears and tiredness when the clinic phone rang at 8 PM. I'm always reluctant to answer it and it's not my responsibility. But I worried it was the home bound elder with the breathing problems I missed earlier that morning, and sure enough it was.

I apologized repeatedly for not going to her house. My voice was catching all the time as I talked so I finally blurted out the truth. "I haven't made it because I've been on the phone with my husband in Minnesota talking about our daughter's recent death by suicide." She says not to worry, she can wait. My professional self kicks in: "But what kind of breathing problems are you having?" After she describes the problem, I inhale and promise to be right over. After looking over her health summary, I pack along steroid pills and and an antibiotic.

I walk out to the ambulance, vaguely reaching around my pockets for the keys out of habit. I forgot that they're always left in the ignition. This vehicle, which is a cross between a pickup and hearse, would be just right for a joy ride. The radio pops on as I look around the cabin, figuring out where the mirrors and sight lines are. Kotzebue's AM station is playing nonstop Christian music -- some live -- as it's pledge week. The voices are a wee off-tune with a steady thrum-thrum of the guitar behind them. The sky is clear with stars, the moon three-quarters, and the air is very cold but still.

The village is divided into three parts: the village center on the big Noatak River, "Beverly Hills" which is on higher ground with newer houses overlooking the river, and the outskirts inland from the river where the clinic and school are. It's a crooked ride into the center village. She had told me she lived near the large "tank" in the blue house. I knocked on the door of a blue house not far from a storage tank and it was the wrong house. Too many tanks in town storing all kinds of stuff from over all the years. And a rash of blue houses to add to my confusion.

As I entered the house, I was hit with the acrid smell of tobacco coming from my patient's bedroom. I asked her from the entryway to put out her cigarette as I have asthma. I hated being so blunt when I hadn't even met the woman yet, in person.

An elderly woman sitting on the couch in the living room beckoned to me with her hands upheld in a V. Hugging me, she said, "I'm MB's friend. I help take care of her. She told me about your daughter. I lost three of my fifteen to it." I asked whether they were living home at the time. She said, "just my foster son" -- one of the other two boys was married at the time of his suicide. An evangelist is preaching on the TV, the cadences so familiar I don't need to hear the words to know. I asked her how she managed to deal with the losses. She says "Jesus. And he will make you well." I told her I didn't believe in Jesus as savior but I appreciated her words of encouragement. I immediately felt guilty about speaking the truth, not wanting to violate this well-intentioned elder.

I headed back to the bedroom. M.B., a 79-year-old with long gray-blond hair and twinkly eyes, lay half-reclining on her bed in her 6 by 8 foot bedroom. You could see how beautiful she once was. Her breath came at about 40 times a minute, shallowly but quietly.

She presented a confusing history. Her upper back had bothered her the night before and the tribal doctor had come over and massaged it. Her shortness of breath and cough are like always. "Show me your nuvuk" and she spit into a nearby orange juice bottle. Frothy white -- chronic lung disease and maybe heart failure. This was the fourth hocker I had seen that day. The Inupiat people do not feel shame or embarrassment talking about or producing phlegm. Maybe it's because noses run so frequently in cold air. Mothers from the old times were accustomed to sucking it out of their babies' noses. Some still do.

She tells me she had 16 children with two sets of twins but many died when they were young from diseases like Influenza. When I ask her how many are alive she starts to name each living one, using her fingers. I tallied it at six. By percentages, she is batting 3/8 to my 4/8. I think about how impossible it is to compare suffering, or to even measure it.

I listen to her breathe -- wheezes everywhere in her lungs, she is barely moving air. We collect all her inhalers and I find out she does not know how or what to use when. She complains that the health aides never bring her medicine (which is not their job.) And I ask if the sons who live there can do it. She shrugs no as they have no vehicle to get to the clinic. Walking is evidently not an option for the younger generation in this home.

She has great compassion in her eyes as I answer her questions about my daughter. I feel this sense of connection -- I am no longer only the Naluagmiut (white) nurse practitioner coming to treat her medical problems.

She asks me if I want canned soup for dinner. I thank her and say no, worrying a rejection is implied in my refusal. Then I see two big bags of candy on her dresser. "But I would love some candy." She breaks open the bag left over from Halloween, eager to give me something, as is the custom when someone pays a visit. I grab Smarties, Sweet Tarts, and Tootsie Rolls. I didn't realize until that moment that I was craving sweets. My dopamine receptors (the brain chemical that makes addicts keep looking for more) were parched.

After teaching her about her inhalers and extracting a promise from her son to go get her medicines when they run low, I don my layers of clothes as she tells me I am welcome any time to eat or sleep in her home. I climb onto the ambulance seat and try to find my way back to the main road. There are no street lights or signs. I find myself becoming increasingly confused about where I am. Turning around is tricky since I can't see very well behind me without a rear-view mirror. I worry about crunching some wandering child if I back up. Or that I'll get stuck in a hill of gravel, which is like a mound of snow, which is unaccountably absent.

Then I spot a car stopped in front of a house, the man leaving the engine running. I feel around quickly for the door handle. He's already inside by the time I finally find it and pull. I turn off the engine, leaving the ambulance in the middle of the road. Without knocking, I tail him inside and find myself in a living room stocked with boxes of candy and coolers with soft drinks. A baby is standing in a nearby playpen. The man tending the customer who has just walked in ahead of me finally looks up at me. A little embarrassed, I ask how to get back to the clinic. He starts to draw me a map and then I hear someone say, "I thought I recognized that voice." One of the villagers I know enters the room and gives me a big hug. "I was wondering when you would get down to our store." Their business kicks in when the big Native general store closes at 6 PM.

As I step back into the frigid night with the map, I am greeted by a woman wearing an official-looking hat and badge over her snowsuit. "Anything wrong here?" It's the village peace officer. Her eyes mean business. After I explain my recent predicament, she makes me an offer. "Would you like me to drive you where you need to go?" With relief, I slide into the passenger side and she takes the wheel. Except she thinks I'm on my way to, not from, the home visit. So we wind up back at MB's house.

"Do you work with someone else?"

"No, just me, twenty-four seven." I register my amazement. "It must be hard and scary to handle domestics by yourself." Two squads always go to scenes involving domestic violence in the city because of the high risk of injury to the response team.

She says,"Nothing scares me." I comment with a question in my vocal pitch, "Some of your own life experiences must've toughened you up for this line of work?" No comment.

"How many years?"

'Twelve."

"I'll bet you know where all the trouble houses are."

"I do."

After we pull up to the clinic, she offers me her cell phone number, in case I get into any more trouble. I stammer something about not usually needing help while I'm in the village. I ask her to come in and have hot chocolate or tea. She comes in briefly to write her cell and email address for me. She has to keep patrolling the village -- 9PM to midnight -- every night by foot or vehicle. Only now her truck needs repairs so it's all on foot.

I ask her how she does this work without a weapon. She pulls out pepper spray from the left upper pocket of her snowsuit, then her baton from her right side. She shows me the flashlight in her back pocket. No further explanation needed.

She says, "Gotta get going to the other side of town now and ring the curfew bell at 10." Then for the first time she smiles at me and I open my arms to embrace her, briefly.

Night in and night out, no matter what the weather, she makes the rounds. Puts herself in harm's way. She is the keeper of many village stories, including a few of her own I suspect.

Love,

Rachel