Suzanne Ohlmann | Longreads | December 2019 | 16 minutes (4,121 words)
I once cared for a patient who looked like Jesus and, after 40 days in a coma, rose from the dead on my shift. I worked nights as an intensive care nurse on an abdominal transplant unit, and Leonard was the spitting image of the white sacred heart Son of God.
It was the week of Christmas when he became my patient, though Leonard had been hospitalized since before Thanksgiving. He was 50 years old and smelled of dried sweat, sour breath, and incontinent bowels. Before I’d been assigned to Leonard’s care, every major organ system had failed, down to his skin, his entire body covered in large, fluid-filled welts called bullae. He was dependent on the mechanical ventilator due to respiratory failure, and connected to the machine by a tracheostomy tube surgically inserted into his throat. His blood pressure and heart were sustained by three different intravenous medications, and his failed kidneys replaced with hemodialysis, the blood from his body washed by an intricate filtering mechanism the size of a Pepsi machine. He had tubes in every orifice, nostrils to anus. Alone, his family three states away, Leonard’s comatose state left him completely vulnerable to the whims of his medical team. He was incapable of closing his eyes, his stare casting an eerie spell over the room until we decided to start taping his eyelids shut for two-hour intervals. Nurses clucked their tongues upon hearing his story, shaking their heads at his plight with a combination of disbelief and indignation, whispering reactions like, “He should have known better,” or, my favorite, “People like that are the reason I’m not an organ donor.”
Leonard was an alcoholic and had Hepatitis C, most likely from IV drug use, though it’s possible he wasn’t aware of his diagnosis. When he went out with his fellow migrant construction workers to a seafood joint north of San Antonio, he should have ordered the fish and chips. But Leonard ordered a plate of raw oysters, fresh from the Gulf of Mexico. Maybe one of Leonard’s physicians had warned him about raw oysters and Hepatitis C. Maybe Leonard knew that because he had Hep C, he shouldn’t drink alcohol; that his immune system was weakened by his ailing liver; that raw or undercooked seafood from the warm waters of the Gulf can carry a monster bacteria called Vibrio vulnificus; that a person with Hep C who contracts Vibrio vulnificus faces a 50 – 85% mortality rate from infection and septic shock. Maybe Leonard knew, but I doubt it. I can’t say that he should have known better.
My biological father died of liver failure at age 50 from alcohol and Hepatitis C. His name was Mike, and I had just discovered him in the year leading up to my care of Leonard. My first full year as an intensive care nurse coincided with my first year of contact with Mike’s family. If Mike had known better and skipped the needles and beer, he might have lived long enough to meet me, but he didn’t, and died not knowing of my existence. A year before I met Leonard, I sent identical letters and a photograph to my father’s two siblings, Aunt Christine and Uncle Greg. I’d found their names in his obituary, and located their address on the Internet. They shocked me with emails of sudden welcome just days after I’d sent the letter. I had to lie down when I read phrases like, “You’re part of our family,” and, “Your dad would have been so proud.”
Before I’d been assigned to Leonard’s care, every major organ system had failed, down to his skin, his entire body covered in large, fluid-filled welts called bullae.
After the initial exchange of letters, Uncle Greg asked to talk on the phone. When I called, he skipped the chitchat and dove into Mike stories: that he was his big brother and best friend; that he never missed a birthday; that he loved to work with his hands and had a bit of a mail-order problem.
“He sure did love his knick-knacks from the Franklin Mint,” he said.
“How did Mike die?” I asked.
“Well, Mike liked to drink Old Milwaukee,” he said.
“Old Mill? Really?” I asked.
“Yeah,” he said, “I never liked that stuff — got a real twang to the taste — but Mike drank it for breakfast.”
I laughed. “Breakfast?” I asked.
“Yeah, let’s see: there was the beer, and Mike partied pretty hard in the 70’s. You know how it was: live hard, die young,” he said.
“Yeah,” I lied, thinking of my parents, who spent their 70’s (and 80’s, and 90’s, amen) singing in Lutheran church choir, eating at potlucks in the church basement, or practicing recorder for their failed recorder group. We have photos documenting Dad playing a polished, wooden, tenor recorder, a bowl of black hair on his head, with my mom laughing in a hand-sewn denim suit, blonde highlights in her hair, cocktail glasses of soda within reach of each of them.
“We’re pretty sure Mike had hepatitis from all that partying, so that didn’t help with the beer,” he said.
“Hepatitis? Which hepatitis?” I asked.
“Well,” he said, “we’re thinking it was probably Hep C that got Mike in the end. Hep C and beer.”
So there it is. I knew that my biological father had died of Hep C and beer when I cared for Leonard. I even had the information when I took the job in that particular liver/kidney transplant hospital. But it never crossed my mind; not in my choice to leave New York and move south; not in my job search; not even during the interview with the nurse manager. When she asked why I’d decided to pursue intensive care, I told her I wanted to work in a setting that would provide the widest variety of illness, teach me the most about nursing, and in the shortest amount of time.
“You’ll be right at home here,” she chirped during my interview, her heels clicking across the floor tiles as we toured the hospital. As we passed the rooms, she barked out the illness of each of the 20 patients on the unit. “This is a post-op Triple A with blood pressure issues. We’re about to put him on a nitro drip…and here we have a fresh kidney transplant. Just look at the sparkling urine in that Foley bag. Bed Four is a total septic train wreck. Bed Five is an ESLD/Hep C/Cirrhosis awaiting transplant and headed down the drain with a new viral infection. And Bed Six? Oh yes, overdose, on a vent and a Narcan drip that came through the ER last night. You get the picture? Sound like what you’re looking for?”
Though overwhelmed by the multiple diagnoses, all I could see was a green light. This was my job. This was my next adventure.
“Just one quick question,” I said. “What’s ESLD?”
“End Stage Liver Disease. You’ll become an expert on it if you join our team. ”
I moved and started the job in late December of 2008, six months after passing my boards, eager to master a new set of skills. I worked overtime and followed written orders and hospital protocols. I helped my fellow nurses clean and turn their patients, studied Advanced Cardiac Life Saving protocols to get my ACLS certification, jumped into Codes (cardiac and respiratory arrests), cracked ribs with chest compressions, pushed meds, called out times, and donned gowns, gloves, and splash masks when things got messy. In a matter of months, I’d transformed from a free-lance-musician-slash-nursing-student in New York to a full-time ICU nurse.
Though I had begun to learn about Mike and Hep C, I hadn’t found a way to comprehend his life, or how it related to me. When I arrived to this new realm of Intensive Care nursing, many of our Hepatitis C patients had contracted the disease from needles in the 1970’s, and now needed liver transplants. Many were men in their early 50s, with long hair, mustaches and beards, tattoos and missing teeth — not a group you often find in the Lutheran churches of my childhood. I grew to love them as my patients, and soon learned that these men were a tribe I would come to call my own.
By the time I met Leonard during the holiday season, a year had passed since I’d first connected with my biological family. I’d been working the night shift for most of that year and fully succumbed to vampire hours, awake for shorter and shorter amounts of daylight as fall succumbed to winter.
I’d begun to disconnect with conventional life, partly due to my sleep schedule, and partly due to the trauma I tended throughout each 12-hour shift. We had stretches where we’d lose a patient every night, most often those with ESLD who bled to death, or whose lungs filled with fluid, or whose depressed immune systems fell prey to nasty bacteria. My work consumed my life. On my days off, I did little else than laundry and sleep.
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On my first night with Leonard, “Feliz Navidad” piped over the hospital speakers, while a janitor mopped the hallway outside his room, humming along. Two nurses stood over his bed to change the linens, with Leonard on his side facing out, his crystal blue eyes staring past me. He was on Contact Isolation for drug-resistant bacteria, which required any personnel entering his room to wear protective gear. I’d be spending the next four nights in a gauzy yellow gown and blue medical gloves with Leonard, so was content to get report from my post outside the room amidst the flurry of soiled linens and sanitary wipes.
“He has so much gas,” said Trent, his day nurse, scrunching up his nose. “I’ll show you.”
“Please, no, I believe you,” I begged from the doorway.
Trent began gently kneading Leonard’s abdomen, and waves of flatulence opened forth like the bellows of a blacksmith. “It can’t be comfortable for him, poor guy,” Trent shouted over the gales of wind wafting into the hall.
My biological father died of liver failure at age 50 from alcohol and Hepatitis C. His name was Mike, and I had just discovered him in the year leading up to my care of Leonard.
“You have a point,” I said, plugging my nose. “Will you stop the Christmas Fart Fest and give me report?”
I looked back at Leonard’s face, my eyes locked with his empty gaze. I couldn’t admit to anyone that I thought Leonard looked like Jesus, and that music from Messiah rushed into my head whenever I saw him. He was despised, I heard the alto sing, low and mournful with the sighing, string accompaniment, despised and rejected. Brown hair, mustache, beard, piercing blue eyes; this is the Jesus I grew up with in Nebraska. Leonard’s cheeks were less rosy, covered with skin lesions and overgrown facial hair, not to mention the jaundice from liver failure. But even unkempt and yellow, Leonard was a Jesus doppelganger.
I tried to compliment him when I spoke to his mother on her nightly phone calls.
“How’s my sonny?” she’d ask in a thin, scratchy voice.
“He has such beautiful, blue eyes,” I’d say, after listing his maladies and overall poor prognosis.
“Oh thank you, honey. But how can you see them if he’s sleeping all the time? I thought he was asleep?”
This is the danger of trying to look for a silver lining in the realm of intensive care, or deciding your patients look like the Lord. Every connection you make between a patient and something familiar to you, even something ridiculous like a celebrity or a religious figure, makes you more connected to them as a person, and thus an intimacy is born, and thus the sense of loss greater when, as often happens, they die.
“He’s in a special kind of sleep called a coma, and he can’t close his eyes. We see them a lot, and they are beautiful.”
“Oh,” she paused, her voice softer, “I see. Well, you take good care of my boy.”
She ended all our conversations with those words. I imagined her like my grandma, seated at a small kitchen table, her white hair in rows of wavy curls, with an apron and wire-rimmed glasses. Her sweet voice belied the strain of a mother thousands of miles away from her dying son, a son who should have known better.
I sang to Leonard when he was my patient. No matter what task or medication brought me into his room, I sang to him all night long and from a lifetime catalog of Christmas music. Leonard lay still in the bed, unresponsive to verbal, physical, even painful stimuli, and I sang. The music kept us company, since Leonard’s non-blinking stare unnerved even the most veteran of nurses. Though I sang in soft tones, I wanted to fill his room with sounds other than the beeps of the IV pumps, the heaves and sighs of the ventilator, and the alarms of his cardiac monitor.
My nursing colleagues laughed at me if they walked past and heard my quiet Christmas concert in Leonard’s corner room, but I grew up in the Ohlmann family, its own four-part chorus. Dad sang tenor, Mom alto, Jeff baritone (after the age of 15), and me, soprano. Lutherans are prone to harmonizing when we sing, church organists accompanying hymns through the first verse or two, then dropping out to let the congregation morph into a choir, which we do nimbly, almost instinctively. Though singing is encouraged, even expected, the emphasis, since the time of Bach, falls on choral music and congregational singing, not on solos; you wouldn’t want to draw too much attention to your voice, even if it were beautiful. Once I branched out as a soprano soloist in college, my mom was sure to remind me, and often, “Don’t be a diva.”
When I was little, both Mom and Dad sang in the church choir, with Dad the occasional cantor/soloist. Each year during Holy Week, he chanted a psalm at the end of the Maundy Thursday service. After communion, the head usher turned down the lights in the nave as the ministers began stripping the altar. In the darkened church, Dad’s raw, tenor voice pierced the silence with the words of Psalm 22.
My God, my God, why have you abandoned me?
Why are you so far from helping me, from the words of my groaning?
O my God, I cry by day, but you do not answer; and by night, but find no rest.
My God, my God, why have you abandoned me?
I never knew who to watch, my dad in the balcony behind me, or the pastors at the front of the church, dismantling the altar in sober, mournful gestures. But were they mournful? Or was it my dad and his pleading music that set the tone?
But I am a worm, and not human; scorned by others and despised by the people.
All who see me mock at me; they make mouths at me, they shake their heads.
My God, my God, why have you abandoned me?
Polite church-goers don’t turn around to see who’s singing in the balcony, an expression of such obvious curiosity considered untoward. But he was my dad, so I craned my neck to see him in the soft glow of his music stand light, eyebrows furrowed, shoulders rising with a deep breath before each phrase.
On you I was cast from my birth, and since my mother bore me you have been my God.
Do not be far from me, for trouble is near and there is no one to help.
My God, my God, why have you abandoned me?
Dad got busy with work at the library and eventually quit the choir. Once I grew up and left home for college at St. Olaf, I took the mantle from Dad and started singing solos from the balcony during holidays and summers at home. But I never sang Psalm 22; not on any Sunday, nor Maundy Thursday, the solo better sung by a man to evoke the voice of Jesus as he died, the antiphon some of his last words from the cross.
I am poured out like water, and all my bones are out of joint;
my heart is like wax; it is melted within my breast;
my mouth is dried up, and my tongue sticks to my jaws;
you lay me in the dust of death.
My God, my God, why have you abandoned me?
I know Dad didn’t realize it, and neither did I as a child, but he was singing my song, the psalmist all those centuries ago writing verses to a primal wound. I don’t mean to speak blasphemy, but Jesus doesn’t get to claim abandonment as his own. In some way, and at some point, we have all been left, like my biological father in his trailer that Christmas he died; like Leonard that Christmas with me. My dad sang Psalm 22 to God, but he sang it to me, too, and somewhere in that little girl inside me, I knew it.
I knew that my biological father had died of Hep C and beer when I cared for Leonard. I even had the information when I took the job in that particular liver/kidney transplant hospital.
But just as I did with Leonard and all my ESLD patients in the ICU, I had the information, but didn’t connect the dots. Maybe I was in denial. Maybe I was trying to survive. For so long I couldn’t see when my biological past rose to the surface and manifested in my present. I pushed forward on the timeline of my life, and went along with the socially accepted adoption script: all’s well that ends well. But Leonard, my own Jesus doppelganger, had come to renew my faith; not in the Christian sense of salvation, but as the closest I’d come to tending the suffering and death of my own biological father.
I moved into my new apartment two days after Christmas, a few weeks after I’d established contact with Uncle Greg. Once I settled in, he sent me a care package that included a pair of photo CDs. One was labeled Miscellaneous Pics, the other, Funeral.
Greg and Christine had prepared a photo collage of Mike’s life for his memorial service just two years prior, so I fired up the Funeral disc first, eager to see if I looked anything like my father. With a double click, photos of Mike began to swim across the screen, with Ozzy Osborne’s tinny voice singing in the background, “See You On the Other Side.”
“Como se dice not Lutheran,” I laughed to myself.
I paused on a picture. Mike sat at a kitchen table, a baby with a bottle tucked into his arms. He looked healthy, young, maybe in his late 30s, with brown hair, a mustache, and a plaid shirt, Western-style with pearled snaps for buttons. Behind him, a clock on a side table showed ten o’clock, and judging by the soft light on walls, it was morning. Mike gazed down at the baby, a can of Old Milwaukee next to him on the table.
I fixated on that photo. I downloaded it, and for weeks looked at it first thing when I woke and last before sleep. I memorized every detail and began to dream about it — not fluid, narrative dreams, but moments where I was part of the scene, sitting at the table with Mike, or watching him from the next room. After a month of near obsession, I called Greg to see if I could glean any information.
“Uncle Greg, can you tell me about a photo from Mike’s funeral collage?” I asked, describing the photograph in detail.
“I’m pretty sure that’s Chelsey or Shawn, Chris’s boy,” he said.
“It’s not his baby?” I asked.
“Oh, no,” he said, “he had a baby girl when he was married but she was barely home. Born premature and spent most of her life in the hospital,” he said.
“I guess I forgot he had a daughter. I didn’t know she was sick,” I said.
“She didn’t breathe too well and once they got her home, she woke with a fever one morning and was dead before suppertime,” he said. I didn’t respond. “Mike never got over that, he said. Think he got a DUI on her birthday for three or four years after that. Sad, all Mike ever wanted was a daughter. Just his luck he had one and never knew it.”
By my fourth 12-hour night in a row with Leonard, I’d run out of holiday music, not to mention energy. As the shift wound down to the final hours, I chose one closing act in my attempt to revive his dignity, if not his life. I’d given his body, bed, and room a thorough cleansing, but his ragged hairstyle remained, a mullet, the short-in-the-front/party-in-the-back style famous in the 1990’s, though it’s been worn by men and women alike since the 1970’s (Michael Bolton, Rod Stewart, David Bowie, my brother, Jeff, during high school). Leonard’s mullet had become a rat’s nest at the back of his neck, tangled in his central line dressing, and stuck to the ties that anchored his tracheostomy tube.
So I climbed up onto the stool I’d been using to reach Leonard on his high-tech air bed and cut it. I found out later I needed a physician’s order for such a thing, and, thanks to a good-humored pulmonologist, I got one after the fact. (Okay to trim mullet for hygienic reasons, he wrote.)
As I stepped back to admire my work, I noticed Leonard’s right eye open under the soft, clear tape I used to close his eyelids every two hours. I moved in to peel the tape back, but as I tugged at it gently, his eyelid flinched.
“Leonard? Did you just blink your eye?” I pulled the last edge of tape from his cheek.
No response. I held my breath as I peeled the tape off of his left eye. He flinched again.
“Leonard? Can you hear me?”
“Leonard, if you can hear me, I want you to concentrate and try to blink one or both eyes.”
After a long minute, he winked his right eye.
I couldn’t admit to anyone that I thought Leonard looked like Jesus, and that music from Messiah rushed into my head whenever I saw him.
He winked his left.
“Leonard!” I started shaking his bed. “Are you winking at me?”
Night shift speeds quickly into day on an intensive care unit, and you hope nothing disastrous occurs between 4:30am and 6:30am as you long to end your shift in peace, not in the scuttle of a cardiac arrest or spontaneous hemorrhage.
But Leonard had other plans. After 40 days of sepsis and metabolic coma, at 4:30 in the morning, Leonard decided to open his eye under the tape and wink on command, the flirt. Nurses came running from all ends of the unit, unsure why my singing had changed from Christmas carols to shouting.
“He woke up! He woke up! Leonard! Woke! Up!” I hollered, dancing a jig around his bed.
When his pulmonologist, Dr. Ball, arrived at 5:00am, I waved in maniacal semaphore from inside Leonard’s room. A tall, stern man — not humorless, but never goofy — he donned his gown and gloves in silence. Twenty-five years of critical-care medicine had taught him to lower his expectations.
“Leonard,” I said, “can you wink for Dr. Ball?”
He obliged, first right eye, then left — making us wait a split second longer for the left side; comic timing from a nearly dead man.
“Well,” Dr. Ball cleared his throat. “Good we ordered that haircut then.”
I cringed, unsure Leonard would like his new do. “Uh, Leonard — I hope you don’t mind, but I cut your hair. You were starting to look like Jesus.”
Two months later, Leonard walked out of our hospital and took a bus home. Several months after that, I moved to the day shift, bought a house, and made plans to meet my Uncle Greg in the fall. Just after Thanksgiving, nearly a year after Leonard’s resurrection, he sent me a card with this message written inside:
Miss Hollywood (Suzanne),
I cannot thank you enough for the mental stimulation that your lovely voice gave me to bring me back from that place I was (which is still a mystery!) You were a beautiful sight to wake up to with a beautiful voice. I’ll never be able to explain the joy you’ve given me by bringing me back to my family. The enclosed photo is of me and my two daughters.
I dug the photo out of the envelope and found Leonard with his arms around two very happy-looking girls. He had brown hair, a mustache, and wore a Western-style shirt with pearled snaps. Good health had transformed him from the look of the Lord to an even higher status in my Book of Life. Leonard, his beloved daughters in tow, was a doppelganger for my dad.
* * *
Suzanne Ohlmann is a writer and heart failure nurse in South Texas. She lives with her husband, a firefighter, and a quintet of dogs and cats in downtown San Antonio.
Editor: Sari Botton