In Sleep, In Silence, In Wonder, In Revelation
Amy Wright: Are you religious? I ask because I wonder what kind of resonance the name Lazarus has or had for you.
Diane Kraynak: The short answer to your question is no, I’m not religious.
The longer answer is: I consider myself spiritual. I don’t believe in a malevolent god that will strike me down because I support Plan B. I believe that we all should be kind to each other (humans and animals), not hurt each other, be honest, and do no harm. Yoga resonates with me, as does Tao. I think God is more of a collective unconscious—a spirit we need to look up to. But, if push comes to shove and if I have to pick a camp at the End of Days, I’ll join my tribe with the Catholics.
Being in health care may have influenced this. I’ve seen many a child live because of prayer and love—even if they shouldn’t based on statistics. I’ve listened to many debates about “God’s will” and “murder” (vs. withdrawing support). It’s fascinating how so many people can stand in the same room with the same devastated child and walk away with different viewpoints, and we all think we’re right. And we are right. Each of us. It’s like the story of the six blind men and the elephant, one of my favorite parables.
There is no right answer. Ever. The right answer is the one you make at the time with the information you have available at that moment. I didn’t even know the Biblical Lazarus story until I looked it up for this essay. But I had no idea at the time that he is the living embodiment of all the ethical healthcare issues I would face. I am bothered that I see this so coldly, but it’s also the only way I can survive in it. And hence the angst, and the need to write about it. . . .
AW: Will you tell me the parable of the six blind men and the elephant? I don’t know it.
DK: I learned it in therapy school. I’ll try to find the actual poem, but the gist is: six blind men walking along a road in India come across an elephant. They circle around it. They each have a side and they describe what they’re feeling—a rope, a snake, a sword, a wall, a fan—and they all start arguing because each one is convinced that they’ve described the animal perfectly and that they are right. Of course, they’re all right; it’s all just a different perspective. I love it.
AW: Ah, yes, now I remember it, thank you. You call Lazarus, “the living embodiment of all the ethical healthcare issues I would face.” I can make some assumptions about what the ethical healthcare issues are based on your essay, but I wonder how far the symbol extends. Are there issues that providers feel the need to resuscitate out of an obligation to something beyond their control?
DK: Our whole day is out of our control. Truly. I realized one day that between 7:30am and 6pm—I control nothing. Not the patient, not the clinic, not the schedule, not the fax machine— nothing. Once I figured that out, life got a little easier.
We are obligated to present all available options to families, no matter how futile. If we present it, we’ve spilled that milk; there’s no unspilling it. So if we think an option is futile and we present it and the family wants it, we have to go through with it. I have a couple of essays that deal with that. The physician I’ve worked with for nine years is very good at presenting bad news, and very, very good at explaining options with absolute truth—so the family really understands that the dialysis won’t fix anything, it’s just buying them time to say good-bye. Sometimes though, those good-byes linger for months and become traumatic for the nurses and doctors (also another essay). We do things because we can; we don’t always think about “should we.” And our culture supports that. Our culture says—preserve life at all costs. We don’t think about quality of life until later. Especially with a baby. Who wants to say, “No, we decided your baby can’t live”? It’s an impossible situation to be in—to make that split-second decision of who should live and who should die. They don’t teach it in school, and we don’t talk about it at work.
AW: It’s easy to understand why you would feel the need to write about that confrontation since at some point some decision is made. I notice my lapse into passive construction of the verb, and can imagine why no one would want to own responsibility for such decisions. You include a patient log in your essay. Are these logs where your writing began?
DK: When you come into the hospital, I am legally, morally, and ethically obligated to treat you (99% of the time anyway, but that’s a different issue). You put your trust in me, that I am going to take care of you—to heal you, not hurt you. There’s a baseline expectation that I’m going to “do something” even if that “something” is to monitor or watch. My role as a healer is to preserve life. But sometimes to heal you is to say it’s ok to not be healed. Our culture doesn’t always support death as a viable option. And we don’t always make it easy for anyone to recognize that death is an acceptable option.
Yes, eventually a decision is made—whether it be a family’s wishes or a body’s surrender to the illness. But to decide to do nothing is still a decision. I wonder if it was easier, way back when, when to do nothing was more of an active, black/white decision, because there weren’t a lot of options. Nowadays, we have so much technology and tools and tricks that “doing nothing” takes on many shades of gray. It is a tremendous responsibility. Part of what makes the situation impossible is trying to make sense of all the gray. So most of the time we don’t. We Can, so We Do. And we forget that To Do, can mean To Stop.
The writing began many years ago and has a different origin. In fact, my original ideas are nothing like what comes out in the essays. The writing directs itself where it wants to be. Lazarus came out of a prompt in Dinty Moore’s non-fiction workshop at the Kenyon Review’s Writer’s Workshop. It’s interesting that I hadn’t written about Lazarus prior to that because he certainly has lingered with me all these years. In fact, if you walked into the NICU and said “Lazarus,” any nurse who was there in 1999 would know exactly who you were talking about. Anyway, after Kenyon, I went back and pulled my logs to see if 1) I had them and 2) I got the story right. Not only did I find all my clinical logs from school, I also remembered the story correctly, twelve years later. What struck me about reading his log is how my reaction is still the same. I still ask those questions in my work and I still question if we did the right thing with him.
AW: How do you know when an essay should be left alone, when to say, “okay—it’s time, go on your terms,” and when do you keep trying to do everything you possibly can to resurrect it?
DK: When indeed? It’s funny—my mentor talks a lot about ego and “ego getting in the way.” Even though I started life as a psychologist, I wasn’t sure what that meant. In the fall, I thought Lazarus was ready. I really did. My ego wanted it in print so badly. But my first readers weren’t 100% thrilled with it. I had to trust that my mentors are mentors for a reason and that I’m still new at this, and had to trust that shelving it was a good idea.
Turned out they were right.
I learned a valuable lesson from that process—the lesson that’s in all the writing books: write it, commit to it, and put it in a drawer. Let the unconscious do its work in sleep, in silence, in wonder, in revelation. Picking it back up after writing another essay and a few other non-work related short pieces also helped pull the material together. I’m definitely learning that the more I write, the more I write. The more I remember, the more I remember.
I guess it’s like a relationship: time and distance can usually provide a decent perspective. The tricky part is learning when to let that happen, put the impatient ego aside, and have the patience to let it happen. I read Lazarus out loud again this morning. For the most part, my ear heard a good flow and a nice balance, and I didn’t feel like there were any lingering questions. I’m discovering that it’s a fine line between revision and fiddling. It’s like a really good first date that you don’t want to talk about too much because you don’t want the magic to wear off.