It’s summer 2020. I’m an ER nurse on the swing shift—1100 to 2330—and lately I’ve been lunching around seven p.m., knocking out my eight or so hours in the hot zone first, then cruising to the end cold. Hot zone, cold zone—this is the lingo we now live with, and within. These past few months our department has been cleaved in two: one side filled with respiratory-symptom patients, permanently in isolation, the other side reserved for everyone else. The cold zone is a haven for my pregnant or otherwise immunocompromised colleagues, and a much-needed respite for me at the end of the day, though sometimes this frontloading backfires, a real sick one coming in hot just before shift change, the kind of complicated patient you can’t really hand off safely—or at least I prefer not to—and suddenly I’m stuck, stuck like my son’s Croc that got swallowed by ten inches of river muck last summer. Stuck in all this PPE, slowly suffocating. For this or some other reason, most of my coworkers go four in, four out, four in, but I still prefer to start out sprinting, get it done, then coast.
On an ideal shift, seven o’clock hits and I slip out of my reusable plastic gown, bleach-wash my face shield, peel my week-old, snot-filled N95 off my face, and take a mini-bath under the faucet in the med hallway. Fall into the break room. Grab my stir-fry, or chickpea stew, or black beans and rice. Stiff-arm the clutter. Sink to a seat. Then I crack The Book of Delights.
All this Covid season, the poet Ross Gay has been propelling, or more often dragging me, through my lunch breaks. For this book he wrote one installment each day for a year, musing on whatever most pleased him: watching a praying mantis take a poop, high-fiving a stranger in a coffee shop, seeing a woman and child co-carrying a grocery bag down the sidewalk, smuggling fig-tree cuttings for his backyard across state lines—presumably the gamut of his daily life. A friend recommended the book back in early March, and here we are, months later, me and Ross Gay, still hanging out on my lunch breaks.
If I’m being honest, I only ever manage a delight or two. I eat fast. I stare at the table. Sometimes I actively try to think about nothing. If anyone else is around, it’s my nature to engage, to inquire about their day, how they are, and it’s always people in, people out, people in. I share this shift with thirty others—nurses, docs, PAs, ER techs, health unit coordinators, pharmacy techs, scribes, patient service reps, security, housekeepers, respiratory therapists, physical therapists, imaging assistants, transporters—so there’s no end to it really. No escape. There’s one bathroom in our department. And one break room. So, one Ross Gay delight, maybe two, and I’m doing okay.
Five months into this mess and The Book of Delights has become something of a ritual for me, the focus of my breakroom meditation.
I think a lot about Gay’s preface to the project, where he talks about the importance of daily reflection, of developing a way of seeing, of reacting, of being open to experiencing delight each day. And yet, it’s not enough to just be open. For this project he fostered a more active approach. He came to see writing these daily essayettes (as he calls them) as akin to exercising his aptly dubbed “delight muscle.” I love that—the idea that this is something we might exercise and strengthen. Something we might, periodically, flex.
The other day, working my own delight muscle: I helped settle another nurse’s patient, a woman in her forties who came in with shortness of breath. Her name was Felicia. She was a hard stick, so I brought an ultrasound machine when I went to place her IV, adding another ten minutes to an otherwise simple, two-minute procedure. I’m chatty at work, small-talking, distracting. I asked about her kids, her job, where she got those sweet shoes, Cheetos puffs versus the much more satisfying regular crunch-style Cheetos, and then boom, I’m done. Wrapping up, I lingered, said to her, You know, we’ve got something in common. Both our names get quoted a lot, from the same movie . . . She looked at me, quizzical-like. Then her eyes got wide.
Craig! she said, referencing twenty-six-year-old Ice Cube playing Craig Jones in Friday. She finished the line: You ain’t got to lie, Craig! You ain’t got to lie!
I dropped my own, Bye, Felicia! She smiled, and I left the room.
Utterly delightful. A total delight. One of those rare, perfect interactions with a patient.
I didn’t expect to see her again.
A few days later, she was brought in from home by a paramedic crew, worsening shortness of breath, really sick, her 02 dipping, like Are we gonna intubate, or what?—that kind of sick. But again, she wasn’t my patient, so after we settled her, I left.
The next day, the nurse who’d been her primary pulled me aside and told me she’d tried to log into Felicia’s electronic chart to see how she was doing in the ICU. She’d been met with a YOU ARE TRYING TO ENTER THE CHART OF A DECEASED PERSON flag.
Just like that.
Shit, Felicia.
~
People I don’t see very often but who know what I do—family friends, cousins, in-laws—tend to start conversations with me by asking if I’m working a lot. There’s sympathy in the question, or commiseration, but there’s also an edge, a thrill. I know the answer people want, or expect—that I’m working crazy hours, the ER is packed, shit’s out of control—and for a while I might indulge and say, simply, Yep. But of course, the truth is more complicated.
I’ll pick up an extra four-hour princess shift here or there, but I have a family, two kids, my wife works, it’s summer, so I try to stick to my regular three twelves a week. I try, but those twelve hours too often turn into fourteen or fifteen, and with coworkers quarantining or out sick, we’re always short-staffed, it seems, when I’m supposed to leave, and suddenly it’s the middle of the night. It’s hard to convey just how intense those long days can be.
I don’t want to be too dramatic—it’s not like I’m nursing in the Bronx, or Chicago, or Houston—but in the year pre-Covid, I worked maybe five codes throughout our mid-sized community hospital, and in the last month I’ve worked five in just our department, and helped put half a dozen other patients on ventilators, and everyone just seems sicker, too. It’s the virus, for sure, but also people with chronic health conditions who’ve been avoiding the hospital. There was the alcoholic GI bleed who needed a mass transfusion, and the man with lung cancer who vomited pints of blood, and the IV drug-user whose arm had gone gangrenous because she’d let an abscess go, and go, and go, and the woman who hadn’t been able to walk for a month because her legs had swollen to the size of her trunk, and the homeless man found unconscious on the side of a freeway who arrived with a temp of 106.4, and the twenty-five-year-old combative schizophrenic who’d run out of meds back in April and couldn’t get in to see his primary, and the woman who came in with a month-long migraine that wouldn’t quit and left with a diagnoses of metastatic cancer, and the other day I sat with a woman in her seventies who had come in for chest pain—she was fine, but I sat with her for half an hour because she hadn’t been out of her house and hadn’t talked to anyone in months and she started crying when I tried to discharge her.
Of course, this isn’t our every day. The ER is still a lot of dental pains, and stomachaches, and middle-aged men cutting off the tips of their fingers with power tools. But all of this, all of it, really starts to weigh on you.
On my drive to work the other day I thought of Jackie, a nurse in long-term care, who’d come in with worsening shortness of breath. She worked at one of the first nursing homes in our city to get swamped with Covid. I was with her as she declined, and helped put her on a ventilator. She had some other complicating conditions, and when we started the sedation drip her blood pressure tanked to 40s/30s. We stopped the Propofol, ran norepinephrine instead, and eventually started a Fentanyl drip.
We tried to keep her comfortable, but she was awake, tubes coming out of most of her orifices and her wrists restrained so she couldn’t reach for the one stuck in her lungs. I spent two hours with her, held her hand and asked her questions; she would nod, or shake her head, and like that, we talked. When I finally handed her off in the ICU, I told her, You’re doing so well. You’re so brave. You’re doing great, and she looked at me, and she looked, I think, terrified, and she squeezed my hand until I pulled away.
I was thinking about that on my way to work, about how I had to finally take my hand from hers, and I almost started crying. I didn’t let myself cry, though, because I was on my way to another who-the-fuck-knows-how-long shift. Gotta steel yourself, dude. Got shit to do. I love my work, but there have been some seriously stressful days, and when that lunchtime meditation flops I just sit and stare and shovel food and think: There is nothing redeemable about this. There is nothing good to be found here.
There it is, a self-diagnosed delight muscle strain.
When the search for delight in our day-to-day fails, so catastrophically fails, where do we go? What might we salvage here?
~
Delight #14: “Joy is Such a Human Madness.” The title is Gay quoting Zadie Smith as he admires her “almost constitutional proclivity toward being pleased” (a proclivity I like to think I share).
Gay uses #14 to tease out pleasure from delight from joy. His own example of pleasure is easy enough: an especially delicious donut after a bike ride on a beautiful morning. But pleasure, he says, is distinct from delight, which more closely relates to joy. He offers by way of explanation “a false etymology: de-light suggests both ‘of light’ and ‘without light.’ And both of them concurrently is what I’m talking about. What I think I’m talking about. Being of and without at once. Or: joy.”
Gay has that poet’s willingness to suggest the answers are in the white space. To leave it to the reader.
Imagine the actual sensation of chewing fried dough, light and airy, the grit of a sugar sprinkle, maybe a lick of Boston cream on your tongue. Now imagine gloriously eating that donut while also knowing, maybe subconsciously, that this donut may be your last. That combination: joy.
Zadie Smith defines joy this way: she’s on her way to visit the memorial at Auschwitz with her husband, who is holding her feet. “We were heading toward that which makes life intolerable, feeling the only thing that makes it worthwhile. That was joy,” she writes.
To have something, to enjoy a moment immensely, intensely, but also to know, consciously or not, you may someday be left without it—the donut shop is closed on Mondays, the doc might prescribe a diabetes diet, the world might run out of vegetable oil. Your man caresses your sore arches but maybe it’s a prelude to an argument, the train might derail, that aneurysm will burst, our hearts will give out, millions of ordinary people living ordinary lives were killed in a genocide, and history repeats, and the future might be barren, unbearable, untenable. This moment is wonderful, absolutely, but what comes next? No promises.
This moment then: that’s joy.
It’s a riddle, Gay admits. “The intolerable makes life worthwhile. How is that so?”
~
We’re camping with friends. The kids are off cavorting; we adults are finishing the pizza and drinking beers. The sun is just tipping toward gold. One of our friends is also a nurse, and the two of us have shifted the conversation to something nursey. Suddenly, my wife Angie interrupts to say, “You never talk about it, Craig, but you’ve seen people die. You’re with them as they die. Have you ever wondered what effect that’s had on you?” She’s never seen someone die, never been with someone as they died.
I balk a bit. This has come out of nowhere, and the conversation has the potential to get awkward. Our friends are quiet. “Well,” I say, trying to carve a way out, “I don’t know what to say to that.”
But Angie persists. “Try,” she says.
So, I try.
We were coding this woman, fifties, heavyset, I tell them. There were a lot of us: a doc, a respiratory therapist, a tech, and five nurses, all of us drenched under our shower curtains, N95s melded to our faces, face shields fogged like San Francisco in the morning. We coded this woman for thirty minutes. Fifteen rounds of CPR, five rounds of epinephrine; we defibrillated twice, and each time her heart rhythm converted back to sinus, with a weak pulse, and each time we lost it.
It’s a surreal experience to be next in line for compressions just as we all know it’s over. We’ve talked it through. We’ve played it out, but the doc says, as they often do, Let’s give it one more round. I’m up, so I get to work. Everyone else stands quietly, slowing their breathing, bodies tired and loose, like they’ve just finished a 5K. Wherever they’re looking, it feels as though all eyes are on me. I’m the only one moving, hovering over the patient, pushing. The only sounds in the room are the beep from the monitor and my own quiet counting, trying to keep pace, one through ten, one through ten, one through ten, 100–120 compressions per minute for two minutes. I try to focus on this counting, on pushing and breathing, but the mind drifts to all kinds of places: other codes, another patient waiting for her headache meds, how much CO2 is building up inside my mask, and from there I’m thinking about snorkeling with my five-year-old last weekend, lying on the lake bed smiling up at him, my son euphoric, smiling down at me, and then, inevitably, my thoughts turn to the three-year-old boy we coded a few years ago. Right there I pull myself back. Refocus. One through ten, one through ten, one through ten . . .
Finally, the recorder calls time. One more look at the monitor, which shows a rhythm, but still no pulse. The doc calls it. Someone mutes the beeping and there is a moment of intense quiet. A collective breath being drawn in. Then the room’s back in motion.
A sheet goes over the patient. We organize and clean equipment, all the cords, wires, counters, the floor. Bag random linens and towels. Empty the trash. Ten minutes and the room is back to where it was an hour ago, except for the patient on the cot. The preferred language is expired. I prefer the word dead. Feels more honest.
Despite the outcome, there’s an element of pride in how things went. The code had been well orchestrated. We’d worked well together. We were a team, professionals. Then, as we headed for the door, someone adjusted the patient’s leg on the bed, and no shit, a fucking bedbug crawled out from under her calf—and the room exploded.
Shrieks, panic, OMIGOD OMIGOD OMIGOD! Gowns ripped off, the hamper lid slamming, and a race to the door.
That’s what it took to wreck us. A bedbug.
It was the funniest thing I’d seen in a long time.
I laugh again, telling this story to Angie and our friends. I don’t think they get it, but what else can I say? I’ve said it all. Or there is just too much to say.
~
The death of that three-year-old—years ago, but still right here with me—as I switched in and out every couple of minutes pushing on his chest for nearly an hour, contrasted with the Pepsi I immediately afterwards stole from the EMS fridge and chugged in the break room. The terror of someday losing my own two boys, and the feeling of their cheeks pressed against my skin, my youngest’s eyeballs on me as I swim beneath him, playing beluga and he’s my calf. The gravity of that woman’s death and the way I smile now thinking about how we flipped out over a bug.
Two truths, two realities, side by side. Together. Alongside. Entwined. Gay says it: “being in joy . . . It’s not a feeling or an accomplishment: it’s an entering and a joining with the terrible, joy is.”
It’s a way of being in the world, a way to remain in the world, despite everything.
Here it is: Death in the room, on my watch, under my hands—literally, under my hands—but I’m still here.
I am still here.
When delight fails, there’s that.
Craig Reinbold is a writer and ER nurse from Milwaukee, Wisconsin. His piece, "What We Might Salvage," originally appeared in AGNI in the spring of 2021, and is the winner of the Council for Wisconsin Writers' Kay W. Levin Award for Short Nonfiction.
