Venice Ambulance Adventure

When I was 5 years old I was home alone with my full term pregnant mother when she called me with a sense of urgency in her voice. She was hemorrhaging and asked me to run across the street to get the neighbour who was a physician. I remember the sense of fear and overwhelming responsibility that that stressful situation caused.
Fortunately that situation ended well with the cesarean birth of my sister.

So it was not altogether unfamiliar 47 years later and a world away in Venice when my wife called me to announce that she was hemorrhaging heavily. The situation was somewhat different - I was an adult, a physician; we were in a foreign country with a foreign language and medical system. Despite these differences, the emotions this situation evoked were all too familiar - an overwhelming fear bordering on panic.  A part of my mind was objectively commenting on my reaction making note of the fact that I was trained in dealing with medical emergencies so why was I so discombobulated?  The difference of course was not only the unfamiliarity of the  landscape but also the familiarity of the "patient". The stakes were definitely higher.

When Marguerite passed out and took what seemed like forever to regain consciousness, going white as a sheet and emitting short sonorous noises from her foaming mouth it heightened my concern. The bleeding was moderate and didn't seem life-threatening but accessing medical care was going to be a challenge.  If she fainted lying down, the likelihood of walking 10 minutes to the vaparetto and enduring a 30 minute boat ride to the hospital in the upright position was small.  Should we wait and see if it would stop? Should we call 911 (or in this case 118) and get an ambulance?  How would I explain where we were? What was the cost of an ambulance?  How long would it take for them to get here?

Finally I took the proverbial bull by the horns and called 118, and after a bit of back and forth between myself and the operator, communicated (I thought) within reason what the situation was.  After asking if she had any medical problems and if she was conscious the operator said she would dispatch an ambulance and it would be there "soon".

Ambulances in Venice are large motor boats. We had laughed as we passed them parked in front of the hospital on our way into Venice never thinking that we would be the recipients of the grand canal tour in one 2 short days later.

I was torn between staying with Marguerite and going down to the "street" to await our saviours. The distance between the two involved 3-4 flights of narrow  18^th century marble stairs, a jaunt across a courtyard and through 3 doors, all of which closed locked. I made the trip back and forth 4-5 times before finally, after 20-30 minutes of these round trips, I saw 3 guys wandering somewhat aimlessly toward me. This vision was not what I had anticipated. I had in mind  bells and whistles, lights and sirens, high speed approach, and controlled recklessness in landing directly in front of our apartment the resultant wake flowing up and over the canal wall onto the sidewalk, lightly soaking my waiting feet. These fellows' approach was more subtle and reserved having parked 1 block away with no fanfare.  They seemed neither in a hurry nor equipped for an emergency. They were wearing orange rubber fireman like pants and white polo shirts. They were pushing an object  which appeared to be a cross between a wheelbarrow and a rickshaw. No first aid bag, no oxygen ..... nothing. It made me wonder if I had somehow undersold the situation to the 118 operator.

After we established with my non-existent Italian and their marginally better English that they were indeed the help I awaited, I directed them into our apartment and up the stairs. En route 1 of them (presumably the designate English speaker though that was questionable) took a cursory history and asked whether my wife could walk down the stairs. I replied that I thought not given that she had already fainted once and was wired to faint at the drop of a hat at the best of times.

After a brief assessment and, I suppose not being overly impressed with our blood offering, they attempted to get her up. No half measures here (let's sit her up and see how she does with that and then get her standing). No, they took her by the hand and in 1 fell swoop jerked her into the standing position. Simultaneous with this maneuver the faint residue of colour in my wife's complexion vanished and approximately a liter of clot and blood plopped on the floor and splattered outside the bathroom into the hallway.

There was a brief moment of awkward silence following fast on the heels of the splashing plopping sound created by the blood/floor interface.

It was at this moment that plan B went into effect. One of the keystone cops was dispatched presumably to return to the boat for some equipment, and the patient was placed in the modified wheelbarrow and taken down a short flight of stairs to a narrow hallway/landing. I was instructed to get some clothing for her. When I returned she was sitting partially reclined with an attendant slapping her ashen obviously unresponsive face having entered her second faint of the evening. I assisted them in getting her more horizontal and when she came to under the therapeutic administration of more slapping she promptly vomited - spinach and ricotta cheese ravioli which, through the effects of gravity wound it's way down between the space between her neck and shoulder ridge, seeping down into her upper shoulder blade region. This display coupled with the impressive faint seemed to in some way trigger plan C - incomprehensible urgent words were exchanged between the remaining 2 attendants and 1 ran down the stairs and presumably out to the ambulance. I was left in the narrow hallway attempting to clean up the vomit, and administer a cool cloth to her forehead while the remaining orange pant clad Italian maneuvered the wheelbarrow either up or down depending on his patient's apparent alternating likelihood of fainting or puking again.

After a seemingly interminable time with increasing concern and impatience I grabbed the front of the transport device and indicated that I would assist in getting her down the stairs. 1 short flight was all the attendant would agree to and shortly later his cohorts arrived back on the scene with a bag of equipment and quite handily went to work starting  an iv and covering her with sheets.

I was designated to hold the iv bag and we commenced down the remaining 2 flights of stairs, through the courtyard and down the street to where the ambulance was docked.

We took off and sped through the canals with blue lights flashing. The only disappointing thing was the lack of a siren the presence of which would have completed  the scene. Apparently we created a bit of a stir as tourists on bridges and passing water taxis took video and still footage of the event as we flew by.

Arriving at the hospital canal-side the stretcher carrying Marguerite was expertly whisked through the loading bay area into the emergency room. I followed close on their heels feeling quite ignored by the medical personnel during the trip and disembarkment.  The team entered the assessment room and one attempted to close the door on me. After much discussion they decided to let me stay the announcement that I was a doctor having finally seemingly convinced them (being a husband apparently was not adequate qualification to stay.

She was assessed and quickly transported through an open courtyard featuring crumbling facades and ancient marble and brick floors to an elevator which served to deliver my wife to the gyne ward and myself back to the 21st century.

The gyne team demonstrated their efficiency by accepting her in transfer, hurrying her into an assessment room and slamming the door in the face of the quickly pursuing, objection raising husband/doctor.  This time neither credential was sufficient for my admittance to the inner sanctum.

The outcome ultimately was that they were going to try to control her bleeding with medication overnight and reassess the situation in the morning. By this time it was midnight and I was unceremoniously advised to leave. I felt quite unprepared for the task of returning the 3-4 k trip to our apartment - a somewhat dazed brain and a iPhone gps running at 10% power where my tools. I felt a bit like I was setting off on the amazing race with no map or sense of direction with which to arrive at my intended destination.

After floundering around somewhat aimlessly for 30 minutes hoping to see a familiar landmark and sparingly doling out short glimpses at my failing gps, I asked for help from an American couple studying a map. They pointed me in the right direction and, a vaparetto ride and multiple dark narrow streets later, I arrived "home".  After saying a  short desperate prayer and taking stock of the unusual feeling in my stomach (like I had just free-fallen 10 stories in an elevator), I fell into a dreamless sleep.

To be continued.......

AED – 3 letters that meant nothing to Colton Boechler before Saturday June 2, 2012; before he went into cardiac arrest after a 360 degree spin off the diving board at a public pool on that spring day; before lifeguards applied the adhesive pads of the automated external defibrillator (AED) to the 11-year-old’s chest and discharged over 100 joules of electricity to jumpstart his heart.  After that event those 3 letters mean everything to him.

If his heart had chosen a less opportune time to stop he may not be here today.  If he had had a cardiac arrest at school or in the skate park or even at home; in fact, anywhere in the absence of the AED, he would have succumbed to his ailment.  For him, the UBC aquatic center where his heart stopped was his “safe place” – where equipment and personnel were available to shock him back to life.

We too need a safe place when our hearts are sick.  When tragedy strikes or we’re overwhelmed with life or we’re simply wandering off course, we need to be in a place where resources are available for our resuscitation.  For me that safe place is my Christian community – my immediate family and the extended family of my church cluster – those that are living life with me; people who know me - my strengths and weaknesses, my personality and vulnerabilities; those who know how to apply the proper treatment to my ailing heart.   

Sometimes that treatment is to apply the “shock” of the gospel – to remind me of who my God is and who I am in Him; to zap me with the good news that I have a God who loves and cares for me and that that love is in large part expressed through my brothers and sisters – my family in Him; that He is in control and that all things work together for good to those that love Him and are called according to His purposes.  Sometimes the treatment comes in the form of a loving rebuke.  Sometimes it’s a listening ear, a warm embrace or loving, empathic companionship on a difficult road.  Usually it’s just helping me to process and gain perspective.  I have experienced all of these resuscitations in Christian community and they have restored my heart, allowing me to continue on life’s journey. 

Just like Colton and the potential tragedy of being outside a safe place when his heart failed, we too are in a dangerous place if we’re not where our heart can be attended to.  We need others in Christian community as much as Colton needed that AED.  May we never stray too far from that safe place.

Celebration!!!

I am not one inclined to celebrate – I don’t know why - a part of me is more Eyore than Tigger.  I want to hold back and not give myself wholly to unfettered joy.  I object to inauthentic displays of positivity and flakey fluff so I sometimes err on the side of pessimism.  I am cautious and miserly with my public display of enthusiasm.  There is sometimes something pathologically enjoyable about wallowing in the muck of gloom and despair. 

I don’t want to give the impression that I am always down.  I have moments and seasons where I exalt in being alive; where everything is sunshine and happiness.  I do have seasons though, where I am inexplicably down; viewing everything through mud tinted glasses. 

I have recently been going through one of those down seasons.  Part of it had to do with my perceived failure in ministry.  As a Christian “leader” sometimes my value and worth is too closely tied to my performance and results.  If my small group or cluster is going well, I am happy and feel worthwhile and conversely, if things are not going well, my stock crashes.  Lately our cluster has not been going the way I had envisioned it.  I felt that I had a vision for where God wanted to take us and unfortunately, others seemingly didn’t share the same opinion.  By making some strategic changes to steer us in a “new fresh direction”, I ended up decimating the group – at least if one can measure decimation by the numbers turning out.  In fact, it got so bad that a couple of weeks ago our cluster (defined as a group of 30-40 people living life together) had an event attended by only myself and one other (the other being my wife and she had to be there!).  No matter how much of a positive spin I tried to put on it (“we had a quality time together” I said), the event became a symbol of my failure as a leader and an emblem of my lack of worth. 

As others talked about their cluster success stories (“we’re bursting at the seams and are thinking about splitting into two groups!”), I found it hard to “rejoice with those who rejoice.”  In fact, the thought of strangling those who rejoice came to mind.  A deep intense anger was building – anger at my cluster people, anger at myself and my inadequacies, and, when I peeled back the layers, I realized I was angry at God.  Why hadn’t He made my vision happen?  Why do ministry and mission always have to be so hard?  Why can’t you just bring the fruit God? 

I got alone to stew (in my hot tub) and started pouring out my heart (and a tentative bit of my anger) at God.  Actually it started out as full on pity party.  As I processed through prayer, it began to become clear to me that I had reversed roles with God.  The servant had become the master, the subject the king, the private the general.  I was annoyed and angry because God had not carried out my vision.  He had not blessed and brought about my plans.  In a moment of insight I realized that I had put myself in the place of God and expected him to be my celestial butler.  

My joy and my worth had become dependent on my circumstances.  If things did not go the way I wanted, my being screamed out “not fair!” in adolescent-like immaturity.  This was not a view of myself that I found overly attractive.  Several passages of scripture came to mind.  I thought of Job and his dressing down by his creator – “dress for action like a man (translation: man up!), I will question you….where were you when I laid the foundation of the earth?…”  In other words,” who are you to question my ways?  If this is what I have for you right now in your life that is for me to decide.”   

I thought of the words of the prophet Isaiah ^“For my thoughts are not your thoughts,
neither are your ways my ways,” declares the Lord.  “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts. “  God is above and beyond us.  He sees the big picture and is in control.  Not only that – he loves and cares for us. 

The next day I was reading in Lamentations (a suitable book for the state of mind I found myself in) and came across a long lament in chapter 5 about the state of the city of Jerusalem and environs at the time of the exile.  The author goes into vivid detail about the desolation and desperation of the situation.  Famine, slavery, injustice, jackals prowling – happy stuff!  Certainly things where not going the way he or the Israelites had pictured it.  In the midst of this depiction, the author says “but you oh Lord, reign forever; your throne endures forever”.  In the midst of the stark imagery of the brokenness of the situation, hope breaks through and a stake is driven into the ground – Despite all that is going on around me, my God reigns!   

As the prophet Habbukuk said: “Though the fig tree does not bud and there are no grapes on the vines, though the olive crop fails and the fields produce no food, though there are no sheep in the pen and no cattle in the stalls, yet I will rejoice in the Lord, I will be joyful in God my Savior. The Sovereign Lord is my strength; he makes my feet like the feet of a deer, he enables me to tread on the heights. “ 

The apostle Paul, in the midst of his imprisonment (a fate worse than a poor cluster turn-out) for his involvement in mission and ministry says on numerous occasions “rejoice in the Lord always!” and, in case he wasn’t heard “again I say rejoice!”  We are to be a joyful celebratory people!  Our joy is to be found in Him – not in our circumstances, not in creation, not even in the cool stuff He does in our lives – IN HIM!!!! 

Does this mean that we ignore disappointment and difficult circumstances?  Do we simply put on a happy face and “suck it up”.  Are we to be all happiness and blissful inauthentic fluff?  No.  Our joy comes from a deep place.  An underground stream of deep peace and satisfaction based on our relationship with our creator runs consistently in our souls.  It is unaffected by the above ground stuff – our circumstances. 

So why should I celebrate? Why should I rejoice?  Because God’s the King of the universe, he’s my Papa and He loves me more than I can imagine.  That’s why.

Venice Ambulance Adventure

When I was 5 years old I was home alone with my full term pregnant mother when she called me with a sense of urgency in her voice. She was hemorrhaging and asked me to run across the street to get the neighbour who was a physician. I remember the sense of fear and overwhelming responsibility that that stressful situation caused.

Fortunately that situation ended well with the cesarean birth of my sister.

So it was not altogether unfamiliar 47 years later and a world away in Venice when my wife called me to announce that she was hemorrhaging heavily. The situation was somewhat different - I was an adult, a physician; we were in a foreign country with a foreign language and medical system. Despite these differences, the emotions this situation evoked were all too familiar - an overwhelming fear bordering on panic.  A part of my mind was objectively commenting on my reaction making note of the fact that I was trained in dealing with medical emergencies so why was I so discombobulated?  The difference of course was not only the unfamiliarity of the  landscape but also the familiarity of the "patient". The stakes were definitely higher.

When Marguerite passed out and took what seemed like forever to regain consciousness, going white as a sheet and emitting short sonorous noises from her foaming mouth it heightened my concern. The bleeding was moderate and didn't seem life-threatening but accessing medical care was going to be a challenge.  If she fainted lying down, the likelihood of walking 10 minutes to the vaparetto and enduring a 30 minute boat ride to the hospital in the upright position was small.  Should we wait and see if it would stop? Should we call 911 (or in this case 118) and get an ambulance?  How would I explain where we were? What was the cost of an ambulance?  How long would it take for them to get here? 

Finally I took the proverbial bull by the horns and called 118, and after a bit of back and forth between myself and the operator, communicated (I thought) within reason what the situation was.  After asking if she had any medical problems and if she was conscious the operator said she would dispatch an ambulance and it would be there "soon".

Ambulances in Venice are large motor boats. We had laughed as we passed them parked in front of the hospital on our way into Venice never thinking that we would be the recipients of the grand canal tour in one 2 short days later.

I was torn between staying with Marguerite and going down to the "street" to await our saviours. The distance between the two involved 3-4 flights of narrow  18^th century marble stairs, a jaunt across a courtyard and through 3 doors, all of which closed locked. I made the trip back and forth 4-5 times before finally, after 20-30 minutes of these round trips, I saw 3 guys wandering somewhat aimlessly toward me. This vision was not what I had anticipated. I had in mind  bells and whistles, lights and sirens, high speed approach, and controlled recklessness in landing directly in front of our apartment the resultant wake flowing up and over the canal wall onto the sidewalk, lightly soaking my waiting feet. These fellows' approach was more subtle and reserved having parked 1 block away with no fanfare.  They seemed neither in a hurry nor equipped for an emergency. They were wearing orange rubber fireman like pants and white polo shirts. They were pushing an object  which appeared to be a cross between a wheelbarrow and a rickshaw. No first aid bag, no oxygen ..... nothing. It made me wonder if I had somehow undersold the situation to the 118 operator.

After we established with my non-existent Italian and their marginally better English that they were indeed the help I awaited, I directed them into our apartment and up the stairs. En route 1 of them (presumably the designate English speaker though that was questionable) took a cursory history and asked whether my wife could walk down the stairs. I replied that I thought not given that she had already fainted once and was wired to faint at the drop of a hat at the best of times.

After a brief assessment and, I suppose not being overly impressed with our blood offering, they attempted to get her up. No half measures here (let's sit her up and see how she does with that and then get her standing). No, they took her by the hand and in 1 fell swoop jerked her into the standing position. Simultaneous with this maneuver the faint residue of colour in my wife's complexion vanished and approximately a liter of clot and blood plopped on the floor and splattered outside the bathroom into the hallway.

There was a brief moment of awkward silence following fast on the heels of the splashing plopping sound created by the blood/floor interface.

It was at this moment that plan B went into effect. One of the keystone cops was dispatched presumably to return to the boat for some equipment, and the patient was placed in the modified wheelbarrow and taken down a short flight of stairs to a narrow hallway/landing. I was instructed to get some clothing for her. When I returned she was sitting partially reclined with an attendant slapping her ashen obviously unresponsive face having entered her second faint of the evening. I assisted them in getting her more horizontal and when she came to under the therapeutic administration of more slapping she promptly vomited - spinach and ricotta cheese ravioli which, through the effects of gravity wound it's way down between the space between her neck and shoulder ridge, seeping down into her upper shoulder blade region. This display coupled with the impressive faint seemed to in some way trigger plan C - incomprehensible urgent words were exchanged between the remaining 2 attendants and 1 ran down the stairs and presumably out to the ambulance. I was left in the narrow hallway attempting to clean up the vomit, and administer a cool cloth to her forehead while the remaining orange pant clad Italian maneuvered the wheelbarrow either up or down depending on his patient's apparent alternating likelihood of fainting or puking again.

After a seemingly interminable time with increasing concern and impatience I grabbed the front of the transport device and indicated that I would assist in getting her down the stairs. 1 short flight was all the attendant would agree to and shortly later his cohorts arrived back on the scene with a bag of equipment and quite handily went to work starting  an iv and covering her with sheets.

I was designated to hold the iv bag and we commenced down the remaining 2 flights of stairs, through the courtyard and down the street to where the ambulance was docked.

We took off and sped through the canals with blue lights flashing. The only disappointing thing was the lack of a siren the presence of which would have completed  the scene. Apparently we created a bit of a stir as tourists on bridges and passing water taxis took video and still footage of the event as we flew by.

Arriving at the hospital canal-side the stretcher carrying Marguerite was expertly whisked through the loading bay area into the emergency room. I followed close on their heels feeling quite ignored by the medical personnel during the trip and disembarkment.  The team entered the assessment room and one attempted to close the door on me. After much discussion they decided to let me stay the announcement that I was a doctor having finally seemingly convinced them (being a husband apparently was not adequate qualification to stay.

She was assessed and quickly transported through an open courtyard featuring crumbling facades and ancient marble and brick floors to an elevator which served to deliver my wife to the gyne ward and myself back to the 21st century.

The gyne team demonstrated their efficiency by accepting her in transfer, hurrying her into an assessment room and slamming the door in the face of the quickly pursuing, objection raising husband/doctor.  This time neither credential was sufficient for my admittance to the inner sanctum.

The outcome ultimately was that they were going to try to control her bleeding with medication overnight and reassess the situation in the morning. By this time it was midnight and I was unceremoniously advised to leave. I felt quite unprepared for the task of returning the 3-4 k trip to our apartment - a somewhat dazed brain and a iPhone gps running at 10% power where my tools. I felt a bit like I was setting off on the amazing race with no map or sense of direction with which to arrive at my intended destination.

After floundering around somewhat aimlessly for 30 minutes hoping to see a familiar landmark and sparingly doling out short glimpses at my failing gps, I asked for help from an American couple studying a map. They pointed me in the right direction and, a vaparetto ride and multiple dark narrow streets later, I arrived "home".  After saying a  short desperate prayer and taking stock of the unusual feeling in my stomach (like I had just free-fallen 10 stories in an elevator), I fell into a dreamless sleep.

To be continued.......

Stereotypes

During a recent sermon our pastor referenced in a funny way (in passing) how husbands relate to their wives - I can't remember the exact stereotype but it was something to do with insensitive, less emotionally and relationally in tune, etc.  I wondered (admittedly in a somewhat self-righteous way) what impact these types of references  had on our way of viewing ourselves and the other gender.

Initially I was critical, thinking that this type of reference is subtly offensive to those of my ilk, but then I realized I had done a similar thing in a conversation with a young male patient and his mother that week.  We had been talking about a potential depression I suspected he was suffering from.  He scored quite low on a depression screen I had asked him to fill out indicating that my suspicion of depression was probably wrong.  I took another stab at it - "we guys are usually not really well in touch with our emotions" I ventured.  Obviously this was a blatant though probably widely held stereotypical belief about the less fair gender.  Busted!

The reason we can get away with such biased statements is because in making them we include ourselves with the guilty party.  We are in a sense engaging in self depreciating humor to make a point.  However, we would never get away with saying something like that about a group that we were not a part of.  For instance I would never imply that women or Torontonians (2 groups in which I do not hold membership) were insensitive, emotionally uninformed boors.  In a way our biased statements are permissible because we are including ourself in the "joke" much like the Indocanadian comic Russell Peters whose Indocanadian mocking shtick is edgy but would be blatantly racial if offered by anyone of a different background.

Despite this apparent self effacement, we are in a subtle way influencing thought and perpetuating stereotypes. If we joke enough about husbands being insensitive will we begin to believe it, accepting behavior consistent with and rejecting behavior inconsistent with this belief? I wonder....

Would it perhaps be more useful if one wants to be self effacing to use oneself alone as an example and not drag the rest of one's group into it. "I know that often I am not tuned in to my emotional state" rather than "guys tend to not be too well tuned in to their emotions."  Maybe not as amusing but perhaps less likely to create and perpetuate stereotypes.

Do angels Swear?

About a week ago, I was feeling overwhelmed with church stuff – cluster, small group, elders, mentoring, and shepherding. Wasn’t Jesus’ yoke supposed to be easy and his burden light? In a moment of discipleship fatigue, I cried out “Lord, please bring your kingdom to my world this week without me even being involved. Show me your power and capability to do this without me.” I then spent the week in anticipation – looking for God’s hand in “bringing his kingdom.”

Later in the week I was meeting a friend for coffee. He is going through a difficult time in his marriage, having been separated for 6 months, and I had been challenging him with the gospel – to love his wife as Christ loved the church – that uncommon unconditional supernatural love that only God can fuel. I knew that he had been challenged by and resistant to this message.

I arrived at the coffee shop first and ordered a drink. Seeing my friend’s car (let’s call him Bill) pulling in I said to the barista that I would pay for his too. There was an older woman off to the side at the counter apparently just “hanging out”. As Bill entered the cafe he called out his usual loud friendly greeting “hey Bro!” I asked him what he wanted. “A friend” he said promptly hanging a right and going down to the washroom. The three of us at the counter (myself, the barista and the older women) had a chuckle. “I’m not sure if you guys have those on the menu do you?” I said.

When Bill returned minutes later the older woman started talking to us about her “friend” that she had had for 53 years – her husband. Bill, always one to pursue conversation with strangers said “so what’s the secret to a successful marriage?” She started to list them – “Get along. Work on it. Hang in there through the good times and the bad.” (Exactly the words that Bill needed to hear). “That is so what we’re not going to be talking about” he said intimating his desire for an out in his marriage relationship. The conversation continued back and forth between them in rapid succession:

-“Are you married?”

- “For now”.

-“It’s like the vows say ‘to death do we part’ “

-“That can be arranged!”

-“Jesus....” she said shaking her head ripe with good natured exasperation ”... you know.... you guys....” (further head shaking).

She then wandered off to have coffee with her “friend” of 53 years and we sat down to our drinks and conversation. I wondered if this was how God had shown up. I couldn’t have scripted that gospel message introduction to our conversation better if I had tried. It truly was the heart of what Bill needed to hear. Bill kidded that she was “a plant”. I sat there marvelling at what God had done and wondering if she was an angel. But.... do angels swear?