M.K. Thekkumkattil

Move at the Pace of the Body

We breathe, we eat, we sleep, our hearts beat, we shit, we piss. The hidden labor of nursing: wiping shit, changing linens, washing faces, checking the swelling of limbs, feeling for pulses, listening for breath and lung sounds. I look and listen and feel. I treat people the way I’d want my family members to be treated. I ask people how they want to be treated; if they can tell me I follow their instructions.

As a Critical Care nurse, every sound begs me to respond, suction, console, and to keep someone alive, even if briefly. My femme body is a conduit for care.

Caring about others, and being cared for by others, has been dangerous in my lifetime. I learned from racist nurses that it was weak to care, so I feigned indifference and made death jokes. Nursing, in its best moments, has allowed me to reclaim my ability to care. The body is the setting of my attention. Often limp on a specialized hospital bed, the body in the ICU is surrounded by IV pumps, ventilators, monitors, cables. On night shift I dim the lights and close the blinds, finely manipulating the sleep-wake cycles of the sick. I organize piles of syringes, alcohol swabs, and gauze left in disarray by the previous shift. I write my name and the date on the white board, even when there’s no one awake enough to see.

We nurses are afraid to talk about the breadth of our care because of laws governing how much we can say, and because when we do talk about our work with lay people, they’re often disgusted or disturbed. Most don’t know what we actually do: suctioning airways so oxygen can reach lungs, cleaning blood out of decaying mouths, testing swallow function, feeding people through tubes and with spoons, wiping faces with warm wet washcloths and removing the sticky eye goop built up for days, washing and braiding hair, titrating precious medications that can change blood pressures wildly, responding to beep after beep, talking through death with grieving family members, speaking up for patients who are ready to die, coordinating care with three to seven other staff members, assessing the minute details of a body, identifying what’s not quite right, escalating problems, questioning the ethics of a situation, and filing incident reports to push for structural change.

I work with bodies. Bodies whose brains herniate right before shift change. Bodies who don’t check what medications I have due or what other tasks I have before shitting all over the floor. Bodies in sync with the energy of death, whose hearts stop at the same exact minute in the middle of the night on different floors throughout the hospital. Bodies who vomit at the most inconvenient time; bodies who choke and gag when I’m trying to do my charting. Bodies who cough secretions into the ETT, blocking flow of air. Bodies who will die if I do not pay attention.

As a Critical Care nurse, every sound begs me to respond, suction, console, and to keep someone alive, even if briefly. My femme body is a conduit for care.

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BEEP–Would you like to accept a call from Lidia? asks the walkie-talkie clipped to the collar of my scrubs. My hands are covered in shit beneath two pairs of gloves in room 215. The machine never understands my east coast “Yes,” so I’ve perfected the art of bumping the center button with the edge of my wrist. My hands return to the body. They wipe, front to back, between the folds of this person’s thighs. My hands push the flesh apart so as to not miss any trace of shit, no matter how stuck to the skin it may be. 215 has been laying in bed for a week shitting liquid.

“I’m in 215 with a cleanup,” I say, but Lidia, my supervisor, is already talking.

“I have a patient for you in the ER. They’ll go in 216 or 14, although it’s not COVID, so if we can keep the negative pressure in 14 open, let’s do 16. Sepsis from outside hospital, found down and she’s already gotten 4 liters of fluid, but she’s tiny and they didn’t see her history of CHF. So,” I can hear the eyeroll in her voice as she sighs, “There’s that. Pressures are soft and they want to start dobutamine. Sound good?” 

Lidia is invested in a facade of kindness, so she asks questions whose answers are meaningless.

“Sure. I’m in the middle of a cleanup. Can you leave the name on my WOW?”

“Oh, no problem, take your time. Yes, I’ll put a sticky there.” 

I wait for her to end the call. In my ideal world, before I get an admission, I want to look the patient up, check their advanced directive and social history, and make a list of things to address that the ER hasn’t gotten to yet. I love admissions, the hurry and excitement, but Lidia becomes a tornado. She yells down hallways when there are no true emergencies, she asks for many hands to be involved in situations that require few. Our individual roles make us collectively skilled, but when Lidia is involved she pulls people out of their roles, leaving patients neglected. Nurses hide in the medication room to avoid her. Because I’m an experienced nurse, she doesn’t boss me around the way she does others. She respects my boundaries, but it takes intentional effort to keep her from stepping on me. If I can create pauses, if I can pee and have a snack before this admission, I will give better care.

She’s got one more thing to say. “Heads up though, they might try to call if you don’t in a few minutes.They have 8 patients boarding and I don’t think any of those nurses know how to run dobutamine. Last pressure was 84, but MAP’s still fine.”

I affirm and click the call button to hang up. My best friend and coworker, Jason, holds the patient up from the other side of the bed. He overheard the conversation and says, “They can do dobutamine on the floors.” Across the room, he vocalizes what I’m already thinking. I move slower. I move at the pace of bodies, both my own and those I care for. While talking to Lidia, my hands finished cleaning the shit. The angry red of the patient’s skin exposed, I pivot to the bedside table, where I’d set up bath wipes and Calmoseptine. I take the tube of Calmo and squeeze the thick pink cream out with all my hand strength onto my now single-gloved hands. Half the Calmo will smear off on the bedding, so I spread it a centimeter thick. I imagine that red skin is so painful, but the patient can’t tell me.

When Jason and I are in a room together, we are graceful. We communicate with eye contact and gestures, we anticipate what the other person wants. I take the bedroll dangling at the end of the bed and set it in the center. I tuck the edge of the new linen underneath the old, starting from the patient’s head and moving down to their butt. Jason pulls the patient towards him to lift the body’s weight away from the center of the bed, allowing me more room to tuck under. I straighten out the half of the linen that will stay on my side until there are no wrinkles. The patient’s shoulder, hips, and knees have become handles we can manipulate as needed. I grab the shoulder and hip, while Jason straightens out the bent knee. We roll the patient over the linens towards me. 

“Did you hear about Cindy?” Jason gossips. He blasts music from the phone in his pocket, creating a sanctuary behind closed glass doors, a shield of noise to protect us from eavesdroppers. He tells me about the latest from our resident narcissist stalker ICU nurse. We tuck the patient in with fresh blankets and pillows under each limb. I adjust the IV tubing, check how much more volume I have in each of my IV drips, click through the numbers on the fancy digital urimeter so I can chart his hourly outputs, throw away my gloves, use hand sani, and open our glass doors. It’s time to get a patient. 

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My care requires hurting people every single day.

My care requires hurting people every single day. The hospital requires it. I tie wrists down with restraints, I press on nail beds to assess brain function, I clean the mouths of sedated patients to prevent infection, which often causes them to wake up grimacing, gagging, and coughing. I draw blood: I remove the lifeforce of the living, the carrier of oxygen and nutrients, every single night to be sent to a lab for tests. These are doctors’ orders, the most banal part of my job. Hurt people so we might prevent infection. Tie them up so we might keep them from hurting themselves. Take their blood so we know whether they need blood.

Hurt is woven into nursing care, but alongside these intended cruelties, we are part of a system that unintentionally harms people: medication errors, surgeries in which the wrong organ or limb is removed, missed orders and diagnoses.

My nursing practice is a spiritual art that asks me to be present to the bodies in front of me, that asks me to move slowly and with intention. When I nurse, I am attuned to minute changes in blood pressure, heart rate, respiratory rate, and body temperature. I pay earnest attention to changes in color, moisture, and sound. On a good night, the person I care for is an extension of my own body and their needs are my own. I control their breath, heart, urine output, how much they do or don’t shit; I control how much they can move or not move in bed. I control the sounds in their room: if I program the monitors a certain way, they’ll alarm often, keeping the person up all night; if I don’t close the curtains at night, the person might not sleep and end up delirious. I control sleeping and waking; I control rest and stimulation.

I am responsible for their lives. 

I came from a chaotic home where I controlled almost nothing. I went straight to nursing school from high school, drawn to chaos again and again. I’ve rarely chosen the stable path: I worked as a travel nurse for six years, on three- to six-month contracts; I drove drunk on icy rural roads; I cycled over ten thousand miles in five years across multiple continents. And yet, once I clock into the ICU, I wipe down every single surface. I follow a diligent routine and checklist. I am thorough and efficient. 

First, I learned to move quickly. As I nursed for longer and longer, I slowed down.

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I find my WOW. Someone has moved it to an outlet to plug it in, it must have beeped low battery. I badge in. I open Cerner and drink water while it loads. I find Julia in the system. She’s a 68-year-old woman with CHF, COPD, a history of metastatic lung cancer, coming from a small town where her sister found her down. She’s septic, X-rays look like pneumonia, but, given all of that, her vitals look decent. 

I call down to the ER and they give me report. From how the nurse speaks about the patient, it sounds like she isn’t Critical Care trained, so that’s probably why they want to bring her to us to start the dobutamine drip. The patient’s labs are predictably out of whack, but at least she’s not on BiPAP yet. Within a few minutes, she’ll be up here and there will be a kind of chaos I adore.

When you cut your finger, your body tries to protect itself by flooding the area with white blood cells and protective factors. The capillaries expand and open up, allowing for increased blood flow. The body defends against infection and repair begins. The skin around the cut gets slightly red and taut with fluid; it’s tender to touch, announcing that your barriers have been broken and you’re sensitive to being hurt again. Sepsis occurs when this happens on a systemic level and the whole body’s vessels dilate. Shit gets weird. Blood pressures drop. The heart pumps faster to keep up with the increased need for volume. There’s simply not enough blood to go around. The hole is too big. The circulatory system, once expanded, needs more.

Our job, then, is to fill the hole. We pump people full of fluid until they can’t take anymore. If their pressures are still low, we give them powerful medications to squeeze veins and arteries. This increases blood pressure. When I was in nursing school, I was amazed to realize that the term “blood pressure” refers to the literal pressure of blood against the walls of vessels. If we increase blood pressure adequately, it flows to the brain, the kidneys, the vital organs. If we don’t, blood stagnates where it doesn’t belong, organs are deprived of oxygen, and the heart will push as hard as it can until it gives up.

I see sepsis as femme, sepsis as hysterical, sepsis as a queer death drive. A body, trying to protect itself, endangers its future. To be alive is not always the best option for our infected bodies. The body’s natural response to threat is to self-destruct.

Per the ER report, Julia’s blood pressure is soft. She’s been given fluid, but because of her history of congestive heart failure, too much fluid can drown her. Protocols don’t always serve bodies. We cannot manipulate organs in isolation. Each body system affects other body systems; if the fluid they gave her overwhelms her heart, then her lungs will fill with fluid. At some point in sepsis, third spacing kicks in. 

Third spacing: the flooding that first brought white blood cells to fight infection expands beyond where it was once useful and, like the streets of Kerala during monsoon, water becomes uncontrollable. Blood vessels leak, their boundaries porous. The risks of our treatment: Julia’s lungs could fill with fluid, requiring increased oxygen, non-invasive ventilation, or intubation; her limbs might swell, growing heavy with water she can’t secrete. Kidneys, heart, lungs, liver all work together to maintain balance. When that balance is interrupted, the body teeters towards death. 

I see sepsis as femme, sepsis as hysterical, sepsis as a queer death drive. A body, trying to protect itself, endangers its future. To be alive is not always the best option for our infected bodies. The body’s natural response to threat is to self-destruct.

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My nursing practice changed over the years. No longer about the high stakes situations like code blues, traumas, and massive transfusions, my nursing practice has become about creating calm, caring environments. How can I offer my devotional service to the person in front of me? How can I be there for them emotionally, physically, and spiritually? How can I remain calm and protect my own spirit in the process? How can I maintain the lines between self and other, even as I use my body in service of another?

Moving at the pace of the body means moving in resistance to dominant timescales. White supremacist capitalism requires progress and forward motion, sees success as keeping a person alive, and demands we work ourselves to death to prove our lives matter. Bodies resist white supremacist capitalist narratives, each heartbeat its own timescale. I trust that my body will find its purpose in relation to the person in front of me, even if my mind doesn’t consciously yet know how.

The ER nurse wheels Julia up on a stretcher. She’s covered in piles of blankets. I remember that the ER didn’t document a temperature on her; my guess is she’s freezing. She’s lethargic but opens her eyes when I say her name.

I get my gloves on and the room fills: Jason, Lidia, and Tess, another nurse. Julia barely stirs when we slide her from stretcher to bed. Jason plops the packs of bath wipes on the end of the bed. We become a single organism. Temperature checked (she’s 94 degrees, too cold), Bair Hugger on, bed bath given, gown changed, skin checked for breakdown (none), blood sugar checked (96, normal), patient assessed and oriented to her surroundings, stringy gray hair washed, heart monitor placed on chest, pulse ox on finger, blood pressure cycling every 5 minutes (in the 70’s, too low, pressures tanking on arrival is common when transferring someone from the ER to the ICU), doctor called to bedside, dobutamine ordered, pulled, primed, and hung, third IV placed in case her pressor line blows, charting complete.

One by one, as the tasks get done, each person peels off until it’s just me and Julia.

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To do no harm as a human in a body is impossible, but it is especially impossible as a nurse.

To do no harm as a human in a body is impossible, but it is especially impossible as a nurse. The process of healing is often more painful than the injury itself. Julia’s injuries are out of control: the body threatens itself. The body, in an attempt to save itself, enters an inflammatory response that can kill it.

When everyone else is gone, I turn to the earth to teach me how to care. I move at the pace of the body, which is to say, I move at the pace of the earth. There is an interplay between what’s inside and outside all the time: breath steadily taking in the outside world, lungs changing the air in turn; sweat, pee, shit, moving the waters of the body; skin, sensitive but absorbent, a flesh boundary; firing synapses creating thought and movement; desire, guiding forward.

The earth does not move at one pace and neither does my body. Glacial time is slow. Glacial time reminds me that what must change in this world will happen over generations, centuries. Glacial time offers the lesson that everything that appears hard, immovable, unchanging, will eventually be worn away. Glaciers show me that there’s so much more than the surface of a thing: on some glaciers, it looks like we’re standing on solid rock, but the ice cuts hundreds, thousands of feet deep into the mountain. 

We cannot predict what will happen in the melt.

Glaciers remind me of slowness, but when I turn to earth, I see speed, too. Earthquakes wake me up from my night shift sleep and rattle my walls. Lightning illuminates the far sky, a gift in the deep darkness. Roaring rivers move everything that was once frozen. In the summers of the far north, when there’s only a few short months without snow, all the flowers, trees, and medicines of the land do the work of a lifetime in the ever-shining sun.

Moving at the pace of the body also means listening to the intuition that says ‘get it done as quickly as possible.’ Pull up intubation meds, prime tubing on a crashing patient, get monitors on, push the bed to the ICU without delay. Other times, intuition begs pause. Take a breath, go to the bathroom, drink a sip of water, walk a lap around the unit, debrief with a coworker, talk to the doctor.

A human body caring for other human bodies cannot go at the pace of a roaring river all the time, no. The river must join the lake, must find the ocean, where it is consumed by rhythms larger than itself, where there is no urgency to its movements. The river knows it is not the only source of water, not the most important or best way to exist as water. The river knows it is only one. And so I care for others: knowing I am only one, knowing I am not going to save anyone, knowing there is no urgency because the body before me will, like my body, ultimately join the body of earth beneath our feet.

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Julia and I flow together. As the antibiotics and dobutamine take effect, she becomes slightly easier to rouse. Color returns to her face. “Go away and let me sleep!” she yells. She’s in the category of what I affectionately call a grumpy old lady, and she doesn’t want to emerge from underneath her blankets.

I grin under my mask. A personality! I love when my patient gets their personality back! If they’re annoyed, they’re getting better!

This could have gone another way: pulmonary edema, respiratory failure, and intubation. It could still go that other way. All I get is a few hours in which she is mine and I am hers. When my shift ends, I tell the next nurse everything I know. I clock out. I go home and do my best to come back to my own body. Away from Julia, I am my own. I eat my breakfast and brush my teeth, shower, take my pills, watch tv, and listen to a soft meditation until I fall asleep.

The nurse/patient binary is false. While I am a nurse, I am often a patient. I am disabled, brown, trans, and a child of immigrants. Doctors have gaslit me, denied me care, told me my pain isn’t real, that I didn’t know the terminology for my own body. Medical offices have lied to me, ignored me, overcharged me, treated me as less than human. Sterile white walls and windowless offices have silenced my voice. My body has been categorized, split up into distinct systems, my wholeness denied. My mind has been separated from my body. I know the medical industrial complex for which I work has hurt me, and my heart aches when we hurt the people in our care.

The nurse/patient binary is false. While I am a nurse, I am often a patient. I am disabled, brown, trans, and a child of immigrants. Doctors have gaslit me, denied me care, told me my pain isn’t real, that I didn’t know the terminology for my own body.

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Julia lives in my body in ways that have forever changed me. I forgot I existed, forgot to eat, take my pills, pee. Julia hit, kicked, spit at, bit me, Julia called me a bitch and a liar and called the police to break her out of the hospital. I jabbed Julia with needles and catheters, sedated and restrained her. But I also washed Julia’s body and hair, I applied lotion, I played the music of her choice, when she could choose. I’ve longed for Julia for so long. Longed to see these dying women heal, longed for the hurt to be erased from their bodies. I’ve agonized over Julia when bicycling in the middle of nowhere with no cell reception and I’ve wondered how Julia was doing days, weeks, years after our encounter.

When I left Julia, she wouldn’t leave me. Julia imprinted herself on my body beyond memory. She changed me on a cellular level and, when I entered the next patient’s  room on my next shift, my body remembered what happened and why. 

Everyone I care for next has been impacted by the care I gave to those before. My body connects the thousands of people I’ve touched.