Page 107 of Light Up The Night
I lean against the counter by the stove and wait, watching Cadence. She's lost in thought, or memory, or both, her gaze fixed on the middle distance. After what feels like an hour, the kettle whistles, and I pour the boiling water over the tea bag, bringing the mug to the table.
Cadence wraps her hands around it, and I sit and wait, knowing she'll start talking when she's ready.
"I have seen many horrors in my life, Riley," she murmurs. "Starvation. Disease. Rape. Murder. War. Genocide. Accidents of all kinds. From the time I could walk, I accompanied my parents everywhere. Their mission was simpler than mine—provide medical care to those in need, and to spread the love of God wherever they went. They were not missionaries in their own minds. They were simply answering the call. They did not venture too near the more war-torn countries—for my sake, I think, but…it is impossible to avoid, over there. Or the results of it, at least."
I frown. "Not sure how I feel about the decision to let a little girl see shit like that, if I’m honest."
She wrinkles her brow, nods a couple of times. "I understand your position. In theory, for normal people, I agree. But I havenever been normal. This is not self-deprecation but mere reality. You must also understand that the vast majority of the cases they allowed me to witness were fairly innocuous. Broken wrists, colds, cuts and abrasions, things of that sort. And in the few rare instances where the patients had suffered violence, they arrived unexpectedly. They did not allow me to be present for the treatment of violence until I was ten or eleven, by which point my capacity for detachment was already well established."
"Capacity for detachment?" I ask.
"Yes. It is…from a medical professional standpoint, somewhat of a superpower, you might say. It is not a lack of care, compassion, or concern, but an objectivity which allows me to view a patient from the perspective of their symptoms alone, which provides my eidetic memory the room to operate unhindered by squeamishness."
"I guess I see that."
"Emergency medicine is…it is a unique beast, Riley. Every second that passes is utterly critical. One must make split-second decisions which often mean life or death, recovery or…not. To an emergency medicine caregiver, be it an ER nurse or doctor or combat medic, pain is a symptom. An indicator."
"I don't follow."
She frowns, blinking. "We do not treatpain, we treat theproblem. If I am in the ER and a patient comes in complaining of pain in his or her lower right side, pain so severe that coughing, walking, or palpitation worsens the pain, I can determine, using the location and presentation of the patient's discomfort, that the problem is appendicitis. The pain is merely a symptom, not the problem."
"Okay, I follow that."
"I cannot allow myself to be distracted by the patient's discomfort—I must treat the problem as swiftly and accurately as possible. Just so, if a patient arrives with an open femurfracture—that patient will be in excruciating pain. Yelling, screaming, howling, grunting, cursing—or, in some cases, unwisely bearing it in silence. It is obvious what the problem is in that case. But I cannot allow the fact that treatment will cause further discomfort to slow me down. I must reduce the break. I must assess whether the patient has a pedal pulse. In that second case, the presence or absence of a pain reaction assists in the determination of a pedal pulse. In emergency medicine, we use pain to triage and treat. We must inure ourselves to the patient's discomfort so that we may treat him or her or them. We cannot be distracted by their discomfort; this is detachment, and I am excellent at it. So much so that many patients find my bedside manner disconcertingly stoic. They mistake it for a lack of care. But Idocare. I care more than I am able to express. I care so much that I will stop at nothing to treat their problem, even if it means causing them more discomfort in the short term."
"I understand now,” I say. “Quick question, though–you said ‘unwisely bearing it in silence. Why ‘unwisely?’”
“Oh. Studies show that vocalization while experiencing pain releases endorphins and other chemicals which help the body process pain. Studies also show that doing so can even speed the healing process. I always encourage my patients to be as loud as they wish.” She sighs. "Anyway. My point in telling you this as an introduction is to provide context. I worked in one of the busiest ERs in the country. I have worked in violent places all over Africa. I have seen horrors, as I have said." Her voice shakes, now. "What I saw in Sudan…" she shakes her head. "I was not ready. I did not know. I…I was unprepared."
"God, Cadence, how…how could you be prepared?"
She shrugs. "I could not. I went knowing, intellectually, that I would be…challenged…by the experience. I did not know how badly it would…" she swallows, sighs, starts over. "Mycapacity for detachment was strained and then broken, and then shattered completely.” A long pause. “I have never required much more than four or five hours of sleep. I have what is known as the P384R mutation to the DEC2 gene, which allows one to function at full capacity on half the amount of sleep as everyone else. Just another way in which I am unique. I am used to extraordinarily long shifts. Twelve, eighteen, and twenty-hour shifts are not unusual for me. I have worked on call in the ER for days at a time, catching only cat naps here and there between rushes. I am used to it. But that? Over there?" A shake of her head. "I was pushed beyond capacity to the point of…" she shrugs, trailing off, unable to find the right word.
"I can't even imagine," I say.
"No, I don't suppose you can." She blinks at me. "Oh. I…I did not mean that as a derogatory statement."
I smile, cover her wrist with mine. "I know it's true—Ican'timagine. Not any of it."
"So much death," she whispers. "So much suffering. The hospital where I was stationed was where people fleeing the fighting went to be treated. It is where the wounded and dying were brought from miles around. It was constant. Trucks, vans, cars, buses…they arrived full of patients all day, every day, without cease. Women, children, men, old men, and women. Pregnant women. Babies. Gunshot. Stabbed. Blown up. Hacked apart. Raped. Brutalized. Beaten. Tortured. I…there was no time to eat, to sleep, to rest. I worked for days on end without eating or sleeping. The nurses often had to force me off the floor. My guards had to force me to leave the hospital for a day or two of rest. But there was no rest. I found sleep difficult, knowing what was happening in my absence.” She sighs shakily. "It never, ever ended. There were lulls. Times when fighting moved farther away, and the injured were slower in arriving, or in fewer numbers. But it was never none. We were always shorton rooms. I treated more patients in the hallways than I did in the rooms. I removed bullets while the dying watched from their gurneys. I lost more patients than I saved, I think. I do not know how true that is, but that is how it feels. That I…that I failed. Again and again and again."
She sniffles.
"You will lose patients,” she says. “It is a certainty. You will make mistakes. You will fail. But I…I received so many patients who were beyond saving. One must still try, however.”
Her eyes fill, shimmer, and then tears spill over and trickle down her cheeks unheeded. "I lived a whole lifetime over there, Riley. I fear I…I will never be the same."
My throat is hot and tight again. "Cadie…"
She smiles weakly. "I will be alright. I will seek therapy for the PTSD. And…" She swallows as she gazes at me. "Being here, with you…that will help more than just about anything."
"Anything I can do, Cadie,anything.”
"I know." She smiles again, brushing tears away with her knuckle. "Understanding and patience and love—that is what you can do, and I know down to my soul that I will receive it from you."
"You will. I promise."
"Now we come to the hardest part to relate." She inhales deeply, filling her lungs and holding her breath, and then letting it out slowly through pursed lips. "In the weeks before my departure, we could hear fighting in the distance. The influx of patients increased by the day, and then as the fighting grew closer, by the hour. The gunfire and explosions came without cease, all day and all night. I often wondered where all the munitions came from that the fighting could carry on for so long without stopping."
