The Sopranos
(Warning: If you watch, but missed this week's episode, stop reading)
Also, this may be upsetting for my widow friends. Proceed with caution

Sunday night's episode was incredible, but particularly painful for me to watch. Tony was in the ICU, and his family was standing by, looking miserably exhausted, talking to him. Looking at Tony hooked up to all the machines made me flashback to Joe.

If you could have seen him in ICU.... If you saw the episode, you have a bit of the image. But Joe's was worse. I could not have imagined more machines hooked up to one person. It took me so long to get those images of Joe out of my head, to remember how he really looked. But this episode brought them back full force.

I have cut and pasted a tiny bit of the essay Joe's doctor wrote. This is what Joe looked like:

I was the senior resident in the medical ICU, it was 3 AM, and I was gathering my thoughts amid the whooshes, beeps, and flickering monitors of the sleeping unit. I was preparing to go
tell Betsy that Joe, her 31 year-old husband, needed prone ventilation. Joe lay dying, of all things, from chicken pox. He was receiving twelve infusions, including four pressors [blood pressure medicines], sedatives, antibiotics, acyclovir, full strength bicarbonate [combats acid], his 26th amp [or ampule] of calcium, and liter number-who-knows-what of saline. He sprouted two IVs, two central lines, a foley catheter, endotracheal and orogastric tubes, an arterial line, and an array of monitor leads. His blood pressure plummeted*from a systolic of 80*whenever we interrupted his bicarb drip to spike [to start or hookup] a new bag, so we knew moving him might kill him. Every nurse raced to finish tasks on other patients, preparing to help.

His course had been like watching a pedestrian struck by a truck in slow motion: a sudden, jolting, irreversible cruelty*drawn out over hours. Anasarca [the diffuse swelling] had folded his blistering ears in half and forced us to revise his endotracheal tube taping three times so it would not incise his cheeks. He had unremitting hypotension [low blood pressure]. His transaminases climbed above 6,000 and his creatinine to 6 [measures
of liver inflammation and kidney failure]; his arterial pH dropped to 7.03 and his platelets fell to 16,000 [both commonly fall with infections]. His partial pressure of oxygen sank below 60 mm Hg despite paralysis, maximum PEEP and 100% oxygen [we were unable to keep his oxygen at goal despite best efforts]. Crossing that terrible threshold felt like drifting below hull-crush depth in a submarine. I waited for the walls and windows of the ICU to groan with the strain as disaster neared.

I realize this was in doctor language, but I think even if you don't understand it, you can imagine all the tubes stuck in him. What you can't imagine is the swelling. By the time Joe died (the day after this description) he weighed about 60 pounds more than he had a few days prior. He was truly unrecognizable.

And his chest would rise and fall dramatically, just as Tony's did. Even after he died, I told the doctors they were wrong, he wasn't dead, because his chest continued to rise and fall, a sure sign of breathing. But then they unplugged the machines that were giving me the false impression. His chest stopped rising. He was dead. There was no denying it.

This post was rather rambling. Sorry. Just where I'm at.

Gotta love The Sopranos.

-b