Michael Ortiz Hill

Crossing the threshold back to the hospital from the forest was nothing if not dramatic. I was a little frightened, of course, but also bright eyed and bushy tailed with the idealism of a healer who is still impossibly young, a nurse who has, with some humor, taken on the role of resident nganga at UCLA Medical Center.

I was sent to a neurology floor where I was given five patients, one of whom was a severely mentally retarded man in his late twenties. "Failure to thrive" was the diagnosis, which is to say he decided to stop eating. His mother didn't know what to do; so she had him hospitalized. We put a nasogastric tube down his nose and into his stomach to pump "food" into him and strapped his wrists to the bed so he wouldn't pull it out. He had pulled it out already once that day, and shortly after I arrived, hands or no hands, he managed to do so again. I had to stick another tube in. What else to do? Let him starve?

I do not like sticking things down people's noses, not the suction catheters that draw secretions from people's lungs, not the trumpets we jam in and tape to the patient so the suction catheters don't overtraumatize the cartilage of the nose, and certainly not nasogastric tubes which, when a patient resists, are nearly impossible to advance to the stomach. Needless to say, this fellow resisted with everything he had in him.

For the tube to go into the stomach and not the lungs, the head must be tilted completely forward, chin to chest. I tried to convince this mentally retarded man that the torture I was about to visit upon him was for his own good. I gently and firmly pressed on the back of his head as I pushed the tube in. He responded by arching his neck back while he sputtered and screamed out and spit on me. I asked for assistance from a couple of other nurses, and after advancing the tube for virtually a foot into his body, I was sure that I was successful, that we could continue "feeding" him.

I was wrong. I placed the end of the tube that was not in his body in a cup of water. Bubbles indicated that it was lodged deep in his lungs. I was afraid that perhaps I had injured him. I'd never seen a catheter extend so far down the bronchial tree. When I withdrew the tube, I was relieved to see that there was no blood at the end of it.

The man looked at me with stark terror, unanswerable and uncomprehending. I placed my hand quietly on his shoulder and sang an African song to the father of light, not knowing for sure whether extending tenderness to someone you have tortured intensifies the torture or softens it. I was grateful to be transferred to another floor before I was obligated to try inserting a nasogastric tube a second time.

I rely on my patients to remind me I am a nganga when I am lost in the ordinary violence of the work that I do. Another floor, another world, another little nest of possibilities -- my savior that night was an old Jewish man who had just found out his cancer had spread from lungs to brain. He was what we call "sundowner"; pleasant and lucid in the day but through the night quite out of his mind.

After midnight I walked into his room, and he was straining against his wrist restraints and crying out. Over and over he said, "It is a terrible thing to die on Yom Kippur."

I glanced at his wrist and at the crude tatoo: kazetzik, a concentration camp survivor. I remembered a cold afternoon I spent at Auschwitz-Birkenau with my Deena, squatting in the mud in the shambles of the old crematorium and planting a few kernels of blue corn. I was surprised that the Polish mud was still thick with splinters of bone almost fifty years later.

"I know where you are," I told him. "It is a dreadful

place. I can't make this better than it is, but I can pray with you." I held his hand, and together we chanted the Hebrew Shema, "Here O Israel, the Lord our God is One."

In the morning he told me of the terrible dream he had in which we prayed together and then laughed apologetically for wasting my time with such a dream.

I've heard it said that the kindest of the Buddhas live in hell. I knew this to be true because I once lived in the hell realms and know the kindness that was extended to me. Suffering calls forth Buddha's mind to meet it: bright, skillful and generous.

Everything seems to be a matter of crossing thresholds, invisible boundaries that separate the worlds: entering the forest or leaving it, the parting of the electric doors of the hospital as I enter or leave into the cold morning air, passing that threshold as one approaches the bed of unimaginable suffering or leaving the bedside to the comradery of peers. And of course that threshold between Africa and America, hoping to bring a little of the intelligence that I was initiated into back to a world that contradicts it on every level but where I insist that it thrive against whatever odds -- thrive and be honored.

The last time I was in Zimbabwe, the Zimbabwean dollar was worth half of what it had been a few months previously. The price of maize went up, and poor people were rioting in the street. As my plane left Johannesburg, CNN was broadcasting the news of the moment -- something to do with the adventures of Bill Clinton's sex life. My heart sank. I was aware that I was returning to a country that was on the verge of psychosis and terminal self-involvement.

My friendship with you, mapatya, has delivered me to the far edge of an imperial domain: economic and cultural imperialism, brutal and predictable in its greed but also Western medicine, no less an Imperium -- no less greedy, no less hungry for territory, no less infatuated with its certainties, no less disdainful of other ways of knowing.

When you lament the ngangas who think they can heal without listening to their ancestors and kill so many people with herbs, I think of the recent study that found that the fourth most common cause of death in American hospitals are prescribed medications. Properly prescribed medications, mind you, given under direct and constant medical supervision. There is no way to estimate the number killed by medications away from institutions, but one could easily guess it to be in the hundreds of thousands every year. In light of this, the American debate over doctor-assisted suicide seems quaint: to undergo medical care itself is to take your life into your own hands despite the oath of Hippocrates that all doctors swear by: "First, do no harm."

We rely so much on the magic of numbers, and by numbers we attempt to heal people: a medical regimen based on statistics and lab values manipulated with drugs and blood products while the person of the patient is often nearly ignored. Or a culture of "time management" that has doctors and nurses flitting from patient to patient as if performing purely mechanical tasks along an assembly line. The dollars and cents that the insurance company will pay or refuse to pay for this treatment or that. Numbers, numbers, numbers.

In this flurry of numbers, the West has set itself separate and above the most basic tenets of hundreds of thousands of years of healing tradition on this planet -- which is to say it has placed itself beyond the reach of the ancestors. We split things down and then split them again and again. Body split from mind, self from community, community from the natural world and all of it split from the felt presence of Spirit.

I write these bitter words at the hospital itself, a cancer ward, three in the morning. A brief break as my patients sleep. Already I distrust the bitterness. Too simple. Too much certainty and thus untrustworthy. Yes, one must rage against the organized lovelessness of any institution, but there are other stories. I confess that part of my commitment to the hospital is that it confounds me, regularly undoes me, shows me the superficiality of my thinking and my loving.

Last week, for example, I came to care for a man the last few days of his life and care for his family also. Thirty seven years old, end stage AIDS and a rare form of cancer that had eaten away much of his face. He frightened people, of course, but for reasons I can't understand, I saw only beauty in him. On my breaks he would sleep, and I'd meditate and pray at his bedside.

Though it was clear he had very little time to live, doctor after doctor continued writing orders of aggressive treatment that, I felt, did not honor the moment but seemed to prolong an agonizing death. His whole body was giving out -- what we call "multisystems failure." He was very confused and had fallen out of bed twice. And so we strapped him in his bed. He screamed, "Untie me, I am not an animal," until we had to sedate him.

I was charting my nurse's notes when a young doctor looked up my patient's lab values on the computer and decided that he needed blood. Numbers!

"Why?" I asked. "His kidneys are shutting down. His body is trying to die. What he needs now is to be made comfortable. A little love at his bedside."

She heard me and scratched out the order. "I don't know how you do this work," she said. "I have four patients like him, and I don't know what to do. It is so sad. How do you return to this every night?"

The following night I walked into his room and found him lying in blood, pooled around his mouth and eyes, gurgling. I called a nurse's aide to my side, and we elevated him up and tried to stop the bleeding from his nose and mouth: used pressure dressing, ice and a dab of lidocaine that I hoped would freeze the veins. But no luck. We couldn't stop him from bleeding.

I went to the computer and looked up his lab values. As I suspected, the part of his blood that makes it clot was depleted. Suddenly it was me who was arguing for blood. Nobody should die of bleeding from the face. I felt sympathy then for the young doctor who kept faith with numbers, and although she couldn't bear to look at this man, I knew that she was struggling with the impossible, with how small we all are before the reality of suffering.