This [place/job/world] will change you, if you let it.

My very first patient in the ER was a 65 year old woman picked up by the cops after she fell down at the bus stop. She was high. She had no shoes or underwear on, just a big t-shirt with Tweety Bird on the front and a pair of black jeans with a hole in the left knee. Her matted hair was full of leaves and bits of twigs. When she came around, spitting invectives one minute and calling me angel the next, she admitted that she'd shot up with dope every day for as long as she could remember, probably since before you was born. No one saw her fall, so the doctor ordered a head CT to make sure that she wasn't bleeding into her brain. When I told her it was time to go get the test done, she looked at me as though I was out of my mind. You want me to go out of this room looking like this? I can't go out of here looking like this. I need to comb my hair. Hand me my pocketbook.

Like a song or a smell that takes you back to a place you can't quite name, something about the way that woman rifled through her purse - handing me her tattered address book, nubby tissues, a tube of lipstick, demanding a clean blouse before going out in public- reminded me of my grandmother so keenly I felt my throat catch. Oh no you don't. We are not playing this game. You can not see yourself and everyone you know in these patients. TOUGHEN UP NOW. GO ON.

So I have, mostly. I didn't give it a second thought when the principal with chest pain comes in, don't blink when I see the constant stream of patients with the same birthday as my friends & loved ones, don't think twice about the girl my age who was raped a few blocks from where I used to live. I ignore connections and shun similarities. These are other people. What do they have to do with me? Watch me shrug my shoulders as I give them their medications and send them on their way.

And then today the paramedics bring in a patient, another woman in her 60's, my lot in life it seems. She collapsed this morning, they tell us, she didn't have heart beat but we threw some epi at her and now she's got a pulse, they practically grin. She is unconscious, with a tube down her throat, and when I cut off her clothes I see that her emaciated body is literally eaten away by cancer. Her hair is cut stylishly and she is wearing earrings, complete with a tiny diamond in a third hole mid-way up her ear, just like Squirrel. There is no family, someone tells me, and after awhile, a woman with grey hair and a brave smile comes back, looking for my lady. I'm not technically family she tells me, but I might as well be. We've been friends for 44 years and we've been through a hell of a lot together. We met when we were 18 and then moved here. She looks over my shoulder, where her friend is lying on the stretcher, a tangle of wires and sheets. Is she in pain? If she were awake she'd say 'Lou, who cares if it's 10 am, we need a scotch.' Oh God, I hope she fed her cats this morning. She starts sobbing uncontrollably.

After the friend calms down and I walk her over to talk to the doctor, another nurse and I begin the task of making my patient look more like a human and less like a power strip. The smell rising off her body is terrible, and as I work, holding my breath, all my unanswered questions about life and death bubble to the surface. She is covered in drainage from her wounds and her own excrement. We work from head to toe and when I wash the excrement off her feet I notice 1) that her soles are mottled, which any nurse will tell you is a sign of imminent death and 2) her toenails have been freshly painted bright red. My 6 week old resolve cracks and I feel my throat catch once more. It is Sunday morning and everyone I love is at church and I am washing excrement off the feet of woman who is alive but dead and this is Squirrel and me in 40 years and I am not tough and really, does being human meaning living with half broken hearts our whole damn lives?

My patient's best friend of 44 years makes it clear in no uncertain terms that she would not want to live this way and produces the necessary papers to back up her claim. Someone comes over and removes the tube from the lady's mouth. I turn all the alarms on the monitor off, and pull up 2 chairs. As best as I can, I explain what all the lines on the screen mean, that no one can say for sure how long she'll hold on, that the medicine going in her arm keeps her from feeling any pain. She asks if her friend can hear us and I tell her that it's very unlikely, but I could be wrong, so we talk to her and tell old stories about their double dates, their trip to Europe. Before she leaves, the friend clutches my hand and says I could not have done this without you and instead of falling apart, my heart fills -- stronger, fuller.

The rest of my shift passed in the typical blur of people, their need, my ineptitude, cold coffee, paperwork, alarms. At 23:15 I clocked out and walked through the empty halls of the hospital to my lonely car, exhausted but oddly hopeful. It is a strange & abundant grace that allows us to see ourselves so clearly in our neighbors; that erases the line between us & them and bids us wash their feet, go on.