Eventually, Mara’s physical state had improved enough that the hospital wanted to move her out of the ICU and onto the floor which focused on respiratory issues.  The main problem the doctors needed to deal with at this point was the state of Mara’s lungs.  It would take time and treatment for them to build up proper strength.  Once they’d done that, they could focus on more aggressive physical therapy to enable her to walk again and move properly; that would likely take place at a different facility.  In the meantime, it was felt that after more than three weeks in ICU, it was safe to transfer Mara upstairs.

Mara’s mother and I were very anxious about this move.  The nurses in the ICU had been tremendous, not just in terms of Mara’s medical needs, but also the incredible emotional support they’d given all of us.  A suicide attempt, a *real* one, is such a traumatic experience.  When someone gives up on life, the guilt which is spread around can make you consider – in a warped way – that making the same choice could end your emotional pain as well.  For me, it was all I could do to face myself in the mirror each morning.  Between my own self loathing, and the guilt which I saw heaped upon me by Mara’s family and the faces of others, this was my fault, 100%.  I had failed Mara in every way possible, and I had driven her to this.  Wipe away her mental illness, her years of sexual abuse, her physical suffering through Crohn’s Disease and horrific migraines; in my mind, I had willed this to happen, I had failed to stop it, I was at best an accomplice and at worst I was guilty of attempted murder.  At the same time, I had to carry the guilt from Mara’s side, of not being able to somehow allow her to die, condemning her to continue her miserable life.

If I hadn't been so terrified of the idea of death and non-existence, I surely would have killed myself.  Well, there was also the gnawing realization that in doing so, I might inflict on my family the same thing which was being inflicted on me.  That was the last thing I wanted to do.  Besides, I was too damn tired to kill myself, and in my convoluted thinking, suicide would be akin to letting me off the hook.  If I was as terrible a person as I now believed myself to be, the act of living would be much more painful than silent nothingness.  Death was too easy.  I deserved to live, and suffer, and be miserable.

Despite our objections, Mara was transferred up to the respiratory floor.  She was still on a feeding tube, and she had an oxygen monitor clipped to her finger at all times to make sure her oxygen level was adequate.  The trache tube was still present, staring me in the face every time I looked at her.  And now that her lungs had begun to be used, they were slowly emptying themselves of the mucous and debris which had collected there.  Coughing fits would be followed by globs of mucous clogging in the trache opening.  There was a suction machine next to Mara’s bed, with a long wand attached, and we were encouraged to assist by suctioning out mucous if we saw it collected there. 

In the meantime, there were other physical and cosmetic issues which I didn't’t want to deal with.  Mara was developing some minor bedsores on the back of her head, where clumps of hair were falling out.  I would try to remove the hair as cleverly as possible, but Mara would sometimes notice and get terribly upset.  I tried to reassure her, but in the meantime all I could wonder was what sort of terrible bedsores she might be developing elsewhere, such as her back and her butt.  Since she was basically immobile still, barely able to lift her hands or wiggle her feet, there was no way for her to lie on one side or the other.  With all her weight on her back, 24 hours a day, I knew it couldn't be a pretty sight.

I don’t envy the jobs of nurses.  They do a ton of work, deal with sick, miserable, cranky people all day long, and are usually shorthanded and understaffed.  Unable to make necessary medical decisions without a doctor present, they are usually treated as second class citizens.  Despite years of training, they spend a good deal of their time emptying bedpans or completing other disgusting and non-technical functions.  Mara’s father was a doctor, which meant that for some unclear reason, doctors who had met her father would act more naturally around us then they would other patients.  This included yelling or berating nurses without hesitation, which led me to believe than many doctors are simply assholes with God complexes.

Yet in numerous cases, I’ve had to witness how those nurses who develop a negative attitude, or who numb themselves to the chaos around them, simply become uncaring or lazy – or both.  Mara’s sister had done work as a blood tech, and would horrify us with stories of nurses refusing to check on patients who were buzzing their nurse call buttons because “he is rude” or “she buzzes too much” or even “she won’t turn off the TV when I am talking to her.”  Once, when a patient in one of the New Jersey hospitals where her father was on staff, Mara became seriously ill because a nurse hadn't given her any of a critical medication for over twelve hours, simply because she was too careless to look at her chart and see that the medication list continued on the second page.  If the error hadn't been caught when a doctor wanted to change the dosage, she might have died.

So on December 23rd,  when I walked into Mara’s room after work to visit her and found her oxygen monitor alarm screeching, I was not really surprised at the lack of attention it was being given.  I could see immediately that the clip had simply slipped from Mara’s finger, and when I reattached it the machine registered normal oxygen levels and quieted down.  Mara explained that the thing had been going off like that for nearly an hour, but nobody had been in to check on her.  Meanwhile, the nurse call button, which had been clipped to her dressing gown, has slipped as well and was now dangling off the bed.  Unable to push the button, and incapable of yelling, Mara had been forced to lie there and listen to the machine scream bloody murder until I showed up.

In some ways, the relationship between patient and nurse can be similar to that of inmate and prison staff.  As a patient (or inmate), you are not free to take care of yourself.  You rely on the staff to do certain things for you, and when problems arise you have to decide if it is important enough to bring to their attention.  If you complain or cause “trouble” too often, you’re generally ignored and suffer for it.  Likewise, because they have all the power, you cannot afford to make enemies of them even when you are being mistreated.  Basically, you have to suck up to them and thank them for doing their jobs.  Sure, there are some who treat you better, who care about your well-being, and those make up for the rest.  But when you get stuck with a hard-ass, there isn't a lot you can do.  If you make an issue of their job performance, even if you are in the right, you’ll likely earn the disdain of their co-workers…and suffer for it in the end.

With that in mind, I went and found a nurse and tried to discuss the situation with the blood monitor.  In my mind, the doctor would not have ordered its use if he hadn't thought it was important.  Instead, I had to listen to the nurse complain about how the clip kept falling off of Mara’s finger, and what a hassle it was to go back in the room to replace it.  She’d even tried to find a way to silence the alarm, but no to avail.  I tried to sound understanding, while at the same time expressing my concern for Mara’s well-being.  I think I did a decent job, since I wasn't overly-critical and I did not try to lay blame or complain.  Since I didn't receive any eye-rolling or arguing or muttering under her breath, I figured I had done the best I could, and returned to Mara’s room.

Walking in, I found Mara undergoing a “breathing treatment.”  This was something which was not only necessary but crucial to her improvement, but which Mara found very unpleasant and uncomfortable.  Basically, the respiratory therapist would use a huge football-shaped instrument to force air into Mara’s lungs, expanding them as much as possible, and then Mara would be instructed to hold that air (if she could) and then expel it.  It was sort of a weightlifting session for her withered lungs.  Mara did not want to cooperate, and she’d cry and complain and plead, but at the same time she’d comply because she knew she needed to.  I suppose, sentenced to still being alive, Mara knew she’d be happier if she tried to make the best of it…at least until she could attempt another escape from the prison.

The therapist finished the breathing treatment, packed up his stuff, and left.  I sat beside Mara’s bed, wiping away her tears and holding her hand.  She was a bit disoriented, as she always was after a treatment, so I didn't say anything.  I just sat there and wondered how life had gotten off track so terribly, and if things would somehow turn around after this nightmare and begin to improve.

Just then, Mara began to vomit.  It wasn't a projectile Exorcist-type explosion.  It was more of a gentle burping, filling of her mouth with greenish slop (the nourishment provided by the feeding tube).  But there was a problem: Mara wasn't emptying her mouth; the mush was dribbling out onto her chin and chest, but she couldn't expel it and breathe, as she seemed to have fainted or something.  I shouted for help and pushed the call button.  Sticking my fingers in Mara’s mouth, I tried to clear the airway, but as soon as I would, she’d burp again and more would come out.  In the meantime, I used the suction apparatus to clear things more fully, which would allow Mara to get a breath or two at most before a new serving of vomit would appear. 

The oxygen machine began to scream again, as the flinger clip had fallen off.  I couldn’t get up and go for assistance because I feared that if I left her side, Mara would choke to death on the vomit.  So I sat there, suctioning out the green slop and calling out for help in vain over the machine’s alarm.  The alarm was screeching, I was yelling, the call button was pushed, and Mara was vomiting.

And nobody was coming.