Melodious Memories

Some people trace their past through memorable events: birthdays, graduations, taking Amrit, changing jobs. I use sounds to form a timeline: certain shabads remind me of road trips taken with family and friends; I can map nearly all my years in school through songs released during the same time. Some sounds have become Pavlovian: hearing Mil Mere Preetama Jio makes me feel like walking against a crisp wind through a quiet tree-lined neighborhood. The urge to run on a beach and build sandcastles comes on strong when I hear Paul Simon’s “If You Be My Bodyguard.”

When I hear a single solitary beep followed by a 1.5 second pause on an overhead speaker in a hospital, however, the Pavlovian reflex is entirely distressing. A woman’s voice follows the pause and usually asks for an illegally parked car to be moved or for an employee to return a page. Yet, sometimes the calm and soothing nature of the voice is all but deceiving.

I was near the end of discussing my plan for a very sick patient yesterday on rounds. “So, in terms of GI (gastrointestinal system), the differential includes Clostridium difficile colitis, ischemic bowel, or toxic megacolon. We continued fluid resuscitation and started broad-spectrum antibiotics. Surgery just came by to see the patient but is waiting for imaging studies. Mr. A finished his contrast and was rolled down to CT roughly 30 minutes ago. Pending the scan we’ll decide on a total colectomy versus medical management.” The resident flipped through his papers while the attending scribbled his note. “Very good,” the attending replied. “Anything else?”

A single solitary beep came through the overhead speaker followed by a 1.5 second pause.
[My Pavlovian connection kicked in: Stomach drops. Heart skips a beat.]
A woman’s voice followed. “Code Blue, Radiology CT.”
[Gasp.]
“Code Blue.”
[Hold onto everything in your pockets and bolt towards Radiology.]
“Radiology CT.”
[Crap, it’s Mr. A! We just sent him down there!]
“Repeat.”
[Fly down 4 flights of stairs.]
“Code”
[Keep running.]
“Blue.”
[Turn the corner and keep running.]

The room was packed with frantic nurses and technicians trying to recount what had happened. The other intern and I grabbed gowns and gloves and pushed our way through to the patient lying on the table and covered in his own bloody vomitus. Being that the man barely made the weight requirement for the CT scanner, I jumped on a stool and compressed his chest with all my might. The sounds of the room and the voice leading the code suddenly became soft and muffled. All I could hear were crunching noises of broken ribs that transmitted beneath my hands. I couldn’t help but look in his eyes while I kept count of my compressions. Strange, I thought, he’s looking back me. But how? Did he have enough blood perfusing his brain that he was still “alive?” Was he really looking back and communicating through his eyes?

“Hold compressions!” screamed the resident.

I stopped and caught my breath. We had been at it for 20 minutes and there was still no heart rhythm. His eyes rolled to the side. Perhaps I was witnessing a soul in the process of departing. Oh, Waheguru.

He was pronounced dead 2 minutes later.

Later that day, I passed by the room that was once assigned to Mr. A. It was being disinfected and prepared for another patient: a woman, Mrs. E, who had given birth 6 hours earlier but had an unsteady blood pressure and was still bleeding. My ears picked up a familiar sound in the distance. Playing on the TV in the corner was one of my favorite tunes of recent: Orba Squara’s “Sunshine.” As I listened thoughts of warm, sunny days full of love, life and cute pigs came racing in. Spirits, both inanimate and of organism, were being reborn.

In Japji of Guru Nanak there is a phrase that refers to a cosmic phenomenon that takes place when the disciple gets embedded in his soul-consciousness– nucleus of the life of the spirit, small as a mustard grain, bright as a point of fire. The disciple lives inspired of it, and is sustained by it as the mother is by the child, the artist by beauty, the opium-eater by his dose, the Majnun of his Leili. The disciple dies when this spark of life is extinguished. His lungs breathe the moral spirit of the spiritual universe, and his eyes see what those around him do not see.*

One can only utter Waheguru when learning that the baby was born at roughly the same time Mr. A. had passed away. The spirit of the limitless one breathed life into another. Mrs E. is now thriving in the same hospital room where Mr. A spent his last few moments. The same room where “Sunshine” played before she arrived.

Death, renewal, and spiritual reincarnation are inevitably linked. Just like sounds and memories, both pleasant and anxiety-inducing, both past and newly formed. Thank you, Waheguru, for your constant watch, guidance and protection and this kind reminder.

*Spirit Born People, Puran Singh

Steps toward initiation

Working in the Intensive Care Unit (ICU) absorbs me both mind and soul. The ICU is not only a sanctuary for those who are critically ill; it is my tent within the camp of caring for others. It has propagated my desire to capture the spirit of Khalsa: to be selfless, noble, and brave while in constant meditation of Waheguru. I am a strong, spirited and optimistic soldier protecting the sick. My ego, however, is tamed as I see Waheguru’s expression in every thought, decision, and action that is made by both myself and others. Although my attending may believe otherwise, I kindly obey the orders of my guru to assist in both the processes of restoration and death.

The ICU can be terrifying and stressful to both young doctors and patients alike, yet it is a place where miracles often happen and it always manages to tug at my Sikhi strings without fail. I feel the rhythm of Khalsa enrapture my senses when I enter the unit. I hear it bounding against me as I make my rounds through each patient’s room. I hear it in the beeps of the telemetry monitors and ventilators. I hear it permeate through the chaotic motions of a resuscitation. I hear it softly emerge behind conversations of end-of-life care. I hear it shout gloriously when a person leaves the ICU alive and well.

“When the Khalsa runs, he is in trance. On the bed of thorns, he lies on roses. Outside is immaterial; it is the aim of life that matters. The Khalsa is he who has found the centre of life and has enshrined God in the temple of his heart. The Khalsa looks at the world from a supreme height, blessing all, helping all, loving all, with his beautiful looks from the inner self of all life.”1

I often yearn to leave my Sahajdhari status and live as a Khalsa, and it usually reaches its zenith when I’m in the ICU. Recently, however, I have noticed the rhythm of Khalsa pulsating within my consciousness even when I’m outside of the ICU. I remember singing “we are the Khalsa, mighty mighty Khalsa” when I was a child and wondering whether a modern Sikh could truly invoke Khalsa and live in a similar fashion. Funny how opinions change over time. Perhaps feeling the rhythm inside oneself is the first step to realization of its possibility.

1 Creation and the Purpose of Khalsa, Puran Singh