A WEDDING ON THE ICU

Last night on “Grey’s Anatomy” there was a beautiful scene depicting a wedding on the ICU.  The female character breathed her last right after the vows, physicians standing around her, holding up pictures of lights and stars while “Stand by Me” played in the background.  If visual storytelling can do anything, at its best it moves our hearts off empty. This scene did just that for me, while bringing me right into the vivid memory of the day I performed a wedding on an ICU.

For two years I trained as a lay Zen Buddhist chaplain, thinking I might work in a hospital providing spiritual care to sick people and their families.  After ordination, I spent three months doing a unit of Clinical Pastoral Education (CPE) at a large urban teaching hospital.  I was assigned to the MICU – the Medical Intensive Care Unit, nicknamed The Stairway to Heaven.  This is where the very sickest patients came, quite often to die.  As most of the MICU patients were unconscious and on ventilators, tethered to a robotic existence in medicine’s last grasp on life, I worked with grieving, bereft, lost families.  It was brutal.

But Jim* was an aberration. Although weak and extremely ill from liver failure, he could talk – very softly and slowly – and understood his grim prognosis: without a transplant ASAP, there was no hope.  His longtime partner Linda*- a sturdy, faithful woman trying to navigate the complexity of this hospital course – had been by his side for decades, many of them involving alcoholism. They both very much wanted Jim to live, but with end stage liver disease, recent alcohol use and several co-occurring conditions, he wasn’t a viable candidate for transplant.  Like most humans, they held out and clung to hope, rooting for a miracle.  I’d lost count of the number of times families prayed for a miracle.

As Linda and I talked about her life with Jim, despair nipping at her heart, she told me they’d never gotten married.

“Never got around to it,” she smiled through tears, “Have a teenage son, a long life together but I was never a bride.”

My response was simple.  At the edge of death, you just ask people what they want, what they need.

“Do you want to be a bride?”

She stared at me, wide-eyed with simultaneous grief and joy.  From the bed, Jim gave a thumb’s up and a weak smile. There you go. It was on.

Jim was yellow with disease and time was short.  There was no waiting period in this state, no pre-marital blood tests or prerequisites; I just needed to marshal some forms and do whatever I could to make Linda a bride, to make her wedding day – in the ICU with a dying fiancé – as amazing as possible.  

“Do you have something clean to wear?” I asked smiling.  She hadn’t changed her rumpled shirt in days.

“Do I have time to go across the street to the motel and shower?”

“You bet. And maybe go find something white to wear if you want.”

Her heart lifted – I could feel it; the divine privilege of working on the ICU was seeing and feeling energy in a way you never could when just bustling around, in traffic, watching TV, yapping on the phone. No, the MICU was the razor’s edge where death and sadness hung around each corner like a thug, ready to rob you of your mother or son, or the man you’ve loved for decades. There was no time for hiding anything. Raw emotion was everywhere.

    

Linda jumped up and Jim turned his head to rest.

I went out to the nurses’ station to start corralling the paperwork. I looked over the hive of beautiful women and men in scrubs, working tirelessly to stave off infection, arrhythmias, clots, and as Shakespeare said, “the heartache and the thousand natural shocks that flesh is heir to.” In your wildest imagination, unless you work in this world, you cannot fathom what these souls see and endure in terms of suffering every single day. How do they do it? I took a deep breath:

“Hey people,” they looked up from their computers, surprised that the chaplain would be drawing their attention, “Linda and Jim want to get married.  We’re gonna throw a wedding. Right now.”

The nurses gasped - a wedding!  There was rarely a joyous occasion on the MICU – happiness was a stranger here, on this floor where people hung at death’s door while loved ones cried and struggled.  A wedding!  The nurses’ station started buzzing.

“I’ll get the flowers!” a nurse rushed away.

“And I’m gonna clean up the room,” said the sweet lady from Environmental Services, the quiet, unsung angels who hover in the background, cleaning up the detritus of the sick.

“How about music?”

“Balloons!”

Suddenly there was humming and laughing, a break of sunlight in the grim sameness of the unit. The staff was excited. There would be joy, soon, on The Stairway to Heaven.  A quiet, serious doctor tapped me on the arm.

“Hey, can I come to the wedding?” he asked hopefully.

I sniffed for a minute, every bit the regal wedding planner.

“Well, I’ll have to ask the bride,” I smiled, “But I’m guessing it’ll be okay.

With affidavits signed and a license in hand, balloons, cake, music and everything but ushers in tuxes, we gathered around the bed.  I had learned a bit about Linda and Jim, and met their 17-year-old son who had just arrived the day before.  It was a Thursday, and young Sean was planning to fly back home the next day for his senior prom.  When I’d asked Linda about the ceremony she got quiet, narrowed her eyes and said only this:

“Nothing about God.”

I assured her there would be no religion in her wedding. Lots of people were angry at God in the MICU.  I made no judgments, and hope you won’t either.

So, doctors, nurses, techs, housekeepers, and even a security guard formed a circle of love and protection around Jim, Linda and Sean.  The officiant of a wedding should never be the focus of it, and I only wanted to say a few things.  Time was short.

“We gather around Jim and Linda to celebrate the meaning of long love.  They have already lived their vows over the decades, especially now the ‘sickness and in health’ part of this commitment.  While most young couples get married and look ahead, Jim and Linda have years of memories already that they bring to this day, along with Sean.” 

He smiled shyly. 

“How many kids get to watch their parents get married one day, and go to their senior prom the next?”

We laughed quietly.  Someone had put on beautiful guitar music and for about ten minutes we were not struggling with suffering and sadness, the nurses weren’t toiling in and out of glass rooms with monitors and fluid bags. The doctors weren’t hunched over computers, or tied to a phone. We felt free, together, for a few minutes, swept away by love.

    

“By the power invested in me by the Medical ICU,” we laughed again, “I now pronounce you husband and wife!”

It was so sweet, the kiss, and the cake, the flowers and music, the tired clinicians smiling and hugging at the bedside, staving off for a minute the knowledge that Jim was going to die really soon.

I found Linda the next morning, sobbing at the bedside, bereft.  Jim was in a coma and would never come back. She wailed, screamed at me about how unfair it was and the very same room that held a minute of hope and joy one day became a cavern of pain the next. There was nothing to say, no comfort to give, nothing to do in the moment but be there, next to her. In my short stint in the MICU this is what I realized was the greatest and only thing anyone could do when someone’s beloved is dying: show up and be quiet, breathe and cry with them. Be present and just try to keep them from flying away in grief. Try to keep them tethered to life when they want to leave too, when they want to evaporate right there with their husband or mother, son or sister.

I left healthcare chaplaincy after three months.  There was just too much suffering and pain for my heart to hold it and I was suffering in my personal life at the same time. But I feel like my whole world expanded on the MICU, that entering a family’s pain was a sacred charge where we connected quick and deep, into the heart of each other.  Jim and Linda took us on the rollercoaster ride of joy and sorrow, up and down, ecstasy and despair all in 24 hours – married one day, gone the next. I’m so grateful for my time on the MICU because it was an accelerated class in the deepest secrets of life, a window into what it means to be family, love another person, and to be in the trenches with them, in sickness and in health.

*Not real names