Who By Fire And Who By Water?

Who will live and who will die?

Who in their time, and who not their time?

Who by fire and who by water?

Who by sword and who by beast?

Who by hunger and who by thirst?

Who by earthquake and who by drowning?

Who by strangling and who by stoning?

Who will rest and who will wander?

Who will be safe and who will be torn?

Who will be calm and who will be tormented?

Who will become poor and who will get rich?

Who will be made humble and who will be raised up?

It is a prayer speaks of the the fragility of life, tradition, ritual and repentance. It is the instructions implicating our destiny, it marks the direction of our future and the cusp of our fate; into the book of life, or death.

Humans can only dictate the pace, and influence the flavor of a final destiny. Spending more time in synagogue this month than I spend in a whole year, the lyrics of the prayers and the meaning of their messages follow me to the bedside. Only hours after speaking this prayer, and sealing my own unknown fate with the Yom Kippur prayers,  I am at the mercy of another’s fate. My profession encompasses the promotion of life, yet often involves chasing the serenity of death. This comes not from a nurse who has been, chilled and frozen to the sadness and emotions of an ending life. It stems from the practicality of the reality, and recognizing the boundaries of my role in such a setting. It is a higher power that determines the fate of my patients; but it is the caregiver at the bedside that can influence the flavor of that fate.

It was only hours after I said the prayer that spoke my own possible destiny; It was the first hour of my shift, and I go in to greet her. She is up in a chair, eating to live,  yet each bite threatens her grasp for a breath, seemingly beyond her reach. I run for medicine to open her lungs, but it will also accelerate her already speeding heart. So now I must weigh the options, what will be comforting or what will delay an already decided fate. I quench her thirsty lungs, with Morphine. She rests, but still with grunting lungs, dissatisfied with the minute tease of ventilation. We call her family, we think her fate has been decided, we think her destiny will meet her soon. She awakens again, her lungs are parched, I quench it with some additional Morphine. And then some more. I moisturize and rub her fragile, paper thin, skin. I attempt to redirect her pain pathways with my touch. As the day progresses, so does the battle between comforting and accelerating her destiny. Who should win?  She grasps my hand, and calls my name. She begs me to let her go, she wants me to help her end the fight. That choice isn't mine. Soon her lungs begin to surrender. We call the team, we call her family close. I feel her pulse and watch her chest rise and fall as it travels on that bumpy, almost lifeless road. I recognize the deadly cheyne-stoke breaths, her pulse weakens and her fingers go cold. Her destiny has caught up with her, her battle is complete.

Man does not decide who will live and who will die; but man can influence how painful the process. We can ease the pain with medications, words, or our caring touch.  

It's is not man who decides who by fire and who by water, but man can determine the type. We can make it a fire of warmth and we can sweeten the water and keep the being afloat with hope until their journey reaches its endpoint.

We can use the swords to advocate and protect our patients like a beast protecting its own from a ravenous prey, when one is alone or unable to advocate for oneself. 

We can satiate the being with hope and we can quench their thirst with the honest knowledge of what their fate may be. 

As the earthquake shatters and drowns all their aspirations with a terminal diagnosis, we touch them and hold them together. We keep them afloat with optimism despite the prognosis that destructs their dreams with an uncertain future.  

We can soften the news that strangles the ties holding onto their faith, and we can buffer the stones shattering whatever remaining desire to keep going with our straightforward, yet gentle honesty.  

We can readjust, massage and make those beings as comfortable as possible, so that they can rest and their soul can peacefully wander about at the brink of life. 

We will hug them so they feel safe, and so their illness does not tear the remnants of their barely beating heart. We will calm them when the fears of the next minute torments their current one. 

We keep their minds rich with dreams and fantasies to mask the darkness and dread that paints their reality. 

We become humbled by their strength, their attitude and their stubbornness, as they hold on to that delicate thing called 'life', as it dangles on fragile, thin threads. Their lingering effects raise us up after they fall; but not before we mourn. Even after they are gone, they help us manipulate the destiny of the next human being cuddled under the sheets, battling yet another mortal fate. 

So who by fire and who by water? Who by cancer and who by heart attack...? A higher power determines that fate and the time it will meet a being, but man may help influence how that meeting unfolds.  With our stethoscopes, we can differentiate a beating heart from a stationary one; but also a beating heart that needs another beating heart to advocate the destiny of its next beat.