CHEECH
I’d been thinking about torture lately. Not in the conventional sense of fingernail pulling and waterboarding, but in the general sense of subjected prolonged agony. I’ve been wondering if it’s an inevitability that at a certain point in a person’s life he or she has to go through something so difficult that only others who have had the exact same experience can possibly understand it. Hardship being a condition of life, extreme hardship would, in fact, be an inevitability as time increases, due to the nature of probability. Yet I’ve been struck that so many people volunteer for such pain, or inflict it upon others for good or bad.
My grandfather is dying. At eighty-six his Alzheimer’s addled brain has reduced his quality of life to essentially nothing. Problems compound with old age. Recently his broken mind caused him to become confused; he started wandering about the pantry in his underwear, looking for his socks, when he took a nasty fall. In addition to releasing the contents of his bowels, the impact caused a spinal injury that prevented him from supporting his own weight. My father, a physician himself, and my grandmother took him to the hospital where he promptly forgot the incident and became agitated that he’d been wrongly interred in a beeping prison of scrub-wearing guards, stethoscope-wielding sadists, and overseen by a warden calling himself a neurosurgeon. Despite his pain, he assumed he’d be able to walk home if only he could win the fight with the sheets and the heart monitor and the IV. He had to be held down, and constantly reminded that he was unwell, as he was monitored, imaged, and tested for days on end. Then he was drugged and operated on. The doctor came out saying, “I’ve done what I can do. If he was fifty, I’d expect him to make a full recovery.” The implication being that he’s not fifty and thereby won’t.
Air-flighted from Florida to Cleveland, my grandfather showed no real signs of improvement. Unable to be away from a full-time staff of caretakers, he was moved to a rehabilitation clinic in a retirement community. They have a policy there that if you refuse treatment three times they kick you out. There are more potential patients in need of rehab in the area than there are beds and nurses willing to do the thankless work of geriatrics. I went to visit him. His face was sallow and colorless, his lips thin, and I don’t think he knew who I was. Still he wanted to escape, throwing the blankets off his body and revealing the diaper they had him wearing. His degraded condition caused a great deal of stress to my family. I knew immediately that he wasn’t going to recover, that time would catch up with him eventually, and though no one knew how long, it would probably be sooner rather than later. But emotion trumps logic much of the time, and so my aunt and my grandmother harbored delusions that he’d get better. Even if people could snap their fingers and make his spine problem go away, no one could return his mind to the state it was in thirty years ago. They feared he’d yell at people trying to teach him how to walk again and get evicted before he healed.
A moot point. The stress and drugs and other issues caused him to have a pulmonary embolism, and he was soon back in another ICU in another hospital. As my dad struggled to explain his degrading condition to the rest of the family, his blood pressure dropped. They had to put in a mainline, a large tube that feeds directly into your neck, allowing for better monitoring and easier administration of more aggressive medications. That was when the discussion of, as my dad said, “advanced directives” started to come up. The next step of his treatment could cost him his kidneys. Then he’d have to go on dialysis, and no one would dream of performing a kidney-transplant on even a healthy eighty-six year old, so it’d mean he’d be on dialysis for the rest of his life. There’s no end to the snowballing complications, I realized. It was my mother a non-doctor, domestic savant, accountant, and brilliant cook, who’s lost both her parents already, who came up with the new name for his condition: he has the dwindles.
My dad was faced with the challenge of getting my grandmother to understand the situation, and wanted to be able to explain to her why some treatments, some tests, would simply be too much. I said to him something I think about when I struggle to get my writing career off the ground: “We all have to decide how much torture to endure for the preservation of hope.” Dad seemed to find that a satisfying enough phrasing, and went forward with it in mind.
A few days later, I left for my yearly trip driving up and down the east coast. One of my friends is a medical resident. I have him lined up to be my go-to doc for when my dad retires. He’s enduring a torture of his own kind with thirty-hour shifts and endless arduous tasks related to patient care. Sadly we only see each other a couple times a year at best, but we talk on the phone constantly. He’s the kind of cerebral and serious man who somehow never loses his sense of humor or positivity. Our conversations are effortless, hilarious, and deep. When we talk it’s like we’re discussing aspects of the world in a way no one else ever has before, growing as men with each and every syllable - perhaps a delusion on both our parts, but it’s the existence of that feeling that matters. Always the attitude we share is that, if we can’t fix this world, at least together we can understand it.
This time I was seeing him only for a quick lunch before he went to bed at four o’clock in the afternoon, an unfortunate necessity of his recent nocturnality. As we strolled through a park near his house, my golden dog running and sniffing everything she could reach before I called her back, he casually told me of a heroin addict destined to die soon who had accidentally broken off a needle in a vein. Terrible prognoses are so common that the residents and attending physicians at the hospital are able to laugh about them. He has a joke about patients T to T ratios. If the T to T ratio is greater than one, that’s a very bad prognosis. T to T stands for tattoos to teeth.
So about this time I asked him what was really on my mind. “How do you know how much care to administer someone who maybe has not such a good medical destiny, who maybe doesn’t have much time left. Do you ever feel like you’re just torturing patients with the tests, drugs, and treatments? Seems like you do your rounds, read charts, titrate medications, and shake your head at bleak futures.”
He replied, “There was a woman in the hospital with an acute kidney injury. We did a whole bunch of testing - a lot of invasive and complicated procedures - and eventually realized that all she really needed was some fluids.”
“So a waste?”
“Oh yeah. A total waste. She got the Cheech.”
“Excuse me?”
“The Cheech. That’s a term we’ve been using for years for such incidents. I decided that I wanted to know where this term came from. I asked a few of the nurses, other residents, and some of the other attendings. They either admitted that they didn’t know or they said that Cheech is just code for ‘check every box,’ meaning make sure you try everything that it might be.”
“Wouldn’t that be Ceb?” I asked.
“Yeah, so I wasn’t satisfied with the derivation. I asked around some more until I eventually got to one of the oldest physician, some doctor who has been around for decades, a big-fucking-deal in critical care and the medical director of the MICU. And he told me this story:
** **
A long time ago, three young men crashed their plane in the middle of the ocean. They survived the wreck, but were left to drift on the waves, beneath the hot sun, with paltry rations. After days bobbing in violent seas, they drifted to a small remote island peaked with a smoking volcano. They stumbled up the beach, weak and dehydrated, and encountered primitive tribesmen, who quickly bound their hands and marched them into the jungle. Alive, but helpless, the three were forced at spearpoint into an entire village of loin-clothed people. In front of the largest hut, their captors shoved them to their knees to await the village leader, the volcano spewing fire high above them.
He came out wearing a giant headdress, silencing the rest of his tribe with a gesture. When he spokes he did so in perfect English. “Strangers, the gods demand a sacrifice. Someone must volunteer to jump into the volcano lest the mountain destroy our home with a blanket of steam and a river of lava. Whoever does so must go willingly. Therefore we offer you a choice: death or Cheech.” The leader pointed to the first of the men. “You sir, what is your choice?”
The nervous and starving man shook a little as he asked, “Well, what is Cheech?”
“No!” The leader replied. “You must choose now. Death or Cheech.”
The man quavered as he gave his answer, choosing Cheech of course, feeling that whatever it was, it would be preferable to jumping into an active volcano. As soon as he said the word, the villagers started to echo it with a deep chant. “Cheech. Cheech. Cheech. Cheech.”
At their call, a behemoth of a man came running out of a nearby hut, roaring. Half again as tall as a normal man and three times the weight in solid muscle, this of course, was the Cheech. Calmly and clearly, the village leader explained that the man had elected to fight the Cheech to the death. The man recognized the battle ahead to be a tough one, especially given his physical condition, but he was determined to give it a shot. They squared off against one another and it began.
The Cheech grabbed the man by the neck and kneed him so hard in the stomach that he vomited blood. Next he beat every inch of his body until his breathing became erratic. Then he chucked him to the dirt, stepped on top of him and pulled his arms clean out of their sockets. Just before he was going to bleed out, the Cheech bludgeoned him in the skull with something that may have been a rock and may have been a bone. He would never know.
As soon as the battle was over, the village elder turned to the slack-jawed second man and gave him the same choice. He thought long and hard but eventually decided that the first man had had a tiny chance at life and that that was better than no chance at all. Maybe he could beat the odds and succeed where others had failed. He’d already survived the terrible plane crash and subsequent weeks out on the open ocean. “I choose Cheech,” he said.
“Cheech. Cheech. Cheech. Cheech.”
The second fight was even worse. The Cheech started by breaking the man’s spine in six places. He plucked out an eye and ate it, then snapped off every finger. The man was in the middle of being sodomized by the Cheech when his throat was ripped out by the Cheech’s massive and mighty hands.
Thus the leader turned to the third and final survivor, standing outside the hut, surrounded by tribesmen and the now entrail-coated Cheech, quivering, crying, dehydrated, tired, and sunburnt. “Choose between death and Cheech,” came the instruction. This third man had family back home, a wife and kids and a job that he loved. His future had looked so bright before the plane went down and he’d been so happy. Despite all this, he decided it had been a good life and that he didn’t want it to end with such torture and indignity.
“I choose death!” he said loudly and proudly.
The tribe leader stood in the shadow of the volcano catching flakes of ash in his upturned palm as he said, “Ah, wise choice.” He rubbed his fingers together, coating the tips black. “But first, a little Cheech.”
** **
I laughed and shook my head at the legend. I’m so naive, I thought. We all must decide how much torture to endure for the preservation of hope. Sure. But first-
a little Cheech