Dying in Three Acts

Act I

Hemoglobin is a protein in red blood cells that carries oxygen to your body’s organs and tissues and transports carbon dioxide from your tissues and organs back to your lungs. Inhale and exhale. Low hemoglobin levels mean low red blood counts, and this means anemia. Really low levels mean death. As my hemoglobin levels fell, my red blood cells thinning out into a few (metaphorical) droplets, I descended from a state of depressive anxiety into the realms of delirium; I entered the heart of madness at the aperture of death. And, then, crossing the Rubicon, I entered that opening without conscious comprehension, yet my intuition, which I have (especially now) learnt to trust more, whispered, then shouted: call the ambulance.

Some bloody background: I have had a problem with hemorrhoids for about ten years. At the end of July and beginning of August they began to bleed more than usual. I chalked it up to stress; these bloated veins have a tendency to bleed more when I am under duress. Actualizing my Italian citizenship de jure (it’s already de facto) had started with my arrival from Warsaw, at the end of February, to Rome. Then on 11 March the nation went into a (sensible) COVID19 lock-down and I – along with Alex – remained inside in a Naples flat for months. I made it to Sicily on the 21 June, hoping to resolve matters quickly. The government reopening happened at a snail’s pace. So I waited. Wasting time. Or so I thought (what does this ‘wasting’ of time really mean? More on that later). My biological father, whom I had not seen in 30 years, was also on the island. We never met. He had kidney surgery, needed to spend time with “family family” (whatever that means), and said “you have everything you need.” It is true I have all the documentation in English and Italian I need, but his help would have proved invaluable. [He has since tried returned to his home in Mexico. Or so I thought.]

Stress, it must be stress – I said this to myself every time I found globs of blood in the toilet, or when I noticed blood streaming out of me like a crimson colored waterfall. Slowly, I found myself unable to do basic daily things. Must be my bad back – I do have back and neck problems from a severe car accident in early childhood. And my back and neck did hurt. I began to feel my pulse in my neck. On the back of my neck. Pump, pump, pump. Little did I realize that this was a death rattle. By the time I went to an orthopedic doctor I could barely get down the stairs to the street from my first floor apartment. I had not really moved from ‘inside’ for a month, and this apartment felt like death. I could feel the Grim Reaper’s violin and flute vibrating next to me as I spent two weeks on the couch. I hired someone to cook and clean, daily. Whilst this is a luxury, life is cheaper in Sicily, I have never had a personal assistant and I find the fact that I hired one a product of my growing hemoglobin and oxygen deprivation insanity.

During the first 20 days of August my mental state significantly deteriorated. The process sped up around the 14th or so. I could not leave my apartment. A physician in Rome suggested – via a horrid Zoom ‘consultation’- that I visit an orthopedic doctor. Doctors in Italy referred me to – and booked – a doctor who shouted at me and didn’t speak English (despite advertising that he did), a “doctor” who wanted me out of his office as though I were detritus. After his colleague translated some of my concerns – in a 2 minute ‘conversation’ – I was given a prescription for injections. And that was extent of my examination beyond the doctor’s shouting; oh yes, Dr Francesco Giacco also pushed on my stomach and slapped my back. I could barely stand. The staff placed me in a chair. The doctor’s staff literally held the debit/credit card machine in my face, greedily awaiting payment (€132), and then helped ‘shove’ me out to the street. I barely made it to the taxi. At the pharmacy, I fell twice. My vision going, I climbed the stairs, collapsed at the door (the taxi had run over my key) attempted to open the door, eventually succeeded, collapsed on the floor for a few minutes then staggered on to the (hard) sofa. I felt burning heat throughout my body, tingling, pain in my hips, legs and feet, and presence of a figure like Death from Ingmar Bergman’s The Seventh Seal (incidentally, the character who plays chess with death is named Antonius!). Everything in that Apartment of Death: designed to torture. Eventually I got up and examined the items from the pharmacy: I found syringes and several medications in vials. I learnt that I needed to hire a nurse to administer these. The initial injection was made by a friend, a Dutch physician, of my usual landlord. The second night by a nurse. By now I had been inside mainly for over two weeks. I could not go outside during the day; the light hurt my eyes. Early that morning, around 3am on Friday the 21st of August, I knew something needed to be done as I lay dying. As my body fell further into death’s grip, a part of my brain wouldn’t shut off; my intuition told me to call the ambulance.

The paramedics – both men – arrived and took the masculine approach. I needed to suck it up. No laying down. A chair in a bumpy and horrible ride to the hospital. By the time we arrived I felt myself dying. The doctors noticed this and rushed me to the inner parts of urgent care. My father, being Italian, spoke to the doctors, and this – along with my British marriage – cleared up the insurance issue. I was treated like a citizen. COVID19 tested. Negative. Rushed to a scan with some radioactive substance, so that my innards could be better seen. Hot sensations. Hands over head. Then back to the urgent care unit. I was treated with respect. The staff knew I had little time left before death. I needed immediate treatment. I needed blood. Some spoke to me in English to cheer me up. A man named Angelo (or Angel) helped expedite the process, noting that I had not been in the COVID19 infested USA. A very sensitive young doctor made me laugh. She joked that I was not dead yet, but if I was, the boss (head physician) was an Italian woman who didn’t speak English; I laughed and exclaimed that I knew God was an Italian woman! We went on like this awaiting my blood results. There is sometimes comedy in tragedy.

“Here’s your box of blood!” Angelo said as I was laying in a gurney being taken by ambulance to another unit. University Hospital Policlinico Paolo Giaccone is a massive complex, constituting its own neighborhood.

At the next building, I had a large, quiet – and as it was still quite dark outside – surprisingly calming Stygian private room. This is where a nurse spoke to me calmly in English. He explained every possible reaction to the blood transfusion. I signed a form giving my consent to receive a blood transfusion. The irony of growing up a Jehovah’s Witness only to become a gay vampire was not lost on me. My hemoglobin levels had fallen to 2.4. I was not told of this until later. I was an intensive care patient. I was not told of this until later. Although I suspected it. As a doctor later told me – where there is 2.4, there is no life. 13 is considered the minimum. As the first bag of life-saving O negative blood began to fill my body the sun began to rise. The nurse opened the window. I looked out at the thin, short leaves on the tree in front of my window, illuminated by the new day.

End of Act I

This short piece is dedicated to my anonymous blood donors, the nurses, doctors, surgeons and other staff at the University Hospital Policlinico Paolo Giaccone, and especially those in Internal Medicine and Emergency Surgery. They saved my life.

Consider a one-time $10 donation towards this and other writing: science fiction, novels, interviews with artists, poems and more. Thank you.

Death (Bengt Ekerot) in Ingmar Bergman’s The Seventh Seal (1957)

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