Talking Death and Existential Anxiety with an ICU Nurse

My friend Ernesto Barbieri turned out better than I thought he would. Ernesto is the friend who, growing up, got me into shitty over-the-counter truck-driver speed from 7-Eleven (the kind that's no longer legal). He's the friend I hooked up with in his parents' bed when we were both unsure as to whether he still had a girlfriend. Then one day the girlfriend just reappeared, and I was like "uh, OK." Mostly, Ernesto is the friend I drove everywhere, because he was an entitled little shit who didn't think he needed a driver's license. But for some reason I enjoyed driving him.

Then one day, Ernesto told me he was in nursing school. I was like, "How is this self-centered, cynical writer bro going to be a nurse?" But he did become a nurse, an ICU nurse who deals with dying people all the time, and he's been doing it for three and a half years. This is something that I, with my death anxiety, could never do. Or could I?

I asked my friend Ernesto some questions about existential anxiety, fear of death, and how surrounding oneself with the dying can affect one's brain.

VICE: What's your official job title?
Ernesto Barbieri: I'm an ICU nurse. I work mainly in cardiovascular intensive care, but sometimes I float to the medical ICU or to Trauma/Burn.

I would say ninety percent of our patients have entered the dying process. Often the decision is made to discontinue care, which means I become a kind of de facto hospice nurse, making the patient comfortable in his final moments. But we also see our share of acute events—sudden cardiac arrests, patients bleeding out after surgery, or going into weird arrhythmias. When this happens, all hell breaks loose—you're running around for the next ten hours hanging blood products and helping to put in breathing tubes and central lines.

What drew you to this particular type of nursing?
Ernesto Barbieri: A desire to understand death and the dying process. Really, I got into nursing for selfish reasons. I wanted to be spiritually useful. I needed to challenge myself in a way that went beyond sitting alone in a room and churning out little ghost stories.

After working this job, would you say you think about death more, less, or about the same amount?
Ernesto Barbieri: Definitely more. You can't see death every day and not have it bust a leak in your head somewhere.

It's weird because on the one hand, you become inured to it. Death is just another pain in the ass thing you deal with at work. You bury it in your brain—but then it pops up at random in your daily life. I'll drop my cellphone and be like, Oh shit, I have multiple sclerosis, or ALS. Last night, I was writing a blog post, and for thirty solid seconds, I could not think of the name of the guy who wrote Fear and Loathing in Las Vegas. He's one of my favorite writers, and I just could not produce his name. And I thought, That's it, early-onset Alzheimer's, you're fucked. Better write a will. Pretty soon you'll be pissing and shitting yourself.

Hunter S. Thompson is one of your favorite writers? That's, like, so Bukowski. Anyway, so it seems like you are still scared of death. Has your relationship with this fear changed at all since you started working this job?
Ernesto Barbieri: I'm terrified of death. This idea that one day it all just STOPS, and everything you felt and believed and experienced is rendered irrelevant. Such an absurdity. And the greatest absurdity of all is that everyone who has ever lived has gone through it. This should give us some comfort, but it doesn't.

I know. It's so weird that we all are gonna do it. I think I'm more scared of dying than death itself. Do patients talk to you about their lives? Do they ever talk about regrets or things they wished for?
Ernesto Barbieri: They talk to me about their pets. They're worried about who will take care of their pets. How sad is that?

That's fucking sad as fuck. What are some of the hardest things about your job?
Ernesto Barbieri: Just the physicality of it. All the little ways I fail my patients because my body is breaking down. The first time I worked a twelve-hour shift, on my feet the whole time, and I realized I wasn't going to get a lunch break… I was like ready to cry. I was like, I'm a human being, I have needs! Also the mental fatigue. A few weeks ago, I walked onto my unit with my coffee, and there were a bunch of nurses in a room doing CPR—it was going to be my patient—and I just kept my head down and walked right past the room, into the locker room. I was like, I'm not clocked in yet, I'm not dealing with this shit. How terrible is that? A person is dying, and you're just like, This is another pain in the ass thing I'm going to have to deal with today. But you learn to forgive yourself for those thoughts.

Yeah, I guess you have to compartmentalize. Like, the fact that you go on a lunch break is even weird. How do you pick a sandwich when someone has just died in front of you? How do you swallow it? At the same time, though, I get the compartmentalization. Sometimes I feel the most chill when extreme chaos is going on around me, because I feel like the world has risen to meet the level of panic I always feel. So now I'm just normal. What are some of the best things about your job?
Ernesto Barbieri: Being able to comfort a grieving family member, or helping to walk people through the dying process. Or even just making it so patients aren't scared—letting them know you're right outside, and they're not alone. The first time a family member told me I made a difference, or a patient hugged me after a long shift, it was actually shocking. These people leaning on me for support, as if I'm a person of substance.

I'm proud of you. You seem nicer and more grounded—like a fucking adult—since you started this job. Really, since you've been in nursing school. Do you think your job has changed your worldview or the way you live your life?
Ernesto Barbieri: I used to be consumed by what my therapist calls "arbitrary imperatives." I'd be standing in a long line at the grocery store, and I'd be like, This is ridiculous. Why is the world not bending to my writing itinerary? Does the universe not know I have a pretend novel to write? Now I'm more like, You are in a position to buy food and have food, and that is a goddamn miracle. Don't push your luck, don't piss off the universe.

I really do believe the universe gets personally offended when we fixate on silly crap like book deals and glamour and money and youth, how much money is in our bank accounts, the kind of car we're driving at the moment. The universe is like, "There are plants growing out of the ground that you can EAT. There is air in your lungs, your blood is pumping, the Grand Canyon exists, and you want to waste your time fantasizing about some dumbass, theoretical book contract? Fuck you, you're not getting that."

I don't know that much about the universe, other than that I feel like I'm being judged by it as a piece of shit all the time. But I totally sense that shift in your relationship to arbitrary imperatives! Your therapist did a really good job. Is there a way you might want to die instead? Do you want to have control over your death in a euthanasia-type way?
Ernesto Barbieri: I think I would want painkillers—lots of painkillers. I'd spend time with family and friends, make sure they know what they've meant to me, that I felt their love. Under no circumstances would I want a funeral. Honestly—and this is going to sound so messed up—I would probably find some little shack on a beach, wash some pills down with vodka, sit in my car with Buckethead playing and the engine running, and fall asleep while breathing in carbon monoxide. That is my preferred method of expiration.

Would you describe yourself as an anxious or depressed human being? Has this changed in any way since you started your job?
Ernesto Barbieri: Depressed, I don't know. Most people would probably say I'm a pessimist. A lot of times, I come off that way, which is unfortunate. But I consider myself an optimist.

As you know, I started having panic attacks in nursing school, and it almost ruined my life. I was sitting in chemistry class, and suddenly I felt really BIG, like a giant, like I was too big for my chair, too big for the room. I ran out of class like a fucking weirdo. I went into the bathroom, splashed some water on my face and was like, Whoa, that was weird, but I'm OK now. Then I went back into class, and BOOM, I was a giant again, this lumbering, mutant giant. I left all my shit in class, got in my car, and drove off.

And then, of course, once you have that first panic attack, it's all over, because now you're afraid of the NEXT panic attack. Every situation, no matter how trifling, is an opportunity to embarrass yourself in public. It's such an incredibly vicious cycle, your mind just starts to cannibalize itself. For a long time, I genuinely believed I would never be cured of this problem, that I was impossible to fix. Panic attacks have robbed me of so much.

And yet, I've never once had a panic attack in the ICU. It's the only place I'm not susceptible to a panic attack, and it's literally the most stressful environment imaginable! It's a hornet's nest of anxiety. In that sense, nursing has given me a kind of serenity. When I feel myself getting anxious, I'm like, If you can bring a flatlining patient back from the dead, you can certainly handle riding a bus.

Still, I look at what you do, with your poetry readings, and I'm like, How the fuck is she not running off the stage? How are you not seized with the sudden urge to "escape"? But I think your poetry is like your ICU. I'm sure it causes you stress, but it's what you do. It's how you're spiritually useful. And I think your poetry really does help people—particularly your So Sad Today stuff. But then you'll be driving in your car, listening to the Smiths or whatever, a perfectly nice day, and you'll have a panic attack because you don't know what song to play next. How fucked up is that?

Yes! Not having a panic attack in the ICU is totally what I mean, like when there is chaos you sort of feel more comfortable, because the outside world matches your insides. Have your views of other human beings changed in any way since you started your job?
Ernesto Barbieri: I think my opinion of people has generally changed for the better. There's this really timeworn nursing platitude that goes: "You see people at their absolute best, and their absolute worst." And I would agree with that.

But then, when you see them at their worst… it can be brutal. You'd be surprised how many family members are willing to let their loved ones languish in horrible agony, simply because they're not prepared to have a funeral. Doctors who just keep treating and treating a terminal illness, long past the point when doing so is reasonable or humane. We are so afraid of death. All of us.

You know, my ex-girlfriend died this Christmas. She was an addict. Before I was an RN, I was her own personal detox nurse. I can't tell you how many times she went through withdrawals on my couch. I spoon fed her. I bathed her. I cleaned up her vomit. We finally broke up when I found out she was using my nursing school needles to shoot up with. I'd find them on my windowsill, caked in dried blood and drug residue.

Eventually she was able to string together something like a year and a half of sobriety—that was its own miracle—before she relapsed in a gas station bathroom. And she lost everything. She took a risk, got high one more time on some bad dope, and lost everything. I kept imagining what her cadaver must have looked like—I've seen hundreds of cadavers—and it haunted me for weeks. For a while, I didn't want to eat because she couldn't eat; I couldn't listen to music because she couldn't listen to music. I went through the same shit everyone else goes through: denial, anger, bargaining, etc. Right in sequence.

What I'm saying is, no amount of exposure to death can prepare you to absorb the shock of it. We see these family members and we're like, Why can't they let go? But then someone close to us is dying, and we do the exact same thing.

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