The Sun Will Rise

My Daughter was afraid of the dark.  So she climbed in bed with my son and he read her a story.  As he closed the book, he realized that she had fallen asleep.  Like any sweet, kind older brother, he wandered off to her room and crawled into the unoccupied bed.

Chaos, of course, ensued at three in the morning when my daughter awoke in the wrong room, and grasped for her absent teddy bear and blanky.  It took Katie and I fifteen minutes to calm her down.  I barely closed my eyes before the alarm clock blared.

Four forty five on a Saturday morning. 

Thirty minutes later I was closing the door, and striding toward the garage.  Four admissions to three different nursing homes last night.  One of which was spiking a fever to 102.  Another patient tucked into the hospital yesterday afternoon.

The roads were less quiet than you would expect.  The sun had not yet risen, and most of the store fronts on Central Street were hidden in shadows.  I stopped for a red light at the same corner which I always seemed to time imperfectly.  To my left, a beacon of light emanated from the bakery.  Inside a middle aged man bustled to and fro directing four or five others. 

Every morning I marveled at the hurried flurry of activity.  The bakers and I, the only souls in the universe silly enough to be rushing around at such an hour.  The owner kneaded dough relentlessly while his workers lifted, carried, stacked, and arranged.  Although the light already turned green, I lingered a moment to watch before pressing down on the gas.

The patient at the nursing home had stabilized, her fever was gone.  On the way out, I grabbed a few pens and a reflex hammer for the kids.  They always enjoyed such little trinkets.  I stopped by the hospital and eventually landed in the office. 

Saturday morning clinic is refreshingly slow.

Sometime between patients, Katie called to tell me to meet her and the kids for lunch.  I finished my paperwork and shut down the computer.  The afternoon sun was a stark contrast to the somber morning haze.

Passing by the bakery on the way home was a different experience.  It failed to stand out under the glare of the sun.  The middle aged man was now helping customers.  The store was no longer clean and tidy.  The remnants of heavy foot traffic had brought in the dust and dirt.  The loaves of bread in the display counter were either absent or jarred to the extent that they no longer sat neatly in the case.

Time will pass, and the store owner will gray and his movements will slow.  Driving by from day to day, the changes will be so subtle that I'll probably not even notice. 

My children will grow up. 

In the brief moments alone before I park the car and jump out to meet my family, it hits me that this is a life. 

The sun will rise.
The bakers will bake.
And I will father.

And doctor.

In The Midst Of Tragedy

At first it's a little daunting.  A friend or colleague approaches you to take care of their parent. You pause for just a second before accepting.  Do you really want to get involved in this person's life?  But it is a compliment after all.  They are entrusting the well being of their loved one in your hands.

You tread lightly.  You spend extra time teasing out the symptoms.  You explain each diagnostic test and medication.  Days or years go by. Usually they get better, sometimes they don't.  But eventually tragedy ensues.

And you're calling your colleague or friend in the middle of the night.  You don't mince words, you tell them the end is near.  Physician to physician, friend to friend, there must be a level of truth and certainty. 

The appropriate orders are written.  Morphine and ativan.  Hopefully you can avoid the IV's and diagnostic tests.  While looking into the teary eyes of the family you again question whether you should have gotten involved.

The truth is, you will honor your friendship.  You will bath their relative in a cocoon of loving care.  Because you owe at least that much.  Because you will do it better than others.  Because you will be there to comfort and explain patiently in the midst of tragedy.

We do these things for acquaintances.

In fact, we do these things for complete strangers also.  Every patient eventually becomes like family.  We care for them as if their sons and daughters were our best friends.  We shower them with the best we have to offer because that is the covenant we make when we usher them through our exam room doors.

It's an intimate relationship between doctor and patient.

Even more intimate than with friends and colleagues.

Would You Do It All Again?

I suspect I would have changed anyway.  It's not just medicine, but life itself that distributes it's share of blows.  Battered and bruised, the body adapts. Unfortunately the mind also adjusts. The softer, more sensitive parts, are often the first victims.  We become hardened to the difficulties of reality.

There is no doubt that medical education is particularly aggressive.  The ego, like a scab picked over and over, maintains a solid exterior .  The skin becomes leathery and tough.  Our behavior subtlety changes.  A patient is quietly castigated or a child is allowed to whimper without the benefit of our empathic touch.  There is an attempt to assault the victim.  Instead of facing the difficulties and harsh realities of dumb luck, it's easier to cogitate blame. 

If they had just exercised more and eaten better!

There is an urge to cower and protect oneself.  In residency, many imagine that they are under siege.  They devise a plot where the world is out to get them.  The poor CHF'er in the emergency room on thanksgiving morning no longer becomes the wounded soul in need of healing, he becomes an agent of torture.

Those who read my writing will scoff.  They will say that I exaggerate, and point to the ideas expressed on this blog as proof. But I will counter.  Words on a page are much easier than real life. They are more safe and require less action.  I have known the coldness and bitterness that goes along with doctoring.  Accusations find their target on my chest from time to time.  And often they are deserved.

So it comes as little surprise that I paused when asked by the exuberant young college student if I would do it all again.  Her eyes scrunched together and her lips pursed in anticipation as she waited impatiently for my response.

Ultimately, the answer is yes.  But it's a calculated and often unsteady answer.  I would do it differently.

I would hold on to my idealism more tightly.

I would try not to protect myself so much.

Superman's Burden

I mean, your like superman.  You fly into the room with your white lab coat.  You might not bend steel, but you do something more important.  You save lives.  I wish I could do for a living what you do.

Superman. Hmm.  I guess it's been so long I forgot.  It use to feel like that!

Use to?  What happened?  Are you no longer a doctor?  You're a hero in my eyes.  There are so many people who wander around this planet aimlessly.  They bounce from job to job, firm to firm, and year after year they toil without making a shred of difference.  They touch not one life.  Their footprint is wiped away the minute they take the next step. 

It's funny how it stops feeling that way.  Sure, the first time you help someone, the first time you save a life there is a certain rush.  But you finish medical school and enter residency, and that rush disappears.  You may help hundreds, but it no longer feels special or different.  It just feels like your job.

Yet you become acutely aware of those times when you can't help, when your skills are not enough.  You suffer through every failure.  You remember every death until the day comes when there are so many that you can't possibly hold on any longer.  And then you forget.  The worst part is when a name disappears and all you have left is a face imprinted in the depths of your subconscious.

You don't blame yourself, do you?  You try your best.  What else can be expected of you?

The funny thing is that even superman doesn't feel like superman all the time.  I bet sometimes he wishes he were batman or wonder woman.  Sometimes he feels that there is a pile of kryptonite waiting around every corner.

And sometimes, he finds that helping an old lady cross the street is a heck of a lot more gratifying,

than the death defying acts of bravery that everybody expects of him.

Social Media's Fun House Mirror

I like to think that I would write like this anyway.  I like to think that the breath, depth, and quantity of my output would be the same regardless.  I always say that I do this for myself.  Of course, the occasional comment and retweet are gratifying.  Can you blame me for basking in the joy of being heard?   But there is a certain danger in notoriety.  When does hoopla replace the primacy of the writing process?

I have started and stopped a million times.  The record laid forward in my blog history is marked by periods of great productivity interspersed with vast deserts of low yielding crops.  The ebb and flow of my emotion crests and falls with motivation.  I write and write and write, then stop.  These dry periods can last days or years.  There's no way to tell.

Never in my life have I produced as consistently as in the last year.  Never have I blogged so much.  When I look back at the last three hundred posts, I feel great pride.  Some are better than others.  Some have barely been read.  But they all are an accurate reflection of who I have become (spelling errors and all).

I don't know how long this fruitful period will last.  Maybe I will push the publish button and disappear for a month, maybe not.  Your guess is as good as mine.

The one thing that is abundantly clear, is this period began when I linked my blog to Facebook and Twitter.  Is it a random coincidence?  Or has the process of social media altered me.

I look into social media's fun house mirror.

In the reflection, I see the writer I was so hoping to be.

But better.

Without Succor

If my car was ninety years old, I would have thrown it away a long time ago.

She speaks nonchalantly as she appraises the wrinkles that bunch together on the back of her hand and collect at the base of her knuckles.  The skin hangs from her once muscular biceps.  She is neither bitter nor sad.  Acceptance oozes from her brow like the drops of sweat that collected during her labored walk into the office.  She is tired.

We talk of her shortness of breath.  Even as I offer a plethora of tests to draw back nature's curtain,  she shakes her head quietly.  For her, the betrayal of the body is simply the unassailable progression of tempermant.  She would no more try to fight it, than attempt to manually disassemble the second hand of a clock. 

Time passes regardless of whether it is measured. 

She will slip away delicately.  Inch by inch, pound by pound she will succumb without succor.  There will be no protestations, and no proclamations.  One day the phone will ring and I will be informed that she is gone.  Likely, found cold in her bed by a neighbor who noticed the mail piling unnaturally at the front door.

And as she hobbles out of the office, I can't help but think there is some important lesson to be learned.  Why do some die angry, regretful deaths while others pass gently without fanfare? 

It is said that we die as we live.

And we live as we die.

Room 2413

I could've sworn the hospital operator said room 2413. But as I wandered the halls, a perplexing look came over my face.  I searched above each door: 2411..2412...2414.  I stopped a smartly dressed nurse rushing past with a cup full of pills.

Where's 2413?

She laughed, and called over her shoulder as an after thought.

There's no 2413, 3413, or 4413 for that matter!

I started to protest, but it was too late.  She was long gone.  And the truth was, I didn't need an explanation.  How many buildings skipped from the twelfth to the fourteenth floor?  How many room numbers had been intentionally changed?

It was a myth.  Superstition and folklore permeated even the most holy of scientific grails, the hospital.  As an institution we failed the most basic test of identity.  And I started to wonder what other myths pervade our culture.

This won't hurt a bit!

How often do we knowingly mislead or water down the truth? Furthermore, how do we justify this charade in light of the dictum "to do no harm"? 

Sadly, I think the answer reveals the worst kind of ugliness.  We would rather defer to ease, than accurately interpret the reflection in the mirror.

Don't worry, we'll do everything!

Because the truth is much more difficult.  Patients die regardless of the room number.  The procedures we perform are often hurtful. 

And "doing everything" can be more than just dangerous.

It can be cruel.