Wednesday, November 2, 2011

Chapter 1, Part 1

Note: Yes, I am trying NaNoWriMo yet again, and will likely fail yet again. But I am taking a cue from my smoking patients; you probably won't succeed the first time you try to quit, but just keep going and eventually you'll get there and celebrate the ability to breathe freely!  Have low expectations... going for volume, not quality... and I won't be able to post everything here, just excerpts for now.



Chapter 1
     The two neighborhood boys had pointed in that direction, so my father switched on the comically large flashlight, stepped off the path, and set off into the woods.  It had only turned dark a few hours before, but the trees already looked stark and intimidating, their bare bark drawing sharp vertical lines of contrast against the blackness of the ravine.  I tensed a few muscles in my throat, which was unusually dry, and followed with my mother close behind.  I can't remember which of us had the shovel, but I think the newly unpackaged garbage bag belonged to me, its black plastic beginning to unfurl from the rubbing of my thumb and forefinger.  It felt criminal, the three of us marching into the empty forest, the crunch of dead leaves giving away our progress to no one in particular.  I imagined a flood of light and sirens and noise filling the night, a glaring beam of attention arresting a small Asian family mid-step, their mouths frozen open in shock, their terrified minds racing to articulate a reasonable explanation as to what they were doing with grave digging implements in the middle of the local park at night.  I laughed out loud. 
     My mother gave me a stern look.  Her face was obscured and shadowed in the night, but the thinness of her lips and the hardness in her eyes communicated enough.  We hesitantly picked our way over dry branches and rotting trees, our eyes scanning the textured and confusing landscape for clues and signs.  In retrospect, the whole situation seemed absurd.  I was straining my senses to look for something black at night, for something we could identify easily, inconspicuously, and perhaps less hazardously in the daytime.  But there are certain people at certain times who can occupy that space of sorrow and desperation.  They can understand why waiting would be the insensible thing to do, why traipsing off into the dark suburban, autumnal wilderness could be the only logical and unquestionably right course of action.
     The three of us carefully crawled down into the creek bed, taking care not to slip on the smooth and loose rocks.  I hadn't done this in years, since I was a child running through the more tame areas of the same neighborhood park.  My mother forbade me from playing in the creek because it wasn't safe or supervised, and the memory of that made our whispered questions and commands all the more surreal.
     My father's flashlight swept back and forth, scanning the ground, leading us on.  "Is that it?" we would occasionally ask, stopping to poke at soggy messes of leaves with branches and our shoes.  When we decided "it" was nothing important, I would breathe a mixed sigh of relief and disappointment and move on.
     Something caught my eye, and I knew immediately that we had found it.  "There.  Give me the flashlight," I said.
     "No, that can't be it," my dad declared.
     "Yeah, it is."  I swapped the light for a shovel and began clearing away the surrounding leaves.
     "No, it isn't.  That's just a branch, Dave," my dad insisted.
     "Dad, I know what bone looks like.  This is it.  See?  It's a rib."  I was frustrated and proud at the same time.  Frustrated because of my father's tone of dismissiveness, and proud because I knew I was right.  I had done it.  I had found Ruthie, my sister's beloved and missing dog, the dog she still didn't know had died.  I had identified the long rotted remains, and only because I knew what a ribcage looked like, having sawed one open on a human cadaver the week before.
     That was the first real life application I had of anything I learned in medical school.  That was the first time I knew things had changed permanently, if only subtly.

Sunday, October 30, 2011

Inward, Outward

I've done the Myers-Briggs personality test many times before this year but always found myself puzzled by the results.  This year, I was "forced" to take it twice as part of intern orientation and was surprised at the results.  I am technically an "INTP" for anyone familiar with the classification system, which in a nutshell indicates:


INTPs are pensive, analytical folks. They may venture so deeply into thought as to seem detached, and often actually are oblivious to the world around them.
Precise about their descriptions, INTPs will often correct others (or be sorely tempted to) if the shade of meaning is a bit off. While annoying to the less concise, this fine discrimination ability gives INTPs so inclined a natural advantage as, for example, grammarians and linguists.
INTPs are relatively easy-going and amenable to almost anything until their principles are violated, about which they may become outspoken and inflexible. They prefer to return, however, to a reserved albeit benign ambiance, not wishing to make spectacles of themselves.

http://typelogic.com/intp.html

This seemed accurate, and as I've been mulling these classifications over in the past month or so, I think I've come to learn more about myself.

For one, I appear to be "driven by internal stimuli".  As sketchy as the wording may sound, it is true.  I chew things over, processing them slowly, often taking time to form an opinion that I then hold very strongly to.  I am introspective (no surprise there to those who read my blogs), sometimes to the point of paralysis and mutism.  One of my favorite quotes as a young teenager was, "A belief is something you hold; a conviction is something that holds you," and ever since reading it I tried to live according to conviction.  Sometimes this makes me appear stubborn or inflexible, but what I am learning is that the best way to change my mind is to convince me that "it is the right thing to do."  There.  I just gave away my secret to beating me in an argument.

For another, I am driven by a "sense of possibilities".  A side effect of this is that I procrastinate, which should come as no surprise to those who know me well.  But what that really means is that I think in terms of what could be, in terms of abstract potential.  A visionary or dreamer, I suppose.  Some may laugh a little, for I have developed a reputation for being cynical and dark.  But as I am also fond of saying, "Cynics are the only true idealists, because they are the only ones who have an ideal that the real world falls short of."  I like to think of what I could do, the things I could learn, the kind of person I could be, rather than what I am doing now.  Perhaps that is why I prefer to shop by impulse rather than planning, or why I love to start projects but have difficulty completing them.

Why am I rambling about this?  Because it helps explain to me why I do what I do, so that when I am faced with hard decisions and difficult times, I will remember what are the important things that drive me.  I will remember to "see myself" in the Pauline words of Scripture, looking both inward and outward, to the present and the future:

I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death, and so, somehow, to attain to the resurrection from the dead. - Philippians 3

Monday, October 24, 2011

Idols

In the small church with its old and worn pews, the pastor spoke about idolatry.  He spoke about Hosea, a prophet whose life would become a parable and spectacle to describe that hussy of a nation, Israel.  Hosea, who had to go and buy his own prostituted wife back from the slave market.  Hosea, who had to name his children, "Not Loved", and "Not My People" as an illustration of all that was wretched and wrong with the  Chosen People.  Hosea, whose mouth could only beg his people:
 1 “Come, let us return to the LORD. He has torn us to pieces    but he will heal us; he has injured us    but he will bind up our wounds. 2 After two days he will revive us;    on the third day he will restore us,    that we may live in his presence. 3 Let us acknowledge the LORD;    let us press on to acknowledge him. As surely as the sun rises,    he will appear; he will come to us like the winter rains,    like the spring rains that water the earth.”
There are times when I question why God does what He does... why He allows the wicked to prosper while the righteous faint, why He chooses such difficult and anguished paths for those He loves, why He injures those for whom His affection seems strongest.  And the answer, as the pastor described, is so that we might have the false dependencies we have built on lesser gods, those pandering, self-serving, indulgent fantasies, ripped from our hands so that we can embrace the living God.



I will remove the names of the Baals from her lips;
   no longer will their names be invoked.
18 In that day I will make a covenant for them
   with the beasts of the field, the birds in the sky
   and the creatures that move along the ground.
Bow and sword and battle
   I will abolish from the land,
   so that all may lie down in safety.
19 I will betroth you to me forever;
   I will betroth you in[e] righteousness and justice,
   in[f] love and compassion.
20 I will betroth you in[g] faithfulness,
   and you will acknowledge the LORD.
 21 “In that day I will respond,”
   declares the LORD—
“I will respond to the skies,
   and they will respond to the earth;
22 and the earth will respond to the grain,
   the new wine and the olive oil,
   and they will respond to Jezreel.[h]
23 I will plant her for myself in the land;
   I will show my love to the one I called ‘Not my loved one.[i]
I will say to those called ‘Not my people,[j]’ ‘You are my people’;
   and they will say, ‘You are my God.’”

Monday, October 17, 2011

Tired

Some days I just get really tired.  I get tired of trying to puzzle things out in my mind, in trying to figure out what is the right thing to do when all my options seem gray.  I get tired of finding the best thing and am tempted to simply settle for good enough.  I get tired of doing what I thought was right, only to find myself doing more work or causing more pain or struggling with more things.

In the context of work, sometimes I wonder if I am doing too much or caring too much... bearing too much of the weight of the world on my shoulders.  In the context of my personal life, sometimes I wonder if I am being too complex, too self-conscious, too conscientious and if I should simply do what my gut instinct tells me to, consequences be damned.

I get tired and I wonder if I will ever be able to "make it" and achieve that wondrous plateau where all things are finally well and at peace.

Then I remember that doing the right thing was never promised to be easy, that the road to righteousness is narrow, and that we are called to carry a cross and not a feather duster.  I remember that we have a Savior, that we have a Protector, and that his name is Wonderful.  O Savior!  Carry me but a little further for a little longer.


Psalm 121

A song of ascents. 1 I lift up my eyes to the mountains—
   where does my help come from?
2 My help comes from the LORD,
   the Maker of heaven and earth.
 3 He will not let your foot slip—
   he who watches over you will not slumber;
4 indeed, he who watches over Israel
   will neither slumber nor sleep.
 5 The LORD watches over you—
   the LORD is your shade at your right hand;
6 the sun will not harm you by day,
   nor the moon by night.
 7 The LORD will keep you from all harm—
   he will watch over your life;
8 the LORD will watch over your coming and going
   both now and forevermore.

Saturday, October 15, 2011

Learn their lessons

Elisabeth Elliot, in her book Passion and Purity, wrote:
     I write in the hope that those who know what honor means will be cheered to see that they are not entirely alone.  It may strengthen them to find that, even in recent decades, there are those who recognize something far greater than their own passions, even though for the world at large there seems to be nothing else of any consequence...
     The greater the potential for good, the greater the potential for evil.  That is what Jim and I found in the force of the love we bore for each other.  A good and perfect gift, these natural desires.  But so much the more necessary that they be restrained, controlled, corrected, even crucified, that they might be reborn in power and purity for God.
     I don't think we ever talked about honor as a concept.  Jim honored me as a woman; I honored him as a man.  We saw the difference, all right.  How sharply we saw and felt and were awed by the difference between a man and a woman.  A system of fixed values and relations held us apart, each holding the other in reverence for the Owner.  His we were, all the rights were His, all the prerogatives to give or to withhold according to the pattern of His will, which remained as yet a mystery to us.  Few, I suppose, even of those who hold the same system of values, need to go through so prolonged and so exquisitely cautious a process.  Perhaps most learn their lessons with greater facility than we did.  I don't know.  For us, this was the way we had to walk, and we walked it, Jim seeing it his duty to protect me, I seeing it mine to wait quietly, not to attempt to woo or entice.
Perhaps the most difficult thing in the world is to realize that you must come to your own conclusions and convictions about things.  You can poll all the people you want, debate over endless cups of coffee, and mull things over in your mind ad nauseum, but at the end of the day the decision must be yours with no apologies or reservations or excuses.  Your convictions must be able to stand on their own and you must be able to take responsibility for them.

How gracious it is that we do not do this alone, that our teacher is none other than Jesus Christ, who, for the joy set before him, endured the cross, scorning its shame, and is now seated at the right hand of the throne of God.  Thank goodness He guards our hearts and our lives even to the very end of the age.

Tuesday, October 11, 2011

Liberty

It's strange that often the only way in which we find true liberty is through restraint.  I suppose this is what it means to seek first the kingdom of God and His righteousness before "all these things" are added to us, or to lose your life to save it, or any of the other commands in Scripture.


Think about the Old Testament prophets.  Poor Ezekiel; God's command to him was:
Then lie on your left side, and place the punishment of the house of Israel upon it. For the number of the days that you lie on it, you shall bear their punishment. For I assign to you a number of days, 390 days, equal to the number of the years of their punishment. So long shall you bear the punishment of the house of Israel. And when you have completed these, you shall lie down a second time, but on your right side, and bear the punishment of the house of Judah. Forty days I assign you, a day for each year.  And you shall set your face toward the siege of Jerusalem, with your arm bared, and you shall prophesy against the city. And behold, I will place cords upon you, so that you cannot turn from one side to the other, till you have completed the days of your siege. - Ezekiel 4:4-8
Or Abraham, called out of his father's home into the fierce wilderness by the voice of a God he barely knew.  Or Joseph, enslaved for years before any vision of hope and justice appeared.   Or Daniel and his three friends, sacrificed for their faith.

And what more shall I say? For time would fail me to tell of Gideon, Barak, Samson, Jephthah, of David and Samuel and the prophets— who through faith conquered kingdoms, enforced justice, obtained promises, stopped the mouths of lions, quenched the power of fire, escaped the edge of the sword, were made strong out of weakness, became mighty in war, put foreign armies to flight. Women received back their dead by resurrection. Some were tortured, refusing to accept release, so that they might rise again to a better life. Others suffered mocking and flogging, and even chains and imprisonment. They were stoned, they were sawn in two, they were killed with the sword. They went about in skins of sheep and goats, destitute, afflicted, mistreated— of whom the world was not worthy— wandering about in deserts and mountains, and in dens and caves of the earth.
And all these, though commended through their faith, did not receive what was promised, since God had provided something better for us, that apart from us they should not be made perfect. - Hebrews 11:32-40
That last line is what really gets me: "And all these, though commended through their faith, did not receive what was promised..."  Is it possible to see with a vision that extends beyond the span of your own life?  To strive for something beyond what appeals to our senses?

I was talking to a philosopher-friend and he was trying to teach me about various forms of and epistemology, or the ways and validity of things we think are true.  Some of the theories seemed rather wild and absurd: metaphors for shadows in caves, how our reality might only exist if someone else perceives it (like the reverse of the "if a tree falls in the woods" question), and so on and so forth.  They sounded silly... and then I wondered how my faith and the things I do for it might sound at times.

But then I thought about Jesus, the author and perfector of faith.  And I realized (again) that the one who truly demonstrated self-restraint, self-sacrifice, and self-emptying was God Himself.  Jesus, who being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking on the very nature of a servant...

And so that is what I want to be.  A servant.  I am not a very good one, imperfect in far too many ways, but at least I know that my ruling authority, my Lord, is just, good, and God.

Saturday, October 8, 2011

Born Again

Jesus answered, "Truly, truly, I say to you, unless one is born of water and the Spirit, he cannot enter the kingdom of God. That which is born of the flesh is flesh, and that which is born of the Spirit is spirit. Do not marvel that I said to you, 'You must be born again.' The wind blows where it wishes, and you hear its sound, but you do not know where it comes from or where it goes. So it is with everyone who is born of the Spirit." - John 3:5-8

It is easily forgotten that these words are the precursors for understanding the most powerful and well known words of Christ: "For God so loved the world..."  Why?  What is the significance of such a cryptic preamble?

Its significance again finds itself in the hidden: that the truth of God, no matter how plainly stated, can only be truly understood by those rejuvenated and reborn and recast in the spirit.  This is why the world, in all of tis carnal and utilitarian and indulgent, hedonistic forms will never understand the glory and devastating attraction of God.  It is born of a different nature and into an altogether foreign tongue.  Its biology is incompatible, its logic folly, and wisdom foolishness.

This is why redemption demands rebirth and re-creation: to start from a nascent germinal concept - the glory and sovereignty and humility and love of God - and arrive at the most profound of all mysteries:


For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life. For God did not send his Son into the world to condemn the world, but in order that the world might be saved through him. Whoever believes in him is not condemned, but whoever does not believe is condemned already, because he has not believed in the name of the only Son of God. And this is the judgment: the light has come into the world, and people loved the darkness rather than the light because their works were evil. For everyone who does wicked things hates the light and does not come to the light, lest his works should be exposed. But whoever does what is true comes to the light, so that it may be clearly seen that his works have been carried out in God. - John 3:16-21

Friday, July 15, 2011

Rituals of annotation

I am not exactly sure of what prompted me to do it, but I began keeping a tally of all the pronouncements I have done.  I never really knew this before, but pronouncements are done in a remarkably simple and impersonal way.  Most patients who die in the hospital do not go with a bang but with a whimper.  While some situations involve spectacular theatrics involving beeping monitors, charged paddles, and the cracking of cartilage from chest compressions, most patients die with a quiet, gasping sigh.  I am still not sure which is more unnerving, but the former is what we typically imagine or see on TV during a pronouncement: a sweaty and distraught doctor ripping off latex gloves in frustration and listlessly intoning, "Time of death..."

What usually happens, however, is that the person will expectedly but spontaneously expire.  Death is typically spotted from a fair distance and in most cases the family is cognizant of this.  Sometimes hospice arrangements are made and the patient goes home to die surrounded by family and friends.  Sometimes a volunteer in the hospital will keep a death vigil of sorts, sitting in a chair while reading a book or watching TV to pass the time as they wait to fulfill a promise "not to let anyone die alone."  Sometimes a nurse will make the rounds and discover that the patient is simply dead.  It happens at all hours and in most floors of the hospital.  Regardless, whenever the death is discovered a page is put out to whichever resident is on call to come by and make the official pronouncement, even though everyone already knows the truth.

This means that I usually know nothing about the patient or the family.  I have to make an effort to commit the name and overall disposition of the patient to heart long enough to speak with the family and request their permission to grant or deny an autopsy.  It typically takes thirty seconds to do the examination and less than thirty minutes to speak to everyone and document everything I need to before moving on to other things.

My little tally is nothing fancy, nothing more than a series of hatch marks in a small booklet of mundane medical information tucked into my white coat.  So far, there have been five marks in two weeks.  I can hardly remember the patients at all, much less their names or even what they died from.

But I remember the families.  I remember the different reactions of different people, some joking and laughing about the whole affair, some quietly sniffling in a brother or a sister's shoulder.  I remember their words, which are often filled with appreciation and deep respect for everything that has been done for this house of memories.  And I feel unworthy and deeply unsettled because I had no part in it... in fact, I never knew the patient, because the only reason I came into contact with him or her at all was because there was only an it left.

If the family was particularly effusive, I will write a little note of it in the chart: "No pulse, no audible heart beat; no corneal, pupillary, or gag reflexes.  Family expresses deep appreciation for all staff."  And every single time, I am tempted to then write, "Kyrie eleison," as has become my habit to say whenever I am otherwise speechless with sorrow.  But not all the patient's family members might appreciate that sort of addendum, so I say it to myself, place a little tick in my booklet, and move on.

To "pronounce" means to state, often with a degree of finality and certainty.  But to me, it has also meant to describe and therein impart an element of meaning.  Pronouncements have become a ritual of annotation, one that is suffused with meaning precisely because it is routine without being mundane.  Small wonder that the closest I have come to intimacy with God in this heavily secularized profession have been in moments like these, where that which is ephemeral proceeds into the eternal.

Making a note of it is the least that I can do.
     But someone may ask, “How are the dead raised? With what kind of body will they come?” How foolish! What you sow does not come to life unless it dies. When you sow, you do not plant the body that will be, but just a seed, perhaps of wheat or of something else. But God gives it a body as he has determined, and to each kind of seed he gives its own body...
     So will it be with the resurrection of the dead. The body that is sown is perishable, it is raised imperishable;  it is sown in dishonor, it is raised in glory; it is sown in weakness, it is raised in power; it is sown a natural body, it is raised a spiritual body.
     I declare to you, brothers, that flesh and blood cannot inherit the kingdom of God, nor does the perishable inherit the imperishable. Listen, I tell you a mystery: We will not all sleep, but we will all be changed— in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed. For the perishable must clothe itself with the imperishable, and the mortal with immortality.
- 1 Corinthians 15 

Sunday, January 30, 2011

Birthdays In Absentio


I'm somewhat used to Facebook catching me by surprise by now.  A friend (or two or three) has a new girlfriend.  And is now engaged.  With children.  Usually it happens to people that I'm tangentially friends with or to those with whom I've lost touch over the years.  Occasionally I will feel particularly disquieted by it.  I will feel guilty that I did not know, as if my ignorance were fundamentally due to a lack of genuine concern.  In some senses this is true; we tune in to the lives of those we feel strongly about, and for everyone else the starkness of such disconnects is often the first tangible indicator of the magnitude of that distance between.

I thought about this as I stared at the Birthdays section of my Facebook newsfeed.  It usually lists several people there, most of whom I haven't seen in months or even years.  But that day, there was only a single name.

Sonia K. Lee was a good friend, but we had grown apart by the time she got sick with leukemia and died.  I still feel guilty about it... not about her death, but about all the things I left unsaid about our friendship.  I don't suppose she would have wanted that but it's disquieting to shake off those sorts of feelings even now, these several years after her passing.  I suspect that part of me will always feel guilty in the same way that a part of me will always feel the responsibility of friendship.

The hard truth of life is that we move forward and only those who run a parallel path will continue to remain in our view.  I suppose it is equally natural that we, in the face of loss and displacement, continue to surround ourselves with activity and life.  We crowd our vision with elements that speak of community to us, that defy and deny the thought that we are progressing further and further into the unknown territory of the future, a land in which we may one day wake up to find ourselves frightfully alone.

I looked at the papers scattered around my table.  They were lab results, CT scans readings, and handwritten descriptions of a patient I had seen in the hospital and was writing up.  I thought about the divinely orchestrated irony that he had the exact same illness that killed Sonia three and a half years ago, and had also been in good health before being struck down so suddenly.  Such things used to fill me with fury, but repeated exposure has tamed the sentiment into a mild frustration.  I wonder, with a mild sense of surprise, at my loss of innocence and sense of justice.

Perhaps I am being morbid in consistently dwelling on these topics, returning to them again and again.  Perhaps some part of me does so out of fear; in this moment, I struggle to fend off the thought that as a brother, lover, father, I might one day also wake to find myself frightfully alone, a Facebook profile with a feed filled with ghosts.  But I think more fundamentally, I simply don't want to forget.  I want these things to amplify the momentum of life instead of being brushed aside by it.  I want the gravity of eternity to tug at my heart with all the irresistibility of the divine.
Psalm 103
Of David.
Praise the LORD, O my soul;
   all my inmost being, praise his holy name.
Praise the LORD, O my soul,
   and forget not all his benefits—
who forgives all your sins
   and heals all your diseases,
who redeems your life from the pit
   and crowns you with love and compassion,
who satisfies your desires with good things
   so that your youth is renewed like the eagle’s.

Dedicated to Sonia K. Lee, born January 27.  You are not forgotten, and we are not alone.  Reposted from http://wasaiwarrior.xanga.com/740099664/birthdays-in-absentio/

Leave It There


"I thought I could beat the ICU, you know?"  My resident looked into the distance abstractly as he spoke, talking more to himself than to me.  "Sometimes you think you won't let it get you down, but you can't.  It always wins."

I wondered what he meant by winning.  Did he mean getting to leave on time?  Did he mean keeping a positive attitude?  How can you "win" in the ICU?  I thought about all of the patients we were caring for.  A comprehensive list of their names was scrawled all over a big whiteboard, where imminent changes were haphazardly heralded by beeping pagers and a flurry of activity.  The rapid shuffling of names and the random clamor made it seem like a perverse scoreboard; successes were annotated with new room numbers and locations for transfer elsewhere, while failures were simply wiped away with minimal fanfare, leaving an off-white space that waited patiently for a marker to squeak out a new set of letters.

The resident's pager went off.  There were phone calls, some hastily scribbling, and we were off to pick up the next patient.

The night wore on and I kept my eye on the clock.  Of my sixteen hour shift, there were two hours left.  Then one hour.  Five minutes.  Finally my resident dismissed me.  "Go get some rest," he said kindly as he scanned the computer screen and mechanically punched in orders.  "All that's left is paperwork.  Nothing more for you."  As per medical student etiquette, I thanked him, wished him a good night, and strode out of the ICU.  I walked down a quiet hallway paneled on both sides by glass.  The view on the left side faced out into the cold, dark, northeastern night.  The right side faced the surgical ICU waiting room, still lit with muted, tubular fluorescent bulbs.  I glanced into it momentarily and was surprised to see someone still waiting inside.

She was sitting alone.  Her eyes were puffy and red, but they were dry, and they looked as if they had been that way for a long time.  A thin hospital blanket was draped carelessly around her shoulders, which were hunched forward slightly as if carrying a palpable heaviness.  Her motionless presence made the room seem more static than if it had been empty, as if Time himself had decided to stop in and say hello, that there was nothing particularly important for him to do and he could afford to wait around for awhile and sink into the vinyl furniture, listening to the ventilation hum while he got things ready for eternity to end next Thursday or perhaps the week after that.

My feet continued to move.  I got in my car and felt immensely grateful that I could simply drive away.  I could leave this place and the bodies in their beds and the score on the whiteboard and the timeless terror of the waiting room.  I could sleep without nightmares and wake up without fearing that moment when I suddenly remember that everything is different now that she's gone, ohmygod she's really gone.

*****
So tempting to take up a crown
of guilt around my head
and proudly wear another's weight
of paralytic dread.
So hard to sacrifice the love
of self-divinity
And rather speak a better word
of true humility:
"Fear not the lack of task to do,
presumed irrelevance,
Or for the merit to survive
The deathly duty dance.
Recall instead the words they sang
to pause and leave it there
in callused hands long pierced by all
the burdens that we bear:
There is a balm in Gilead
To make the wounded whole;
There is a balm in Gilead
To heal the sin-sick soul.
Some times I feel discouraged,
And think my work’s in vain,
But then the Holy Spirit
Revives my soul again.
If you can’t preach like Peter,
If you can’t pray like Paul,
Just tell the love of Jesus,
And say He died for all." Reposted from http://wasaiwarrior.xanga.com/739512670/leave-it-there/

Preparing to Die


She was like so many other patients I had seen: thin, pale, elderly, and short of breath.  The oxygen mask and its large ballooning bag seemed unnatural and almost comically oversized on her face, obscuring everything but her eyes and the dusky, blood-matted hair plastered to her forehead.  She squeezed the bag, hungrily trying to force more air into her cancer-infested lungs.  The situation was bad.  I knew it, my team knew it, and it was becoming increasingly clear that she knew it as well.

Some of the other medical staff said that she showed signs of confusion, but her words were clear in speech and meaning.
"Oh God... This is it... I don't want to..."

She was afraid of so many things, and we weren't doing much to help that.  There was the strangeness of the environment, the necessary but painful things we were doing, and above all, the dreaded possibility that she could die, heightened by the worry and concern frozen on my face.  One of the attendings was repeatedly jabbing a large needle (I mean inches long) into her neck and she would occasionally moan and move feebly in pain.  I was holding her hand and doing my best to reassure her, but I didn't know what to say or to think.  In that moment, all the isolation and chaos and alienation that has become modern medicine hit me hard, and I looked around the room littered with medical waste and harsh noises and complete strangers.  I thought, "No one should have to die this way," and realized that it was not the first time I have thought this.

These words seem so melodramatic and cliched now that I write them, but perhaps I have the manner of things backwards.  Perhaps melodrama is so overdone because it tries to imitate these sorts of events and emotions with some reflection of their gravity and substance.  But there is no truth to the imitation, because in reality no words can express the absolute lack of poetry or grace that characterizes death.  There is no premonitory music that plays in the background, no dramatic panning of camera angles or dynamic lighting to throw the monumental event into starker contrast.  The physics and mechanics of death are unglamorous.  We often die in appalling ways: lying in a pool of our own urine and bodily waste, surrounded by alien and otherwise threatening entities, unknown and possibly unloved.  Death can easily happen in the next room without leaving anyone the wiser; in fact, that is often why people do die... because no one else knew it was likely to happen.  In so many ways, death is one of the most unmagical and ordinary things that happen.  As medical students are often taught, "Nothing else in existence is more certain or inevitable."

And yet there is such a strong, innate resistance to this notion, one that has been ritualized in every known human culture.  We make death meaningful, as if the act of remembrance and reverence elevates the importance of who and what has passed.  Such respect is somehow written into our emotional DNA, though some philosophers (and one of my professors) have argued that this is because human beings are arrogant, elevating their self-worth something of greater value than what our naturalistic compositions warrant.

But this is not what I thought of, staring at the large needle boring itself into and out of her neck.  I did not philosophize or ruminate.  Instead, I looked down at my own hand, which was holding hers, and realized that I was the one clenching my fists the most.  I was not any more prepared for her death than she was, and for some bewildering reason, this gave me great comfort at the same time that it struck me with sorrow.

I am not sure why I am still writing, except that I desperately want to believe in the Divine.  I want to believe in persistent purpose, in the significance of death, in a life beyond what we can see and know in the here and now.  All the evidence and momentum of this great engine of the soul inside me screams for something more and meaningful and lovely and beautiful and it will not be denied, it cannot be refused, it must not be quieted.

You are witness to it.  Speak its truth to me, again and again.  I want for us to be eternal, for us to be prepared and consequently, divine.

Listen, I tell you a mystery: We will not all sleep, but we will all be changed— in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed.  For the perishable must clothe itself with the imperishable, and the mortal with immortality.  When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory.”
  “Where, O death, is your victory? 
   Where, O death, is your sting?”
1 Corinthians 15:51-55

Dedicated to my patient.  Reprinted from http://wasaiwarrior.xanga.com/738626008/preparing-to-die.