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.

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 

The Pursuit of Suffering

I watched the grainy, blocky video in silence. My friend was singing “Landslide” and I felt a certain tautness in my eyebrows and a peculiar heaviness in the corners of my mouth. By now it had become a familiar feeling, this physical expression of sorrow.

Can the child within my heart rise above
Can I sail through the changing ocean tides
Can I handle the seasons of my life?

Sonia Lee ’06, whose mellow and resonant voice was captured in that video passed away last year. For most of us at Manna Christian Fellowship, her passing became our first encounter with the death of a friend. In many ways, it challenged my most deeply held convictions about the way the world works. I came to medical school with the growing conviction that my calling was to deal with death and suffering on the professional level, but this experience - so unexpected, tragic, and terrifyingly personal - cast everything under a different pall.

Sonia had acute myeloid leukemia. The onset was rapid and completely unexpected by friends and family alike. I can still remember the dread of the moment I first found out: a string of e-mails with the titles “Urgent prayer for Sonia…” waiting quietly in my inbox. Sonia and I had been good friends during our undergraduate years but had fallen out of touch since my graduation two years prior and I had not heard much from her since then, which made the suddenness and ferocity of the disease all the more shocking. A full year in medical school did nothing to prepare me for the daily anxiety of opening my e-mail in anticipation of an update from the family on her condition. I still have all those e-mails: seventy-seven messages with headings ranging from “A positive turn for Sonia!” to “Sonia—Chemotherapy day 3” and “Emergency request for platelets.”

I received those updates nearly every day for several months, tracking her progress through the end of the summer and into the beginning of the school year. It was a trying time for our community of mutual college friends. We prayed together, planned gifts for her together, and waited together every day for those e-mails with hope and fear.

I remember the tightness in my gut during our first medical lecture on leukemia, trying to suppress my emotional confusion as the professor raced through hundreds of slides. I remember listening to the complaints of classmates about how “overwhelming” the lecture was and nodding my agreement as I headed over to a computer cluster, dizzy and ambivalent and anxious to check my e-mail. By that week Sonia had been doing much better and was simply waiting for a bone marrow transplant donor. Her family hadn’t been able to match but, by some miracle, had been able to get her story published on the front page of a big South Korean newspaper asking people to test for matching. Her picture in that article was the only one I saw taken of her during that time and it did not show the smiling, radiant friend I had known.

The seventy-third e-mail on the subject, received only a few days later, carried the heading, “Bad News.” The seventy-seventh e-mail was entitled, “Memorial Gathering for Sonia K. Lee ‘06”.

All these events took place nearly half a year ago and yet I still find myself dwelling on them. Friends I talked to in medical school or in church – those whom I had expected to understand my struggle and accompany me through it – said that such a fixation on death and suffering was unhealthy and perhaps even pathologic: “It’s over now; she’s in a better place,” “Everything’s going to be alright,” “Life just goes on.” I couldn’t understand why words like those hurt. They were true, but I resisted them fiercely and was even irritated and angered by them. “There is no purpose behind death,” one friend simply replied, “We just say things like that to make ourselves feel better.”

On hearing that, my ambiguous sentiments and tensions revealed themselves for what they were: fear. Crippling, disabling, and terrifying fear. Speaking at graduation, Toni Morrison once said that humans react to fear by naming it, attempting to feel as if we have some understanding and therefore some control over it. We name our diseases and our disorders and our bogeymen. We name our failures and our enemies and the secret longings of our hearts. But in the end, a name is all we have. A name is not much.

I named my fear The Gravity of a Moment. For me, the death of a friend is the lost opportunity to sing in harmony, to shout at, to laugh with, to cry on each other. It is shocking in its finality and irreversibly strips my future moments of something precious, the weight of which I cannot measure. How many more moments will lose gravity and appear a little thinner and gaunt? Will I ever realize the magnitude of what has been - and will continue to be - lost?

Shortly after the death, a close friend of Sonia’s told me, “I don’t understand why people didn’t want to come to the funeral or the memorial service… maybe they didn’t feel ready, but somehow it feels like they’re just trying to move on. At the funeral, her parents told me, ‘Don’t forget her,’ but I feel like that’s what we’re doing… forgetting and moving on.” When I heard that I felt guilty because, deep down inside, I wanted to move on too but simply couldn't. I wanted to find a tidy closure and a proper perspective from which to define the experience. I didn’t want to forget, but I didn’t want the remembering to be so painful either.

Henri Nouwen once wrote:
We tend, however, to divide our past into good things to remember with gratitude and painful things to accept or forget. This way of thinking, which at first glance seems quite natural, prevents us from allowing our whole past to be the source from which we live our future. It locks us into a self-involved focus on our gain or comfort. It becomes a way to categorize, and in a way, control. Such an outlook becomes another attempt to avoid facing our suffering. Once we accept this division, we develop a mentality in which we hope to collect more good memories than bad memories, more things to be glad about than things to be resentful about, more things to celebrate than to complain about.
Gratitude in its deepest sense means to live life as a gift to be received thankfully. And true gratitude embraces all of life: the good and the bad, the joyful and the painful, the holy and the not-so-holy. We do this because we become aware of God’s life, God’s presence in the middle of all that happens.
Is this possible in a society where joy and sorrow remain radically separated? Where comfort is something we not only expect, but are told to demand? Advertisements tell us that we cannot experience joy in the midst of sadness. “Buy this,” they say, “do that, go there, and you will have a moment of happiness during which you will forget your sorrow.” But is it not possible to embrace with gratitude all of our life and not just the good things we like to remember?

Suffering is and must remain an integral part of our human experience. It cannot simply be a byline in our pursuit of happiness, for if we fail to embrace suffering, we fail to embrace Christ himself. As Philip Bliss wrote, “Man of sorrows! What a name for the Son of God who came ruined sinners to reclaim.” Paul, in describing suffering as the loss of things he once considered profitable, wrote with paradoxical conviction and mysticism, “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.”

I write about death because it represents one extreme in our human experiences with suffering and, for better or for worse, reveals the raw power of our reactions to pain. It exposes our tendencies to sentimentalize it, to avoid it, to explain it away, to do everything except embrace it. We may refuse to acknowledge suffering but in doing so we eliminate an opportunity to experience the true and piercing presence of God. If we cannot experience pain, how can we understand the comfort of healing? If we do not understand death, how can we comprehend the victory of resurrection? And so, while we ought not to idolize suffering or intentionally inflict it, we cannot ignore its centrality in our journeys toward the divine.

The last post of Sonia’s weblog is a quote from the movie, You’ve Got Mail: “Sometimes I wonder about my life. I lead a small life. Well, valuable, but small. And sometimes I wonder, do I do it because I like it, or because I haven’t been brave?” In the smallness and shortness of our mortality, do we dare to embrace every moment of it? Do I have the bravery to love each painful and pleasurable instance so bitterly intermingled in its brief course?

I cannot help but wonder if somewhere beyond the pall the gravity which I thought was lost has simply become a part of something greater, something that draws me to it a little more closely and tugs at my soul a little more sharply. Perhaps all the moments that are torn from this life are really just being transported, in the twinkling of an eye, to a place where the weight of the world becomes the weight of Glory and everything I thought I lost will be found in even greater measure than before.

If there is one reflex in my soul stronger than all the rest, it is the longing for that day.

"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?'"