first, to endure

     The extra vertebrae in my back along with their respective degenerative disks cried out in pain.  The terrain was a glorified walk of only 2 miles with no altitude gain.  And while my backpack was not light, I had carried far heavier far further far higher in my past.  I expected my back to hurt but even my legs were getting a bit wobbly by the second mile.  My dog paused obediently whenever I had to stop for a few seconds to catch my breath but she looked at me expectantly.  She had cardiac damage from heart worms and she was kicking my butt.  What the hell happened to me?  I used to be able to do far more physically.
     I recalled an email from another student who was also older than the average student.  In it he counseled me, "Man, stay in shape now while you still can or med school hours WILL damage your health."  It seems that it had indeed taken its toll on my physical health.  But sitting on a rock, petting my lone and faithful furry hiking companion, med school may have taken some toll, but I was stupid to think it was just that.  I laughed grimly at myself.  What had happened to me?  I really had to ask such a question of myself?  Life had kicked the ever living shit out of me.  Physically, mentally and emotionally.  That's what happened to my body.
     And while I reflexively resolved to get myself back into shape with some gung-ho enthusiasm, I immediately tempered that with realism.  Be a bit more forgiving towards myself.  That's great to get back into shape, but first, I must endure.  And enduring metaphysically is the ultimate goal for me right now and that's ok.  That philosophy of life has served me well.

answering the call of the wild

But especially he loved to run in the dim twilight of the summer midnights, listening to the subdued and sleepy murmurs of the forest, reading signs and sounds as a man may read a book, and seeking for the mysterious something that called -- called, waking or sleeping, at all times, for him to come.
- jack london

call of the wild

Sometimes he pursued the call into the forest, looking for it as though it were a tangible thing, barking softly or defiantly... Irresistible impulses seized him. he would be lying in camp, dozing lazily in the heat of the day, when suddenly his head would lift and his ears cock up, intent and listening, and he would spring on his feet and dash away, and on and on, for hours, though the forest aisles.
- jack london

ave atque vale

Two years later, I'm not sure these words are any easier to live:

Through many countries and over many seas
I have come, Brother, to these melancholy rites,
To show this final honour to the dead,
And speak (to what purpose?) to your silent ashes,
Since now fate takes you, even you, from me.
Oh, Brother, ripped away from me so cruelly,
Now at least take these last offerings, blessed
By the tradition of our parents, gifts to the dead.
Accept, by custom, what a brother’s tears drown,
And, for eternity, Brother, ave atque vale
‘Hail and Farewell.’

nearing two years

Make the most of your regrets; never smother your sorrow, but tend and cherish it till it come to have a separate and integral interest. To regret deeply is to live afresh. By doing so you will find yourself restored to all your emoluments. - Henry David Thoreau 

     It's been nearly two years since I watched my brother die.  No, that's not quite accurate.  I was an active participant in his process of dying.  I walked with him every step of the way and in doing so forever changed my notion of being a doctor.  As if the stress of medical school wasn't enough.  The first patient I ever took care of was my brother.  The first time I ever had to make those decisions at 3 in the morning without anybody to ask was with my brother.  No one was looking over my shoulder to ensure that I did not make a mistake.  I did not have the benefit of years of experience to aid me, either.  The first patient I ever lost was my brother.  The second patient was nearly my dad.  And I had both at the same time.  I was rushing my dad to the ER on the day of my brother's death AND the day of his funeral.  If that's not enough to turn a man to drink or drug, then what is?

     Through much grief work, much sadness, much therapy, and even medication I have come to accept the following paradox.  While a part of me wishes to be happy again, that part involved in loss will always grieve and dwell in the darkness.  I accept the notion that two mutually exclusive thoughts can be both equally true.  I continue to, and likely always will given my profession, grieve the loss of my brother, and the near loss of my father.  And I selfishly grieve the fact that my career will always be inextricably entwined with those losses.  I can never naively enjoy my training with this knowledge.  Every time I see a patient in horrible and chronic pain, every time I see a patient with a terminal disease, every time I see a patient with existential angst, I will grieve that loss again and again, all the while still hoping for happiness.

     I have been told by multiple people, including grief counselors, that I will be a better doctor for it, that it is a gift.  I can empathize and sympathize on a level that can only be experienced.  But that brutally misses the point, which is the pain still remains in order for that knowledge to exist.  One simply cannot exist without the other.  And in speaking with others who have experienced such traumatic loss, time does not necessarily heal all wounds.  As a soldier who saw all of his friends die in WWI, Tolkien aptly penned, "There are some things that time can not mend. Some hurts that go too deep, that have taken hold."  So after two years, is the pain healed?  No, it merely ebbs and flows, much like the seasons passing time.

limitations

     Having made it out of the hospital by a reasonable time, it was no longer dark and daylight was breaking.  A trick I learned I early on was to always park in the same spot.  Multiple hospitals, multiple shifts, brain overload, sleep deprivation...losing your car is not hard to do.  In walking to my car I noticed a man pulling a wheelchair from the back of the car for the woman waiting in the passenger seat.  Something about them seemed familiar. 

     As I passed him, I caught a glance of his eyes.  Five steps closer to my car and my brain made the connection.  She was a patient of mine on a previous rotation months ago.  I kept walking and with each step my brain recalled a piece of their story from my memory.  The eyes were the trigger.  I couldn't recall their names, but I could not forget their eyes, nor their story.  I closed my eyes and I could see the office room where that visit took place.  His eyes were moist with concern.  Her eyes were yellow with the failing of her liver.  It was not a visit with good news and so I was a bit surprised she was still alive.

     By the time I recalled all this, I was at my car and they were a hundred yards behind me, one wheeling the other towards the hospital.  I slowly pulled out my keys and felt regretful.  I wished I had stopped.  I wished I had remembered quicker.  I wanted to ask them how they were holding up.  Did she get on a transplant list for a new liver?  Or, was she terminal?  But by that point, I was simply too tired and they were already entering the hospital.  Everyone has their limits.

break

A MUCH needed break.