Friday, November 11, 2005

Some Friday Thoughts

Well, she's home now. My lovely ailing patient of whom I have written so much is now home with her daughter with the care of hospice. Refusing the placement of a gastric tube for feedings, liquids, and medications, she is now receiving "comfort measures only", meaning morphine, medications for anxiety and other symptoms, as well as whatever she might be able to swallow through her constricted esophagus. I saw her the day before she left the nursing home, and I just couldn't make it over to the house this latter part of the week.

With some friends visiting us for a few days, we each took turns tonight reading something aloud that we had written recently. Our friend Deborah read from the amazing novel she's been writing for several years, and her wife Nancy delivered a funny and poignant toast that she's practicing for the fortieth birthday party of an old friend which they'll be attending tomorrow. Mary read from a memoir of her childhood that she's writing, this particular chapter describing the death of her nine-year-old brother in a collision caused by a drunk driver. I chose to read a recent blog entry about this wonderful and soulful woman who I have come to know and love, first as a patient, but really as a human being.

Human suffering was as usual a focus of my attention this week, both my own and that of others. While I could judge my own suffering as unworthy or egocentric, it is a reality which I choose to experience and will most likely experience again. In the context of others' struggles with debilitating illness, addiction, and poverty, my struggle with depression seems to pale in comparison. There is such a thing as scale, and the relative scale of my challenges is both humbling and embarrassing, especially in light of the black clouds which can so easily descend and diminish my ability to see my life clearly. Serotonin deficiency or not, I still make conscious choices in my life, and those choices directly impact my state of mind and level of suffering.

Whether one embraces the notion of endogenous, genetic depression or not, one must still take responsibility for one's life and choices. Looking at myself in the rear-view mirror the other day, I was acutely aware that I was holding my mouth in an almost cartoon-like frown. The corners of my mouth (and my moustache, I may add) were almost absurdly pointing towards my chin, and I forced myself to smile wildly into the mirror momentarily, if only to break the pull of gravity on my lips and cheeks. Did it work? For a moment, anyway. Then I realized that the frown had returned as if it had a life of its own, despite the protestations of my inner optimist who just wants my face to remember how to smile, depression be damned.

Do Selective Serotonin Reuptake Inhibitors really force one to smile even when one wants to frown? Not really, but they can make it so much less painful a process as one cuts through the miasma of depression, lifts the veils, and slowly emerges back into the light of day.

My beloved patient,who has suffered from depression, anxiety, and psychosis for decades, has not been so lucky as to have a full reprieve from her symptoms over what we might consider a generous amount of time. But her ability to smile, to know that there is a power greater than her in which she believes and upon whom she relies for strength, and her ability to rise up out of herself and genuinely revel in the happiness of others, that is a gift beyond measure.

After I read my piece, Mary said that she's afraid that the imminent loss of this particular patient may be quite powerful for me, and it may be a catalyst for further healing and grieving. That may be true, and I embrace that reality readily. Having made such a heart connection with this being, I can only be ecstatic that we've had time to share the same air on this troubled sphere hurtling through space. It still holds true---to love another being is the greatest accomplishment, the greatest joy, and at times the greatest sorrow. But the sorrow---and the loss---only add to the sweetness of the moment. To paraphrase Modest Mouse, if life isn't beautiful without the pain, then I'd rather not ever see beauty again.
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