Saturday, March 11, 2006

Contrasts and Ironies

Warm sun and milder temperatures herald promises of Spring and Summer to come. The sun is warming the soil, and so many of us will use this blessing as an excuse to go outside, clean up the yard, hastily beginning the process of easing winter's stranglehold on our world. The bike path will probably be jammed with bikers and walkers today as a sense of "carpe diem" sends the vast majority towards the sun, like flowers searching for their cosmic fix. The dogs pine for a walk as I try to write---they also get Spring Fever of the canine variety.

Some of my first thoughts of the day turn toward my two hospitalized patients, both struggling with cancer, both sealed in their respective hermitages, cut off from fresh air and the outside world. I think of the hospital where I volunteered in Jamaica, where an ocean breeze constantly blew through the wards, the windows open almost year-round, shuttered only during the rainy season and at night when the cool air might cause a shiver, and when "duppies" roam the earth.

The contrasts abound: patients sealed in "therapeutic" environments where multiple antibiotic-resistant organisms thrive, colonizing stethoscopes, equipment, furniture, and clothing. These critically ill individuals go to busy hospitals to "rest", with vital signs taken every four hours, multiple specialists, doctors, nurses and therapists interrupting sleep at all times of day and night. Televisions blare, the intercoms blurt out their coded warnings, call bells ring, IV equipment beep out warnings of occluded lines and bubbles. Don't even mention the food, the bane of many a hospital patient's existence.

We are surrounded by contradiction and contrast: malignant and benign, DNR and Full Code, regular diet and NPO, remission and relapse, acidosis and alkalosis, inpatient and outpatient, the quick and the dead.

Some patients resign themselves to illness, embracing its limitations as a new baseline for living, fatalism sometimes overcoming yearnings for the miraculous. Others see illness as a call to arms, a formidable foe with whom one will grapple for supremacy over one's body, as well as the very quality (and quantity) of that body's life. At times religious belief and spiritual zeal will fuel that fight for life and against the ravages of illness. At other times, I've witnessed faith assist a person in accepting illness as par for the course, no fighting necessary, the mortal struggle removed from the equation.

I am often moved by the contrast when I leave the office and head for home. It's not guilt for leaving my patients in their lives while I return to mine. It simply is acknowledgement that while they struggle for life, battle against illness, and live in the wake of trauma, I return to my cozy home and leave those struggles behind me. While some of them may never leave my mind entirely over the course of a weekend or a vacation, their lives continue whether I am at their side or not. No one has ever insinuated that I don't deserve to go home and rest. On the contrary, many patients urge me to take care of myself, recharge my batteries, and return to the fray refreshed and eager to continue. It just reminds me that my patients' struggles don't commute---they're 24/7.

Just yesterday, I was visiting the rehabilitation hospital where my patient with throat cancer is recovering from a very serious cancer-related infection. I observed as he took part in group physical therapy, intermittently applauding and joking with him and his fellow patients as they tossed bean-bags and honed their fine and gross motor skills. Unable to speak, he waved me closer as I prepared to leave, looked deep into my eyes, smiled, and mouthed "have a nice weekend". Due to my poor lip-reading skills, he had to repeat himself several times, but I eventually caught on, took his hand, and wished him well, hoping that he would have many loving visitors. Our handshake was a lingering one, and then I took my leave, walked out into the light rain, and looked back at the windows of the institution temporarily housing this gentle and kind soul. He may be locked inside and I may be free to roam, but his spirit is as free as mine, and part of him left with me, and I carry it with me still. It lives in my heart, and no physical boundary can dissolve the strings of compassion which connect us all.
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