river

The clinic is a river of people, a river of experiences, and in some cases, of suffering: suffering large and small, the suffering of feeling unbeautiful and of growing old, or the suffering of physical disability and death.  Sometimes, it was simple: sewing up a simple laceration in the emergency room and seeing someone go from face drawn in pain to clearing with relief and gratefulness.

Sometimes, it was telling a woman who was perfectly fine eight months ago, but who now is unexpectedly falling, and who now can barely walk, that her disease will continue its inexorable march upward, upward until it reaches her diaphragm and neck.  She already searched on the Internet; she knows she will die a horrible death, slowly losing her ability to breath.  Here, the physicians didn't want to tell her until they had ruled out all the other diagnoses; they badly wanted to diagnose her with some strange hepatitis-C related paralysis, some other treatable disease that would be better than ALS, amyotrophic lateral sclerosis, Lou Gehrig's disease.


Sometimes it is seeing the effects of poverty, of long-term abuse that only immense effort might, just might be able to shift.


I think in some ways the heroic stories we hear on the news and in magazine articles and novels do us a disservice.  What we see is the ripe fruit of a long, long effort, many of which may risk failure.

We in the clinic, in fifteen minutes, will not solve problems that were years or lifetimes in the making.  We can nudge.  We can treat and manage diseases.  In some cases, we really can cure them.


But this river of human experience and stories, this river of suffering roiling with powerful currents of past history and generations of momentum - to try and stand in the way of this, we will be bowled over.  The force of that tide is too strong for any one person.

To raise a family to be mostly good, eventually self-sufficient - this is no small thing, and it is the work of years and decades, ultimately a lifetime.  To attempt to fix the brokenness which is also in some ways adaptive to broken circumstances - the reality is, in many cases, it cannot be fixed.  Or the healing is a long, slow process of years, maybe decades, which the healthcare system may not have the resources to do.

In medicine, we box very complicated problems into clinical decision tools, enabling us to deal in some cases very successfully with complex problems.  In other cases, we call a social worker, call a chaplain, call a consult.  The algorithm gives us some ability to act, an ability to decide, the illusion of control.

Some, like the surgeons, will pluck out from that current individuals whose problems they can perhaps solve.  Others will set up dams to slow the current enough to reroute rivulets of experience.  Others will set up hiking upriver to try to nudge the sources of suffering. Maybe some will pick an individual out of the river and pour a lifetime into shifting the course of that path, maybe failing.

To try to withstand the full force of the current is to be knocked over and potentially drowned.  I think our place is to journey with our patients and our fellow healthcare workers so that people know they are not alone in their struggle, knowing that we may only be able to temporarily divert this particular rivulet.  I hope that people can feel and understand that they are loved, that they are beloved and valuable just because they are human.  They are not alone.

In the end, everyone dies anyway.  But I do think I have very much of a palliative care mentality in that it matters very much to me the process by which we do so.  In reality, we are living, even in the face of disease and death, up until the moment at which we are not.  Even dying is part of living.