Leslie was the kind of person who made both men and women's heads turn as she walked down the hallway. Her back arched forward with perfect posture as she waited for me to enter the exam room. She stood, using one hand she parted the blond curls that fell in front of her face, and extended the other towards me in greeting.
I sat comfortably at the desk and opened my computer in preparation to start the physical. Leslie swayed back and forth in her chair slowly, and I sensed that something was bothering her.
Because she was a new patient, we chatted about her current health and past medical problems. I asked gentle probing questions to tease out the source of her discomfort. Although I had finished all the requisite social and family history, I still found myself searching
I opened the cabinet above the desk and pulled out a gown in preparation for the physical exam. At the sight of the white flimsy covering, Leslie's face became a bright shade of pink, and she turned in embarrassment. I was surprised by this kind of reaction from such a strong, confident appearing woman.
Is something wrong?
Leslie turn to face me again, and paused as she mentally rehearsed the next sentence.
You see Dr Grumet...I thought you were a woman....and I didn't shave my...
Her words trailed off as we both started to laugh. I offered her an appointment with my female partner, but instead she decided to return and finish the exam the next week when she was better prepared for the visit.
I sat in my office and giggled as I looked out the window and watched Leslie gracefully lower herself into the driver seat of her car.
And then I remembered something.
*
The morning rhythm of the ICU greeted my ears as I walked through the doors. The sound of shuffling feet, blowing ventilators, and beeping machines formed a raucous chorus. I stopped at the computer bank and looked at my patients labs and vitals.
She was much to young to be in this setting. Her twenty five year old body was stronger and more resilient then the average ICU patient. But the effects of chemo had taken their tole. Her immune system damaged and short handed, couldn't fight off the bacteria that plunged into her respiratory system.
Things were looking up. The chemo had finished. The ventilator was removed and life was beginning again. A bed was ready in the step down unit and hopefully she would go home soon. We chatted for a few moments before I started my examination. The lungs were clear; the heart was normal.
As I went to examine the legs for edema, my patient threw back her covers to reveal newly manicured toes with a bold shade of red polish. I looked up to the head of the bed to see her smiling.
She had been waiting all morning to spring this on me.
*
It becomes very easy in medicine to shun vanity. We looked past the dirty, unkempt, disease ridden bodies of our patients as a matter of course. We somehow picture ourselves too much above the fray to stoop to such banality.
But one thing I've learned from my patients is that dignity transcends sickness and health. That caught in the middle of a health care system that focuses on depersonalization, it takes courage to maintain ownership.
These women were trying to remind me that they are not just patients.
They are people: flawed, vain, courageous, and awe inspiring.
Monday, January 9, 2012
Saturday, January 7, 2012
Reports Of Our Demise
I shuffled some papers on the desk to avoid looking into the hospital administrator's eyes. His lips curled into a half baked smirk as he talked. I marveled at the tailored suite and the crisp tie.
He was a business guy. And it didn't take long to ascertain that he saw me as an asset. I was a widget; an interchangeable part. If one physician wasn't on board, find another. I imagined that somewhere in his slick briefcase there was a list with each physician's name and two columns. Check marks were neatly penciled in to demarcate the doctor's status. Pens were never used because they were not erasable.
The majority of the conversation was like a Peanuts cartoon where most of the words sounded like distorted rubbish. Occasionally my ears would perk up as a phrase caught my attention.
Blah blah blah, blah blah ACO blah blah blah ICD-10. Blah blah blah blah healthcare reform blah blah ACA.
*
When are we going to stop talking of Armageddon? We treat private practice as the red headed step child, and not the predominant mode of physician organization. We huddle in the corner of dark alleys and wait for the boogey man that never comes.
And we jump ship the minute the going gets tough, and become employed physicians. It's what happened in the era of HMO's and it's whats happening now. The scramble to escape the unknown becomes more important then thinking about self interest.
We try to forget that we are staunchly independent professionals who don't like being told what to do. Certainly we can submerge our needs for a time, but eventually our true nature bursts forward. And when it does, we break through the chains of employed existence and venture out on our own.
It has happened in the past, and it will happen again
*
I have worked for hospital owned medical practices. They stand on the backs of their laboring assets. Physician sweat leads to profits that exsanguinate through administrative fluff and overblown salaries. Economies of scale give way to inconsistency and bloat.
The government is sadly mistaken if it thinks that ACA will lead to a tenable solution by placing the power and money in the hands of greedy hospital systems loaded with administrators and oozing with self interest.
You want to see who's running the tightest ship in the business? Find the little guy; the few physician practice that lives or dies by its own ingenuity. There are no unnecessary administrators, no burdensome policies, no political flotsam.
The consultants say that the ACA will end private practice. They say that ICD-10 and the new regulations will make small practice untenable.
I say let's look at history.
The reports of our demise are frequent and uncompromising.
They're also greatly exaggerated.
He was a business guy. And it didn't take long to ascertain that he saw me as an asset. I was a widget; an interchangeable part. If one physician wasn't on board, find another. I imagined that somewhere in his slick briefcase there was a list with each physician's name and two columns. Check marks were neatly penciled in to demarcate the doctor's status. Pens were never used because they were not erasable.
The majority of the conversation was like a Peanuts cartoon where most of the words sounded like distorted rubbish. Occasionally my ears would perk up as a phrase caught my attention.
Blah blah blah, blah blah ACO blah blah blah ICD-10. Blah blah blah blah healthcare reform blah blah ACA.
*
When are we going to stop talking of Armageddon? We treat private practice as the red headed step child, and not the predominant mode of physician organization. We huddle in the corner of dark alleys and wait for the boogey man that never comes.
And we jump ship the minute the going gets tough, and become employed physicians. It's what happened in the era of HMO's and it's whats happening now. The scramble to escape the unknown becomes more important then thinking about self interest.
We try to forget that we are staunchly independent professionals who don't like being told what to do. Certainly we can submerge our needs for a time, but eventually our true nature bursts forward. And when it does, we break through the chains of employed existence and venture out on our own.
It has happened in the past, and it will happen again
*
I have worked for hospital owned medical practices. They stand on the backs of their laboring assets. Physician sweat leads to profits that exsanguinate through administrative fluff and overblown salaries. Economies of scale give way to inconsistency and bloat.
The government is sadly mistaken if it thinks that ACA will lead to a tenable solution by placing the power and money in the hands of greedy hospital systems loaded with administrators and oozing with self interest.
You want to see who's running the tightest ship in the business? Find the little guy; the few physician practice that lives or dies by its own ingenuity. There are no unnecessary administrators, no burdensome policies, no political flotsam.
The consultants say that the ACA will end private practice. They say that ICD-10 and the new regulations will make small practice untenable.
I say let's look at history.
The reports of our demise are frequent and uncompromising.
They're also greatly exaggerated.
Friday, January 6, 2012
Metamorphosis
When I heard the phrase, I couldn't quite believe what I was saying. Not only were the words cruel and unforgiving, they were intentional and calculated.
I hope you sleep well tonight knowing that you tortured this poor lady in her last moments before death.
I could hear the sounds of CPR in the background as the nurse paused to digest what I said. I imagined strong arms pushing against the cracked ribs of a frail, demented, elderly woman whose quality of life had been minimal for the last few years. Even though I spent months trying to convince the family, they had only agreed to the Do Not Resuscitate order a few days prior. I dutifully placed the paperwork in the hospital chart, but apparently it meant nothing till the power of attorney signed the form.
Days later, as my patient was coding, it was noticed that the order had never been signed by the family. The nurse was unapologetic.
We've got liability issues doc. No order....No DNR!
I slammed the phone down in anger. I hoped the sting of my words would at least convince the code team to move in slow motion.
*
I grew up the youngest of three boys. I was shy and withdrawn. I spent a good deal of my youth afraid of my own shadow. I was soft and supple, pliant. By the time I reached medical school, it was safe to say that I had never raised my voice to anyone.
It is impossible to explain the deluge of medical education to someone that is unexposed. Students and residents learn to fight for scarce resources. In an attempt to advocate for patients, voices are often raised, threats are made.
I learned quickly that in order to protect those under my care, I either had to become a master of confrontation or get trampled. For the first time, I used cruelty and anger to force the unwilling hand.
And it worked: the X-ray tech would schedule the MRI early, the specialist would leave a full clinic to meet me at the bedside. The more voracious my attitude, the more I could accomplish.
*
A few minutes later my thoughts were interrupted by the jolly ringtone of my cell phone. It was the nurse again. The code was over. I took a deep breath and began to apologize for my inexcusable behavior. She interrupted me.
It's okay Doc! If it was me on that table, I would've wanted someone like you as my doctor!
I thanked her for being gracious.
I hung up the phone.
And then I wept.
*
It's only now that I realize that the anger of training wasn't about advocacy or about getting the job done.
It was about grief.
We fought so many unwinable battles that we grasped at any form of control that was available to us. We may not be able to cure the disease, but we certainly could get our patient to the front of the line.
We yelled, we threw things, we were cunning and underhanded because that was better then crying.
Ten years out of training, I realize that I've seen enough suffering for a lifetime.
And it has changed me.
Often in ways that I'm not proud of.
I hope you sleep well tonight knowing that you tortured this poor lady in her last moments before death.
I could hear the sounds of CPR in the background as the nurse paused to digest what I said. I imagined strong arms pushing against the cracked ribs of a frail, demented, elderly woman whose quality of life had been minimal for the last few years. Even though I spent months trying to convince the family, they had only agreed to the Do Not Resuscitate order a few days prior. I dutifully placed the paperwork in the hospital chart, but apparently it meant nothing till the power of attorney signed the form.
Days later, as my patient was coding, it was noticed that the order had never been signed by the family. The nurse was unapologetic.
We've got liability issues doc. No order....No DNR!
I slammed the phone down in anger. I hoped the sting of my words would at least convince the code team to move in slow motion.
*
I grew up the youngest of three boys. I was shy and withdrawn. I spent a good deal of my youth afraid of my own shadow. I was soft and supple, pliant. By the time I reached medical school, it was safe to say that I had never raised my voice to anyone.
It is impossible to explain the deluge of medical education to someone that is unexposed. Students and residents learn to fight for scarce resources. In an attempt to advocate for patients, voices are often raised, threats are made.
I learned quickly that in order to protect those under my care, I either had to become a master of confrontation or get trampled. For the first time, I used cruelty and anger to force the unwilling hand.
And it worked: the X-ray tech would schedule the MRI early, the specialist would leave a full clinic to meet me at the bedside. The more voracious my attitude, the more I could accomplish.
*
A few minutes later my thoughts were interrupted by the jolly ringtone of my cell phone. It was the nurse again. The code was over. I took a deep breath and began to apologize for my inexcusable behavior. She interrupted me.
It's okay Doc! If it was me on that table, I would've wanted someone like you as my doctor!
I thanked her for being gracious.
I hung up the phone.
And then I wept.
*
It's only now that I realize that the anger of training wasn't about advocacy or about getting the job done.
It was about grief.
We fought so many unwinable battles that we grasped at any form of control that was available to us. We may not be able to cure the disease, but we certainly could get our patient to the front of the line.
We yelled, we threw things, we were cunning and underhanded because that was better then crying.
Ten years out of training, I realize that I've seen enough suffering for a lifetime.
And it has changed me.
Often in ways that I'm not proud of.
Thursday, January 5, 2012
Dirty Little Pills
His hands shook as he unfurled the sack of bottles. He placed them on the examining table one by one. He looked at each label, and then shook his head quietly as if he was reaffirming his own good judgement. Much to his chagrin, I noticed the empty can of Jolt laying in the wastebasket. It hadn't been there a few minutes ago.
We talked a few moments before I tackled the supplement issue. I could picture a cigarette dangling from his brown stained fingers. His belly protruded over his waist and struggled to conform to his undersized pants.
He was working too hard, eating poorly, and spending little time with his family. He felt too nervous to quite smoking, but too lethargic to stop imbibing energy drinks. His business teetered from complete destruction to overwhelming success on any given day
*
Doc...why do I feel so bad?
Again he glanced over at the pill containers sitting on the table. While I knew the answer, I could tell that I wouldn't make much headway till I addressed the passion of his wandering eye. I reached over to the counter.
So what do we have here?
I mentally read through the list while I tapped away at my computer: Ginseng, vitamin E, Vitamin D, Vitamin C, Multivitamin, folic acid, St Johns's wart, fish oil, aspirin, and chondroitin. It was a myriad off supplements costing hundreds of dollars a month.
I picked up each bottle as I explained why it was inappropriate. Vitamin E had never shown to be beneficial for almost anything. Vitamin D was unnecessary in a person who had healthy bones and was not deficient. Folic acid could be harmful. Aspirin was ridiculous in a thirty year old with no heart history regardless of some risk factors. He stared at me impatiently as I droned on about one pill after another. Eventually he interrupted before I could spit out the last words of my prolonged run on sentence.
But if I stop those, what are you going to give me to take their place?
I paused. I could either go with the hard sell or the soft sell. I wondered which would work.
You want to feel better?
Stop all pills.
Quit smoking and energy drinks.
Exercise, lose weight, and sleep better.
Spend more time with your family.
His head slumped down towards the ground and for the first time during the visit, his legs stop shaking. He looked up and our eyes met. For a brief moment, I thought that I connected. But then he opened his mouth.
Isn't there some pill I can take instead?
We talked a few moments before I tackled the supplement issue. I could picture a cigarette dangling from his brown stained fingers. His belly protruded over his waist and struggled to conform to his undersized pants.
He was working too hard, eating poorly, and spending little time with his family. He felt too nervous to quite smoking, but too lethargic to stop imbibing energy drinks. His business teetered from complete destruction to overwhelming success on any given day
*
Doc...why do I feel so bad?
Again he glanced over at the pill containers sitting on the table. While I knew the answer, I could tell that I wouldn't make much headway till I addressed the passion of his wandering eye. I reached over to the counter.
So what do we have here?
I mentally read through the list while I tapped away at my computer: Ginseng, vitamin E, Vitamin D, Vitamin C, Multivitamin, folic acid, St Johns's wart, fish oil, aspirin, and chondroitin. It was a myriad off supplements costing hundreds of dollars a month.
I picked up each bottle as I explained why it was inappropriate. Vitamin E had never shown to be beneficial for almost anything. Vitamin D was unnecessary in a person who had healthy bones and was not deficient. Folic acid could be harmful. Aspirin was ridiculous in a thirty year old with no heart history regardless of some risk factors. He stared at me impatiently as I droned on about one pill after another. Eventually he interrupted before I could spit out the last words of my prolonged run on sentence.
But if I stop those, what are you going to give me to take their place?
I paused. I could either go with the hard sell or the soft sell. I wondered which would work.
You want to feel better?
Stop all pills.
Quit smoking and energy drinks.
Exercise, lose weight, and sleep better.
Spend more time with your family.
His head slumped down towards the ground and for the first time during the visit, his legs stop shaking. He looked up and our eyes met. For a brief moment, I thought that I connected. But then he opened his mouth.
Isn't there some pill I can take instead?
Wednesday, January 4, 2012
A Gift To The Dying
The photo was more for my benefit then hers. The ninety five year old woman staring at me through the frame was completely blind. She wouldn't be able to enjoy it. Yet she had her young companion bring a camera to the visit. We snapped the shot, and two weeks later she walked in with a beautifully framed picture. It would be our last visit before she died.
I studied my own face. Had it been a full decade? My features were softer, my hair thicker. I glowed with an innocence that has long since faded. As I contemplated my growth as a physician, I struggled to remember her name. My face burned with embarrassment and then settled with a heavy sense of guilt.
So much had been gained over the last couple of years, and so much lost.
*
I have watched hundreds of patients die. I start each journey with a full emotional tank of gas. But as time passes, complications arise, and fuel is consumed at an ever rapid pace. As we reach the finish line, I often feel like I'm existing on fumes.
And when the death certificate is signed, and condolences are given to the family, I run on empty. Of course the tank refills with each and every new patient that walks through the door. But the truth is, my endurance is limited to one fill per customer.
So as time goes by, I often forget details. Names and diagnosis slip through my clenched hands like sands in the hour glass. But themes remain. Love, fear, rapture, joy, and connectedness permeate my soul and affect the person that I have become.
*
When I look at the decade old picture, I realize that my patient was giving me one last gift before she died. As the memories flood back the details become more concrete.
I may not remember her name, but I can tell her story.
I can tell their stories.
I studied my own face. Had it been a full decade? My features were softer, my hair thicker. I glowed with an innocence that has long since faded. As I contemplated my growth as a physician, I struggled to remember her name. My face burned with embarrassment and then settled with a heavy sense of guilt.
So much had been gained over the last couple of years, and so much lost.
*
I have watched hundreds of patients die. I start each journey with a full emotional tank of gas. But as time passes, complications arise, and fuel is consumed at an ever rapid pace. As we reach the finish line, I often feel like I'm existing on fumes.
And when the death certificate is signed, and condolences are given to the family, I run on empty. Of course the tank refills with each and every new patient that walks through the door. But the truth is, my endurance is limited to one fill per customer.
So as time goes by, I often forget details. Names and diagnosis slip through my clenched hands like sands in the hour glass. But themes remain. Love, fear, rapture, joy, and connectedness permeate my soul and affect the person that I have become.
*
When I look at the decade old picture, I realize that my patient was giving me one last gift before she died. As the memories flood back the details become more concrete.
I may not remember her name, but I can tell her story.
I can tell their stories.
Monday, January 2, 2012
An Officer, A Gentleman
I wasn't surprised by the sirens. As I pulled over to the side of the road, my speedometer floated down from the fifty mile per hour mark. The first sign of sunlight was inching over the horizon. I was one of the only cars on the road.
The officer moved at a glacial pace. I imagined him tapping away at his computer similar to how a physician does as he enters a patients room. The flashing lights reflected in my rear view, blinding me. My feet shook nervously as I waited.
It was a hell of a welcome back from vacation. The night before my partner called to tell me that Mrs. Silver was in the ICU. As I listened to his report, I couldn't help but feel guilty.
Mrs. Silver was a charming eighty five year old with her share of chronic medical conditions. For some reason, I doted over her like she was my long lost grandmother. There was something about her essence that brightened my spirit every time she entered the exam room. She was like a whirlwind. Before she left each appointment, she had my nurses and medical assistants pealing with laughter.
*
The day I left for vacation, Mrs. Silver was admitted to the hospital for pneumonia. My partner examined her and started antibiotics. Although she originally began to improve, she suddenly developed chest pain and severe shortness of breath. She was placed on a ventilator and her cat scan revealed a large pulmonary embolus.
Days later she was dying. Her blood pressure was dropping and her kidneys were failing. The family had gathered at the bedside and were waiting for me to arrive to turn off the the ventilator.
After the dismal report from my partner the night before, I barley slept. I sprinted out of bed five minutes before the alarm went off and hurried through my morning routine. Although I couldn't verbalize why I was in such a hurry, I knew I needed to see Mrs. Silver one last time before she died.
*
The officer eventually strode out of his car and walked up to my door. I rolled down the window and started to speak, but he interrupted me.
Are you OK?
It is only years later that I realize that my face must have been a pale shade of gray. My eyes were bulging and the sweat was starting to form on my forehead. Afraid, confused, and worried, I said the first thing that came to mind.
My favorite patient is dying!
His stared at me intently and then his gaze turned to the passenger seat where my lab coat rested comfortably. His voice was steady and commanding.
Go!
As he walked back to his cruiser, I put the car in gear and pressed down cautiously on the gas petal.
It wasn't the first time a police officer would show me a simple act of kindness,and it wouldn't be the last.
I arrived in the Intensive Care Unit minutes later.
Mrs. Silver passed quietly.
The officer moved at a glacial pace. I imagined him tapping away at his computer similar to how a physician does as he enters a patients room. The flashing lights reflected in my rear view, blinding me. My feet shook nervously as I waited.
It was a hell of a welcome back from vacation. The night before my partner called to tell me that Mrs. Silver was in the ICU. As I listened to his report, I couldn't help but feel guilty.
Mrs. Silver was a charming eighty five year old with her share of chronic medical conditions. For some reason, I doted over her like she was my long lost grandmother. There was something about her essence that brightened my spirit every time she entered the exam room. She was like a whirlwind. Before she left each appointment, she had my nurses and medical assistants pealing with laughter.
*
The day I left for vacation, Mrs. Silver was admitted to the hospital for pneumonia. My partner examined her and started antibiotics. Although she originally began to improve, she suddenly developed chest pain and severe shortness of breath. She was placed on a ventilator and her cat scan revealed a large pulmonary embolus.
Days later she was dying. Her blood pressure was dropping and her kidneys were failing. The family had gathered at the bedside and were waiting for me to arrive to turn off the the ventilator.
After the dismal report from my partner the night before, I barley slept. I sprinted out of bed five minutes before the alarm went off and hurried through my morning routine. Although I couldn't verbalize why I was in such a hurry, I knew I needed to see Mrs. Silver one last time before she died.
*
The officer eventually strode out of his car and walked up to my door. I rolled down the window and started to speak, but he interrupted me.
Are you OK?
It is only years later that I realize that my face must have been a pale shade of gray. My eyes were bulging and the sweat was starting to form on my forehead. Afraid, confused, and worried, I said the first thing that came to mind.
My favorite patient is dying!
His stared at me intently and then his gaze turned to the passenger seat where my lab coat rested comfortably. His voice was steady and commanding.
Go!
As he walked back to his cruiser, I put the car in gear and pressed down cautiously on the gas petal.
It wasn't the first time a police officer would show me a simple act of kindness,and it wouldn't be the last.
I arrived in the Intensive Care Unit minutes later.
Mrs. Silver passed quietly.
Sunday, January 1, 2012
Y
I would have sold my soul for those secrets. I gorged on the remnants during gross anatomy, ward rounds, and the sleepless nights of residency. I drank from the cauldron, and inhaled the magic till my jowls were complacent and full. I sat at the table of humanity. My chair neither higher nor lower.
Afterwards, looking into mirror the reflection was anything but transformed; older, but not measurably more wise.
*
I have seen the question in your eyes as you stare blankly at the pathology report held inches from your face. You read the word "leukemia", but shock rearranges the letters as if you are at home playing a game of Scrabble with your youngest son. Your wife holds your other hand, and you both sit silently. You haven't yet begun to process the difficult and possibly fruitless battle that lies ahead.
Until now, denial had been your shameful bedfellow. It whispered in your ear countless times like a forgotten lover.
Just wait. The shortness of breath is only allergies. It will pass.
Your friends noted how the pallor of your face changed. Your wife fretted over gasping breaths when you walked up a few stairs to the bedroom.
*
I have listened to your voice beckon and coax during the silence. Your husband smiles as he sits next to you, oblivious. He laughs one minute and cries the next. His memory is like an annoying fly that buzzes back and forth, but always is barely out of reach.
Your partner has become an innocent. You lead him back and forth about the house as if he is one of the children of your children. Moments and details are lost and replaced with sinister plots.
Someone has been in the bedroom and stolen my glasses!
He sits in a haze of plaques and tangles. He inhabits a world in which you no longer belong. You fill the same space, but he is not your companion.
*
I have interpreted the rise and fall of your syllables as your look longingly toward your son. The beast of mania, swollen and bloated, becomes as sad as the depression. His twenty five year old body is strong and agile, but guided by a brain that is no longer nimble.
You heave on the bile of his physical vitality as it mocks you. You survived the fear and uncertainty of childhood to land here. You talk of your friends, the empty nesters, and how they complain about free time and unused bedrooms.
You long to have space that is yours alone.
*
And as I look back at my four year old daughter who has fallen asleep on the way home from the airport with her hand intertwined with my seven year old son's, I can't help but choke on the irony. How can the world hold such sweet and passionate hope alongside the desperate, crushing pain.
As a physician, I thought I would have developed answers to such riddles. But as I grow older, I realize that my training has been more about answering "how". Such banal descriptions of cells and physiology rarely satiate the hungry. The answers to the fundamentally pressing questions are left to philosophers and clergy.
So you'll have to forgive me. When I thought I was learning secrets, I couldn't have been more wrong.
And besides my empathy, I have little else to ease your suffereing.
I don't know why.
Afterwards, looking into mirror the reflection was anything but transformed; older, but not measurably more wise.
*
I have seen the question in your eyes as you stare blankly at the pathology report held inches from your face. You read the word "leukemia", but shock rearranges the letters as if you are at home playing a game of Scrabble with your youngest son. Your wife holds your other hand, and you both sit silently. You haven't yet begun to process the difficult and possibly fruitless battle that lies ahead.
Until now, denial had been your shameful bedfellow. It whispered in your ear countless times like a forgotten lover.
Just wait. The shortness of breath is only allergies. It will pass.
Your friends noted how the pallor of your face changed. Your wife fretted over gasping breaths when you walked up a few stairs to the bedroom.
*
I have listened to your voice beckon and coax during the silence. Your husband smiles as he sits next to you, oblivious. He laughs one minute and cries the next. His memory is like an annoying fly that buzzes back and forth, but always is barely out of reach.
Your partner has become an innocent. You lead him back and forth about the house as if he is one of the children of your children. Moments and details are lost and replaced with sinister plots.
Someone has been in the bedroom and stolen my glasses!
He sits in a haze of plaques and tangles. He inhabits a world in which you no longer belong. You fill the same space, but he is not your companion.
*
I have interpreted the rise and fall of your syllables as your look longingly toward your son. The beast of mania, swollen and bloated, becomes as sad as the depression. His twenty five year old body is strong and agile, but guided by a brain that is no longer nimble.
You heave on the bile of his physical vitality as it mocks you. You survived the fear and uncertainty of childhood to land here. You talk of your friends, the empty nesters, and how they complain about free time and unused bedrooms.
You long to have space that is yours alone.
*
And as I look back at my four year old daughter who has fallen asleep on the way home from the airport with her hand intertwined with my seven year old son's, I can't help but choke on the irony. How can the world hold such sweet and passionate hope alongside the desperate, crushing pain.
As a physician, I thought I would have developed answers to such riddles. But as I grow older, I realize that my training has been more about answering "how". Such banal descriptions of cells and physiology rarely satiate the hungry. The answers to the fundamentally pressing questions are left to philosophers and clergy.
So you'll have to forgive me. When I thought I was learning secrets, I couldn't have been more wrong.
And besides my empathy, I have little else to ease your suffereing.
I don't know why.
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