Helping People Die, or, R3: Internal Medicine

His name was Ray, he was a lovely old man, and he had metastatic cancer.  When he got his diagnosis several weeks ago, initially the plan was to fight it; CyberKnife had shown some decent results with his type of cancer and his family really wanted him to beat it.  The only condition was that he had to gain some strength back before he could begin treatment.  Instead, however, he got weaker.  He quickly lost his appetite and his immune system.  When his family brought him in to the hospital, he was suffering from a bad infection that had set in insidiously but deeply.

The first day I came on his case, I talked with his family as Ray slept.  I told them that for most of our lives, living longer and living better are the same thing, but sometimes we reach a point where those two options fork away from each other.  I told them that we had reached that crossroads with Ray.  The next day we stopped the antibiotics and the blood pressure meds, the fluids and the suppositories, and placed him on comfort measures.  I asked if I could pray for them.  It was a very peaceful prayer overall, intercession for a family that has accepted what is coming and has started mourning, which God can use as its own kind of healing.

I walked out of the room scrubbing tears off my face and ran into their nurse, who looked at me with concern.  "Oh, praying with the dying never gets easier," I said as lightly as I could.  She nodded, mouth twisting with understanding.  "You would think with time," she said, laying a hand on my arm, "but it never does."

I actually love the oncology floor because the nurses and techs acknowledge things like that a bit more readily.  And it doesn't seem to be getting easier, at least not for me.  This time I think I actually mourned in aggregate, seeing as I prayed several faces of past patients that I assisted in the dying process.  The sense of grief lingered with me the whole day, making it hard to move on to other patients who needed me to be present.

I cried all the way home.

I don't know why internal medicine does this to me.  I find it exhausting.  It certainly is honourable work, helping families navigate the medical system and helping terminal patients die well... but I personally can't sustain it.  Whatever distance other practitioners have that lets them disengage easily, whatever perspective they have that helps them feel that death is not a failure, I just don't have it.  I think this is an area where God wants me to grow, but I'll admit that I don't understand how.  There's a balance there that I have always struggled with.

Ray died about a day after being placed on comfort measures.  He was surrounded by his family, and there was laughter as well as tears.  I can tell his was a life very well lived, and I'm glad he's free from pain and finally home with his Father.  One of my duties in these situations is to declare time of death.  After I had done what I needed to in the room, we prayed again, and as I was about to leave, Ray's daughter stopped me. "Thank you so much," she said, "for helping us to have this time and let him go.  He gave us so much.  We were grateful as his family we could give him this last gift - to pass naturally and in peace."

Honourable work indeed.

Well, That Took a Long Time, or, The Price

Things are getting better.  They are certainly better than they were a year ago.

I contemplated apologizing for not writing for so long, but whatever.  I'm allowed.  I had very little to say this past year anyway.  I finished intern year without any major (external) problems and moved on to being a senior resident.  In my program, rank has some privileges; your workload drops from 80+ hours a week to more like 60, and (most importantly for me!) you don't have to get up nearly as early most of the time because you do more outpatient, or clinic, rotations.  I do not miss 4am!

All of that luxurious ease (ha), however, made it possible to sink into a state of quiet apathy.  It was easy to do, and apathy has a lot to recommend it for someone who's coming back from hysterical sobbing in the middle of the resident lounge.  You don't enjoy much, but you also don't have to walk around bleeding emotions on everyone, which is not my favourite.  I learned a lot of medicine.  I did not learn much about myself or grow much in my understanding of Christ.  The ice started cracking this summer, though, and I have been a bit sad to see it go.  I'm not saying that's a good way to feel; I'm just being honest.  It was very effective self-protection.  I think the last couple of years (and in a wider way, the last six years or so, with my husband's deployment and all) taught me a lot about how to be afraid and how easy it is to get compacted into a smaller person by the worries and risks of this world.  I think I needed to learn this first so that I could be prepared for the next lesson - how to love people anyway. 

Jesus tells us to count the cost of following Him - "Whoever does not bear his own cross and come after Me cannot be My disciple.  For which of you, wanting to build a tower, doesn’t first sit down and calculate the cost to see if he has enough to complete it? Otherwise, after he has laid the foundation and cannot finish it, all the onlookers will begin to make fun of him, saying, ‘This man started to build and wasn’t able to finish’...  In the same way, therefore, every one of you who does not say good-bye to all his possessions cannot be My disciple."  We can understand from the larger context of Luke 14 that Jesus is not only speaking of the willingness to give up material possessions.  He is also referring to the willingness to abandon ourselves to serving the goodness of His will.  There is a vulnerability required in showing people love.  And there is inherent danger in showing love to people who you don't know; in fact, there is a guaranteed emotional price that you will have to pay, because not all of those people will choose to love you or the One who sent you.  You will at times be betrayed and abandoned by the strangers you have chosen to love.

I paid that price a couple of times as I was learning to serve people at the beginning of residency and I didn't like it one bit.  God knew I would react that way and He very kindly gave me time and the comfort of His Spirit to pull back somewhat and heal up.  For a while it seemed as though I'd gone through something horrible that it would've been better to avoid.  I'm remembering, though, that my call as a Christian - and by that I mean the regular everyday Christian job description - makes no mention of safety of any kind.  It says God will go with us, that He loves us, that His ways are good and His plans for us individually and collectively are also good, but safety and comfort are not guaranteed.  Despite that I say God is worth it.  His kindness, the peace of His Holy Spirit, the care He takes with my life - these things remind me that the price is not too high.  I am still, after almost ten years, only beginning to learn how to walk with God, but I have learned that His presence is immensely valuable to me.  More valuable than safety.  More valuable than any price I could pay.  And I believe that even more good will come from this painful lesson. 

He has stuff for me to do.