Wow, I wrote this a long time ago, and I’m not sure why I didn’t post it at the time. This goes all the way back to March, when Lime was still working intensively in the hospital. But it’s still true now, and perhaps, as she’s studying for her biog, fat, important exams in the next few days and months, seeing this will give her a little strength. So I’m going to post it here, now.
But I’ll put what wrote back in March in the extended post, because (a) it’s a bit personal, though I still want to post it here, and (b) because it’s also a bit gory, shocking, and perhaps disturbing. If you have no wish to see the scary, painful, tragic side of learning to be a doctor, of working in a hospital, you may wish to skip this.
Have you ever seen what liver cirrhosis does to a person? When the liver stops filtering toxins effectively, and the toxins go to their brain, and they start acting like a completely different person? When they need to be held down for an enemato aid in the removing of toxins from the bodyand they fight back in a strange voice, saying things they never would say in front of their family, as the family looks on in stunned horror, too shocked even to cry? And felt the clear tragedy that he did this to himself, without knowing it, and that for that, his family must suffer? Have you tried to reassure his wife that everyone understands this is part of his condition, that he really isn’t violent or crazy, and met with only the woman’s palpable, blooming sorrow?
Have you ever looked into the eyes of a girl so young she is still, really and truly, a child, who is pregnant for the fourth time and who explains that her boyfriend refuses to use a condom is simply because he doesn’t like them?
Have you ever gazed into a person’s opened chest and actually seen cancer, spread out within his abdomen like a little colony from another land, looking for all the world as if some restaurant waitress had spilled a bowl of rice grains all over his internal organs, and heard the man say, “I don’t feel any pain!” and know that, in a few days, he will be in agony, and soon after will die? And not said anything to him of what is to come, on account of the fact that his wife has told him nothing of this because wants him to feel hope, at least for the few days he has left before the awful, inevitable pain kicks in and he starts the quick descent into death?
Have you ever looked into the eyes of someone who tried to kill herself, but swallowed only a thimblefull of bug poison, and had to try not to laugh because of the preposterousness of the attempt?
Have you ever performed CPR on someone you know is about to die officially, but who for almost all intents and purposes is dead, and looked at her as a human being afterwards? Have you noted how she is wearing a fastidiously clean pink sweater and a nice skirt, and that her underclothes are scrupulously neat and tidy, despite her extreme age, being in her nineties? Have you ever seen the life slip away from someone, and still looked upon the body she left behind as human, worthy at least of dignity, and seen the pain-filled eyes of her son looking on? Have you watched as others walked away from the body, without a thought to how she would want to appear, and after they’ve left, have you pulled the skirt back down over her legs to cover her, and pull the sleeve down to cover where the blood was taken out? And had the image of that woman’s neatness, her simple obstinate tidiness haunt you and pain you, as other eyes meet yours?
And have you ever walked out into the world, after seeing these things, and wondered what you were doing, who you were and where you were going, whether this whole thing was worth it?
All of these moments are not mine: they are Lime’s, shared with me over the months and months where she has been looking into the real world of the hospital, the doctor’s world.
And so I am learning from Lime, every time we meet and talk, about the kind of tragedy that surrounds doctors, being surrounded always by the sick, the weak, those who are pricked by aches and those who are slowly, or rapidly, sliding into the dark waters of death. I have seen how difficult it can be to move among the dying, to give them what help you can, and to be unable, sometimes, to help at all, or to only administer help by doing things that the people you’re helping cannot understand, which they cannot accept, which shames them: the old man who fights you off when you must insert a Foley catheter, the child who whines and begs you to be gentle when you check to find out why his poor little penis is red and swelled up, the teenaged girl who has come to ask you to kill the life in her belly, even if it should cost her the ability to bear a child when she finally wants one.
I get the feeling that despite the brief moments of laughter and lightness, that sometimes being a doctoror at least, being a doctor in certain departmentsis like being in the middle of a horror show; like seeing nature, red in tooth and claw and bacterium and virus and metastasis, and having to keep your white coat on, keep your calm. And what are you supposed to do?
You’re supposed to just do what you can to help whoever you can help. Run through the algorithm of diagnosis again, for ther Nth time in the day, to give the current horror a name. Help those who needn’t die, comfort those who must.
Of course, it’s not always that way. Sometimes, or in some departments, it is very often lightness and laughter and the joy of a child being born, or the luck of a disease found early and averted, or the peacemaking of talking with someone who needs to talk, or of just being with mental patients as they go through their routines. But it can very often be a trying, difficult kind of work, and the more I learn, the more I see of what she’s living through in her experiences at the hospital, the more proud of Lime I become.
And I am most proud of her because of the way she retains herself through that kind of experience: the way she thinks that the old woman would prefer not to have her body left with the skirt hiked up, and the sleeve pulled up her arm; the way she feels pity for the inmates (yes, inmates) at the psychiatric hospital outside of town; the way she felt sweet amused sympathy for the little boy in Pediatrics who begged “Gently, gently” as his pants were taken down, and as, after the interns finished checking him over and got him dressed up, he pulled his pants down again to check that everything was still there.
After all, I suspect it’s not living through all these kinds of experiences that is the most difficult challenge: I believe it is retaining yourself, some sense of compassion for these people, some of whom made themselves sick, some of whom don’t want to be treated, some of whom surprise you or even look silly. Respecting them as people who have come to you, opened up themselves, given you their bodies and asked for help in the same kind of voice they pray in, it’s quite a thing to continue to respect them through that, to continue to care and to feel what you have been given is first and foremost a heavy, precious burden, one which not everyone can carry, one which you even doubt yourself able to carry at times. And it strikes me that, she asks these questions honestly, to herself, while I suspect that too many of the interns, residents, and even doctors she’s talked about in the pastthose whose eyes light up at the mention of money or of glorynever even begin to broach the kinds of thinking that lead to these questions that she has wandered through like a dense, bristling thicket.
And that is why I am most proud of Lime.