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Sunday, November 13, 2016

The Illusion of Impermeability

by Laura Patel

As I sat in my hospice interdisciplinary group meeting, reviewing the many patients who have died in the past two weeks as well as our new patients, there was a slight break in the discussion. Being ever the multitasker, I clicked on a NY Times article I have been meaning to read and scanned the first two sentences: “When my husband died from cancer last March at age 37, I was so grief-stricken I could barely sleep. One afternoon, I visited his grave — in a field high in the Santa Cruz Mountains, overlooking the Pacific Ocean — and lay on top of it. I slept more soundly than I had in weeks.” Suddenly, I felt sharp tears forming and a sob threatening to release itself. I quickly closed the article and came back to the present moment, discussing the complexities of our patients and families.

After the meeting was over, I retreated to my office and closed the door. I reopened this beautiful essay written by Dr. Lucy Kalanithi, whose young physician husband died from lung cancer. His book “When Breath Becomes Air” was released earlier this year. She tells of their life together, his life-changing diagnosis, and the unbearable grief she felt after he died. I found myself with tears streaming down my face, deeply moved.

Working in the field of hospice, we are continually reminded of the fragility of life. We walk down the road of grief, loss, pain, fear, and acceptance with all of our patients every day. We have to maintain an ability to be present while maintaining boundaries in order to continue to provide the compassionate and difficult care that hospice requires. But sometimes, there are certain patients or families that just get to us. Perhaps they remind us of our own loved ones, or of ourselves. Despite understanding that death is a natural part of life, we still fear our own mortality and the mortality of those we hold dearest. As physicians, we serve in the role of healer, held at an arm’s distance from the other side of the hospital bed. We can easily lull ourselves into the illusion of safety and impermeability. All it takes is to lose one of our own to remind us that the imaginary line between doctor and patient is truly precarious.

Reading this essay jolted me in a personal way. This hit close to home. Two students who fell in love the first year of medical school; a husband with a background in English literature who chose to pursue a career in medicine, but still yearned to write; two physicians spending the majority of their waking hours in the pursuit of knowledge and service… and now a widow who is now left to raise her young daughter alone... With the exception of the last statement, this could be a description of my life. For a moment, I allowed my thoughts to go to that heartbreaking place of loss, fear, and loneliness: it was nearly unbearable.

It is no wonder we in the modern world often distract ourselves with stuff, with technology and gadgets, with food and alcohol, with self-made drama. Anything would be better than to think about the terrifying possibility that we could lose it all in an instant. And yet, that potential for loss, that recognition that nothing is permanent, is what helps bring meaning to our daily existence. No matter how tightly we squeeze, we cannot hold onto anything forever. It will slip through our fingers, changing shape as it slides away. We can scramble to try to chase after it, or we can relax and appreciate the feeling as it slips and slides across our hands. Either way, it will be gone.

As we approach the season of Thanksgiving, I want to consciously go about my life and my work with intention. I will try to find the moments every day that create meaning. I will not wait to express gratitude, love, or kindness. I will dig into the moments that feel uncomfortable as they often coincide with opportunities for growth and transformation. This is my promise to myself.

Laura Patel, MD is the Chief Medical Officer at Transitions LifeCare, a nonprofit hospice and palliative care organization in Raleigh, NC.

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