Except for a psychiatrist.
Yes, I added that.
Ron puts up a slide with one word on it: suffering. Then he flips to van Gogh’s painting, Old Man in Sorrow.
He asks: What does everyone notice?
I notice he’s hunched over. He’s either super-depressed or hanging out on a commode until a nurse comes to help him back to bed.
Blue. People are noticing lots of blue, naming the shades. Cornflower and marine, all those second-rate crayons you only move to after the real blue is used up.
I don’t know much about art, but I know this is a self-portrait, and van Gogh looks rough in this picture. He’s painted himself in the universal posture of despair.
I’ve sat like that, with my head propped in my hands, usually because I think I might have killed somebody.
Ron asks how people feel looking at it. The group spits out a bunch of predictable adjectives.
I’m remembering the first time medicine put me in this pose. Sitting in the locker room, post-call, head in my hands, just like van Gogh. Shaking so bad I couldn’t get the combination on my lock. Saying into my wet palms, I can’t do this. I can’t do this anymore. The stakes are just too high.
I’d been on call in the hospital every second day for no less than six days. Call regulations said you weren’t allowed to do more than one-in-four, but that limit was just an average over the month. If someone on the rotation was on vacation, or sick, you could end up doing one-in-three. Or in this case, a stretch of one-in-two. You might be part of a skeleton crew of four interns and residents doing call solo, or, when you were on internal medicine, taking call together as a team but covering the entire medicine service, not setting foot out of the hospital, often looking after more than a hundred patients combined. At work and awake for 96 of those 144 hours. Would you want that person even walking your dog? Without a note of irony, we call that being on call in-house. Just not in your own house. That’s why they referred to us as “the residents,” because we lived in the damn place. We might as well have gotten our mail there. Sometimes you wondered whether there was even a point in going home post-call—around noon if you were lucky, statistically more likely to get into a vehicle accident on your way there—only to come back the next morning at 7 or 8 a.m. for a “regular” ten-hour day, until that next on-call shift.
In the hospital, you had a call room, with a bed and a lamp and a desk, but you had no expectation of sleeping—maybe, at best, getting to lie down for an hour or two somewhere between 4 and 6 a.m. Maybe. On an amazing day. You ate meals when you could, usually several hours late, sometimes ordering food with the other residents, sometimes going hungry, because it seemed like so much work to hunt and gather anything more than a Diet Coke and a bag of stale chips from the vending machine. Your pager going off constantly. Patients crashing, needing admission, EKGs and arterial blood gases and acute medical situations: all of that your problem. Everything in that massive hospital felt like your problem, and even though it was full of other interns and residents and somewhere off in a far corner some staff surgeons and anesthetists and possibly a fifth-year resident covering in the ICU, sometimes you could go for hours without seeing anyone other than the patients and the nurses, all of whom wanted to believe that you—with your degree in biochemistry, or maybe even English, and an average of four years of medical school and now a few months of internship under your belt—were somehow capable of solving their complicated medical problems and of operating without the sleep that even the hospital union recognized was crucial to the janitor’s ability to properly disinfect the ward. And he, unlike you, was entitled to breaks.
That shift, the one when I wept by the lockers, I’d been called in the late evening to see a young woman I’d met for the first time that night, a woman with a new diagnosis of heart failure. She had just moved to Toronto; she was from somewhere on the East Coast. She had no family, no friends, no one at the bedside. She was confused, and I was too. Why had she suddenly become unreasonable, hissing at the nurses, tossing things, overturning the bedpans? What could be causing her delirium? Nothing was obviously wrong. Her vitals were stable, her chest X-ray unchanged. I examined her, couldn’t find anything amiss. What would I tell the staff doctor if I called him at home, beyond the fact that a patient had just thrown a cup of ice chips in my general direction? I couldn’t name the unsettled feeling in my gut, a feeling I’d never had before. Or maybe I confused it with the sensory hell of profound sleep deprivation, the pins and needles in limbs too tired to be moved, the leaden heaviness of every breath. I wasn’t experienced enough to know that the moments when we don’t know what’s going on are the moments we need to treat with fear and reverence, because we can’t predict what’s going to happen next.
I stumbled back to the call room and collapsed on the bed, shivering under the hospital flannel before falling quickly into a thick, dark void of sleep. Less than an hour later: another page. I woke up, unsure of where I was, unable to even remember what service I was covering. I called the ward; it was the nurse who had paged me earlier about the young woman. That lady isn’t responding. Suddenly wide awake, heart pounding, running to her room in a state of terror. Pushing past the nurse, finding the woman barely breathing, shouting that she wasn’t responding because she was unconscious, yelling at them to call a code blue, thus summoning a crash cart and the intensive care team. My stomach felt like it was falling out of my body, descending into the heart of the world. The code team arriving in a stampede, filling the room with chaos. No pulse. No pulse. No pulse. The team intubating and ventilating her, and still no pulse. Nothing was bringing it back. Me saying more than once, pleading with the universe, repeating it like an incantation, Please let her be all right. The code lasted an hour. The fifth-year ICU resident ended it. The woman was officially, irrevocably, irreversibly dead: a shocking, sudden death. I couldn’t stop shaking. I told the senior resident: I don’t know if I missed something. Did I miss something? Leaning against the wall, teeth chattering like a wind-up toy. Asking him over and over, repeating myself: What did I miss? What would you have done? What should I have done differently? Should I have done something differently? Is there anything I could have done differently? He wasn’t unkind, but he was cool, clinical. He didn’t chastise or comfort me. He just told me, matter-of-factly: “That’s why we call it a teaching hospital, Jill. This is how you learn.”
How you learn what, exactly? I only learned one thing that day: It was my fault. That’s what I thought: It was all my fault. As if I had intentionally cut into this woman’s already damaged heart with a knife. A sick heart, as thin and fragile as a cellophane bag. Long before the night she died, her life was on a trajectory I could probably only have nudged, not changed. But I didn’t know that then. I had no one to compare her to. And so I left the hospital that morning believing, really believing that a woman was dead because of me.
I’ve carried that case ever since. I’ve talked about it with a few residents, usually after they’ve experienced some similar trauma or perceived failure and I’m ushering them into this exclusive club, where membership is for life.
I don’t want to look at van Gogh, the old man in despair. He should keep that to himself. I stand up, tiptoe through a maze of cushions, quietly exit the hall.
The mirrorless washroom feels like a refuge, as if I can’t follow myself in there. I splash some water on my face, lean against the white wall and peer out the screened window. I pull out my phone. Yes, Ron, I know you suggested we put them away for the time we’re here, but seriously, if I don’t answer messages for five days, people will assume I’m dead.
I text Eric: Are the boys ok?
Of course the boys are okay. What’s he going to say—that he hasn’t seen one of them since Tuesday? The boys are resilient, and well attached, and my husband is an amazing dad, not just a watered-down substitute for me.
I google Old Man in Sorrow. There he is, on my phone, with few paragraphs of random information, includ
ing a subtitle in brackets: At Eternity’s Gate.
Just before he killed himself, van Gogh painted this self-portrait after getting out of the psychiatric hospital.
I hadn’t known that—that he killed himself. Apparently, my knowledge of art history is worse than my ability to spot a gorilla on an X-ray.
He went to be near his physician, Dr. Gachet, whom he sometimes painted.
I google Dr. Gachet. A picture appears on my screen, a deep blue rendering of another very sad man. This blue, blue doctor is gazing at Vincent as he paints, with a look on his face that is probably identical to the look I’d see in a mirror right now, if there were a mirror on the wall in this weird washroom at the Doctor Rehab in the Woods. I enlarge the picture on my phone.
Dr. Gachet is not taking new patients. Please have the courtesy not to ask.
What’s that look?
It’s Dr. Gachet, sitting with it all in that moment, whatever is being given to him. Containment. Holding all the things he can diagnose but not change. It hurts to do that, if you’re doing it well. If it’s difficult for him, we don’t necessarily want to know.
I go back into the hall. People are working in small groups again, talking quietly. Jodie is hanging out by the door, nursing a cup of coffee. She’s foraged one for me too.
She hands it to me. “Where were you, smoking?”
“I can’t even find anywhere to buy drugs around here.”
“I’m waiting for you.”
“That’s why I came back.”
Jodie points at a pair of cushions in the corner. We sit down.
“You joke about everything,” she says.
“Except coffee, remember?”
I remembered. “Do you want to talk first?”
“About what?”
“A time when we were present with suffering.”
Suddenly I’m tired. The sky outside is crisp, cloudless. I can smell damp earth through the open window. I’d like to be out on the grass by the water, upstream, by the little mill.
“Do your patients see you, Jodie?”
She looks at me, raises an eyebrow.
“When you’re in the room with them, talking to them. Do you think they see you?”
She adjusts the cushion, spills some coffee on the hardwood floor, wipes it up with her sock.
“What do you want them to see?”
I pull out my phone. I show her the picture of Dr. Gachet.
“You want them to see this guy?” She studies my phone. “Who painted this?”
“Van Gogh. It’s his doctor.”
“Give me that. Devices are contraband. We’re supposed to be talking about suffering.”
“This guy looks like he’s suffering. And how is this not a conversation about suffering?
“Feeling unknown might be the worst social pain there is.”
“Besides working with blue-haired Canadians?”
“That’s in a class of its own.”
“So what’s a time you were fully present with suffering?”
“Not including breakfast with you this morning?”
“Cut it out, Horton.”
I settle on my cushion. I find a bit of oatmeal on one of my sleeves. I take a deep breath.
A Time I Was Present with Suffering
A tragic story wherein the hero dies and the heroine is emotionally maimed
BY JILL H.
Stan was about forty years old. I met him when I was a third-year resident on the neurology service. He was a karate instructor. He looked like an ad for your favourite gym or maybe even an illegal supplement that was too good to be true. That’s how fit and healthy he was. He had a five-year-old son.
It started with his legs. He noticed they were numb, or weak, or both. He saw a few GPs, and they told him he’d pulled something. Or he had a slipped disc. But things kept getting worse, and one day he couldn’t pass urine. So he went to the ER, and the doctor there sent him for a CT scan of his back. And they saw something in his spinal cord that the doctor told him looked like a “shadow,” and the doctor made references to The Karate Kid, which by then was an old movie, and this was cheesy and cliché and left him with no meaningful information about what was actually happening in his spine.
But of course, everybody thought this was cancer.
Stan was super smart. He was really positive. This was a guy who had read more philosophy than me, but also mushier stuff, like Jonathan Livingston Seagull and The Alchemist. He liked me to be upbeat too. He got that something really bad was evolving, but karate had taught him to believe in the power of mind over body. So every time I came in to tell him something terrible, like, your calcium level is high, which in a situation like this is pretty much cancer leaving a “sorry I missed you” card, Stan took it like it was a training exercise.
He needed a biopsy of the “shadow.” We arranged it, but it kept getting cancelled. Every day he got bumped for a trauma that had to go to the OR, or some more urgent problem than a shadow in your spine. And every day when I got the news that he’d been bumped, even though each day he’d been fasting since midnight, I had to go in to his room, look him in the eye and tell him once again there wouldn’t be a biopsy, apologizing for something I had no control over but that still made me feel horrible. He never once blamed me. He could see I was helpless. He was helpless too. By this point he had no ability to move his lower extremities. And yet, every day, he still managed to ask me how I was doing.
“Oh, I’m fine,” I’d always tell him. “It’s you I’m worried about.”
Then this SARS thing happened. Right in the middle of this. The hospitals in Toronto went on lockdown. Because of a suspected exposure, even though it was incredibly low risk, I got stuck in a quarantine in my apartment, which frankly was the best thing to happen to me during my entire residency. I slept and read trashy magazines, and Eric got me delicious takeout. I stayed out of the hospital for five glorious days. When I went back, Stan had finally had his biopsy. They’d transferred him onto the neurosurgery service. Now I didn’t have to go see him every day, because he was under their care. And to be honest, in a way I was glad I didn’t have to see him. There was such a mismatch between his bravery and the grim conclusion we were inching towards, I almost couldn’t handle it.
A few weeks passed. Visitors of patients who weren’t imminently dying were banned from hospitals in the Greater Toronto Area, while officials tried to figure out how SARS was spreading. I thought of Stan, alone in his room, his wife and child unable to be near him. But of course, I wasn’t banned because I was hospital staff. So one day, after I’d finished rounding on the neurology patients, I resolved to go see him. I took a book I’d bought for him, some dumb thing called Life Is Mind Over Matter, which really seemed hilarious to me at that point, because after three years of residency beating me to a pulp, my own mind was pretty much of the opinion that nothing mattered anymore.
I went to the neurosurgery ward. I knocked on his door and pushed it open hesitantly, afraid of what I might see. We all had to wear yellow gowns and plastic face shields because of SARS, and I must have looked like Big Bird walking into that room. He smiled when he saw me, a smile I didn’t think I deserved. I sat down next to him. I asked how he was doing. He said he was doing okay. He was waiting for the final biopsy results. I’d read in the chart that they’d given him a preliminary result: a really bad kind of poorly differentiated lymphoma. This basically meant he was going to die, but not until we had poisoned him with chemotherapy that probably wouldn’t do a thing for him anyway. Did he know that? I wasn’t sure if he knew that. Should I tell him? It wasn’t really my place, and I didn’t know how much he wanted to know just yet. Sometimes we say we want to know “everything” but might not pick “everything” if we actually knew what was behind that door. The curse of knowledge.
I pulled Life Is Mind Over Matter out of my bag. I stupidly said maybe it would help. It was the dumbest gift of all time, a parka in the desert for a man who wouldn’t live t
o see any other season. But he turned it over in his hands a few times and said thank you at least five times. He was so grateful for this useless book that I started to feel sick about giving it to him. Then he asked how I was doing, especially with all this SARS stuff going on. I told him I was fine, which was a lie, because all of us were terrified we were going to get SARS and die foaming at the mouth and choking on our own secretions. I was panicking every morning walking into the hospital, picturing my parents getting a phone call that I was in the ICU on life support with an incurable mystery illness. This wasn’t hyperbole. An internist at one of the other hospitals got it and almost died. But I didn’t dump that on Stan. I told him we’d get through it and that with time things would settle down. I told him I believed that hope mattered, and in his case nothing was settled until they knew the final results of that biopsy for sure. I told him my sister had cancer when she was six, and everyone expected her to die, and here we were thirty years later and she was still alive. He said, Wow! But of course, I didn’t show him her picture, because I didn’t want Stan to realize that it was possible to come out on the other side of cancer treatment looking like the Bride of Frankenstein when you went in a handsome stunt-double karate instructor or a perfect little girl.
And the truth was, I knew he wasn’t coming out on the other side. I knew he was a condemned man. I looked at him clutching that stupid book and suddenly I couldn’t hold it back anymore. I burst into tears. I remember telling him over and over again how sorry I was. I remember that at some point I wasn’t wearing my Big Bird mask anymore, because I knew I wasn’t going to get SARS from Stan. The only thing Stan was going to give me was a broken heart. We were just holding each other and wailing. And I remember that it felt like Stan was comforting me, because he just kept saying it was okay, and when I’d say I was fine, I was just so sorry, he’d say I know, touching my face and telling me he would be okay, saying it’s okay, but of course it wasn’t okay, so that only made me cry more.
That yellow, yellow gown, a canary, a coal mine. And the photo on the bedside table of his son, Aidan. Aidan was missing a tooth and smiling, and one of the reasons I cried so hard was that I knew Aidan would soon be missing a dad.
We Are All Perfectly Fine Page 9