“That will be the easy part. Compared to what invariably follows, this will be the sweet phase of the process. The next phase will be bitter and prolonged; even unpalatable to the point of insufferable when you’re back at home.
“It’s the other parts,” I continued, “the mental, emotional, and spiritual parts, that are harder because these are the parts that you have to do. Not only do you have to begin this healing while you’re here, but you now have to accomplish it without the old crutch of the alcohol. Sure, alcohol can ruin your life in the long run, but it served the purpose of being a pretty powerful coping mechanism for a very long time. It was an aid that helped you survive. Now you take the alcohol away and you deal with your life sober. All that stuff that was drowned out by the alcohol when you were little, before you went to war, when you went to war, when you came back from war—now you face that stuff without the drink. We are here to help, but even with the therapists, social workers, groups, and medications, it will be challenging—but worth it. You’re a strong man, and you’ll get beyond this to be stronger than you’ve ever been, stronger than most people will ever be in their entire lives. You’ll get beyond this so you can be happy, so you can have a job that fulfills you, so you can be the father you want to be to your son, so you can tell the story of your survival and your victory. This is the story that will save your life and the lives of many others, so it is truly all well worth it. And you’ll need to remember this end goal every hour of every day because this will likely be the hardest thing you’ve ever done in your life. And you can do this.”
He drew a deep breath and nodded as he clasped his hands in front of him. He sat upright on the bed, sturdy, preparing himself to win an exacting victory.
“Again, many good people are here to help you,” I continued, “but the most important thing is that you must want this for yourself and that you are willing to do the work to claim it. That’s the only way it happens. This decision to own your life every second, which will turn into every minute, which will turn into every hour, and then into each day, one day at a time. Eventually it’ll be second nature. And one day soon, it won’t be hard anymore. It’ll just be everyday life, like breathing.”
I could see the resolve in his eyes, the move he was making in allegiance to his health.
“Thank you, Doctor. Thank you.”
I extended my hand. “Mr. Wade, one day come back and tell me your stories. Tell me your stories of how good it is. Just remember: First it will be challenging, and then you’ll be free.”
We shook hands. I felt his heartbeat pulsing in my hand. He nodded again. “Thank you. I will.”
All of Ms. Hernandez’s results were back. When I returned to her room, I saw her lying on the stretcher with her head resting back and her eyes closed. I knocked on the door, and she opened her eyes with a smile.
“Welcome back. All good news. Let me just cycle your blood pressure while I give you the update.” I pushed the button to start the measurement again. “As we anticipated, your blood work was all normal—your kidneys, electrolytes, et cetera. Your chest X-ray was normal, and your head CT, too.” The blood pressure cuff stopped cycling, and I regarded the reading. “And,” I stated in the way of all great game show hosts, “your blood pressure is down to one-fifty over eighty-seven!”
She sighed and raised her hands in a little happy dance. “Praise Jesus. Doctor, you know I just sat here and breathed. I meditated like I used to do in martial arts. And it worked!”
It had worked. It worked better than the pill we could have given her, better than the medication we could have pushed into her veins. Sure, it’s always faster in the moment to silence the body’s ailments pharmacologically, to write a script in lieu of having a conversation. When your main goal is to get through each patient encounter as quickly as possible, these approaches will do. But if the goal is patient autonomy, to support patients in achieving long-term self-generated health, it’s better to pay careful and thoughtful attention to the roots of what makes us healthy.
“Of course, follow up with your doctor for a blood pressure check. Best to call them today to arrange it, since they referred you to the ER today. It’s still a little high, so they may need to tweak your medication. I know you’re super busy and you have so much to do for your family, but your body and spirit are calling out to you, asking you to take care of yourself so you can remain the healthy, strong, caring person you are. Know what I mean?”
“I do, I do,” she said, smiling.
“And that’s all you need from us today. This was the universe’s way of tricking you to come in simply so you could be reminded. That’s it, that’s your message.”
As she collected her belongings and prepared to leave, Ms. Hernandez expressed her rejuvenated commitment to self-care.
“I’ll write up your discharge papers so you can get on with your life. Any questions?”
“None at all. Thank you, Doctor.”
I signed my notes for Mr. Wade and then completed discharge papers for Ms. Hernandez. Dale had picked up the two new patients. Five new patients were in fast-track, and it looked like the three patients in the waiting room who had just signed in would be coming over to the main ER—two medical and one psych. Perfect timing, because both Dale and I were just tucking in the patients before them.
As I waited for the new patients to be triaged, I considered the journeys of Mr. Wade and Ms. Hernandez. Mr. Wade’s door to healing had opened in a loud and dramatic way: by armed men who had literally come knocking at his door (before breaking it down). He had been passed out on the floor, a limp heap of a man, and then he had been jolted awake. Ms. Hernandez’s call came quietly—a slow throb at her temples, a dull ache of fatigue that goaded her to get checked out “just in case.” As she was waiting for the results of our tests, she had brought herself to stillness; she had found a way to gather herself into a healing peace.
Both these patients had let go in their own ways as they moved toward health. And isn’t that how healing usually happens? In these ordinary times, in these everyday moments, people open themselves to what serves them most.
It’s with these chronic states of dis-ease that prescriptions of traditional medicine fall short. Don’t get me wrong—heaven forbid, if I’m hit by a car or contract bacterial meningitis, 911 me to the nearest ER for the best that traditional medicine has got. (And, yes, vaccinations are good.) But once traditional medicine has delivered me from that acute phase of illness, I know that if I want to stay well, the root and core of that health come only from complementary means. It was acupuncture that alleviated my seasonal allergies, thereby permitting me to stop an exhausting regimen of allergy shots, nasal sprays, eye drops, and two different antihistamine pills. It is yoga, cardio, and Pilates that keep my body limber and strong. Maintaining a healthy diet—well, that does everything. My meditation practice has made it possible for me to live in a way that is nourishing while the rest falls away. For the chronic conditions of daily life, it is these other modalities that will stave off depression, anxiety, hypertension, high cholesterol, diabetes, obesity, heart disease, stroke, and cancers so that we can find a better quality of life than we can by adding yet another bottle of pills.
Ms. Hernandez, Mr. Wade, and patients like them inspire me. I, too, knew instinctively to stop fighting for my life and begin allowing it. In this way, I had to let my attachment to Colin float away in order to permit both of us to be our best selves. He needed time and space to decide whether he would be a warrior in this life. My decision had been made: I was a warrior already. Whether it took Colin the seventy years it had taken my father or simply the next twenty, he deserved to go at his own pace, as I deserved to continue at mine. With that realization, I had walked away from Colin softly, quietly, and decidedly. Somehow, with only the effort it takes to let go, receive, and believe, what my heart called for would come in. My dis-ease would dissolve. This time now was the invitat
ion to be okay, even happy, without filling in the details of how my love would come to me, how my family would look, or what the final destination of my professional journey would be. While I figured out the next bold career move, I would continue to serve. This was the time to live my love now. No better time.
ELEVEN
Jenny and Mary: What Falls Away
My first day back, and I can’t stop thinking about the goo I discovered between the pages of the in-flight magazine.
Come to think of it, I’m probably one of the few people in the world who actually reads the in-flight magazine tucked in the seat pocket in front of us when we fly. Maybe it’s an extension of my type-A personality, but part of me believes there could be some critical morsel of information in it. Or it could be that I’m still gullible enough to think that if the airline put it there, it must contain a safety update necessary for my survival or, at the very least, a surprise deal on the afternoon snack. Or maybe I’ll be tipped off about the perfect place for Sunday night jazz in Nashville, should I ever go there. For all these reasons, one of the first things I do whenever I board a plane is check out the magazine. And after years of my being vigilant, my last trip delivered.
In the midst of everything—the job switches, the blockage of my complementary medicine center, the breakup with Colin, the what-the-hell-am-I-doing-with-my-life internal conversations—I had forgotten that I had volunteered to attend the VA conference on women’s health. While it turned out to be, arguably and quite sadly, one of the poorest-quality conferences I had ever attended in my medical career in terms of providing the attendees with comprehensive, up-to-date medical information, there were a couple of highlights: The patient models who coached us in optimizing our physical exam skills were masterful, and a female veteran gave a heartfelt talk about how she had survived her time in the military. While I was used to providing female veterans with general medical care and treating their military wounds related to sexual assault and harassment, there were other aggressions on military women I hadn’t yet considered before hearing this vet share her experience: for example, the various chronic pain syndromes that developed from their being forced to use gear that had been specifically designed for male bodies. While women were allowed in the military, in most cases they weren’t permitted to exist on an equal footing with men.
There were three nonclinical elements that made the conference worthwhile as well. My fellow conference participants were delightful. Of course, we swapped the all-too-familiar stories of the creative workaround strategies we used to compensate for the lack of resources at our respective sites, from the Carolinas to Colorado. The fact that this was often done over quesadillas and drinks by the pool only added to the camaraderie. Hearing about the dedication of my colleagues in other parts of the country was a nice reminder that there are still doctors and nurses out there who aren’t willing to give up on the art of medicine or on the people who rely upon it.
Then there was the hotel fitness center’s steam room, the discovery of which inspired an unreasonable amount of joy in me. I can always find refuge in a steam room. Whenever I use one, any toxic thoughts expire on the vapor, leaving space for positive inspiration. Assuming a sense of ease as I breathe in the sweltering steam is the only way the extreme heat becomes tolerable. This requires the engagement of every component of yoga—the body, the breath, and the mind. In this way, within seconds of my entering its quarters, the steam room challenges me to achieve alignment. My reward? An ultimate fast track to the infinite.
As if primed by the steam, I was now ready for the pièce de résistance of the trip. On my flight back to Philadelphia, after I collapsed into my window seat, I picked up the in-flight magazine. After skimming the ads for watches and suitcases, followed by hot new restaurant listings across the globe, I happened upon an article about the life cycle of butterflies. As I learned in my youth from The Very Hungry Caterpillar, a butterfly begins in the caterpillar stage, in which it eats and eats and eats, and finally ends up majestically bewinged. But I didn’t know that after this growing caterpillar enters its cocoon for the pupal stage, it literally turns into goo. Apparently, scientists don’t understand why or how the caterpillar form breaks down during this period of transformation in order to emerge as a butterfly.
As I placed the magazine back into the seat pocket, a thought struck me: That’s truly how it is, isn’t it? As long as we’re willing to move forward, to nourish our body and spirit and allow for the disintegration of any attachment to patterns that do not serve us, without our understanding exactly how the next bits will fall into place, beautiful outcomes do unfold.
Back at work, I continued to ponder this process of transformation. Breaking my butterfly daydreams, an announcement blared over the speaker system: Campus response parking lot level C. Campus response parking lot level C. Within minutes, the campus response team, the group of men and women designated to respond to potential medical emergencies throughout the hospital, were rolling in a stretcher bearing a small, limp patient: a child. A distressed young man followed quickly behind them. The team assembled in Room 4, encircling the child. I stood at the foot of the bed and supervised Jaya, the medicine resident on her ER rotation, as she assisted in care for the patient.
“What’s going on?” Jaya asked the team leader.
“Twenty-two-month-old with febrile seizure. She was here today with her dad, visiting one of the patients. She has no past medical history. Dad said she’s had a cold for the past couple days and fever this morning. She started to have jerking movements in the parking lot, and a bystander called for help. She has appeared post-ictal the whole time with us. Dad said the seizure lasted for less than a minute, and she’s been like this since. No seizure activity with us.”
The child was small and beautiful in her golden yellow dress decorated with unicorns. Soft brown curls swayed from side to side as she stirred languidly on the bed. Her thick black eyelashes fluttered as we positioned her on our stretcher. Her eyelids stayed closed, then tensed for a moment as if she were warding off a nightmare, before relaxing back to whatever dream state she was in. The nurses rapidly scrambled for pediatric supplies to get a set of vitals. When we hooked her up to the monitor, we found her heart rate was in the 120s, saturating 97 percent on room air. Her temperature was 100.5, and her blood sugar was a reassuring 89.
“Jaya, please go talk to Dad and get any additional history and come back with the scoop,” I instructed. “We’ll continue the case together at that time.”
I turned to the tech. “Liza, please help completely undress baby Jenny. We need full exposure.”
To the nurse assigned to Room 4, I said, “Ted, we’ll need basic labs, chest X-ray, and urine. Let’s also give a bolus of normal saline at ten cc/kg.”
Jaya returned, and we examined this little doll together. She moved her extremities spontaneously in reaction to our gentle touch. She flinched, and her lips curled in a slow-motion cry, when the IV was inserted, and then two tears formed in her right eye before she slipped back into her stupor. While she wasn’t yet alert, at least she was intermittently responsive. Her skin was flawless from the crown of her head to the bottom of her itty-bitty toes. Her diaper was normal and wet with clear, light yellow urine. Jaya lifted the child’s eyelids to reveal large green eyes with pupils that reacted to light. Tympanic membranes and oropharynx normal. Lungs clear and heart sounds normal. The abdomen was soft and appeared to be non-tender.
“Jaya, you want me to enter those orders for you?” I asked.
“Please, Dr. Harper.”
At the computer, I clicked on all the boxes I needed: chemistry, CBC, urine, chest X-ray, liver function tests. Wait, I said to myself, I wasn’t going to order liver function tests. There honestly was no reason to get LFTs in a healthy, febrile seizure patient. But this child wasn’t waking up, so the situation could be turning into a more serious medical issue. I moved the cursor over the LFTs to unclick it
, but then I didn’t. I couldn’t bring my index finger to press the button down.
Something just felt wrong. I had no good reason to suspect badness here; after all, apart from her semiconscious state, the child had a normal exam.
The dad, who was now at the patient’s bedside after we had completed our initial evaluation, appeared to be appropriately concerned as he caressed the child lovingly between medical interventions. The stories he’d given to the rapid-response team and to Jaya were consistent, but I decided to go ahead with the test anyway. There were greater crimes than adding one extra, non-evidence-based test to a pediatric patient’s evaluation. Perhaps there was some metabolic issue that LFTs would help elucidate, I said to myself, knowing full well that this was untrue. I signed my orders and waited.
“Dr. Harper, we might as well get this kid ready for transfer. Even if it turns out to be a simple seizure in the end, she’s not waking up, so she needs to go to a pediatric hospital for further testing and observation,” Jaya said.
“One hundred percent agreed, Jaya. And this is why you’re one of my favorites.” I smiled.
“So far, we know her exam, vitals, blood sugar, and urinalysis are negative. Her chemistry is fine, too. Her X-rays are pending. I’ll call the Children’s Hospital now for transfer,” Jaya said.
As Jaya went to do that, Dr. Berry, the attending working the fast-track section of the ER, approached her to see if she would be interested in helping with the reduction of an acutely dislocated shoulder when we finished our case. I told Jaya I’d finish the calls and paperwork on our case so she could complete the joint reduction with Dr. Berry.
The Beauty in Breaking Page 21