Gratitude

I sat by her bed for many consecutive days in the ICU, tubes running out from under stiff white sheets, making the trip to Boston after working all day. No hope was whispered around corners, from the quiet lips of nurses, and in a physician’s office the impossibility of a heart valve replacement was given to us.

While on a recent hike, I reached the top of a hill. It wasn’t much of a climb, but I was glad to be alone so I didn’t have to hide the fact that I was out of breath. Perched at the top was a bench. I sat down, still breathing hard, and took in the vista. During the climb, my eyes had been focused on the ground in front of me. I took a picture that I’d probably never look at again.

Not so far away from cornfields ripe for harvest, the pinnacle of Nebraska’s beauty unfolds each October around a two-lane crevice through a section of Omaha. It is the envy of all streets in the Happy Hallow neighborhood, yet it is not boastful. I do not reside on it, but I get to enjoy its bounty nevertheless. In summer, kids play football in yards and sell lemonade and rocks. While other seasons offer their views–spring with its purple blooms and winter with its holiday fanfare–it’s the October evening air that bestows a magical weightlessness.

As anyone in health care knows, work has been difficult this past almost-two years. There are layers of dysfunction and disconnect. Despite our collective fatigue and overwhelm, however, we show up and do our best. We apologize for the system, the lapses in care, the way that everything feels complicated. This emotional work is heavy. Sometimes I have the image of myself, like Atlas supporting the globe, hunched forwards with my patients piled on my back. I am carrying them to higher ground.

According to Oprah Winfrey, it’s when we feel least thankful that we are most in need of what gratitude can give us: perspective. The neurologist Oliver Sacks expressed a similar idea; his reflections on what it means to live a worthwhile life were published posthumously in a book titled Gratitude. Diagnosed with a terminal illness, Sacks wrote that his predominant feeling was one of gratitude, expressing appreciation both for what he had been given in life and what he had been able to give in return.

I wasn’t looking for a new dog. I had recently lost my best friend of over sixteen years, a beloved terrier mix. My sister had dragged me into the shelter so that she could get a new cat. So, while she looked at cats, I decided to pet all the dogs, lingering a little longer with the ones that looked the most sad.

The shelter staff began to follow me like I was a shoplifter. “Can we help you find a dog?” “What kind of dog would you like?” “Would you like to meet that dog?” Desperation tinged their inquiries.

Late one evening, in Open Heart Recovery, my seventy-five-year-old patient’s temperature shot up from 98 to 103. I gave her Tylenol suppositories, double-checked the blood she was getting and called her surgeon. Dr. Vance instructed me to repeat the Tylenol, add intravenous steroids, then quickly hung up the phone. He needed some sleep after performing cardiac bypass surgery all day and on-call.

Mrs. Smith’s elevated temperature both worried and puzzled me. She might be having an allergic reaction or malignant hyperthermia.

I was on the 36th hour of a 48-hour ambulance shift. We had been up all night and had remained busy all day. I was starving, so I ran into a deli for a quick fix. The kid behind the counter told me they were closed. I paused, jaw dropping in disbelief.

“Just kidding, boss,” he cackled.

Being over ninety years old, I have a long list of things to be grateful for. I’m especially grateful for all the lessons I learned over the years that helped me become a better practitioner.

Much of this was acquired fortuitously. The era in which I began my practice. Having four dedicated children who taught me to be fully present by never hesitating to tell me when I wasn’t.

A tug of war lives within me, and my physical body and soul are struggling mightily. Gratitude pulls one end of the rope, and burnout yanks the other. I feel immensely grateful that I can meaningfully contribute to people’s care during the pandemic. I’ve triaged, tested, talked with and tended to countless patients since COVID-19 began. I am blessed with wonderful family, friends and community plus a job with deep purpose and meaning. Each workday I feel enriched by those around me.

Today, I am grateful. After eighteen months of fear, uncertainty, anger, weariness and despair — today, I feel hope. It is finally the day that the two youngest members of my immediate family have been vaccinated against COVID-19, making our family circle of protection complete. 

As a pediatric hospitalist, I have seen plenty of acute COVID and MIS-C. I have nearly lost my mind trying to home-school my children in the early days of the pandemic, while also working full time.

Each morning when I wake, my first thoughts are of gratitude—for the soft bed in which I lay, deliciously warm as I pull my down comforter around my shoulders.

Yes, I may also be experiencing nausea, diarrhea, neuralgia, an acne-like rash reminiscent of my teenage years covering my face and bald head, and the permanent swelling in my left arm from lymphedema. The side effects of cancer treatments seem endless.