For months, as I’ve visited Evan as his hospice social worker, he’s been praying to die. In his early nineties, he has been dealing with colorectal cancer for more than four years, and he’s flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.
On this visit, though, his depression seems to have lifted. He’s engaged and upbeat–and this sudden about-face arouses my suspicions: Has he decided to do it? Is he planning a way out?
A few months ago my friend Phil gave me a newspaper clipping from the Sunday New York Times on body-focused repetitive behaviors, from nail-biting to hair-pulling to skin picking. I know he gave it to me because he wanted to help me with my own problem. He’s heard me express my frustration about it at the support group for faculty in our family-medicine residency.
I had planned to take care of my dad at the end of his life.
In 2009, Dad retired at seventy-five because of Parkinson’s disease. Over the next couple of years, he lived in his own home. My younger brother Mark, who lived nearby, faced the first difficult milestones brought on by Dad’s declining health. Mark was the one to tell Dad that he could no longer drive. And after Dad moved out, Mark took on the monumental project of cleaning a half-century of detritus from the house Dad left behind.
“I long, as does every human being, to be at home wherever I find myself.” — Maya Angelou
Before starting my dive into medicine, almost four years ago, I was an avid violinist, pianist, disc golfer and novice chef. Each of these activities felt comfortable and familiar–like “home.” But when I began medical school, I somewhat wistfully set them aside to focus on becoming a doctor.
I was young when I met Larry. Well, not that young: I was thirty-one. My medical training–thirteen years in all–was finally over, and I was working as an instructor in the child-neurology clinic at the University of Michigan, Ann Arbor, and caring for kids with epilepsy.
My patient Larry was seventeen. A stocky, dark-haired, nonathletic boy with borderline intellectual disability, he suffered from depression, and my notes mentioned his “pugnacious personality.”
As a third-year medical student midway through a family-medicine rotation, I’m supervised by a family physician in several free clinics in our large city.
On Fridays, we run a clinic for torture victims who’ve left their home countries to seek asylum in the US. I’ve been following a new patient, Julian, an African refugee.
Julian is a small, thin man in his early thirties. His large eyes, shy smile and soft voice belie the determination and resilience evident in his story.
On a damp, overcast Friday morning, I was wandering around the downtown area of a nearby city with my camera. I found an interesting scene and photographed it, carefully adjusting my camera’s settings and the composition until I felt I’d conveyed what I’d felt when I saw it.
Lowering my camera from my eyes, I realized that, for the first time in months, my mind felt clear and my heart felt open. This realization struck me so hard that I sank onto a park bench. Tears of relief and sadness leaked from my eyes.
Opening my purse to pull out my reading glasses, I notice the small white nasal-spray bottle still encased in its clear plastic packaging. I’ve been carrying it for a few months now. Do I feel reassured seeing it there?
As a physician, I wonder if the chance is greater that I’ll one day use this bottle to save someone’s life than it is that I’ll rescue someone with CPR or the Heimlich maneuver.