We are here.
At the foot of your bed,
I warm your limp feet in my hands.
A daughter cleans your mouth, a thirsty anemone.
Your only action is its eager suckle
of the sponge. My sister’s
offering is careful, sparse—
your retiring body can take little but air.
to watch his memory falter,
fail. Light fades and falls. Dark
to watch his memory falter –
Cans of beans: gone. Toothpaste.
A shoe, bills, a sister –
to watch his memory falter,
fail. Light fades, and falls dark.
Sometimes I wish that skin and bones didn’t exist. Of course, that would be impossible—the skeleton is the scaffold for our bodies, while the skin is the insulation for vital organs such as the heart, kidneys and bowels. Without our skin and bones, we’d be mere piles of goo on the floor.
Bones are too complicated, for the simple reason that there are too many. As a first-year medical student studying anatomy, I agonized over learning the grooves and prominences where the muscles originate and insert into the bones. I always struggled to find these so-called bony landmarks on our simulated patients.
And flesh…the skin is even more horrifying than the bones beneath it.
It is a mitzvah to take care of your parents: “Honor thy father and thy mother.” And caring for people comes naturally to me. I’m a physician; this is what I do.
But when my father looked to me to cure my eighty-five-year-old mother’s dementia, saying, “You’re the doctor! Help her!” I knew he was asking too much.
And yet. How could I stand idly by while my mother’s mental acuity slowly drained away?
The year 2020 was a lot of things for a lot of people. Chaotic, exhausting, heartbreaking, hopeful. It was a year in which my immense privilege—as a healthy, educated white woman—protected me from much of the pain born by others.
And while it was many of those things (especially chaotic) for me, it was also the year I started medical school. The year I moved from LA to Austin, driving across California, Utah and Texas in the process. The year I read fifty-four fiction books to escape the monotony of lockdown.
And it was the year my dad died.
Driving from the Atlanta airport, I arrived at the hospital ICU where my mother had been admitted the day before for trouble breathing. This was the hospital where my siblings and I were born and where our father died. This was the hospital featured in The New York Times following the coronavirus outbreak in March 2020. The hospital still sees record numbers of COVID admissions, and I expected the staff to show signs of exhaustion and numbness to personal tragedy.
My brother was at our mother’s bedside, as he had been from the beginning. The critical-care attending physician was also present.
“Does the hospital have a palliative-care unit?” I asked.
The last two years of my father’s life were interesting. Our previous roles were reversed: Dad was now the child, and I the adult. I moved him to a new city and state, getting him close enough to keep an eye on him. He was already suffering from dementia, a realization I came to after he had forty thousand dollars stolen from him.
That’s right. Forty thousand dollars.
Sauntering into the dark hospital room, I was dazzled by my patient’s radiant smile. It spanned her face and crinkled her eyes; her crooked teeth peeked through her lips, making her seem approachable and kind.
“Hi, Ms. Radha, I’m a third-year medical student,” I said. “Is this an okay time to chat? I’m here on behalf of the psychiatry department.”
In the first months of medical school, we’re taught that patient autonomy should be one of a physician’s guiding tenets. The doctor provides diagnoses, prognoses and treatment plans, but ultimately it’s up to patients to make decisions about their own care.
As a family doctor, I often tell patients: “Only you can know what the right decision is for you. I’m here to provide information and recommendations and then to support your decision.”
But over the past year, as my father’s memory deteriorated and his life drew to a close, I learned about the ways in which our medical system limits patient autonomy.
During his last months, my father said repeatedly, “My brain is in chaos.”
When I met Mr. Rosenbaum, age ninety, I’d been a physical therapist at the hospital for all of three months.
The nurse had propped up his scabbed foot on several pillows. Cushioned on them like a precious jewel, it extended over the bed’s end.
I introduced myself and asked if he’d like help adjusting his yarmulke, which was entangled in the nasal breathing tube slung around his left ear. He smiled at me, one eye wider than the other. I grinned back, reminded of my own grandpa.
“Are you married?” he asked.
It must have come in a hurry
on a ship of pain, breaching
the weak seawall of her lungs.
The tumor, split from its moorings, set adrift.
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.
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