Richard Scott Morehead, MD is Professor of Medicine at West Virginia University School of Medicine and teaches and practices pulmonary and critical care medicine at Charleston Area Medical Center.
Searching for something analogous to my essay “Of Walls and Windows” (Intima, Spring 2022), I stumbled onto “A Rusted Bronze Star” by Sarah Bugg (Intima, Fall 2018), which was a two-fold blessing: it was very poignant and well-written, and I had taught Sarah in medical school. Our essays are linked in my mind. Mine has a plaintive tone concerning the experience of aging professionally, and hers describes what happens at the end of our days: the loss of relevance, agency, respect, and in the end, the absurdity of losing touch with reality as the senses and the mental faculties fail. In medical school I recall learning that dementia makes the victim “more like themselves”— in other words, the inhibitions are lowered and you get a view of the interior of the person, sans façade. We should all think about this carefully as we live out our days, because we will leave an impression at the end, one way or the other. My favorite poet, T.S. Eliot, wrote darkly about this in “Little Gidding”:
Let me disclose the gifts reserved for age
To set a crown upon your lifetime’s effort.
First, the cold friction of expiring sense
Without enchantment, offering no promise
But bitter tastelessness of shadow fruit
As body and soul begin to fall asunder.
Second, the conscious impotence of rage
At human folly, and the laceration
Of laughter at what ceases to amuse.
And last, the rending pain of re-enactment
Of all that you have done, and been; the shame
Of motives late revealed, and the awareness
Of things ill done and done to others’ harm
Which once you took for exercise of virtue.
Then fools’ approval stings, and honour stains.
When we are young, this contemplation is consigned to the place in the brain where fairy tales are stored, if they are considered at all. But as we age, if we are honest with ourselves, it takes on a progressive reality. In the end, I think the best we can do is to be faithful, honest, and humble. Make every day count: practice telling those close to us that we love them, remember that each patient matters, and for me, the hope of ultimate redemption in a place where there will be no more tears.
And before I forget, I hope you are doing well Sarah. I recall you fondly.
Richard Scott Morehead, MD is Professor of Medicine at West Virginia University School of Medicine and teaches and practices pulmonary and critical care medicine at Charleston Area Medical Center.