Grief walks in many forms, and its footsteps are padded and quiet, imperceptible even, except to those who lay awake at night, counting its tip taps on the upper floor.
Every now and then, at the end of a call shift, I leave the hospital with aching feet and heavy eyelids. And then I remember: I am the lucky one. I am the one who gets to go home. My patients – the grandfather whose kidneys are failing, the ten-year-old with meningitis – are not so lucky. They will not go home tonight. They may never go home again.
During the 10 years my mother spent in her nursing home two states away, I struggled with feelings of guilt and remorse. She suffered from dementia, requiring 24/7 care, and I couldn’t provide it to her. Yet there was always the plaguing thought that I should. I knew it wasn’t realistic. Still, I felt inadequate and like I abandoned her, even though I visited every few months.
Carl Jung believed house imagery in dreams represent the human psyche. In both artworks, the houses are familiar structures of shelter that simultaneously represent ominous confinement and isolation. We may be capable of observing and moving past some psychological structures that have become an obstruction, while others feel intertwined with our very being, like a house that fits more like a skull.
Even with the astonishing knowledge of medicine, the anatomy of an illness cannot fully be known from the outside. It takes an act of tender and careful acquaintance. And the only one who can truly map the illness of a living being is the occupant of an ill body. The geography of sickness is mysterious: its borders begin vague, its peaks conceal its valleys, its oceans rove and deepen and rearrange patterns of flood and firm ground.
The poem titled, “To the Woman at My Mother’s Funeral Who Thought It Was So Lovely that My Mother Died at Home” by Kathryn Paul (Spring 2022 Intima, Poetry), circles around my mind days after reading it. Paul’s poem eloquently speaks back to the assumption that it is always good to die at home, that home deaths are always peaceful. The literal hands-on work of caregiving—the cleaning of blood, mucus, urine and feces — is unspoken and generally done by women, whether paid or unpaid, and the writer, who in her bio calls herself “a survivor of many things” captures this in her poem.
It is the great privilege of medicine that we are asked to show up, constantly, albeit in a different role than a family member would be. To not look away is in the fabric of what we do. It is partly why the practice of medicine can be exhausting, electronic charting and reimbursement quibbles aside. We are asked as caregivers not to dispense always but to receive, to hear questions that we don’t want to reflect upon. It is our privilege to be present.
I am at the point in medical school that I can forget how strange a place the hospital is. Most days, I pre-round around 5am and I leave as the pink and gold of sunset reflects in the windows of the inpatient tower. I no longer smell the antiseptic that pervades the air. I write my notes oblivious to the announcements of “code blue” or “stroke team activation” playing over the intercom. When I walk through the hallways, there is purpose in my strides. The core clinical rotations that every medical student undergoes (family medicine, surgery, pediatrics, etc.) are a time for exploration and the forging of identity. We learn: This is how doctors act and react.
My first-ever clerkship rotation as a medical student immersed me in the realm of inpatient psychiatry. This profound and eye-opening experience blurred the boundaries between sickness and health. It challenged my preconceived notions and deepened my understanding of mental illness.
I have been practicing medicine since completing my residency in June 2000. It baffles me that to this day I still hear comments from patients, families and loved ones that we physicians often cannot relate to their concerns, their health struggles and their ailments because we are doctors, because we harbor medical knowledge, because “we are not human.”