Paradox

Death.

I would be lying if I claimed I did not think about this daily. When I walk into my clinic, my pace is slow, deliberate and meditative.

I remember once walking at my usual pace, preparing for my clinic in my mind, sinking with each step into the depth of the struggles that I will face on my road that day. I remember seeing a colleague from a different discipline of medicine pass me, racing to get to the road that crossed into the hospital. He called hello and asked what I’m doing. I said “looking at the birds.” I got to the light before the crossing and there he was in his haste to get to the same spot I was. He looked at me and smiled “I should have just looked at the birds too.”

Death.

We don’t talk about it. We remove ourselves from any sort of discussion about it. It’s as real as the sun. Tell me, when could you hold your stare at the sun? It’s brief, often blinding and hard to maintain. You turn away because it’s just too much to bear. Is that why we don’t sit in circles, lecture rooms, or theatres to understand the meaning of death? Is it why we don’t talk about it, teach it to the young, and educate them about its vitality and its supremacy? I ask not about the meaning of life, for that is permissible, well-described and easily talked about. I ask about the nature of death; that paralyzing moment none of us want to face, share or discuss openly.

Death.

Are you a hole? Are you a spring, a waterfall, an avalanche, a bursting star, the string theory, gravity, or the sum of all of our acts in life?

Every living thing dies. What a mystery. What a powerful way to really see the world. To slow your pace, to “smell the roses,” to “see the birds,” to walk with deliberation, to reach your inevitable destination. While we cannot stare into the sun, can we acknowledge its singular beauty? We should find ways to stop denying this fact about humanity that all of us must die. Death might be beautiful.

Today, I saw several of my patients who circled death but continued to live. One witnessed the birth of a granddaughter and another returned back to life without even realizing that they were even in danger. I did not sit with them and reflect on the near-death experience. I just marveled at what they had accomplished by not dying the moment they could have.

Death.

You wonder why I preface each paragraph with one word? That word. I’ll tell you why. Death dictates the cadence of my walk. It’s a deliberate attempt to make you see each moment of life that passes you by, unique to each individual, your own experience with the one mystery that none of us know anything about. Would you share your experience? Would that bring you closer to the truth of our existence?

That sun never waivers, always there, always looking, always giving. Is that Death? The giver of life?

Death.

The ultimate paradox.

Mute

There is a button on everyone’s remote control that can at any time mute any electrical device that makes a sound. It’s there and we can use it. We don’t always mute things. We have all grown accustomed to the noises around us. Being around a device emitting any sound keeps us distracted, engaged, and connected.

Death is an irreversible mute button. It leaves behind a bewilderment of emotions, a tearing separation of souls, a loss of interactions that once were, a silence that is deafening. Once pushed, a person is blocked from life. We cannot engage with them. I have questions that are left unanswered, events that I cannot explain to the family of a lost one, to my coworkers and to myself. Unsaid things can never be shared, and unfulfilled connections can never be restored. I have to go deep inside me to find a reason behind what just happened, how they felt, what they last shared before they got silenced. I have to work my emotions through the grief of loss, balance my mind to help someone else and continue to live on through the perils that life still has for me.

I try to imagine a life after the loss of a loved one, where only the living participate, and life must produce from its sole ingredients the answers to those who are no more; answers that even challenge the scientific mind and the soul.

“Why go on?”

Every human life lost to cancer has its toll. To me I struggle with the question, “how to get up and do this again?” I don’t mute my feelings, or block my emotions.  They travel with me, and sadness does overcome me many times over.

Together with those who have felt a loss, I get up.

 

Understand

Death does not put an end to everything. It inspires feelings, questions, and gives perspective. People ask me how I feel when I lose patients. Do I feel sad, angry and defeated? I have walked with my patients down this path and returned alone. It does not end there. Death does not end things. Death is not the last thing.

From each patient I keep something with me. Patients help me gather knowledge that flows stronger than a river and wisdom that propels others who have to walk that path. The path remains uncertain but the journey of those we lost refines and paves the way. There is a certain enlightenment that comes from this that I hope to make you all perceive. What started small in the beginning, with the trust of a few, has become an organic tangible construction of the science needed to move us forward. 

 “A bend in the road, is not the end of the road, unless you refuse to take the turn”. Families always take the turn. What’s the alternative? To go on grieving what could have been? Do we live in our memories? When you meet the loved ones of a lost patient, trudging their way through the rest of life, do you wonder what drives them? I am always touched and humbled by what they say amidst their sadness and fear, their feelings of loss and grief. They say prayers for other cancer patients, and a shout out to me, “You go get this, Mo”, “You figure this out”, and “You find out why?” These words push me on, make me get up, make me see what still needs to be done. 

Memories ebb and flow rubbing into our wounds and heightening our suffering. At times they gather together, like a swarm of locusts they invade, leaving nothing behind: a loss of meaning and loss of purpose, a desolate place. Out of it emerges a new beginning, a new start, that puts the bounce back into our feet and we are alive again. Understand, that is how we make our memories live within us without their crippling effect, and those we have lost can show the way for all of us to succeed.

Dialogue

Person: Can you help me?

Me: I believe that is why I am here, ready with a new treatment, a loaded gun and many tricks up my sleeve.

 P: Is it always this hard?

 M: Yes.

 P: Is there hope?

 M: Without it, we will not survive.

Imagine this dialogue that starts in the pit of someone’s stomach, a mixture of fear, anger, hope, and courage.  I partake in it and I do not dismiss it. Have you ever been afraid?  Where the walls caved in and it seemed confusing? Where what consumed others felt petty, trivial and meaningless. When you sit on the edge of a diagnosis of cancer and are worried about yourself, your family and your loved ones. This is the human I meet, sometimes confused, often afraid, and always hopeful. This is the person from which courage emanates. With this person, I stand united.

Cancer: I am here.

Me: Who are you? And why have you invaded us?

C: I am a product of survival, a state, a process. Who are you?

M: I am here to kill you.

These are my words when I look at cancer, the perfunctory introductions. A long battle is about to ensue. This is the enemy I know well. On this battlefield, a new sword has to be forged, to fight in the face of fear, uncertainty, and discouragement.  Every day a different person walks into my life and stands stronger against this common threat. Our unique existence, our individuality is a paintbrush that brings to life our depths and our dreams. In life, we march only forward regardless of how timid we feel or where our hearts want to be. I sharpen the reality that was thrust upon this person with my words. My patient stands steadfast in trust and belief.

And the dialogue resumes………

 Me: Which way this time? Cancer, are you ready?

 

Quiet

“I don’t need this right now,” he said as I finished telling my patient the plan of his care. He had been quiet. I sighed and made my way back to my chair to settle down. Sitting down, I let my mind wander. It’s not easy to change things midstream but I think oncologists should re-examine when prompted subtly or blatantly, to what they are actually saying to a patient. I started to eliminate the stressors that plague every day practice. It’s a busy clinic, 40 odd some patients to see, bouncing between good and bad news. We were both quiet. In his silence I sensed his resentment, and I felt sad. Behind his silence, there was anger.

He fidgeted. I watched him remove his cap, stifled by the news I had just delivered. They try to teach you this in medical school as my mind raced through my training (14 years), empathy they called it. As a physician I have learned not to depend only on my training to help my patients but also on my life experiences that have brought me to where I am. I searched for something within my life that he could relate to; I know adversity and I know anger. I looked specifically for strengths that I had understood at his age when I myself had faced difficult situations. Yes, I thought quietly, I know where you are. You’re angry. I let that emotion into me, a little bit of self-exposure, and the patient and I became one. Sometimes it’s hard to invite a complete stranger into your own home, but anger was not a stranger to me.

I was young when I was touched by a war – the Gulf crisis as it is referred to. I was angry then, like a young person would be if their life had been interrupted by something they had no control over. Cancer is a war. It demands a constant engagement of every aspect of our humanness to fight. It does not mean we fight without emotion. It does not mean we are raving lunatics either. It’s a constellation of problems, an inconvenience, a cost, and an interruption. It puts a halt on education, careers, motherhood, retirement, and vacation. It consumes time, money, and emotions. There is never a good time for it, and there never will be. Empathy is a deep connection that exists between two humans where one can show true understanding and bring meaning to a difficult situation. Empathy is not observed it is felt.

We sat quietly. Nothing more needed to be said. In the end, like a spilt jug of water on the floor, we both got up and started to pick up the pieces and clean the mess. Cancer, you can’t defeat the human spirit. Cancer, you are just in the way. Cancer you are not winning anything. Cancer, you have a lot to answer to. Naive is my scientific brain, just as bravery is when facing a formidable foe. I am not the one to bring cancer to its knees but I do believe that those who suffer from it do that daily.

Mo