I Am Here

It was Thursday when an ambulance brought my aunt to the hospital. Her breast cancer had metastasized to her femur. It had shattered the bone.

The next day, a Friday, she traded stories and jokes with my parents from her bed. They learned from my uncle that she had three more months to live.

When my sister and I visited her the following morning, she was unconscious. Her breathing was heavy, uneven. An hour later, as I dropped my sister off at a play practice at school, I sobbed over my steering wheel in a corner of the parking lot. Three months... I returned to the hospital.

Within the hour, my aunt passed away.

Afterward, I could only think of the moment I stood in her room early that morning: of her labored breathing, the hum of the air-conditioning. My uncle's words: "Tina, Patrick and Kelly are here. They came to say hello." How I had stood there unable to summon the strength to simply say, "Hi, Aunt Tina, I am here."

I have never forgotten my silence.

***

Our conversations were long and energized. He would ask me about my life, my running, my education, or fuss over whether I was wearing appropriately warm clothing for the weather. In exchange, I would listen to the latest of his medical maladies at the Northfield Retirement Center, sometimes with 'colorful' descriptions of its resident doctors.

So I listened. About his pain meds and physical therapy. About how he could no longer see. About how he could no longer walk. About the back pain that would wake him up at night. About the loneliness that would consume him like a storm. Many times, we would end up laughing about our lives - the taste of the cafeteria food or the latest failures of the college football team. At other times I would try and comfort him as he sobbed; his head would heave and tears would roll, all in utter silence.

I remember one time in particular when he asked me what the year was. He let me do the math for him. "Six years... I've been here six years..." he murmured. "And all I can do is sit here and wait to die."

For once, I did not know what to say.

***

When did I decide to become a doctor? It could have been one of those cliche childhood moments we all reference in retrospect--but I doubt it. After all, I wanted to be a train conductor, courtesy of Thomas the Tank Engine. As my mom will tell you with chagrin--as mothers do--the intricacies of trains were the singular obsession of my grade-school-age life.

Then perhaps it occurred much later, when I stood with two young parents as their wheezing, three-month-old baby tested positive for RSV and was admitted to the hospital for supervision. Or when I placed my stethoscope on a scar and heard the repaired heart of a young boy with Down Syndrome. Or perhaps when a woman heard sounds on her left side for the first time following an aggressive ear surgery. She started to cry. She was thirty-two years old.

In these moments, I knew I wanted a real and palpable role in shaping the form of a patient's care.

Of course, there were the purely academic joys. Perhaps I fell in love with medicine the first time I heard something like 'replacing an eardrum with a piece from the outer ear' described with some esoteric phrase like 'cartilage tympanoplasty.' Then again, maybe it was the moment in which I was first hypnotized by the rhythmic, almost musical cant of the surgeon: "irrigation, please..." "suction..." "suture..." Or perhaps it was merely the nerdy thrill of seeing a dermatome actually mean something outside of that one neuroscience textbook, pg. 487, figure 13.5.

Yet more than anything, there are these memories which have irrevocably changed the course of my life. The day I could not find the voice to say hello to my aunt when I visited her in her hospital room. That winter afternoon when my friend Obert down at the nursing home began to cry. A summer car ride with my friend as she shared her unfulfilled plans for suicide. The next hour of that conversation remains one of the single hardest moments of my life.

Just what do you say when words are inadequate? When people expect you to solve things but you are helpless to change them?

It is not only illness, but isolation that destroys patients. Above all else, to break such silence is why I have chosen to become a doctor. Because beyond the academics and long hours and interminable paperwork, I want to offer my presence. Sometimes I still succumb to this tempting idea that after medical school, illness will somehow bow before my knowledge and grant me exquisite control over the forces of life and death. Medicine, after all, is replete with such metaphors.

But a metaphor is little encouragement for a patient.

While it is true that I may not be able to be my patients' number one confidante nor their go-to moral support system, I do want to be someone worth trusting when all else fails, even when there is not a single thing I can do to cure them. Because ultimately, that is the real side of life, and that is the real role I intend to play as a physician.

Yes, I hope to treat and I hope to cure, but neither encompasses why I fundamentally intend to become a doctor.

I want to be there when no one else is. This time I will not remain silent.