Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, November 07, 2006


I am truly blessed, even though I often forget it.

The universe likes me. Not just in big ways (I am healthy, as is my family; I have enough money to meet my needs, even if I worry about it; and so on) but also in small ways: when I run late with a patient who needs extra time, the next patient or two will come late or no-show. By and large, the universe gives me what I need exactly when I need it.

I'm not sure why, but that serenity has been somewhat more elusive of late.

Then last week -- right about the time I posted that whiny rant about how boring my life seemed -- I got a letter. A dear friend of mine, a local oncologist, sent me a note:

"I received the enclosed article published in JAMA in 1988 from the best friend of a patient recently deceased. I found it remarkable and intuitive and thus I thought I would share it with you."

Wouldn't you know that in addition to being remarkable and intuitive, it was just what I needed to see. It was titled The Rain:
"Please go away. Some other time."

I am a liaison psychiatrist. I'm accustomed to being turned away by patients. This one is an elderly woman who had a large pelvic sarcoma removed several weeks ago and lost a leg in the process. Things have gone badly with her since then. A wound that won't heal. Fevers. Intractable diarrhea. Your classic surgical patient gone sour. She won't eat. She won't look where the missing leg was. I've been by to see her several times and each time she has refused to see me.

"Please. Some other time." She smiles politely. I stand in the doorway. I never know quite why I persist when I do. Maybe it's because I like her. I like her smile, even though it's there to keep me away. It's diplomatic but not phony. She strikes me as warm and wise and considerate.

"The nurses are worried about you," I say.

"Oh, they try so hard. They try to get me to sit up, but I can't." The smile is gone.

"Sounds pretty bad."

"Oh, Doctor, you have no idea."

I make my way slowly around the bed.

"No, please. I can't talk." There is a moment of hesitation. "Look how they butchered me. I didn't want this operation. My daughter talked me into it. Now look at me. She tells me to fight harder. Fight harder? Doctor, you tell me. How can I fight any harder?" She turns away and begins to cry.

I am beside her now, standing at the bedside of this crying woman, as with her back to me she sobs into her pillow. "Those can I fight any harder?" She turns back to me and clutches my hand, transformed. "Doctor, could you just give me a pill? To make me go to sleep forever?"

My experience as such a moment is that of standing in a drenching rain. I can't use my education and I can't think of anything constructive. I just get wet. Depression? Adjustment reaction? I can't remember the criteria. Now I am falling with the rain, tumbling in the air. Medication? Transfer to psychiatry? I can never think clearly when it's raining.

"How bad is the pain?" I ask. Pain. Yes, good. A symptom. Someplace dry to stand. Pain I know something about. Butchers? Daughters? What can I do about them? With pain, I know what to do. The downpour in my mind lets up a bit. I ask her if she would like to learn to handle the pain better, and she nods. I instruct her to relax, which she does with surprising ease. I knew I liked her.

"Now," I say, "I want you to imagine yourself off somewhere peaceful and quiet. When you get there, tell me where you are."

"I'm in Cape Cod. We have a house there."

"OK, when the pain comes I want you to relax just we did now and go off there. Give yourself a vacation." This last phrase just comes to me, innocently. I like its sound. It feels good.

But when she opens her eyes, there is a faint cloud of suspicion and of hurt, which I don't immediately understand.

I promise her I'll come back later. All through the day, I'm turning it over in my mind. Butcher...daughter...vacation. Her hurt look. Then, gradually, the pieces fall together.

No one can stand this woman's pain. Or at least that's the way she sees it. The surgeon, the daughter, they can't stand it. So they try to take it away. But they fail. They can't take it away and they can't stand it. That's why she wants to die. Because no one can stand her pain.

Including me. I wanted her to take a vacation from the pain. But she was very perceptive and knew better. She knew that it was I who wanted a vacation -- from her, because I couldn't stand it either.

I go back in. She's expecting me. I begin right away.

"You know, I've been thinking about you. You've got cancer. You're sick. You've lost your leg. I can't even imagine what that feels like. Whenever I get even a hint of it I feel as if I'm tumbling over and over like a raindrop in the rain. And you know what? I don't have the slightest notion what to do for you."

Her eyes clear.

"Except perhaps to sit here until one of us thinks of something."

The tears stop. A truck skids on the wet street outside.

"Thank you," she says.

Weeks later, after her death, I wonder about the value of what I did, or didn't do, on the day I first saw her. I tell myself that in fact I was able to give her some relief, if not from the pain then at least from some of the isolation that went with it. And some of the responsibility.

How wonderful it would be, though, to restore what has been lost. How difficult it is to stand in the rain.

Stephen Snyder MD
New York
JAMA, July 8, 1988 -- Vol 260, No 2; p. 249

Try relaxing a bit; look around. Maybe the universe is trying to give you exactly what you need exactly when you need it. Accept the gifts that come to you.

NaNoWriMo Update: So much for not blogging as much while I write. I guess I just can't stay away.
Word Count to date: 12,032
Excerpt: First paragraph after opening (found at the bottom of this post)

"The electronic chirping that served as a telephone ringer went off next to Roger's head, inserting itself into the dream he was trying to have about sitting on a long sandy white beach, completely deserted; the only sound the droning crash of the waves on the deserted white sand. Suddenly -- in the dream, that is -- a flock of psychotic seagulls decided to alight on Roger's blanket, folding beach chair and head (in no particular order) squawking and chirping like a horde of malevolent teens squabbling over the last slice of pepperoni and anchovy pizza. Wanting to shout, "Shut up! I can't hear myself think!" even though the only thing he was thinking about in the dream was how wonderful the silence was, Roger instead reluctantly awoke to the electronic chirping noise that served as a telephone ringer."


At Wed Nov 08, 05:45:00 AM, Anonymous Anonymous said...

Nice to see you post. Sometimes the best medicine of all, is just to acknowledge another human beings suffering. While those that treat stand in the rain, those treated are in a hurricane.

At Wed Nov 08, 03:09:00 PM, Blogger Richard A Schoor MD FACS said...

Wonderful article. Inspirational.

At Thu Nov 09, 08:25:00 PM, Anonymous Anonymous said...

That was beautiful! Last year I lost my very best friend to brain cancer. She was also my DILs mother. We had been friends for over 35 years. We raised our kids together. Her daughter and my son fell in love and married. She and I just had a brand new grandson yesterday.

Losing her, taught me alot about just being there for those we care about. We don't have to DO or say anything. We just have to be there.

At Tue Nov 21, 05:47:00 PM, Blogger Unknown said...

That was an excellent, touching story.

There is little point in me writing more than to say that it did remind me of my mother.

Regards - Shinga


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