You ask, “Why does the surgeon write?”
I think he writes to become a better doctor.
“The Precise Location of the Soul.”
The piece that follows deserves an introduction for several reasons. For one, it was the winner of the first annual Alan Cross Memorial Prize for the best paper produced in 2011-2012 by a student in the Department of Social Medicine. Alan, who always wanted good things for his students and his patients, would have been proud. Second, it was produced by a medical student in the first weeks of his training, in response to an essay assignment given to students every year in “Medicine and Society,” the year-long survey of the cultural setting of medicine. The assignment is always the same: to tell a story of your own experience with being sick. Its purpose is to give the writer, there at the impressionable start of the long process of metamorphosis, a chance to conjure up the lived memory of illness before that memory is clouded by all the ways we learn of disassociating ourselves from suffering. Responses to this essay vary as widely as individuals and illness can, and sometimes they surprise us: with the force they muster, the current that leaps between the reader and the page.
This is the case with Stephen Kimmel’s “Don’t Get Sick Like Me,” and the third reason why I am honored to give it an introduction here. When this essay was considered for the Alan Cross prize last year, it sparked the most passionate discussion I have ever heard on such an occasion. The story was, some felt, too raw, too dark. Too close to the bone was my feeling, and the reason why I urged the committee to award it the recognition I felt it so deserved. In his portrayal of a health-care professional fallen sick—sick in his soul, sick at the limits of his capacity to care—Stephen has portrayed the dark night of the soul every one of us knows, but of which so few of us speak.
The dawn comes, for most of us, and by daylight the doubts that seize us in the darkness lose their power. But it is in the memory of those moments—when the gap between the ideals of our profession and our individual human frailty yawns so wide it seems we cannot help but fall—that we come closest to experiencing that greater darkness we fight on our patients’ behalf. It is here, face to face with the limits of our capacity—to care, to cherish, to cure—that we confront as well our mortality. Memento mori , went the cold whisper Roman conquerors were said to hear at their moment of triumph: remember death. Whether it is the death of the body, or the death of the spirit as Stephen portrays it here, the lesson is the same, one that all of us, even in the pride of our knowledge and power, cannot forget: we are mortal, we are fallible. We are human.
Don’t get sick like me.
I know the sickest I have ever been was just after my daughter was born. Some of you know and many of you will find out that you haven’t been tired before. When you have an infant at home and you are working health care hours you get tired, bone tired. Weary. I was wasted when I came in that day. And when the shift started, I had 24 hours downtown with half the staff we were supposed to have on a Saturday night, and there was a rave at the civic center. I was fucked. I had recently been rejected from medical school. I had worked for 6 years to get in, and I was still a bit unsure what I lacked. At 1030 we ran a DOA, Buncombe County EMS does the coroner work, and we had to move an obese body, that had been decomposing for approximately three weeks, from an unclean apartment. My wife had packed my lunch, Mexican corn bread, leftover fried chicken and asparagus with parmesan cheese, my favorite.
It was nonstop; it was hot. Paramedics wear polyester pants in Buncombe County, (the management, who work in air conditioned offices, all wear cotton) and I was using Lamisil every other call. That day it seemed like everyone was in a bad mood. The nurses were surly; the doctors indifferent. We actually did some fine work on a young man who rolled a Suzuki Samurai, and the only recognition we got was that we were bringing another code trauma to a packed ED. An ED packed with people who may not need care in a country of entitlement, in a world of mediocrity, and I am mediocre. I am shit. And the dream I can be anything I want to be is dead. I am toe nail clippings, dead skin, which when it outgrows its function is without utility, cut away, and easily replaced.
We got to bed at 0245, and I was awakened at 0300, unkindly, by a rushed and disgruntled dispatcher for subject down.
I am down. I am nauseated. I am over-fed and under-exercised. My mind is whirling but only like a dog on a short leash running in circles. I am a dog wearing down the grass in a circle around his tether. Wearing grass to dirt and the dirt to mud and digging a hole. I am not digging a ditch, a ditch has utility. I am a dog digging a hole. I am Goya’s dog running underground.
I want to suck the eyes from the sockets of infants and spit them into the cocktails of their mothers.
I get in the ambulance with my partner. We do not speak. We have worked together enough now. And know downtown; we know the night, the smell. We know who we are going to see.
Esau Davis is a 5’ 4” black man. He is: uneducated, epileptic, noncompliant, addicted to drugs, and alcohol, and a fighter. He is not fun to work with.
When I was 18 I got struck by lightning. I found out as a consequence that I am an excellent patient. I am upbeat, kind, appreciative - an engaged patient.
Why are Esau and I different? I don’t know.
I have highly educated parents: socially conservative, religious, unconditionally loving, and married. They moved to a small, rural community; they are kind, patient, and present. They sent me to school, supported me, and nurtured me. They expected me to work hard to face adversity with a smile.
When I taught my sister to snowboard I told her “you don’t get cold and nothing ever hurts.” That was the rule. Then I made her ride all day, falling every 2 minutes in negative 10 degrees with a wind chill and east coast snow guns. She never complained and when mom picked us up she didn’t even mention it. I wasn’t raised to be stoic, but if you ask for help you need it.
What about Easu?
I don’t know.
When I started as a paramedic I was chastised for being too kind, for being soft. I was quick to give pain medications and reluctant to get refusals for transport. I was willing to sacrifice a clean shirt and some dignity to help someone infirm or in a disadvantaged position. I recognized the process of wearing in, of becoming similar to the hardened, and I saw it as a natural progression. I learned to recognize a drug seeker after giving the same man 10mg of morphine on two separate occasions. He sat forward before and hid his face in his hands. When he was dosed and sleeping he would lean back and the tattoo of an imp on his abdomen laughed at me. It laughed at me twice, and I resolved to cease to be the butt of his joke. I quit giving so much pain medication, but to do so you have to change your perspective. You alter your vantage point. I think I lost something. I don’t really know what.
Some say when you see someone on a park bench they are in your reality and you cease to see them as separate, owning their own identity. They are only real as it pertains to you. Or, when a woman in a sundress is 20 feet away with her back to you, she is no longer someone’s daughter, someone’s lover, someone’s inspiration. What is she?
I don’t know, but since being married and having a daughter of my own I just look at the ground.
When you see Esau and humanity drains from his face, I would ask you to leave the room.
EMS 12 arrived to find the pt. supine on a sidewalk; fire department personnel say the patient is nonresponsive to painful stimuli. I don’t believe them. I never believe them, but that is another essay. I approach. Me with my background, my culture, my perspective, and I am not thinking. I am acting. I am working, I am doing things that I have done before. The patient is breathing without difficulty. He is probably asleep. Something I long for, something I beg my daughter to let me do, something that Maslow should have put at the top of his list. He is asleep, and I am angry, and I bend over him, and I put my metal penlight on his finger nail, and I check his response to pain.
And I hear a crack.
The sound woke me up. I remembered who I was. I am nonjudgmental, kind, someone who genuinely loves people.
It wasn’t a loud sound. No one else heard it, but in that moment I was sure I had crossed a line that there was no going back from. I am no longer the Good Samaritan. I am seated below the cross. I am throwing dice for the Messiah’s clothes.
I called myself out. I told the nurse what happened, and they x-rayed his finger. There was no damage.
No one even chastised me. In fact, the opposite - there was laughter and the suggestion that next time I try a little harder.
I ran a call on him three nights later, and he had the yellow burns indicative of crack pipe use on his finger. I examined it, and he felt no pain. I suspected as much. I had already seen that the pocket clip on my flashlight had broken, and none of that makes any difference, none of that that changes a fucking thing. I had approached in anger. I was sick, and a happy ending did nothing to change it.