Tag Archives: medicine

the blessing of being alive

DSC_0043Sometimes, I feel as if nothing I do matters.  I have struggled and fought and I have failed.  Oh, have I failed, in a million small ways, and in a few pretty large ways too.  Some days I feel weak and worthless.  But yesterday helped me see a bit clearer.

Yesterday, I attended a memorial service for a patient.  Her name was Angie, and she died at 45 from breast cancer.  The ceremony was held in a garden space, where a stand of trees stood proudly in the middle of barren desert.  In this oasis we were sheltered us from the Arizona sun, still so unrelenting even in late September. Native voices and drumming sliced through the air, carrying our prayers of healing and sobs of grief high in to the heavens.  We honored the four directions, the circle of life and all its infinite passages.  We held hands, a rainbow of humans from all walks of life, touched by this one woman. Years of addiction had scarred the hearts of some, yet there, under the shade trees, there was healing and love and hope for all of us. We were united in grief, united in being alive.

In this sacred space, I received kind words of gratitude for the care I gave to this woman while she was alive. I felt her community honor me as a healer to the sick and a friend to their loved one. Her case worker and strongest supporter during the last year of her life presented me with a print of a dragonfly, a symbol not only of the community where she lived but as symbol of transformation, of rebirth. It was how Angie wanted to be remembered.  She is now in the spirit of the dragonflies. She is liberated and omnipresent and I believe she is still here.  In a way, her illness gave her the medicine to be everywhere and everything, to transform from a homeless crack addict to an inspiration, a visionary, a healer.

I felt some apprehension about attending the service, as it promised to crack open my own barely contained well of grief (which it did). And sometimes it is hard to accept gratitude. I want to cast aside the humble thanks of others and say “its only my job.”  But it’s not “only my job.” It is a blessing and an honor and a calling. I couldn’t save Angie from cancer, nobody could. At times I couldn’t even lessen the pain.  But I walked beside her, I was at the door of her final passage.  I was a part of humanity’s best side, the wide embrace, the soothing words that call forth light in the darkness.  I was part of an easing of her burden, part of her finding wholeness even while she was dying. I was part of a miracle.

We all know about the shadow side of our civilization.  We slaughter, we rape, we decimate, we wreak havoc on the earth. Sometimes, I can’t bear being a human, can’t face being a tiny limb of the global curse. But yesterday, I felt honored to be alive, to be a person, to be a part of a community wider than my own mangled thoughts, my own voice pleading in the darkness.

A single wave is meaningless, yet the collective tide can carve canyons and move mountains.

I am honored to be part of this mysterious force.

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my mother’s autopsy

Prior to her passing, my mother chose to donate her body to research.  I met the physicians who would do her autopsy and tissue collection about 10 days before she died.  They signed up to bring us pasta on our meal donation website.  Mom had told me that they were from the Banner Sun Health Research Institute, but it didn’t occur to me that they would be slicing into my mother’s heart, holding my mother’s brain, until they were visiting with her in our living room.

They were kind. They enjoyed her in health (she had helped them raise money for a new facility while she was still working), and they were devoted to her with death looming near.  They knelt before my dying mother and held her hands.  They looked me straight in the eye and told me they would take care of her.  It wasn’t until then that I understood the depth of generosity in my mother’s donation, and the importance of helping these special people, so suited for the difficult work that they do. Mom, as always, chose well.  I trusted them, and with the intimacy of their task at hand, I started to think of them as family.

Yes, take my mother’s body, I thought.  I would give it to no one else. 

The first phone call was to the research institute after she took her last breath.

Her funeral was nearly a month after she passed.  Those kind doctors came.  She was cremated, their work complete. I gave them a big hug, and knew nothing else to say other than thank you.  Thank you, for helping others learn from my mother’s cancer.  Thank you, for slicing into that big heart, for holding her brain, for dissecting her tumor and sending it to the four corners of the earth.

Today, 8 months after her funeral,  I received the autopsy report.  When I checked the mail I was stressing out over a scheduling mix up over a certification exam; small shit, really. Its funny how quickly one can revert to shallow concerns after months of worrying about life and death. The letter was in a nondescript envelope, but it was thick, and I knew what it contained.  My anxiety about my test fell away.

Reading the report brought up mixed emotions. At first, I felt a little bit like a kid at Christmastime.  Mom’s brain weighed 1404 grams, who knew? But then I felt disappointment.  Coming from an oncology background, I want to understand her cancer on a cellular level.  Why it was so drug resistant.  Why she wasn’t cured.  Part of me was naively hoping there would be some striking insight from her autopsy on why she had to die, on that rainy December day at the age of 58. There wasn’t one.

I didn’t learn much from the report.  Her abdomen was full of lymphoma, but it had not infiltrated her kidneys or her brain like I thought it might have. It still seems unclear what kind of lymphoma she had, exactly. The report didn’t tell me why it was, to quote my mentor and friend, “the world’s worst lymphoma.”  And now, I will learn nothing more from her physical body.  The days of pouring over her CT scans and lab reports and now this final document are done.

I must accept that she is gone, and it will never make any sense.

Mom’s body has been turned to ash, but her tumor is preserved in a tissue bank somewhere.  Perhaps someday those rogue cells will give up their secrets to researchers someday.  Perhaps those researchers will use the knowledge gained to to save another mother’s life, somewhere. I hope they remember, as they hold the cold slides in their gloved hands, that this cancer was terrible and powerful enough to take a most perfect soul, and break the hearts of those that loved her.

my work

Here I go, breaking my rules again… (the one about not writing about work)

Its been a hard few weeks at the office.  Even though I feel I’m divinely suited for this job (nurse practitioner in oncology), sometimes its overwhelming, and I think maybe life working in urgent care or a weight loss clinic wouldn’t be so bad.  This last month has been full of disease progression, hospice discharges, and death.  People I have grown to love, struggling with pain, dying too young.

My years of working in bone marrow transplant taught me a certain brand of detachment–  how to stay rooted in the present and not be attached to a future for the human beings in front of me.  It was a powerful lesson in letting go; I couldn’t look into the eyes of children with high risk leukemia day after day and worry about what was awaiting them next month or next year– it was unlikely to be a healthy, normal childhood. I had to care for and advocate for my patients, do the very best job possible every day, but turn over the outcomes and what would happen tomorrow to the universe, God, Buddha, Mother Mary, physicians, someone or something else other than myself. Because there are patients that will die despite a favorable prognosis and everyone doing the right thing, and there are patients that will somehow fight their way out of the grip of death and against all odds, survive. You never quite know in this business.

My patients these days are healthier and many of them are cured.  Even the women with aggressive, metastatic disease usually live years rather than months. I see them week after week, month after month, and I grow very fond of them.  We laugh together, we hug, we share photos and stories, I meet their best friends and relatives.  Its hard to say goodbye after such a long relationship.  I thought I was getting better at this but now I’m not so sure.  My loss of my mother has made me more sensitive to what the families are going through. As I work through my own grief I can feel what the surviving loved ones are experiencing.  It hurts.  I also see my mother in some of these patients and feel as helpless as I did to fix things during her illness.  I sit in the exam rooms with my dying patients and look down at my empty, searching hands.

And yet perspective is everything.  I am greeted with success stories every day.  These women plunged down the rabbit hole of cancer treatment and emerged on the other side, bathed in sunlight. As elusive as those rogue cells can be, resorting to every dirty trick in the book, sometimes cancer is completely slaughtered with the arsenal of treatment.  It happens.  An everyday miracle.  A billion cells, a million microscopic explosions in the battlefield of the body.  Victory down to the smallest unit of life.

Even when the war cannot be won, the enemy is usually held at bay for a while.  Mom’s cancer was very drug resistant, but I still think chemo bought her time.  Important time.  If she were here, I think she’d say that the nausea and the hair loss and the fatigue was worth it for her.

So, what I do weighs on me sometimes.  But it matters.  I can’t forget that.