Wednesday, February 16, 2005

High in the Sunlit Silence

When I was a teenager I loved to watch the television comedy M*A*S*H, which may have subconsciously spurred an interest in medicine. Part of my fascination with the show was the realistic portrayal of how the doctors dealt with the stress of working in a chaotic war zone. It seemed that the hospital was the destination for an endless caravan of wounded soldiers, all desperately in need of the unique blend of surgery and fatherly advice the show's characters dispensed. The surgeon's shifts were long and grueling, yet they never failed once to complete their duties. Nothing could disrupt their devotion to patching up the young patients - the operating room survived blackouts, bombings, belligerent patients, snipers and supply shortages. It was the paradigm of grace under pressure.

There was one event, however, that rocked the surgical suite more than any other crisis ever broadcast on the show, and like most viewers on that day I was shocked by the tragedy. Part of the reason why the moment was so dramatic was that it consisted merely of an item of news delivered to the operating room staff by the company clerk.

The news was that Colonel Henry Blake, the freshly discharged commander of M*A*S*H 4077 had been killed in an airplane crash on his way back to the states.

I will never forget the looks on the surgeon's faces as they absorbed this devastating shock of the loss of their likeable leader. Because the doctors remained silent after hearing the news, the effect was stunning. They took this blow as stoically as Caesar took the dagger of Brutus, pausing briefly to stare at nothing and no one, then leaning over the open wound to carry on. This was an inspiring show of fortitude, but at the time I also thought it was unrealistic - how could anyone remain quiet in such a time of grief? Are doctors so obsessed with their work that they avoid showing any signs of human frailty? Could this reaction eventually lead to what our psychologist colleagues call repression?

The years passed, and by some miracle not seen since the parting of the Red Sea I was accepted into medical school, and furthermore, mirabile dictu, matched at a reputable internal medicine residency. I now viewed the bustling world not as a layperson, but through the goggles of an authentic physician, albeit a greenhorn. I slowly learned how to survive the hospital's routine, which apparently was modeled after the Hanoi Hilton's. After months of exhausting service comparable to the barbarity suffered by the good surgeons of the 4077th, we residents became inured to the bellyaching of patients, fellow physicians, spouses and pets. Our work was an addiction. The outside world faded from our sights as quickly as if we were rocketing away from Mother Earth.

On January 28, 1986, while on morning rounds in the intensive care unit, the space ride came to an abrupt, awful end. The universe awakened and stomped our little hideaway into an unrecognizable heap, and we realized that we were still citizens in a massive living thing called America. The question I posed all those years before - does the news of a tragedy stop a doctor in his tracks - was answered that day.

When the space shuttle Challenger exploded shortly after takeoff we not only stopped, we forgot why we were in the hospital in the first place.

Residents, attendings, nurses and anyone else close by on that day huddled around the nearest television as the drama unfolded. We watched the horrific moment again and again. The event staggered us so much that it transcended sadness and became baffling - we simply could not fathom what our eyes had just witnessed. We suspended our work that morning because we had just been shown a parallel universe, previously unknown to inexperienced minds - a strange world where a song of triumph disappears while it is being sung, a world where certitude is but a wisp of floating silk waiting to be swept away by the pitiless wind.

Like the rest of America, I experienced this heartbreak once more on September 11th, 2001. Again doctors stood in disbelief before the television, unfocused and afraid. We sank with despair on that day and hated ourselves for returning to the exam room - but return we did. We could have cancelled our clinics, but instead we went back to work on one of the worst days in the history of our country. I understand more clearly now why the doctors on M*A*S*H kept working on that fateful day. After catching their breath they looked down at their hands and saw them move; they opened their mouth and heard their voice. The surgeons searched within themselves and concluded that their only usefulness, their only worth in the world was if they kept the promise they made to another human in need. That promise is what fuels the doctor's engine for the magnificent journey called his career. It is the only thing that can lift him high enough to slip the surly bonds of earth and touch the face of God.


At 3:11 PM, Blogger Marinade Dave said...

I find your articles very interesting. My brother, a captain in the Air Force, lives in O'Fallon, Illinois, but is presently in Kirkuk, Iraq.

My brother-in-law has AML and went through chemo at MD Anderson Cancer Center in Houston. It didn't work. His blasts are up to 35 now and he will be going through a stem cell transplant very soon. He and my sister are moving there for six months. I just hope they stay there for the whole six months.

It's nice to read about what goes through the complex mind of a doctor. Keep up the good work.

At 10:25 PM, Blogger Dreaming again said...

I just watched the re run of that episode last week. It struck me just as hard as the first time I saw it ...and the second time, the third and the fourth. (who knows how many times I've seen it, I've never tired of the re runs, now my 13 and 15 year old sons watch it with me every day there isn't school)(on mash topic, off post topic ... my favorite line in the whole series was when the general's gun came up missing and a drunk Radar thought he'd be going to the clink forever and said "I'll be going in in my puberty and coming out in my adultery!" )

It's funny that you compared that feeling to the space shuttle and 9/11 ... my husband and I said that it gave us the same sinking feeling. Obviously not as strong as the real situation, but you could feel, even in re runs when you know it's coming, the loss ... the loss of a loved one through battle. The loss of a loved one through tragedy. The loss of a loved one through something that never ever should have happened.

Marinade dave ... I hope your brother in law does well. My 35 year old cousin is in the Portland with AML ... his chemo isn't working either, and they're testing his siblings for bone marrow match. If that doesn't work, they said something about stem cell, but wasn't exactly sure what they meant by that. His will have to be done very soon also.

At 3:42 PM, Blogger gemmak said...

I had never seen that episode of MASH until two days ago when it was coincidentally re-run over here in the UK. It was remarkably powerful and bought home to me just how fragile and ironic life can be sometimes.

I've visited your blog a few times previously but not commented. It makes quite difficult reading at times but it's good to hear the thoughts of someone on the 'other side' and to whom (at least in the UK) most of us don't have access to other than in a professional capacity.

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Everyone has days when they are down, worn out, generalized anxiety disorder symptom and just not feeling all that happy.

That's OK, you need to have days like this, otherwise how would you know when you are happy. You need to have something to contrast your happiness with. What is black without white?

Even though you know that sadness (generalized anxiety disorder symptom) is a part of life, let's try to make it a small part of life.

With that said, here are a few tips to help you feel better when you are feeling down in the dumps. They are easy to do, easy to practice every day and they work!

1. Stand up straight, sit up straight. When your body is in alignment your energy can flow and when your energy is flowing freely, you can flow.

2. Smile! Yes, just smile. Easy to do and effective.

3. Repeat positive affirmations. Things like "I feel good", "Positive energy flows through my body", "I see the good in all".

4. Listen to some music that you like. It doesn't have to be anything specific, just something you enjoy. Certain types of music work better than others, but experiment and see what works for you. Studies have shown that Classical music and new age music work best.

5. Take some time out for yourself, relax and read a book, do something for yourself.

6. Meditate. Meditation is an excellent habit to develop. It will serve you in all that you do. If you are one who has a hard time sitting still, then try some special meditation CDs that coax your brain into the meditative state. Just search for "Meditation music" on Google or Yahoo and explore.

Our outside work is simply a reflection of our inside world. Remember there is no reality just your perception of it. Use this truth to your advantage. Whenever you are sad, realize that it is all in your mind and you do have the power to change your perception.

These tips will lift you up when you are down, but don't just use them when you are sad or generalized anxiety disorder symptom . Try and practice them everyday, make them a habit. You will be surprised at how these simple exercises will keep the rainy days away.

On a final note, if you are in a deep depression that you can't seem to shake, please go see a doctor. This is your life and don't take any chances. generalized anxiety disorder symptom

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