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.