We’re at this place here in Seattle where summer bestows upon winter a confused, wet kiss. Fall is born and residents don’t know whether to don fleece, shorts, or some combination of the two. On one sidewalk, ear-muffs and flip flops co-exist amongst the decoration of fallen leaves. I love this change, this confusion, when rain doesn’t always equate cold and when the sun does not always chase away the chill.
Growing up in a place like San Diego where a rainy day has somehow become “tweet-worthy,” this refreshing chill of autumn, is welcomed. Shuffling through water-matted leaves clinging to the city’s sidewalks under grey skies is oddly cathartic.
It feels as if the weather, as if the region, is helping to bear my burdens. The pacific northwest itself is lending its understanding and even advice to my emotional state. The past few months have been interesting, to say the least. And in hearing the wind’s perplexing songs and seeing the ruffled brow of the clouds, I am led to believe that autumn knows. Or maybe it’s God who knows. Or both.
I began working in stem cell transplant as a physician assistant in the beginning of February. I work with the actual patients going through the process. We treat complications, infections, regimen related toxicities, etc. Our primary patient population possess hematologic malignancies (leukemias and lymphomas). While our researchers are tremendously brilliant, I imagine it might be somewhat easier (at least emotionally) to remain on that side of transplant. You can remain detached. Deaths can remain face-less numbers. Holding the hands of those mourning remains on the inside of the building up the street.
Ironically, these faces and stories are what originally attracted me to oncology in the first place. On cover letters and in interviews, I stated, “I want to help people, to be there for individuals who are going through their most difficult moments.” This is still true. I just did not realize how difficult it would be.
“How can there be laughter,
How can there be pleasure,
When the whole world
Is burning?
When you
Are deep in darkness,
Will you not ask for a lamp? ”
-The Dhammapada
How can I not feel what they feel? How can a small part of me not die each time they suffer, each time another patient passes?
In PA school, we had a lecturer named Kathleen who did the majority of our hematology/oncology lectures. She was amazing. There is not one person in my class who was not somehow inspired by her. She somehow balanced on this tightrope of daily giving of herself, maintaining openness and empathy alongside of an ability to, at least partially, compartmentalize in not taking every difficult case home with her.
I have not yet learned how to do this.
Either I flip some internal switch within myself to allow for emotional distance or I end up crying in the bathroom on a semi-regular basis (though it seems that I suffer from the latter more often than the former). I work with a few other providers who seemed to have perfected this delicate dance. In asking how they do it, I have not yet found a real, concrete answer that I can actually put into practice.
I suppose it is a rather vague concept, as well as somewhat personal. Dealing with death and tragedy isn’t really something you want to bring up at an after work happy hour.
More than fearing sadness and pain though, I fear detachment and coldness and the gradual distancing of myself. I fear a slow extinguishment of a part of my personality, a part of my soul, that I very much treasure.
I am not alone in this. Of this I am certain. So, for those of us who encounter tragedy, sadness, and human suffering on a regular basis, how do we cope? Does the answer lie in spreading the burden, in sharing these moments of sadness with those with whom we are close? Does the answer lie in prayer, casting our cares upon Him because he cares for us?
Maybe this gradual distancing is inevitable, regardless of how vigilant we are in attempting to retain our emotional availability… I would be a fool to assume that traumatic experiences do not change us in some manner. Am I a fool to hope that it will change me for the better, as opposed to turning me into a bitter and cynical old woman?
I am reading a book called Trauma Stewardship: An Everyday Guide to Caring for Self while Caring for Others. The author states something simple that really resonates with me… “Being present [in difficult circumstances] is real work.”
Until I stumble upon some very wise person who possesses the answers to each of these questions, I will continue to work on being present. I will continue to try and bring all of me to these difficult encounters, embracing the fears, disappointments and sadness of both my patients and myself. I will try to wholly be there, offering all of myself all of the time. I recognize this is much easier said than done. And I pray that the changes that each of us experience, the rapidity of water moving over these stones of jagged edges, will change us for the better.
In the past 9 months, I have learned already that living becomes a much more powerful, poignant activity when death is kept in mind. It reminds us to say the words we should, to be bold and courageous. It prompts us to love those around us so hard, so mightily. The idea of death instigates action now, while we can. It is so easy to turn around and ask, where did that week go? Where did that season go? Where did that decade go? I just don’t want to turn around and ask, “Where did that life go?”
I want to be ready. I want to love and to care and to do now.
Before it is too late.
