Behold the Wail

Omar Haque Sultan, Harvard Medical School, MS2

I.

In New England one hears a subtle song of elation in the heads of children on every November morning that still allows an adventure to be had amid the crisp and crispening breezes of the day. Play is a thing without apology: along the flowing grasses, muddy fields, and patches of squash and gourd, many small and shallow footprints can be found witnessing to the joy of a spontaneous day well spent doing nothing in particular. But as they soothe, these days also warn. The meaning and weight of anticipation presupposes its failure: a stern winter arrives soon. Yet the fleeting Fall still yields its last magic in an expiration by slow radiance. Colorful leaves complete their epoch, wrinkle and, one day, descend by a soft, floating dance back to the clay of their Creation.

II.

His forehead and hands spoke with furrows of wisdom and toil. His face speckled with a grey sandpaper shadow, I could still see his smile under the bandages. From my brief interview, I found him well-versed in the classics of 18th Century French literature. Mr. R was a charming, shiny-eyed and retired professor now close to his end after a failed liver transplant. My eclectic and hybrid upbringing easily forgave his racial bluntness ("Are you from Bombay? How do you like American food?"). I found him endearing, as were his attempts to communicate amid his severe pain.

At seventy-seven years old, his chances of another transplant in the next few days were near impossible.

"I'm on the waiting list in case they thaw Ted Williams. In this game, its only two strikes and you're out."

"Is your family in the area?"

"Yes. But I don't let them come see me…"

"Can I ask why?"

"Kid, even if you pay good money to go see a boxing match, did you ever wonder why no one in the audience protests when they stop the match after a TKO?...Even if the guy can get up after 3 knock downs?"

He wanted to make it to Thanksgiving, to witness his grandchildren's children arrival into the world. He wanted to see the newest little ones wiggle and giggle, spit and spurt. He loved them all too much; he tried to make me understand these depths.

If an excess of love brings pain, then an excess of some kinds of pain bring numbness. A continuous 8-week barrage of burying my face in Albert's Molecular Biology of the Cell, and I was not surprised to have found myself hesitant to touch Mr. R without a well defined 'diagnostic endpoint.' I was methodically losing myself for a more perfected kind of irrelevancy.

Lost in this brief dissonance, I suddenly noticed a tear well up in his right eye, hang precipitously, fall into a chiseled crease in his cheek, and disappear behind his ear. Without thinking, I reached toward him and took his swollen, calloused hand in mine. It felt cold and limp. I was speechless.

I have been trained to interview. I know the CAGE questions like I know my mother's birthday. I have been programmed with a question for every answer. But now, who is doing the asking? Here, what counts as an answer? In becoming a doctor, the blind insatiability of youth meets what Freud called, "the painful riddle of death." We are a room of warm bodies getting colder-some faster than others-and no spectacle of form or fact will fill this lonesome Cold Shadow. A Shadow that asks not to be illuminated, completed, concluded, solved, or given a p-value-for it has none.

My shiny, but clumsy, bag of toys held no power anymore.

"Kid, haven't they told you yet? No one cries when an old man dies."

In the silence, he stared at me behind his jungle of tubes and bandages. Those quivering steel-blue Irish eyes begged for an answer. Then his left eye let go its cautious pearl. I leaned over and wiped the salty drop caught in the curve of his crusty upper lip.

Hesitant. Clumsy. Leaning in, I kissed him above his gray and bushy left eyebrow.

Without speaking, we sat and just stared at each other.

The room grew dark, and now the harvest sun was almost beyond its horizon.

His last words to me were: "No one can ever know if it was the beginning or the end of the day."

We remained just like that, unmoved well into the evening.

He refused his dinner. I missed my bus home.

III.

We have chosen a profession of constantly devoting ourselves to the care of others in need, yet this does not insure or require even occasional care for each other's needs as human beings-which are emotional rather than embolic. The problem of doctoring presupposes the impasse of all ethics: Why care for another human at all? No global consensus exists on the source and nature of our ethics. The problem of doctoring neither allows nor inclines any such placid answers. Rather, it mocks them.

Whether with fish or Irishmen, both evolutionarily and developmentally, we arise, are nourished, and consume from the earth, and to it we shall return. Is it then, "reverence for life," to quote the famous phrase of Dr. Albert Schweitzer, that does carry us forthright to medicine's salvific altruism? Season after season, this answer is easily applied to things without contradictions or mortgages. Our ethical answer to the non-conscious world should be to nourish its almost limitless renewal.

But the human is a thing of majesty and paradox, where even "most of the time" is an achievement worth celebrating.

Mr. R shows how a solution is not reliably an answer. Even the most properly perfected formula can be a transgression if applied at the wrong time, in the obtuseness of human sentiment and decline. Mr. R demonstrates the privilege to have once lived perennial joy and sorrow; and the agony to now feel too much love in the vortex of rewind.

Our blessing is that nothing like Mr. R has ever existed before. Our curse is that nothing like Mr. R will ever exist again. Astute philosophers rarely fail to remark on the privilege and pain of too much knowledge.

What then, of Death?

The lonesome Beast
Too conscious of its finitude.
Anguish felt ever more acutely
Aching slowly, with passing of ourselves
to our negation.

Like every and all,
Stammering from adolescence to adulthood,
Medicine must confront its surplus of knowledge.
Can it be taught: curses and blessings alike?

To tell another:
This autumnal splendor is passing for
Winter only to find spring once again,
To conceal another's hopelessness by our denial.
Giggle at the abyss!
The bounties of human
Fragility, made awkward.

Death! Be what you always must;
These kisses make it as such:
To have been not is now impossible,
To one day be not is the only possibility.

Yes, Winter creeps and then comes,
But only so that we could have been.
Tears require because they fall;
Kisses last because they graze.

Yet, it must be not how it has
For far many. The lonesome Cold
Stings, and we forsake each other
As each in its own way,
Still giggles at the abyss.

We can attend, witness.
To affirm a world that denies us this
transcendence at every bend?
We can, we must,
Behold this wail.