Pietà

It took only hours for me.

Just a couple of hours in the World War I Museum in Kansas City.

Its entrance, fittingly, a long, sloping slide to heavy, brass doors. The doors themselves fronting what seems at once a casement, at once a tomb.

But for those of that generation who once manned such casements, too many of whom too soon came to man such tombs, my own couple of hours seemed sacrilege.

Me eyeing those munitions, the likes of which stilled some by the shell, slaughtered thousands by shot, by shock, by gas, by grenade, by the butcher’s cut of machine-gun fire, by bullets sawing life from limb; lives then pooling in seconds, those ponds of blood all at once rimmed by mud, by wire; anything that might ever have been itself puddling a landscape pocked from then to tomorrow.

And me, now, shrinking from these, these encased bayonets, these saved shells, themselves rescued from rust, the ignominy they once, always, deserved.

Me, here, now, almost a century later, eyeing dice, mere dice, mere playing cards, all, face value, even if in miniature. Dice, cards, that all those decades ago made life for moments some semblance of life for those for whom life was then otherwise mud, otherwise stench, otherwise the whistle of shells, the rip of machine guns, the nearness, the irrepressible imminence of death.

And me, this moment, in this museum, staring, in photographs, into the eyes, the eyes of the dead.

Some stunned dead by war.

The rest, all the rest, silenced since by life itself.

By this, the slow cadence of life. Too many of those in those photographs never outliving all they had lived before.

My own grandfather among them.

He, in 1917, then 21 or almost so, a boy made quickly a man by war, packaged in khaki, then shipped to the front.

To him, to everyone then, packed off to that Great War. That war then presumed to end all wars. The one commemorated by this same monument, itself today stabbing a clouded sky.

And far away, in time, in place...

Far from my dead grandfather’s New York City. Far removed from those words inscribed on this monument in Kansas City. The words commemorating this war “the world war,” the emphasis on “the” lost today, as if, naïvely, no one then could ever imagine that one world war might ever engender another.

Only to have my own father fight that next world war, the one never imagined. Only himself to escape by marriage, maybe by newborn me, fighting another, the war after that, the one in Korea.

And my brother, my own brother, a couple of decades later, enlisting during Vietnam.

And I, older than that brother, living, in effect, under the gun, spared by the only lottery I have ever to win. Me, my own five children, since then living life in the shadow of too many wars since that one of my own youth.

And all of us knowing today what my grandfather, almost a century ago, could never have known.

That those in command then, in that Great War, a war now so soon nearly a century dead to history, were convinced to blindness to stand their ground, even if standing ground meant digging deep into that ground.

Meant trenches.

Meant what we now know as trench warfare.

Meant snarls of barbed wire. Senseless forays over the top, the top of the trenches, the top of the wire. Meant traversing no man’s land, itself a cemetery of the willing; of those prodded by whim, by conscience, by any sense whatsoever, misplaced or otherwise, whether of God, of country; every last man now a name on a stone or dust known only to some god, every last soul utterly, ineluctably luckless.

And all that museumed here.

Here, mid-prairie. Here, in what is, to many, the middle of nowhere.

An ocean, and half a continent more, from there, from anyone’s anywhere. Decades, nearly a century, from then.

And me here, now, in 2011, two wars at a time currently engaging us, them, and two of my four sons with me today, both, so far, blessedly removed from either, both wars.

Me grateful today, every day.

Me, having, let’s face it, escaped death myself by the luck of the draw during Vietnam. My four sons so far, to this day, their lives, their whole lives, still ahead.

And then, this morning, these eyes.

Eyes that had seen so much, now saying so little. Eyes like searchlights sweeping a hospital room, lighting, in their passing, only shadows.

His mother, so young herself, what, three, four, feet from his, her boy’s, hospital bed. Her own eyes, any mother’s eyes, this morning lidding sorrow.

His eyes, again, not once on mine, never on mine, never on Tara’s, the social worker with me, me this morning doing palliative care.

His neck, arms, whatever else, inked with tattoos.

His face a mask.

All he lived before, before. All since, since. All, everything, all of it, every last minute in Iraq, a cipher.

“Thank you,” I tell him right away. “Thank you for what you did for all of us,” his own eyes even then darting to anywhere but meeting mine.

I don’t tell him that I myself dodged bullets by the numbers. That he did what I, my own sons, others his age, might otherwise, under other circumstances, have done. Might, if blessed, have survived.

But I did, this morning, think those thoughts.

All those thoughts.

My last, this son, hers—hers beloved as any, beloved as my own—he, in her mind, draped in his mother’s arms; she, in his, still cradling the boy he’d been. Their eyes saying what eyes alone can say…


© 2011, Dónal Kevin Gordon

“How do you do this?”

We had just spent the better of two hours with a newly diagnosed cancer patient.

A patient young, certainly by the standard of my own 60 years.

She herself still absorbing the news that she, no one, ever hopes to hear. Her husband, at more remove, fathoming, all at once, the unfathomable. The visit itself emotional, more so than any of us in that room might ever have expected.

With me, this visit, one of the Family Medicine residents with whom I work as faculty. She, the entire time, quiet, but attentive, paged once from the room—and long then in returning.

It was one of those patient visits when I do what I usually do; when Melanie, the palliative medicine nurse accompanying me this day, most days, does what she usually does on any day; when neither Melanie nor I thought we were anywhere outside the territory we usually inhabit, despite the patient’s relative youth, despite the poignancy of the moment.

But for the resident—new to this and young herself, perhaps new to death, and certainly to this, to death’s insistent rap at the door—heartrending.

“How do you do this?” she asks me, seconds after leaving the room, her voice rising on that last word, the two of us praying foam into our hands, the better to deaden exposures more benign than those to the heart, even as we put backs to the room, even as we turned to the corridor.

“I twice wanted to get up and leave, was glad for that page,” she says.

And again, seconds later, “How do you do this?”

“I don’t know,” I replied, that much the truth, pausing a few seconds. “Someone has to,” I say feebly. “Maybe me.”

The thing is, until that resident asked me that question, I had not ever asked myself how I do this.

I just do it.

Sure, there are nights when I come home from a day on palliative all but empty emotionally.

The whole day death, dying.

And me, in the evening, just home from work, in a chair, in the living room, quiet, my wife Karen respecting that silence, maybe an hour, maybe a little more, me the whole time awaiting the tide: for life to flow again, for death to ebb again, at least for today, for now, for the moment, this moment.

So, how do I do this?

Nothing in med school, not one hour of pathology, not an entire semester of pharmacology, no amount of biochemistry, no one or any combination of rotations, could ever have schooled me to do what I now do.

Even I, now faculty at a Family Medicine residency, adjunct faculty at the nearby medical school, am unsure how to teach what I’m not sure can be taught, except by me letting that resident, any resident, just experience this: life, life itself; death, the awful imminence of death.

But how to instill in those residents, those med students who follow me, my own long life before I began med school at age 49. My own losses along the way. The things that make me who I am, that taught me.

My mother’s death, herself, her beautiful self, then just 49, to breast cancer. My father’s to pancreatic cancer at 66—and him, a good man, a good father, looking to life ahead, but dead almost before he knew he was dying, before he could make amends for things no one of his five children thought needed amending.

And before that…

An uncle, my father’s kid brother, dead to fire at 28, only two weeks after the death of my own mother’s mother. Just two years later, my father’s only, other brother, dead himself, at 26, in a car accident. And, in the year between, a miscarriage, it just shy of taking my own mother’s life, she a breath from death that day at arrival at the hospital.

And me coming home from school that afternoon, blood spotting, no murdering, the path our family doctor had walked from mattress to front door; he, seeing what he had seen, scooping my mother in his arms, carrying her to his car; the oar of the steering wheel then in his hands; and he, suddenly Charon, ferrying my mother to the hospital. And my father, later that night, his eyes hollow, the near loss of his loved bride beyond any attempt to be anything less than just that, lost.

And me, all this time, only a boy, oldest then of four, but, oldest or not, a boy.

And later still, a friend, my age then, my age then young, dead by his own hand at 29. An uncle, himself later a suicide. All aunts but one, all uncles but one, now lost to all but memory.

How do I do this?

I learned only from life.

My hand, only days ago, on a patient’s hand. She, only weeks ago turned 50, new to the news that she had incurable lung cancer. Her eyes, lids pooling tears, on mine.

“I’m scared,” she says, her voice failing.

“I know,” my hand tightens on hers, hers tightening on mine.

And, just behind me, her three daughters, all of them young, all three thinking, as all of us always do, that they would have their mother, their loved mother, forever.

And just minutes before, my own arm around the shoulders of one daughter, and me telling her, “I’ve been here. I do understand.”

But, God, how I myself so often hurt, still often cry.


© 2011, Dónal Kevin Gordon

Once in September…

Until that day, that day was our son Brendan’s birthday. Always, always a happy day. A day, in our home, to celebrate life. Our own Brendan’s life.

But that was before September 11^th became 9.11. Before Brendan’s birthday became a remembrance of things past, that past all at once lit against sudden darkness. Before Afghanistan. Before Iraq. Before Homeland Security and pre-flight pat-downs. Before any of us thought any of us had anything to fear.

And now…

The pages of history dog-eared by columns burning. By pictures of the lost, taped and thumbtacked, sunlit by day in that last summer, by night by candle. By hope, tears, anger, memory, grief, revenge and, for some, an uncentered joy.

And Brendan himself, today 27, a decade after a teenager’s birthday was hijacked and made his generation’s Pearl Harbor?

Four years in New Orleans, helping to rebuild after Katrina.

Two stints in Haiti after the earthquake.

And just yesterday home from Japan, after months doing his part to undo a tsunami.

A life, so far, well lived.

But all those other lives lost.

Those many thousands of lives, these many thousands of days later.

The good those lives, left to live, might have done. The love they would have shared. Those other hearts, those hearts the lost themselves once loved, not ever broken.

And today?

Today we remember things past, even as we imagine that future all those lost would have all of us imagine.

And here at home, here in this small town in Iowa, here at this old yellow house that has already seen its share of history, watched so many lives quietly come, quietly go. A house that has heard laughter dampened by time. The laughter of children who lived their lives, only in time to themselves become ghosts. An old yellow house that remembers, in its way, all those who passed this way.

Here at this old house, we today celebrate life. Celebrate Brendan. The good he’s done. The joy he’s given. The hope he, at 27, represents for us. For all of us.

© 2011, Dónal Kevin Gordon

Oh, to prey in Pray…

“Come on in! Have some fun!”

That invitation—coming from one of four guys pumped on something stronger than sun, all four doing their own kind of homeland security, all of them posted outside a bar in this, the middle of a weekday afternoon, here in the middle of sky-big, sun-amped Montana—was, not surprisingly, not at all a pass, lateral or otherwise, in my direction.

Not when the first of us to cross any one of those eight, paired guy-eyes was my attractive, my looking-decidedly-younger-than-her-years wife, and our own equally attractive, calendar-younger daughter. With me lagging enough behind. Just enough so to make both lasses look like they’d not ever be with a guy so grey above the ears as me. Not by choice, certainly. Not by any stretch of any guy’s imagination. Let alone the beer-and-a-bump imaginations of these particular guys.

“Come on in!” one bleats, beating his buddies to their own blurts. “Have some fun!”

Those guys, those four, all four steadied by the four legs of their chairs, those chairs outside a bar, mid-afternoon, all of us, this very mid-afternoon, somewhere south of Pray, in southern Montana. All four guys, at the least, the bar’s own welcome committee; at best, the town’s chamber of commerce; at worst, just four guys hoping, hoping for their own, anyone’s, version of the best.

Me, remembering a younger me, can’t blame them, though, for trying.

“Come on in! Have some fun!”

A come-hither, at once consummate, consummation itself still anyone’s guess.

Meanwhile, this hither worth the hither, brew-breathed or otherwise.

Y’miss most, y’get lucky once, y’go to bed counting the day good, they gotta be thinking.

And, always, always, the prospect of another come-hither, lucky, if luck revisits, and another, at the end of the day, good day.

So, yeah, why not. “Come on in! Have some fun!”

© 2011, Dónal Kevin Gordon

Love in the Afternoon

Start any day on Palliative Medicine, and you already know that your day is anything but that which you might otherwise predict.

Family meeting, half past nine, but no family there.

Move on to the ten o’clock family meeting, son there, not the daughter. Try to squeeze in a follow-up, only to find that that patient is down in radiology. Back to the half-past-nine, hoping against hope, in this, this our own mission of hope…

Our days, our agendas, we all know, are fluid.

We start with lists of patients. We plan to see most in some timely manner. And then…

Lovely woman, 58 years old. Her husband at the bedside.

She had come in with pain, pain in her fingertips, with, studies confirm, micro-embolisms in those fingertips.

Only ten days earlier, however, she had learned of her Stage IV lung cancer, she still absorbing that.

Radiation not an option. Chemo still out there, waiting, waiting for the oncologist to call the score.

“They give me a year,” she tells me and tells the nurse with me. “And that, that, they say, is generous,” tears starting.

Her husband, now and all this time, stoic, even as we continue to talk, talk about those things no one wants to talk about. His chin, once or twice in all that time trembling, the weight of her future, theirs, all at once nothing but that, a weight.

And then from nowhere…

“I do love you,” she tells him, her eyes, her eyes brimming with tears. “I just never told you.”

All at once, his eyes turning to hers.

Hers to his.

His surprised.

Decades married. Two adult children.

And love.

Love this very afternoon, a surprise.

Letting go…

She is eating her lunch, as I interrupt that lunch.

Yet, she, she already knows.

Already knows that some kind of cancer, maybe lung from above, maybe pancreatic from below, has already charted a path from here to tomorrow. A path other than the one she and her husband of some fifty years might otherwise have wished, have ever imagined.

Still, here I am, the palliative care physician, the one echoing the oncologist’s bad news.

The patient herself, frail, gray hair cropped short, quietly forking food to mouth, mostly ignoring me, anything I have to say.

And her husband—her husband now of decades, his love so very obvious, so obviously obvious. Even as he, like so many men of any age, tries to make that love, any love, seem somehow less noticeable. At least to eyes, any eyes, especially eyes, eyes as inquisitive as mine.

And he, to my eyes, losing already what he never envisioned losing.

Looking to me, then quickly to her.

And his eyes—oh, my God, his eyes—his eyes right now damming tears, even as those eyes redden, their lids swell. And he struggling to keep me, the nurse with me, from ever, ever noticing.

How to give up what we love…

I myself love poetry.

Love the interplay of word with word within any given line.

Love line tumbling after line, those lines forming a stanza, stanzas a poem, the poem itself music. The music that of my life, your life, all lives.

To lose it, that poetry, is, in a sense, to lose life.

But to lose those we love…oh, to lose those we love…

My own loved mother, dead at 49 of breast cancer. My father, loved at least as much, gone at 66 of pancreatic cancer.

Their ghosts, their ghosts in the room, this room, this morning, with me.

Their own son, these decades later, still freighted himself with those memories.
And me now, talking to this woman, her husband.

Me, thinking at the same time, of all I myself have ever lost. And, at the same time, all I still have.

My wife Karen, our children; my siblings, Karen’s; that next generation, the one extending ours.

All of us, hope against hope, tumbling day after day, no less than those lines of poetry I love. Lines rippling iambically or otherwise one after another. The music, that music. That of lives, mine, yours, ours, everyone’s, now and forever.

And still, she, this patient, fork to mouth, no eye contact whatsoever.

And her husband, straddling some moto-chair, cowboying his own emotions: ignore this, his body seems to say; ignore this, like all those rashes ignored this life long, like any and all colds.

And maybe, just maybe, everything, all this, will, will just go away.

But those eyes, his eyes…

Those eyes…

Those eyes pooling tears even as they say what ineluctably is:

“This will kill you, my love, you I have loved so long, these fifty years.

Kill you no less than any knife, the gun in any murderer’s hand.

You, my lover, you I held so often, so long. Mother of our children. The woman, the woman I remember young, so very young.

The murderer here, the murderer it has always been, the murderer life itself.

And all you love, all I love, all who ever loved you, ending in some instant.
Some instant so soon to come.

A moment you, I, those you love, are now cruelly left to imagine…"


© 2011, Dónal Kevin Gordon

Dying by degrees…

After a week and the better part of another out west, out where, on Washington’s Olympic Peninsula, temperatures flirted with a decidedly coquettish 70, where, in Montana, temps hit the upper 80s, albeit with the humidity in the temperate 30s, we bird-dogged this summer’s heat wave home to Iowa.

Driving east from Rapid City, South Dakota, we saw temperatures climb from the mid-90s to 100, eventually to 106, the road crews on I-90 somehow undeterred. Me, at the same time, cursing my whereabouts, blessing the car’s air conditioning, wishing somehow that sometime soon all this, this intimation of hell, would break.

We’re home now ten days, and I’m still breaking sweat.

Oh, sure, it has rained, often and to notable effect, that much water on so much hot rock creating nothing more than a regional sauna. And the temp here has dipped, maybe, to the upper 80s, only to rebound to, what, to some, a tepid, 95; to others, a balmy 97.

“I’m Irish,” I tell Karen, as I, suffering, surrender, heart, soul, arms- akimbo in abject submission, to the nearest air conditioner. “I’m built for cold, bleak islands.”

Indeed, Iowa itself, neither particularly cold, nor in any way bleak, let alone an island, unless imagined as some landlocked island of corn, is hardly hospitable to the likes of me, even as it makes itself home on so many other levels.

Heart of the heartland, the state certainly wears that heart on its sleeve, welcoming one, all, even as it welcomed my own family almost a dozen years ago, the only test that, and a test somewhat less than a test at that, of winter.

“Been through an Iowa winter?” we were asked, asked often, as newcomers to Iowa, those winters from the first scarcely requiring attention compared to the winters we had known in northern Vermont.

“When does winter start?” our own Vermont-born kids asked, halfway through our first Iowa winter, their disappointment measured as much by inflection as by the dismay on their faces.

And every summer here since, even as the corn, year after year, revels in heat, in humidity, I crank the air conditioners, only, only to make life here, at least summer here, otherwise tolerable, somehow still tolerable.

Outside, though, I die, die by degrees, wishing fewer of them in summer, fewer even in winter; wishing this summer, every summer, to feel what I so rarely feel: alive.

© 2011 by Dónal Kevin Gordon

All that matters…

I have written here in recent weeks of place, of time.

But so much of our recent trip west had to do with people, with family—with a sister, brothers, their spouses, children—family I’ve long not seen, never less than loved, too long neglected, so often missed; and yet another sister, beyond those other siblings, herself absent.

I am myself the oldest of five, and I confess that while I often see my youngest brother, who himself lives conveniently in the same state, I have not seen my next younger brother in 12 years; his wife in 17; our youngest sister, since she married, moved to London, in 26 years. For her, for me, half her life ago; she then only then just beyond a girl; now a woman; a mother, mother of a daughter; a daughter to the very great credit of mother and father; those years between, those many years, my profound loss.

What had brought us all together, on the west coast of Washington’s Puget Sound, was the wedding of my niece, Courtney, older child of my younger brother Michael—he whom I’d not seen in 12 years—to fiancé Joe.

The wedding itself simple, but eminently elegant.

The reception a chance for me, my wife Karen, our daughter Siohbán; that sister Meghan, her husband Kevin; brother Michael and wife Carol; another brother, Patrick, and his wife, Dawnelle; nieces Courtney and Ellie, nephew Sean, and yet another, much younger nephew, Gavin, to tie time’s loose ends, as much as anyone could tie any number of years into so many hours.

But, ah, those hours, those, those glorious hours!

A father’s toast, heart-spoken and forever.

The mother of the bride plotting, beforehand, to sabotage a Polish tradition—one foreign to anyone but the bride herself, who had once worked in Poland—but a tradition sabotaged much to everyone’s amusement, especially, with more than a nod from that mom, to those of us at mom’s table.

A wedding preluded by deluge, consummated by rainbow.

The laughter. All that laughter. The love. All that love. All that evening. That night long.

And me, wishing I’d not lost these years, any lost memories.

But time is, of course, relative.

Einstein wrote as much, even as he saw time in terms of physics, of relativity itself.

And for me, time, too, is relative, decidedly relative.

My brother Mike, my sister Meghan, our youngest brother Patrick. Another sister, Moira, whom I much miss, much love, whom I only wish had joined us in Washington.

All five of us separated by time, by space, even as time itself continues to collapse, not respecting any one of us, not respecting time itself.

And, now, Courtney joining Joe.

A generation beyond ours joining hands.

Ensuring that all that matters, beyond us, beyond them, beyond anyone who ever calls any one of us mom, dad, grandma, grandpa, aunt, uncle…is that this love, the one that binds, that which made us all of us, this one Saturday, one…that this love, in the end, still matters.

© 2011 by Dónal Kevin Gordon

Watching snow melt…

July 10th, and on our way west from Iowa, Wyoming’s Big Horns are the first of the big mountains to scratch the horizon, the highest, Cloud Peak among them, syruped with snow.

And the next day, along the Beartooth Highway bridging Montana and Wyoming, at, what, 10,000 feet, snow banked at the road’s edge to 10 or 12 feet, names carved, graffiti-like, in the walls, those walls of snow, the names of wife Karen and daughter Siobhán now among those many names, and likely there for weeks, if not months, a year, memoriam.

By the time we had rear-viewed Yellowstone, snow was, however, passé: we had seen it, walked it, even, in July, formed and thrown snowballs.

And then came Montana’s Paradise Valley, snow still drizzled across ranges east and west, every last river and stream all but riotous with run-off.

And me outside a cabin, this cabin, in that valley, there in the sunlight, watching snow melt.

Someone, the old line goes, has to do it, so why not me?

And, given, I’m told, that the snow on one nearby ridge has not melted in three years, this could well be a full-time job, one, even if I’m not yet qualified for, I might grow into.

Doing little more this.

Little more than watching.

Watching what has year after year unfolded, decade by decade, century after century.

Winter at last relaxing, unpacking kit and case, drop becoming dribble, dribble a trickle, trickle a rivulet, rivulet to run to creek to river. And, by August in Montana, kids from bridges leaping, those rivers at last tamed by summer, summer already languid, languid with the imminence of fall.

But back to watching snow melt.

Think of that now, this moment, whatever else you might this minute be doing.

Because there is, even now, snow melting, not all of it seen, let alone under anyone’s careful scrutiny. If not in the Rockies, then the Pyrenees, the Andes, the Alps, the Urals.

And someone—you, even—should be watching, watching snow melt, watching life happen, watching time, time itself, those seconds become droplets and on to rivers, to bays, to the ocean of life itself.

And your hand, your one hand, the rest of you maybe now, maybe making love, that one hand, though, liquid in the sunshine, catching what cannot, not now, not ever, be entirely caught…

© 2011 by Dónal Kevin Gordon

Home

…is, I know, where the heart is.

And my heart, for all that Iowa has done for me and for my family over this last decade, has never entirely been here, never entirely been at home.

Always, I have hankered after the Vermont I knew, always wishing I might have again what I had once known.

And, if not Vermont, then Montana, maybe Michigan, maybe Wisconsin.

This, my wayward heart…

This heart wanting more than any one life might willingly give me.

This heart, this past week, out west, and finding itself…at home

And how to explain?

Those mountains speaking to some deeper sense of myself. A certain wildness, certainly absent in Iowa. A rough edge here in Montana, a reminder of a place not yet entirely tamed. And, yeah, the heat, this heat, usually intolerable to me, but tempered, tempered just enough, by low humidity.

And something more…

That thing intangible, all but indescribable. That sense, that if I were strung now, strung here, here in Pray, strung between two trees in a hammock, I’d be at peace.


© 2011 by Dónal Kevin Gordon

A farewell to paradise…

Behind me some 2,000 miles, Iowa to Poulsbo, Washington.

And since then another day’s drive, this one east, another 700 miles.

East now as far as Livingston, in Montana, to the gates, to the gap, to Paradise Valley. The three of us—Karen, daughter Siobhan, me—holed up in the Murray, as Peckinpah once did, albeit without bullet holes in the walls to commemorate our stay.

And out there in Paradise…

This morning, this last morning, I’m alone in Paradise Valley, Karen and Siobhan in the car, me scuffing dirt car-side, the sun chinning up over the Absorakas.

Not far away the Yellowstone rippling, loudly rippling, river meeting rock. The smell of hay from nearer fields, hay as redolent as July itself, the bales themselves rounded, tumbled into some semblance of a stack. Cows from across the road lowing, reminding me, if reminding were necessary, of life.

And rimming the horizon, the Absorakas themselves, the highest still skirted with snow, those skirts tattered by sunlight. Clouds this morning skirling peaks. The air crisp, but waiting to warm again to 90°, the heat’s saving grace its low humidity.

A last look, this last look, and eastward to home…


© 2011 by Dónal Kevin Gordon

Along Mill Creek Road…

Today, along Mill Creek Road, Montana’s Mill Creek itself did what it has done for millennia, times like these, times when winter’s snowpack has meant an extended spring, creeks like Mill Creek, roiling as it has so often roiled before, meeting the Yellowstone River, the river itself belly-high, spreading itself hip to hip, water, so much water, rippling between.

Out here in Montana’s Paradise Valley, life literally flows on.

The valley itself at the whim, the wile, of that Yellowstone.

The river, yet again, declaring ownership of its banks, reminding those living nearby that those banks are fluid, that life itself is ever subject to change.

This one river announcing itself one year, surprising another. Those mountains now and forever rimming the horizon.

All that is different is that I am this year witness.

Witness to this life.

To this creek, this river.

To life itself.

Life rippling rock to rock. Bank to bank.

Those banks widening, this year to accommodate life’s flow, as it has always before accommodated life’s flow. And, another year, barely breaching rock.

And me, looking, listening to that water meeting that rock. The creek itself today exultant.

Me, at the same time, so small.

This speck, my life, against this landscape, against all of time.

And me today sixty…

All we have is what we bring into the room

Practice medicine, and getting a CBC, checking a potassium level, ordering a TSH is as easy as asking. Want a chest x-ray? Need a head CT? What about that ultrasound to rule out that DVT?

Write it. Sign it. Done.

Less easily ordered, less easily done, is that CT of the soul. The ultrasound that tells those of us in Palliative Medicine that there’s a herniated depression, a pocket of anxiety, some fulminant pain. The x-ray that reveals that this patient never got along with her daughter, but loves her, loves her to no end, would never hurt her, even if it means not making her power-of-attorney, not having her make those, those terrible decisions. That another patient’s son, faced with saying goodbye to his father, had yet to learn to say hello.

All we have is what we bring into the room.

Any experience. Whatever medical knowledge. Some amount of insight, of intuition. None of it measured in milligrams, colonies, rads.

Oh, to see what cannot be seen…

To enter that patient’s room and to know, not just a creatinine level, not only a sodium value, but to already have depression’s number, to have seen the spirituality films, to understand, by some algorithm of the EMR, that this patient’s pain is not in her back, has nothing to do with her diagnosis, will never respond to narcotics.

To see what can’t be seen…

Like the fifty-two-year-old woman I saw yesterday, only recently diagnosed with rapidly advancing pancreatic cancer.

How to measure the fact that her husband loved the light in her once, loves that light still, will love it forever, even when that light is out.

That, as he said to me, pleasantly, with no anger toward the world shuttering his world, and me believing him from his first word, “You can’t tell me anything worse than what I have already heard.”

That their youngest child, a daughter, will be married in September.

That her mother once never questioned seeing her younger daughter’s wedding day.

And that patient herself?

Beautiful.

Head without a hair. Earrings defiantly in place. Cheeks summered, red. And now and then a smile. A smile transcending any and all pain. Her face itself transcendent. A face all at once reflecting all she is, all she loves, all she is so likely to so soon lose.

My hand reaches for hers, and hers, tellingly, reaches for mine.

“My father had pancreatic cancer,” I say to her, almost whispering, lest her husband, talking to the nurse, hear me acknowledge the obvious. “I understand.”

But, of course, I don’t.

Sure, I lost my father to pancreatic cancer.

But this woman is losing her one loved life to the same thing.

And her husband, his tears dammed by his smile, his laughter, is himself losing the girl he married. The girl, who at 18, bore their first child. The woman who has shared his life since, and who for more than 30 years returned a love that appears more than love.

How can I understand?

Maybe one day with that CT of the soul. That ultrasound of anxiety. That x-ray of family dynamics.

But today all I know is what I somehow know.

Labs more or less normal.

Imaging unremarkable, except, of course, for that mass.

Nothing, really, by the numbers physicians so often care about.

But my own father dead of pancreatic cancer.

This woman, her husband, losing the life they loved, the one they, like all of us, took for granted on too many a day.

And she herself beautiful.

Her face, her eyes, those cheeks, transcendent.


© 2011 by Dónal Kevin Gordon

And at light's end...

He’s only 25 years old. My daughter’s age.

But he’s dying, and there’s nothing I, just one of his doctors, can do to stop the dying.

We’re talking a good kid, a kid until March just living his life.

A kid not unlike most 25-year-olds.

Not unlike my daughter, my own 25-year-old daughter.

Hanging with friends. Living. Loving Iowa’s Hawkeyes. Never thinking the inevitable. Until three months ago, when a foot drop signaled, not just a problem, but the inevitable.

His tumor, his glioblastoma, is right now doing what glios do.

Making his brain its brain.

Short-circuiting everything that makes any 25-year-old a 25-year-old, let alone anyone, anyone.

But his smile.

His smile makes you think that tomorrow could truly still be tomorrow.

With all the promise of another day.

Another day to go to classes.

To text friends. To catch a round of ultimate Frisbee. Complain about cafeteria food. Wonder who that girl is. Whether she might be his.

But the boy, this boy, is dying.

And this morning, this boy—and, Lord knows, he’s still but a boy—curled to half his height in the bed, so soundly asleep after radiation that I cannot wake him, his shaved head the only glimmer in the darkness of this, his room, too likely his last room.

“I don’t get to make the rules of the world,” I tell him, one hand on his, the other on his shoulder. “If I did, you wouldn’t be here…you’d be doing what my own kids are doing. You’d be just twenty-five…doing what 25-year-olds do…”

Again, that smile.

That smile, in that darkened room, even if then just half a smile, a night-light from the door to his bed.

And, at light’s end, this boy, curled in that dark around this, his unwelcome death…


© 2011 Dónal Kevin Gordon

I Don’t Want to Die…

Who does.

Not you. Not me.

At least not yet.

Most patients I see in the course of most weeks, even if dying, only want to go home. Whether to some home you and I might think of as home; whether to a care facility; whether to the care of some caring son, daughter, sister, or, even more poignantly still, a mother, a father.

One and all, those patients all want to go home.

And you, who, wouldn’t?

Your home. Your room. Your bed. Your death. Your way.

For those of us in the business of shepherding the dying, ours is too often about the shepherding.

The dying itself is, after all, for the dying themselves.

Far be it from us to intrude.

And yet we do.

Want this?

We’ll crush your chest; we’ll crack your ribs. Not like TV, I tell patients.

Want that?

That tube down your throat. That tube to a machine. And you no longer you afterwards, even if you are, somewhere, still somehow you.

I don’t want that, most say.

“I’m 87,” one tells me, just the other day. “I’ve lived a long life. I’m done.”

And who am I, the palliative care doc, to say otherwise?

I’m not 87.

I’m not willing to say that my life, at almost sixty, is a long life. I don’t yet know when done is done.

Her choice, then, is not my choice.

“And if you die now. If you stop breathing now. If your heart all at once falls silent…”

Then, by your choice, I, standing nearby, stand nearby.

Watching death do what death does…

Me, cradling the rope to your small boat…

The pond beyond. That larger pond. And my hand opening…

The rope slipping from hand, my hand, slipping from my hand for good…

For good.

Surely, for good…



© 2011 Dónal Kevin Gordon

Over the Rainbow

I am, I know, as I slip up on sixty, entering the age of imminent death.

Indeed, on any given day when I see palliative care patients, some, sometimes most, bracket my own age. Ordinary people living ordinary lives, no different than me living mine, than many I know or love, until life tosses a stick into the spokes and sends them over the handlebars.

Such a spill, in younger days, only meant scrapes that soon scabbed and healed.

But in my world now, over the handlebars too often means over the rainbow.

And bluebirds?

Not sure.

As for dreams that you dare to dream, all that’s important is all that ever was important, that they really do come true.

Which, of course, makes dreams still worth their dreaming.

And time, time all the more to cherish.

As in this, this very moment…


© 2011 Dónal Kevin Gordon

“Don’t put me out with the trash…”

His smile meets mine from the corridor, as I gown and glove to see him.

“I’m not contagious,” he tells me, weakly, his face still a smile, one nevertheless showing concern, even if his only contagion is he himself, his life, what he learned along the way, what he, my new friend, may now teach me.

“You’re not contagious,” I say immediately from the doorway, knowing that he is thinking only of the cancer, that wolf, the one as real at his throat as the central line taped to his jugular, and me, myself, thinking mere MRSA, mere VRE, bugs as ubiquitous in hospitals these days as charts or IVs, so common as to be irrelevant, certainly now, now in the face, the very face, of this man, this one man, and this cancer leaching his one life.

“The hospital has rules,” I say, arms into gown; “I have to abide by them,” hands into gloves; “I’m not worried, nor should you be worried,” me, stepping into the room, finally and quickly closing any space between us.

“How are you, my friend?” I ask, my gloved hand reaching for his, his own as bare, as warm, as human as his God first made it, that hand his mother once held, and this — both of us so well aware, both the sons of mothers killed young, so very young — the day before Mother’s Day, “How are you feeling?”

Go ahead.

Go ahead and dismiss him as yet another disheveled 57-year-old, any better days long behind him, one of those prior-to-his-hospitalization, living-in-his-own-care, living-in-his-own-car guys, and this, in a Wal-Mart lot, at that, a dog his only companion, a dog loved and loving to this, a bitter end.

Go ahead.

57, just turned, looking 77, and that generous.

Found by whomever in the car he called home.

Brought to the hospital. Noted to have a blood pressure of 60/30, something you wouldn’t want. Hemoglobin 5, and ditto on the you-wouldn’t-want-that list. Badness, in a familiar term familiar to physicians, lurking, with more tests pending. An interesting patient. And, from any patient’s perspective, you never, ever, want to be interesting to a physician.

But whatever you’re now thinking, none of that matters.

Not the necrotic, metastatic cancer in his belly, as in tissue dead and tumor spreading from somewhere. Not the fact that he is the very vision of cachectic, as in skin over bone. Not his anemia, that ebb of a blood pressure, his critically low potassium level, not anything anyone but a physician might care about, at least by the numbers physicians so care about.

“Don’t put me out with the trash,” my new friend suddenly tells me. “Please, don’t put me out with the trash.”

His face is all eyes, eyes the color of sky.

Eyes as blue as the bluest June meeting mine, my one hand covering his, my other embracing his face, the two of us a kiss, my yellow gown papering my bent form, white sheets shrouding the little left of the man who’d been, the two of us carving pietà from the room around us, from time itself, from all of time.

And his face shrunken by cancer to bone. His teeth rotted by time, by disease, maybe, it might be thought, by meth — and who cares, who cares now.

But those eyes, those blue eyes.

Listen to him, and you only guess at what those eyes have seen…

“I’ve made a lot of mistakes…”

“A marriage gone wrong,” he goes on, me letting him talk, my own plan to get home early after rounding, now nobody’s undone plan but mine, a plan all at once abandoned, as I let him talk — and talk.

A girl he loved. A girl at 17. A girl he, of course, had to love.

And children.

Later, a farm in Ohio, a farm lost, lost to another woman who took him for what he was worth.

A job in Iowa. Lost, too, with lost benefits. The flood in Cedar Rapids in 2008, it taking anything left.

And then a car.

A car suddenly a home.

And those kids, also lost now, so sadly lost. And his eyes saying that, just that. One son local, who can hardly bear to see him, even now, especially now. Two other sons in Afghanistan, both wishing dad dead.

And now this. Those sons all but getting their wish.

Cancer that would make Christmas of a PET scan, and no joyeux Noel in that.

“We all make mistakes,” I tell him, after he tells me that he had done that and more.

“I’m no angel," I go on to confide. "Just ask my kids.”

His face tilts to mine, skin stretched over bone, lips taut over teeth only remotely teeth. And those eyes, those eyes, my one gloved hand on his, my other on his shoulder.

And my own eyes, I confess, all at once a lover’s…

“Don’t put me out with the trash…” he pleads. “Please, don’t put me out with the trash.”

“I won’t,” I promise, meaning it.

“I trust you,” he says in a whisper, his hand tighter on mine. “I trust you,” the voice ever so stronger, those eyes again on mine, those blue eyes.

Twenty minutes later, note dictated, orders written, I leave the hospital, into Saturday, into sunshine, into May and all its warmth, toward the car that will take me away from this, from all of this, and me, me weeping as I walk.


© 2011 Dónal Kevin Gordon

Now, Karen, now...

Sunlight this night splayed by blinds and splashing, splintered, across the living room’s wooden floor. And again, and from more of a distance, some neighbor’s mower grinding air, to no effect but sound, to no effect but sound, that clamorously insistent sound, and, in its wake, plumes only of ground grass.

And me here tonight, one day nearer sixty, still contemplating now what…now, for goodness sake, what…and all the more so with yet another job offer now in the offing.

No need now to trouble readers with details; those are mine, as they have before been mine.

The question, rather, is older, as those who have long considered such questions were themselves so often older: who am I, what have I done, what more might I yet do?

To my son, Brendan, the answer is likely quicker: I’m 26, have so distant an end conceivably ahead, have already worked for years for others in New Orleans after Katrina, have twice been to Haiti and am now poised for post-tsunami Japan.

And my son is, truly, my son.

A younger me had similar inclinations, if fewer opportunities, with, alas, the shadow of the Vietnam War graying my teens, my early twenties. And time, as it is wont to do, then made itself the thief of later opportunities, with responsibility freighting daily, weekly, inevitably by the decade, any hope of, well, any hope.

Until now. And still now.

And still tonight the chance to do good, to do what I once set out to do, to not do what I’ve since done, what, arguably, is merely offered again. And now, my love, mindful that similar offers earlier have only gotten us here, now.

Here.

Now, Karen.

Now…

Just April…

My neighbor is this evening mowing his lawn, and not just mowing, but giving it a burr-cut, the air around and between us just noise, just noise.

Still, we’re talking April 24th, as in April…again, just April. The same April that saw 85 degrees on the 10th, and me that day cursing every degree over freezing; me that Sunday in my drawers and only my drawers, in the living room, the windows open, fans fanning, the air otherwise dead and me, again, loudly cursing every degree over freezing.

Back in the Vermont I knew (and, yes, I already hear my children moaning, “There goes Dad again about Vermont, those perfect summers, winters walking through head-high snow—and that’s only after shoveling—and, any god knows, you were the better for the shoveling!”), April was April.

If lucky, April was a muddy month, and muddy only by inches, given how feet-deep the ground had frozen by winter’s nadir and how slow any thaw in any year.

And snow, in Aprils then, was still the not-unexpected stranger at the door. In fact, our youngest son was born on an April 17th, during a night softened by eight inches of snow, a snowfall that slowed the midwives and made their one-hour trip north, two, but still in time. And Mother’s Day, one year, yes, Mother’s Day in the middle of a month wanting to be May, itself dawned to eight inches of snow, although by then, by anyone’s reckoning, winter’s back was surely broken, and that particular snowfall, doomed at the outset, little more than fertilizer.

In April, in Vermont, no one would ever mow a lawn, not unless there were some question of sanity.

April was a month to be enjoyed for the temptation it was, and undoubtedly still is there—the odd day warming to 50 degrees; the night again reminding you of winter; the road ruts, warmed in the day’s sunlight, freezing again overnight and, in the chill of morning, claiming the odd water pump (our car’s, one year) or exhaust system, only for the wrong choice of a rut. And any snow then was short-lived, blanketing, only momentarily beautifying, with the writing already on the sky: the days longer, the nights less, any chance of any snow lingering for hours, let alone days, increasingly just that, a chance.

Spring when it came, when it truly came, was a gift and, almost always, languorous; no all-at-once pushing-90, no instant lawns, no mowers robbing this, or any, April evening of the peace April has earned and deserves.

What I remember, instead, was one day only gently warmer than the day before, spring greening the landscape by leaf and branch, a green barely green, its shimmer pilfered from an impressionist’s palette, a green which, as it deepened, melted the winter that had been.

And sometime, maybe May, more likely June, the need to mow.

Second Son, Second Stint

I left you last with Brendan talking Haiti.

Here’s what I’ve not told you: That Brendan went to Haiti. Started a blog. First link all about almost being kidnapped. Accosted by a car, guns bristling from windows.

Almost, happily enough, was the operative word.

Still, this, in an e-mail, was his first mention of his blog, as in, Brendan, this couldn’t wait until the ride home to Iowa from O’Hare?

O’Hare came. Went.

And a few months more. And back again to Haiti. This time only for weeks, not months.

Still…

As the father who loves him, I can only admire, even as I worry. This, my beloved son, in whom I, echoing an even more paternal father, am well pleased.

Brendan is now home again, home for him, back in New Orleans, and safely so, back where he has been almost since completing college, only a year or so after Katrina, ever since doing what he could do to undo what Katrina did.

And Brendan has done what I’ve not done.

I am a doctor, but…

Brendan, newly graduated from Beloit College, went to New Orleans, built homes, dozens of them, his mother, at one time, for a week helping to hammer nails.

I am a doctor, but…

Brendan left New Orleans for Haiti. And I, doctor that I am, hoped to join him there, but didn’t.

And Brendan went back to Haiti, and I am still doing what I do in Cedar Rapids.

And what I do, in light of what Brendan has done…