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