“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