“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