Wednesday, June 6, 2012

Patients #1: "Mr. and Mrs. A."

     The most important things in the world happen in the space between two people.
     Why did I say this to two patients as I left the exam room yesterday afternoon?  I believed I was celebrating their marriage of nearly sixty years.  Given the terrible events of my doctorhood in the past three years I believed I was also thanking them for vocalizing their endorsement of me as their long-time physician.  (I will reveal more about the excoriating events of my personal career in upcoming posts because they have forever altered the experience of myself as a doctor in America.  But right now it is this interaction with my patients that magnetizes me.)
     The wife, Mrs. A., has four different cancers, none of them cured and every one under treatment with some extravagant, potent therapy--the usual:  chemo, radiation, pills with awful side-effects.  She has a cornucopia of other medicines which I am perpetually trying to pluck from her basket and throw away. But some patients are attached to their medicines, and discontinuing even the harmful or inconsequential ones can cause a setback.
     The husband is unremittingly in love with his wife.  I do not say this lightly, in the love-dot-com way relationships between men and women have unfolded in the twenty-first century.  Between these two was constellated an attachment, long ago, that has the nature of rootedness:  two gnarly trees whose roots are intertwined all the way down to the underground river that nourishes the earth, and them.
     Mrs. A. loves her husband too.  She must, but there is no sentimentality about it.  For me to speak outwardly of their feelings for one another would be embarrassing, of course, and might throw our visit off course.   But once I asked Mrs. A. how the two of them met.  Her face flushed, she seemed transported back in time, and for the next twenty minutes she shifted from her usual laconic answers to a lyrical, moment-by-moment description of their first date.
     Today I ask Mr. A., "What do you do the entire time your wife is in her sewing class, after you drive her there?" and he says, smiling, "Nothing."  He seems joyful.  Can it be that taking his wife to her sewing class and waiting for two hours gives him joy?  Can it be that organizing her many medical appointments, watching her go through her laborious morning routine, or preparing her coffee are good-enough reasons for being happy?
     By all estimates, given the odds for the metastatic cancers Mrs. A. has harbored for ten years, she should not still be alive.  I doubt if anyone would argue against the notion that the relationship with her husband (and all the relationships that become possible in the world outside their marriage because of this one inviolable connection) is the most effective "cure" for the ills that have visited her.  "You don't look like a cancer patient," I say, and she tells me, "Everyone says that." Her marriage is like a rampart against the bombardment of her immune system by forces of destruction both inner and outer.
     In an analogous way my relationship with these two patients has fortified me against the besiegement of my medical practice over the past few years.  As I stood at the exam room door, finished with my formal treatment recommendations and ready to move on to my next case, I felt the force of love between the two of them, and I felt the pregnant space between them and me, and I understood that I could be redeemed by whatever was being enacted in that space.

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