Just A Floor Above - life and death in a physician's practice; narrative - Brief Article

Just a floor above, a patient lies angled across the clean and freshly turned sheets. Her hollowed cheeks are glazed in sweat. Her pursed panting and her moans puncture a silence as heavy as slushed snow. Yet in the darting of Dorothy's eyes you can catch what her exhausted lungs might otherwise conceal: that she is dying. The priest has arrived and sings his cheerful songs. He has strung the family around her deathbed like a rosary, roping in her reluctant children who gaze in angered disbelief as their mother sinks fast beneath that grim horizon.

Almost directly below, in a more hopeful room, another patient has begun the full wind-up of labor. She is double in size and chubby-pink with possibility. Her husband is here, too, and the children are on the way. As I nick her waters, there is an unexpected gusher that soaks my pants. We joke about her new son, Wilder, and our hope that he will not--at least in labor--live up to his name. There is a palpable spark of anticipation in the air, as electric as the calm before a nor'easter or the opening pitch of a championship game.

On my hospital rounds, I tread back and forth between the Hospice Wing and OB, between these two beautiful women whom I have come to know. One is a member of our small church choir; the other a nurse in my office. And so I weave them into the morning routine of kidney infections, chest pains, the ER, and the ICU, with a quick hello or a quiet presence and the relief of having a reason to be there.

I carry their clinical outcome on my shoulders. It is the kind of burden you must balance and share. But don't misunderstand: It is a tolerable load for the properly trained. Mr. Marquard, who taught me all the college calculus I could ever forget, spotted my talent early on. He knew that some of us would grasp the Eleusinian mysteries of abstract math, reach the top drawer, as he liked to say, and make it to the floor above. And so it was that I learned capably in school and readied myself for the clinical challenge, every knotted complication that general practice could shuffle my way. But nothing prepared me for the aggregate loss, when each problem list and interesting case turns out to be your neighbor and friend, and every final parting rends you where the heart resides.

I slip away from the hospital and go about my day, pushing off on those firm, familiar poles of birth and death. Wading through the afternoon office hours, I barely remember my hospital charges, until a midafternoon telephone call notifies me of Dorothy's death. And at 4:30 p.m., another call: Could I make a home visit on Mr. Briggs, whose family is convinced he is filling up with fluid? OB is quiet, so I point my car away from the hospital and head toward the Briggses' old cape, perched high on a bluff overlooking the ocean. Here live the retired headmaster and his ailing wife. And at their portal, on this snowy night, I enter into the wife's hospitality as she collects my wraps and settles me into a musty couch. As I talk, he sleeps, taking it all in, everything that I say about the specialist's report and how the stomach cancer has returned to prune his days. Suddenly my beeper goes off. "ob now." But I am twenty minutes out! Thank God my partner has received the same call, for when I arrive she is stitching the perineal laceration, which is the only work remaining after this precipitous, unattended birth.

And in the corner I sulk. I cannot enter into the family's exquisite joy. I needed it too badly myself, to fill the cavity of this depleting day. So my wound becomes their worry: "I tried so hard not too push, but it just shot out of me," she apologizes again. And I am embarrassed twice, because she has recognized me in my despair, and thinks that I blame her for spoiling the doctor's plans.

Three days later we gather at Saint Francis of Assisi Church. And to compensate for the choir's thinning ranks, I sing a little louder for Dorothy. (Yes, I know it would have annoyed her, but I consider it fair restitution for the recorder she sometimes played off key.) There is no casket at this requiem Mass, only the family in its stead. Her husband is bent in prayer in the first pew, left of center. Beside him are the same sad faces I watched, as they watched their mother slip away. If only I could assure them that it is they, and their extended family, and the community all around us, who channel the graces that keep us going.

I believe in an expanding universe, unbounded by time, where I can mingle with Francis, our patron saint, and my parents long departed, and my children whose lives will flower long after my own life has come to an end. And I imagine, too, that Dorothy waits in the place we are all heading. Just a floor above.

David Loxterkamp is a physician who lives and practices medicine in Belfast, Maine.

COPYRIGHT 2002 Commonweal Foundation
COPYRIGHT 2002 Gale Group