Wednesday, November 05, 2008


I remembered him on the drive back to WV yesterday. I was on my third sermon of the drive, a talk on the Song of Solomon from Mars Hill Church by Pastor Mark Driscoll. Something inside me snapped…and as I reached back for the quickly-emptying box of Kleenex, I remembered him from my visit to the nursing home last week.

My attending grabbed my arm and pulled me into the doorway of one room in the third wing on the first floor. We were making rounds & had just finished with a lovely 92 year old Italian woman when I was yanked into a quiet room in the middle of the bustling hallway.

The residents, as I wrote before, were a bit unruly because of the Halloween party that was to follow dinner. The staff was busy in the dining room, stringing orange & black streamers across the ceilings and stationing CMA’s at the cookie tables to ensure their Diabetic residents didn’t indulge themselves into a sugar coma.

From inside the room, though, the squeak of wheelchairs & big-tongued babble of denture-clad residents seemed miles away. And aside from the low hum of oxygen tubes, I might have guessed I was in an entirely different building. I was captivated. By the quiet. By the tubes. By the white net crib the body before me rested in…

The attending told me he was only 59. The patient had been under his care for at least two years—and hadn’t changed a bit since then.


His skin was smooth, almost glowing. Women would pay money for that natural glow. A thin white tube hung above the netting slowly dripping liquid protein into his deteriorating stomach.

And there he lay. Silent. Still. Unaware of the chaos that ensued around him, just feet from where his sunken face rested.

Apparently he had suffered an unexpected stroke…and just never recovered. I asked about family & the attending shook his head slowly—no one had come to visit this man in the white netted-crib. And when I was updated on his medical condition, it was quite clear there was no chance of improvement.

I thought about the tears running down my cheeks. And then I cried for him. Because the truth is that the brave staff who bathe him, who change his liquid-protein, who rotate his bony body to avoid pressure sores; the brave staff who walk by his room countless times each day, they won’t notice when he is gone. And the truth is that I won’t either. We all, sadly enough, are waiting for him to die.

And then I cried some more. Because at this point in his life, he is alive…but he isn’t living. He doesn’t cry. Doesn’t grimace. Doesn’t laugh. He doesn’t converse. And in every way is playing a non-contributory part in this society.

I’m reminded of the lyrics of the song “Somebody’s Baby” by Jon Foreman:

She yells, "if you were homeless
Sure as hell you'd be drunk
Or high or trying to get there
Or begging for junk
When people dont want you
They just throw you money for beer."
Her name was November
She went by Autumn or Fall
It was seven long years
Since the Autumn when all
Of her nightmares grew fingers
And all of her dreams grew a tear
She's somebody's baby
Somebody's baby girl
She's somebody's baby
Somebody's baby girl
And she's somebody's baby still
She screams, "Well if you've never
Gone at it alone, well then go ahead
You better throw the first stone
You got one lonely stoner
Waiting to bring to her knees"
She dreams about heaven
Remembering hell
As a nightmare she visits
And knows all too well
Every now and again
When she's sober she brushes her teeth
She's somebody's baby...
Today was her birthday
Strangely enough
When the cops found her body
At the foot of the bluff
The anonymous caller this morning
Tipped off the police
They got her I.D
From her dental remains
The same fillings still intact
The same nicotine stains
The birth and the death were both over
With no one to grieve
She's somebody's baby...

And that is just it. HE was somebody’s baby. And when I walked into that room, my faith & the limitations of this miraculous field we call medicine engaged in a head-to-head battle. My faith telling me that he should be loved, that every human being has the *right* to live…and medicine telling me that with no chance of recovery, this man that once was is no longer

So where do we define life? And furthermore, what do we define it by? The ability to cry? To engage in conversation? To respond to questioning or small pokes or painful pinches we call stimuli? The ability to eat independently? Or blink? The ability to move at all? And where do we draw the line? Two years? No improvement? No response? No chance of a hopeful recovery?

I’m still left pondering. When I get around to writing my own Advanced Directive, I know I don’t want to be stuck in a white netted crib for the rest of my life…I know I don’t want to be pushed into a side room and rotated every two hours to avoid pressure sores…I know that I’ll just want to go home.

My instinct is to think the same for all of my patients as I do for myself…to think that this man in the white netted crib would also just want to *go home*. But such is the conundrum of medicine: each person is autonomous…and as a physician, I have to respect that, no matter how difficult, tainted, or burdensome their care may be.

And so fell my tears. Tears for the life that is frozen in time—for the man in that white netted crib that no one is missing. Tears for the life that seems wasted…the years that have passed without so much as a moan. And tears for the mind of this man…because those fancy beeping machines can’t tell us what he is thinking, or wanting.

And so lays this man. Surrounded by tubes and beeping machines that give us no hint as to whether or not he will ever wake up, much less his awareness of the Halloween party down the hall. Surrounded by the echoing sounds of squeaking wheelchairs and the big-tongued babbles of denture-clad residents. Surrounded by a white netted crib and freshly sterilized sheets.

…and perhaps, too, surrounded by angels...waiting patiently for the commencement of his journey home…

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