A likeable and thoughtful young doctor describes consecutive days at work in one sentence. “There was no joy in it.”
His parents become concerned and wonder if he needs help. Why? I say. Helping patients should make him happy, they reply. Noticing my unconvinced expression, they add earnestly, “Don’t you feel happy at work?” I promise to think about it.
I think about their question all week as I meet and care for a patient who has survived a cardiac arrest. He was running outdoors when he collapsed; fortunately, it happened so close to a lifesavers’ club that he was rapidly resuscitated, but the arrest robbed his brain of precious minutes of oxygen leaving him with significant cognitive impairment.
Now, off tubes and machines, he lies quietly in a bed which barely fits his lanky frame. He can’t swallow well so his nurse spoons pureed food into his mouth, encouraging him to close his lips fully. He can sit with assistance but tires easily; she coaxes him to stay up a little while longer before returning to bed.
On our ward round, he lets his eyes do the talking. Hello, I greet him. He maintains his gaze on me. How are you? There is no answer, only that warm but passive smile we have come to know so well. There is no sign of an internal struggle to speak, like you see with some patients. I squeeze his hand and he flinches. “I’m sorry, did I hurt you?” It’s hard to say.
The intern uncovers his legs and turns his feet carefully to examine a small skin break on his toe, which has healed. There are four doctors at his bedside but there is only the sound of our breathing as we examine him and his charts. He is stable, no better, no worse.
“We are waiting for a bed in rehab, where we hope to get you better.” Given his deficits I must sound weak, unconvincing, but I say this with all the optimism I can muster. Outside, the intern asks if he will recover. I tell him that some patients walk back in to say thank you and others are discharged to a nursing home. It’s too early to tell.
“That’s really sad,” another intern says, her voice wavering. You should have been here on Sunday, I think. His wife brought in their two young children. The nurse had moved him into a bright corner of the ward in a recliner, where he sat facing the outside world. A child sat on either side, stroking his hand. There was no snack and no device in sight. No child is so patient and tender with a parent unless taught by circumstances. I gulped and debated whether to disturb the perfect moment but really, I was just looking for an excuse not to confront the reality of the situation.
But just then his wife said, “This is Daddy’s doctor.” I bent down to introduce myself and caught his expression. He looked awake, alert and happy like I had never seen him. Wordless, but so content that my heart skipped a beat. If only I could return him to being the father he used to be. I ask his wife how she is doing. They are recent migrants and he is the sole breadwinner; I know she has been dependant on the charity of friends. They must be good friends who drive her, mind her children and bring her food. I hope they stay the course.
She beams and says things are fine. The health system works, he is smiling more and he has even been mouthing some words. Is there anything troubling her? No, she answers, and so genuinely means it that I am stumped and humbled. The hospital is so full of impatient, angry and frustrated people that she serves as an ocean of calm.
All these weeks, he is just one of many patients. We make good diagnoses, get people back on their feet and help them in other ways but he is always on our mind. When he gets a urine infection we break into a sweat. His moist cough raises our alert and his unusual somnolence sends us dashing to the CT scanner. It feels as if the patient we can help the least is the one who preoccupies us the most. We yearn to tell his children that things will be fine but all we can say is that they are the nicest children we have met. We’d love to tell his wife that her optimism will yield rich rewards but all we say is that her devotion to him is amazing.
Through those draining weeks, if you had polled us, every one of us would have said there was no joy in our day. We were not depressed but frankly, it felt impermissible to entertain the notion of joy when we watched little children walking away from their dad more than once wiping tears from their eyes. There was no joy in those days but there was something else. There was perspective. We learnt about the impermanence of health and the vicissitudes of life. We saw how a broken body and spirit mend, bit by bit. We witnessed the transformative effect of a loving family. And caring deeply about a patient led us to confront our limitations and deal with our own mortal fears.
Modern life is awash with tips on how to live well, exhorting us to practice gratitude, discover meaning and ponder our legacy. I often think that nothing reminds one about why these things matter as time spent in patient care, dwelling on the lives of others and in turn, our own.
It’s true, sometimes there is no joy in it, but there is always meaning.
— Guardian News & Media Ltd
Dr Ranjana Srivastava is an Australian oncologist, a Fulbright scholar and an award-winning author. Her latest book is After Cancer: A Guide to Living Well.
