Tears have the power to act as a wake-up call. Whether my own or observed, tears mark the moments that become everlasting.
I've noticed my favorite movies are the ones that make me cry: Big Fish, Arrival, Eternal Sunshine of a Spotless Mind, Everything Everywhere All At Once, and Star Trek (2009 reboot Kelvin timeline for you Trekkies. Yeah, the opening scene makes me cry every time).
My favorite stories are the same, especially when I try to read them aloud: Saint-Exupery's The Little Prince, Ted Chiang's, The Great Silence, and Norton Juster’s, The Phantom Tollbooth. (Try reading the last page of each and see if you come out dry.)
I think the film Inside Out explains the mystery of tears most simply when the character Sadness, with all her awkwardness, discomfort and imposed isolation, ends up being the one emotion able to heal the main character's heartache.
Cue: Sadness.
****
Internal medicine residency ended two weeks ago. I am in a new hospital, in my first week of becoming a hematology fellow. This multi-year subspecialty training program begins with me overseeing the care of people coming to the hospital's infusion center. If anyone with a blood cancer needs a procedure, or a nurse has a concern about an order or a patient has a fever, I am the "go-to" doctor of the day.
My pager beeps, then flashes the five numbers of the infusion center extension.
My well-rehearsed, mechanical reply: “Hi, it’s Dr. Gross, returning a page.”
“Oh, thanks for calling back,” the clerk says. “I’ll get the nurse.”
Waiting on hold, my heart thumps as my mind sprints through possible scenarios I know only as algorithms on a page. I may have a medical degree, a medical license, a long white coat and a stethoscope, but when it comes to caring for people with cancer, I feel like a pager drawing a blank. I look like I am built to do something useful, yet still in need of some serious programming.
"Hi, Dr. Gross. It's Carly. I'm the charge nurse today. Thanks for calling back. Ms. Gibson just arrived. She's here for her methotrexate infusion. We need you to come and administer it."
"Uh, oh, sure. Okay," I say. "What's her diagnosis?"
"A-L-L" Carly says.
"Right." I begin flipping through my Pocket Guide to Chemotherapy Protocols looking for the section covering acute lymphoblastic leukemia as I reply, "I'm on my way."
There’s an adage in medicine: Never be a patient in the hospital in July. This is specific to teaching hospitals, where medical students, residents and fellows train, because the clinical academic year begins July 1. Many of the doctors are new to their roles and have no idea what they are doing, let alone where to do it.
Carly, perhaps sensing my hesitation, was likely well-versed in the ways of July transitions in academic hospitals.
"We'll be waiting for you," she says just before hanging up the phone.
I walk out of the library where I had, unfortunately for me and Ms. Gibson, been reading about a different type of blood cancer and make a beeline for the hospital information desk to ask for directions to the infusion center.
Arriving at the entrance of the infusion center, I stuff my pocket guide back into my pocket and offer a casual wave at the clerk sitting by the entry door, trying to convince myself I know where I am and that I belong. Carly greets me on the other side of the "Staff Only" door. "You'll adore Darla," Carly says as she walks me to Ms. Gibson's cubicle. I am surprised to see her sitting with two other people—her parents.
"How old is she?" I whisper to Carly.
"Nineteen."
I take a breath attempting to quell the thrashing of my heart.
"Darla, this is Dr. Gross," Carly says with an easy smile. "She will be providing your treatment today." Her voice sounds far more confident than I feel.
As I reach out to shake Darla's hand, the first thing I notice is her smile: radiant, vibrant, a youthful toothy grin reminding me of my college classmates’ faces cheering our football team to a Rose Bowl victory. The second thing I notice, about four inches above her smile, is the perfectly symmetrical, one-inch bulge on the top of her forehead. I have no idea what it is yet can't help but wonder if I am supposed to know. Greeting her parents, each with an equally inviting smile, it seems as if everyone else is either unaware or indifferent to the bulge. I try to avert my eyes without looking as though I am averting my eyes, simultaneously wondering if I, as the doctor, am supposed to be attentive and thorough in my examination and address the obvious.
Carly turns to me. "Dr. Gross, Darla is here for her methotrexate infusion," Carly's eyes widen as her speech slows, "through ... her ... O ... mma ... ya ... reservoir." Looking into my eyes, I am sure she sees an all-too-familiar deer-in-the-headlights stare in return. She quickly smiles and adds, "Dr. Rhines is in the back, verifying the medication order. Why don't you go check in with him?"
I exhale and nod, "Great. I'll be right back."
Darla and her parents have been through this routine more times than either would care to remember. The treatment for Darla's illness requires that she receive numerous months of chemotherapy injections directly into the fluid surrounding her brain. Instead of repeatedly trying to puncture through the very narrow space between her spine and the structure carrying spinal fluid to her central nervous system, a device the size of a taw or shooter marble was placed underneath the skin of her forehead that connects directly to the liquid bathing her brain.
All I must do is inject the medication into the balloon-like reservoir—the bulge at the top of her forehead. The only obstacle to providing the required care: my ignorance, or more accurately, my expectation that I should know and therefore the humiliation awaiting were I to admit I don’t know what I am doing.
Fortunately, in this case, none of the people involved are interested in my humiliation. They are all committed to my learning, including Darla.
For the next nine months, Darla returns to the infusion center for her methotrexate infusions when scheduled. I greet her with an earned familiarity, confidence and joy. Darla exudes radiance. Never once do I recall seeing her feel sick, not even tired. Her wonderful smile is as stable as the bump on her forehead. I assume her leukemia is equally quiescent. Something I have since learned never to assume.
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