This is When it Radiates
Grief changes. It never ends.
Our greatest teachers are those who have gone before us. Their lives become entwined in our own. Their wisest teachings are taught by example.
I feel it is auspicious and appropriate that I share the final chapter of Heart Sounds on this day, July 11.
18 years to the day.
The anniversary1 of my father’s death.
He remains my greatest teacher. Entwined.
And my grief… it never ends. Which is how I continue to learn… how my love continues to grow.
****
“Who is that beside your bed?” I reach for a velveteen doll dressed in a simple black gown with a green butterfly in her hand.
Ms. Dupuy’s southern accent seems to lilt in the air as she gently takes the doll in her arms.
“Why that’s Emily of course.” Her fingers delicately smooth the elegant dress before resting her on her lap.
“As in Emily Dickinson?” I spontaneously offer.
She nods approvingly.
“Do you write poetry?” I excitedly ask.
“Oh goodness no. I don’t write. But I love to read. Poets have such a gift for noticing everything and finding just the right balance of words.”
Her eyes glaze over a bit as she searches for the words to a favorite poem, “… and miles to go before I sleep.” She pauses and focuses her gaze back on me, “You know the one.”
Floundering, I suggest, “Ralph Waldo Emerson?”
“No,” she says dismissively and then returns to her thoughts and almost whispers, “… a walk in the snow … a snowy field … you know the one.”
I apologize, saying I recognize it but don’t know the words. I promise to find a copy to bring to her my next visit, and this seems to satisfy her restless mind for the moment.
“I do know one poem … it’s my own,” I offer somewhat hesitantly, having never shared it aloud before.
“Oh, yes, do let me hear it,” she exclaims.
I straighten my shoulders and take a moment to presence my father before saying, "It's called, This is when it hurts2."
This is when it hurts.When the sticker on the surface
Of a non-stick pan
won’t come off…
When your HMO offers a PPO
With PHI protected by HIPAA
and you’re lost in translation…
When you, who used to tap your toe
And roll your eyes at the
One person in your life who
Relished solving these mystifying trials
is no more…
This is when it hurts.
When your mother has lost her way
But righted herself just in time
To say goodbye
Yet hasn’t packed her suitcase
For her trip tonight,
the one you used to pack for her…
See, this is when I gasp for air,
When I clutch my throat,
While the wind is yanked from my
alveoli…
As I watch the sun blaze and
Extinguish itself
Into the rolling clouds,
And the stars innocently chide the night’s sky
with iridescent laughter…
This is when it hurts.
When I taste seared foie gras
and d’Yquem
For the first and only
Time. And for a moment
Leave my body, but return
Only to choke as I am still
Too far to reach, to share,
This succulent joy
with you…
This is when the absence
Of you is too intense.
Yet, I continue to write
In search of someone
To share
this emptied life…
And so I retrain my cell,
redirect my calls,
To share these joys, these woes,
This strife
With my mother – your wife -
And trust that you still hear us
through the rustling of the wind…
As I look to each nodding leaf,
Each arching petal,
Each blade of grass,
My grief is silenced and I begin to see
That you are free
And here with me.
And this pain is merely
Joy more magnified
than man knows how to bear…
And this, then, this tiny pocket of
Gems – the engrams in my brain
Of you in my life –
this love …
This is when it radiates.
Ms. Dupuy smiles at its conclusion, “You taught me poetry, and anyone who can do that … well there is nothing more beautiful … no finer gift.”
We both sit quietly for a while enjoying each other’s company. Eventually, Ms. Dupuy appears to be getting tired as she begins to stroke Emily’s head.
“I wish for you to sing it … or just say it … your poetry. That would be the last thing I wish to hear when I go.”
I am not certain to whom she is speaking, until Ms. Dupuy turns to Emily and says directly to the doll’s face.
“Now you cannot go with me,” she says as she straightens the doll’s legs.
I suddenly feel like a child peering through the keyhole of a dimly lit room with a secret being passed.
“You cannot go to the grave with me.”
Unsure whether Ms. Dupuy still realizes I am beside her, I am shocked when she turns Emily to face me while still speaking directly to her.
“You must go with her. You have too much more to do.”
She then turns her eyes on me and smiles. With a relaxed gesture, no longer animating Emily, she says, “You can do with her as you please. She simply cannot go with me.”
When I next return, Ms. Dupuy is resting comfortably in her bed. She doesn’t open her eyes to my greeting but smiles and nods her head when I announce I have brought her Robert Frost’s Poem, Stopping by the Woods on a Snowy Evening.
“Oh yes, that’s the one,” she dreamily whispers as I offer to read.
She begins to gently bob her head in rhythm as if walking alongside in the deep, cool drifts. She seems to know where it is leading. And as I read the final passage, it is as if she is mouthing the words all her own.
And miles to go before I sleep.
And miles to go before I sleep.
What a gift to know what you want and how to ask for it.
****
I had no idea when I became a hospice and palliative care physician that that is exactly what I would get to offer patients and families in my care. It is what we all have the power to create for ourselves and each other.
Some see my work as hard and depressing. Others view me as the Grim Reaper. I prefer fairy godmother.
Though the occasional brandishing of a magic wand, fishing pole, backgammon board or treasured doll may come in handy, you certainly don't need a stethoscope to be able to listen for these kinds of heart sounds. They naturally become audible the moment we become curious. And no one needs to be dying to begin the conversation. Because when we talk about what matters most at the end of life, with the specifics, and share them with the people who care about us, what we are really talking about is what matters most, in life, right now.
Talking about these things won’t save your life.
They will absolutely fill your life with what matters most throughout your entire life.
So, now it’s your turn. And here’s my question…
If I had a magic wand, and I’m not saying that I do, though if I did… what would you wish for?
aka yahrzeit
This poem originally appeared in Annals of Internal Medicine and is shared with permission.