SGIM Forum

Breadth: Part I

The Shared Raft

Dr. Pesquera (pesquem@amc.edu) is a geriatrics fellow at Albany Medical College, Albany, New York.

The following essay was one of the top three Arts and Humanities submissions presented at the plenary session of the 2021 Mid-Atlantic SGIM Annual Meeting.

Sociologist Arthur Frank’s book The Wounded Storyteller describes serious illness as a loss of the “destination and map” that had previously guided the ill person’s life.1 Ill people have to learn how to “think differently” as their lives have been totally upended. Their “new normal” could be very challenging if faced alone. This mix of isolation and fear was precisely how it felt when I was suddenly forced to face a new reality brought on by an unwelcomed microscopic organism during Spring 2020. My life screeched to a stop, thrown by strong gravitational forces, caused by uncertainty and the fear of death. This stopping-in-my-tracks moment made me reflect on the way my patients felt soon after having been the recipients of a terminal diagnosis.

Back in the early days of the COVID-19 pandemic, it felt lonely and scary as I scrambled between my life as a doctor in a hospital in upstate New York, a mother of two children, and a daughter living far from her beloved elderly father. I remember those days as being marked by a vast cloud of surrealism, interrupted by showers of confusion and inadequacy. An initial sense of denial felt somehow familiar, making me think again of this common defense mechanism used by patients assaulted by a newly diagnosed devastating illness.

Frank also writes “the fatigue, uncertainty, sometimes pain and fear have always called for stories to repair the damage produced by illness”1, especially after a terminal diagnosis has been disclosed. Patients’ narratives under those circumstances tend to be chaotic and usually resemble someone experiencing a shipwreck in the middle of a storm. When I think of Frank’s term narrative wreckage, Daniel Richter’s dramatic painting Tarifa comes to mind.2 The painting depicts a group of people hunkered low on an orange dinghy just large enough to bear their weight as a black sea threatens to engulf them all at any moment. I always found this painting a perfect metaphor for what many seriously ill patients endure. Somehow, I also think it depicts the inescapable feeling of uncertainty that many of us experienced during the early months of the pandemic.

During Spring 2020, the chaotic narrative was palpable in every story told by my coworkers, neighbors, and loved ones. The air was one of impending doom everywhere I turned. This new reality started to suddenly feel inescapable. The mandatory lockdowns and quarantines created a sense of entrapment. Inside the hospital, the use of tight masks coupled with a constant sensation of imminent danger made the air too thin and difficult to breathe. Along with my own physical and mental discomfort, I witnessed the relentless suffering by the most vulnerable and seriously ill. Images of patients of all ages, forced to remain in isolation and unable to have their loved ones by their side during their final days, became morally damaging. I constantly stepped on eggshells of fear, anger, anxiety and despair. This felt many times like a drip of poison endlessly running through my veins, a feeling that I envisioned my patients receiving chemotherapy have experienced.

The concept of time as I knew it was also transformed. Suddenly, I was confronted with no future, similar to what patients have described to me after given their terminal diagnosis. Like them, I could only plan for my day-to-day because of not knowing what to expect next or when this nightmare would end. Oddly enough, this somehow started to feel liberating. The usual time constraints, expectations, and deadlines were no longer a priority. This new collective timelessness and forced life-pause presented opportunities for reflection. My never before experienced phenomenon ended up displacing the unpleasantness of the initial months and lifted some of the pandemic’s original burden. I started to cherish the extra time to reflect on the goodness in everyone and be grateful for all the good as well as the bad. I discovered the beauty within the pain. I embraced kindness and was even more driven to care for others and for myself with compassion. This tectonic shift in time and space helped me to let go and ride the waves of grief, something I had previously witnessed with family members and patients did as they contemplated the end of their life journeys.

This whole awakening propelled me to establish a new routine. I began to meditate, read more poetry, and do reflective writing. Last fall, I enrolled in Columbia University’s Narrative Medicine Program to further study the intersection of humanities and Medicine. I also went for regular walks in a nature preserve near my home. And finally, after years of pondering, I decided to put a hold in my practice and embark on a Fellowship in Geriatrics. I could not be happier with this move. This most recent path of my journey as a human learner has provided me with the opportunity to interact with wonderful people and take care of vulnerable older adults in a variety of settings. These experiences have resulted in precious knowledge and led me into further exploration of my spiritual life. Needless to say, this career “sabbatical” has reinjected my practice of medicine with purpose and has given my life new meaning.

There is no question that life in the times of a pandemic has provided us with many negative and painful life changing experiences. However, it has also given us a gift to collectively experience uncertainty and discover new opportunities for spiritual growth. Staying present and attentively listening to others not only has deepened my human interactions but also has helped me heal. This pandemic has granted me a better understanding of what it means to suddenly lose a map and a destination. I now feel closer to patients who are constantly challenged by the raft of fear and who struggle with the dimensions of grief. I can better relate to what having an imposed life-pause means. And because I also ride the dark waters of uncertainty, I can connect more with those who do the same. Sharing the crowded, small dinghy with my seriously ill patients is also a constant reminder that there can be healing in the middle of the storm.

References

  1. Frank AW. The Wounded Storyteller: Body, Illness & Ethics. 2nd ed. Chicago: University of Chicago Press; 2013.

  2. Richter D. Tarifa. Oil on canvas.137 ¾ x 110 ¼ in. Private Collection. Artnet Worldwide Corp. http://www.artnet.com/artists/daniel-richter/tarifa-UMnF2G4aNVSrw3ObwVMi5w2. Accessed October 15, 2021.


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