In conversation

"You know doctor, we put down my little poodle last week. I'm still in mourning, but what got me thinking was my husband. We took her little body out to a field to bury her, and he said 'it's a shame she can go like this, the shape we're in, but there's nothing similar for us, with all our problems.' And you know doctor, I'm not sure he's not right. Look at me, all the money people spend on me keeping me going. And all I have left is my china to paint."

It is a young man's conceit that the world is for the young. But people like Mrs. Parkin, who made that declamation as she walked through the door on the way out, force me to wonder about the ends of life. My life now is so centered on doing, on accomplishing, on driving hard to meet ends, that a time without ends, without accomplishment, where I measure success in terms of a hobby, is inconceivable to me.

Looking at the impressive list of maladies plaguing my patient, my entreaties to reconsider her assessment were not wholehearted. She is a life lesson in morbid anatomy, a walking textbook of internal medicine. Diabetes, heart failure, hypertension, obesity and all the complications thereof. Most depressing is that she's reached the point where we can't do anything for her. While weight loss would help, she can't exercise because of her heart failure and hypertension. And until she gets those under control, she can't get gastric bypass.

I've reached the point in my intern year where most the common things are becoming automatic. I can cite studies and counsel this patient for any of her problems individually. But the big picture, the pitiful living compendium of pathology that modern medicine allows still saddens and confounds me.

It is in discussing these patients that the macabre side of the intern comes out. When we toss these stories around the intern work room, everyone has a different reaction, but at the same time, our core thought is the same. While one person may declaim "that's why I exercise" and another "that's why I sky-dive" the underlying conviction is "that will never happen to me." The black humor and macabre attitude hides our discomfort. The discomfort comes from facing our own mortality through the lives of our patients.

All flesh is grass, and all the goodliness thereof is as the flower of the field

Even so, I'd like to leave something more permanent than painted china behind. Something more than the accumulated bits of plastic which mark my life as a twenty-first century man. But I'm thinking it's really only the effect we have on others that we can hope to leave behind. Mrs. Parkin's china may not survive the ages, but it certainly reminds me of the desperate sadness all around me. And though I failed to do more than smile sadly with her, next time, I'm going to be five minutes late for my next appointment.