Although the physical maladies of our patients vary greatly, one theme runs through all patient encounters: the meaning of the illness (or health) to individuals, and the part played by stress, tension, and worry in their lives. We spend much of our time encouraging restoration of balance, good timing, and a sense of proportion in their daily lives. We are taught to pick up on clues to their depression and anxiety, and to diagnose and treat these when non-drug methods do not work.
Yet often we are not consciously caring for the most important person in the equation: ourselves. Without good mental, physical, and emotional health, we can help no one. Our own attempts to balance our lives, between duty and diversion, between family and work, work and play, play and creativity, creativity and reflection, are really attempts to organize meaning and significance out of an experience of life, the practice of medicine that could and has become for many, an all-consuming passion in an unhealthy way.
For my own play, diversion, and creativity, and to balance my own life, I choose mainly music. I've always looked for a community or university chorus in which to sing, no matter in which city I lived or how busy I was.
But one never knows how closely one’s diversion and one’s duty may converge.
I was singing in the University-Civic Chorale in Miami, whose conductor is an international icon in choral music and whose wife is a well-known local artist and a patient of mine. One of her unique specialties was making paper, which entailed handling huge vats of boiling materials.
One Tuesday night, from 7:30 – 9:30 p.m. as was my wont, I was happily singing, after a full day’s work. The singing itself is work, but different. One must stand most of the two hours, and concentrate on reading and perfecting the music. The loyalty is always to the music, over any personal concerns.
My beeper went off at around 8:45 p.m. Usually it’s something I can handle from my phone in a few minutes, resuming the rehearsal. I gathered my purse, chorus folder with music, and went outside the choral room to call. This time it was the Emergency Room of my hospital, and the patient was the choral director’s wife! From the ER doctor, I got that she had burned herself pretty badly but was alert, awake, and basically okay, at that moment.
My hospital was only two miles from the choral rehearsal, so I was faced with one of those decisions that one hates to make, for fear of choosing, of two simple paths, the wrong one. I agonized only a minute before deciding to let him finish out his rehearsal without interruption, while I went to the ER to assess the damage. I scribbled a note to the graduate student assistant of the chorus to be sure to give to him immediately when the rehearsal stopped, and I took off for the ER.
Her story was that she was carrying a huge vat of boiling material for her paper-making, when she tripped and fell, pitching forward while the liquid heaved backward, and felt the mass fall over her back, buttocks, back of her legs, shoulders, and arms. The mass was of paper pulp, etc., and heavy, so that once soaked onto her clothing, it stayed, absorbed and burned severely, at a temperature higher than boiling. She was in excruciating pain, some of the lesions were full-thickness, and it was obvious that the Burn Unit down at Jackson Memorial Hospital was where she would be headed.
This was a burn that could threaten life, both immediately, short-term and long-term. This was a burn that would induce painful scarring no matter how skillful the rehabilitation. I was shocked, sad, and very much involved, in such an ironic way. I did not know if my director or my patient, his wife, would be furious at me for letting him finish the few minutes of his rehearsal, but he was so happy and lost in the music, accomplishing with his/our chorus the perfection and attention to detail which was so important to him and to us, that I couldn’t see where allowing a clean conclusion to the rehearsal would make any difference where his knowledge of his wife’s condition was concerned, since he wasn’t the determinant of her well-being at that point.
No, I decided again, (by now it’s 9:15 p.m.), but to bolster my confidence I get her opinion. “How are you feeling – apart from the pain of the burns?” I asked her. “Oh, don’t worry about me. I’m fine,” she said bravely. “I was beeped out of rehearsal. I left a note for your husband for as soon as it’s over. Should I have interrupted him to come right now? Shall I call the choral office right now?” She smiled through her pain, “Let him finish out the rehearsal – it’s just a few minutes, and he has so few rehearsals in which to prepare the chorus.”
I went to work, along with the doctors in the ER, to stabilize her (she also had high blood pressure and was on medication for that), and to detect any possible antecedent to the fall. Her husband showed up within the next 30 minutes, having been duly told to come directly to the ER, but that his wife was doing fine for now.
When I saw him, he was too concerned to be struck by the coincidence and the irony, or to be upset with me, since he figured I really didn’t know the extent of it, which was true.
After explaining to him, but not yet to her, in detail (but as gently as I could within the bounds of truth and my ability to predict), what the next few months would bring in terms of pain, risk, and scarring, I got him calmed down at least to where he felt he had a handle on what he needed to know, what he could control, what to expect. Then, I went about the administrative nightmare of getting her into the burn unit promptly. That accomplished, a few hours later, I went home with the chords of the beautiful music I had been singing ringing emptily in my heavy heart.
Only much later did I realize, selfishly, how the episode had invaded upon my own need to gain some balance, some space, some peace. At first, when I pondered this irony of best-laid plans I was suffused with self-pity. In a flash, it was replaced by my solid satisfaction that these worthy people, whom I was privileged to know, had allowed me into their lives with one more privilege: that of helping them in a time of dire need. That revelation, which came as a bolt, gave me all the balance, timing, and proportion I needed.