As a native Southern Californian, I have always found rain to be somewhat of a novelty -- a welcome respite from the fluffy vacuous days that fill our calendar. This winter has been different; the rain is incessant. As if angered by our sunny complacency, black clouds have descended, and in their wet fury left flooded streets, sliding houses, pacing kids and desperate parents.
It was one such stormy weekend when the house reverberated with cooped-up kids and my head reverberated with the noise that even the pouring rain offered serenity, so I enlisted my four-year-old daughter, Julia, to take a walk with me. Not a hearty sort, my delicate princess was hesitant, but finally lured out by the thought of "rainbow hunting."
So out we went into the blurry water-colored day. The sky was slate, the air strangely electric and unstable. We clutched each other, huddled under the umbrella, and listened to the rhythmic staccato of the rain. As it began to loudly pound, Julia grabbed my hand tightly. "Mama, are you sure this is a good idea?"
As quickly as it intensified, however, the rain began to ease. Finally, lulled by the soft patter of the rain, I was able to exhale some of the weeks of pent-up tension, so we walked on. I, getting giddy on the sweet, clean air, and Julia a few steps behind, splashing in every puddle.
A few minutes later she squealed, "Mama, look!" I spun around and saw her staring into the sky mesmerized, completely oblivious to the droplets, that reflecting her pink hood left glistening trails of rosewater on her bright cheeks. I followed her gaze and saw that the first tiny bit of sun we had seen in a week had managed to penetrate the granite clouds and the ray it sent through illuminated each raindrop as it danced down to the grass into a jeweled tapestry. It was unbelievable -- a glittering spotlight from the heavens.
"Ooooh Mama," Julia breathed, eyes sparking, "we're gonna see a rainbow."
I thought it couldn't get any better but she was right. Above the pixie dust path the first strain of color had begun to seep into the deep slate of the sky, and we held our breath as, like a symphony reaching its crescendo, the color became louder and more vivid until finally a brilliant rainbow arched across the horizon.
Sometimes only the bleakest, darkest day can yield the most unexpectedly beautiful sights.
I could feel Julia's soft warm grip around my fingers as, peaceful and serene, in the whispering rain we stood, transfixed, as our own private miracle played out against the menacing backdrop. And I understood. Sometimes only the bleakest, darkest day can yield the most unexpectedly beautiful sights.
I was reminded of that day a few weeks later while on call for my internal medicine group. I got paged to the ER.
"She's back" the ER doctor said.
I knew exactly who he meant -- Mrs. Hartman. A patient of one of my partner's, hers was the type of case that most physicians dread. At 68, she was terminally ill with cancer, heart disease and diabetes and had no possibility for cure. She had been in and out of the hospital for two years and just one week earlier had been discharged to a nursing home after four months in the hospital. For the past year her body had been trying mightily to die. Infarctions hobbled her heart, infections crippled her lungs and it was only because of the heroic measures insisted upon by her husband that she was alive -- sort of.
In her neck, a tracheostomy tube tethered her to a ventilator to breathe for her, a gastric tube pumped nutrition directly into her intestine, and a pacemaker sent currents to her heart to beat for her. The worst part was that because she was only very intermittently lucid, we did not know if these aggressive treatments would be her choice.
I walked toward her ER room. In the contrast to the typical cacophony that crackles in ER rooms, hers was resigned and somber, still, save for the gurgling of the ventilator. Mrs. Hartman lay as she always did - glazed eyes half open and listless, balding head lolling to the side.
As I watched her pale liquid eyes stare into the distance and occasionally twitch, I wondered, "As she straddles consciousness, what is she thinking?" Was she, as an intern once suggested, making amends with God? Or, as my ethereal son Joey is convinced, dancing with angels? Or had we launched her into some painful, hellish limbo (almost too unconscionable to entertain)? I shuddered and then noticed her husband who had stood up to see me.
I realized that his detailed attention gave his life purpose, but at what price to his wife?
"Hello, Dr. Yaris," her husband intoned officiously. "As you know, she has another bout of pneumonia, so she'll need respiratory therapy … make sure you get Nadine … she's the best … and when you get the IV nurse …"
I watched him as he spoke. A retired engineer, his angular grayish face seemed always to frown. Since his wife's illness, he took copious notes -- of medicines and doctors and had learned to navigate the chronic care system quite well. Because I am the daughter of an engineer, I understood his meticulous documentation not to be litigious, but merely his way of making sense of a completely nonsensical situation. He continued on, his droning voice now added to the rhythmic wheeze of the ventilator. As I nodded toward him, I tried hard to feel compassion. The truth was that it was difficult. I realized that his detailed attention gave his life purpose, but at what price to his wife?
After writing orders for antibiotics and most of Mr. Hartman's minutiae, I left the hospital feeling uncomfortable. As a doctor, I had taken an oath to preserve and enhance life, not prolong painful death. I prayed that as her surrogate, Mr. Hartman was doing what his wife would have wanted.
The next day when I checked her chart, her x-rays, fever and lab tests had all improved. It seemed as if she would, yet again, prevail. Her husband waited at the door for me and as I walked in, started on his demands. "Dr. Yaris, we need the Albuterol every two and one-half hours, not every three … and I really think 10 milligrams of Ambien is better than five…" He followed me as I bent to examine her.
"Mrs. Hartman?" I ventured.
Almost imperceptibly, her eyes opened!
"Can you hear me?"
Her eyes widened and seemed to be pleading as, ever so slightly, she nodded. Threatened, Mr. Hartman's voice became shrill, more demanding, but I stared into her eyes, willing her into lucidity.
"Mrs. Hartman? Are you in pain?"
Eyes fixed on mine, her cracked lips mouthed the word, "Always."
I gulped and took a deep breath, "Is this what you want? Do you want to continue like this?"
I watched carefully, but her eyes had already begun to glaze. I screamed, "Mrs. Hartman! Mrs. Hartman!" trying to pull her back into this dimension. Like a child fighting sleep, her lids fluttered open again as she struggled to pay attention.
"Is this what you want?"
Very slowly, she nodded. I was shocked.
Thinking she didn't understand, I clarified, "Are you sure? Because the next time something happens, we don't have to be so aggressive. ARE YOU SURE THIS IS WHAT YOU WANT?"
Her eyes remained focused on mine and again she nodded. Her husband, who had gone silent, exhaled loudly and began again with his litany, his voice somewhat smug.
As a physician, however, I was relieved, because though I couldn't comprehend her wishes, they were hers, and I was not contributing to some elaborate form of torture.
I didn't understand. What kind of meaning could she be finding in this painful half-existence? As a physician, however, I was relieved, because though I couldn't comprehend her wishes, they were hers, and I was not contributing to some elaborate form of torture.
The next day, I was happy her husband wasn't waiting for me at the door. Hoping to get in and out of there quickly, I walked toward her room, but was halted, transfixed by a breathtaking sight.
Through her half-opened door, I saw that the outside storm clouds had cast the room in a monotone gray. The only light was that of a tiny florescent hospital lamp above Mrs. Hartman that illuminated the chrome of the ventilator and the bars of her bed, and caused them to glisten. Mr. Hartman sat by her side, his severity softened by the light's odd blush as he stroked her face and gazed into her eyes, whispering to her. What was striking however, was Mrs. Hartman. As if lit by a glittering spotlight, she glowed. Her eyes sparkled like jewels as she stared beatifically up at her husband with a peaceful, serene stare. The love between them was electric.
I looked away, ashamed, as if a voyeur to their private miracle. But I remember it -- because somehow that image of the stooped, gnarled old man caressing the bloated bald face of his wife was one of the most romantic, unexpectedly beautiful sights I have ever seen.
I could almost feel Julia's soft warm grip around my fingers as I watched, yet again, as one of the bleakest darkest situations yielded another rainbow. And I understood.