Fear
by Lawrence Scariano

      Jumbling my keys in the dark, I finally found the one opening the front door. How many times has the wife asked me to change the porch light, I thought as I made my way through the dark entryway and towards the bedroom? I deposited my backpack and jacket on the large leather stool at the end of the bed where she slept oblivious to my return and then headed back out to unwind a bit before going to bed myself. In the kitchen I grabbed the cold plate of breaded Italian chicken from the fridge and together we at last proceeded to the basement. 

      My favorite chair was large and worn and it was where I frequently had my late meals, a place to relax and to forget the frustrations of the day, but not tonight. My stomach full, I sat there, numb after another long shift at the hospital, too anxious to sleep, watching one of the clownfish in my tank protect its brood, and wondering what the hell we are doing to ourselves. 

     Today like so many other days I broke bad news to the families of patients I hardly knew. Cancer, severe heart disease, strokes, terrible infections; it's always something"isn't it? How many times today did I herald the inevitable death of a seventy or eighty-something year old person to a shocked family, mortified that I could and should do little to stay the hand of nature? How many professed their faith, not in eternal salvation or life beyond death, but in that God would not let their loved one die. I thought we were saved and no longer need fear death yet all around me it was there, in the patients, in the families, even in my fellow healthcare providers. These situations, more than any other seemed to now torment me day after day as though someone was trying to force me to see the truth so clearly placed before me, in the fish tank and in the stories of those I've known. 

      One of my patient's, a 28 year old woman recently gave birth but unknowing to her she had a small seed of breast cancer just waiting to awaken and ravish her body. The hormonal flux normally occurring after child birth was all it took and now she had cancer in her lungs, her bones, and her brain. What was I to say, "Sure you'll see your daughter's first birthday"? No, but they tried and after four months of she and her family suffering, after the well intentioned efforts of her doctors, and after tens of thousands of dollars that might have gone into a needy school program or for providing basic healthcare to others, or relieving poverty, she died. "She was not a quitter" everyone had said but I knew that was not it, not even close to the truth. We had all been too afraid to let go and give in to the way of things, to what was horrifically true and obvious from the start, too afraid to say "no more! "

      Not long ago I walked through the halls of my hospital's intensive care unit realizing that one entire wing of that department, equipped with its state-of-the-art life saving technology and staffed by the some of the best trained nurses in the city, was filled with people suffering from alcohol poisoning or withdrawal. I saw their names and knew most of them from their previous one, two, three or four visits for the same problem in the past year. I was personally responsible for many of them being there that day in so much as it was me who got them back on their feet the last time. How myopic our compassion has become. Who suffers today because I and the resources at my disposal are not as freely available to them? Who will suffer in fifty years for the compassion we bestow today. I recall questioning this aloud amongst my peers once. "Where is your compassion for the patient?" I was asked. "Where is your compassion for mankind and the yet unborn" I thought to say, but didn't. 

      One of my first memories working at "The Palace" was attending to a retired firefighter who after a long fight with ALS, Lou Gehrig's Disease, was in respiratory failure and soon to die. He had recently returned from China, a journey which exhausted all he owned, where a physician practicing holistic medicine bored a hole in his skull as part of an elaborate last ditch treatment. It didn't work. In the end he had become confused with the lack of oxygen and his well intentioned wife gave in to the emergency room physician's "he's going to die if I don't save him." Having read the man's medical record I entered the treatment room to find him on life support. Without betraying my shock, my disgust at the apparent neglect of professional ethics, I coaxed the ER physician from the wife's side. "What are you doing? He signed a living will when he was of sound mind and you placed him on life support." The other doctor, no doubt insulted that I would challenge him in his own church growled, "I wasn't going to let him die from suffocation." "Good god! What the hell else do people with ALS die of?" I replied. I know the wife heard me and three days later she faced the hardest decision of her life; she pulled the plug. I remember crying for her, that mother of two, and for her loss all the while wondering how much needless pain and suffering we inflict on ourselves and those we love because of our fear. 

      I moved my chair up to the tank as I often did and rested my forehead against the cool, algae speckled glass. I looked into the clear water which shimmered from the lights above as several clownfish swam close and gathered near to where my face pressed against the pane. What do they think of me I thought? As I pushed back the fish scattered and I took in the complexity of what I had built nearly three years before; the perfect reef tank, nearly self sufficient in every way, capable of recycling its own wastes and replenishing its own chemestry. I never worried about water changes or minerals and I rarely had to even feed the fish. Everything was in perfect balance down to the bacteria and other microscopic inhabitants. 

So what is it that took me in such a way as to make me question everything I have been trained to believe as a physician? It's quite simple really; man is not broken. 

      How is it possible that we believe God is perfect and only creates perfection yet we can profess no explanation for our obvious shortcomings other than "God works in mysterious ways"? That's way too easy and convenient, and lazy. What if we are imperfect by design? What if we are not intended to live forever but instead to live a good life, contribute to the development of our race and then pass on so that others may continue the tasks of being without overwhelming our world's ability to sustain us? What if, like a forest fire ignited by the lightning of a spring storm, certain diseases serve to thin our collective mass and thereby keep our numbers and our impact on all of God's creations in balance. Did not God create disease as well? 

      I watched silently, contemplating, as one of the juvenile fish before me shot from behind the brood swallowing not one but two of the babies of another pair of clownfish; barbarism or design? I thought further. If my fish were "smart", would they find a way to prevent their babies from being eaten? Would they find a way to cure all of their ills and more than double their life span, as we people have in the past four hundred years? Would they learn to fear death and struggle with all of their might to defeat it with as much disregard for the future of their race as we have? Would their collective fear of death not ultimately lead to their own destruction and possibly that of their world? 

In the morning I showered and dressed as usual and saw my children off to school. I sat and finished a fresh pressed cup of stout coffee, the kind my wife said could raise the dead. On Fox I watched as more panicked with the recent outbreak of the swine flu. 

      When I finally arrived at the hospital and began my rounds I was met by the family of an elderly patient of mine who had recently suffered a stroke. It was bad but I knew she could be stabilized and possibly would on her own if I could just support her oxygen and hydration for a few days. The daughter was smart and knew her mother well and she realized, after consultations with me and a neurologist, that if mom stabilized she would be significantly disabled.  "She wouldn't want that" the daughter told me of her mother. So we withdrew care, everything except some morphine and valium, no IV fluids and no oxygen. Three hours later the woman who had the stroke passed away with all of her family in attendance and without tubes or needles to delay the inevitable. They cried for themselves, I did a little too, and then they smiled and laughed in remembrance of her. 

      That night I drove home with no thought of the other people I had cared for that day, only that one family. I felt good but more than that I felt as though I had been blessed with an awkwardly disturbing, if not totally politically incorrect understanding of the workings of the world and its creator. God, or that guiding force of nature that some choose to align with when they are uncomfortable speaking of Him, created man but not just man the individual. He created mankind who as a race must live in balance with God's other creations if he is to truly defeat death, not necessarily death for the one but death as a whole for mankind. 

      We come and we go as it was always intended and perhaps if we spent more of our time and resources on society and mankind we would have less to fear, hate and fight over. Maybe instead of spending massive amounts on curing heart disease and cancer so we can all live to be centurions, we should focus on preventive medical care, our education system, poverty and starvation. What if everyone could have more of everything including time to spend making our world better? I don't see it happening as long as we continue to allow ourselves to be ruled by an irrational and possibly even selfish and ultimately terminal fear of death.