He Blessed Them Unaware

On the night of November 7, while NBC was putting Florida firmly in the Gore column, an ER physician and his young assistant were interpreting the “mass” in my 90-year-old dad’s belly.

(I’ve always been fascinated by the art and process of diagnosis: the presentation of random symptoms, the diagnostician’s questions that winnow away the irrelevant, and that “Aha!” moment when some pattern, some sentence, some path emerges from the chaos. I think that a diagnostician has to — like Odysseus’ son, Telemachus, wrestling with the guileful sea god — just hold on no matter what horrible things he may see, hold on until he hears the human voice.)

A few minutes later, the ER physician drained five liters of urine (yes, five) from Dad’s distended bladder. He looked at me with a wry smile and said, “I told you it was the bladder, remember?”

How Dad and I got to this point is not the subject of this article. Though you won’t be able to tell it for a while yet, my central topic is not the thing that I rediscovered during my Dad’s hospitalization — the unfairness and inefficiency of our broken healthcare-delivery system. If you grow old, I pray that you are wealthy beyond measure and vigorous: wealthy enough to get timely attention and strong enough to cut through the bureaucratic crust of folks who are evidently not compensated to think beyond the check boxes on a third-party reimburser’s form. In other words, if you get old, don’t get sick.

(I can remember my dad getting the flu or a cold three times in his entire life. He had cataract surgery 20 years ago. In 1927 he and a cousin ran a half-mile footrace after eating too much at the Thanksgiving table. Dad’s appendix burst. That night, through a thick fever, he heard the family physician whisper to a nurse, “He’s not going to make it through the night.”)

Throughout Dad’s acute care, I kept hearing healthcare professionals ask the same questions — a brand of institutional amnesia.

(Couldn’t the first ambulance attendant start capturing this critical information with a wireless personal digital assistant [PDA] feeding a hospital database? There are privacy issues, I know. As I was later informed by a hospital administrator, some patients do not want a central medical database because of what their insurers might find out. But couldn’t there be a secure way for me to control all of my medical information, authorizing access — with certain defined roles and rules — for healthcare providers as I engage them?)

It was as if Dad’s entire physical history had to be replayed with the appearance of each new person on the scene.

When you reach an advanced age, there are persistent toxic assumptions that can fix the boundaries of your care — assumptions about just how well you are supposed to be, what you should hope for, what kind of pain you can endure, and what legal risk you might pose.

As luck would have it — and there is good and bad in this luck — I’ve spent whole months of time waiting in various hospitals, asking questions, wondering if a brother or a mother might make it through. And worrying about what capacities they might lose in the act of making it through. I have too many stories from these times. If I start with one, I might keep you here for days. There was the conversation with Mom a day or two after knee-replacement surgery during which her heart stopped twice and the surgeon discovered that he’d ordered the wrong-sized replacement. For example.

Mom was so happy to see us. We were so happy that she was alive. Then, like a man noticing a patch of blood on his sleeve, I started finding all these holes in her mind. I didn’t mean to find them; they were just too obvious. Why had no one in the hospital prepared us? We’d rushed headlong across a burning bridge, with no time for making provisions. There could be no going back. Ever. Rehabilitation wouldn’t take. The caseworker had a sheepish, hooded look that I didn’t have a frame of reference for. Not then, at least.

Since my first waiting-room experience — I was 17, I think — so little has changed. Hospitals are still organized for themselves, not their patients. Doctors are still afraid of questions. Nurses will still startle you with their kindness.

What’s lacking is nothing more (or less) than human imagination, a fuller understanding of what it is to live, how it feels to be afraid, and some respect, if not awe, for the divinity there is, even in (or especially in) our wounds, masses, occlusions, and fevers.

Which brings me, only now, to the subject of this article. It’s that you have no time, friend, for anything other than what might lift you or others. That you must, today, begin the habit of encouragement: Start with yourself, and see what other habits may drop away. That you don’t need the excuse of being in love to see the world the way a lover does. That the best you can hope for — it is a wonderful thing — is that your life might occasion accidental blessings. That you might, like Coleridge’s Ancient Mariner, find beauty where others don’t, even among the water snakes, coiling, green, and menacing. (Remember? He “blessed them unaware.” Think about that for a moment. Wouldn’t your blessings be sweeter and more welcome if they didn’t have the weight of intention? If they were as natural as the song of your own breathing?)

And Dad? He’s doing fine, thanks. He’s reading novels about British sea captains, an average of two a week. And, knowing that I’m in advertising and all, he ended a phone conversation the other evening with, “Son, I pray for you with all my heart every night before I sleep.”

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