The Give

It often seems like each rotation has something essential about it, and that essence often echoes the themes of my life (or vice versa - this is a chicken or egg situation, of course). For example, while I was on orthopedics, every day I saw desperate patients begging for (and often promised) a solution to their pain. In my life, I seemed to be making all sorts of rather desperate hail mary gestures (there is an entry in here somewhere, I promise). Now that I am on neurology, I am watching people deal with breathtaking loss of physical functions; my life this last month has been filled with a wide range of witnessed and experienced loss of people, ideas, expectations, and places.

What amazes me is that no matter the source of the loss, the outcomes all seem to converge. It appears that loss in any form distills the world down to something very small. Like someone who has suffered a stroke, an emotional or external loss leaves one childlike. Someone coping with loss moves from moment to moment (for how can you think beyond that?) and, similar to the recovering stroke patient, even the most fundamental activities become a challenge. Eating, drinking, moving, speaking, sleeping can be so difficult that they essentially have to be relearned. Sometimes it takes all the effort and concentration one has just to breathe - and there is nothing more basic than that. And those who lose are completely dependent on those around them to hold them, feed them, remind them to breathe until those activities are relearned. Loss, then, is so transformative that it serves as a sort of rebirth (although it's a rebirth partially mocks our fantasy of wiping the slate clean).

But it's only a partial mockery of the clean slate fantasy, since the loss of something familiar (and it has to be familiar, for we cannot lose something we did not know) results in at least the hope of pursuing the aspirations and dreams that were blocked from fulfilling before. "I will do this because I was never able to do this with them around/that plan in place." It's a partial mockery because the slate is not clean - it is not simply a free space, but an actual vacuum created by the loss. In other words, what was once there defines the "clean" slate. The decisions that follow in response to loss are wholly created and shaped by the loss itself. And in stroke patients, the parameters for how they relearn walking, talking, reading, eating are set by the nature of the functions they lost.