Medicine, from the heart . . . Ciarán DellaFera, SOM ’12
On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Forgive them, for they know not what they do
My good friend Daphne is an Episcopal deacon, and one of the chaplains at Mass General Hospital. Back in February she approached me, yet again, to ask if I would be willing to offer a medical student reflection as part of the Good Friday observance at the chapel. For several years in a row, I’ve declined because of school commitments. This year, I felt that my schedule finally had some breathing room, so I agreed.
For those who are unfamiliar with this service, it’s helpful to know that it is part of the Christian observance of Passiontide, which ends with the celebration of Easter, and coincides with the Jewish observance of Passover; the two are theologically and historically linked. The “Three Holy Hours,” as the service is referred to, focuses on seven themes drawn from the last three hours of Christ’s life: forgiveness, salvation, relationship, abandonment, suffering, culmination, and release/reunion. The service content, format, and participants tend to vary greatly. I’ve always been a big fan of the Mass General Hospital service because the reflections are given by clinicians, and are always drawn from their personal experiences with patients.
Because of a moment of ultimate forgiveness that I experienced during my pediatric clerkship, I chose to take the reflection on forgiveness. That particular reflection springs from the scriptural passage: “Father, forgive them; for they know not what they do” (Luke 23:34). What follows is the core story around which I wove my reflection.
It was late on a cold, dark, winter evening, and I was exhausted; mornings on the pediatric service start early. I had been on the floor since well before dawn pre-rounding on my patients, I had a stack of notes and orders to write, and now I was stuck waiting for someone from neurosurgery to come down and perform a ventriculoperitoneal shunt tap on “Andrew,” a young boy with cerebral palsy who was suffering from “fevers of unknown origin.” His case had been vexing us for nearly a week, and we were all frustrated, especially Andrew. He couldn’t really verbalize what he was feeling, but I could tell from the frowns, grimaces and occasional unhappy cries, that he was frustrated and uncomfortable. I decided that the best approach to making everyone less grumpy was to put on one of Andrew’s Barney DVDs, and start working on summarizing some of my patient notes while sitting in Andrew’s room. I have no idea what it is about purple dinosaurs, but Barney was better than any drugs at making Andrew feel better.
About 50 minutes later, the neurosurgery team arrived and apologized for the delay caused by a critical case that had run long—about what I had expected. We quickly went to work setting up for the procedure, laying out the required instruments and supplies. Unfortunately this also meant two very unpleasant things were about to happen: shutting off Barney, and causing Andrew pain. Neither of these were things that had gone well in the past. Eventually the moment came; I turned off the DVD player and pushed it aside. I tried to give Andrew a bit of a warning, as best I could, that we were going to have to hold him still for the procedure. He just looked at me with big unhappy puppy eyes that communicated loud and clear, “What’s going on? Why did you turn off Barney? Who are all these weird people in gowns and mask?” It’s truly remarkable how communicative people can be without speaking a word. To make matters worse, since the surgical team had their hands full, the task of holding Andrew down for the procedure was going to fall to me. This wouldn’t be the first time that I had to do something unpleasant to Andrew. Like always, I prayed that somehow it wouldn’t ruin our friendship, such as it was; somehow, miraculously, it never did.
As the surgeons began the procedure, I held on tight to Andrew, and the prayer that came to me in that moment was, “Father, forgive them; for they know not what they do.” The words were from my heart, but I hoped that were in Andrew’s as well. My moment of prayer was shattered as Andrew started wailing in that plaintive way that is unique to people who are non-verbal. My heart was breaking for him; I didn’t know if he understood what was going on, or had any idea that this was all in hope of helping him heal. Within my arms was another person whose suffering was partly my own doing. Did he understand why? Was he fully aware, but just unable to communicate? What was all of this like from his perspective? How could we possibly know what was going on in his mind? It’s in moments like these that I truly wish our medical school training included the ability to read minds.
The procedure only took about ten minutes, but it seemed like an eternity to me, and I’m sure to Andrew as well. We weren’t able to get much diagnostic fluid in the tap, but perhaps it would be barely enough. I thanked the surgeons, and started the automatic work of labeling specimens and cleaning up. I got Andrew comfortable in bed, turned Barney back on, and slowly he began to settle down. When I was finished I tentatively squeezed his hand. He looked up at me with his brow still furrowed, skeptical at first, and then his face changed into something that was almost a smile, but not quite. In that moment I had an overwhelming sense of forgiveness. There was a look of grace about him that clearly said “It’s OK. I forgive you.”