From My Journal
Today is my birthday, a time for recalling yesterdays.
I'm thinking of Father's Day last year when Scott invited me to share the day with him--just father and son.
We started with lunch at a restaurant that Scott selected, one of my favorites. Over the meal, we talked about many things, including his plans for school.
Afterwards we drove to a park where we tossed a baseball back and forth for awhile, and then walked a few miles, continuing our conversation, topics ranging from memories to philosophy.
We recalled enjoyable events before Scott's illness struck.
We talked about love, and we discussed life and death.
Sharing my thoughts and feelings with Scott was easier than usual that day. My father and I had never talked as intimately. Scott asked me to tell him about his grandfather. He hadn't shown much interest before, so there was much to tell him.
I told him the story of how my father became my first patient.
As a 21 year-old medical student, I had completed my first clinical clerkship. During this clerkship, I worked with real patients for the first time--under supervision, of course.
The clerkship had prepared me for my final two years of medical school. But it hadn't prepared me for my first solo experience with a real patient.
Early one Sunday afternoon in September, I received a telephone call from a hospital nurse in a small town. Betraying grave urgency in her tone of voice, she told me that my parents had been injured in an automobile accident and that I would probably want to be there with them.
Responding more to the nurse's tone of voice than to her words, I started the three hour trip to the hospital immediately. I wondered and worried all the way.
The attending physician told me that my mother would live, but that my father might not. Dad was bleeding internally from a ruptured organ. Surgery was needed, but the operation required the staff and services of a better equipped hospital--an hour's drive away.
The physician informed me that he had already ordered an ambulance to transport my father to the larger hospital. And he assured me that a surgeon would be ready to operate when we arrived.
I rode in the ambulance with Dad during the trip, monitoring his vital signs with the equipment I had brought. Only a few words were spoken by either of us. Dad was suffering, but he didn't complain. For most of the trip his face was placid, his eyes closed. He grimaced intermittently, and he opened his eyes a few times to smile at me.
I believe now that he smiled because his son was with him. But this thought didn't occur to me then.
I was eager to reach the hospital; I didn't like the tension I was feeling. I worried about my inexperience as I sensed an awesome responsibility. I hoped that the surgeon was competent. But mostly, I hoped that he would be there, ready to operate, when we arrived.
As we entered the hospital's emergency entrance, I asked a nurse to notify the surgeon.
"The doctor isn't here," she said. "He's probably fishing."
With that chilling notice, I became my father's physician.
I hid my apprehension from the nurses--and from myself. I concentrated on the challenge before me.
As the nurses rolled Dad's gurney through the hallway, I shouted, "Start a liter of glucose with an 18-gauge needle. Get four units of O-Negative blood!" Seeing the stethoscope around my neck and hearing the authority implied by my orders, the nurses assumed I was a physician and promptly followed my orders.
Almost immediately after we transferred Dad to his bed, a nurse tried to insert the intravenous needle.
"I can't find a vein," she warned. "His veins have collapsed."
I looked at my father's face. His eyes, though open, didn't move. His pupils were fixed and dilated. His chest didn't move. Quietly but decisively, instinct told me he was dead.
Desperately searching for something to do--an action to perform so I wouldn't have to think about what I knew--I placed my stethoscope to my father's chest and listened.
Astonished, I heard a loud, strong heartbeat. Just what I wanted to hear! I was bewildered for a few seconds.
Then I realized I was hearing my own heartbeat echoing in my ears, amplified by the silence of my father's heart.
I began switching between two levels of consciousness: the patient's son, who was experiencing intense emotions, and the patient's physician, who sought to provide care objectively.
Feeling anything was too painful for me, but I could still think. Thinking had always been my refuge from pain. The physician in me took charge.
I thumped Dad's chest with my fist, trying to start his heart. No response.
I injected a syringe of epinephrine directly into his heart. Still no response.
He had lost too much blood. There was nothing I could do to bring him back.
I looked into the eyes of the nurse standing opposite me across Dad's bed. She returned my gaze, sorrowfully confirming my diagnosis.
My first patient had died.
The physician receded and the son emerged.
My father had died.
I started lashing myself with accusations of guilty incompetence. To escape these thoughts, I dissociated my thoughts from my sensations; I separated my consciousness from my mind and from my body.
I was totally numb.
I was submerged in loneliness.
Without attending to my retreat or to external reality, I drifted into the hallway, my heart pounding. Anesthetized for several minutes, I saw nothing, heard nothing, felt nothing. I had started grieving but I didn't know it. Grieving was unknown to me.
I didn't cry until Dad's funeral four days later.
I understood Scott's stoicism. I had also disguised my emotions when I was his age. Crying was alien to me then. That's why, 34 years later, I still vividly remember crying at my father's funeral.
I also remember my grotesque, uncontrollable sobbing six months ago when I learned that Scott had died.
I wonder what Father's Day will be like next month.
I wrote this story more than five years ago, when I was about halfway recovered from the injuries caused by my son's death. In gathering my thoughts to write the story, I frequently connected losing Scott and losing Dad. This isn't unusual. Recent losses typically evoke memories of past losses.
Despite their resemblances, however, a major difference marked my approach to these two losses: When my father died, I knew nothing about healing after losses. In contrast, even though Scott's death was the biggest crisis in my life, I knew I could recover from it. Because of this difference, I responded to the two losses in radically different ways.
After Dad died, my eyes had been dry. After Scott died, I cried uncontrollably.
After Dad died, I was depressed for many years. After Scott died, I was energized with anger.
After Dad died, I was immobilized by guilt and self-blame. After Scott died, I quickly mastered my guilt.
These differences yielded another critical contrast: More than twenty years elapsed before I could heal from Dad's death. Yet, I healed from Scott's death in about a year.
I learned how to recover from my losses by teaching others. As a psychiatrist, I taught my patients how to recognize and accept nature's way of healing, and to value their own feelings and thoughts.
In teaching them, I learned.
I learned that my anger was the most difficult aspect of my healing for losing my father, as it is for many people. Knowing how to manage my anger helped me immensely in healing for my son. It also helped me understand why I didn't heal after Dad's death.
Except for angrily blaming myself, I didn't realize that I was angry after Dad died. Not knowing what else to do with it, I had isolated my anger from my consciousness. My anger lingered, however, creating a reservoir of energy to turn against myself.
My sadness also remained, accenting my depressive outlook of self-reproach and unworthiness. I was prepared to receive life's worst penalties, but not its rewards.
In contrast, I was prepared to heal after Scott's death disrupted my life. From the time he was born, I had expected Scott to accompany me through the remainder of my life. I no longer expect this. Now, I am living with new expectations.
Knowing that I'll die without Scott at my bedside still brings tears to my eyes. I wouldn't want to lose this sensitivity to the greatest loss I've ever suffered. Thanks to my healing, I don't have to. Indeed, I now treasure my memories of Scott in ways that are richer than before.
Healing does not mean forgetting.