Saturday, January 10, 2009

The Valley of the Shadow of Death

I was Atlas, bearing the weight of the world pressing down on me. Under the emotional exertion, my heart beat faster, also crushed by the heavy responsibility before me.

I walked down creaking pine floorboards to where I would take up my mantle as senior “Médico,” not that 22 years gave me any qualifications for such a title. I took my place in a bare, makeshift examination room. As it seemed with everything in this part of Tijuana, the furniture was being held together by sheer ingenuity that comes with poverty.

The quiet, black fear broke out into an active yellow terror, like a rat out of a cage. I began to think of any means of escape. My mind darted left and right. Could I pass it to another? Could I leave it undone? No and no. All escape was blocked. If I was to be anything but a coward, I had to do this. I clenched my teeth, preparing for what would be an anaesthetized vivisection of my emotions.

Señor G staggered in, leaning on a friend. I greeted him warmly. He was wearing a blue Chargers hat that he had received as a gift. I complimented him on the hat, and he beamed with joy. I yearned for this moment to stretch into eternity.

It did not. The moment came that I had feared, the moment I had run through a hundred times in my mind. I had to tell him he was going to die. Sr. G had been on heroin and cocaine for many years. That together with alcohol had destroyed his liver, and he did not have long to live. He was my patient, and I alone bore the weight of delivering the news. Everyone dies, but woe unto me, for I had to translate a fact into a reality.

I gathered up all the courage within me, but it was only sufficient to produce a euphemism: “You’re not going to live much longer.”

“I know,” he replied. But he didn’t. He talked about plans he had for years ahead. And now I had to crush them.

“You don’t have much longer to live,” I tried again to make the sting of death less sharp. But death’s sting cannot be dulled by soft words.

“I know,” he said again. But still he didn’t. His planning continued.

“You’re going to die soon.” I used the word. I said it. And I saw despair in his eyes. His spirit overflowed with sorrow and his eyes with tears.

Then something happened that I did not understand. I spoke without speaking, and a voice that was not my own asked if I could pray for him. He and I shared a common faith; the request would have been reasonable, but for the alien source. Laying my hand on his shoulder, I prayed, pouring out my heart to our God. I thanked God for his love to us in giving salvation; I prayed that we would have faith in the valley of the shadow of death; I prayed in the hope of eternity. Then his dirge entered a new movement, as if a light new flute melody danced atop the low and mournful chorus: he remembered hope. The blackness of his night was pierced as if by the morning star; black indeed, but not black complete.

My own terrible weight of fear was cast into a sea of sadness. But even in the darkness above the waters, there was a wind of hope that hovered there unseen. As he limped away, I realized it would be the last time I would see him this side of eternity.

What did I fear? I entered medicine to speak Life, and I had to declare Death. I learned that doctors do not only announce hope, wearing white coats and stethoscopes; we must also proclaim doom, taking up the black hood and sickle. We are not saviors, but guides. We may be angels, but sometimes we must be the Angel of Death. Though we always desire to lead our patients out of the valley of the shadow of death, not all leave the valley. For those who must stay, we must be faithful guides even unto the grave. And it was that grim task that I feared.

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