What's It All About?

There is a creeping bias towards agnosticism, if not outright atheism, throughout most of modern science and medicine. I can say for a fact that most of my mentors in college, medical school and training were, for the most part, nonreligious, and sometimes, quite hostile to belief.

I, myself, a child of physicians, grew up in a household where atheism was viewed through the prism of truth and science and religion in the realm of voodoo and blind faith. I must say that to this day, I remain deeply skeptical of faith, at least as it is promulgated by the Judeo-Christian-Muslim triumvirate.

What the hell are we doing here then? It plagues me, torments me, affects every aspect of my being. I know that that sounds awfully melodramatic, but it's the truth. Maybe it's the daily existential crises that I see going on in the minds and hearts of my patients. Maybe it's getting a bit older myself. Maybe it's just being down. But, I can't shake, in the dark quiet of the evening, this essential, age-old, unanswerable, but extremely difficult question of our existence.

I tend to subscribe to the Carl Sagan-ish approach to our existence in that: many say that the origin of the universe traces to "God"... when asked "who created God?", the answer is often that it is beyond our comprehension. Sagan's rejoinder to the this was that he preferred to remove the middleman and just say that the very nature of our existence and the universe is beyond our comprehension. Period.

If, then, we are all just "star stuff", and our molecules decay back into the nothingness of entropy, what is our brief time on this planet about?

Christians often say the communion with God's love. Muslims speak of obedience. Buddhists talk of dharma. Taoists talk of , well, the indescribable Tao. Existentialists talk of our own whims and desires.

I read and read and read and yet, as I think of how so many people I see have confronted illness and death, I still have no answer.

I would like to believe that we are all children of a loving creator. That there is something eternal to our souls. That a soul even exists.

But, I don't believe and I won't believe.

I simply cannot accept that the suffering of the world is justifiably caused by a knowing being. If it is, then I reject such a being.

I suppose I take more comfort from the idea that we are all together in this absurdity of life. That we all exist in the same short window of years. That, although, as Ecclesiastes says, there is nothing new under the sun, that there is something holy and mystical about each of our own individual journeys through life. However mundane, however painful, however comedic.

We all face the same fate. We are all humbled eventually by illness and death. Life is a treasure, despite its lack of purpose per se. It is simply about living itself. And respecting how others choose to live.

And having a few laughs along the way.

The Hurt That Never Leaves

It's been a pretty crappy week. Three years into full-time practice and it still gets to me when a patient dies. I know to the lay person that that seems appropriate, but there is a certain amount of detachment/PTSD/burnout/self-survival that occurs when you're knee deep in trauma of some kind, be it cancer care, war, police work, or any number of personally demanding jobs that are wonderful and horrible simultaneously.

But, it's still gets me. Maybe too much. I've laid off the blogging for nearly two years to kind of get my bearings in full time practice. It's never pretty when idealism collides with reality, but I guess that's what "growing up" really means. It's not chronological, it's psychological.

My last 10 days... a colleague, 32 years old, another doctor, was diagnosed with node-positive breast cancer. she's 32 years old...! granted, I've treated a fair number of young breast cancer patients, but that sucks. oh, and it was diagnosed shortly after the birth of her second child.

i just found out that a woman, 37 years old, 2 years ahead of me in training... she was my senior resident in the ICU for Christ's sake, 2 kids, the usual... she has metastatic breast cancer that is progressive through 3-4 regimens. She probably won't live another year. Her last email talked about the "end of the tunnel" which she knows is coming, but can't quite see around the bend. I cry when I even think of her and all my countless patients, young and old, who lose so much freshness in their lives during these battles.

One of my all-time favorite patients (i know, we're not supposed to have favorites, but we do), 50 year old man, with chronic lymphocytic leukemia diagnosed 3 years ago. He had a complete remission to his chemotherapy at the time, but a few months ago, his white cells came back, but they were a little different. This time, he had a different leukemia, something called acute myeloid leukemia, a completely ominous and often fatal diagnosis. Likely, it was a known complication of the original chemotherapy he received, a side effect of the DNA damage from those drugs... he died last week. Hearing his wife sob on the phone sends chills down my spine as I write this.

Last night, I had an end-of-life discussion with a 49 year old with metastatic prostate cancer that I treated for 2 years. In one year, his PSA was normal, the next year it was in the 100s. I had to sit there as this guy, a state trooper, salt of the earth, broke down crying at the thought of not seeing his daughters get married some day.

And on and on...

I sometimes wonder what being exposed to suffering constantly will do to me in the long run. I'd like to say that I've achieved wisdom and compassion and the full range of emotion and life, but sometimes, I just feel a bit fried.

I often think, in the quiet of my evenings, about some of my patients and their families. You get to know them so well as an oncologist. Where they went to school. Their pets. Children. Hopes, dreams. The things they are fighting so hard to keep. Love.

Sometimes, I just sit there and cry.