July 2014 – Maria Yang, MD

Though you are now a member of the club, you don’t know it.

It feels like no one understands and that you’re alone. The memory of what happened to The Person You Love is heartbreaking.

The feeling seems endless. Perhaps you feel it in your body; maybe it feels like a hollow weight in your chest. Maybe your head feels heavy. Maybe most of it unfolds through your thoughts: You hear good news and your heart floats for a few moments, but then you remember what happened. Even good news somehow seems sad.

Sometimes it feels like time doesn’t move the way it did before it happened. Thoughts like, “This is the youngest I will ever be… will I remember this?” become regular visitors to your mind. You grasp those little things that bring you joy and cling to them:

The summer watermelon is cool, crisp, and sweet against your tongue. Will this be the last watermelon I ever eat?
How wonderful it is to see the splashes of peach, pink, orange, and purple across the evening sky! Will this be the last time I witness this supernatural work of art?
He has a delightful laugh! I hope that this won’t be the last time I hear it.

Life takes on a quiet desperation.

Because you don’t know if you will experience these moments again, gratitude overwhelms you:

I turn on the faucet and hot water comes out in seconds! I get to take a comfortable shower every day!
I have a place to live! My mind doesn’t have to spend every waking moment worrying about where I will sleep tonight!
I have friends! We talk, we laugh, we spend time together, we enjoy ourselves!

Life is beautiful and sublime.

You dream about The Person: Sometimes the dreams are comforting, sometimes they are disturbing, but they are all cryptic. You wake up, your limbs heavy in bed, and wonder: Is she really dead?

That feeling comes back. You know the answer to that question. She is, but you’re not, so you get out of bed.

There are moments throughout the day when you do forget what happened. The weight disappears and you focus on the things in front of you right now. Things shift, and your mind begins to make associations that you didn’t make before:

“I look at grass and I think of tombstones now.”

You concoct explanations to comfort yourself, though sometimes they don’t:

Molecules of air that were in her lungs are still in the house. When I inhale, some of that air is now in me.
Though she is dead, her genes live on in me. The genes continue to experience the world, even if she does not.

Some things don’t matter anymore. Kindness becomes essential. Relationships with people become vital.

When people in the club learn that you are a new member, they welcome you with a grace that you didn’t realize existed. You acknowledge that you had no idea that they were a member of the club.

“That’s how it works,” they reply.

They spend time with you. They share wise words. They share wise silence. They comfort you.

You then realize that you’re not alone, that there are people who understand. They appreciate how heavy the weight is in your chest and help you carry it. They remember the difficulty and loneliness of having to carry the weight alone. They also know that, ultimately, you often must carry it by yourself.

Everyone eventually joins this club. If you, too, are a new member, know that you are not alone. There is no club uniform, badge, or pin, but we are here and share your grief.

Four adages I learned in medical training that I still speak of today:

“Common things are common.” (The alternate version of this that might have more appeal to zoologists: “When you hear hoofbeats, think horses, not zebras.”)

This cautions physicians to remember that it is more likely that the patient has a common condition than a rare one. Although it is prudent to consider all the possible diagnoses that might match a given clinical presentation, one should not seek confirmation for an exotic condition first.

Urinary tract infections are more common than bladder cancers. High blood pressure is more common than pheochromocytomas.[1. A pheochromocytoma is a rare tumor of the adrenal gland, which is a small lump of tissue that sits above the kidneys.]

Once you’re sure that there are no horses present, though, then begin the search for other ungulates.

“Treat the patient, not the number.”

This is a reminder that physicians should treat the person, not lab results.

If a patient’s blood count is a little low, but she’s not experiencing any symptoms, then do nothing. If someone’s lithium level has been low for months, but they haven’t had any mood symptoms, then don’t increase the dose of lithium.

This, however, does not apply to all conditions: People with alarming blood pressure numbers often feel fine. Same thing with high blood sugar numbers.

“The longer someone stays in the hospital, the longer he stays in the hospital.”

Hospitals are not sanitary places. The longer a patient stays in the hospital, the more likely he will develop an infection that is resistant to multiple antibiotics. This leads to complications that lengthens the hospital stay.

This also applies to staff: The longer a physician stays in the hospital (beyond her shift, for example), more things will come up that she will have to address, which will will keep her there even longer.

“When you only have a hammer, everything is a nail.”

This is a reminder to consider other perspectives. It is also an exhortation to recruit the minds and skills of others.

If the psychiatrist only knows how to prescribe medications, then all of his patients will receive pills. The surgeon might believe that cutting out the offending tissue is the only solution.

One wonders when these phrases first came into being. It’s an oral history that physicians pass along every July.