A large woman, she has soiled herself.  With practiced motion, Bob rolls his wife onto her side. Yellow diarrhea has leaked out of the diaper, soaking the nightgown and sheets, finding its way into each fold, crease, and flaw.  The room fills with odor, but the winter house remains dark; outside wind blows down the empty street. It is 2:00am and Bob is cleaning shit.  Only 90 minutes asleep, he works quickly through fatigue’s fog, as her breathing rasps.  He rolls her gently back, her breath is again even, and she slips into the safety of dreams.  Bob cleans up the detritus, climbs back in bed, hoping for two hours.

I read a fortune cookie the other day that said, “What one must, one can.”  Not classic literature, but it got me thinking about caregivers.  Who decides for them what they ”must” do?  I mean, why all the bother?  What is it about human beings that we sacrifice so much to help, when it would be easier, efficient and reasonable to “pull the plug,” and walk away?  Why do we waste our lives in the service of those who will never return the favor.

That got me thinking about Bob.  His wife was very sick for many years with a fatal neurologic disease and she required almost complete care.  She could not live one day, one hour without him.  She would never recover, never “give back,” and she leeched years from him.  I asked, sometime after she died, why he did it. Bob said, “You do what you have to do.”  Salt-of-the-earth wisdom.  And I think, partially wrong.

Now I am not saying that necessity is not the mother of action. I am saying that this kind of massive sacrifice is much more than a required chore. Far deeper than “its time to make the donuts.”  For Bob, and the millions of caregivers who give of their lives when there is no hope for recovery, these altruistic gifts are complex and speak to the soul of man.  It is more than love.  I think these actions connect us to the mystery of life itself.

Whatever there is evil about the soul of man, one of our great goods is our need to mend each other.  What makes the gift of caregivers for severely ill patients so remarkable is that it is given, at least partially, without hope of recovery.  Rather, such actions define what it is to be human as they connect us to all men, present, past and future. We understand through evolutionary intuition that to allow another person to fall, without trying to gentle that landing, is to sever our link to the long line of mankind.  Our unbroken relationship with each other is our bond to eternity.

While it may seem, for moments, that we are individual, single and alone, the reality is that all of humanity, past, present and future, is but one life, one long experience, bridging time and space.  Compassion is what connects us all.  It is as necessary as oxygen, water and sun.  We are there, with Bob’s wife in the empty morning, in every alley, hospital room, nursery, and at every desperate moment.  Alone there may be no hope at all, but together there is hope for all tomorrows.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.