“… slipped the surly bonds of earth to touch the face of God.”

This quote, borrowed in part from poet and pilot John Gillespie McGee, Jr., was used by President Ronald Reagan to honor the seven astronauts killed in the Challenger shuttle explosion. I was in the 6th grade when I first heard this phrase. In a tiny schoolroom in remote West Texas, President Reagan’s speech was broadcast and replayed over the intercom system to us, just children, who couldn’t comprehend death. Even so, I remember being struck by the imagery and beautiful language. It is a vivid description of the aeronautical ascent prior to the tragedy and their journey from this life to what follows.

I knew that experiencing death in medicine would come. Like storm clouds that are forecast, approach, build, then darken prior to releasing their torrent, I expected the experience of death. Not one of us is immune to it. Personally and professionally, it approaches. I knew this. In some ways, I was prepared for it. The form and razor sharp blade it would wield, I was not prepared for.

Death is ugly. My wife described it as an “ugly invader”; moving in and interrupting our lives, our dreams, our very breath. We spend billions of dollars on training, medicines, interventions, and spells and charms to keep it at bay, but yet it remains. An ugly invader it is, pursuing us all.

In his brilliant novel The Lord of the Rings, Tolkien weaves a magical story that includes struggles of power, of light and dark forces waging war, with frail and humble Hobbits caught in the midst. In the Letters of J.R.R. Tolkien published in 1981, Tolkien stated the following regarding his work:

But I should say, if asked, the tale (The Lord of the Rings) is not really about Power and Dominion: that only sets the wheels going; it is about Death and the desire for deathlessness. Which is hardly more than to say it’s a tale written by a Man!

To Tolkien, to be human is to be both confronted by death and to desire to avoid it. As physicians I think that is where we exist. Daily we are reminded of how precarious life sits on the edge, teetering between life and death. Yet we push, scratch, and claw against it to help others avoid what ultimately awaits.

And so, what is our response as physicians? We are trained to wage war against it: to scratch and claw to keep it at bay; precisely trained to beat back its advances, to attempt to limit its spread. Like weary soldiers securing our flank against the spreading tide, we use our training to hold it back but for a moment.  So why stay and fight? Why battle against a relentless enemy that doggedly pursues our patients, our loved ones, and our very selves?

In November of last year, my wife and I held hands in a quiet pediatric ICU room as our 13-year-old son, our sweet, sweet boy, slipped from this life to a life we hope and believe awaits. Hours prior to this, many hands were working loudly, feverishly, and frantically to beat back the rapidly advancing grip of that ugly invader for our sweet Caleb. Doctors, nurses, pharmacist, and technicians all relied on their years and years of training to fight for him, for us. Yet as the battle drew to a close, a quiet peace filled that ICU. Nurses held their breath. Doctors grasped our shoulders. We held tight to the hands of those who had been strangers only hours before.

Why stay and fight? Why join the battle as a physician?  Because we care. Our worlds are full of people constantly confronted with death while desperately pushing it away as alluded to by Tolkien. As doctors we are uniquely trained to hold out options and hope against the inevitable, but when those options fail, may we be uniquely trained to care, and love, and comfort.

As I think about those last few hours of Caleb’s life, the actions those doctors performed in those dreadful closing moments are just as much about being a physician as healing. Holding our hands as we wept was just as important to us as the attempts to place central lines. The respect they showed our Caleb in how they spoke to him and touched him was just as critical as the vasopressors they were pushing.  The tears and embraces they shared as we left the PICU, shattered and breathless, were just as important as the ventilator that hummed futilely in the corner. We train to heal. But greater than that, I hope we train to care. I hope we train to love and support and stand by those we love and those we hardly know. I hope we realize that physicians long desperately to heal; but when we can’t, we hold, and cry, and love.

Grant Woodfin is a medical student.

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