Something was missing as I walked into the house, something was just not right. It took me a moment as I closed the door to realize. My greeter was not present. And then I remembered, she would not be coming to see me any longer. Her time with us had come to an end. And at that moment, the sorrow that had been lurking near the edges of life came in the door with me and settled into my heart. This empty feeling, the silent absence — it feels vast, powerful, all-encompassing. It feels so much larger than her little frame. But here it is, occupying my heart.

Today death has come for a visit to our house. He has come to see our friend Isobel and take her with him. He has kindly given me a chance to work with sorrow once again. In medicine, death is ever-present — sometimes obvious, sometimes lurking but never absent. It is the unasked question during many encounters. And on the hospice wing, it is the destination that awaits. In medicine, I was taught to fight death as a foe, to stave it off if possible and that losing to it was a failure. However, death always wins. While we do not speak of this in polite company, it is the truth of the matter. Death wins the war despite the number of battles it loses; it always wins the war. So often we go about our lives as if there is time enough for everything as if these days will last forever, forgetting that they are numbered. Today I was brought back to this truth firmly and given an opportunity to look at sorrow more closely.

Digging her grave today, I thought of all the times that I stand next to the dying and how often once death has come and gone, I simply move on to the next task to see the next patient. It is a strange dance that occurs in medicine: We move from one thing to the next, never really stopping to reflect upon these lives we touch or how we touch them. I see it in the nurses as they go from one thing to the next. The patient in 124 dies, and they stand for a moment with the family holding shoulders and witnessing tears until the bed alarm in 119 sounds and they depart to care for the next need. Moving from need to need in an ocean that is endless never taking a moment to feel what has been lost or to notice what has gone missing.

In my own life, I see how this is. I care for the dying every day. I get to know them as they come and go from the unit. I speak with their families. I sit with them. I hear the worries of those that love them and the worries they have for those they love. When they finally leave, I am surprised at how often I simply move on to the next task at hand; I shuffle off to clinic to see my scheduled patients or move on to the next admission or discharge.

Feeling this loss today, I am struck by how different it is. I feel the emptiness in life that so often is filled in medicine by the next thing on the long list of things that need my attention. Today, I dug and noticed this empty feeling. I wonder what has been lost in my world of day-to-day work of looking at this suffering as normal, as a clinical thing to work on and work with. Today I feel it differently. I am not in my defensive analytical medical frame. I am in my right mind, not my left, and I feel it deeply. There is a little fear as I notice this feeling. This little fear is that if I feel this fully, it will destroy who I am completely. I feel the fear. If I open this door a little and truly feel the loss, then all the loss that I have witnessed throughout my life will come crashing through that door, and then nothing of me will remain. But life is kind; it gives me little doses, small measures of medicine throughout the day. I get a dose as I sit to lunch and realize there is no one here to share this pizza. I notice it as I cook breakfast and see that this time, the last bite is mine. The snoring in the bedroom is no longer a duet.

There is only one asleep tonight. The pillow on the floor is empty. Each moment is a little medicine for my soul. Each moment allows me a chance to feel things again that have for so long be closed off. It is potent medicine, and I feel how it turns inside me — how it burns away the walls I have made. It purifies the feelings I have had and forgives me of my actions in the humblest and most touching way. I know that this is a course of treatment that will take some time. There is much to heal that lies beneath this brush with sorrow. But beneath this healing, there is a strength that I have not known. I can sense its presence just out of reach. This strength requires me to look and question.

Am I doing what I love? Am I doing the things I need to do so that I can love what I am doing? Am I honoring the humanity that I am so that I can bring all of myself into this work and life? Am I living in such a way that nothing is left behind? With each tear, I come closer to these questions and closer to myself. And I honor the teacher who has gone.

Gil C. Grimes is a physician and can be reached at Doc Grimes.

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