He came for a second opinion, of course he did. You could see it in the eyes: the disbelief, the uncertainty, the despair. "Sleep deprived," he'd call it, then apologize for his abruptness. He was much too young to look death in the face, so he pretended not to notice the pathology.
As doctors, we are given a gift and a curse at the same time: the opportunity to peer into the circumstances of life in ways unimaginable. We see images that are so profound they haunt as we lie awake perplexed, imagining the unthinkable that lies ahead based on our understanding of anatomy, physiology, and yes, pathology. We wrestle quietly in the wee hours of the morning, looking toward the ceiling hoping to find an answer, yet often, despite our knowing better, none come. It is hard to return to sleep.
We roll over to see a peaceful head next to us, grateful for what we've got, knowing full well our patient yearns for the opportunity to experience such a moment just once more. No words are spoken, no thoughts exchanged as we we wrestle with images so profound that they humble our soul, then flip it upside down and turn it inside out as if to reinforce our human frailty and limitations.
From the moment we start medical school with the unsettling slice of a blade though the juicy grey skin of a cadaver, we struggle to rationalize the meaning of such an act. Of course we cut that skin to learn how to help others! I'm going to be a doctor!
If only it were so simple.
With time and a million experiences, we later realize our skills of compartmentalization have a function - like the well deck of a mothership that lowers to accept smaller ships - to gather our psyche while simultaneously sheilding our loved ones and patients from the gruesome realities we've witnessed. These images are ours forever, quietly tucked away and compartmentalized into a carefully-constructed hive of rationalization. Stored, but never forgotten.
Until one day, another image enters.
And suddenly, like rapping a stick upon the hive at two in the morning, the images swarm once again.