Monday, December 24, 2007

Off for Christmas

Last year I wrote about Christmas in the hospital. This year I’m home in Alaska for the first time in three years, taking advantage of my luck in having the holiday off. We get so used to working weekends and holidays in medicine, helping others to stay healthy, that having Christmas week to ourselves seems extravagant, like a special bonus. It feels good to put up the white coat for a week, to escape the wards. Too much time in the hospital, in the face of unrelenting illness, can make you forget what life is supposed to be like, what you’re fighting for in the first place.

As physicians, we stand at the intersection between the constructed world of our daily lives, which is ordered, meaningful, even protected, and the cold, impartial reality of the natural world. In Alaska the divide is particularly evident – though our lives are filled with the normal stuff of human existence – friends, family, food, films, music, plans, jobs, dreams, they are lived in the shadow of the simple reality that with one misstep – a car breakdown in mid-winter, a frozen set of water pipes, everything could come crashing down. It happens rarely; mostly we are allowed to live our lives peacefully, but on occasion the natural world forcefully collides with the quotidian one, obliterating it. A woman is diagnosed with breast cancer. A tsunami hits Thailand. What we’re fighting for is to keep our safe, purposeful, constructed worlds, of competitive sports and holiday parties, intact, shielded from nature’s unwelcome intrusions.

We’re somewhat successful. Most people live a rather insular existence, sheltered from natural disaster. The well are frustrating to care for because they think that they are impervious to illness, that they will never get sick; as a result, they tend poorly to their bodies. They feel that the world is fundamentally fair. As doctors we are fallen from this illusion. We live in the midst of the natural world’s devastation. We know that anyone can get sick, can up and die. A young man at the height of his powers, contributing greatly to society, raising a family, can collapse suddenly without warning.

The medical fight is an important one, but seeing sickness and disease every day wears on you. Being greeted a daily good morning by failing kidneys, bid good evening by an ailing heart, paid unexpected nightly visits by struggling lungs: it takes a toll. The curse of the chronically ill is to experience pain that nags just enough to constantly remind the sufferers that they are ill. The curse of the doctor is to be cognizant of his patients' sufferering. On interval, a break is needed, an escape from the hospital, a vacation.

This week I’m going to forget that disease even exists. I’m going to experience Christmas the way I hope my patients do: oblivious to hardship and suffering. People say to live each day like it’s your last, but that’s rubbish, or at least, it’s lousy advice for a vacation. How about relaxation instead? True luxury is to live as if you were going to live forever, to dally with each and every trivial pursuit. To watch movies and feel no guilt about how you could be better spending your time, to sleep in late, to indulge yourself completely: that is vacation at its best. That is how I intend to spend this Christmas.