Priorities

There are those patients I dread visiting. Usually that dread comes from a sense that I am not doing enough for this person. It's a comparison thing. A smarter physician, someone more assertive, with a stronger grasp of physiology and psychology, this person would be making changes that would lead to an improved quality of life for the poor soul unfortunate enough to be meeting with me instead. This is the feeling I have as I head up the walkway toward Ben's place. Ben lives in a garden apartment a stone's throw from the lake. The shades are nearly always drawn. After buzzing us in at the gate, he will have arranged for the door to his apartment to be open. Perhaps it is always open or perhaps he has some device to reach up from the rolling chair where he sits, over the short stairway  framed from 2x4s, to the lock. I'm not sure how he does it. I do know that we always find him sitting at the base of the stairs, looking up at us, in a grubby T shirt and tighty whities usually with a nervous expression. Ben is a man of 70 with a beard like Santa Claus. In body shape, he is a very exaggerated version of the Christmas saint. He weighs 450 pounds if he weighs an ounce. And he doesn't fly through the air. He gets around his studio by edging his roomy desk chair backwards over its creaking casters. He has the litany of diagnoses that you might expect with someone of his age and size: diabetes, hypertension, congestive heart failure, obstructive sleep apnea, osteoarthritis. Along with these more typical burdens, he must also contend with bowels temperamental enough that he fears going out even on those occasions he can make it up the stairs to his power scooter. The contents of his apartment speak to a lonely technical mind. Old computer and A/V  parts abound. Because he has no access to his roof, off to a side he has set up an elaborate if rickety ham radio antenna. Though he has a home health agency, including a home-maker and visiting nurse, the  place is a mess. It smells. Even if I didn't believe it to be part of my mission to make his life a little better, just being in Ben's place would be a real downer.

Ben is a smart, smart guy. He has researched all of his diseases and medications, and even claims to have diagnosed his own sleep apnea back in the '80s, before the phenomena was so well known--perhaps before we were quite so heavy as a society. When I first met him, my number one goal was getting him out of this horrible, depressing apartment and into an assisted living facility. However, I soon learned that because he would likely require more than one able-bodied person to help him with daily activities, he would likely end up in a nursing home. And after a hospital discharge, he had a very bad experience in nursing care. Ben felt as though all autonomy suddenly vanished as he because a thing that things were done to as opposed to a person. Also, he was fairly sure that there were no facilities that would allow him to set up his ham radio equipment, and this was a deal breaker. His point reinforced for me a lesson that I am forever relearning: my priorities, though they may seem totally reasonable (a clean environment that would not serve as a deathtrap in case of a fire or flood, with healthy meals), may totally ignore the very thing or things that make life worth living for someone. If a car enthusiast were to offer me the keys to a $100,000 roadster with the caveat that I could not ride my bike for as long as I kept it, he would be aghast when I handed them back to him. The more subtle point for me is that, even on an objective plain, when it comes to such decisions I often have no idea what I am talking about. When I recommend that Ben enter an assisted living or nursing facility, I do so as someone who has frequently visited such places, but not as someone who has ever lived in one. My knowledge is entirely second-hand. I see support and security; Ben sees and has lived loss of independence and exploitation. I don't mean to indict all supportive living facilities. Clearly there are some very good ones, but there are also some very bad ones. And finally there is the weight (not a pun) of meaning involved in taking that step (again, not a pun). He retains the capacity to make his own decisions, so it is his step to take and the meaning of the decision is entirely his.

This line of thinking brings to mind the notion of surrender. AA first demands that we surrender the belief that we are in control of our use of alcohol. As we move forward in our recovery, we find that there are a great many things over which we must surrender any idea of control. This is the only path to serenity. As odd as it seems to me, I know that I must surrender my own sense of omniscience if I am to be of true service. I call this odd because I do not see myself as omniscient. If anything, I am often awash in the anxious worry that I know nothing at all, or at least that I know far less than I should. But self-deprecation is not the same as humility. In fact, as long as I continue to view myself as the god at the center of my own existence, my mind remains a wrestling match between "I am brilliant" and "I am an idiot;" "I am all" and "I am nothing." If I can give over the idea that I am in control of my path through the universe, I will divest myself of expectations and thereby lose the burden of judgment. As an example, though I should enter each meeting with Ben with the hope that I will be of service to him, we both would be better served to leave any agenda at the door and just try to keep an open mind. I can begin by asking: "What do you hope to get out of our interaction?" and go from there. I can insert my own experience of what helps make people healthier, then get his take on what he thinks of these, then see if there is some common ground where we might work. And finally I must bear in mind that I cannot take credit for the result. I have contributed something to the process but, in the end, I had no control over where our endeavors led. It is not my achievement and it is not my fault. It just is.