physicality

Hepatic sinusoidal obstruction. Encephalopathy. Hypoglycemia. Sepsis. Hypotension. Lactic acidosis. Intubation. Multiple organ failure.

Prepositions strung these words together, a litany of the goings-on in her body and what ultimately took her life. Having a slight sense of what these mean, the words were bullets. Instead of blood, they drew salted water. It can never be as visceral as it is for a person whose physical life is slipping, but it reminds us that it is visceral, and today I felt that maybe that's part of what they mean when they speak of all this as a gift. We tend to polarize, sometimes focusing on the science and other times emphasizing the emotions, with elbows nudging us to meld the two. In between lies something less lectured, less considered, equally present--physical sensations, from which so much flows.

I started my neurology rotation today, and we began by observing neurological exams on a couple of patients. Neurology more than other disciplines draws quite a bit from the physical exam; you can often localize what part of the brain has been damaged by what part and side of the body can't move, or what the person can't say. The brain is the center of complex feeling and thought; it's also the source of tactile sensation and bodily movement, and to me this can often be the most touching loss.

One test requires a person to close their eyes. Without visual balance, one should still be able to center themselves. When our patient closed his eyes, I heard a gasp slide from the classmate behind me. When our patient closed his eyes, he swayed to his right side, and had we not known this to be a possibility, he would have fallen. One way to treat his condition, which causes vertigo because deposits in the inner ear dislocate and end up in the wrong place, is to rotate your head and roll your body in various directions, to shift the deposits back into place. We marveled at this cure, so simple beside the antibiotics whose names I can rarely remember and the surgeries involving anatomy I often can't visualize.

A bit later we observed our first stroke code, meaning the standardized protocol when a person is suspected of suffering from stroke. Aside from the acute event, she had a past medical history of HIV, hepatitis C, breast cancer with metastases to the liver, COPD, and obesity. The four of us, students with nothing to do but watch, huddled in the corner but there was no way not to be in the way. Red stained needles and whatnots fell to the floor inches from us and we were benignly smacked as people went to and from a corner of the ED made flimsily separate with shoddy curtain. As all this went on, a doctor spoke loudly in the woman's ear: Close your eyes. Open your eyes. Stick out your tongue. Say your name. Lift your arm, and hold it there. There is a point system that adds up a person's ability to follow these commands and thereby determines how dire the state of a person's consciousness is. There's no modesty, much noise, and carved out among this are the listless failures of a body to move.

For fatal cancer, for benign vertigo, for someone in limbo--it can be these everyday sensations that are stolen, and sometimes never given back. A friend of Natasha told us in Natasha's words how she felt about her cancer, and she said this when she had relapsed: lucky, without regrets or a wish to turn back time and eradicate the experience. Because of it, she felt beyond what she called earthly, and I believe that must paradoxically be some kind of sensation too. We talk a lot about feeling happy, what seems a communal and obvious and ever elusive goal. It seems to me that between the innate and fragile capacity to feel the "earthly," and the "beyond" that we acquire and earn--there lies the most honest, coveted desire to merely feel.