5R

In just a few days I'll be traveling to Kampala, Uganda to work in Mulago Hospital as part of a global health elective through my residency program.  I am excited and anxious; I have never worked in a hospital outside of the US and expect that I will see a great deal more human suffering than I am used to.   And that's actually saying a lot, since I feel like I am surrounded by suffering all of the time in my work as an internal medicine resident, most recently working in the ICU at a community hospital.

So dramatic!  Surrounded by suffering all of the time?  Maybe it's not true, maybe the patients in the hospital who are living lives I can't possibly imagine living aren't actually suffering, maybe it's my privileged lens that projects that on them.  After all, almost every one of them chooses to keep going, each day, because they believe that what they have is worth living for, or what they might have in the future when they get better.  And the rare ones who dare to try to leave we make prove to us that they are capable of making their own decisions, and if not, we find ways to keep them in the hospital.

To be clear, it's not the patients who come and go, even though they can be quite sick, who make my heart ache as I imagine their suffering.  It's the patients on hospital day 67, who have tubes in their tracheas and stomachs and sometimes draining fluid from their pleural space or biliary trees.  They are connected to ventilators and IV poles and would not survive if those connections were lost, though they are kept in strange steady states and are not imminently dying, either. 

Sometimes these patients are lucid, and speak over the noise of their machines and their inflating and deflating beds, telling you how they feel, how they slept and where they have pain, or in the case of Mr. I, exactly what he would order from the Vietnamese restaurant across the street (spring rolls with peanut sauce).  Sometimes they only look up at you with imploring eyes, or make babbling or moaning noises, like Mr. A.  He had a board with pictures and phrases that was meant to help him communicate, but he was so delirious he would just sweep his hand across the board, nodding and making noises, so we were left to guess at his feelings and needs, usually in a ridiculous pantomime that made us also appear delirious.  The board itself was ridiculous and also sad, the worst little icon an illustration of a patient grabbing a loved ones' hand whose back is turned, with the heart-wrenching phrase, "don't leave."

In the end, we are all alone.  But along the way, we can strive to feel compassion for each other, and in the words of Sakyong Mipham Rinpoche, "open our hearts to all beings, nearby or far away, who are living in fear, who are undergoing unthinkable hardship, who are wracked with pain, who are consumed by hatred," in hopes that all sentient beings may be free from suffering, and the root of all suffering.