A Fundamental Flaw

We have left ourselves out.  We have not included ourselves in our experience.  And everything we build from this flawed consciousness is doomed to reinforce and hide this glaring error.  

When I was a cardiology fellow, I took care of a 25 year-old woman in the cardiac intensive care unit. She was admitted with her third episode of an infected heart valve and she was dangerously ill from it. Without a third valve replacement, she would die. Can you imagine a more helpless scenario? Essentially still a child, a sick young woman presenting herself to a hospital, fully subject to their decisions about whether or not to offer life-saving surgery…

No one on the ethics committee asked “why did she relapse?”  She had used IV drugs once recently (in the context of some years of sobriety) so we attributed her infected valve to that (though it’s impossible to be certain). The surgeon told us all about how she lives in a psychology of high risk-taking and thus can’t be trusted to reasonably consider the high risk of death and morbidity with the procedure. I was happy for someone else to take the helm and steer us through this mess. I felt very uncomfortable, even walking by their room. We agreed as a team to not offer her a valve replacement. We never stated that we were going to let her die.  We didn’t discuss her friends or family.  We didn't talk about her life at all.  We just sentenced her to death and moved on.

As she slowly died over a week, we even stopped going in on rounds. She was in there with her mother behind a curtain. They didn’t ask any questions. They didn’t complain or beg. They just waited. We just waited…

I couldn’t have told you at the time why I felt uncomfortable. At least, I couldn’t have told you more than the facts of the scenario. Turns out, I was uncomfortable because helplessness was present. I felt confused. I felt fear… I felt a warmth for this young woman and I cared about the tragedy she was living out. I didn’t realize that I was in this tragedy too. I couldn't consciously participate in an embodied, loving way as long as I avoided feeling fully what was present: helplessness. I now wonder: what might have happened if I had been able to feel helplessness with her? How might the full feeling of helplessness have opened up new possibilities? How might I have been changed by the experience? How might all of us involved in her care, in her life, have been changed through knowing and honoring helplessness?

I felt through my own helplessness recently and it revealed itself as preciousness, power, and clarity.  Rather than feeling helpless in the face of the eventual death of my son, my wife, and myself, I felt the blossoming of the deep preciousness of life. Rather than the disempowerment of helplessness, I felt the profound power to bless each other and to live out grand stories of creativity, authenticity, and love while we’re here.  Rather than feeling lost in the murky contraction of helplessness, I felt the pristine clarity of staying connected to truth even in times of intense sorrow.  

I feel no shame for what I did and didn’t do in caring for that young woman. And, I would do it utterly differently next time.  This young woman has blessed me with a powerful story of the cost of not feeling helplessness when it is present.  Without the willingness to feel helplessness, we cannot fully embody harmlessness. If we are willing to step into the agony of helplessness when it is present, to stay connected to truth and to each other, then we gain the possibility of infusing our world with deepening wisdom and love. 

Helplessness is a lens through which our whole healthcare system makes sense. The system has organized itself around the avoidance of feeling helplessness.  Consider some questions: why do we escalate the care of actively dying cancer patients to the ICU?  Why do we place cardiac stents in vessels unrelated to the heart attack the patient presented with?  Why hasn't anyone discussed goals of care with the 90 year old admitted with rib fractures after a fall?  Why do we wear white coats and don the title “doctor”?  Why are so many little old ladies taking benzodiazepines? Why do we think that scientific advancements are what really matter when it comes to helping each other live full, meaningful lives?  There are infinite answers to each of these questions.  Just notice that the avoidance of helplessness is a thread that runs through all of them.  What might happen if we pulled that thread fully?  I wonder how everything would change.

If you look closely, if you’re willing to get close enough, you’ll see a twinkle in the eye of helplessness, a possibility that things are not how they seem.  Be warned: reading of this twinkle is nothing like experiencing it yourself.  It is seen only when we surrender all of ourselves to helplessness and allow our resistance to it to collapse under its incredible gravity.  We must not leave ourselves out.  We have done so long enough…

This was the original end of the article.  Later on the same day I originally posted it, the following unfolded:

It was day one of an online retreat. I felt a restlessness build in me through the morning session so, instead of eating lunch, I went for a hard run in the Tennessee summer heat. I slowed into a walk as my run ended and there, three houses from mine, was a baby bird partially feathered struggling on the pavement. I felt unsure what to do and just watched it for a while. I found some big magnolia leaves and scooped it onto one and placed it under the shade of the magnolia.  Now the retreat was gonna restart in five minutes, and I was feeling torn about what to do. I looked into the tree above me and didn’t see a nest. And as I stepped back into the road, I saw two other baby birds. One was smaller and was panting and feeble like the one I had just moved. The other was dead. I picked them both up with magnolia leaves and placed them under the tree. I hurried back to get to my retreat feeling a tension in my chest all a while like part of my attention stayed under the magnolia tree with them. When I got home, I realized I wanted to get them water. Also realized that I have no idea if baby birds can even drink water. I filled a small jar top and took it to them and left it between the two and left them to make it through the next couple hours on their own. I spent the next two hours of the retreat thinking about them often, feeling helpless. 

As the retreat session came to a close I walked back to the magnolia, half expecting to find them all dead. Not only were they not dead, the alive ones actually looked better: more calm with normal breathing. It felt incredibly inconvenient to be faced with the care of these young birds.  I was on retreat after all! I asked Claude what I could do and was directed to some animal rehabilitation resources available in my county. I called one and got a message that they were full and not accepting admissions. I called the other and left a voice message and just waited. I returned with gloves and scooped up the birds into a small box lined with paper towels. Now that they had recovered some strength, they reached their scrawny necks up and chirped, clearly asking for some nourishment. I asked Claude again about it, who suggested I feed them soggy dog food. I did a little bit of that, but it didn’t feel quite right (turns out that’s not a great idea). Cut up blueberries were the ticket.

The animal rehabilitation center texted me and I found out they had an appointment the following morning at 9:45am. The location was 45 minutes away and 9:45 was in the middle of the morning session of the retreat. I felt resistance in me to missing the retreat (inconvenient…) and I felt a clear care for these birds.

We (my wife and I) fed them blueberries that evening and my 4yr old son loved watching.  I moved them to a fresh box lined with an old tee shirt of mine and placed the box inside a wired dog cage to keep them safe outside in the air they know.  We placed a heating mat under the box to provide a gentle warmth through the night.  They mostly rested in the passenger seat on the drive. I felt a love for these helpless birds grow with each minute I spent with them. A pang in my chest announced itself as the woman at the rehab rehabilitation center walked away with them. As I drove away, I started crying as I thought about the young woman in the hospital. I growled, then an unresisted roar-wail released from my belly followed by another. It felt like a tribute, an exaltation from the universe moving through me, a bow of gratitude to the beings who brought me this lesson mixed with a sorrow for its cost. 

Turns out the magnolia is a symbol of endurance and purity.  These birds were not weak.  They had the power of endurance.  They were not pitiful.  They radiated the pure innocence of life.  They were not helpless.  That was how I felt.