Chapter One
All change is a miracle to contemplate; but it is a miracle which is taking place every instant.
I gunned the engine, pulled the truck out of my parking space, and flew over the speed bumps on my way out of the apartment complex. A young mother grabbed her toddler and gave me a dirty look. I thumped the face of my watch, and the second hand seemed to groan before deciding to move. Too late now, I'll never make it, I thought, glancing at the clock in my dashboard.
I couldn't believe it; I was never late. I'd noticed that my watch was having problems a couple days earlier and had been relying on an extra clock in my bathroom to make sure I was showered and out the door on time. As I was shaving I must have accidentally pulled out the cord just enough to stop the clock from running. The tires squealed as I pulled out onto the main road, and the gardener working at the entrance to the complex gave me my second nasty look of the morning, even shaking his head for effect.
If I made all the stoplights through town, I could get to the hospital in fifteen minutes. Turning into the hospital lot, I glanced at the clock-fourteen minutes-a new personal record. There was no time to circle for a spot, so I parked at the far end of the lot and ran for the main entrance. Maybe he hasn't started yet. Who was I kidding? Dr. Goetz never failed to start on time. I ran faster between the rows of cars.
As part of my third-year medical rotations, the university had placed me under the tutelage of Dr. Crawford Goetz-the best cardiologist in the hospital. Cardiology wasn't part of a normal rotation block, but the university felt that a rotation in cardiology would only enhance a student's studies. So, I was stuck for the next four weeks with Dr. Goetz. He was a Harvard and Vanderbilt man, the chief of cardiology, father of four, grandfather of two, and a thorn in my flesh. He specialized in pediatric cardiology, but since the hospital had only a small number of child patients a year, as department head, Dr. Goetz would also oversee the treatment of adult patients.
In each of our rotations, a medical student was part of a team that consisted of an attending physician, three to four students, and an upper-level resident. Peter Vashti was the upper-level resident on Dr. Goetz's team. My clipboard with the day's rounds was hanging at the nurses' station, the last to be picked up. The other students and Peter were already following Dr. Goetz from room to room. I checked the room number for the first patient to be seen and ran to catch up, sneaking in behind William Radcliff, an old friend and fellow student who, to my good fortune, stood six-five. Dr. Goetz was sitting on the patient's bed, a forty-seven-year-old man recovering from open-heart surgery.
"She's working like a thirty-year-old's heart," Dr. Goetz said.
"Does that translate to the rest of his body?" the man's wife asked, cracking a wad of gum. Dr. Goetz laughed. He had a carefree, easy way with his patients and their families; too bad that didn't translate to his students.
"So everything feels normal?" Dr. Goetz asked, resting his hand on the patient's shoulder.
"He's cranky again," the wife said, her gum exploding like a firecracker.
"Is that good or bad?"
"I don't know if it's good or bad, but for him it's normal," his wife continued.
The patient looked sheepish. Poor guy, no wonder he had heart surgery. She was relentless.
"All right, Jason," Dr. Goetz said, smiling. "You're ready to go home." The man shook Dr. Goetz's hand and I could see his eyes fill with tears; he started to speak, then stopped. He didn't want to get emotional in front of a handful of medical students. He pumped Dr. Goetz's hand again, nodded, and looked down at the sheet resting on his lap. Dr. Goetz squeezed his shoulder and turned to leave, nodding for us to follow.
Filing back into the hallway, we could hear Jason's wife get an early start on what could be heart attack number two. "What do you mean you're not going to wear the piece? Just because your heart's working again doesn't mean your hair's going to grow back. Put this on. Put this on, or I'm not walking out these doors with you, I mean it. I will not walk out these doors." For the sake of his heart, I hoped his head would shine like the new dawn as he left the hospital.
"Who's our next patient," Dr. Goetz asked, scribbling something onto Jason's chart. "Andrews?"
I looked down at the chart in my hands. "The patient in room 2201."
"Mr. Andrews," he said, as if giving a speech to a room of five hundred. "Just as you were not given a number at birth, but a name, you will find that your patients came into the world in the exact same manner. Learn who they are, not where they're located."
I could feel sweat break out on my upper lip. I never intended to seem demeaning toward the patient. "I didn't mean it that ..." I began, but it was too late. Dr. Goetz had already learned the name of the patient and was leading the students through the halls.
"And Mr. Andrews, as a reminder, your rotation begins at six A.M. Not six eighteen." I felt my chest tighten. I should have known that Dr. Goetz would pick up on my tardiness.
During a break in rounds, I retreated to the lounge and sank into the sofa. I leaned my head against the wall and rubbed my temples. If I'd known there was going to be someone like Dr. Goetz in my future, I never would have signed up for medical school in the first place. I glanced at my watch and noticed it had stopped running again. I tapped the face, but the second hand wouldn't budge. I took the watch off and flipped it over to thump the battery casing. I ran my finger over the inscription: With all the love in the world, Mom.
My mother died about a year after she stood with me on the hill overlooking the valley. Maybe she knew she'd never see me grow up; perhaps she was preparing me for the long valley I would go through without her, or maybe preparing her family and herself for death was the final step of faith she would take.
I remember my father coming into my room during the early morning hours of that Christmas. He said that my mother had stepped into Heaven. He let my sister Rachel sleep; she was much too young to understand what was happening anyway. I ran to the living room, where my mother lay still on the hospital bed; my grandmother was holding her hand, weeping. I watched my mother for the longest time, praying she'd move again, that she'd reach for me and say, You need to get back into bed, Little Man, but she couldn't reach for me, and I knew it. She was thirty-four years old.
Wilson's Department Store was about to close on that Christmas Eve as I ran from one department to the next looking for the perfect gift until the shoes caught my eye on a sales rack. I ran them to the front register and pulled a crumpled wad of bills and loose change out of my jeans pocket. When the clerk told me I didn't have enough money, I was heartbroken. I just had to buy those shoes for my mother. I turned to a man behind me, and, before I knew what was happening, he paid for the shoes, and I ran out the door for home. When I helped my mother unwrap the shoes, she held them to her chest and made me feel as if I'd just handed her Heaven itself. We buried her in them. I started leaving shoes on her tombstone again when I was sixteen. The owner of Wilson's somehow found a similar pair every year and ordered them for me.
During the last weeks of her life, my mother wrote a series of letters to my sister Rachel and me. In one addressed to me she wrote,
Dear Nathan, I have had many joys in my life but none that have compared to you and Rachel. I always want you to know that I fell more in love with you every day. Please don't ever dread Christmas, Nathan, but remember to look for the miracles instead. It may be hard to see them at times but they will always be there because Christmas is the season for miracles.
She finished the letter and signed it, With all the love in the world, Mom.
I was helping my mother string lights on the shrubs outside our home the winter before she got sick when she first told me about the miracles of Christmas. "Jesus was born at Christmas," she said, wrapping a long strand around a juniper yew. "He left Heaven to live here." She bent over the back of the yew and tugged at the lights, stuck on a low branch. I pulled along with her, and together we continued wrapping the bush. "That's kind of like us becoming a worm and living in the dirt," she said, wiping her nose. "Love came down on Christmas, Nathan. That's the greatest miracle of all. That's the true blessing of Christmas and why it will always be the season for miracles." She stood back and admired her work, frowning at the tangled mess. "It'll look better when the lights are on." She dug into the box and pulled out another jumbled string, talking as she worked. "If you get too busy, you won't see the miracles that are taking place right in front of you," she said, replacing a blown light.
Before she died, my mother bought special gifts for Rachel and me; she wanted my father to give them to us on our sixteenth birthdays. Rachel got a gold locket and I got this watch-a flat, gold-faced Timex with a simple black band. The inscription was a reminder of something I'd always asked her.
"Is your love for me as big as Texas?"
"Bigger," she'd say.
"As big as the United States?"
"Bigger."
"As big as the world?"
"It's even bigger than the world! But if you combined all the love in the world, it might come close to how much I love you," my mother told me.
I'd worn the watch every day since my father gave it to me, as promised, on my sixteenth birthday,
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Soon after my mother's death I told my father and grandmother that I wanted to be a doctor. When people asked what I wanted to be when I grew up I responded the same. I wanted to be a doctor so I could help people just like my mother.
Before I knew it, I was through college and into medical school. What a tribute to your mother's memory, an aunt would say or, What a tremendous way to honor your mother, an old family friend would comment. I felt the pressure mounting-people were counting on me to become a physician-my mother's memory depended on it. But after three months of rotations and watching people suffer and die, and now a week with Dr. Goetz, I questioned whether I'd made the right decision. In all honesty, when someone died it left me emotionally drained, and I was taken back to the morning my mother passed away. I felt as if I didn't measure up, that I wasn't cut out for it. I opened my eyes and realized I needed to get back to rounds.
Our team gathered outside the patient's room, and Micah, another third-year med student on our team, stepped forward and began to give the patient's blood pressure, pulse, heart rate, and the results of a heart test administered the previous afternoon. Micah was the "gunner" of our group-a med student's term to describe a fellow student who was always the first to answer, the first to volunteer for a procedure, the first to give stats on someone else's patient, and the first to get on other students' nerves. The term had been around long before we ever applied to medical school. William and I shot each other glances as Micah handed out Xeroxed copies of an article on angioplasty from one of our textbooks, one of at least twelve articles so far, all of them filed after our rounds in the nearest garbage can. William and I suffered in silence; it was all we could do, there was a gunner on every rotation.
Helen Weyman was the next patient on our rounds. She was a fifty-two-year-old woman complaining of chest pain who had a history of cervical disc disease. I had done Helen's workup when she was admitted to the hospital the previous afternoon. I went over her progress notes with the team before entering her room. It was customary that the attending physician took over once the group entered the patient's room; it was our time to stand back and learn, but I felt it was important to greet my patients first.
"Good morning, Helen," I said, standing at her side.
"I see your daughter was able to bring your knitting to you. Now you're not so bored, I hope." Dr. Goetz glanced at me. "What are you making?" I asked.
"A baby blanket for my next grandchild ... number three. I've made a blanket for all of them. She's due in the next week or two."
I picked up the blanket and turned it over in my hands. "You've even got her name in here!" I sensed Dr. Goetz waiting for me to finish. "Let's go ahead and take a listen to your heart again this morning." I listened to her heart and felt for her pulse. I was taking up too much time. "Dr. Goetz would like to listen to your heart today as well." I moved away from the bed. Dr. Goetz took my place and examined her. As he did, he asked her about all her grandchildren, where they lived, how long she'd been married, and if she'd make him a pair of slippers. She laughed, and I watched as Dr. Goetz won over yet another patient. Before leaving the room I squeezed Helen's shoulder and told her I'd be by later to check on her.
I walked with William toward the cafeteria for lunch when my pager went off. I walked to Helen's room. The baby blanket was still sitting on her lap. Her daughter Mary, looking very pregnant and uncomfortable, was sitting in the chair next to the bed. "Is everything all right, Helen?" I asked.
She leaned forward and rubbed her hand over her lower back. "My back has been hurting."
I helped Helen into a more comfortable position. "You've been immobile longer than usual, and that may be putting pressure on those discs in your back. Does that feel better?"
She paused for a moment. "Yes, thank you, I think it helped."
"So you don't think it's anything serious?" Mary asked.
"No, it may be just some inflammation around those discs. But we should rule out any other possibilities," I said, handing the knitting back to Helen. "How much longer before this is done?"
"Just a couple more days, I think," she said, taking the needles in her hand.
I left her room and went to the nurses' station to discuss follow-up with the nurse on duty and to page one of the residents when Mary came rushing from her mother's room.
"My mother needs help!"
A nurse ran past me and headed to Helen's room. I followed close behind. I had just stepped inside when the nurse called in a loud, firm voice.
"Page, Dr. Vashti."
I stood in the hallway, right outside Helen's door, feeling helpless as Peter wheeled Helen to the OR.
Copyright ©2003 by Donna VanLiere
