The following story is an excerpt from my memoir, In the Witness of Self–Healing is a Way of Life. In the early years of my practice, my passion for helping those with diabetes was sometimes caught up in my boundary confusion. My empathy was so strong at times that it morphed into identification. Emotionally I sometimes lost sight of my own individuality and felt totally a part of my patients with diabetes. Like many physicians, identification with people in distress led to a reaction formation: I protected myself from my own vulnerability fears by secretly believing I was “different”–not “one of them” — a paradox, to be sure. This is my story about how that bubble burst.
Looking in the Mirror
I met Dale in the days of my full court press against diabetes. It’s a time when life is heady with professional success. Patients travel for miles to see me. My restored Victorian house-turned doctor’s-office provides home and family for me. Most of my human intimacies and meaningful events transpire within its walls. The margins of me blend seamlessly into the work, keeping boundaries dangerously permeable and communications open.
When we meet Dale is 50 and I am 36. It is 1986. We’ve both had diabetes since we were seven years old. Meeting another long-term survivor always gives me pause to contemplate. When I meet Dale, I am enchanted and excited when I find he’s had diabetes for so long. I want solace from him, simply by his presence. I long for wisdom and the secret of survival’s magic. I want him to be my comrade in arms.
Dale is round and balding—a pasty little fellow who looks as though he’s been a little old man since his tenth birthday. Each time we meet he meticulously narrates the locked monotony of his daily life: precisely measured meals, counted steps and metered work hours. His mother started his routine in the early 1940s and he now carries that legacy through into the 1980s. By the time we meet his mother is long dead. Dale never married and lives by himself. His daily calendar displays row upon row of tightly penciled notations: insulin at 7am and 5pm; breakfast at 7:05, lunch at noon, dinner at 5; bedtime snack at 9. Thirty years ago he found a clerical job.
“My job was just what I wanted.” Dale smiles quietly, “…so I could keep up my routine.”
As I listen a familiar knot clenches my diaphragm, shortening my breath and tightening the back of my throat. ‘Oh my.’
“You’re so lucky.” Dale has come for his usual checkup. “I would have loved to be a doctor…” His soft brown eyes cast lids to the floor, “…but my job was okay.”
I never do understand what Dale did for all those years. He’s told me, but it didn’t strike me loudly enough to remember. I regret that. I recollect a Kafka-esque clerical appointment in California State offices from which he’s taken early retirement. He has come to Washington to be near a brother in Seattle.
“Then why didn’t you do it?” I don’t understand.
“I couldn’t.” His face still carries the youthful shadows of an easily shamed little boy.
He looks at me knowingly. “You know.”
I ‘m puzzled. “No, Dale, I really don’t know. What do you mean?”
“You know.” His voice hushes to a conspiratorial whisper. “The diabetes.” His eyes meet mine with the granite of certainty. “I couldn’t.”
I feel hot anger at this silly pathetic little man. ‘How dare him! I don’t believe it! He rolled over and played dead!’ No life, no family, no mark on this earth.
Now over three decades later, pain and sadness wash over me when I think of Dale. I hear his odd razor-pitched voice, see his sallow smile. I blush remembering his obsequious and admiring attendance to me and all I represented. I remember his abject resignation.
Most of all I remember my own armor of righteous anger, shielding me from my own fears. ‘There but for the Grace of God go I.’
Dale continues to come to see me and for awhile I try to change him—feeling that if only I can show him the way, he’ll have a better life. I offer freedoms with his diabetes that he’s never known. He dutifully agrees to try my innovations yet upon his return they’ve never been implemented—like household appliances given to one who still waits for electricity. The magic I’d felt at his meeting evaporates and I feel somehow personally abandoned by this strange boring little man. To me he is a stubborn child bound by fear to antiquated rigidity.
‘He doesn’t get it.’
Pretty soon I come to dread Dale’s name on my schedule. Yet he keeps coming. As he begins to travel his own road to mortality, I judge him his passivity. I believe myself different from Dale. As his ankles swell, his breath shortens and his energy wanes I shamelessly blame him for giving up the fight. I medically treat his heart failure and his pneumonias. I go through the motions of medicine—dispensing, examining and testing his blood. As I watch him decline, I try to ignore the familiar fist beneath my ribs.
Our last conversation takes place with me standing at the foot of Dale’s hospital bed. He is slowly recovering from another pneumonia. His wan little smile is ever present.
“I’m doing okay,” he tells me, his face yellow against the white of the starched pillow. “Just tired.”
“I’ll see you tomorrow, Dale,” I hurry. “Hopefully we’ll get you out of here in a couple of days.”
“If you say so….” His smile is soft with acceptance.
I almost run out of his room to the chart station, ready to quickly write a progress note. I want my rounds to be over. Where am I going with Dale this admission anyway? The familiar progress notes on the page aren’t traveling logically to a ‘proper’ synthesized conclusion. Treatment plans that lead to a recovery and discharge aren’t there. A vague, guilty discomfort makes me want to close the chart, run away and never return. ‘Damn!’ Somehow, I’m angry…angry at having to be caring for Dale at all. I blame my anger on the pressure to get through the schedule of the day with enough time to pick up Brant from daycare. Yet somehow I know that isn’t it. I don’t know what to do. I’m scared. There is no plan. There is no charted path. And Dale believes in me so much. He believes in our common ground.
Later that evening the nurse on his floor calls me at home. “I know you’re not on call tonight,” she apologizes, “but I thought you’d want to know. Mr. Estergreen died this evening.”
Painful grief lands in the familiar pit of my gut. Tears well in my eyes.
“What happened?”
“We just found him.” Her defenses rise. “The night nurse had been speaking with him within the hour.” She pauses, seemingly expecting something from me. My silence meets hers and she continues. “He was simply found dead—for no apparent reason.”
In medicine we’re taught that it’s always a ‘them and us’, a ‘you and me’. I still see Dale’s face. He’s lying in his bed, his white hospital sheets pulled to his chin, his pallor everywhere. “I’m feeling better.”
He was 54 years old. I was 40. No matter how many times I try to forget it, from then on I know. ‘It’s us..always us. We’re all in this life together.’
We all carry wounds of the human condition. We can either allow our wounds to fearfully lock us away in isolation, never to know others or our Selves, or we can use our wounds as our own unique path to understanding.