Just One More Day

When I was in training to be a doctor, and during my clinical years, I could not help but be impressed with the cruelty that is native to the process of life itself. I saw things that most of you should never have to see---from the death of good and kind people, to the ravages of inexorable cancer, slowly eating the very flesh and life out of human beings whose only crime was to claim title to life, nothing more---to the death of children, the inane coincidence of accident and victim, the cataclysmic grief visited upon families of the afflicted, the inexplicable resource of courage discovered and assumed by ordinary people, no different than you or me.

I recall oh so clearly being absolutely convinced that I suffered from each and every terminal disease that I studied, and in the precise order in which I studied them. All of us felt similarly I have no doubt; but we rarely admitted it to each other. I remember my relief on discovering that I was spontaneously cured of one disease, only to be convinced on the following day that I surely suffered from another yet more diabolical disorder.

There was the seven-year-old adorable little girl, suffering from fatal kidney disease….

Each night her parents visited. They were an older couple, old enough to be the child’s grandparents. Each night they would materialize from the elevator. They would walk towards her room, slowly and apprehensively, to find, with looks of sad relief, that their daughter was still there, where they saw her last. Her father had a look, a combination of sweet sadness, and a trace of mourning, tempered by gratitude that she was alive---at least for one more day.

Then, inevitably came the day…

The mother came alone. Just before she arrived a group of nurses suddenly descended upon the girl’s room, like a flock of starlings simultaneously descending upon the branch of a tree, they twittered with intense and hushed tones. I was transfixed, as if present at a spectator sport. Suddenly, the elevator opened, and the mother stepped out. She spied the nurses, and she froze momentarily. Then she rushed into the room. She bent over her lifeless child. She looked up, simultaneously as her husband stepped out of the elevator. In a voice that only a mother could understand, she said,

Oh Jack! We’ve lost our baby!

He paused for a fraction of a second. Then he walked slowly and deliberately to his daughter’s bedside. Everyone froze, like ice statues. He looked at her with that same smile, now sadder still, a look of total resignation, like a man receiving an anticipated death sentence. Then he bent forward, slowly---and kissed her cheek, tenderly.

I lost it---completely. I cannot say what happened to the rest of the cast, but I bolted for the broom closet, and I cried bitterly for a half hour, hoping against hope that no one would hear me.

During my first year as a resident in Internal Medicine I had the inevitable misfortune of having the responsibility of telling a man he was going to die.

He was a quiet and yet cheerful individual. In those days patients—and doctors—could take more liberties: He had a coffee pot at his bedside. Each morning when I arrived at his bedside, he would greet me with a cup of tea, and would join me, draining his cup behind a bushy moustache. We would chat for a while, and then I would turn to the business of informing him how far we had proceeded in his diagnosis. He inevitably had those “Social Tea” cookies. (If you recall these, then you are as old as I am.) It was a high point in my morning, and a welcome way to start a day. This one-day, however, was different. I had seen laboratory reports that indicated clearly that his cancer—a lymphoma, (cancer of lymph tissue) had returned, this time to stay. There was no question about it: He was going to die.

I walked into his room. Initially, he did not seem to change his demeanor. He bustled about officiously, serving me with a flourish. I sat down slowly, and could not return his gaze. I started to speak. First, I emphasized the thoroughness with which my colleagues and I had researched his case. I attempted to ease into the possible alternative diagnoses, and I think I rambled a bit. I was speaking more rapidly now, and my heart was pounding. I attempted to clear the lump from my throat, and to fight back the tears that started, without mercy. My voiced cracked. I looked down, not seeing; it was no use. I could not speak. I wept, silently, mortified, ashamed. After what felt like an eternity, I felt a hand grip my forearm and squeeze it gently. There was a moment of total silence, and then a gentle, soothing voice spoke:

It’s all right, son. It’s just my time.”

After three years of residency in Internal Medicine, I became a Research Fellow in Cancer and Hematology at the University of Southern California. I was elated. I applied myself diligently to the task of learning about very powerful drugs that were used in the treatment of the various forms of cancers. I saw more horrors. Then I went into the practice---of Internal Medicine and Oncology---cancer chemotherapy.

Then there was Joan….

She was the epitome of Doris Day. She was voluptuous, yet perky. She wore her dirty blond hair in a flip. She had freckles on her nose and a disposition to match. She was the all-American girl. A General Practitioner had sent her to me. A lump had been found in one breast, and both were surgically removed. We started chemotherapy. As part of the workup some months later, I ordered a repeat chest X-ray. When I saw it, my heart sank. She was riddled with cancer. I called her in. She arrived with her husband. They sat, like statues, barely acknowledging the death sentence that I had just pronounced upon her.

Shortly after this she was hospitalized. As expected, I visited her every day; and day-by-day, she grew weaker, and paler. Her blood cells were being destroyed where they were made. The cancer had reached her bone marrow. I tried more aggressive treatment, but it was to no avail.

I came in that day. She was lying, quite still, on her side, white as her sheets, her mouth open, tongue out, panting like a dog. She was still beautiful in a ghostly way. I tried to maintain a professional, almost cheerful air, yet well aware of the absurdity of it all. As I had done in the past, as I was exiting the room, I asked the rhetorical question: “Is there anything I can get for you?” She looked at me for a long moment, and said, between gasps,

Yes. One…more…day.”

God forgive me, I could not even get her that.

I gave up the practice of Oncology and focused primarily on General Internal Medicine. This I did this for ten years. I even spent five years in the Navy. On the island of Okinawa I was the Chief Medical Officer for the Navy. I toured all the bases. I was responsible for the inmates at the Marine brig at Camp McTurious, and visited the GI prisoners unfortunately confined in the Japanese jail in Naha, the major city on the island. I knew what agony they suffered. Perhaps it wasn’t a coincidence that I went to work in the Correctional System.

I have seen suffering in all forms---from the innocent to the guilty. I take suffering very seriously, and I know what it does to people both guilty and innocent, so I’d like to share my thoughts with you:

Many people, in and out of Corrections, feel that retaliation against inmates is morally proper. They see retaliation in the name of the victim as the natural and logical consequence of having committed a crime; therefore it is a fact of life and it is exactly the reason why people are incarcerated in the first place. Most of us learn by making mistakes and being “punished” by life So many folks in Corrections feel that the inmate “got away with” hurting people—up until the time they entered prison. That is why they feel that the inmates “got nothing coming to them,” including medical care, or courtesy, to say the least; and that they are now due a healthy dose of retaliation, to say the most.

They also are lukewarm on the idea of “Restorative Justice,” where the inmate and the victims agree on some program of restitution. Outside of the inherent limitations involved in such programs, there is the fact that Justice doesn’t just mean reimbursing the victims; Justice claims a moral place for punishment as well. And that involves forcing people to take the time to experience and to know what it is not to have the freedoms and all of the perks thereof, so as to appreciate what was taken from others and how very special it is.

This is not as crazy as it sounds. Incarceration gives inmates the time and the space necessary to learn this fact and then to want to take this responsibility to regret having done the crime--or in other words, to become "penitent." That's why these places were originally called "penitentiaries." In order for this to work however, it has to be with this goal and a program clearly in mind. I’m speaking here of those cases of determinate sentencing and possibility of parole. Even in the cases where the sentence is life without parole, there is at least a life worth living better than before. “Life without” is not a life sentence: It’s a death sentence---death in increments, death by slow torture, unless an inmate can work a miracle in his life.

That all having been said, it is critical for those on the front lines to be trained to be professional and objective and self-controlled in their work. Professionals dealing with human behavior are properly held to a higher standard. This is why law officers, jurists, and physicians are trained not just in the principles of their chosen professions, but also in critical thinking and self-discipline. Because human life is so precious, those who would be players have to make the "first cut." These men and women are our Olympic players, and they must choose to remain so if they are to deserve our respect.

I hold the leaders of the CDCr responsible, for two reasons:

First, administrators of the Correctional system don’t give a clear message to anyone—either to the people working in Corrections or the inmates or the public. The leaders of the Correctional system don’t support or protect either side It’s at best ambiguous for both inmates and custody alike Administrators are supposed to have answers. That’s what they get paid to do—have and implement answers. They are taking paychecks under false pretenses, and so far I don’t see anyone holding them responsible. You don’t see them losing their jobs. Yet when correctional officers get stabbed because the vests are lying in storage somewhere, they lose their lives.

Second, the leaders don’t want answers; that’s the last thing they want, because if they had answers then they would have to act and to be held responsible. They want to survive politically, and they will step on anyone in order to accomplish this. The proof is very simple:

The front lines are the very interface where institution and inmate meet. This is logically undeniable. When have the top administrators ever come down and spoken with the rank and file in the institutions? Why don’t they ask the people on the frontlines what they need--not whom do they blame—but what they actually need--to do their job? When have the attorneys for the PLO or these other august organizations ever came down and talked to the people on the line to find out what their obstacles are in providing care? They will speak with inmates, the janitor, and the cat—but not with the doctor. They will have their panel of “experts” to review charts, to find out how many ways they can hold the doctor responsible. Unfortunately, the chart can never reveal the obstacles that the doctor encounters in getting and giving the care.

Why don’t they demand that the Quality Assurance program be put into practice—with representatives from those who are being held responsible forming part of the makeup of the committees and the Quality Improvement Teams, designing the studies that are mandated to accomplish just such tasks?

I would like to see the public empowered to send independent observers into the prison system—retired law enforcement officers who owe nothing to the Powers that Be, to speak with fellow custody officers, doctors who do not work for corrections, to speak to their correctional colleagues, corporate executives retired, to speak to the administrators, and yes, even ex-cons with clean records to speak with inmates. This should all be done publicly, to force people to put their money where there mouths are, so as to avoid obvious retaliation, and to ensure safety and security.

These representatives should then put their findings and recommendations in the form of a report, to be presented first, to the public, and then to the legislature; and that legislative body—the Assembly—can likewise be held accountable by the public for implementing the proposals. This is preferable to having Assemblypersons who know next to nothing of the real problems pontificating in public.

All we need is just one more day.