If only…

I was thinking about something I think about too much. 

It was early May 1995, the third day after our son Jesse’s liver transplant. I was the parent on duty that evening. The others among Jesse’s double family had gone to the nearby transplant shelter to get a night’s sleep. 

Jesse’s abdominal pain, modest at first, went to severe. The ICU resident called the surgical team. When the surgical resident strolled in hours later I commented on the wait. ‘It’s been busy in the OR,’ he said. He asked Jesse where the pain was. Jesse, writhing on his hospital bed, circled his hand over his lower right abdomen. The resident diagnosed him with bad gas and had him pumped full of fentanyl. 

The fentanyl took a long time to kick in. When it did, Jesse was fine until early evening of the next day, when the pain came back fierce. An X-ray showed free air in his belly and he was taken back to surgery. A perforation in his bowel had allowed intestinal contents to leak into his abdominal cavity. Sepsis, rallies and downturns, and multiple surgeries including a second liver transplant followed before his death in early August. 

There’s no way to know if catching the problem that first evening would have saved Jesse’s life, but you don’t have to be a doctor to understand that an extra day’s worth of intestinal contents leaking into your belly is a bad thing. What if the surgical resident had not, maybe, been overtired from the OR? What if the pediatric ICU resident, who suspected a perforation as we gathered from scraps of information after the fact, had pushed back harder against the surgical resident’s diagnosis? What if I had thrown a fit, demanded to talk to the surgical attending, at home with his family or not? 

That last won’t do, though. I didn’t pitch a fit, but I advocated for Jesse. It was their job to protect him. They fell short. End of story. 

But it’s not the end. I still think about it, still see it twenty-eight years later. So what’s the deal here? Glutton for punishment? A cheap play for the audience in my head that applauds a father’s love for his son decades after he’s gone? Long-term trauma?

Maybe all of them. That’s not all of it, though. ‘What if?’ may be fantasy world, but it has a powerful logic behind it. Who among us can’t think of a consequential action they might easily not have taken, or the other way around? But that fantasy world and its logic leave no room for tragedy. Yes, the surgical resident might have . . . Yes, the ICU resident could have . . . Tragedy doesn’t lower itself to argue with such futile fact checking. Tragedy works not by different rules so much as by no rules at all that we can discern with our logical minds, or our ‘What if?’ fantasies. 

Can you hold tragic and optimistic views of life at the same time? I think you can, but such a combined view can’t rely on logic alone. 

A different question. Would such a dual capacity stretch our memories of others’ grief beyond the first few days of their grieving and enhance our capacity, and will, to support and include them in Lifeworld even as they inhabit Griefworld for months or years on end? 

In an earlier post I wrote that Dr. Howard Spiro, after I told him Jesse’s story, said ‘You never get over something like that.’ Years later I told my Dr. Spiro story to Dr. Arthur Frank, the dean of narrative medicine. He took a long pause then said, ‘No, you can’t get over something like that. But you can go on.’ 

And not only with sorrow but with your own portion of joy. And not only alone, if we can exercise our double hearts and minds.