there is an increasing gap between our expectations of medicine as an endeavor with an understandable, achievable goal, and our realization that medicine is an inexorably progressive enterprise with no immediately apparent endpoint, a quest without a grail.

In spite of this realization, and in spite of all the changes in medicine, doctoring, and health-care delivery systems over the past century, we cling to the belief that there is a rock-hard and immutable essence at medicine's core: a medical ethic, a doctor-patient relationship, an ideal of what the profession should be. Yet the current turmoil in the health-care system is evidence that the core is crumbling. It is time to reimagine what we want doctors to be and do.

Disease and medicine touch all of our lives in intimate, profound, and frightening ways. As patients, we don't want the wonderful abstraction of modern medicine. Above all, we insist upon recognition of our messy, personal tragedies.

A few years ago, my wife's father, Carlton, died of emphysema. As his lung disease worsened, his life closed in around him. He quit farming; then he had difficulty walking up stairs; and finally he became oxygen-dependent and lived tethered by a nasal cannula to an old, green, metal tank that the home health-care agency picked up and delivered the way he used to pick up and deliver bottles of milk. At one point, the claustrophobia and fear became too much, and he walked out into the road in front of an oncoming truck.

His suicide attempt failed. Hospitalized for a psychiatric assessment, he was started on an antidepressant that picked up his mood. He lived another year and a half, long enough to see our third child, his fifth grandchild. She still treasures the photograph of her as a baby in his arms, a picture she returns to now and again as she rehearses her genealogy. In the end, he died at home in his bed, a 19th-century death made possible by 20th-century therapeutics. He appreciated what medicine had done for him, but never had much good to say about the doctors.

A few years after he died, his wife, Evelyn, was diagnosed with breast cancer. Evelyn had a lumpectomy, then a course of chemotherapy and radiation. She lost her hair, lost weight, and was tired all the time. One of her daughters, Bethann, moved back to the farm and helped out with everyday stuff--grocery shopping, driving to church, taking the car to get the oil changed. When Evelyn finished her chemotherapy and was declared cured, we had a family reunion at Bethann's house to celebrate.

We loved to visit Bethann. She lived with her husband in a house her grandparents had built, on a hill overlooking a farm that had been in the family for generations. She nurtured a huge perennial garden and dried the flowers in the attic to make wreaths and wall hangings. They kept goats, honeybees, and chickens; heated their house with wood; canned tomatoes; lived simply. At night, we could see stars and listen to cicadas. On the South Side of Chicago where we live, we put our kids to bed each night to the sound of sirens and, occasionally, of distant gunfire. At the farm, the kids became different, more relaxed and open.

Bethann prepared a wonderful picnic. About 25 aunts and uncles and cousins, nephews, and nieces feasted on fresh-picked corn on the cob, fried chicken, enchiladas, salad right out of the garden. Earlier, we'd gone blueberry picking, and the pies were just coming out of the oven. The kids were playing tag, the dogs were begging for handouts, the sun was setting over the rolling hills of northeastern Pennsylvania. The August evening light was mystical, wistful, almost magical in a romantic-movie way.

After supper, Bethann stood up, grabbed her chest, and collapsed. She was 39 years old.

My wife, Nancy, and I are doctors. We ran over, felt for a pulse. Nothing. Bethann's eyes were rolled back in her head. She was gasping. Her color was terrible: pale, bluish-gray. We looked at her, at each other. This was it. I told somebody to call 911. We were way out in the country. Miles from nowhere. Better start chest compressions. 1-2-3-4-5.

Nancy couldn't do mouth-to-mouth on her own sister. We switched. She did the chest compressions; I started mouth-to-mouth. I had never done CPR in the field before. In the hospital, CPR is, weirdly enough, a friendly, communal activity. When a "code" is called, the team comes running, just like on TV. The equipment is familiar. People work together. Anesthesia intubates. Residents start intravenous lines. Nursing, poised by the well-stocked crash cart, hands the meds. Monitors beep.

In the hospital, you never do mouth-to-mouth resuscitation. Respiratory therapy has the ambubag. So I had never actually done it except on the plastic "Resusci-Annie" dolls in CPR class. It was a little like that. Tilt the head. Watch the chest. Puff. Count it out. 1-2-3-4-5. Breathe. 1-2-3-4-5.

In fact, it was nothing at all like class. It was a nightmare. The sun was going down. We could hardly see what we were doing. Mosquitoes buzzed by my ears. Kids screamed and cried, but I heard them like a distant soundtrack. I cut my lip pressing it against Bethann's teeth. My blood began to drip onto her lips and chin. With one part of my mind, I kept listening for a siren. With another part, I wasn't listening for anything, I was simply going through the motions of a routine as strange and mysterious as any prayer ritual, a set of actions I had learned in school and now could do well, even though doing them seemed as unreal and as meaningless as the whole strange scene. This wasn't really Bethann on the ground, this wasn't what it seemed; it was CPR class, it was a movie, it was going to have a happy ending.

Continue reading, "Life Support."

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