the old familiar darkness

ah, the old familiar darkness. and the old familiar ritual of digesting you by writing you out, probing the completeness with which you color everything, all details.

granted, i have been neglecting the things that replenish me, whether due to poor prioritization of limited time, whether due to letting the darkness let myself sink deeper, whether due to the facts of internship. lack of sunlight is probably part of it, and finally i'm done with nightfloat (only to start ICU, the true heart of darkness), so perhaps things will change (though the darkness says "nothing changes, this is the rest of your empty life"). i haven't been exercising in any way, which, as i know myself, is asking for the darkness to linger. intermittent meditation, but the quality has been waning. sometimes barely edible meals, not particularly healthy. no piano, no time, no yoga. no reassuring, replenishing conversation or interaction with people that reassure and replenish me, making me feel strong. and of course, the reality of the hospital:

so the thing about the hospital... the same things i remember from inpatient sub-i last july at tulane. of course, there are many things i love about the work i do, and about the way a hospital functions, which is not interesting to me right now (remember: this is all about the darkness!), which i have mentioned in the past and will again in the future. but too much work, too many admissions, that are spiritually (no better word i can think of) frustrating.
1) people with pain needs. sometimes sickle cell, sometimes some obscure disk herniation, with a wierd relationship to the healthcare system that i will never be able to understand. never be able to surmount the feeling of their distrust, or the feeling that this is one big swindle, that there is no connection between us.
2) dying old people. i pronounced my first death, end stage liver cancer, no family to really contact, a dude without IV fluids or any intake for several days, except for morphine. a dude with no consciousness for even more days. and some employee from the nursing home he came from, changing shifts every 8hrs, whose job it is is to sit and watch him, and watch his tv. and the employees know how ridiculous this is. i don't mind death, i just mind the fact that the dude was dead wayway before i pronounced him, but since he was still breathing he was still there in the hospital for like a week, staying on our list, worthy of a daily token SOAP note.
3) not-yet dying old people. sent over from a nursing home, usually spanish speaking here, making the feeling of darkness a million times worse. the definition of the GOMER. they are on a million meds, they have a biblical medical history, and they don't remember any of it, and we tune 'em up just to send 'em back, curing nothing, and just telling ourselves we have alleviated some suffering, perhaps prevented some premature death (a premature death in an 80year old??). do they have a quality of life? this is impossible for me to answer, no matter how many awful nursing homes i visit.

which really brings me to the crux of the darkness: deathdeathdeathdeath. so i should mention that in between work, on the slower nights, i'm reading all these nytimes articles about how powerful the "grassroots" mobilization of the conservatives has been against any health reform. can you believe the fucking bullshit about "death panels"?!? sarah palin is going to have soooo much karmic backlash for this. holy god, that's definitely the darkness talking, i apologize, but i won't erase that. the point is that in our society, we have a fucking TERRIBLE relationship with death. old people cannot want to die. in fact, they should always be happy they are alive. even if they have nothing, just sit in a nursing home in some mediocre consciousness, watching tv all the time, waiting for the rare moment when they can recount their life story to someone who will never stay to listen long enough. if they are unhappy, they usually are drugged up, with antipsychotics or at least anti depressants. because there shouldn't be a reason for them to be unhappy, right??? i know there is a very fine line here, about the social/spiritual pertinence of old people and how difficult (or impossible) it is to measure, but even amongst physicians it seems that the same people who are so involved in their elderly parents' health issues are the same ones that never visit the nursing home, that have their parents in a nursing home in the first place, that no longer have a connection beyond nostalgia/regret/memories to their parents. and that nostalgia/regret is powerful, no doubt, powerful enough to make you move and act without thinking it seems, to fight against death and debility, but there's something missing, and it makes me feel the darkness.

is this the point of my role? am i here to bear witness, as paul farmer says, and experience the darkness of others in solidarity? because i haven't even gotten to substance abusers and profoundly mentally retarded people yet! the problem for me is not the ethics of death and caring for the wretched of society, for sure i've gotten plenty of training in all of this. the problem for me is the philosophy behind what we supposedly do. because if we are trying to alleviate suffering, shouldn't we be most focussed on the roots of all this mess? ... i don't even know what this means... because when i see the conservative backlash at these "townhall" meetings they have been having, i realize that there is a force in our society that really loves how things are, wants to keep them that way in this status quo, and this makes me profoundly discouraged. this is in the context of the other thing i've been reading during slower moments at 4am: people's history of the united states by howard zinn. sure he presents plenty of examples of grassroots movements and revolutionary people throughout history, unwritten in books, but it almost seems like he's trying TOO hard to balance out the overabundance of darkness since the first terrorist, columbus, initially came and murdered on this continent. because that 1% cream of the crop of society has always controlled everything, and since healthcare reform would decrease profits for doctors and insurance companies and richrich taxpayers and hospitals and pharma, they will stop any attempts at social justice. even if this includes the slightest of gestures to increase the amount of end-of-life counseling doctors will do.

i don't have time, now, to continue this irreverent and meandering train of thought, as i have to drive to a hospital i've never been to to witness the unparalleled world of the ICU, but this is something i will continue to explore. why do i feel so disconnected, so frustrated?