Dr. Francesco Enia
Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
A cold coming we had of it
just the worst time of the year
for a journey and such a long journey
the ways deep and the weather sharp
TS Eliot, “Journey of the Magi”
The dizziness again … stunning images …
A child with no hope of a cure, affected by dilated cardiomyopathy, looks at the doctors in the hospital and plays at taking an electrocardiogram of her doll. She whispers, “Mummy! Mummy! I am afraid!” as she loses consciousness.
An old missionary coming back from Brazil is suddenly struck by disease before landing: aortic dissection, the rupture of the entire aortic wall from its roots to its terminal branches. He will never make it to the operating theatre. I have done aortography under desperate conditions, listening to a continuous, agonizing, morphine-resistant scream. In this scream, I distinguish only “Mummy” and “My God.”
Then there is the calm young professor of astrophysics with the devastating acute myocardial infarct. He says to me, “I have two little children, and I wish to help them grow up.” I think this man is clever. I should like to know him better. I immediately perform the coronary angioplasty. Unfortunately, he has come too late. The electrocardiogram is unchanged. There are no signs of reperfusion. The heart ruptures suddenly. It takes him by surprise.
Then comes the charming thalassemic girl. Long ago she had dreamed of having a family and children. Now she refuses to be treated. The boyfriend has abandoned her, unwilling to tie himself to a sick girl.
A young student, also, son of divorced parents, suffers from thrombotic thrombocytopenic purpura, and the plasmapheresis is not helping. What can a seventeen-year-old boy understand about his own death? He has fever, kidney failure, convulsions, chest pain from ischemia, and his vessels are blocked by plugs of aggregating platelets. An unusual case! Nobody has as yet reported such a case. We must gather all the data and write him up for the journals. A game! We are playing with science. But he, seventeen years old, is playing chess with death and will lose within two days. And what game are his estranged parents playing? The mother is always crying. The father does not want to enter the room to see the dying son, saying, “I’d better go away.” And so he goes away.
Then comes the grandfather, screaming as he rushes to the emergency room, his ten year old grandson in his arms. He has shot him with a rifle, by accident, while hunting. The child is dead. How can such an infinite agony be contained within a finite body? Quickly! Quickly! We must urgently make an incision anywhere in the body of the grandfather, even in his soul, to let it out.
And finally, behold the exasperated old man with severe respiratory failure who has thrown himself out of the second floor hospital window. He is a deformed body on the asphalt. Why was no one near him holding his hand, to give him a smile, to let him know that someone was near, to make him think that perhaps he may come through it? I call out, “How can you explain all this?” And my friend replies, “Look! It is true. Suicide is a mortal sin, a terrible disorder. However, there is God’s mercy in the seconds between the window and the asphalt. Objectively this time passes like the snap of a finger; subjectively it may pass more slowly. Do you think that God did not give him, the poor unlucky man, the opportunity to repent in this subjective time? In this time where he can relive all his life?” The words are true, but they are not enough for me. Who was holding his hand?
How much reality can human kind stand? Who can help us? We trace the Eliotian journey of the Magi, searching for answers, to understand the meaning of it all. Like the Magi coming from the East, we search for an answer but find no escape. Either we face this “hard and bitter agony, like death, our death,” or the pattern of life remains patternless. For the journey we must take is an inner journey, a hard journey, a process of reconciling the outer physical world with the realities of the spiritual inner self.
To be oblivious of the necessity of this reconciliation fragments a person’s authentic self. The physician, alienated and estranged, his life mired in technicalities and confined to isolated issues, who has fragmented experiences without a unifying reference, finds that life loses its meaning. Like Eliot’s Magi, the physician caught between two worlds, between death and birth, is “no longer at ease, in the old dispensation, with an alien people clutching their gods.” All too aware of the tragedy of life but also intrigued by its mystery and wonder, he is left with the need to journey towards his inner self, and within this inner self to discover the presence of the hidden and silent God, who is closer to man than man is unto himself.
FRANCESCO ENIA is the director of the Department of Cardiology at Ospedali Riuniti Villa Sofia-Cervello in Palermo, Italy.