Illness and metaphor: Bonesetting

Another year begins. January — long, cold and businesslike — is waiting in the office. Coming back from the holiday I always feel let down, aware of the length of time that stretches before me until spring. There is a new date to get right, but everything else seems just as it was. The patients who were depressed are still depressed, maybe more so. No one has miraculously recovered from dementia or schizophrenia. Illness never takes a holiday. Looking at the charts, I can almost see my patients lined up in neat alphabetical rows, waiting for their turn, just as always. Yet I know that even if it seems like things will never change, they always do. Twelve months from now, there will be notes in the charts that continue the stories with twists in the plot as yet unwritten and unpredictable. Some of these people will have passed through the door many times; others will have mysteriously disappeared, having been cured or given up and moved on. Each person, by some combination of fate and choice, shapes a life that is never the same, like the river you step into twice. Every day of the year to come, something unexpected will occur. I won't see most of what happens to my patients, only the small part that they tell me. Maybe the unimportant part. I hope that the stories will not be interrupted. In psychiatry, patients are not expected to die. A death would probably mean a suicide, something every psychiatrist hopes to avoid as long as possible. But other physicians will look at their charts knowing that some of the people whose stories they contain will not be around for another January. This year will be the last for them, and their charts will open on a final chapter. For many, this may be expected and even accepted. Yet there are others whose lives will change suddenly, so that this time will be remembered as the time before their lives changed, and will seem not just months but thousands of years in the past. But there is always the possibility of cure or relief to balance things out. Bones mend, cancers remit, panic subsides. Children grow. Babies arrive, or get started, and this year will become the year of a birth, the year that will always mark the place where a story began. A doctor might like to know where each patient will be at the end of fifty-two weeks. Some much worse, some much better. Some so agonizingly unchanged. A prediction that we call prognosis, heavily seasoned with fate and a tincture of time. Among my rituals of January is hanging up a new calendar. It is a satisfying thing to do. A calendar suggests order. It suggests that time is manageable, controllable. We can book our days according to the time it takes to do our job, whether it's the psychiatrist's fifty-minute hour or a five-hour surgery. Yet, even as we measure time, time measures us. It finds our pulse, numbers our breaths, places us at an unknown location between birth and death. Without prompting, our bodies count the seconds for us, and then the years — so that even when we are not mindful, our blood and our bones keep pace with the passage of time. The practice of medicine leads us to believe we know the body's time. We have figured out how long we should leave the sutures in, how long to stay off an injured foot, how many days a cough should last, even how many weeks form the span of normal sadness. These are the yardsticks against which we measure symptoms. How long have you had this? When did it begin? When was the last time you can remember feeling okay? It tells us a lot about what we can and can't do, to know when the lump appeared, how many years of drinking and smoking there have been, how long the chest pain lasted before it eased. Because we stand outside the stream of illness-time as it engulfs our patients, we can miss the currents that move us. As we watch a patient progress from health to death, it is easy to feel immortal. Are we not still here, unchanged, not a day older, not the slightest bit altered from what we have always been? Until, at the strangest times, something catches us, we look at our bodies, and we realize that we too have been making the journey the whole time. But medicine has taught us that it is not a bad thing that life is short, or that we are getting older. Before I became a doctor I was afraid of illness and death. I thought that being exposed to these conditions on a regular basis might make that fear worse, but instead it has helped. I still don't relish the thought of becoming sick or old, but at least the processes seem more natural. If I remember that I am not exempt, I can be grateful for the time that I have, whether it is fifty years, more, or less. I want to make the most of it and not, as Thoreau said, come to the end of my life only to discover that I have not lived. The turning of the New Year lasts only a moment. Before I realize it, the decorations are back on the shelf by the photocopier and it's mid-January. Resolutions are broken, and things move along as before. The days come quickly, one after another, pushed along by the many small worries that rise and fall like the tide. But, at the strangest times — at the change of the seasons, or on a midsummer night — I get the feeling that comes to me most consistently in the first days of the New Year. The feeling that time has stopped for a moment, or that I have stepped outside of it just long enough to look around. To see where it is that I find myself. To wonder how much time remains. To consider what it is that I want to do now, what it is that I resolve I will become on this New Year's Day.

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