The bilious oil hemorrhaging from the bowels of the Earth, coupled with the usual stressors of life, makes me feel sad and pessimistic of late. And while I’m still pretty sure that ignorance, intolerance, and our polluting routines will be our ruin, I also search for ways to retain optimism and hope. Amid the constant erosion there are basic roots that hold life together. If you share the belief that life is fundamentally absurd, then life is truly what you make it. Are there small steps proven to make us happier?

Psychology often concerns itself with helping ailing people get back to a neutral ground, but the field of positive psychology aims to do more. University of Pennsylvania psychologist Dr. Martin Seligman, positive psychology’s most renowned proponent, once said: “I realized that my profession was half-baked. It wasn’t enough for us to nullify disabling conditions and get to zero. We needed to ask, ‘What are the enabling conditions that make human beings flourish?”

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How could she be on my schedule again? I had just seen her the day before, diagnosed her with an infection of the skin, placed her on a few medications, and told her to follow up only if the infection worsened. Was her arm now being consumed by the bacteria, or had she returned simply to tell me of a new problem? Perhaps she felt I had rushed her out of the examining room yesterday. It was hard to look at her directly, I admit. It took all the compassion and intellectual power I could muster to see beyond her terribly scarred face to the lovely woman at the seat of her brain.

“How are you today?” I asked. “What brings you back so soon? You must really like it here,” I cringed at my own clichéd banter.

“I’m so sorry. I’m just a lonely old lady with too many problems,” she said out of the corner of her mouth, the side that was still tethered to functioning muscles. The other half of her face had been shattered by an automobile accident years ago. Despite many surgeries she still looked puttogether by surrealist hands.

“You’re not old,” I reminded her. “And I hope you’re not truly lonely.” She was only a little beyond midlife, and her hair was still silky and black as it fell unevenly from her patchwork hairline. “How have you have been since yesterday?”

She ran her fingers over the swollen infection on her arm. “It hurts, but I think it’s getting better.” She looked up with her one good eye as the other drifted aimlessly in its wet socket. The tunnel between the eye and the nose which normally drains tears had long since collapsed. Her face appeared to be perpetually crying on that side, despite the small smiles that would escape the other.

I rolled my chair closer to her. Her wounds were indeed healing, and I couldn’t imagine why she had come in. “Looks good I have to say.”

“You don’t think it’s still infected?”

“Yes, it is still. But it’s getting better.”

“Why did this happen to me?” she asked.

I looked away from her rutted face and pondered the question. “This” could signify the festering wound upon the skin of her infected forearm, or it could reach back to the accident that had buckled her facial bones. I didn’t answer why either had befallen her. I didn’t know. I was pretty sure the question was as flawed and absurd as existence.

She brought up several more problems to flesh out a respectable visit, but they were all minor complaints, ones that had troubled her for years and were more or less stable. I reassured her about prior CT scans, blood tests, physical exams, and specialists’ consultations. She didn’t seem satisfied. I concluded the visit and walked her out to the front desk to check out. I stooped over the counter and finished her note while she waited for something.

“Are you all set?” I asked her.

She nodded while wiping the spittle from the slack corner of her mouth with a handkerchief. I noticed that she had painted her lips a vibrant red. “Aren’t those flowers nice!” she remarked, pointing at an old wilted bouquet of roses that another patient had brought in as a gift for the office.

“Why don’t you take them,” I said. “They’ll look nice in your house.”

“No, I couldn’t possibly,” she replied. Her good eye looked at them again. “Those are for your office.”

“That’s it, you must take them,” I said, handing her the vase and the lovely roses. The petals were blood red, and although wilted their vibrant color was still extraordinary.

Her appearance brightened and she seemed exceptionally moved by the token of friendship I had passed on to her. She had no choice but to accept it, and while she feigned modesty and refusal it was obvious that she was thrilled. How long had it been since she had been given flowers?

“They’re beautiful,” she said. She pulled my face to hers so that she could give me a kiss on the cheek. I watched her leave. In the parking lot she opened the back door of her perfect new car just as the first drops of a summer rain began to fall. She carefully positioned the flowers among a few boxes so they wouldn’t tip over on her way home. Then she nimbly raced to the front door and slid in behind the wheel. A smile lingered on her broken face, and as she backed the car away and drove off through the rain I knew that she wouldn’t need to come in tomorrow.

Someone close to you died, was sick, or you simply figured out that humanity could be wicked, fallible, and miserable. But instead of recoiling into cynicism and solitude, you decided to embrace the suffering of the human condition. Fundamentally you hoped to change things, to protect others, to make the world of the infirm a less wretched place.

But ironically you have led a life of solitude. Sequestered in your cave you studied the old scripts, memorized the ancient maps, and honed your skills with the knife and pen. Many friends tired of you and your obsession, or thought you odd and distracted. Family was often deferred. There was no other way.

One day you emerged brimming with accomplishment and optimism, albeit conflicted about the more simple life you forsook. You finally earned the noble uniform. You experienced the exhilaration of helping others, comforting them with your heart and intellect, carving off the bad things of their lives. Slowly you let go of the imperative to be home. There was just too much work to do. And it was good.

One night you looked up at the dark, stormy sky, with its burgeoning thunderclouds, and realized your smallness beneath those anvil tops. You were a vulnerable tree in an open field like everyone else, rooted and exposed.

Something inevitably went wrong. You arrived too late. Your powers were too weak. You awoke from the dream to realize the world’s dubious appreciation for you.

Increasingly each token of thanks for a job well done seemed cavernous, filled by some parallel world in which things might not have worked out so well. Despite your self-proclaimed acts of heroism, your self-styled dark nobility, the public only trusted you when things went well. A few questioned your motives. They impugned you for a perfection you never claimed.

You move on, relegated to a dual life, incredibly fulfilled by the good works you achieve, and terribly worried by the future. You must bear the heartache of those who suffer or die in your arms just as you revel in the happiness of those you successfully protect.

Do not lose heart. Do not retreat from awesome responsibility. This is a pinpoint world, but you have sworn an oath to avenge it. Your calling must be to fight the injustice of pain, disease, and fear, even when the immensity of such a goal surely renders you a failure.

You can only hope to craft and rule your self, and therein be true to a moral creation.

I don’t watch much television, but I have remained faithful to the Lost series over the years. I found the final episode moving, not because I’ll miss the characters so much, or because any particular unity was achieved from the still-conflicting plotlines. But if you saw the finale you couldn’t help being stirred by each character’s “memory flashback” while living their (absurd) parallel lives.

These sudden epiphanies revealed to the character a great love, a great friendship, another meaningful life entirely, standing squarely in front of their previously unaware eyes. Memories of happiness, pains endured, adversities overcome, even deaths shared – all unexpectedly flooded the characters’ minds in an intense moment of spiritual reckoning.

It got me to thinking about the characters in my own life, and how superficially I exist with them – but how wholly I might permit myself to be aware of their full worth and consequence, and how utterly precious and fundamental they are to my very being.

For example, instead of a casual conversation with my parents, should I not allow myself to brush back my mother’s hair, caress my father’s cheek, and in that moment be flooded with a brilliant awareness of their courageous journey to my birth day, wiping the tears from my child eyes, standing by my side as I became a man, fighting, and humming lullabies?

My wife, who is my very breath, my carried heart, my reason for being. My brother, my family, my lost grandparents, my lost dog, my oxen friends, my dearest patients – do they all not deserve such a private epiphany? Shouldn’t we all be jarred into a naked awareness of our mortal legend and its epic characters once in a while?  How could I have been so blind, so numbly ignorant of the mayfly colossuses in my life?  How desperately I cherish them beneath the humdrum routine.

And then the show ended (along with the melancholy side effects I felt from the antihistamine I had taken earlier that night). I settled back into a comfortably numb, semi-aware state that would permit me to go to work in the morning.

“And your mother, how is her health?” I asked the cheerful young woman who had come in for a physical examination. She was draped in a blue paper gown under which her naked alabaster skin seemed translucent. Her branching veins coursed like roots close to the surface as they returned indigo blood to the warmth of her core.

She smiled, albeit woefully. “My mother actually died several years ago. She had a brain tumor… glioblastoma multiforme it was called.”

I stopped writing and looked up from the notes I had been scribbling in her chart. “I’m so sorry.”

The young woman nodded her head silently, blinked a few times, and looked purposefully at her chart as it lay on the table before me. Her body language implored me to skip along to the next subject, but I couldn’t. I couldn’t help suspending the moment as the weight of her loss attained its proper gravity in my mind. Again I noticed the cerulean web of veins stretching throughout her skin, and it summoned in my conscience a long forgotten specter.

She was lying beneath the blue canvas bag, zipped and sealed in preservative juices. On a cold metal slab among sixty other lifeless bodies she rested. There was no smell of death in the fluorescent-lit room; rather it was ripe with never-living formalin.

When our dissection was done her remains were cremated, along with the others, but not before we each gave our own goodbye. Some wrote poetry, some spoke aloud, some reached out in prayer. It was a reverence for another being unlike any I’ll ever feel again. I wondered what she had envisioned in her final days, whether she knew four anonymous medical students would spend the better part of six months traveling along the roads of her preserved universe, with studied anatomy books serving as our poor guides to the back alleys and sudden turns of her necropolis. Did she wonder when we would discover her terrible secret, her unstoppable murderer? Did she know it would make me feel a kind of sadness stirred from the disparate emotions of sorrow, exultation, and wonder?

Did she hope, correctly, that each time I palpated a liver, delivered a child, interpreted an EKG, peered into an eye, injected a joint, reviewed an MRI, or tapped a spinal canal that I was unwittingly polishing my vision through a lens first ground in her anatomy? And as I shook off my moment’s delayed reflection, in a small family practice, during a routine physical examination all those years later, I still wondered at what kind of woman she must have been, and recoiled from hearing an echo of the horrific tumor that inspired her final offering – a body for our cold slab of an altar.

“I’m sorry to hear that your mother died of a brain tumor,” I said. My patient nodded once more, and then it was time for me to move on.

Welcome to Grand Rounds, a weekly collection of excellent writings submitted by medical bloggers.  The theme for this week is minimalism – I’m going to restrain myself and let the authors speak for themselves:

Editor’s Pick:  OB Cookie, a future Ob-Gyn who writes a creative medical and food blog, baked a funked out cake with Smarties to celebrate the 50th anniversary of the birth control pill.  She describes the profound changes wrought in society by the oral contraceptive pill, and a tasty recipe including how to make vanilla butter cake with white chocolate ganache.

PalMD contributes a sobering, sincere, and poetic look at a friend’s coping with disease: “There is no glamor in her illness, an illness which she fights with humor and dignity. The beauty is in her, and in her family.”

The Sterile Eye presents a photographic tour and report from his visit to the medical museum in Copenhagen, with lots of vintage medical paraphernalia on display.

Who better to point out the similarities between tailoring fabric and making incisions for plastic surgery than Dr. Bates, a sewing surgeon extraordinaire?

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The zombie is an undead, shambling, flesh-hungry monster with a particular appetite for human brains. Although an uncommon sight in the doctor’s office, it behooves the astute physician to gain some familiarity and expertise in the medical care of zombies should one appear for an impromptu “check up.”

Universal precautions are of utmost importance when evaluating zombies in the office. After a chaotic check-in at the front desk, and a hasty collection of co-pay, the zombie should be promptly escorted to a private, strictly isolated room. Health care workers should wear masks and gowns, as well as eye protection. The zombie’s arms and legs should be restrained in case of sudden hostility or aggression. Unfortunately this isolation and restraint may cause the zombie anxiety, loneliness, and a suspicion that he is somehow being punished. Reassurance and a welcoming smile may help to reduce unease. Perhaps the office could invest in a calming fish tank.
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