Alone in a storm

I am a pediatrician and opted to pursue a pediatric palliative care fellowship after pediatric critical care training; I hadn’t examined an adult patient in eight years. I forgot the way adults smell. The way their hands felt, weathered with time. The lines on their face, a historical map of emotions. Oh, and their eyebrows and ear hair that seemingly defy gravity. Yet in some ways, adult hospice care is just like pediatrics. Too fragile or without words to speak, families are the storytellers. In our hospice visits, through tears and laughter, we hear what mothers, fathers and grandparents were like at their best. They were soldiers, medics, nurses, award-winners, florists, and avid comic-readers. Mr. Norris was a veteran. His room was mostly empty except for a painting of a boat with a man, alone, in a storm.

I met Mr. Norris and never said a word to him—neither of us said anything at all. Yet, I still think about him daily. As I walked into his room, the sun shined so brightly through the windows, I needed to squint to see Mr. Norris clearly. He built those windows. He built the house his family lived in—the one in which he was dying. I touched his arm, and then his hand. He squeezed mine. I wonder who he thought I was?

Outside his room, his daughter, Nancy, prepared dinner. Together we sat in a circle—Mr. Norris’ children, my attending, and I. Pictures of Mr. Norris in uniform, medals of honor, and the aroma of vegetable stew, surrounded us. In our visit, we briefly talked about his pain and changing breathing pattern. Like most other families, we talked about how his appetite had diminished. We talked about how his body was slowing and would eventually shut down. We spent the next hour learning about who he was as a person—past tense. We learned about how he served our country. We heard about his children and all that he taught them: above all, the importance of family.

It was special to sit in a home Mr. Norris built, in a circle with his children. While trying to stay present, I noticed my mind shifted to thinking about the painting above his bed. In pediatrics, kids are surrounded by pictures of superheroes. Their parents explain why their child is most similar to Wonder Woman or The Hulk. At other times, parents taped pictures of their children to the walls around their hospital bed to remind us of what their child was like before they became ill. Natalie liked riding horses. Sarah liked feeding ducks at the park. Andrew was happiest when snuggling his dog, Pickle. These pictures tell a story, provide insight into personhood and help us to understand what individuals and families value. In palliative care, one-liners become filled with facts about who patients are beyond their diagnoses.

Why did Mr. Norris have a painting of an isolated man, in a boat, in a storm? I couldn’t help but feel the symbolism as he was dying. Had he been steering the ship in life’s turbulent waters and was approaching a more peaceful place? Or is the water representative of death and he was fighting death? Perhaps the person in the ship is not Mr. Norris at all.

I never asked him. I’ll never know. But I’ll think of Mr. Norris often and that painting of a man, alone, in the storm.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editor (Paul Rousseau) for the series “The Human Experience” published in Annals of Palliative Medicine. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-22-979/coif). The series “The Human Experience” was commissioned by the editorial office without any funding or sponsorship. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The author has been given permission by Mr. Norris’s family to use real names.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.