among the peaks

Last rays reaching over the Rockies, throwing many shades and hues, the peaks sharpen then merge in succession, and the saying comes to mind: “beyond mountains…there are more mountains.” Challenge after challenge both separate and merged, such also is the vista of health care. Forth spring peaks of egregious injustice, ignored innovation, and inconceivable carnage.

Awe, dread, dismay, feigned nonchalance are our postures in the face of these peaks, but maybe also dedication, courage, and defiance? We cannot explode nor flatten these mountains; they are part of us for better or worse; we have built our home, our basecamp, our livelihood in their shadows. Yet we watch as clouds and rains may pass over; we feel the fresh air flow down to us from distant snowfields barely glimpsed, and newly heartened we begin to say, yes, although there are mountains beyond mountains, we can learn to climb, move about, and perhaps emerge from the shadows below to touch that snow.

“Heartening” may then be the key.

Which troubles me.

A great mentor and one of the giants of burn surgery once told me, “Guard your heart! You only have a finite amount of emotional myocardium. Once infarcted, it will scar. Once scarred, it will fail, and you will die.”

We have all seen it. Burn-out is real. The despair and suicides of our brothers and sisters haunt us. We know that road too well; we know where it leads. As we were taught: we guard; we harden; we deflect; we self-protect.

So what then is this growing call around basecamp to be “heartened?” Acknowledging our mistakes, our frailty, opening up to our patients that no matter how much we starved, sacrificed, and deprived ourselves we were never good enough, we still failed them? Sitting with our broken colleagues, weeping bitterly with them at the tragedy in our laps? Facing death over again and again over all its forms, grieving each time anew, mourning each loss as your own? What manner of “heartening” is this?? This is more like repeatedly shattering one’s heart open until only love flows out—surely this is a calling for only the hardiest, holiest of mystics. Any mortal foolish enough to attempt the summit in this fashion will massively infarct their emotional myocardium, and they will surely perish. Our predecessors and mentors did not lie to us on this point.

Yet the solution has always stood closer to us than we imagined. And sat and lain next to us, in our brothers and sisters. Though the ascent be too great a strain for the single heart, wherever there are gathered two or three hearts together beating toward the same, there we will find our “heartening.” There will we be able to walk unbowed through the valleys of death; then can we bear up our broken brother; then we can finally be able to look our failures in the face and say, yes, I am a human in the shadows of mountains, yet I will continue to attempt to heal, attempt the ascent, engage in defiant celebration, compassionate outrage, outrageous compassion because you are here with me my colleagues, my patients, my family, and ye all come and do likewise!

The last rays have left the sky over the Rockies. In the peace of night, I await the dawn of tomorrow.

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