The Garden

February 13, 2021

The following work was drafted as part of a writing retreat with my residency program, and was loosely in response to the following prompts:

• In the words of Andrew Solomon, “Any serious illness is a medical event, but it is lived in narrative terms.”
• Write about a physical space in the hospital. Why did it come to your mind? What stands out about it for you?

When I think of Boston Children’s, my mind is immediately drawn to the rooftop garden. Gardens have an innate attraction, of course, the promise of life amidst unforgiving concrete. Perhaps unsurprising that the garden became an early and consistent place of solace throughout residency: a sunny retreat on one of my first pulmonary calls, wondering how I was possibly the primary doctor responsible for 18 young lives on a scorching hot Sunday in July, taking hurried bites out of the hospital chicken pesto BLT while hoping I could respond to a page without being next to a computer if one came through during my ten minutes of repose, my to-do list ever present in the corner of my vision and the corner of my consciousness, impeding what might have been an otherwise frankly placid appreciation of the summer sun over the city. I ask the fellow I’ve worked with for the prior few weeks for feedback on our last rotation together, and she suggests the garden for a spot of privacy. As I hear her words, I find myself having a somewhat out-of-body experience as I contemplate whether or not what is happening is real – have I really just finished my fourth week as a doctor, and my work is being affirmed and not scolded? Was this what I envisioned life in medicine would be like when my 18-year-old self sat in the basement of the university science center and met with a pre-med advisor, eager to check whatever boxes I was instructed to in order to set my career along that path? I return to the garden after finishing my last 28-hour call of the month, snapping a commemorative selfie while hoping my smile will override the fatigue that has already worn lines into my forehead at age 26 (from the responses of others – “you look tired!” [why does anyone ever say that?] – it did not).

The garden was where I came again, four months later, aghast at what was the first but would sadly be far from the last death of a patient, a patient whose passing was made all the more poignant by virtue of the fact that I had first assumed her care on that self-same Sunday in July when I looked out over Boston, rooftops then splashed by sun and now covered by the crisp air of an October evening. This patient’s death felt particularly unfair because the patient’s mother, for reasons I may never understand, had opted not to give her daughter opioid pain medications or benzodiazepines for anxiety even in situations in which they were entirely indicated: the piercing pain from a chest tube used to decompress a pneumothorax, air hunger from tidal volumes that became ever more scant as her undifferentiated restrictive lung disease marked its inexorable way towards and FEV₁ of 0, a degree of lung function that needs no severity categorization to communicate its gravity. Yes, on that October night, I wept, wept because death was unfair, wept because I hadn’t realized how sick she was to begin with in July when she was first transferred to my care from the ICU step-down unit, wept because I felt we had done her a disservice by not finding the words to communicate to her mother that medicine for pain was safe and ethical, wept because I felt shame, however misplaced, that I had wept in front of others at lunch that day, wept because as someone who had only been peripherally involved in the care of this child, I felt somehow guilty for taking this so personally, as though I were cheapening her death by making it about me instead of about her and the family that she left behind.

And so as time continued its inexorable march and I continued my journey towards efficiency and away from patients (or so it would seem), my trips to the garden became less memorable but none the less appreciated. It was a place to see patients who were normally confined to their rooms outside and appreciating the warmth from the sun, if only for a few hours, and thereby it was a window into the life these children lived outside of the hospital – these children living with chronic disease, not these chronic disease-defined children, as our callous medical jargon too frequently labels them: the autistic, the diabetic, the psych boarder, the CCS-er, the sickler. It was a place to escape to watch the sunset, or what little remained of it, wondering from where I would be watching the same sun grace the ground with its life-giving rays had I chosen a different career, a different medical school, a different residency program, a different residency altogether. I think back to sunsets in undergrad on foreign study in Botswana, wondering how it is possible that the same sun lights up these skies thousands of miles apart, only to have my reverie broken by the wail of a patient who I know to have sought care here from the Saudi Peninsula, and the sameness of the sun seems less implausible.

Fast forward further still to June 2020, still peak pandemic, as I am looking out on the same sun, not from the garden but from the 8E cardiology workroom. I watch the sun rises around 530 AM on the tenth of my eleven nights on that rotation, a little bonus brought by the peculiarities of June plus COVID staffing. It having been an atypically quiet night, all of my work is done and I am simply waiting for the day team to arrive in an hour. The sunrise is particularly breathtaking, so I decide to wander up three floors to the garden to feel its rays for a moment prior to giving sign-out on the events that had transpired overnight. As I walk up the last flight of stairs, my stomach lurches as I see the doors to the garden are shut, with a sign indicating they will open at 7 AM. I tap my hospital badge against the badge reader, hoping futilely that my privilege as a hospital worker will enable me to skirt the rules, even if just for a moment. Unsurprisingly, the reader changes from red to deeper red as I scan the badge, and I am not permitted entry. As goes the medical maxim, I have pain out of proportion to the situation – I am viscerally upset by this closure, despite it being at best a minor inconvenience.  Somehow amidst all the other sacrifices I had made over the past months in the pandemic, both personally and professionally, it felt cruel that even this place of brief solace be inaccessible in the present moment.

I walked back down and gave sign-out that morning as I had so many others, and that day blended into the rest. I continue to frequent the garden in the following months of the pandemic, if only to have a moment to take off my mask in a safe setting to breathe something other than the fibers of a surgical respiratory-particle-collector. I glance over the same rooftops as I am now a senior resident giving feedback to interns, finding it impossible to consider that more than 26 months, two of earths’ revolutions around that self-same sun and a few moons at that, have transpired since I was that intern getting feedback only a few weeks into residency. I glance around and reflect that the garden feels different, and search around for the cause of the change. With but a moment of introspection, I realize the obvious – what’s changed was not the garden, what’s changed was me.