Sanctuary

It’s good to have a safe place. It’s also not guaranteed. Some people are born into situations of protection. Many others encounter strife from the start. Our paths to shelter vary.

Safe places are not necessarily geographic, place-based. They can be internal, state-based as well. In fact, over a human lifetime, some of the best refuges are those that we discover within. They are havens of being, senses of circumstance in which the lines between individual and social, me and other, why and how are blurred. These are the ultimate sanctuaries. They are the spiritual ones.

It isn’t easy to build such connections in our lives. It takes practice. It demands acceptance of failure. It requires courage.

All too often I’ve thought that I could construct myself, and my future, through personal will. Brute force. Sheer determination. These can be helpful qualities, to be sure. My life, however, has taught me that those qualities do not assure success in touching security. Effort and focus can lead to experiences that are satisfying, yes. But satisfaction in personal goal-accomplishment is not the same – over years of being – as the comfort associated with feeling part of something larger than oneself, the transcendent peace that may be entered when separations shatter and me-you dualities dissolve.

A memory stirred in me last night from thirty-three years ago. I was a surgical intern in a busy urban residency program. My days were challenging. There was limited time outside the hospital. There was independence in care delivery and decision-making that, by contemporary standards, would be considered dangerous to patients and detrimental to learning.

Daily rounds began at 4AM. Evening work typically ended well past dinner. And most months found the surgical intern on call every other night.

One day, well into the internship, we had a very heavy operating schedule. I had been up all night, doing pre-operative work for the seventeen or more patients on our service’s list. The intern’s job was to admit new patients to the hospital and make sure that all the screening, labs, intravascular lines, and other preparatory work was completed in time for anyone scheduled for procedures the next day. Depending on the complexity of patients and their conditions, this could take most of the night. Often it continued into the course of the actual operating day.

Fatigue was standard, of course; I could fall asleep standing and sometimes did, if I wasn’t careful. In order not to nap when it mattered most (such as in the operating room), I learned how to voluntarily cramp the muscles in the backs of my calves. The painful spasms kept me alert during surgeries when my only role was to hold retractors steady inside body cavities and spaces that I usually could not see.

“How about you finish this one?”

The vascular surgical fellow’s question snapped me to attention as quickly one of my leg cramps. The patient was one of the final planned operations for the day. He was prepped, draped, and under general anesthesia. Because of poor circulation in his foot, and multiple failed previous procedures to improve blood flow to his toes, we were performing a mid-foot amputation.

“Sure,” I replied.

The surgical fellow had prepared everything for the final stages of the distal foot removal. All I needed to do was finish. And yet the moment he handed me the reins for the remainder of the operation, something flipped inside me, a switch of uncertainty, a bolt of hesitation not relating to the mechanics of what-came-next in a mid-foot amputation but rather to the leg and foot that was having that amputation. I suddenly felt uncertain that we were operating on the correct side. My hands froze. Everything stopped.

Was it too late? I tried to gather myself, to orient to what was happening and to what I should do. We were standing on the brink of surgical no-return. Had we already crossed it? Noticing my hesitancy, the surgical fellow reassumed the surgical helm and deftly completed the amputation. “Sorry but we need to get this done quickly,” he muttered. “This guy’s heart won’t tolerate too much anesthesia.”

The surgical fellow probably assumed that I was tired; I was. He may have also wondered if I knew the surgical steps to perform the surgery; I did. What he didn’t know, what it was impossible for him to guess, was that my mind was racing over and among the previous night’s seventeen histories and physicals, left vs. right visual memories, a flood of paper consent forms and signatures, the process of reviewing consents before anesthesia, and the clear reality confronting me that half of what may have been the wrong foot was now permanently severed from our patient’s leg. I could barely stand. I couldn’t speak. I had no idea what to do next.

Except help the surgical fellow finish. Which I did. Saying nothing. Doing what I was told. Watching the anesthesia team to see if they had noticed anything awry. Scouring my memory banks to try to recall for certain which side was the patient’s poorly perfused one. I let my hands work while my insides screamed and my heart fell closer, ever closer, to the floor.

“Good work,” the fellow said, removing his gloves and gown and leaving the operating room. “Get him to post-op.”

I finished bandaging the patient’s toe-less foot, and then shuffled to the silver tray table where the man’s thick chart lay. Post-op orders were required. I sat on a stool, watched as the nursing staff readied to wheel the gurney to recovery and cautiously opened the chart to confirm what by then I was sure that I knew: we had operated on the wrong leg.

I was wrong. We had performed the correct procedure, and on the correct side.

The ensuing minutes are lost to my memory. I don’t recall writing the orders or leaving the operating suite. My next memory is being seated on the floor of the surgeon’s locker room, my head leaning back against my locker. Even though we had done the right thing, I still felt like I’d made a mistake. When had I first wondered if we were operating on the appropriate side? Had my uncertainty begun in time to have said something?

My pager buzzed. Call the operator. I reached for the wall phone, dialed “0”, and slid back to the tile floor.

It was my father. “Just thinking about you,” he said. Dad knew better than to call me in the middle of the day. I was almost never available. And yet here he was.

“Everything ok?” I barked.

“Oh yeah,” he said. “I just wondered how things were going.”

I wanted to tell him that I was bobbing in a stormy sea of emotion and instability. Instead I muttered that everything was fine. “Long night and day,” I offered.

There was a pause on the line. “Good,” Dad said. “I won’t keep you. I know you are doing important work.”

Important work. I was on the vascular service. We were trying to salvage people’s limbs, sometimes their lives, and occasionally witnessing our own wreckage piling up in the wake of our interventions.

“Oh, Mark.” Dad’s voice had that I-need-to say-something tone in it. “Mom and I understand that you’ll probably be too busy to make dinner on Sunday. Just know you can stop by if something changes. We’ll be around.”

Easter week of 1986 taught me many things. One lesson concerned safety checks for patients and speaking up for uncertainty; voice that is unexpressed is compassion that cannot be shared. Never again would I stand still and say nothing if someone’s well-being was on the line.

Another lesson – an insight that I feel as strongly today as I did thirty-three years ago – involved shelter. Somehow my father knew that his son was raw, that he was utterly and completely exposed to the elements of human experience. Somehow he trusted that instinct and reached out when his son needed it most. The young man was lucky that he answered the call.

Across space, and now through time, there can be safety. We need only roll back the boulders that block our access to such sanctuary to feel the peace that is possible in its embrace.