Standing at the Edge of Existence

A friend of mine once described to me her motivation for pursuing a career as a criminal defense lawyer: “These [criminals] are people who are alone at the edge of existence. Imagine how frightening, how cruel it would be to be in their position, hated and abandoned. I want to stand there beside them and help them find some peace, help them find what is best for them.” (This is a poor reproduction of her expression which was much more eloquent.) When she spoke these words to me, I knew exactly what she meant: this was precisely what I hoped to do as a physician. In the midst of their suffering, deterioration and pain, my hope is to reach out to my patients in their darkest hour, show them that they aren’t alone, and help guide them out of the darkness and toward their desired destinations (be it a recovered or adapted life or a death without suffering, emotional or physical). Accordingly, I have some inclination toward the field of critical care (or any field where patients have a substantial risk of death). Having known and seen pain, suffering, and death, I feel somewhat better suited than most physicians-in-training toward confronting death or the risk of death on a daily basis.

However, no matter how much death I might see, I hope that I will never be desensitized to the range of accompanying emotions. The end of life can be both tragic and relieving, depending on the ways in which the dying and the living deal with it. Death may bring an end to years of pain from cancer, perhaps if he is lucky, after the patient has accomplished as much as he believes he can in life (with respect to family, work, and personal goals). However, death can also be seen to truncate a life that might have lasted much longer, a life with much potential for bringing meaning to the lives of others. It is this seemingly meaningless shortening of life that makes us sad, because we wonder, “Why did this happen? What did he ever do to deserve this?”

How can we ever understand premature deaths? How can we ever begin to assign meaning or find peaceful resolution to endings so sudden, whether from senseless killing by a deadly virus or by a spray of bullets? We, as a society, have yet to develop a tolerance, let alone an understanding, for the carrier of the disease. It is bad enough to carry a disease in the body, the contagion of stigmatization and isolation spreading with each hacking cough. It is worse still to carry a disease of the mind, especially when our society is so paralyzed by the fear of losing control, for when you lose control you lose independence. The brain is the control center for the human machine, and there is nothing more alien and threatening than a brain gone awry. It took our society so long to begin to accept the idea of mental illness, and the gap between neurology and psychiatry (and the relatively sluggish drive toward unifying the two scientific fields) is evidence of the unwillingness of our society to acknowledge our deepset fear.

As the popular media, in its own disgustingly self-serving way, continues to dramatically villify and demonize the one man we would all like to hold responsible for this most recent tragedy, the nature and source of the disease suffered by this carrier remains elusive. That may be because we don’t want to see it. We live in a society that fails to both properly mediate the effects of stress and properly address the treatment and management of mental illness such as depression and anxiety disorders. [Current theory suggests that chronic stress leads to elevated levels of cortisol which may cause irreversible toxic damage to the hippocampus and amygdala, affecting the emotional processing functions of the brain and inducing the development of clinical depression.] However much doctors may attempt to treat disease, all efforts may be meaningless in the long term if the progenitor of the disease remains intact. That is, we may be able to treat depression, but the positive effects of these medical efforts may be thwarted by a society that stigmatizies, isolates, and alienates. In some ways, he carried not only the contagion of his own self-made frustration, but also the anger of isolation bestowed upon him by each person who neglected to see beyond their own needs and interests at someone who needed help. The price? Outbreak, and the death of so many people. There is so much regret that can be felt in so many places; what could possibly have been done?

On April 16, a Virginia Tech student murdered 30 people and took his own life. Since January 1, there have been at least 54 victims of murder in the city of New Orleans. To date, the United Nations estimates that 450,000 have died of violence or disease as a result of the genocide in Darfur, Sudan. These are presented in order of the magnitude of popular media coverage and their stimulation of the national consciousness, from most to least. Nonetheless, regardless of the magnitude of the numbers of deaths, all of these are incidences of senseless violence. How do we respond? With apathy, with tears, with anger and bigoted rage? To Monday’s killings, ignorance may make excuses and say, “He was clearly messed up.” To the murders in New Orleans, ignorance may say, “They’re just gang members and drug dealers killing each other.” To the killings in Darfur, ignorance may say, “Where’s that?”

It’s easy to want to forget, to not acknowledge the apparent sadness in light of your own life and your own occupations. However, by cutting off emotion, by ignoring that which begs for your attention and sympathy, you are taking the first step toward letting history, and tragedy, repeat itself. We cannot cure our society of its ills if we fail to acknowledge our own collective failures: they are our own, not those of someone else, because we share in the blame and the responsibility. If not with the downfall of this individual, perhaps with another.

To this effect, I would like to take one small step toward making known the story of one individual and his efforts: the Virginia Tech professor who barred a classroom door to give his students time to escape while he himself was killed. The professor was a Holocaust survivor, and one might wonder with a terrible feeling of sadness and futility, “He survived that in order to die like this?” I think that if this man were to look back on his life, regardless of his other accomplishments in the interim period, he might say in response, “I was saved so that I may save the lives of others.”

Knowing this, knowing that this man gave his life to save others, might you be willing to be overwhelmed with sadness at this moment and resolve to do what you can to make sure that this tragedy never happens again?

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