BTW, We Have to Remove Your Feet: Being Mortal, Waking Up, and Dying Together

I had a “minor” surgery last week and was in the hospital overnight for the first time. That’s me in the photo feeling pretty comfortable with a cap, knitted by one of my kid sisters, warming my bald head.

Meanwhile, I’ve been reading Atul Gawandi’s Being Mortal: Medicine and What Matters in the End. I bought the book about a month ago but mostly it’s sat on the bed stand while I’ve been curious about the mild aversion I experienced every time I happened to see it. “‘Being mortal,’ yeah, I’ll get to that in a bit, but first I’ll read that new book about Dogen.”

This surgery, my experience in the hospital, and recovery helped push me over the edge and through the book.

One of the points Gawandi makes is how the primary goal of hospitals is to keep people safe and alive rather than attending to our wide-ranging needs.

He writes, “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.”

I learned that this is rather enormous understatement.

Let me tell you about the seventy-one year-old guy on the other side of the curtain in our double room. Just after I was rolled up from surgery, a young doctor (and, damn, have people in health care gotten young!) came in to “visit” him. Here’s the dialogue as close as I could remember, recorded about a minute after it happened:

Doc: “How are you?”

Patient: “Okay.”

Doc: “How long were you in the cold?”

Patient: “I don’t know. Read the police report.”

Doc: “I’m sorry that I’m going to tell you some bad news. You need to have both feet removed somewhere above the ankle.”

Patient: “Okay.”

Doc: “We’re transferring you to a recovery center for a couple weeks while you regain your strength and then you’ll be transferred back and we’ll do the operation.”

Patient: “Okay.”

Doc: “So I’ll see you when you get back here.”

Then she walked out. The whole interaction took less than a minute. No one came to check on the feet-to-be-amputated guy for over an hour when a peppy young nurse came in announcing, “I’m here for your vitals.”

“First your vitals, then your feet,” I thought.

While procuring his vitals, she told him offhandedly, “You’ll get prosthetics, so … you don’t have to worry about it.”

“Okay,” he said.

Almost whatever was said to him, I noticed, he responded with a flat sounding, “Okay.” I’m not sure that he understood much, though, and “Okay” seemed to be more of a place holder word.

I learned that this poor old guy had been living by himself in a rural area, taking care of himself, and apparently just by himself. Then his mind started to go and his hoarding behavior extended to include even his own feces. There was no one to check on him with his only relative, an elderly sister, living far away. He reported that he did not have any friends.

Finally, and I didn’t learn how it happened, but the police were called and found him unconscious with frozen feet and impacted bowels so severe he would require surgery.

This winter the Portland, Maine, area had the coldest February on record, during which my roommate had neglected to fill his heating oil tank. “That was my fault,” he said quietly, “That’s on me.”

So when the doctor asked, “How long were you in the cold?” she meant, “How long were you in the cold inside your own home?”

Such tragic and unnecessary suffering.

“For more than half a century now,” Gawandi writes, “we have treated the trials of sickness, aging and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs. That experiment has failed.”

One thing that’s freshly important, given what I witnessed in the hospital and the many heartful, compelling, and detailed stories of the aging-and-death process in Gawandi’s book, is how important community is and how in our culture so many of us are alone.

Judith Simmer-Brown writes in her commentary in the recent Buddhadharma, “We’re In This Together,” “What if we began to think of the sangha as a manifestation of our awakened goodness, waiting to be discovered? In our fundamental connection with each other, that goodness is woven into the network of our relationships, even when it gets tangled up in our habitual neuroses and petty politics. What would happen if we began to trust each other, enjoy our mutual humanity, and manifest our compassionate intentions for community?”

“Yeah, right,” you might say, “I’ve been in dharma communities and they’re full of nut cases.”

Nut cases like us! So many of us interested in the buddhadharma are like Woody Allen who refuses to be part of any organization that would have him as a member.

As if anticipating this objection, Judith Simmer-Brown also reminds us, “The Buddha placed great trust in his followers, so much so that he made community the third jewel, to be honored as much as the first two. Could we not place as much trust in each other as the Buddha did?”

The aging process which Gawandi describes in vivid detail, with the various body systems slowly degrading and breaking down, relying on backups and then the backups going too, awaits all of us who are spared a sudden and abrupt death – the way most humans have died through most of our history.

We’re in this together.

All of our communities call for the resources necessary for rebuilding, not the gutting that some call for while we continue to give more to those who already have so much.

Our dharma communities are one place that can wake up and die together.