“It must be hard to stay balanced when you are standing on the edge of a cliff…”
This was a well intentioned (and poorly delivered) phrase provided by a physician to one of our clients at the time of her new advanced stage cancer diagnosis. In my time at Altamount Hospice, I have learned that standing on the edge of a cliff, can also provide an amazing view of all that is around. It does not have to be a scary place, and it is always helpful to have someone with you – even if just to hold your hand while you take in the view.
When faced with the knowledge of a life limiting illness, people often will react in a predictable fashion. They will experience the many shades and stages of grief. When living with a life limiting illness, people also often will surprise you. It is a unique and sacred time that the typical daily bullshit and inconsequential minutia simply melt away from consciousness. When focused on the simple things that matter most to them – it is amazing how people can make such quick and impressive psychologic and emotional progress.
For those of us blessed to be in the presence of these life warriors, we are allowed to bear witness to the revelation of those things that are both universally and individually important. It is remarkable when someone takes advantage of this self knowledge, and really spends their days living the best way they can. I suspect it is a function of the environment and clientele, but at Altamount everyone seemed to be doing this – clients, their families, and the staff.
In normalizing the certain process of death, we have the ability to provide an amazing gift to our loved ones who remain behind us. We can provide them a model of what bravery looks like in the setting of an uncertain transition. As we move from this world to the next, from life to death, we do not know what we may encounter. But if we have faith in something, a peaceful awareness of what is, and a gratitude for what has been, then we can create and leave and impressive legacy for those who will inevitably and ultimately follow.
I can hardly believe that it has been over eight months since I began to learn how to breathe from these amazing souls. Now once again full of inspiration, I stand hopeful and looking forward toward my path ahead. I will begin my medical clerkships in the coming weeks, with new vigor and perspective for what it means to truly care for my patients.
It is my final night on the island, and we celebrated my experience at the weekly group dinner. It was a glorious sunset that provided the backdrop to what I consider my most memorable night ever. Holding to tradition, I made my way around the large table and thanked each person there with a big hug and a reflection on something they had taught me during my time.
It took me over an hour to make my way around to everyone. At the end of the dinner there was a toast. A “bon voyage” to all those who would be headed out on the next tide. For the first time I would be one of them.
As I complete my current adventure and embark on this next stage of life, I feel an unfamiliar calm and an unusual confidence. In the past, this is where anxiety would take over. This whole trip has granted me a lesson that I would have otherwise likely never known given my past.
If these amazing people could have such grace and strength in their own process of life, death, and rebirth – then I would have missed the point if I did not similarly approach my own transitions in this way.
Tonight, I do not die, but rather I am reborn into a different form. I will forever be affected by this place as I carry forward these lessons of faith, love, and hope. These are tools that will allow me to be a successful man and physician some day.
I am coming to the end of my planned stay on the island. I have stayed a few months longer than I initially intended, but who could blame me. I was able to defer re-enrollment into my third year of school and will be rejoining the class that started a year behind me. I will begin again in late January.
The last few days have been challenging emotionally. It is the first time ever that I have celebrated the holidays away from home and family. It also marked the first Christmas eve that I have left out sunglasses, an energy drink, and a bottle of sunscreen, rather than the traditional cookies and milk for Santa and his reindeer.
During the last 8 months I have developed some general familiarity with the natural history of cancer. Most, but not all, of the clients that I have met while here have had an oncologic diagnosis. I am no expert, but with the limited amount that I have retained, I’m led to the conclusion that poor Rudolph’s red nose is most likely a malignant melanoma. Despite this, all he can do is just keep leading, and giving his heart to everyone else. It may be the eggnog talking, but I think most of the residents somehow share Rudolph’s sense of bravery and purpose.
It is endlessly strange for me to see hundreds of blinking lights rigged up in the palms that sway in the 85 degree heat of the island. It certainly has provided for a wonderful effect. There is a sort of Clark Griswold-esque magic to the decorations that adorn the grounds of Altamount this holiday week. The added touch of putting up and decorating a real balsam fir was an absolute home run for encouraging the holiday spirit. It was donated and shipped down by the family of a past client from Vermont. It was the property owner Johnny who was courageous enough to scale the palms and rig the lights last week.
A sense of indomitable courage is exactly how I would describe one of Johnny Sullivan’s most admirable character traits. Not only am I impressed by the holiday decorations, but by the whole thing he has created down here. It was Johnny who took the biggest risk in the joint venture that was now Altamount Hospice Inc. – after all it was his property.
Eventual business partners, Johnny and Andrew Simon have known several dimensions to their life-long relationship. They were childhood friends, high school baseball team mates, frat brothers at Northeastern University, and now they were neighbors again. At this point, they certainly do not hesitate to wax nostalgic on any of these past incarnations of their relationship. As they had grown up and cultivated mutual understanding and respect in one another, these friends still could not be separated.
Johnny talks about the history of the island, and his land, with any and all opportunities. He will often reflect on his grandparents and their gift of the property. They had willed it to him after their passing. I am sure they would be impressed with what he has done with the place. Now it was a business, an oasis, and one stair step closer to where Johnny’s beloved grandparent hopefully were. Johnny has commented that he once read a quote that the virgin islands was a place where Angels stopped to rest before leaving the earth and heading to the heavenly realm. His place was a literal manifestation of this.
Although he doesn’t have a medical background, Johnny’s business savvy and impressive work ethic serve him well to contribute to the day-to day operations around here. He is really the de facto business manager, head groundskeeper, and superintendent of this place. He stays very busy – and I suppose this is good for him.
It was back a few months ago that during a conversation regarding one of the clients, Johnny confided in me that he is a recovering alcoholic. He has been sober for almost 10 years, and isn’t ashamed to talk about his history. In fact he is, and very well should be, proud of his sobriety.
Johnny attributes the spiritual and physical transformation that he experienced to the purpose and meaning he has found in Altamount. Johnny wasn’t a religious guy. He didn’t follow the traditional 12 step program to recovery, and he certainly didn’t develop a consciousness contact with a specific God. He did make a fearless decision to turn his life around – and in that process, it helped him , and many other breathe easy again.
I recently learning about the importance of taking a “spiritual history” the other day from a visiting chaplain. Immediately I was appreciative of her approach. She told me that it is critical to not project our own beliefs (or lack thereof) onto those we serve.
She commented, from her perspective, “most folks that I see these days were actually believers in some other ambiguous higher power, and not any specific individual religion. ” This developing truth led her to always approach spirituality in her clients by asking the simple question
“What helps you breathe?”
She shared that the word spirituality is actually derived from a Latin word that translates “to breathe”. Used in a different context, also represents the Latin phrase “to die.” It was in this understanding that she found it particularly a helpful approach with those that she supported in the hospice. She could cut to the chase quickly appreciating how to support the life of the dying person she was with.
She detailed that for some individuals, the answer is simply prayer, attending church, or developing and practicing their faith. For others, it is more externally focused by doing good unto others and projecting positive vibrations. For some it gets even more interesting and sometimes convoluted.
After learning from the chaplain, I now have a better sense of how Johnny could have developed the strength to conquer his addiction and maintain a healing inertia. He found his breath in his current vocation. He blended his natural skills and interests, and coupled those with a service that could alleviate suffering in this world. With lungs full of air, he was inspired to maintain sobriety and keep providing this blessed service to the world.
The past seven months I have come across some of the universe’s most amazing souls. Each day I find myself catching glimpses of both heaven and hell, yet somehow I am yet to lose my mind. To tell you the truth, I feel like I am only gaining insight . I feel so blessed to be learning how to cultivate my faith and courage from the world’s best gurus – residents and staff alike.
Of the two physicians, I have been able to connect on a more comfortable level with Andrew. I’m not sure if it is because he is closer to my age, or rather just because he is less weird than Peter. Either way, or most likely both, Andrew’s Tao and guidance have granted me a certain confidence and hope in what I am capable of.
One of the most important things that I have garnered from my time learning with Andrew has been the importance of modeling as a teaching tool. Whether it was an illustration of how to talk to a dying person and their loved ones, or an example of how to effortlessly filet a yellow fin tuna, the method works.
Andrew followed Peter’s lead in becoming a physician, but he certainly followed a different path. It wasn’t until after a long-haired, post-bacculaureate, stent in Nairobi, Kenya (as part of a Peace Corps ), and a subsequent work on an AIDS campaign in Botswana (as support staff for Doctors without Borders) , that he acknowledged his fate as a physician. When Andrew finished his residency in infectious diseases at a Philadelphia teaching hospital, he was naturally drawn to a fellowship in palliative care in Boston.
Given his experiences and training, he thought that perhaps he could become an expert in helping support those living with HIV and AIDS. In Boston, while in the presence of some of the world’s foremost palliative care guides, he blossomed. He honed his craft and imagined his life ahead. As his personal motivation and vocational goals changed after his own fathers death, he became acquainted with the prospect of life as he lives it now.
Andrew has schooled me in much technical and theoretical medical jargon during the time I have been here. In all of the details and different words, the same message comes through. He has taught me the importance of being consciously accepting of one’s own transient nature; in moment, in time, and in life…
Andrew took me out to the mooring earlier this afternoon to help him work on repairing some minor damage to the fiberglass deck on the boat. Last week Peter had allegedly dropped an anchor on deck, and splintered off a good chunk of one of the aft gunwales. After, sanding, painting, buffing, and glazing; he showed me the real project he has been working on.
The “project” started nine months ago while the brothers were on a day trip to Tortola. While there, they stumbled upon a amateur rock sculptor with affinity for absinthe, and a desire to share his craft. They saw some of his work engraving granite, and they had a moment of epiphany. They would work with this guy to create a wonderful and morbid symbiosis.
In the months that followed, the brothers commissioned the sculptor to produce glorious and simple headstones for the deceased. Several of the stones were on display in the local cemetery in St John – others were shipped back stateside to accompany those who had commissioned them. Andrew was very excited about the whole process of learning a new trade and found himself spending more time with the sculptor and learning some of the tricks of his craft. As it turns out, he had his own special project in mind.
The product of his wildly creative endeavor now lies 16 feet below the Caribbean Sea. It lies in the form of a 3000 pound granite block, complete with iron chains and rope attached. This of course is the mooring or foothold to keep the “Aqueous Humor” in place.
Andrew handed me a snorkel and mask from the cabin and said, “take a look at the mooring chains- let me know what you think…”
As I pressed the face mask against the warm blue surface of the water I looked down to see its beauty… The granite block that his boat was anchored to had writing on it – The son of a bitch had engraved his own headstone…
1967 – Son, Brother, Physician, Friend
Andrew Jacob Simon
Float on…
I am still perplexed… When I came up smiling, Andrew shared with me that when he dies he would like to be cremated with his ashes spread at sea. Right there – at the mooring. It was his favorite place in the world, his own personal respite. His wish was to become feed for the fish, and fodder for the imagination of those grieving . He will always be a true artist my mind….
I am slowly coming to the conclusion that working with individuals who are dying is not for everyone. Over the past couple of months we have had a number of nursing aids come and go from their positions at Altamount. I think that a couple of them couldn’t take it emotionally, and another one used the opportunity as a stepping stone prior to heading to the states for nursing school in Miami.
Rita Lucas – our latest nursing aid, has been here for a month now. She and her family reside on the Island. She seems to have what it takes to do well – a lot of heart and patience. Her family has been settled on the island for five generations dating back to the end of the sugar plantation/ slavery era. As a medical student (currently on sabbatical), I feel confident to assume that there is fixing to be a sixth generation that will be coming onto “the rock” in no time flat.
Rita is six months pregnant, and she glows when she smiles. She and her husband Edward live down the street from Altamount in the house she grew up in. They are young parents to be, and they sure seem in love. Edward is always over at lunch time bringing her warm comfort food and fresh water; real sweet stuff.
Rita is the youngest of four girls. She is the only one of her sisters that was married. To say that her family is excited is an understatement. Rita had introduced me to her father one day after we bumped into each other in town. Her father is a large and imposing man with an enormous edentulous smile. He was clearly going to be a proud grandfather – and he tells everyone in earshot about it.
Rita and I are about the same age, and we both have aspirations of becoming physicians someday. From what I have witnessed, she has natural compassion, intelligence, and drive in abundance. I would be proud to have her take care of me someday. I think because of our similar age and professional goals, she has confided in me as a peer about her own struggles in this new position.
While commiserating on the prospects of potential provider burnout, she even introduced me to her “personal therapist”. This analyst is actually her favorite local deer – her name is “Wanda”. Apparently she goes by this name as she has no home and “wandas all over the island”. The doe appears to be missing part of her right ear but apparently she is a good listener. I suppose most animals are good that way.
Wanda is actually one of many feral animals living on St. John. It is not uncommon to walk up onto a group of donkeys, cows, chickens, cats, peacocks, or college age men just milling around. Wanda also happens to spend a lot of time at Rita’s house eating the grass and flowers – much to her fathers chagrin.
There is something very special about the awareness of a new life on its way that is disarming to people. I suppose it leads to really awkward moments for women who are pregnant – like when they are touched on the belly by complete stranger in the elevator. In this often surreal environment of a residential hospice, there is something even more unique and wonderful about the awareness.
With the clients, there appears to be some palpable but unspoken joyful hope that is created when they see Rita waddling about. If even for an unconscious moment, they seem to become aware of the cycle of life, death, and rebirth. In that instant they are free of that existential fear that seeps into every other moment of their days.
Rita’s presence really draws them out – or maybe back in to the world to connect with that life force that wanes within themselves. I have heard some of the clients who are mothers themselves talk of there own experiences to Rita. In a few cases when the clients children were present, it was an amazing conversation bridge.
In this unique atmosphere it is customary to talk about death. It is actually encouraged as a necessary part of the process of transition for both client and families alike. It is an infrequent treat to be surprised by the promise and conversation of new life. Rita is by far the most beloved staff member here by the residents and she knows it. Well at least she keeps reminding me of it.
still waters run deep in Pillsbury Sound
Rita and the clients have also been teaching me how undeniably important it is to respond to patient emotions. I think for her it is easy. She clearly possesses a natural grace. I on the other hand, lack this completely. Although I feel like I am confident, polite, and likable enough, in this environment, it is really all about developing a reflective presence.
As a second year medical student, my previous understanding had been that in the event of a patient spiraling towards death, my inclination should be, “don’t just stand there, do something!” I am beginning to learn it that in the appropriate situation, it can be even more powerful and helpful to “don’t do anything, just stand there…”
I recognize Rita’s skill in listening to the clients – she never interrupts the moments she spends with them to provide some data point or unwarranted explanation. When I watch her, I wonder how many times I have seen patients roll their eyes at physicians rambling on about the myriad of things that could or couldn’t be occurring with their bodies. As if detailing a more extensive differential diagnosis makes them more effective as a healer. It strikes me that sometimes pontificating medical assumptions and diagnostic possibilities are useless to the patients. Sometimes they just need you to be there with them in that moment, to feel safe and well cared for.
Rita has taught me to take my own “emotional temperature”. If I feel it rising, I can use that as a tool to understand what the patient is projecting. Am I feeling anxious, or sad, or desperate – well, maybe the clients are telling me something without words that I should follow up on. In following up, I have realized that coming from a place of curiosity, rather than presumptive understanding is key. I have begun to use the phrases “tell me more about…” or “help me understand…” When assessing the issues that are concerning them.
As I learn more every day, about life, death, and myself, I am struck by the possibilities. These lessons I am learning stretch far beyond developing a skill set to be a better clinician some day. They in fact are making me a better and more engaged person today.
Less than a year ago, I was chin deep in a pile of texts and hand-outs, frantically studying for my neuroscience mid-term. While using a Frank Netter human anatomy atlas for my pillow many nights, I would’ve never guessed that given a year – I would be floating in the warm Caribbean Ocean and enjoying a good novel.
It sure is a whole lot more inviting down here than in the dark and quiet insanity of a medical school library. For some reason, the books I have read on the beach seem to stick a bit heavier to my mind. I figure must have something to do with the added salt content.
The stories that I have really sunk my teeth into lately have been excellent fodder for my imagination. While in the didactic phase of med school, I grew used to painstakingly scouring through waxy pages of thick texts. My primary goal of content memorization. The current set up is so much better. I finally finished Moby Dick, for the first time. Up until last Saturday, I assumed that I had read it, but who was I kidding. I read a weather beaten synopsis, and authored a questionable C+ caliber book report in the 10th grade. As it turns out, there was a bit lost in the Cliff Notes interpretation.
Down here on island the “library” that I have been frequenting isn’t a library at all. My local book depository is actually a sailboat that belongs to a couple named the Moore’s. It is tied up just a stones thrown from the west side of the property.
The Moore’s are based out of Denver, Colorado. Daniel is a well known nonfiction writer, and Judy is a registered nurse. Judy works at the hospice, and is probably the most down to earth woman I have ever met. I have learned there is no bullshitting with this dame. She calls things like she sees them, and sees things like she calls them. Somehow she is generally spot on.
Judy and Daniel have a house on the East end of the Island but spend most of their days down on their beautiful forty two foot yacht. As it turns out, about thirty five of those feet are lined with amazing books. Judy told me there were about 3200 books in total, and they represented the favorites of their “collection”. Daniel jokes that they are their to act as a ballast to keep the vessel upright.
They bought this beautiful boat just after Daniel’s third best seller hit it big in New York. He authored a treatise on the European Union and its effect on the world economy. Despite the academic subject matter in his own books, Daniel was clearly an aficionado of fine literature. He also knows how to enjoy his books. I have never experienced a more amazing place to sit and read a book than on his boat. On-board there are several designated reading areas lined up on the deck and in the cabin. They also have a pretty impressive scotch collection tied down in the galley. That might further explain why Judy sleeps down on the boat most nights that she works at Altamount.
Daniel and Judy split time between the mountains and the sea. Judy has been down since August, and plans on staying through next May. I have to admit I am pretty excited that they both will be here through the end of my experience. I have learned so much from them both already; after only eight weeks. I know there is so much more to come.
Judy blew my mind the other day when she explained how in her earlier years, when she first became a nurse, she worked in the neonatal intensive care unit in a New York hospital. It was here that she fell in love with the vocation of ushering blossoming souls into this worldly life. She was a gift to the children and the parents whom she served for 15 years.
After Daniels writing career really began to take off,she took a break from nursing and traveled with him while he was promoting his books. Judy confided in me recently that she actually stopped neonatology because she and Daniel lost a child of their own during this time. It was too much for her to bear in an attempt to return working with the premature babies. It was far too close,and far to painful for her to continue.
Once she decided to return to work , she did some soul searching (and healing) and was reborn as a adult hospice nurse. Now she has fallen in love with the vocation of ushering blossoming souls faithfully on their course to the next realm of existence. I have never met anyone that has impressed me more than Judy. I believe she is the local shaman – she is a true psychopomp.
Having the afternoon off today, I took the opportunity to row over to the “library”. I was due to return the copy of Moby Dick, and pick up a new gospel of unconscious truth. I was thinking maybe I catch up on some Jack London, but it soon appeared that Jacque Cousteau was more appropriate.
When I pulled up to the sailboat, I could see that Judy and Daniel were busy at something on the swim platform at the stern of the boat. As I approached, they appeared to be removing an injured sea turtle from the grips of a fishing lure that she had lodged in her left front fin.
Daniel pulled the turtle from the ocean and held it on the wet platform as Judy quickly and gracefully cut the barb from her flailing arm. Once Daniel placed the turtle back to her own devices in the drink, Judy yelled over to me… “Hey Mark, Do you think we could convince Peter and Andrew to get rid of intravenous access in all of our patients?”
One particularly arrogant, and seemingly steroid injected ex pat that I ran into at the beach the other day , offered me this gem… “In their thirties, men find themselves; while at the same age, women find themselves losing their minds…”
At the time, I remember a mixed reaction from the group that he was with. It got a good chuckle from the guys, and a “protect your genitals” type of look from the girls. Either way, it started an interesting follow up debate among the group of beach goers.
This initial statement was clearly intended to throw spark towards what would be a gasoline soaked conversation. Reflecting back on my own questionable words, just prior to that fateful bar fight back in Ireland, I appreciate how much influence making a provocative statement can have on an interaction and an ultimate outcome of events.
As now I approach my thirties, my most common provocative statements have been self-directed, and primarily in an attempt to stimulate the way to “finding myself.” My faith remains that it will be revealed, but my anxiety and awareness is constantly challenging this hope. I’ve done the right things, and fortunately developed more positive than negative impact around me. As I become more familiar with my true self in time ahead, I pray for serenity.
During his thirties, Matthew James found himself achieving all he ever wanted in life. He had a strong marriage with his beautiful high school sweetheart, Wendy. He had an energetic and talented daughter in Sarah. He practiced a vocation that paid him more than he thought he deserved, and he loved it.
As the years passed, the walls of his once magnificent psychic castle started to crumble and fall. I guess the decay began shortly after Wendy died in that horrible car accident. Matthew had been left to pick up the pieces, and put them back together again for the sake of his family .
Now here he was at forty one, left with little more than the poignant memories of his long lost wife, and now his recently deceased daughter. He is a desperate castaway barely surviving on one of the universe’s most isolating landscapes, an island.
For the past seven months Matthew has lived here at the hospice with purpose. He has lived with steadfast resolve to focus his attention towards being present for Sarah. He knew she was dying, and needed to do all that he could to make sure that she wasn’t scared or suffering; regardless of what he might have been feeling. This was his way with her. It always had been . I am sure any father would be as protective. In her younger years his job involved ridiculous work hours that didn’t leave much room for ample quality time at home. Maybe he was even making up for opportunities lost in the past.
It has been just over three weeks since his beloved daughter Sarah surrendered to her earthy afflictions, and died in his arms. It is strange for me to consider a death beautiful – but hers somehow was. As peaceful and controlled as her passing was, the realization of its finality is now almost too harsh for Matthew to bear. As the days wear on, it appears as though he can barely muster the energy needed to breathe. His spirit has been deflated. Now only a rubbery form of what it was before, he finds himself unable to move forward. I feel so bad for him, but I have no idea what to say. It is just so awkward.
Matthew and Sarah had been living in another of the small one bedroom cottages on the property. Although it has been weeks since her passing, he still remains in it. He has paid the Simon’s for his extended stay, and is trying to pull himself together before the return flight to California. I think he’s only coming out for meals, and occasionally at night to sit on the bench overlooking the bay. Now that his daughter is gone, his cause is seemingly lost. I worry that his mind may be following close behind.
Judy, one of the awesome nurses that works at Altamount has been trying to talk with him daily and offer bereavement support. It has been impossible for him to accept this offer as his despair has begun to slowly but sharply transform into resentment. As patient as Judy is, she is getting pretty frustrated with him. She asked me today if I could try talking with Matthew. I reluctantly accepted the task, and put it off all day as I searched for the least uncomfortable words. It turns out there are none. All words that I can think of are inappropriate and feel awful. I was operating at a loss all day.
Embarrassingly, to be honest I’ve found myself avoiding interactions with him all together recently . It is hard even to think about what he must be feeling. In the 6 months that I have been here, there is a depth of cumulative grief that I am amassing. I am aware of it and it is tightly packed right under the surface of my consciousness.
Selfishly I feel like if I start to talk to him, all of my own grief is going to come pouring out – and shit, I need my head to be straight this week. I finally got a date lined up with this sweet Raven haired waitress from Tennessee who just moved to the island. The last thing I want to do is give her the impression that I seem as insane as I currently believe that I am.
In an effort to make my job a bit less stressful, I grabbed a book from Peter’s office concerning the bereavement process. It has been helpful to read. Although many of the concepts outlined are fairly intuitive, I wish I had access to them years ago.
In reading through it, I have learned that while there is no standard for what is healthy and unhealthy in the bereavement process, there are some warning signs of poor adjustment to be mindful of. Coping by avoidance works for some, as it minimizes early distress, but it places the griever at greater risk down the road. I gather that this is how Matthew dealt with his wife’s untimely passing; and now the total loss of his once perfect family seemed exponentially more painful.
I also read that the when the grieving person loses the ability to carry on daily activities, therapy is often needed. This early grieving process becomes critical, as it has been found that those who function poorly after a month of their loss often fail to regain normal function for a year or more….We were coming down to the wire with Matthew.
You also have to be aware of the potential for the bereaved to develop physical ailments, as there immune system is also negatively affected. I pray that some of the anticipatory grief work that we had been doing with Matthew starts to come to fruition, as often the best treatment for the debilitating effects of loss is prevention.
It wasn’t until about eleven o’clock at night until I saw my chance develop as he emerged from the cottage. He quietly sat slumped in the white plastic patio chair by the front door. He was lighting what looked to be a cigarette. I took a deep breath and made my way over slowly…
My opener was lame at best, but it got me through the first terrifying pangs of my own anxiety. “I can’t sleep either Matthew.., mind if I sit?”
He glanced over with glossed eyes and shook his head with affirmation… Everything I wanted to say suddenly oozed out of my brain and dribbled onto my shirt’s collar. We sat in silence while he smoked… It was perfect.
I began to think of what the most helpful thing a friend of mine had done after I received word that my father had died. It was just sitting with me, nothing else… This would be my strategy. I thank God it worked then, and I think it did again tonight…
We must have looked out over the water and star speckled horizon for at least an hour before a word was exchanged… It seemed like an eternity… But it felt ok. Slowly, as my own anxiety abated, his seemed to follow suit.
“You know, Mark, I’ve been asking myself if coming down here has been worth it,” he offered.
“What do you mean?” I posed.
“It’s not about the money, or the services, because everyone has been great… I have appreciated all of it; but getting as close to her as I did the last several months makes right now so much harder… Sometimes I think I could have benefited from some respite by working if I were at home in California for all this.”
I hesitated, “Yeah, but there must have been a reason that you wanted to get here when the shit was hitting the fan…”
“There was…..” he said. He left it at that…
I did not pursue further. I just followed his lead, and looked up at the sky. Without the orange hue of city lights, the night’s sky was sharper here than I guess just about anywhere; between the moon and the clouds there was fodder for any imagination… I quietly was embraced by the knowledge of my previous conversations with Sarah and her take on the view.
It’s been almost four months since coming ashore. I can hardly believe it. Although I’ve been sort of a shape-shifter when it comes to my role here, I have also been able to get a reasonable amount of practical medical training accomplished. I realize how am lucky I am to be be a learner in the presence of the Simon’s, the staff, and these residents alike. I am feeling quite blessed that this unique experience is going to eventually help me to become a better physician someday, somehow.
I think about the limits of my previous “patient experiences”, and consider how much I have yet to learn. Granted that I am only headed into my third year of medical school, I recognize the lack of exposure that most of my classmates and I share. Most of us have primary experiences afforded by some bullshit EMS class we took as undergrads, or in the form of a personal presence during a loved one’s decline as they passed away in some dimly lit hospital room. Some of us have our own medical issues that paved our path into medicine. Now this here, this was something different. Something real. Something poignant. When faced with the end of life, it is amazing how these residents cut right to the point. All bullshit is shed and only what matters is focused on and discussed. I wonder if all medical students should be started in a place like this -to see what we are trying to save, and how it can be when we don’t cure or fix someone.
An infusion company representative was visiting today from San Juan, Puerto Rico. He stayed for dinner and gave a presentation on his new drug delivery device / IV pump. he versed us in the intricacies of subcutaneous infusions for medicine and fluid delivery to patients with difficult intravenous access. As it turns out, a very appropriate topic for a hospice lecture. The only thing I knew about it before today was that I had a cat named Stanley who once needed this set-up when he got really sick. Good old Stan – he was a hell of a mouser, but he certainly didn’t stand a chance against the speed of that mail truck.
There’s nothing quite like a side-dish of salesmanship to compliment a nice steak dinner. This concept of powerpoint by candlelight is a combination that I am sure I won’t soon forget. Tonight’s cuisine was crafted by Jamie, and offered by Natalie Bartolli, one of the residents. The entrée was called Bistecca alla Pizziaola, and with a name like that, it was as good as it sounded. Natalie suggested this classic Italian dish the other morning during the clean-up after breakfast. Since then we all had been anticipating its greatness.
Tonight we were not disappointed. Placed together with a grilled steak, grilled tomatoes, and a load of herbs fresh from the garden, was an amazing fettuccine. If that wasn’t enough, a cappuccino tiramisu was the desert. I think I ate too much. Perhaps if I ran back the sales rep may have some free samples of insulin or a antacid to take. As I am back on my computer now, tucked into my bunk for the night; my blood sugar rises and my sedation peaks. My usual angry stomach rumbles have quelled to the occasional shrills and squeaks of pure intestinal delight.
In preparation for the evening’s meal, I was able to help Jamie in the kitchen by washing and cutting the herbs an vegetables. I also was tasked with puting together the salad course. All of this was done under the careful watch and direction of our culinary consultant for the evening, Natalie. Making my way around the kitchen with Jamie and Natalie, it struck me that given a few cameras and a live studio audience; we could have a pretty kick ass cooking show from this place. Maybe we’d call it “Death by Chocolate,” or some more euphemistic play on words that could represent who we all were in this time and place.
The only way I can describe Natalie Bartolli is by reflecting on my own stereotypes of a third grade school marm; aged beyond her years, and with a certain warmth only granted to those who she is teaching. It wasn’t until I was slicing the tomatoes the “wrong way” that Natalie has spoken directly to me since coming here a month and a half ago. “Lengthwise, not width-wise” was the lesson for the day. Maybe she was right, it did look much better…
Reading through all of the residents medical records upon arrival was now a part of my learning. My chart review and subsequent discussion with the Simon brothers was all I really had to base my personal opinion of her on. On paper, she is described as a sixty eight year old woman diagnosed with, and treated for, metastatic ovarian cancer. Since the time of diagnosis two years ago, she has received multiple chemotherapy regimens and a few courses of palliative radiation therapy to her pelvis, where there is significant tumor burden. Her other past medical history is significant for fibromyalgia, depression, anxiety, and post traumatic stress disorder spurred on by childhood sexual abuse perpetrated by a family member.
As I read through years of this woman’s medical treatments and examinations, I have been introduced to the jaded view that doctors must have of unknown patients when they first come into their office or hospital. Many might have a hard time getting past her fibromyalgia and mood disorders ( as manifested in her affect). I could see her just getting written off as initially crazy, or someone who couldn’t be helped.
Sure all this bad stuff had happened to her in her lifetime, but she had also been an amazing teacher for forty years. Nothing mentioned about all that… I am sure there are hundreds, if not thousands, of people that look back fondly on Ms. Bartolli and her giving presence. Unfortunately there is no ICD diagnosis code for the important stuff.
I was really stoked that everyone loved the meal… As usual, Jamie deferred all compliments to Natalie. Even though anorexia was a symptom that Natalie was plagued with, suffering with recurrent malignant bowel obstructions secondary to the tumors in her belly, she was able to sample a taste of her own creation and agreed heartily. I could see the satisfaction on her face as she watched us all eat what she had created. I am sure there is an immeasurable sense of being, when you can create something in the setting of internal destruction.
Selfishly I hope that given Natalie’s predilection for teaching, I can get to know her better… Part of my intuition leads me to believe that because I am a young man, I may remind her of past atrocities that she had experienced….
On a night like tonight I look to the heavens and thank God for our also human ability to create. In whatever form or product that results, it is a great sense of pride.
Natalie’s meal
Entered weeks later (September 6, 2008)
We toasted before our meal tonight in honor of Natalie Bartolli. She had died peacefully with the staff sitting vigil around her, and ushering her into the next world. We all had become her family. She passed calmly after becoming septic from an infection that we presumed came from a perforated bowel. In the days before her death Natalie had some profound insights that she was quick to share with us.
In her final hours, she was able to detail what she was physically and mentally experiencing. She detailed her thoughts of what was happening in her body. We followed her lead and listened in awe. These descriptions and reflections were not only helpful for us managing her symptoms, but also for her in ascribing meaning to what was occurring within. From what I have learned, it is not uncommon for hospice patients to experience this blessing in their final moments.
This self awareness at the end of life is coined “near death awareness.” It is a phenomena that can manifest in many ways. In Natalie’s case, she was at first very specific and tangible with what was occurring, and then it progressed to more symbolic descriptions.
When she detailed the presence of her grandmother outside the window, I was reminded of a similar “hallucination” my own mother experienced before she died. Natalie also told us of her own visual perspective changing to that of her experiencing the room from a few feet above her own bed. She even joked that it felt similar to the time she “mistakenly” dropped acid as a college student in the 60’s. Moments before she died, she told us all that she was ready to go home. As she reached out her hand, we all knew what she meant.
Natalie’s death was a beautiful experience. As morbid as that sounds, I feel like I am immediately less fearful about what happens next. I can only imagine what would happen culturally if people saw moments like these, and understood there significance. Perhaps we would all be consciously reborn and work to treat death in a way that accepts it as part of life. Rest peacefully Natalie – thank you.
There’s a strange phenomenon that I am becoming acutely aware of lately. It involves the random airing of particular songs that come onto the nearest radio during the most opportune moments. The most poignant, I am sure, have gone unnoticed; though as my awareness is heightening, I am recognizing these synchronistic moments occurring more and more. Either the universe is conspiring to reveal something, or quite possibly I am going bat-shit crazy.
At the bar the other night, I was talking to this gorgeous girl who was vacationing on the island with her friends from Manhattan. They were there celebrating some sort of post collegiate spring break reunion. At the peak of our slurred conversation she told me about her irrational need to always wear her favorite Yankees T-shirt inside-out for home games against Boston.
Just then – Stevie Wonder’s Superstition came on the juke box…. Being a Boston sports fan, and having my own illogical beliefs about what I can do to help the teams win, it was perfect timing. My earlier decision to not wear any underwear (to help the team) was not in vain. We watched the game together and the Sox were up when I headed home later that evening.
This morning, I was talking to Jamie Sullivan about her time on the island. She told me about how her parents used to bring her here as a kid. She reflected on how those early experiences led her to pursuing her escapist fantasy with her now husband Johnny. They first came to St John when they were 21 and just out of college. As she talked, a similarly well timed tune made its way from the ragged looking FM radio propped up on the kitchen counter. Kenny Chesney’s Girl from Boston played across the static of the local radio station. We both sat and listened. According to Jamie, the song could have been written about her…It somehow made perfect sense.
Jamie is a thirty six year old woman, originally from West Roxbury, Massachusetts. Since the inception of the hospice, Jamie has utilized her sociability and love of the culinary arts as the head chef, hostess- extraordinaire, and part owner of the facility.
Jamie and her husband Johnny, certainly never could have envisioned their lives would have unfolded as they did, but Jamie seemed truly content. She had purpose, lived in paradise with her soul mate, and selflessly gave herself to healing the residents’ weary hearts – one fresh baked chocolate chip cookie at a time. Her philosophy was that if you kept the smells coming from kitchen inviting, then people would feel real nice about coming home.
Apparently this was also the way Jamie met Johnny back at Northeastern. She baited him into her dorm’s kitchen by wafting the smell of fresh baked brownies right up to the men’s floor he lived on. Obviously Jamie also was a believer in the adage about getting to a man’s heart through his stomach.
For all intents and purposes, Jamie is the matriarch of this extended family. She loves everyone with a the selflessness of a mother, the fierce advocacy of a sister, and the loyalty of a best friend. Johnny is one lucky guy. As their Love appears to have been created in the heavens, I bear in mind that so too is thunder and lightning.
In the past months, their “lover’s quarrels,” have been picking up in frequency and publicity. Jamie confided in me that that she has been stressed, and feels like she’s been instigating trouble with Johnny. She couldn’t come up with a good reason for why though. We talked for a while about it on the way into town to go shopping for the day’s grocery needs.
It must have been the eggs… Once we started to examine the boxes for an appropriate dozen, Jamie began to think out loud. “This book I’m reading says that I am getting caught up in ‘senescing experiences.’ It says that I am imposing an inner turmoil to help resolve my ambivalence towards becoming a great chef with my own restaurant, versus my hope of being a mother and raising kids. I think that’s why I’m getting so worked up with Johnny; he’s so aloof about it all.”
For maybe the fiftieth time since coming to the hospice, I felt like I had stumbled into a conversation that was way out of my wheelhouse. From what I’ve heard, Jamie had followed her dreams by getting married, and then coming to the island… Now that she was here and settled, and beginning to see that the territory she was in was no longer the same fertile ground for change, she was now engaging in a reappraisal of her situation.
I suppose on some level this was happening to all of us – residents, staff, natives, ex-pats, and tourists alike…
All of us are constantly moving forward through these new cycles of change and personal evolution. We progress onward, exploring new possibilities and finishing up old business in the way of our future. Sometimes it gets hard to keep the momentum of this personal inertia moving when we’re alone. If we are lucky, then we can ally with friends and loved ones to get a push to keep us going ahead…
It felt good to be Jamie’s friend, even if it just meant listening…
When we got back to the villa we unloaded Jamie’s Jeep, and brought the groceries up to the kitchen. This area is Jamie’s sacred space. There is no tolerance for disturbing the peace… To prove it I still wear a now bruising welt on my arm inflicted by Jamie’s sharply whipped spatula. I received the stinging red surprise after instigating a water fight last week while on dish duty. It was awesome. I definitely didn’t win, but it was a glorious post dinner ambush that caught her and Johnny off guard. It was all in good fun, but shit, that girl’s got quite a backhand,– I wonder if she plays tennis.
As we unpacked the gorcieries, Phyllis and Natalie came strolling into the kitchen. The were prepared to sit and inspect our local grocery purchases. There is always someone hovering around the center island here, pulled up at one of the counter stools (“just supervising”), or more often actively helping Jamie out with her culinary duties. The two residents had plans to help Jamie cook dinner tonight…
“Helping with dinner” usually involves the older ladies sitting and talking Jamie through the process. Though Jamie’s an excellent and acclaimed chef in her own right, she also does a beautiful job playing dumb for the ladies amusement. They both have their unique recipes that they share in order to craft a few meals for group dinners.
It is clear how much this simple act of cooperation means to all of them… The passing of stories, traditions, and love across this kitchen counter is absolutely the best appetite stimulant anyone could create. Quite possibly the conversations in the kitchen also the most ideal social outlet for them as well. I suppose there is something universal about this room that brings people together. Though cachectic and anorexic, and often feeling isolated in their own suffering, the residents always have better nights when they get together i to participate in the creation of a meal.
It was in my junior year of college when I first began to meditate; in the eastern sense anyway. I remember that at first, it felt much like the Christian prayers my mother would have me say as a youngster before bed. These meditations too were complete with random forays into mindless rumination about nothing in particular.
Both reflective modalities provided a meandering riverbed for my flowing stream of consciousness. The trick was maintaining on course. It was about that same time that I first began to value the undeniable effects of stress on my body and mind.
Like most of my contemporaries the majority of my time as an undergrad was spent trying to figure myself out. I was just starting the struggle to understand the world around me. Some peaceful deep breathing was probably the healthiest of my coping strategies. The practice continues to help. Often still, like a diver adjusting his depth in the water, when I need to regulate my psychic buoyancy, I sit quietly and alter my breathing in an attempt to balance myself in time and space. One foot in the future, one foot in the past, and body steady in the present.
This morning was one of those times that self regulation was called for…
I walked down the well worn footpath to the sand at the water’s edge, and sat quietly. I’ve found that it’s always easier to collect myself when I am inspired by a natural view. As I settled in, waves of unnamed restlessness and irritation were crashing over and over again in my head. When the frequency and amplitude of these waves increase, I find it harder and harder to get back to the safe harbor of a quiet mind. I tried to synchronize my respiration to the lap of the warm water breaking against the rocks, and rushing over the sand by my feet.
Between internal screams of frustration, I began to regain calm. I noticed the client Tom making his way down to the beachfront. He seems to spend an inordinate amount of time down on the dock. Whether it be reading a book, writing into his journal, or just sitting under the cover of a white canvas umbrella; he’s always reflecting on this water.
Thomas Djarvek is sixty six year old retired army captain, turned landscape architect from Arizona. He found his way to the hospice, after brachytherapy, surgical resection, and a course of chemo, and biologic treatments failed to quell a progressive prostate cancer. The multifaceted attack on his cancer was profoundly successful in making him a frequent flyer at his local oncologist’s office.
Tom had struggled with many things in life, and now the repercussions of past battles were somehow influencing the ones he was facing now. Part of his past medical history involves toxic exposure to Agent Orange during the Vietnam War. Now he was one of the ill-fated tens of thousands to be feeling its devastating effects some forty years later.
“Agent Orange” was the handle given to one of the weed-killing chemicals used by the U.S. forces back in the days of its use. For over ten years, it was haplessly sprayed from planes, helicopters, and spray packs to clear dense Vietnamese jungles. This was in an attempt to remove leaves from the thick foliage that enemy troops hid behind. One of the chemicals in this deadly mist contained dioxin, a particularly nasty carcinogen that has since been related to several types of cancer and other maladies. Tom is of the minority of effected veterans who actually receive the VA benefit for the suffering related to his exposure to war. It was hard for them to deny his individual claim; after all, as a chemist he had been one of the unlucky servicemen enlisted to prepare the devastating cocktail.
Being the intuitively warm and social guy that he is, Tom made his way over to where I sat … “I don’t mean to intrude Mark, but I could see that your aura was off at breakfast this morning; everything alright?”
I hesitated for a second; after all I was rather surprised that he could recognize my inner discontent… “Yeah, I think so; I can’t quite put a finger on what I am feeling. I came down here to sort myself out a bit…try to give it a name or something…”
Tom replied with a modest and knowing grin , “I know how it is man, I do the same thing; couldn’t be a sweeter place to turn your focus inward… Just gotta keep track of your time in the sun, double edged sword for us gringos. That shit will give you cancer you know…” I looked over at him and smiled while holding up the sandy bottle of Coppertone.
“Tom, you’ve been here for over a month now, looking around it may seem like a stupid question, but are you glad you came?”
“Absolutely, my pain was getting terrible at home, and I couldn’t work anymore. It forced me to go to see the doc way too often…I was losing track of myself as ‘Tom the successful and happy landscape architect’, and was beginning to identify myself by my cancer. Everything that I was doing was becoming centered on it. I was tired of the amount of attention my God damned prostate needed; it was beginning to feel like being back with the ex- wife…” We laughed…
He continued, “plus every hospital, clinic, and support group that I went to was filled with guys that all looked like my friends down there at the VFW. I couldn’t help but feel responsible for all that suffering ; nope, way too much…” he hesitated. “I mean fuck, after all, I was the guy that mixed the shit up over there. I had to get rid of triggering those awful thoughts, I’d tried everything else, only thing I could do was get away.”
“How are you doing with it so far?” I asked
“Well, I realized that the triggers are everywhere, in the trees, on the boat, in my mind… I’ve tried to forgive myself for what happened, but this sadness lives on a different level, it always has…It won’t die. It won’t go away… In some ways, I think my mind is convinced that it’s committing suicide whenever I try to forget what happened. Seems like the memory itself has some notion of self preservation… It really is psychic torture.”
“What helps you breathe easier?” I followed…
Tom thought for a minute and replied with a questioning sarcasm, “A fifth of vodka and a big joint…. Well, not anymore… I stopped all that junk twenty some odd years ago after the divorce; but it really worked… until I regained a healthy consciousness anyway.”
I could certainly understand what he was saying; hell it was only three short months ago that I was testing that same hypothesis, retreating from my own despair…
“What about meditation, I see you down here all the time on the dock; can I assume correctly that’s what you’re doing?”
Tom shifted this position in the sand, “Much better for you, and a whole lot easier on the body, never mind the wallet… I started in ’71 after I got back from my second tour. I was living in California at the time and there was a lot of this ‘new age’ mumbo jumbo floating around. I got into transcendental meditation for a while -then some Kundalini yoga. I even found myself at an ashram weekly getting advice from some knock-off guru. As it turns out, none of that stuff ever had the same effect if you were also stoned out of your head while doing it.” He pensively looked into the distance…
“What made you stick with it?” I asked. “I mean after you gave up the junk?” I clarified…
Tom went inward for a minute, and I thought he was getting tired of the questions. When his focus returned, he asked if I wanted to hear a story. I turned my shoulders towards his, smiled, and he spoke…
“Back in the early eighties, I went to India on a bit of a spiritual journey. It had been about a decade since being in Asia, and I thought I’d find the balance and an answer; the proverbial yin to my yang. I found out some truths alright, but none more poignant than the use of being centered… When I was there, I met this real cool cat in Bombay; what’s now called Mumbai… I’ll never forget his mug, or his lesson… He went by Ramesh… He was an unassuming guy who was a professor at some medical school over there… Basically he detailed a story about when he was a boy. The town he lived in had a festival every year to celebrate the Lord Ganesh, one of the Hindu gods revered as, among other things, the Remover of Obstacles, and the Lord of Beginnings… You’ve probably seen pictures of Ganesh – deity with an elephant head… Anyway during this celebration, they would march decorated elephants in procession down the city’s narrow streets, leading them to the town center; to the marketplace plaza where the festival would kick off and eventually come to a close… For years they had so much trouble with the elephants. They couldnt walk them through town. Every ten God-damned feet, the things would stop and grab some item belonging on one of the street vendors’ displays with their curious trunks. A shiny piece of jewelry here, a ripening melon there… Slow and unsteady was the pace. After a few years of this pattern, it became a joke. The fucking elephants never even made it to the plaza; it kinda blew the punch line, you know?”
I was entrenched in the story, and he enthusiastically continued…
“So this one day, a sage comes down from the mountains just before the annual parade… The town elders who were looking for a solution approached him. They tell him of the difficult time they are having with these enormous mammals, and keeping them on track… Sure they could throw a dress and some make-up on ‘em, but they couldn’t make ‘em dance…”
At this point I was trying my hardest not to laugh; but he was so serious about this story…
Tom continued, “The sage thought for a while, and then gazed at a tamarind tree that one of the largest, and most wild, elephants was secured to… He walked right over to the tree, snapped off one of the branches, and handed it to the curious giant… The sage suggested the handlers then do this same thing with all of the elephants…Wouldn’t you know it, when the parade began; those elephants marched swiftly, and with more purpose than ever before… They were tempted by their natural curiosity, though always focused on that damn stick… They made it alright; right to the plaza in record time, and with record turnout…Times were good, and again Ganesh was the hero. They partied and the festival was never better…”
I sat stupefied, and sure that I missed something in his story… As if the look on my face didn’t already beg the question, I blurted it out, “What does all that have to do with mediation Tom….I think I lost you?”
“That’s what I said too Mark.” He encouraged…
“So this whole story, he tells me, is a metaphor relating to meditation… Those wild elephants and their distractions represent our clumsy and large minds, always tempted by the next fleeting thought… The tree branches that they clutch represent what meditation is. A simple tool, always in our reach, that can provide among other things, a ticket to the party. You know a device to re-focus your ever fleeting and wayward mind upon.” He continued, “just gotta make sure that tree branch isn’t a drink, a pill, or some other shit that’s no good for you…”
We both had a solid laugh, and then sat quietly enjoying the air… “Thanks Tom, you’re a good guy, a weird guy – but a good one.” I said.
Without fail, every Sunday morning one of the Simon brothers will row out to the white ball mooring just off the western point of the property. They head out for a day of fishing, cruising, or escapes to nearby beaches aboard their 1981 Chris Craft Catalina. This is a twenty five foot cruising and fishing boat that they had purchased together in Maryland when they graduated from college. They had it shipped down to the island soon after moving here.
Although it doesn’t have an official name stenciled onto the stern, I’ve heard them refer to it as the “Aqueous Humor.” This boat has been their sanctuary, their respite, and their bliss. It has been something they describe as always available to recharge their psychic energies after a taxing week. So long as it wasn’t breaking down.
As I have noticed, Sunday evenings always make way for a remarkable time to chat with them when they stumble up the hill carrying a fresh catch and a fading buzz. On occasion, some of the clients and staff will join their days’ fun; but it seems that most take care to respect the docs’ Sunday space. Andrew says time on the boat is his preferred version of “going to church”, it achieves a similar connection to God, though with far more more wine available.
Today after breakfast, Peter invited me to join him on a morning fishing trip to a location referred to as “The Shelf.” He billed the impending adventure as a “serious wahoo hunt.” How could I resist… It sounded like an opportunity I could get into?
Andrew couldn’t make it out today, as he had plans to accompany a client over to St Thomas for a scheduled intrathecal pain pump placement procedure. Peter needed a strong deckhand – presumably to help with opening the beer bottles and baiting the lines. Fortunately I was totally available and happy to join the crew.
On the way out of my cottage, I grabbed my sandals, my wallet, and my now trusty sunscreen. I filled up my water bottle with a pile of crushed ice, and added a fresh side of a cut lemon left over from breakfast. I figured it would protect against scurvy in case we got lost at sea. I wanted to be prepared. I wanted my next merit badge.
When I met Peter at the shoreline, he had already prepped the vessel, the lines, and the coolers. I knew this was going to be a big trip. With a five day old beard, an unenviable case of bed head, and a torn Hawaiian shirt; this guy looked like a fisherman who I could trust.
On the thirty minute trip to the hallowed fishing ground, Peter told me a bit about himself in terms of his adventures behind them helm. He told me about an epic struggle against the ill tempered and snaggle-toothed monster bluefish on Cape Cod. He described a fatally flawed oar-powered charter of Key West. He even detailed a story that reflected his own heroism during a hurricane in 1991 that was later dubbed “the perfect storm…”
I guess he figured I hadn’t seen the Mark Wahlberg / George Clooney movie. I grew up in Massachusetts, and I could clearly see that this guy wasn’t a Gloucesterman; not even close…
What I do know is that Peter Simon is a medical oncologist by training. He is single, and he appears to be in his early fifties. He and his brother Andrew established Altamount Hospice Inc. as a joint business venture almost seven years ago. They embarked on the project after both had taken sabbatical from their respective medical practices to complete further training in palliative care.
They too had been inspired to appreciate the utility of this discipline after bearing witness to the death of their respected father. He had experienced a torturous struggle with the diagnosis and treatment of a metastatic head and neck cancer.
The unrelieved symptoms and hardship that his illness revealed made Peter and Andrew question their own professional focus. It was some time after Mr. Simon had died that the brothers took a solemn oath to heal themselves, and create opportunities for others healing as well. They had realized the ideal way to spend life’s waning days; comfortable, in paradise, and with dignity intact…And if possible, with a rum drink nearby…
Peter and Andrew had spent their formative years in southern Maryland, as their father had been an instructor at the US Naval Academy. It was there they had known Johnny Sullivan. It was destined that Johnny found himself as their third musketeer, and balance to the brothers’ dynamic. In the years following their adolescence, they all would follow different career and life paths until they fatefully reconnected on the island.
Johnny and his wife Jamie had inherited the property in the 1990’s from his grandparents (before the island was popular among the East coast masses). They initially spent their efforts trying to build and improve it. It was a dream come true for the both of them. The villa that Johnny’s family left them was run down, and no one had lived in the cottages for years. When they first started out down here, they were camping on a withering investment.
Rising costs of labor, supplies, and recession gave the Sullivan’s a very grave look into the future of their island dream. They prepared themselves to sell the property in the late 1990’s as the taxes and electric bills alone were becoming more than formidable with each month that passed.
Things were looking very bleak for the property until serendipity floated ashore aboard the incoming ferry. It carried the physicians, their hope, and a idealistic vision to build Altamount. With the partnership of the Sullivan’s, and an impressive financial backing of their own, the Simon brothers set out to transform a shared dream. In the process they solved their desperate friends situation, and transformed it into into a thriving new business.
The carpenters returned, and work resumed. Before long they had a business plan, a quality product, and enthusiasm to change the world. After some well placed advertisements in reputable stateside magazines (and a talk show appearance that Andrew arranged), clients began to drift ashore. The rest was history. I had heard the story recently but I wasn’t interested in the details of it today. Today was about fishing.
on the way out
Once we were off shore we set the lines and trolling began. Peter reached into the cooler, pulled out two Carib beer bottles and popped them open.
“Here you go Mark, now you’re ready boss…” he chuckled. He turned, grabbed the wheel, and rested his beer aside the now blinking fish finder.
In a moment of relaxed curiosity I turned my back on the bending rods, and climbed up to the bridge. “Peter, listen I really appreciate this opportunity, I’ve been here long enough to know how impressive all this is…”
Peter looked back over his shoulder towards the stern and addressed the wake with a squint- induced smile, “Yeah it’s a hell of a day, lots of fish along this ridge. They float right up to the surface. They’re tempted by those attractive instincts that keep them fed… I just wait for the screaming zip of my line to start, I hit neutral, and then I do what I do best… I catch fish…big ones.”
I thought to myself, ‘wow, what a weirdo this guy is, I was talking about the hospice.’
I said out loud, “Sounds like a plan Doc, let’s get some dinner.” Saying it that way seemed so much easier and appropriate for the situation.
It must have been a solid two hours before I got my call to duty. Using a wire leader with a double hook trap set up and fresh mackerel bait, I landed a bite. “Fish on, Doc,” I yelled.
The throttle clicked and the engine slowed to a hum. The sound of my drag letting loose cut sharply into the salt air. Setting my feet, I gave it hell… It was real ugly, but I certainly hooked the son-of–a-bitch. Peter talked me through the hard parts, and then the glowing yellow fish came into sight.
After what felt like an hour, the fish was reeled in to a distance fifteen yards from the boat. At that moment my line tightened, momentum shifted, and I flailed. Out of the water it jumped, breaking the surface and exposing itself completely to the air for the first time. A real beauty indeed. Just then a sharper jerk directed my rod to the port side, and my line went loose.
I thought the fish must have freed itself with that last effort through the surface. Disappointed, I reeled in while retracing my steps through the lost catch. As the rig approached the side of the boat I was shocked to see that I had actually still had something. The fish was still there…Well, half of it anyway…
For a second I wondered if I was really strong enough to rip a fish in half? As I raised it from the water, Peter looked amused. “Looks like a good mahi… You got the rest on layaway buddy?” He laughed. “I guess the shark out there was hungrier than you today…”
“Story of my life, Peter…” I woefully responded. We reeled in the rest of the line and inspected the remains of the fish. Sure enough, it had been a shark. There in the ripped scales beneath what remained of the dorsal fin was a small serrated tooth. I picked it up and held it to the light. My optimism convinced me that this tooth was the reward for catching two fish at once; rather than not landing either of them. Blind faith and a constant search for a silver lining was also accurate synopses for the ‘story of my life.’
Although the morning hunt didn’t provide dinner for the night, it did provide some good, old fashioned, fun for the day. As we pulled up to the dock, we threw the bow and stern lines to Tom, one of most “healthy” clients at the hospice. Apparently he was playing dock master for the afternoon while reading from a weathered Robert Ludlow spy novel.
“Hi Mark, you look good friend, what’d you catch out there?” He asked while pointing at my widening grin.
“Just some rays Tom.., and somewhere out there, floats the body of a thirty pound headless Wahoo…” I raised my brow to explain my statement, and Tom got the picture…
Peter cut the engines and we unloaded the boat. Now I sit safely in my room, three hours later, and can still feel the undulation of the waves under my feet. Swells of inertia move awkwardly from my feet to my stomach, and eventually spin into my head. I feel like I’m walking on water here. Easily the sensation lulls me to sleep.
Destination Hospice 