Imagine

John Lennon's "Imagine" speaks of happiness and a peaceful existence. It speaks of the world being as one. And the leading line is "imagine there's no heaven, it's easy if you try, no hell below us, above us only sky."

I'm not sure why, but standing there at the nurse's station last Friday in Queen II, that's the line that came to mind. It was my first day back at the hospital, the major referral center for the country, and I was making my way through the wards, learning each patient, memorizing their disease, measuring their odds.

It was the sight of the 12 year old, emaciated, eyes hollow that made me stop. I had seen another like her, one that had done remarkably well and almost doubled his weight over two months. But here was another adolescent, newly diagnosed with HIV, wasting away before our eyes. Like the other, her esophagus was presumably riddled with a fungal infection that made swallowing feel like downing a razor blade. Her body was ravaged, nothing on her face told me that I was looking at a girl, one who should be starting her life, not watching it come tumbling to an end. Her mother sat next to her, rarely making eye contact.

And it was then that it occurred to me that maybe this was hell.

What if hell is not an eternity of fire and brimstone. What if it isn't a just reward doled out after a life time of evil. Maybe hell was in fact watching one in four of your family, of your country picked off slowly, inevitably. Maybe hell is watching your children die in front of your eyes, and then watching their children follow soon afterwards.

I won't presume to be able to contribute to conversations that have carried on since dawn about the meaning of life and afterward, or in fact what truly does happen. But what if there is nothing better or nothing worse than what's in front of our eyes. What if instead of glory and damnation, existence is a little more subtle, and instead of some payoff at the end of this life, this is all that we have to hope for. Even the idea of rebirth. What kind of evil warrants a life like this? I can't quite understand it. I can't understand what I'm seeing in front of my eyes.

I can't understand why a seven month old died today, and when I starting compressing her chest, thick black liquid starting pouring out of her mouth. And what's worse, I can't understand why it hardly moved me. I can't understand why the sight of it made me want to give up, and made me feel like that was okay.

I thought coming back would be easy. A month's worth of experience, a hardened heart, and a death count in double digits should have prepared me for this. But walking through those doors today hammered home the reality of where I am. I can't count on my vacation at the end of this rotation to wipe the slate clean for my patients and their families. I may have had peace of mind when I left last time, but seeing just how bad things were when I got back made me lose a little hope. Whatever gains I made during my past three months here are hard to see now as I look across the room and see children dying of the same thing over and over. Even my 12 year old didn't make it through the weekend.

And it's this that brings to mind Lennon, and the thought that maybe there isn't anything but this, and that heaven and hell are infact what we witness here on earth, and there is infact no justifiable reason why someone should ever deserve a death like this. I suppose "Imagine" is supposed to inspire hope for something better, but if anything it suggests the possibility that maybe there is no peace at the end of this, no consolation prize for a life of suffering. What if it's this and only this. What if the Queen II wards are a little slice of hell? I ask myself that as I watch my patients and their families struggle to find a way out.