The Road through Residency:

Change

"It doesn't change. It always just hangs there in the sky."

I ignore the patient's comment for a moment as I look down at my notes, making sure I haven't forgotten any important questions. Beyond the wide windows before us, trees sway back and forth, and I wonder how many lives they have witnessed come to an end as they continue to reach toward the sky.

“You could not step twice into the same river; for other waters are ever flowing on to you.
— “Heraclitus, (c. 535 – 475 B.C.E.)

"Do you have any history of diabetes, high blood pressure, COPD, cancer, heart failure—"

It is only after he interrupts me that I realize my fingers are counting the possible flaws brought upon him by time, lifestyle, or genetics, like so many bullet points on a checklist.

"No," he says. "Been healthy all my life."

"Until now?"

"Yeah."

He looks back outside toward the sky, his eyes fixed upon a point far from his predicament. A single star, clearly visible, twinkles back at him. He has told many of us at the hospital that he feels strangely at ease with his fate, knowing that these burning fires-running on helium and hydrogen, light years away, untouchable, unchangeable-will continue without him.

"That's the three sisters," he points out. "They're part of-"

"Orion's belt," I say.

"So you know a little astronomy?"

"I grew up in the country," I answer without looking up. "I would take my telescope out into the fields and try to find my way from one side of the horizon to the other, each constellation leading to the next."

"How often do you go now?" he asks.

"Oh, wow," I say, flipping through the chart, checking a box here, writing an order there. "I haven't been out in over a decade. Just lost interest, I guess."

He turns grim now, looking outside again.

"You should get back into it. Things change down here. Wars end, nations fall, but the stars, they're always there."

"Yes, they're very lovely," I say, finally looking up. "Now, how long have you been on chemotherapy?"

The weeks pass, and his fever starts subtly, a small spike here or there. We react aggressively, but despite our efforts, his condition slowly deteriorates. I come to visit after I've ended my rotation one night. He is in isolation for his low blood cell count. I don the mask, gown, and gloves, thinking how ironic that the closer to death he comes, the more impersonal we have to become. Upon his bedside table are books of Hubble telescope pictures, astronomy reference manuals, and a laptop whose screen shows the Pleiades, a young, open star cluster in the Taurus constellation, which is visible to the naked eye on a clear night. He is gaunt and sallow, his eyes still staring out into the night sky.

"Been out enjoying the spring view?" he asks.

"No, mostly working. I haven't had a chance," I answer.

"Well, not much to see in the city. Too much light. I wish I could get out into a dark sky, take in the view."

"Hopefully you'll be able to soon," I answer, but I know it is unlikely.

As I say goodbye, he scribbles down the titles of a couple of books on astronomy and astrophysics that he says I'll enjoy. His pen runs out of ink during the last title. He swears, and I reach into my coat pocket for another. I walk out of the room with the completed list and muse about the pen. As much writing as I do, I've always wondered which pen will be my last. When I buy a pack of pens, I wonder if I'll run out of time before one of them runs out of ink. With that in mind, I never get angry over a dying pen; I'm thankful that I've outlasted another one.

Three days later, he passes away at home. Sometime after that, perhaps two or three months later, one of the nurses mentions him and his infatuation with the stars.

"He was always saying how they never change," she says. "I guess that's a good thing to hang onto."

I look up from my chart.

"Unfortunately, they do." I tell her. "The Pleiades star cluster he kept referring to is supposed to disperse in another 250 million years. What we see in the sky today is not necessarily what our descendants will see long from now."

She looks down to the floor. "That's really sad. It seems like there's nothing constant to hold onto in the universe, then."

"Well, sure there is," I say. "The constant is change. How boring would life be if nothing changed, and how meaningful is each moment because it does."