A child floats face down in the sea.

The waves dance about her as the sun bounces off the water. I feel the breeze on my face; the bright sun is reassuring. Is her small body out of place, or is sweet light the intruding imposter?

I am stunned for a moment. Where am I? Is this a present-day island in the Eastern Aegean Sea? Or am I a young naval officer again, watching an old retro-image off the coast of Vietnam that has been seared into my mind; or did this child come from Cuba? Wait a minute. Am I holding my father’s hand and hearing a tale of WWII? Or am I at the water’s edge near a medieval city a thousand years ago? My blood curdles and I rage against all things worldly and divine. I inhale death and despair and attempt to exhale hope and forgiveness. Let the sun dim this vision and the wind cool off my soul before I shout out in blasphemy. Time is long, but its memories are short; and the results of such failings become painfully intolerable.

We have all witnessed death, but some happenings indelibly blacken us. While death varies as to time and place and circumstance, I had hoped that its dominion would no longer include that of innocents fleeing darkness and intolerance. This was something I naively hoped would abate as my years on this earth dwindled. While the ascent of technology has not disappointed me, mankind’s intolerance of one another has left a shadow in my space and gathered wind in its sails. Storm clouds cluster about my thoughts and my mood darkens. My mind is dizzied by the specter of such deaths.

A gentle tap on my shoulder causes me to look away from the window. “Doctor Tom, we need you in ICU.” The sudden interruption allows me to vacate my inward gaze where the hairs of my soul stand on end, and to reengage the present reality. I take note of my baldness and the white stubble on my face. I nod in contentment. There are worse things than aging.

I spend the largest portion of my professional life in intensive care units getting cozy with ventilators, trauma, burns, balloon pumps, ventricular assist devices, transplants, extracorporeal membrane oxygenation (ECMO), dealing with horrible patient disabilities, and family members that face the expiration of their loved ones. This job causes me lamentable introspection on a regular basis.

I arrive at the bedside of a young mother who contracted influenza that evolved into acute respiratory distress syndrome. She had struggled to breathe for several days. I am a member of the ECMO team that cared for her immediately after the delivery of her baby girl. As I watch her puny efforts at respiration, I think encouragingly, “in with the good air, out with the bad air,” but do I really mean, “breathe in hope and exhale despair?” I pray to myself, “I hope we can help you with that, too.”

As I stood there in the ICU, my brain went “walkabout,” as it frequently does as I become older. I could not help dwelling on the fact that, amazingly, the vast majority of parents on this planet are willing to subject themselves to extraordinary measures and conditions so they can raise their children in a protected and healthy environment. Mothers put their babies into harm’s way on cold and stormy seas to seek a safe haven; they subject themselves to the placement of extraordinary medical devices; work in offices, stores, and the households of others in order to do whatever it takes to ensure their family’s welfare. Many fathers work long hours in factories, restaurants, and take menial jobs out of necessity. They even shepherd their loved ones on perilous journeys through deserts and uncharted terrain to get into boats that have no life jackets in desperate attempts to avert the torment of oppression and intolerance.

In regard to this suffering: many hear, but do not listen; many see, but do not understand. You have probably heard the old adage “You can knock on a deaf man’s door forever.” Well, I too am cursed by my own demons and prejudices, and have missed that knock on occasion. Nonetheless, I imperfectly seek to expel the chaff, keep what is good, and try to take in only that which can help my patients and patch my checkered soul. In my mind’s tumult, as I ponder parenting, love, children, and our differences in regard to color, religion, race, sex, and culture, I can hear the words of a wise old man now departed spin in my head, “God changes his appearance every second. Blessed is the man who can recognize him in all his disguises.” Truly, that is something none of us will ever be able to do. And that inability causes me to tread lightly among the rows of glass houses and fields of broken dreams that populate my experience and that of others.

My mind is still adrift when a colleague gently nudges me, “Hey Tom, what do you think we should do with the ECMO sweep and flows? By the way, the kid is doing fine.” I am disoriented for a moment. I had wandered back to the sea. After a reflective pause I whisper, “Wean the sweep and leave the flows alone.”