Hospitals can feel impersonal. They shouldn’t, but they do. When the pursuit of health and wellness becomes a stunning corporate edifice with thousands of employees and a regulated database that funnels patients in and out of sterile, off-white rooms all day, the dignified purpose that should permeate hospitals can weaken, at least in a funny little imperceptible way.
People like Marianna Holmes are good for making us remember what hospitals really are–repositories of memory. Those who are treated in them come out with souvenirs, like the patients with portacaths whom she describes saying, “I want this removed…it reminds me every day that I’m a cancer patient.” Is that so bad? For some people, it is. They go through the system and come out with memories that weigh them down.
It doesn’t have to be that way, according to Marianna. “It’s something they should look at as an accomplishment, like, ‘I made it through this; I need to celebrate,'” she told me.
Whether surviving cancer is cause for celebration can be contended. Of course, it is a great thing to surmount and overcome such a huge difficulty. But whether that difficulty need be memorialized, whether that portacath need be left in the chest of someone who’s ready to forget, is not so certain.
It is the tail end of a summer during which I’ve had a lot of interviews with a lot of brilliant people, not the least of which is Marianna, who got me thinking about this. Cancer involves a certain closeness that can make its survivors uneasy. Because it was your cells turning malignant and multiplying, because it was endogenous and came about without warning, and it could have killed you, because of all that, it was almost a part of you. Nobody wants to have within them the means for their own demise. It’s uncomfortable to look at the portacath and know that you came out on the other side of something inside you. Where does that leave the new you? Outside you somewhere, lost in the Abramson Cancer Center?
And what happens to the people who treat you? Surely the experience of doing it again and again makes them a little different. “I take it home. I remember it,” said Marianna. She told me a devastating story about a patient she had 23 years ago: “I was at her wedding one year, and the next year I was at her funeral…Certain ones hit you very hard. They really do.”
There’s an essay called Chimera by Gerald N. Callahan that appeared in Creative Nonfiction magazine a few years ago. It compares the act of remembering to the functions of an immune system, which holds onto little bits of everything in case they become useful one day. When somebody gets chickenpox, they are infected by the varicella zoster virus. This is the same virus that causes shingles. So when you’re a kid and you contract chickenpox, the immune system stores the virus, making it impossible to get chickenpox again, but making it possible to get shingles, which Callahan calls, “a blazing memory of chickenpox…a childhood disease, something we wish we could forget.”
It has to be the same for the people who run hospitals. Every new disease they see makes it easier to treat future occurrences of the same diseases, but it never really gets easier, does it? Just because your immune system knows how to handle the varicella zoster virus doesn’t mean it can’t come back to haunt you. Similarly, just because a nurse hangs a thousand IV tubes, that doesn’t mean he or she can’t feel the memory of a special patient every once in a while. The noteworthy thing here is that the effects are cumulative; Marianna will keep remembering no matter how long she does it. That’s true of all the people I talked to this summer–from the youngish Neha Vapiwala who just got promoted from residency director, to the seasoned guru Eli Glatstein who witnessed the advent of radiation therapy in America. They all make up the lymph nodes of this giant immune system we call a hospital, this memory bank we call Penn Medicine.