Abstract
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Dillard's Pilgrim at Tinker Creek, in which this frog figures, is a meditation that emerges from solitude. She takes up residence in the quiet mountains of rural Virginia and learns how to see the nonhuman world anew. She stalks muskrats, counts ants, wanders among trees, and feels the pall of winter. In the stillness of her solitude, she learns to notice the sheer aliveness of the world. And yet, where she finds this aliveness, she finds death too.
Such is the case with the small green frog: “And just as I looked at him,” Dillard tells us, “he slowly crumpled and began to sag. The spirit vanished from his eyes as if snuffed.” The frog is the victim of a giant water bug, whose poison dissolves the innards of the frog. His skin sags, skull collapses, and suddenly, where there was a brave, small, green frog, there is now an empty skin, slowly sinking in the water. His specific organic functions break down and his identity and body merges into the greater flux of life.
A death has occurred, and Dillard cannot look away. Her breath quickens. She is “bewildered,” even “appalled.” She calls it a “monstrous and terrifying thing.” And yet she still watches, gapes, and notices. Her solitude has voided her of all distractions, and now, at the very moment where life is snuffed out, at the very moment where she wants to look away, she cannot. She, the alive one, is bound to witness to the last seconds of the frog, the dying one. And in doing so, she remembers that her body too is “shot with mortality,” destined to sag and crumple one day. Perhaps, this is the danger of being still; it attunes you to finitude, the unrelenting, although often silent, presence of death in the world.
One of us (KM) is a student of religion who studies solitude, whereas the other (DBJ) is a medical student who spends time in busy medical spaces. On busy ICU rotations, one is constantly surrounded by the noises of machines, overhead codes, and the hustle of bodies. The ICU is not a place of solitude, nor is it a place of stillness—for everyone, at least, except the patients. By our hand, they are artificially stilled and artificially silenced, all in an attempt to stave off their approaching death. We remember specific patients, perhaps a beloved father who “slowly crumpled and began to sag. The spirit vanished from his eyes as if snuffed.” Similar to Dillard's frog, the intubated patient lies quiet, still, always at the borderland of life and death.
Emily Dickenson quipped that “Death is a dialogue between/The spirit and the dust,” 2 and we intervene with our mechanical bellows and dust-pushing machines here in this hard gray zone. Our hands are messy similar to a child's at the beach, tired after a long day of molding doomed sandcastles of body and breath. This medical need to intervene—as necessary as it certainly is—has unnecessarily come to define the daily culture of medical care and medical education. Perhaps, then, renewed attention is needed, not at the site of intervention and action, but rather silence and solitude.
What might such attention look like? Whenever possible, family meetings could happen in the patient's room—folding chairs and all. Two to three minutes of silence at the beginning, merely beholding the silent body of the patient, everyone gently synchronizing their own breaths with the ventilator, can establish a foundation of common peace before the difficult conversation ahead.
Staff and trainees too can practice this attention, spending a few minutes in a patient's room, to pray or meditate. Make the preferential option, perhaps, to spend time with someone whose social world outside the hospital makes you uncomfortable. Above all, behold them; let their stillness quiet—or even bewilder—you. Similar to the early saints of Buddhism who meditated in charnel grounds 3 —the public cemeteries where bodies became open-air skeletons—contemplation at the site where intervention may not succeed is a kind of asceticism. But more than that, it is a kind of solidarity.
Trappist monk Thomas Merton speaks of the attention to finitude as the basis for an interior solitude, and thus the basis of real solidarity. Death, he argues, is fundamentally a solitary act, for no one can take your death from you, and no one can walk with you through death's threshold. 4 And yet, as Dillard's meditations show us, death is a universal experience as well. “We die like one another,” even as we die alone. 4 Merton calls this the absurdity of solitude: people are both fundamentally solitary on account of the aloneness of death, and fundamentally social on account of that shared experience of death. Nowhere is this better demonstrated than the ICU.
Meditative practices oriented toward nonaction in a place where action is principally demanded hold a degree of absurdity. Such practices are no panacea against pandemics or the structural violence that shapes the contours of life and death. And yet, at least for Merton, if we ever want to work toward such panaceas, solitude and silence, meditative practices of attention, are necessary. They teach us to renounce the self and its driving need for productivity; in doing so, they hone our attention to a shared finitude. This shared finitude becomes the basis for “real solidarity” and a “gentle sympathy with all other[s].” It was this solidarity that obligated Merton to participate in the anti-Vietnam and Civil Rights struggle, even while he took up residence in a hermitage in rural Kentucky.
“It is in deep solitude that I find the gentleness with which I can truly love ... Solitude and silence teach me to love my brothers for what they are, not for what they say,” Merton wrote. 5 In the face of ravaging violence, it is gentleness that Merton finds, one that stirs him from his silence, reminds him to once more get his hands dirty with the finite humanness of the world. Dillard and Merton (and Dickinson too) remind us that gentle beholding at the threshold of death is also a life-giving act. In intensive care, where we momentarily pause our patients' humanity in a mess of wires and tubes, these practices are a way of holding them yet within the moral community, tangled in the complex web of care and love. By nourishing a culture of care in these zones of extremity, we keep ourselves human, and bear witness to the humanity of the patients whose very breath is in our hands.