Duty

“The reward of one duty is the power to fulfill another.”

-George Eliot

I met her a long time ago. She was referred by a neighbor who had arthritis. She was bothered by fatigue, and numerous aches and pains that by themselves were minor and inconsequential, but they added up and, more than disabling, became worrisome. She had a husband who provided well for the family; her duty was to raise their only son and keep the household running.

Which she did with (as I learned over the years) stunning and relentless efficiency. She read voraciously, on any subject that was likely to bear any knowledge on her favorite subjects. Good food; fresh nutrients; cleaning ingredients (preferably natural); healthy exercise; meditation. Her day must have been as full as what the president of a major corporation experiences.

When I diagnosed a mild autoimmune disease she was relieved. She listened to what I had to say, then she decided which parts of the therapeutic plan she would follow. I did not mind, because she was honest and up front about her choices (so that if she failed to improve I would have an idea why).

Her primary physician discharged her as a patient because she had dared to seek an opinion other than his (I suspect that the real reason was that he did not want to deal with a patient who spoke her mind and wanted to have control over every aspect of her care). She did not know where to go for general care. I assumed that responsibility.

Two decades went by. The combination of natural remedies, organic nutrition, and small doses of medication worked well. She had occasional flares that I attributed to disease exacerbation and she blamed on deviations from her strict regimen. Her son did very well in school and was hired by a large company. Her husband began to plan for retirement. Of course, she had already done the research on smaller homes to live in and places she’d like to travel to.

Years ago she called, sounding unusually distressed and anxious. I saw her the next day. Her pain level had gone through the roof. She was tired all the time. She had crying spells. She looked disheveled; tremulous; as if she had lost control.

Talk to me.

“You don’t have the time.”

Let’s give it a try. Start from the beginning. Are you following your plan?

Tears began to flow, along with a very sad story. Her son; her pride and joy, became involved with a woman who was a drug addict. She was married, and her husband also did drugs. In the beginning it was him trying to help her; as time wore on he began to use drugs also.

One catastrophe led to another. She got divorced. Inexplicably, her son made plans to marry her. In startling yet predictable sequence, they both lost their jobs, and their homes, and she became pregnant. Items of some value began to miss from my patient’s house.

At some point in this death spiral her son realized that he needed help. He began to attend the self-help meetings. His by now wife went with him, but within weeks it became clear to him that she was still a user. While pregnant. A difficult choice had to be made, and to his credit he did the right thing. He called the authorities, who also acted promptly and wisely.

I’m omitting 90% of the drama, but you can get the idea. When the child was born he was removed from the mother. Since the father had been “clean” only a short time plans were made to place the child in foster care.  This is where my patient stepped in.

Let me guess. You took the baby in.

She nodded.

Allow me to add on. You allowed your son to move back into your home.

“What else could I do?”

Many tears.

While I’m sitting in front of her I’m trying to wrap my brain around the enormity of this situation. This woman had an almost perfect life. Good husband. Successful child. Disease under control. Enough money.  Retirement and relaxation looming.

Now back to reality. She is 60, and she gets up in the middle of the night to feed a hungry boy. She changes diapers, and she plays patty cake, and she’s available 24/7. Also on a constant basis she now worries that her son may relapse (the court ruled that, same as his wife, he had no parental rights, and that my patient was to make all decisions pertaining to the child). She has no realistic expectation that this situation will change (chances that one drug addict will shape up are slim, but two people who are hooked and married to each other?). And she has to supervise the occasional visits with the child’s mother, who now says that she wants to be rehabilitated.

No wonder you feel terrible.

She does not say anything; she just sits there and cries. I realize that I must be the one to talk.

Look. You’re stuck. You have no choice. What else are you supposed to do?

She nodded.

I can say one thing. You’re doing the right thing. At some point, ten or twenty years down the line, you will reap an enormous reward out of this mess. Life is an endless and continuous call to duty. It’s just that you’ve always answered that call, and you had every reason to expect your reward soon. Now you have a child, and you’re older, and you feel that you just don’t have the energy that a child requires. But you’re stuck. You have to do this.

“I want to do this.”

I know you do. Sometimes it helps to hear another person summarize the situation.

She stood up. I gave her a hug. She looked calmer; more determined.

A year passed. The child was doing great. My patient’s symptoms abated.  Her son remained clean, and he was employed. The child’s mother was also drug-free; she went to four meetings a week and she had a job. She did a wonderful job when she was allowed to be with the child. At some point soon my patient’s son would have custody.

Duty. You make your obligations the root cause of your existence, and sometimes things don’t work out and you end up in a big mess through no fault of your own. But you don’t lose your way. You stick to your duty, because this is who you are; because you are defined by your obligations to the people you love and the society you live in.

There is never any guarantee. We’re stuck.