Air date: November 1, 2009

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Interview: Larry Cripe, MD, oncologist
Indiana University School of Medicine

As that previous conversation suggested, knowing how to recognize when the end of life is near is a delicate maneuver, even for the most experienced physician.

That’s what Sound Medicine essayist Larry Cripe discovered, when he thought he was teaching his daughter a lesson about gardening.

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While waiting for my daughter Millicent -- who was five at the time -- to finish her morning glass of milk and walk to the park with me, I began to weed the small garden I had planted for her the year before. I looked up as I heard the screen door slide shut and watched her bounce toward me. She froze, dismay spreading over her face.

"What have you done?" she said looking at the pile of weeds at my feet. And then she turned toward the park. I followed, disappointed we were not walking hand in hand.

After pushing Millicent on a swing, chasing her up and down the jungle gym, and watching her climb the corkscrew ladder without help, I asked, "What upset you?" I sensed her indignation in the straightening of her posture and the smoothing of the crinkles of laughter around her eyes. "You killed my garden’s weeds," she replied.

I explained to her why I weeded her garden. Flowers, I reminded her, need plenty of nutrients, space, and sunlight. I mentioned how neat and tidy her garden appeared now that the weeds were pulled. There was no change in her expression.

"You broke the circle of life," she insisted.

As a physician trained to a rational perspective about life, I garden to enjoy a more intimate and less skeptical relationship with the world. Gardening, then, is an act of appreciation. From that perspective the circle of life is the cycle of tilled earth to seedlings to plants and back again to the apparent dormancy of tilled earth. So I shared this larger impression with Millicent: the weeds, when composted, would return to the earth as flowers. "So isn’t the circle of life still a circle?" I asked.

Of course it wasn’t. Millicent, without wavering, replied "Those weeds won’t come back. And my garden is ugly without weeds."

I have come to believe that Millicent trusted the circle of life more than I did. Her faith originated in the observable and not some remote lesson about life. What she meant was my weeding -- my reasons for weeding -- did not make sense to her. She saw no reason to disrupt the circle. Frankly, there is an enormity to my circle of life -- a notion that must have been difficult for her to comprehend. Not to mention that its Old Testament harshness, "remember man thou art dust and unto dust thou shalt return," was hardly a comfort.

An ongoing source of distress for me as a leukemia specialist is trying to make sense of the questions for which there are no answers. Why, a person might ask, did I get leukemia? What did I do? Or if the disease recurs: why did it happen? Should I have chosen a different treatment? Or if life is likely to end: should I try some other treatment or focus on my comfort instead?

Millicent’s objection to my weeding -- her faith in the logic of life -- reminds me that a sense of control is largely illusory. There are times when there are no rational explanations or solutions.

In those moments, we are called to affirm the questions without answers.

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