By 
From the Winter 2011 issue of Scrubs
I have a photo taped above my desk at home that some people think is grotesque.
It’s a snapshot of two human hearts lying on what looks like a blue tablecloth. The heart on the left is pink and robust. The one on the right is dark brown and shriveled. The picture is from the transfer point of a heart transplant. Each time I see it, I imagine two patients, chests cracked open and empty, whose lives are forever changed and connected by this moment.
I found the photo years ago, lying on the floor of a basement hallway in the vast Los Angeles hospital where I worked for nearly a decade. I keep it because it reminds me of the beginning of my career and how much time I spent looking for God in that image.
Before going into my line of work, I would have described myself as believing in God by default. Although I come from a family of casual atheists, I grew up with a consistent belief in God. In my house, praise and punishment were handed out based on the whims of my mother’s unstable brain chemistry, so the notion that an all-powerful, sane, grandfatherly fellow was in charge of my well-being enabled me to tolerate life under my family’s roof until I could get out.
After leaving home, my personal experience was not incompatible with this notion of God. I was generally rewarded for kindness and integrity, faced consequences for misdeeds and stupidity, and encountered no profound losses or traumas. Although I became increasingly aware of manmade injustice during college and graduate school, individual suffering remained distant enough that I didn’t give much thought to questioning my long-held assumptions about God.
It wasn’t until I started working at a hospital in Los Angeles that tensions arose between my notion of a just God and the reality of what I witnessed.
As frontline staff, I was assaulted daily with evidence that suggested suffering is random and terribly unjust. I witnessed not only pain, but pain compounded by family dysfunction, poverty, mental illness, abuse, addiction and lack of access to care. Many times children were at the center of this suffering.
During my workday, I couldn’t afford to stop and feel my confusion too acutely or ponder this growing conflict too deeply. There were other people’s emotions to absorb or de-escalate or otherwise manage in addition to having to attend to a thousand logistical challenges. It was only after 5 p.m.—during the long stretch of evening when I’d try to settle into my own insignificant life—that all the pain and sadness would simultaneously sink in and rise up to dismantle my cozy paradigm of God.
One Friday, early in my first year at the hospital, I stood in the Cardiac ICU, just outside a glass-enclosed patient room, watching a mother and father spend what would likely be the last few days with their 7-year-old son. The boy had been hospitalized for a month, waiting for a heart transplant. His heart was just days away from failing, so as a last resort, his parents had agreed to put him on ECMO, a machine that bypasses a failed heart and oxygenates and circulates blood artificially. The patient is put under so deeply that he no longer respirates, and the odds of finding a donor in the few weeks the machine can support life are so small that the family is instructed to say goodbye. We watched them through the glass crouching over his bed, their faces inches away from his, as if they might soak him up. They were smiling and talking to him and kissing him. At one point, his father straightened and turned away so his son wouldn’t see the grimace of absolute agony that consumed his face. It was an impossibly private and painful moment to witness, and I was happy to retreat and begin my weekend.
Just then, I was paged by a social worker who needed a favor. A mother had rear-ended a stalled rig on the highway. Three of her four daughters were pronounced dead at the scene, while she and her remaining daughter were in critical condition. I found my colleague in the ICU standing at the remaining daughter’s bedside as the nurse explained the various machines and tubes to the girl’s father and aunt.
