5 life lessons from the ICU

I'm wondering how to live well

My first day on the job at the ICU at Lenox Hill Hospital, my mentor gave me this advice:

You’re not going to be able to get around the hospital in those shoes!

That was my first life lesson as a hospital chaplain.

My second, third, fourth, fifth, sixth, and seventh life lessons happened within moments of visiting my first patient: a guy around my age, curled up crying in a bed covered with stains. I entered his room, introduced myself, offered to chat, and maybe I said a quick prayer; I don’t remember the rest because I was so nervous and awkward and suspected that I probably made his day even worse by the time I left.

All of those initial lessons were variations on the same thing: Listen. Don't assume.

Over the next six months, I visited hundreds of rooms in the ICU, beginning each interaction with, “Hi, I’m Mari, I’m the chaplain on this floor, how’s it going today?”

There wasn’t one moment I didn’t feel completely outrageous offering myself up for emotional support, but with a gulp and a reminder “This is not about you,” I’d sit in a beeping room listening to whatever the patient felt like sharing with a stranger that day.

Two years later, everything I saw and heard among the beeps has formed into many themes—truths from somewhere between living and dying, that have shaped my life since. Here are five stand-outs:

1. “I don’t know” is a valuable statement.

When I first started chaplain-ing, I thought I was going to nail it.

I knew grief, I knew sickness, I knew hospitals, I knew about crises of faith. I came in envisioning that I was going to have the right words for every possible scenario, like a human version of a gift book full of Thich Nhat Hanh quotes.

My mentor, a no-nonsense Blundstones-wearing rabbi who was easily exhausted by hubris and certainty, constantly reminded me, YOU DON’T KNOW.

“Even if you had the patient’s exact illness, or you’ve felt the same way, you don’t know what it’s like to be them. Enter their room only with questions, never answers.”

I was so frustrated that I didn’t have the opportunity to blow everyone’s minds with my yet-to-be-discovered miraculous superpower to have the perfect words for every occasion, but I got to thinking about it: When you’re in the hospital, everyone who comes in your room is sure about one thing or another. Doctors tell you what you have, nurses tell you what to do, family and friends tell you how to feel.

It’s refreshing, perhaps, to hear “I don’t know what it’s like to be you, and I don’t know what’s going to happen.” It can be such a relief to hear the truth, which is that nobody really knows…and how scary that is.

A lyric I love by Josh Ritter goes, “Tell me what’s the point of light that you have to strike a match to find?”

Toward the end of my term, I realized that the role of the chaplain is to hold hands in the dark, not to search around for a flashlight in order to find the light switch.

An offering of darkness can be a valuable gift when everyone else is forcing fluorescence on you.

Hospital cafeteria artwork made in the thick of the pandemic

2. Make your mind a comfortable place to be.

When I was in the hospital, mostly paralyzed with no internet or TV and nothing to do except think, I spent all my time touring my own mind.

Was it sometimes hell? You bet!

Did I feel DESPERATE to numb myself through scrolling through Kardashian/Jenner instagram accounts? Definitely!

But I also experienced my mind in a way that I never had before and I probably never will again. I would conjure up some memory—walking through autumn leaves, eating a luscious pasta dish, learning the Arabic alphabet—and my mind would flare up in such a wildfire of imagery and feelings that it exhausted me within minutes.

I could smell the leaves, I could taste the sage in the pasta, I could recall complex sentences in Arabic. It was as though my mind was working 100x overtime to make up for the fact that it couldn’t tell my legs to move and that I had only four white walls to look at all day. It was as though my mind was flexing its remaining abilities, except it went so far that it felt like virtual reality.

One of my favorite visits in the ICU was to the room of a Pakistani professor who spoke seven languages and had a few fascinating facts on hand for any topic I brought up. It was so obvious that his mind was a wonderful place to be, like a labyrinthine antiques shop filled with storied marvels.

He was so engaged with the world and so interested in whoever he was talking to that his physical predicament barely fazed him.

He embodied “I think, therefore I am,” particularly when the crude facts of biology were fighting against him but his brain still glittered with curiosity.

His mental persistence reminded me of a favorite movie, The Diving Bell and the Butterfly, all about how memories can sustain us through hospital stays and hostage caves. The protagonist, Jean-Dominique, has been recently afflicted with locked-in syndrome, which makes him unable to move or talk—forever stuck in his mind.

In one scene, a stranger comes to visit the hospital to tell Jean-Dominique of his experience being stuck in a small cell for four years after he was captured by hijackers. During his captivity, the man recited lists of the Grand Bordeaux wines bottled in the year 1855: his way of liberating his mind during an undetermined period of torture and imprisonment.

“Other than my eye,” Jean-Dominique concluded after the visit, “two things aren’t paralyzed. My imagination, and my memory.”

The professor, my paralysis, and the protagonist of the film reminded me to constantly find new morsels and memory-buffets for my mind. When all else is stripped away, most often our brain feasts on nourishing thoughts and reflections. Let’s make sure they’re nutrient-rich.

On the rooftop of the hospital, recording patient visits

3. Prioritize friendships like nobody’s business.

Throughout my ICU visits, I constantly searched for a through line among all the most positive of patients.

What made some patients smile and express gratitude for every little thing, and some patients curse their predicament with bitter resentment?

To my surprise, it wasn’t necessarily an active spiritual life, a gratitude practice, or a meditation hobby that contributed to sustained appreciation and joy even in a hospital bed.

It also didn’t seem to matter much whether the patient was married or had kids or not. Resilience didn’t appear to stem from money or knowledge or accomplishments. Or hobbies or ability to run fast.

It all came down to friendships.

Those who had a caring network of friends were SIGNIFICANTLY (like, 50 billion times) more cheerful, accepting, thankful, and at peace than those who didn’t have connections outside of family.

The line from It’s a Wonderful Life rang in my ears whenever I’d find more evidence for this theory: “Remember no man is a failure who has friends.”

It wasn’t just about the emotional support the patient was receiving from a loving community during their hospital stay; they were also the patients whose pets and homes were in the loving care of friends. They had folks to call on for gifts, treats, prayers, flowers, and FaceTimes.

In one of my final interactions, I met with a woman who had many regrets but took note of her finest successes: “A good thing I did was marry someone who likes to laugh. But the best thing I did was make a lot of friends who like to laugh. You HAVE to make friends who like laughing.”

(I’ll be writing more about friendship soon, so let me know if you have questions about it!)

4. We need to get better at suffering.

Western society is pathetic when it comes to suffering.

We have such limited vocabulary for our abundant ambiguous losses and such a limited imagination when it comes to our support systems.

I can think of so many ways this manifests, but here are a few examples:

1) Our hospitals limit visitations and decision-making to a ‘significant other,’ but how did this become a singular term? The others who carry significance in my life range from distant cousins to my sweet repairman to my dance teacher to my oldest friend. Wouldn’t they, too, have my best interests at heart, and enliven my spirit with their presence?

2) Only a handful of people “get” to fully grieve the loss of someone close to them, but how many others are acutely sharing that grief? I’m thinking about how beloved friends of the deceased don’t necessarily get to take their three allotted bereavement days from work because they’re not family members. I’m thinking about the pals who don’t get updates on a buddy’s medical condition because the friends haven’t passed some sort of closeness test.

And yeah, okay, I’m even thinking about the entire day I spent sobbing when Robin Williams died! Did I know him, you ask? No, but he was the unconditionally loving symbol of my absent father, and in a real way I knew him, and in a real way I grieved him.

3) I became so aware of how much we suck at providing space for grief and suffering that doesn’t fit into one small square gift box with a bow.

How about the man I visited in the emergency maternity wing, as his wife screamed with pain during her miscarriage? He took me aside and wondered how on earth he was going to get through this, since there are no resources or groups for men who feel the pain of miscarriage, too. Which direction should I have given him?

Or what about the woman who was closer to her dance troupe than her family, and wanted them to come give a performance for her as she slipped out of life? Where do I place her longing, when only relatives were permitted to visit her death bed?

Or what do I do with myself, when, after over a year, one of my best friends is still minimally conscious after emergency brain surgery? What do I do with all my love for her, how do I process my grief, what words and what feelings do I assign to this ambiguous loss that, according to the hospital’s list of people who belong in a patient’s room, isn’t even fully mine to process?

5. How powerful it is, simply to witness.

When I was considering the path of chaplaincy, I talked with a priest friend of mine who used to serve as chaplain in an Infant ICU.

She told a story of a father who visited his ill infant daughter every day, many hours a day, during which he would simply look at her. There’s no telling what was going through his head as he watched her: awe? adoration? terror?

But in any case, he watched her grow and die at the same time, as long as he could.

The priest thought of that as an illustration for how God watches our lives with loving attention.

It’s also how I came to think about companionship in general. I am a witness to my friends’ lives, and they are a witness to mine. And what higher calling is there for two partners than to bear witness to each other’s comings and goings and foibles and triumphs?

When I was in the hospital, it seemed so backward that I would be evaluated only by my physical changes and not on the growth of my soul during that time.

And when I told nurses that I was a writer and artist with a vibrant social life, it felt like I was talking about someone else—the alternative universe of my own life during which I was still able to use my hands to draw and feet to dance. How I ached to have witnesses to both states.

It feels so necessary to be witnessed, as though the desire for a bystander is baked into human DNA. We want to be seen, heard, felt, smelled, tasted, touched, and we find all sorts of ways to do that: to force our pasta upon guests, to extend our hands in welcome, to douse ourselves in perfume, all with the hope to be held in thought by others.

Whenever I visited a patient and their prognosis was so bleak that I had absolutely nothing to say, I would simply witness and provide evidence of it:

“You have beautiful green eyes.”

“This is really frustrating for you.”

“Is this a picture of Anna?”

“What do you miss most about Seoul?”

“I know you can’t talk, and I can’t imagine how hard that must be, but I’m asking your family all about you and I’m learning who you are.”

The etymology of ‘companion’ is ‘someone to eat bread with.’ It’s as simple an act as watching over, waiting for, and listening to, and makes me wonder if companionship as a verb could be “to witness each other.”

I think co-witnessing is probably what wedding vows are mostly about, and it’s also what the community during end-of-life is about. Watch, wait, listen, witness, repeat.

What have you learned from witnessing? Have you been witnessed in a profound way, in the hospital or otherwise?