Noticing the Exquisite

Mar 17, 2023

by Ronald Epstein, MD

“In difficult times, carry something beautiful in your heart.” Blaise Pascal

I have just completed two weeks of inpatient service in palliative care. The work is fraught, filled with challenges and unsolvable problems faced by those with intolerable suffering, or at the end of life. Family conflict coming to a head after simmering for years. Pain is unmanageable without causing sedation. Patients lingering even though they had hoped for a quick and comfortable death. The backdrop of bleak hospital corridors, empty of human interaction since the start of the pandemic has not resumed. This would seem to be a prescription for burnout, moral distress, and despair.

And yet, I love and am energized by the work. I am not alone. It is not just the gratitude that patients and families express when their suffering is addressed by nurses and doctors who take the time to listen. There is something deeper – beautiful and sustaining albeit in a bittersweet way. Even in bleak environments, there are unexpected moments of exquisite beauty. They are often very simple. The first signs of spring while driving to work. A ray of sunshine through the clouds, visible from a seventh-floor hospital window. The color of a patient’s eyes. An embroidered quilt on a patient’s bed. The humming of one of the techs as she goes about cleaning a room where a patient has died, readying it for the next occupant.

I have been curious about the impact of such moments. I feel my gaze widen, my eyes and face relax, and I experience a quiet “internal” smile, barely noticeable by others. A lightness of step, a sense of hope and connection to others and the natural world, and the energy to keep on going. Perhaps a feeling of awe, in the sense that all beauty invokes wonder. And a sense of delight in the unexpectedness of it all.

It is possible to be distressed and awe-struck at the same time? To take in the horrible and the exquisite in the same breath. In difficult circumstances, psychiatrist and holocaust survivor, Viktor Frankl, reminds us that it is meaning that sustains us, and the diarist, Anais Nin, reminds us that we don’t see things as they are, we see things as we are. We do have agency about what we notice.

Consider this small exercise. Each day, remind yourself that, at some point, you may experience an unexpected moment of exquisite beauty. You don’t need to look for it but just be prepared that it might happen, however small or fleeting, if only you cultivate the openness to take it in.  



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