In her book The Gift of Thanks: The Roots and Rituals of Gratitude, Margaret Visser examines what gratitude is and how it functions in our lives. “Gratitude is always a matter of paying attention,” Ms. Visser observes, “deliberately beholding and appreciating the other.”
Humility is a prerequisite to being genuinely grateful. If we are to become humble, we must learn to esteem others more highly than ourselves.
One afternoon this past week three patients appeared on my schedule for physical examinations. The first was a 10-year-old boy. His father suffers from paragangliomatosis, a genetic condition in which tumors arise from neuroendocrine tissue in the body. The father has already had several tumors surgically resected and has undergone extensive treatment with chemotherapy.
This boy—Norman is his name—and his two brothers underwent screening for the defective gene; Norman tested positive. This past summer markers suggesting a developing tumor appeared in his urine and blood. A scan demonstrated a pheochromocytoma in one of his adrenal glands. The tumor was resected successfully. His oncologist continues to watch him closely with periodic tests every three months.
Norman is a happy boy. He’s put on some weight this fall. His mother tells me that she didn’t sign him up for soccer this year. “We’ve had too much going on at home. My husband had a relapse and had to go on more medicine. I’ve been sick with a cough for four weeks—they just can’t seem to find out what the problem is. I’ve been through three courses of antibiotics, prednisone, other medicines—nothing seems to work.”
“You’ve had a lot on your plate,” I say as I begin to examine Norman.
“Well, what can you do?” she says. “We just take it as it comes. No sense worrying about the future—that will take care of itself.”
In the adjacent room a 6-month-old girl greets me with a huge smile. Her mother holds her up so the baby can bounce on the exam table. “Somebody seems happy today,” I remark. “How’s she been doing?”
“Terrific!” her mother says. “She’s been eating like a champ and putting on weight since you recommended she start cereal. My breast milk just wasn’t enough to satisfy her. And she’s doing all sorts of things now: rolling over, sitting up, holding toys, drooling from a new tooth—she’s a great baby.”
I proceed with the exam, point out the child’s robust percentiles on the growth chart, share some anticipatory guidance and administer the shots. Afterwards, the girl quickly quiets in her mother’s arms, returning to her happy disposition.
“We should see her back in three months,” I tell the mother. Then I remember to ask: “How is your housing situation working out?”
“We finally got the trailer. It’s a little cramped for me and the four kids, but we manage. They say our house won’t be rebuilt until next June.”
“Another eight months,” I say.
She shrugs her shoulders. “I’m not complaining. We’ve got a roof over our heads and food to eat. More important than that—we’ve got our lives. Sometimes I can’t believe that we all escaped from that fire without a scratch. Every day I’m thankful that my kids are okay.”
At 18 years of age, my next patient is technically an adult. At least, he is classified as such according to the ICD-9 codes. Although he’s been coming to our group practice for regular exams over the past four years, this is the first time I’ve seen him. He’s here with his father. Wes is a soft-spoken boy with a pleasant disposition; he’s got a light growth of downy hair on his chin. When I introduce myself and offer my hand in greeting, Wes can barely lift his hand from the arm rest of the wheelchair in which he is confined.
The chart tells me that Wes was diagnosed with Duchenne muscular dystrophy at age 5. He has gotten progressively worse over the past six years. He has no strength to speak of in his proximal muscles; he is unable to straighten his legs due to contractures. He has had spinal fusion surgery, and recently a pacemaker defibrillator was implanted in his chest. His respiratory status is compromised: due to extensive muscular atrophy, Wes is unable to use his accessory muscles to take a deep breath.
I ask Wes how he spends his days. He tells me he likes to listen to music. “What kind?” I ask him.
“Any kind,” he says, “classical, rock, country—heavy metal.”
His father rolls his eyes.
“What else do you do?”
“I play video games, read books, watch some TV, spend time with my family,” he tells me.
“Any plans for the future?” I ask him.
Wes looks at his father. His father tells me that right now Wes is residing at home. “My wife is a stay-at-home mom,” he says. “Wes has talked about going to college, but right now he’s taking a break from his studies. He just graduated high school last spring—cum laude.”
I examine Wes as best I can, given the constraints of the wheelchair. Afterwards I comment that the physical exam is normal—normal apart from the obvious muscle wasting, contractures and inability to move his limbs. “He’s due for two shots today,” I explain to his father.
“I’m good with that,” Wes says.
I administer the shots, and Wes thanks me for taking care of him. I take a deep breath and say: “You know, Wes, I think it is I who should be thanking you. I’ve learned a lot from you during our time together today.”
Wes regards my face with silent eyes of innocence.
“Wes has taught us a lot—quite a lot—over the years,” his father says.
“I’ll bet he has,” I say.
Wes smiles. “I’m no one special,” he says. “I just try to do the best I can with what I’ve got—you know, take it one day at a time.”
That’s the grace of gratitude for you—lived out better than even the best author is capable of putting into words.