Chapter 1; Loneliness, Presence and Theodicy

The intensive care unit is the loneliest place on earth. The loneliness it fosters though is not what a healthy observer would intuit at first glance. The ICU is a place busy with health care workers, family, technicians, administrators and various people coming and going. Alarms monitor status and the occasional sound of a transport chopper overhead further contributes to the systematically controlled chaos. Yet, in the midst of this orchestra of wellness attempting to control disease, there lays a patient separated from others by what might as well be the Sahara desert. This dry and barren place is the sense that they’re ok but I am not.

Six weeks after finishing his second Gulf Beaches marathon, Pat was frustrated by his slow recovery. The joint pain and muscle stiffness had improved within days but he still felt a generalized sense of fatigue. He had finished the 26.2 mile course down Gulf Boulevard and back up the Pinellas County trail in 3 hours and 14 minutes, a personal best. The race was fun and he was prepared. The previous 6 months had been spent intensifying his usual running regimen, building up to gradually longer runs on the weekend culminating in a 22 mile run on a Saturday 3 weeks before race day. He tapered training nicely and had finished the race strongly.

The ongoing fatigue though was disconcerting to him. He did not feel the stamina to get back into his training regimen despite trying easier shorter runs. “I know my body”, he thought, “and this is not like me”. As he explained his symptoms to his Internist now 7 weeks out from race day he also described some purple spots in his mouth and new frequent nose bleeds. On exam, the doctor noticed wet oral purpura, splenomegaly and pallor. “Progressive fatigue can have alot of causes, Pat”, his doctor explained. “So lets order some labs to take a closer look”. “We also need to consider sleep and stress issues”, he added…

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