tethered perspective

One of the key advantages of being a member of the helping profession is the opportunity afforded to observe closely, the breadth and depth of all sorts of human experience. Like peering at the whale of humanity from the bottom of the ocean, the underbelly swimming above, far off floating silhouette of your long lost boat, the murky dark edges do appear to go on forever.

I think I get why this perspective could make you feel anxious and sad all at once.

Or hanging upside down in the cave of bats while the blood rushes to your head, I think I get why it feels especially difficult to think and your throbbing head feels as if it might explode. In the sacred context of the doctor patient relationship, I often find myself on a journey outside of my own perspective, led around vicariously through dark experiences, by my patients.

Most of the time, I can’t help but come away from this sacred space a little bit transformed. Sitting with wounded people, my own perspective often has to expand to hold the space for things percolating beneath the surface of polite conversation, the place where you’re frightened of the dark, or scared of bears, and the monsters under the bed try to grab your feet when you dive under the covers as the lights go off. I feel privileged every time I step softly into this psychic space with my patients.

The oft cited words of my mentor echo, Your patients will teach you much if you allow the space for it.  I remember thinking before graduating that Obi Wan Kenobi was just trying to make me feel more ready for the shift to being a physician. He’s just trying to make me feel better as I’m lambasted with graduation and that overwhelming sense that levels most of us new doctors in a sea of feeling as if we really know absolutely nothing.

He’s trying to make me feel better about cutting the educational, umbilical cord.

The truth is my patients do teach me much. Every day. They teach with their individual perspectives on their collectively similar tragedies. Everybody bleeds this way, just the same.

Sometimes I think doing this helping work is a bit like living a bunch of different lives simultaneously. I walk around with a rolodex of others' experiences in my head. I hear the talk of people sitting around the table, walled in by their own narrow perspective, trapped by assumptions or stories they've told themselves for years. It can't be otherwise. He must not even care.

I realize I'm no different in telling myself stories. But, I get the gift of sitting regularly with the heavyhearted. I get the opportunity of gaining insight by being absent from my own perspective for a while, then returning. I get to be an astronaut drifting in space, looking freshly at the blue and green earth swirls. The Overview Effect its been called. My own story smacks me in the face in a new way. Gifts I didn’t see before stare back at me. Things taken for granted assault me.

I didn’t really have it all that bad. In fact, things were mostly, good in my childhood. My life is rich.

And sometimes the perspective transformation, the blinding re-entry burns a bit more radically and I’m left tumbling my way back into the atmosphere to some sort of spirituality that makes sense of experiences so far from my own. I have to rely on the bells that have stopped jingling from my ankles, praying that the tether to Big Oak Tree on the edge of the forest somehow holds well enough for someone to pull me back and help me land.

weeping at the moon

artwork by Raina Gentry http://www.raintree-studios.com/birthofthemoon.html

I don’t know why I sit here tears dripping, under the moon. Crickets scratching their legs, the sound of the freeway in the distance. I have no reason to be sad. No badness of a day, no complete and utter failures, nothing went all that wrong, today. In fact, things went mostly right.

I haven’t really thought of my brother in a long time, even thinking of him now, that’s not it.

Instead, there’s the cool night air, Seussian silhouettes all around.

Looking up into the sky, halo around the moon’s fullness, little dark spots on it’s circle, I feel something, I know not what. And that something feels like sadness. And I have no idea why I’m weeping at the moon.

  

cold as it gets

When my soul aches singer-songwriter Patty Griffin often has ways of capturing apt expression of that ache. This song feels about right, now.

To the end of the earth

I’ll search for your face

For the one who laid all of our beauty to waste

Threw our hope into heaven

Our children to the fire

I am the one who crawled through the wire

I am the one who crawled through the wire.

There’s a million sad stories

On this side of the road

Strange how we all just got used to the blood

Millions of stories that’ll never be told

Silent and froze in the mud

Silent and froze in the mud.

I know a cold as cold as it gets

I know darkness that’s darker than cold

A wind that blows as cold as it gets

Blew out the light of my soul

Blew out the light of my soul.

I dream in my sleep, 

I dream in my days

Some sunny street now so far away

Where up in a window

A curtain will sway

And you and I’ll meet down below

You and I’ll meet down below.

I know a cold as cold as it gets

I fight a war I may never see won

I live only to see

You live to regret

Everything that you’ve done

Everything that you’ve done

Everything that you’ve done.

-Patty Griffin 

dear front desk girl

I wrote this as a student. As a conscientious student, I remember feeling the angst of how annoyed the front desk girls were with me. As weird as it sounds, they were most angered by the students who actually did their homework. Because it demanded time and energy from them. They had to pull the charts. They had to work on Saturdays to help us. The ones who showed up on weekends to research their patient's charts...This was me working out my angst in poem form. 

I know it must seem that I’m always at your window

waiting

to bug you,

asking for a chart, or even for a stack,

or for you to access

that all-powerful schedule that reigns over both of our lives.

my furrowed brow might seem to convey anger.

in reality, 

I’m concentrating

on the next thing

Mr. Attending asked me to do,

after he told me

how wrong I was

the last time.

forgetting

might suggest

that I’m not taking the teaching seriously, enough.

and sometimes, only sometimes,

furrowing my brow

making it harder 

for the tears to stream

down my face

when I’ve fucked something up, 

yet again.

I know it must seem

I’m demanding so much

on the days 

when I come back

like some adolescent.

pulling up to the drive-up In and Out.

I imagine 

it is rather annoying.

what now?

you must think

as I approach for the umpteenth time.

in reality, 

some days the demanding weights

almost crush.

world full of Attendings

residents

patients

professors

pulling,

in multiple directions,

usurping or contradicting one another.

never doing enough.

never learning enough.

chart note, never quite right enough.

sometimes, crazy as it is

I lighten my load

creating a delusional reality

where

I’m not the one being pushed around.

I know it must seem that I’m moody as I stand here

waiting.

in reality,

I'm pausing,

catching my breath
as my patient just left.
the conversation we had took effort.

wanting

to get it right,

to communicate 

support,

to not fall down in a puddle on the floor.

maintaining,

appropriate expressions,

did not come easy.

new to this realm

of carrying other people’s burdens,

I’ve never had to tell someone

of the cancer

found inside the walls of ovaries.

now I’m standing at this window,

resting,

my soul.

letting my guard down

worrying not

about smiling.

I don’t know much,

but,

I have learned that ovarian is a bad one.

never met someone like that

I’ve never actually met someone in recovery, he said…

I’m not sure how one raw statement could capture so much and at the same time embody such haunting emptiness.

Part of me heard. Part of me couldn’t believe. Part of me wanted to weep. Was this hyperbole for emphasis? Hyperbole for blogger’s sake? Some kind of strange juxtaposition to keep me grounded in patient’s reality? I forget too easily. I forget that no one is supposed to get better.  I forget that no one is supposed to be in recovery. I forget that no one is supposed to be cured.

No one in recovery. Oh, yeah. Right.

And yet, it captured the essential brokenness of the system.

No one in recovery.

It took me to the gut wrenching pain of watching an extraordinary boy be told that this diagnosis meant a lifetime of blunted creativity, a lifetime of a nuanced cocktails of Lithium, Seroquel, or some new sexy drug with its very own marketing minions. Walking past the day room parked full of rockers seemingly keeping rhythm with unseen inner worlds. Visiting meant, tolerating scowls from hardened psych nurses thinking that family members might be part of the dysfunction. Visiting meant, suppressed tears held back by hopelessness, seemingly reincarnated as my brother’s mouth ran with drool after the heavy sedations.

No one in recovery.

It captured the plight of so many forced to put up with so much, already.  The diagnosis morphing into strange stares upon returning to college.  The shame and stigma morphing into the court ordered treatments and outrageous removals of human rights hiding behind the hollow legs of patriarchal medicine. The disease that affects your brain must be causing you to not want to take your meds. It can’t be that you want something different because you are an autonomous human being.

No one in recovery.

On so many levels it captured the essence of the case of the mental illness of the system. The failed American mental illness system that parades about destroying hope. Swallow the pill. Do not ever quit your meds. Do not question. You have a serious mental illness.

Certainly, no one cured. No one in recovery. No, I’ve never met someone like that.  

cutting a line

My brother is a Surveyor. As in cutting lines through the backwoods of VA. No hacking through jungles. No, rather he has a desk job, now. And not Upton Sinclair, though he reads Upton, I'm sure. (most surveyors, don't, FYI, but he is smart). But sometimes he cuts the line. I think that's what they call it, when you go out and hack through the Kudzu, et al. You cut the line.

Sometimes I think I'm supposed to cut the line.




    

No Exit Strategy

Dear Pristiq,

I know I shouldn’t blame you that your parents must have named you due to extraordinary proximity or ana-mana-pia to the word prestige.

I get it.

Pharmaceutical company birthed you in some effort to compete with the Wyeth family's Effexor XR. I suppose somebody got paid boo-koo bucks to spin your Robin hood like effort as reversing the stigma of depression. As in not merely helping but even going so far as to impart prestige in a world of mental health stigma. As in one might have prestige being on this drug. As in, look what we’re doing to help the depressed and anxious of the world—altruistic company that we obviously are.

Doing your part, little cash baby—only one hundred fifty dollars a month coming out of that small disability paycheck. 

I shouldn't blame you, that there is no exit strategy. That you only come in unbreakable, extended release tablets with your 11 hour half-life. Ready to ensure yo-yo symptoms in those who try to crawl out of your web with every other day dosing strategies.

There is no exit strategy.

But that’s not your fault. You’re just an enteric-coated baby released from the Pfizer mother-ship. I shouldn’t be angry that there is no smaller pill—no dosage available less than the 50 milligram suicidality inducing therapeutic dosage. I shouldn’t blame you that your mother tells us that we must taper the dosage to avoid withdrawal—I’m sorry, discontinuation syndrome side effects, when there is nothing smaller to taper to. No smaller pill has even been a twinkle in the mother-ship's eye. And then when the withdrawal effects manifest, pompous arguments can be made about depression relapse. When suicidal thoughts appear, fear motivation can be harnessed for further entrapment campaigns.

No. I shouldn’t blame you. You’re just the greed-powered-wind-up-doll-drug mechanically going through the motions, screwing patients on cue.    

most insincerely,

a physician