Witness

Walking up to a person who looks sad but okay presents an opportunity and a risk. Do I remark that they look sad? Do I have time to engage in the conversation? Would they want me to ask, or am I being nosy? Most of the time, I know that the right answer is to ask. It's to let myself risk looking like a fool for the chance of making a connection.

 After this many years of medical training and parenthood, I am well-practiced at looking foolish. And yet, I still hang back in some kind of attempt to preserve the illusion of dignity - mine or the other person's. This is what prevents me from asking about depressive symptoms in a patient who presents to the ER for some unrelated issue.

 This is also what has kept me from looking at or asking about today's particular Jewish holiday, now some years into this project in interfaith living.

 Last year, in Jerusalem (*not* on Tisha B'Av, just while we were there), I couldn't even approach the western wall, couldn't bring myself to come close to that broken structure, that enormous symbol of loss. I could see, but not really look at that symbol of broken relationships with God, with the earth and between neighbours. I was trying so hard to hold onto my shaky vision of family wholeness that I could barely discern; it seemed far too threatening to look directly at the fractures and divisions between us:

Male and Female

Queer and Straight

Married and Unmarried

Jewish and not...

 Let alone the other divisions that I could sense in that space: divisions swirling around definitions of orthodoxy and legitimacy of conversions, recognition of spiritual expression, and the claims of so many voices to such a small piece of earth.

What is the right way to be in relationship with someone's sadness? With their loss? When do I name it, and when do I choose to allow people to just survive it by going on to the next thing? When do I take the time to look grief in the eye and let it be, and when do I mentally note the depth of the pain I cannot explore and move onto the next patient, the next task, so that the rhythms of this day don't get derailed by yesterday's losses? How do I stay in relationship with another who is in pain? How can I better set aside my own cowardice and really be present for people mourning a loss?

To look at that loss directly, to just be in the sadness of it. Not to look ahead for the healing, not to look obliquely for the silver lining at the edges, but to look directly at that pain and acknowledge it. Not to try to fix it, but to really be present for the person who mourns. To risk the chance that I will be derailed by empathy, or by my own pains. To hold them aside for later and just be present.

 I can only hope to be Winnicott's "good enough doctor". The world is so broken. I am so broken. Even if I don't feel the loss of ancient temples or a husband or mother as my own, I can see the brokenness of God's world in the cracks where grief flows through. I can be reminded to just feel that brokenness. To be present with grief, and to offer my wish for wholeness into the work that I do at home and in the world.

I can't rebuild temples, I cannot rebuild lives, I cannot even heal bodies. I can only surrender my self and my work to the faith that healing can happen amidst such brokenness. So I will send love home to my family, promise myself to listen, and to listen some more. Pour myself another cup of coffee, and sit down to learn how best to just allow for the rebuilding of broken people. (i.e. read more textbooks).

winter.

It's midnight. The grease from the Christmas eve latkes is settling over, well, everything. The kids are in bed. Things are relatively clean. And quiet.

These last four months have been so intense in these parts. The whole residency thing remains fairly similar to the way they show it on the TV (save that my days are not one hour long, scrubs don't make anyone look good, and sex in call rooms is largely unappealing). I don't keep up with sports or video games or reading novels or celebrity gossip. In fact, the only 3 topics of conversation that remain to me are my children, my job, and religion. So you'll excuse me please that I kinda missed that whole occupy movement that seemed to flit at the edge of my attention this fall. Having had two days off, I have tried to look outside my box a bit. And look! the world is still as pretty.

All eight of us went to the Christmas eve service tonight. Four women, four children, part Christian, part Jewish, part godless heathens. Most of us still covered in oil, or flour, or both. None of us with indoor shoes. Some of us with matching socks. The littlest read hannukah books through the service, the oldest stitched a geeky pillowcase for her geeky boyfriend, and we all held our breath every time LittleE took off into the sanctuary, not knowing who we might need to apologize to, or if we would have to extricate him from the baptismal font again...

We are fumbling through two holidays, and I have no idea if we are doing it well or disastrously. We sang Silent Night. We lit candles. We made jelly donuts, and wrapped presents -- three for each of us, just like the Magi. There are stockings, homemade, with oranges in them. And we never did find good candy canes.

Did I prepare for Christmas? I have no idea.

Can you prepare for a baby? Does anyone really have any idea what they are getting into when they fall in love or become parents?

How can I be any more ready for the incarnation than I was for loving my family? Preposterous.

And then I read this post: http://deeperstory.com/incarnation

And on the heels of that, I found this video. Love



Which is old. And not about Christmas, and entirely about it.

"the Lover knows that more for you is more for me too. If you love somebody, their happiness is your happiness. Their pain is your pain. Your sense of self expands to include other beings. That's love. Love is the expansion of the Self to include the Other. And that's a different kind of revolution. There is no one to fight. There is no evil to fight. There is no Other in this revolution".

So I will go to bed. And welcome Love.

Merry Christmas.

Atheists do Advent. Again.

Homeschooling is awesome.

Just had a fantastic curriculum-spanning conversation about anatomy, cubism, and map projections. Two dimensional representation of things is HARD. I have so much to learn about maps. And anatomy drawing. And both of the religions that permeate this house. They are all imperfect pieces of the truth.

But it got me to thinking about work, and home, and change and, well, Advent.

This time of waiting for God to bust everything open. The pleasant anticipation of cute, harmless babies. Everyone loves babies.

And any parent can tell you that the arrival of a baby changes everything.

It's been a while now since I've done any office family medicine. This year is all about the acute care. Same problems, different perspective. But I was thinking this morning about the number of times in a week that I ask people to do utterly ridiculous things.

Lose weight.
Quit smoking.
Stop drinking.
Exercise more.
Reduce stress.

Good and obvious things that few people disagree with in general. Healthy living is good. Like babies. (Aren't they cute!? Oughtn't they not stick their fingers in wall sockets!?)

And I suppose it is slightly less ridiculous/more possible to ask those enormous things in the context of a long-term relationship with someone who is coming to see me as a family doctor. And it *seems* less ridiculous to say these things at a moment of extreme change and upheaval - say, when someone learns they are pregnant, or right after a first major heart attack. But really, I am asking something no less bizarre/impossible than "leave everything behind and follow Jesus".

Who really has the ability to *do* that? What right have I to even suggest such a radical new direction for a life that isn't mine? To suggest that people upend their lives completely and go in a whole new direction?

The way that we eat and move is so deeply a part of who we are. It is really a re-imagining and a new start to a whole life to ask these things of people. I might throw in a comparison to "rebirth" here. Changing something so fundamental as food/activity/habits puts everything else at risk of changing too. Career, relationships, living situation - are all tied into the seemingly innocuous and unambiguously good plan to just "quit smoking" or "lose weight". Quitting smoking/losing weight is good! Like babies are good! And it can turn your life as inside out as having a baby come into it. (I mean, there are differences. obv. You can gain back the weight. Babies can't be returned)

And lots of folks avoid both clinics and the God people out of the belief that the only desire of medicine and religion is to control them/make them feel guilty about not doing "the thing". That we are bad people if we smoke instead of pray. And that prayer and teetotalling are inherently miserable and unpleasant. I wish I could erase that particular myth. Because religion is FUN. It feels good. And being able to move, and breathe, and sleep also feels good. Really, no guilt, mostly pleasure. Come play!

Yes, it really might mean quitting your job, selling your car and house in the suburbs, divorcing your wife and grabbing your own health and life by the short and curlies and making something entirely new and terrifying. Maybe it will be easier than people think, owing to the skills gained from a stable childhood, or the resilience that comes from having lived through war or immigration.... or, I suppose, harder, maybe even for the same reasons.

And you are going to die anyway, whether you do it or not. And you might get killed by a drunk driver as you are biking to work. Your diabetes/liver failure/lung cancer may still kill you. But between here, and death, you have just one chance to be really alive. Why not take it? Why not inhabit this temporary body fully? Why not live well in this body, within loving relationships, in a community that grows goodness? In God's world? It's kinda awesome. It's not perfect, but it's its own reward really.*

And I know I don't know much. Not about medicine, and certainly not about religion (though considering how much of both I do around here, I really wish sometimes that I weren't so much of a generalist).

So, I turn things upside down, and see what falls out. I will invite more love and more children (and more religion) into my life. I will wait and see what surprises are in store. And I will continue to invite others to turn away from suffering and towards hope. As ridiculous as it is to think that a baby could change the world. Or that a 55 year old diabetic hypertensive smoker might lose 50 lbs. But I will just choose to act as if it's possible.



* I remain suspicious of doctors who jog. I tend to trust fat doctors who smoke. And other atheists. Because I'm contrary like that.

Sunday

Someday, I'll get the courage to write stuff again. Honest exposé of my real life. Stuff about finally finishing a fairly tame and occasionally grueling residency, about preparing to be living in community with 7 other people for a year, and hopefully for many more years. Stuff about parenting a very emotional toddler and a child with autism.

Autism. Holy moly autism, would I ever have a lot to say about living with and loving people with autism.

Also stuff about tentatively parenting teenagers, and how exactly to answer the question "how many kids do you have?" (Bestest answer yet: π) I would write about how excited I am about starting my fellowship in emergency medicine, and something about how pleasing and entertaining it is to be religious and queer. (enter some witty quote here by adorable atheist interfaith queerspawn)

But sleep deprivation is a constant. And weekend call is still grinding me down. Another day maybe.

on being bi

Posts that have been fermenting for a while...

News:
1. not dead
2. Still a resident
3. The kids are still cute.




Last fall, I was back in my former large city, ingratiating myself with the powers that be at the job I really wanted the mostest, and trying to psych myself into writing an application for said job.

It felt so good to be back in the town I had spent most of my adult life, in the hospital where I had done so much of my medical training, surrounded by so much that was nostalgic and familiar. Eating the food I liked, bought from local fruiteries and restaurants. Prescribing the drugs that made intuitive sense (Medical culture being just slightly different everywhere, that "obvious" cocktail of Vanco/Timentin or Haldol/Ativan/Benedryl being a "rather unusual choice" somewhere else) and all the while missing my family like crazy.

I have never been good at getting myself to just sit and write. So I took a break from the Grad Skool Appliance process to go get some coffee. I wanted just a big, crappy cup of coffee with enough caffeine that I could then muster the necessary butt-to-chair for writing. (Say whatever you like here about stimulants and ER docs and their/our attendant neurology. I have found. my. people. That is all)

Seeking caffeine, I stepped out into the most vibrant and diverse and familiar neighbourhood in the city of my 20's .... And couldn't find a Tim Horton's anywhere. Lovely little cafe's, all the fanciest espresso drinks and beautiful terraces on which to sip them. Old Italian men watching sports, legions of hipsters behind their macbooks, trendy young parents enjoying the last few months of freedom chatting while breastfeeding their infants. But I just needed a coffee. Preferably cheap. And there was none.



Now I am as annoyed by people (including myself at times) who travel and then eat at McDonald's as the next person. But it wasn't so much homesickness as the sudden feeling of being un-homed. I realized that home was 2 places. That I was both from that lovely and exotic and sophisticated city where I lived for nearly a decade, as well as being from this very much smaller, far less fashionable, uncomfortably WASP, college town where I have grown deep roots in just 3 years. And in that moment, I felt like I was neither. Neither really from here nor really from there. Neither place fit. I didn't fit.

And I was reminded again, that being bi means just that. Both, and neither. Not an identity unto itself usually, but belonging in two places, and not in any. And I was reminded again of how very uncomfortable that can be. How difficult it is to contain multiple selves, how the desire to belong is so strong at times that it is easier to deny a part of ourselves than to continue to be outsiders.

There are good parts too of course. No one doubts the utility of being bilingual, the added perspectives of those are bicultural, the possibilities for relationship and family that emerge from bisexuality, the uniqueness and nuance that are necessary when we are our full and complex selves.

But it isn't always easy, and once I am two (or more) things I can never go back to a simple belonging. Of knowing my place with confidence.




And I am both proud and worried about raising my children in this space between spaces. In my world, my home, my family - where the rules and mutability of gender, sexuality, and religion give them more places to be bi- than to just belong.



I got the job, and now I have to pack up and move.
Again.
So, in a few months, we will all go to the city. Changed forever by the time in this small town, and not at all as the family who left. Our family is larger, messier, older, richer and deeper. For most of us, it will be a "going to" and not at all a "going back."

I try to put the focus on the awesomeness of being both, many, or any. I try to build belonging everywhere. And I am working on celebrating more, giving more things names, marking more occasions. And loving as hard as I can.

We will have our own coffee pot too, and I can look forward to leaving the house each day with the largest cup of coffee that I can carry into the world, caffeinated for whatever may come.

weeping in the courtyard

I hope to hell that this is the last thing I will ever write about love and commitment. The very idea makes me squirmy. So I will phrase it as advice. If you care about someone enough to visit them in hospital, and the doctor asks who you are, have a bloody answer. Even if it's not exactly right.

Acceptable answers could include:

I am her: boyfriend, ex-husband, roommate, partner, lover, friend, boss, drinking buddy, teammate, colleague, dog-walker, parole officer. . .

But take just 2 seconds to give that relationship a name. Names make things real. People deserve names, and relationships are all we really have. I know that one word is not enough to describe everything between you. I don't need to know all that is. Lie to me if you need to. But suck it up, and put that person and that relationship ahead of your desire to be liked/respected/understood by a total stranger.

"Her. . . I, uh, live with her. . . Her common-law . . . whatever, I guess".

I am so so sorry lonely woman. Lonely woman who is so sick and so pleasant and young enough to die. And probably will die soon. You deserve to be loved better. Your "whatever" is a lousy jerk, and he is letting you down yet again.

And that shit makes me cry.

weird nights

Back in the emergency department. love it there.

I had to visit the ER for myself yesterday. It was the first time I've ever pulled rank in a medical encounter. I am well conditioned to wait in line-ups. But I was sick and needed to get better before I could go back to working. And I made it in and out of the department (including seeing a medical student and having the staff look things up on the internet) within 20 minutes. Efficient. Maybe that will go a way toward making hospitals here look better. (You can look up the average wait times around these parts here ) which you might note are currently abysmal.

Night shifts are my favourite. Last night's moment of good clinical judgment: (mind the exclusion of the many many things I certainly missed). A girl came in with a complaint of something that sounded vaguely muscular. On a hunch, I discovered a mummified object in her nether regions. I wish I could share more of the story, but the leap from "my muscle hurts" to "can I have some forceps please?" really was as unlikely as it sounds.

As much as "I know my own body" makes me want to roll my eyes sometimes, I am equally amazed by the capacity of folks to engage in serious denial and utter cluelessness about their physical state.

I realize that I am leaving out a whole lot of context here, but the interaction got me to thinking about a mentor of mine in medical school. (The same woman who hugged my head and spoke on this panel). I ran into her at a conference a while ago, and she had some brilliant things to say about borderline patients:

"So much of the challenge of interacting with borderlines is about power and powerlessness. Their history is about people taking away their power. Interactions with these patients are about them determining if you are just another person going to take their power away, or if you are going to let them keep it and use it themselves. At the same time, they are unsure if they are worthy or capable of handling their own power, and they try to set it out for you to take it".

"Life is chaos, and cutting is concrete".

I am hopelessly broken, and there is no way out. Will you rescue me?

Which, secretly, is a big reason I love the emergency department. I do love the excitement of emergent stuff, the procedures, dealing efficiently with simple problems, and shuffling the long and complicated off to medicine. But I also love the people who use the emergency department as their way of handing crisis. Who can't really manage to keep things under control and deal with problems during business hours, the drug-seekers, and the chronically suicidal. There is something raw and compelling and honest about people in crisis. Sometimes, especially compelling when crisis seems to follow them everywhere. I can't bear that level of suffering in my own life, it's too difficult to meet directly even in an office practice, and it was so, so draining as a therapist. But in the emergency department, when I know that I will walk away in a few hours, I can find compassion. Even though I know it is never enough, never good enough, and won't change anything in the long run. But truthfully, NOTHING in the emergency department is going to change things in the long run.

Time is also the privilege of being a resident, I know that if departmental "flow" and actual sick people become part of my responsibilities, I won't have time to spend with people whose problems have more to do with bad things that happened years ago, and very little to do with whatever brought them to the hospital at 2am. . .

In any case, my creepy "find" garnered me a bit of good will from the nurses, which made for an infinitely more pleasant night.