In Shock Page 17
“Oh! How horrible. I don’t understand what is going on there. Maybe you should come home,” she’d suggest.
But we didn’t go home.
Instead, there was a makeshift memorial held in our hospital’s lecture hall. Someone read a poem he’d written as a teen. Pictures of him during happier times were projected onto the screen. And then the very next day, in the same seats, at the same time, we attended a Grand Rounds on management of chronic heart failure.
The trouble with not having a safe space within medicine is that for those outside of medicine, our stories are almost too much to bear. I’d try to download my day, in an effort to find solace, but inevitably my sounding board would get caught up in the details of the story. I found if an event was terrible enough that I needed to debrief, it was too awful for anyone to see past the drama to my emotions and needs. I’d become easily annoyed, feeling they were missing the point, perpetuating my sense of isolation.
That was when I took up painting. I found comfort in transferring my disquiet and bad dreams onto canvas. With symbolism and oils I could bury painful narratives under a layer of pigment and find a peace that otherwise eluded me. Somehow during the hours that I held the brushes and allowed impressions to emerge, I’d silently shed many of the conflicted emotions that accompanied each new trauma. Art knows death. It understands that the unbearable happens. It mirrors to us that whatever we are feeling, it has happened before and to others, and they survived it. Or they didn’t, but the art survived. The representation of their suffering survived to commune with us. We are not at all novel, art reminds us. We are a very small part of an ongoing and enduring history of suffering and redemption. Art knows subtlety. It knows that our first go at representing anything is almost always flat and insubstantial. In order to really represent an object, we must layer the paints to achieve depth. Our first pass serves only to create a foundation. It’s only on reapproach that we can layer in contrast or highlight a previously neglected area. It’s only on revisiting anything that we can hope to approach understanding.
I painted young girls cloaked in masks, safe in boats or half-submerged in heavy, opaque blue water. Young boys playing dress-up in military uniforms and taxidermied animal masks, not understanding the true threat of death that war confers, or the danger of disguises. A star-marked sheep emerging into a clearing from one small forest, only to enter a larger, darker one. I painted the coldest winter. A young copper-haired girl sitting, waiting pensively for someone who would never arrive. Blooms of flowers bursting through a skeletal birdcage of ribs.
I’d never actually get over the death of my patient or the suicide of my co-residents, but I learned over time to subvert the shame, both mine and theirs, into a kind of willful dedication to their memory. They stayed with me, reminding me to be more vigilant, more caring and more attentive.
In choosing to carry forward and honor each loss in that way, I felt I was keeping a small piece of them alive. As if I could catch some fragment of the light they’d emitted even through the darkness, like fireflies in a mason jar, and use it to guide the way forward.
As an attending, I went through a period of being almost satirically kind to my teams. I brought them cookies if they were post-call, compliment them at every possible turn, reassure them that they were doing a good job, and remind them that they were worthy of compassion. I’d urge them to identify outlets for their stress. It was a blatant overcompensation. They had no knowledge of the darkness from which that light originated. They saw only blind acceptance, and they knew that regardless of their mistakes, I held them in unconditional positive regard. It was the only way I knew to keep them safe.
What did I want to keep them safe from, but the failures? I didn’t know then how transient our successes actually were. Even when everything goes perfectly right and life is restored, is drawn back successfully from the abyss, it’s always a temporary state. We cannot define success as beating death because death cannot be beaten. The undeniable fact of death remains, imposing and impending regardless of our temporary victories. How we care for each other during life is the true restoration—the definition of agency. That is the win, the success we must look for and mark and define ourselves by. Our ability to be present with each other through our suffering is what we are meant to do. It is what feeds us when the darkness inevitably looms.
We cannot avoid the darkness, just as we cannot evade suffering.
Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.
Nine
Revolutions
All told, it took two years from that first night, and multiple surgeries, for me to regain my footing. I can’t say “it took me two years to recover,” because that implies some aspect of completion, that I arrived at some predetermined destination intact and whole. I didn’t and couldn’t become myself again, because that self no longer existed. Instead I found that with each incident, each organ failure or surgery, I was reshaped into a new configuration.
That April, two years later, I was well enough to help plant rows of bright pink and red begonias around the perimeter of the boxwood hedges. I enjoyed watering them, and watching them grow, though deer ate half of the garden. At the end of the season, when the plants were uprooted and torn out, I was surprised to find myself upset. “We should have planted bulbs, or some sort of perennial,” I told Randy. I disliked that so much care and attention went into something with such a brief lifespan. Though they certainly brought beauty and joy to us, I wanted some version of the same flowers to return to us the next year, as a perennial would. I attached to the idea that from some core central memory, a new burst of life, different and yet the same, would bud each spring.
I identified with the life cycle of tulips and other perennials. Their hopeful rebirth each year, enabled by a graceful return to the ground. Rotting as a means to transform. I knew from my study of cell biology that my body, by cellular makeup, was an entirely different physical structure than it had been when I was a resident or medical student or child. Every past iteration had been supplanted by its replacement. I of course carried forth some aspects of their personalities and the strong memories that imprinted upon them, but the people they were had gone missing. Even today, almost everything I know about myself is already a memory. If death is a state of complete inaccessibility, then in truth we die many deaths.
When I arrived at the hospital in shock, I arrived as a physician. It was my default orientation to the world. I had spent the past fourteen years in pursuit of that goal, and I was completely enmeshed. It formed the core of my approach to any problem, medical and otherwise. It was the framework from which I hung my observations, assessments and plans. Even as I approached the emergency room that first night, my thoughts were the measured, structured thoughts of a physician. I was unable to relate to myself as a patient. Presented with the problem of pain, I responded by listing differential diagnoses and prognosticating for myself. When I found myself dizzy and unable to stand in OB triage, the physician in me perversely enjoyed experiencing shock firsthand. The intensity of my focus on medicine was such that I felt fortunate to have the learning opportunity, to personally engage with the pathophysiology I had studied for so long. I knew I was dying, and I was still awestruck by the science of my decline.
The superficial external indicators of my transformation into a patient came first: the gown, the hospital bed and the medications. I had amassed all the accoutrements of illness. But they felt unmistakably other, in the same way the white physician’s coat had years before. I couldn’t integrate the gown or the IV into my sense of self; instead I observed them somewhat ironically. They were incongruous with who I believed myself to be. During the first days of my hospitalization, I continued to observe events from the vantage point of a physician. I translated my lab values into a perioperative mortality estimate, as I had been trained to do. I critiqued the decisions that were being made like a sup
ervising physician. I criticized the doctors’ plan to send an unstable patient for a CT scan. I believed they weren’t aggressive enough getting their crashing patient into the operating room. I didn’t warn the family, my family, how grave the situation was. I maintained the measured distance dictated by my training.
My physical body was the first to transform in that space. It swelled and grew grotesquely, like Violet Beauregarde in Willy Wonka & the Chocolate Factory, and later shrunk, desiccating almost by the hour. My blood was entirely lost and then replenished by the blood of others. Chunks of organs were chiseled out and humbly regenerated. I lost words and memories, while others remained. The change in my body led to the shift in my perspective. I didn’t stop being a physician; rather, being a physician stopped serving me. Without the ability to treat or heal, the orientation became impractical. I had to let those parts fall away in order to grow new, more immediately relevant parts. Anxious parts, parts that understood immobility, pain and helplessness. Like burs and sock-hooks, they stuck to me as I passed through.
When I first returned to work, it was the doctor coat that felt completely foreign. I struggled to wear it, making excuses about the itchy polyester or suggesting that I had spilled coffee on it on the way into work and had abandoned it in the car. For a full year I referred to it as my “doctor costume.” I opted for business attire and would wear a blazer or dress.
My heart remained in the patient realm. I felt my patients’ fear, I felt the weight of fluid heaviness in their lungs when I studied their chest X-rays, I knew their pain. And far from being the distraction I’d been cautioned against, it felt very right to feel with them. To actually see the people beneath the transparent film of disease. With my illness, everything had fallen away, all notions of the so-called right way to approach patients, the value of austerity.
Who we are when everything is stripped away, in our barest moments, is something we don’t routinely examine. When a horrific loss uproots us, we leave pieces of ourselves behind in the soil, the structure on which we built our identity reduced to nothing more than an absent appendage, left behind to rot. We define ourselves, our very identity, by our relationships, and when we lose someone, in the exchange we lose a noun that defined who we once were. We return to our lives as truncated versions of ourselves. We cease being wives, mothers or daughters as we accrue losses. We become the next version. I was not able to be the physician I had been, and I was no longer an expectant mother. I would always be a patient. In the ruined, rotting parts of who I had once been, I found dignity and beauty in the decay.
So it was there, two years later, in my disfigured, amalgamated state, that I first began to feel whole again. I first began to consider another pregnancy.
* * *
I made appointments with each of the doctors I trusted, who knew what I had been through, armed with long lists of questions. I asked my questions and verbalized my fears: What was their best estimate of the risk that I would assume if I were to become pregnant again? What was the risk of another adenoma forming in my liver under the influence of estrogen? Could it all happen again? I had long been in the habit of writing lists. Externalizing my memory of trivia and tasks allowed me to focus. I discovered I could externalize many things—even worry. These physicians did far more than engender trust. They were my soil, physically holding my anxiety so that the nidus of hope buried within my debris could grow in the direction of the light. I learned from them that relationships can shape us, that we grow in the shape and form of the cast they generously supply. That we can allow ourselves to be supported by an enveloping mold in the hands of others. Being buttressed by those physicians let me find the strength to trust my body again. I learned I was pregnant the following spring, just as the tulips were beginning to bloom.
* * *
My hard-won confidence in my body was not shared by my family or colleagues. And it probably isn’t fair to expect that they could have met the announcement with anything but fear. They hadn’t had the opportunity to process everything in the same way I had, they didn’t have all of the same information I did. Information that suggested I would be OK, that any risk I was facing was no different from the risk of most women. The tumors were gone, and I didn’t have a risk of having recurrent HELLP syndrome because I had never had it in the first place. All indications were that I would be fine. No one believed me.
We were not congratulated. The responses we heard in exchange for sharing the news of our pregnancy ranged from “Are you insane?” to “Why couldn’t you leave well enough alone?” to “I don’t know if I can handle this” to the obvious “Great, now you really are going to die.”
I knew the excessive worry wasn’t entirely unjustified, so I reframed it as evidence of love. My illness had hurt everyone who cared about me, and their fear was real. I just couldn’t share in it. From the earliest weeks of that pregnancy, I knew two things: I knew it was a boy, and I knew he’d be OK. I had no idea how I knew either of those things, but I told my husband, less than one month in, “I don’t want you to worry. He’s going to be fine. And I am going to be fine.”
“I’m certainly glad you think so, and don’t get me wrong, it’s a comfort. But I don’t know how you could possibly know that,” he replied skeptically.
“I just do.” I couldn’t articulate that somehow all those years of listening to the signals of impending doom or tumor growth had allowed me to just know. Learning to listen had made me able to hear. I explained it in the only way I thought he could understand: “I know it the same way I knew I would marry you from the day we met.”
He smiled, and accepted I was making some vague reference to luck and fate and chance.
“You’ll see,” I reassured him. And try as I might, I couldn’t tap into the anxiety. Through some process of transference, it had shifted and was being held by others.
* * *
We had met by a trick of fate. Newly relocated to Michigan after completing residency training in New York, I’d brought with me a love of Haruki Murakami, a Japanese fiction writer who at the time would have been considered relatively obscure in the United States. My co-resident, the one who had so tragically dove to his death, had ignited this obsession when he sent me Murakami’s short story “Birthday Girl” on my thirtieth birthday. The most recent book by the author was due to be released that day, and I’d run to the bookstore to purchase it after a yoga class. It hadn’t occurred to me that the selection of Japanese fiction in a Midwest bookstore might not match that of Manhattan’s bookshops. When I didn’t find it on the shelf, I resorted to comforting myself with caffeine in the bookshop café. As I sat down to study, I glanced up and saw the book I had come for, Kafka on the Shore, on the table of the man I would marry just over a year later.
It wasn’t his book—he preferred Vonnegut and Salinger. Perhaps someone had left it behind? He eyed the cover skeptically when I asked him could I have it.
“You need this copy of Har-oook-ee Mur-ah-kam-ee’s Kafka on the Shore?” he needled. His deliberate pronunciation meant to imply that my desire for this particular book by this foreign author was nothing more than a fabricated ruse to get to talk to him.
“Yes, actually. You’re holding what is probably the only copy in the entire Midwest,” I said with a New Yorker’s disdain.
“Sure, here you go.” He passed it to me, smirking.
My adoration of this particular author did not allow that someone could be so dismissive of his book, so I spent the next fifteen minutes drawing parallels between his writing style and those authors Randy had professed to like. And because he didn’t appear convinced, I got up and bought him a copy of a more mainstream book by the author, by way of proof.
“Here. Read this,” I ordered.
“Now?” he asked.
“No, not now, but you’ll see. I’m right. He’s amazing.” I sat waiting for him to start reading, though I knew that wasn’t likely.
Randy didn’t know what to do with the odd woman in the book
store staring at him and demanding he read Japanese fiction, so he asked me to lunch.
As we sat in the exam room of the obstetrician years later, I studied his face, trying to remember a time when he had been a stranger. I couldn’t. He squeezed my hand tightly.
“It’s going to be fine,” I told him.
“You keep saying that. I just can’t stand the possibility of something happening to you,” he replied.
The shape of his jawline from the side brought back a memory of a time when we were sitting in a social worker’s faux-wood-paneled office a year before. We had decided to pursue adoption as a means of growing our family, and we were answering a series of generic questions. The social worker, reading off a list, asked Randy, “Why do you want to be a parent?,” which struck me at the time as almost too vague to allow for a cogent reply. My mind immediately trended to the existential, the transmission of a worldview and legacy from one generation to the next. I had no idea what I would say. I looked at him, expecting to see a tense jaw or a furrowed brow. But Randy had no such issues with the question, and replied sincerely, “I look forward to waking up, hearing what my kid wants to do that day, and saying, ‘OK, let’s make it happen.’ Whatever it is. I just want to make their little dreams come true. I just think that would be so awesome.”
In that moment, all of my thoughts that had been stuck in the precontemplative, even subconscious, realm coalesced. I felt no one deserved to have the experience of being a parent more than he did. I knew I would do anything I could to afford him the experience of being a dad. I acknowledged a deep remorse that though adoption would allow the experience of parenting, it wouldn’t allow us the magic of combining our DNA and personalities into a new miniature being. I worried that we were making the choice to adopt out of fear, and I knew in that moment we had to honestly reexamine the possibility of another pregnancy.