Phillips took Flynn on a tour of his restoration work. They drove down a long dirt road through the reservation’s arid beige lands until they reached a riverbank. Flynn could hardly believe his eyes: hundreds of acres of green river marsh stretched before him. Two and a half miles of channels, fringed with rushes and waterfowl, flowed to the main stem of the Colorado. There were four miles of trails and a mesquite-filled park with a swimming area and boat ramp. Phillips assured Flynn that yes, the area had been just as tamarisk-clogged as Yuma when he started, and yes, what had happened here was replicable up and down the Lower Colorado.
Six years earlier Fred Phillips had been a junior at Purdue University, getting his degree in landscape architecture. He had a fascination with the native cultures of the Midwest river valleys and a growing disillusionment with college. “What I was being taught was how to create these artificial landscapes, which was not what I thought landscape architecture should be. I thought it should be about working with the land instead of imposing our will on it.” When he learned through the grapevine that the Colorado River Indian Tribes wanted to restore their riverfront, he drove cross-country to the reservation to offer his services. An elder took him to a backwater that was filled in with tamarisk. The elder said, “I used to come down here with my dad, a sack of flour, and some bacon, and we’d hunt. There were big cottonwoods, and the river flowed through them. Now it’s all gone. I’d really like to bring some of that back.”
Phillips had no idea where to start. “I knew how to put a plan together, and I knew how to draw and design landscapes, but that was for residential properties and shopping malls. Master planning a thousand acres of restoration? No idea. So I just started gathering information. I talked to everyone from tribal elders to the Bureau of Reclamation. What did this area used to be? What are the problems? What are your ideas? I got some aerial photos. I started hiking and canoeing the whole thing. I was sure I was going to die of a rattlesnake bite.”
Instead Phillips learned one of the key lessons for the Colorado River Basin. One often assumes that restoring natural landscapes is a long, gradual process, but the Colorado River ecosystem is different. Its native plants evolved amid annual disturbances, and they know how to move fast. Give them some free ground and a little bit of water and they go for it. The natural communities of the Lower Colorado were degraded, but perhaps the gap between a desiccated system and a flourishing one could be bridged more easily than it seemed. Just find the water, reset the conditions, and let the system heal itself.
While camping in his Airstream and working 70-hour weeks, Phillips devised and implemented a 250-page master plan. He reconnected an old meander to the river by dredging it, ripped out the tamarisk, and planted native species and kept them on drip irrigation until they could extend their roots to the water table. Amazingly, when wet, the cottonwood roots grew an inch a day.
Phillips also mastered the delicate art of permit applications. In addition to the tribes and the state, he had to convince the Bureau of Reclamation, the Army Corps of Engineers, the U.S. Fish and Wildlife Service, and the Bureau of Indian Affairs that this was a good idea. He learned to move between worlds.
By the time Charlie Flynn tracked down Phillips, he had restored 225 acres of wetlands along the river. His cottonwoods were 35 feet high. He had built parks and even started a nursery when he couldn’t find a source of seedlings. The timing was perfect for Flynn and Yuma: Phillips had perfected his techniques and was itching to see what he could do on the rest of the river.
Fast-forward 10 years to a halcyon winter evening in 2014. Fred Phillips and I carry two paddleboards down to Gateway Park, on the riverfront below the Ocean-to-Ocean Bridge, and launch ourselves up the Colorado River. From our watery vantage point we can see riverbank trails full of bikers and birders. It’s impossible to believe that this exact spot has been ground zero for various crimes against nature and humanity; the place is almost mundane in its pleasantness.
A few hundred yards upriver we portage over the riverbank and slide our boards into a back channel Fred has excavated. The sounds of people and roads fall away, and we find ourselves in a sea of cattails. Ducks and white-faced ibis burst from the marsh as we paddle by. Egrets high-step in the shallows and turn orange-pink in the low sunlight.
Four hundred acres of the Yuma wetlands have been restored with native species so far; another thousand are planned for restoration. Bird diversity has doubled, and even the Yuma clapper rail, one of the most endangered birds in the Southwest, has returned to the Yuma marsh. Water was the key, but the city of Yuma had little to spare. Fortunately, wetlands in the Sonoran Desert are not choosy or proud. Phillips rerouted runoff from neighboring lettuce fields and found another 325,000 gallons a day that the City of Yuma used to rinse the sand filters in its water treatment plant. The wetlands drank it up.
In coming years a garland of green is expected to sprout up and down the Lower Colorado, a beacon to birds and snowbirds alike—all part of a growing realization that far from being antithetical, ecological and cultural restoration reinforce one another. In addition to the Yuma wetlands, Phillips is working on a 1,000-acre restoration project a few miles upriver and a smaller one downriver along the Mexican border. Phillips’s counterparts in Mexico have several more projects in the works and are using the techniques he pioneered.
Returning to the main stem of the river, Phillips and I visit Sunrise Point Park on the Quechan side, where a medicine wheel and ramada frame the summer solstice sunrise. Traditional Quechan herbs buzz with wild bees. Phillips picks a bundle of white sage, inhales deeply, and holds it to my nose. “Best kind for smudging,” he says. The usual camphor aromas are leavened with a lemony brightness like a brain tonic. In a nearby clearing in the willows sits the Elder Village, a cluster of wattle-and-daub huts around a fire pit.
“Our people are finding their way back to the river,” Brian Golding, of the Quechan tribe, later told me. “Culturally, spiritually, and physically, we’re more connected. That continues to manifest itself. Our Elder Village was built by the community. We have our weddings down there, and our Youth Cultural Festival was just held down there.”
Golding also sees potential economic development in the healthy wetlands. “We’ve got this veritable warehouse of material that can be used by elders and youth and middle-agers like myself for our cultural production needs. It’s not just pretty to look at and attractive to birds; it’s what we use for traditional structures, musical instruments, basketry, and artwork. We recently allowed a neighboring tribe to harvest some willow poles so they could make a sweat lodge. It feels good that we’re able to provide that resource to folks who otherwise wouldn’t be able to do it, or would have to use some other material that isn’t authentic. Before, you couldn’t get to it, or it was in such short supply that you didn’t dare take any.”
Yuma too has found its way back to the river. The adobe walls of the Yuma Territorial Prison, where many an outlaw did his time, rise on a bluff across the river. Farther down the waterfront is the Quartermaster Depot, where the riverboats used to unload. Both had been neglected state parks for years. In 2010 the cash-strapped state announced that it would be closing the parks, but the Yuma Crossing National Heritage Area raised $70,000 from the local community in 60 days, and the city was able to lease the parks from the state. The Heritage Area has run them ever since, and the fundraiser is now an annual event. The Quartermaster Depot has become the city commons Yuma lacked. It hosts a new farmers’ market, running races, and the annual Lettuce Days festival, and its displays celebrate the city’s historical and contemporary ties to the Colorado River. The prison, meanwhile, offers breathtaking views over the East Wetlands, with the silvery river snaking through and curling away into the desert.
The leafy oasis was the key draw for a new Hilton Garden Inn and conference center on the waterfront. The hotel promotes its location “on the banks of the majestic Colorado River in downtown Yuma, Arizona.” And the Yuma River Tubing sho
p recently opened its doors beside the wetlands as well. All of this would have been unfathomable not long ago. In 2014 the National Park Service published an evaluation of the impact of National Heritage Areas and pulled no punches when describing the Yuma of old. The Park Service called the waterfront a “blight” and pointed out that the city had not been welcoming to the idea of bike or walking paths. “For decades,” it said, “this region struggled to gain a sense of identity.” Now, having rediscovered its river-town soul, Yuma’s identity seems solid. The Park Service estimates the annual economic impact of the restored waterfront at $22.7 million, most of which comes through tourism. What it can’t put a number on is how different it feels to be a Yuman, or a Quechan, and to be able to point visitors to the river instead of warning them to stay away for their own safety.
As I let the river lead me back into town, I think I can see a new kind of southwestern identity taking shape from the ruins of the old. On the overlook to my right is Fort Yuma. On the bank below, a Quechan man throws a stick into the river for his dog. As I coast beneath the Ocean-to-Ocean Bridge, I listen to the flow of people in both directions. I pass Gateway Park, where clusters of kids chitchat on the beach, soaking up the sun. American coots dodge my paddleboard and hustle upriver, tooting their tiny tin horns. Up ahead the river turns a corner. A finger of wind riffles the surface, and cottonwoods shimmer in the breeze.
LESLIE JAMISON
The Empathy Exams
A Medical Actor Writes Her Own Script
FROM The Believer
DISCUSSED: Inexplicable Seizures, An Ailing Plastic Baby, Teenagers in Ponchos, An Endless Supply of Mints, Another Word for Burning, Crippled Rabbits in Love, The Sad Half-Life of Arguments, A Kid’s Drawing of God, Praying in the Nook, Major Personality Clusters, fMRI Scans, Adam Smith, Pet Fears, Impulse’s Dowdier Cousin, A Broken Arrow, A Bottle of Rain
My job title is Medical Actor, which means I play sick. I get paid by the hour. Medical students guess my maladies. I’m called a Standardized Patient, which means I act toward the norms of my disorders. I’m standardized-lingo SP for short. I’m fluent in the symptoms of preeclampsia and asthma and appendicitis. I play a mom whose baby has blue lips.
Medical acting works like this: You get a script and a paper gown. You get $13.50 an hour. Our scripts are 10 to 12 pages long. They outline what’s wrong with us—not just what hurts but how to express it. They tell us how much to give away, and when. We are supposed to unfurl the answers according to specific protocols. The scripts dig deep into our fictive lives: the ages of our children and the diseases of our parents, the names of our husbands’ real estate and graphic design firms, the amount of weight we’ve lost in the past year, the amount of alcohol we drink each week.
My specialty case is Stephanie Phillips, a 23-year-old who suffers from something called conversion disorder. She is grieving the death of her brother, and her grief has sublimated into seizures. Her disorder is news to me. I didn’t know you could have a seizure from sadness. She’s not supposed to know either. She’s not supposed to think the seizures have anything to do with what she’s lost.
Stephanie Phillips
PSYCHIATRY
SP TRAINING MATERIALS
Case Summary: You are a 23-year-old female patient experiencing seizures with no identifiable neurological origin. You can’t remember your seizures but are told you froth at the mouth and yell obscenities. You can usually feel a seizure coming before it arrives. The seizures began two years ago, shortly after your older brother drowned in the river just south of the Bennington Avenue Bridge. He was swimming drunk after a football tailgate. You and he worked at the same mini-golf course. These days you don’t work at all. These days you don’t do much. You’re afraid of having a seizure in public. No doctor has been able to help you. Your brother’s name was Will.
Medication History: You are not taking any medications. You’ve never taken antidepressants. You’ve never thought you needed them.
Medical History: Your health has never caused you any trouble. You’ve never had anything worse than a broken arm. Will was there when it was broken. He was the one who called for the paramedics and kept you calm until they came.
Our simulated exams take place in three suites of purpose-built rooms. Each room is fitted with an examination table and a surveillance camera. We test second- and third-year medical students in topical rotations: pediatrics, surgery, psychiatry. On any given day of exams, each student must go through “encounters”—their technical title—with three or four actors playing different cases.
A student might have to palpate a woman’s 10-on-a-scale-of-10 pain in her lower abdomen, then sit across from a delusional young lawyer and tell him that when he feels a writhing mass of worms in his small intestine, the feeling is probably coming from somewhere else. Then this med student might arrive in my room, stay straight-faced, and tell me that I might go into premature labor to deliver the pillow strapped to my belly, or nod solemnly as I express concern about my ailing plastic baby: “He’s just so quiet.”
Once the 15-minute encounter has finished, the medical student leaves the room and I fill out an evaluation of his/her performance. The first part is a checklist: which crucial pieces of information did he/she manage to elicit? Which ones did he/she leave uncovered? The second part of the evaluation covers affect. Checklist item 31 is generally acknowledged as the most important category: “Voiced empathy for my situation/problem.” We are instructed about the importance of this first word, voiced. It’s not enough for someone to have a sympathetic manner or use a caring tone of voice. The students have to say the right words to get credit for compassion.
We SPs are given our own suite for preparation and decompression. We gather in clusters: old men in crinkling blue robes, MFA graduates in boots too cool for our paper gowns, local teenagers in ponchos and sweatpants. We help each other strap pillows around our waists. We hand off infant dolls. Little pneumonic Baby Doug, swaddled in a cheap cotton blanket, is passed from girl to girl like a relay baton. Our ranks are full of community-theater actors and undergrad drama majors seeking stages, high school kids earning booze money, retired folks with spare time. I am a writer, which is to say, I’m trying not to be broke.
We play a demographic menagerie: young jocks with ACL injuries and business executives nursing coke habits. STD Grandma has just cheated on her husband of 40 years and has a case of gonorrhea to show for it. She hides behind her shame like a veil, and her med student is supposed to part the curtain. If he’s asking the right questions, she’ll have a simulated crying breakdown halfway through the encounter.
Blackout Buddy gets makeup: a gash on his chin, a black eye, and bruises smudged in green eye shadow along his cheekbone. He’s been in a minor car crash he can’t remember. Before the encounter the actor splashes booze on his body like cologne. He’s supposed to let the particulars of his alcoholism glimmer through, very “unplanned,” bits of a secret he’s done his best to keep guarded.
Our scripts are studded with moments of flourish: Pregnant Lila’s husband is a yacht captain sailing overseas in Croatia. Appendicitis Angela has a dead guitarist uncle whose tour bus was hit by a tornado. Many of our extended family members have died violent, midwestern deaths: mauled in tractor- or grain-elevator accidents, hit by drunk drivers on the way home from Hy-Vee grocery stores, felled by a Big Ten tailgate—or, like my brother Will, by the aftermath of its debauchery.
Between encounters we are given water, fruit, granola bars, and an endless supply of mints. We aren’t supposed to exhaust the students with our bad breath and growling stomachs, the side effects of our actual bodies.
Some med students get nervous during our encounters. It’s like an awkward date, except half of them are wearing platinum wedding bands. I want to tell them I’m more than just an unmarried woman faking seizures for pocket money. I do things! I want to tell them. I’m probably going to write about this in a book someday! We make small talk about the rural Iowa farm
town I’m supposed to be from. We each understand the other is inventing this small talk and we agree to respond to each other’s inventions as genuine exposures of personality. We’re holding the fiction between us like a jump rope.
One time a student forgets we are pretending and starts asking detailed questions about my fake hometown—which, as it happens, if he’s being honest, is his real hometown—and his questions lie beyond the purview of my script, beyond what I can answer, because in truth I don’t know much about the person I’m supposed to be or the place I’m supposed to be from. He’s forgotten our contract. I bullshit harder, more heartily. “That park in Muscatine!” I say, slapping my knee like a grandpa. “I used to sled there as a kid.”
Other students are all business. They rattle through the clinical checklist for depression like a list of things they need to get at the grocery store: “sleep disturbances, changes in appetite, decreased concentration.” Some of them get irritated when I obey my script and refuse to make eye contact. I’m supposed to stay swaddled and numb. These irritated students take my averted eyes as a challenge. They never stop seeking my gaze. Wrestling me into eye contact is the way they maintain power, forcing me to acknowledge their requisite display of care.
I grow accustomed to comments that feel aggressive in their formulaic insistence: That must really be hard [to have a dying baby], That must really be hard [to be afraid you’ll have another seizure in the middle of the grocery store], That must really be hard [to carry in your uterus the bacterial evidence of cheating on your husband]. Why not say, I couldn’t even imagine?
Other students seem to understand that empathy is always perched precariously between gift and invasion. They won’t even press the stethoscope to my skin without asking if it’s okay. They need permission. They don’t want to presume. Their stuttering unwittingly honors my privacy: “Can I . . . could I . . . would you mind if I—listened to your heart?” “No,” I tell them. “I don’t mind.” Not minding is my job. Their humility is a kind of compassion in its own right. Humility means they ask questions, and questions mean they get answers, and answers mean they get points on the checklist: a point for finding out my mother takes Wellbutrin, a point for getting me to admit I’ve spent the last two years cutting myself, a point for finding out my father died in a grain elevator when I was two—for realizing that a root system of loss stretches radial and rhizomatic under the entire territory of my life.
The Best American Science and Nature Writing 2015 Page 14