* * *
ONCE A MONTH, if our schedules align, my friends Frank and Len and I go for coffee in the hospital atrium. We watch the wind picking up outside, leaves gathering by the glass. We are all in or near our forties, parents of little boys, internists of some stripe, sleep-deprived and struggling with an amorphous discontent that has become medicine’s secret ailment. We’re good doctors; we care about our patients. But there’s a force bigger than us pushing us to the brink, and some days I’m afraid one of us is going to tumble over that edge.
I don’t tell my friends what’s going on with me at this point since they’re basically in the same boat. I don’t burden them with the fact that I’m not sleeping enough, that a constant weight on my chest like a barbell is making it tough to get through not only rounds but also supper and playdates and grocery shopping. The radio in my head is set to perpetual glum, Nespresso pods strewn across my desk like drugs and paraphernalia I am relying on to get me through the week on call. Between seeing clusters of patients, I curl up like a caterpillar in a stained armchair in the corner of my office, swallowing against the lump in my throat. There’s a tingling behind my eyes, a feeling I get in my mouth, an ache in the teeth like winter or an empty parking garage. Still, silent, heavy. Boiling the kettle for tea, momentarily comforted by the smell of chai, a whiff of spice, the hint of a kitchen at Thanksgiving. My office has a thin, high band of windows, and they face a brick wall; the effect is like looking up from a well. I am at the bottom of that well. But doctors look fine until the very end. This is a silent emergency, and even if the people around me can smell something burning, none of us has made the connection that the thing on fire is me.
* * *
THE MORNING BEFORE I left for Chapin Mill, my husband, Eric, and I dropped our three sons off at school. As we stood at the lockers, a little girl came running down the hallway, wisps of hair stuck in her mouth. Her face shone with important news.
“The egg hatched!” she shouted at us. “There’s a baby dove!”
My boys went wide-eyed. They kicked off their boots and ran in their socks towards the classroom. Children were gathered around a birdcage. A male dove sat up top, perched on a little trapeze, sounding guttural, excited notes. Below him, a female was sitting on a minuscule body.
The teacher was peering into the bottom of the cage, craning her neck for a good look at the littlest bird. “I don’t know if it’s alive,” she said softly. But a second after she spoke, the baby dove turned its head to the side, extending its translucent neck, its eyelids fused shut. The mother nipped at its hairless body. The children huddled around the cage, transfixed and silent.
On the way back out to the car, I saw geese lined up in a lazy V overhead, their two-tone honking reminding me of the rubber horn I had on my bike when I was a little girl. I felt a pressure in my chest, like a small hand squeezing my heart. The bird had barely moved. Of course it was going to die. The mother didn’t have a coach or a public health nurse or a doula, and the father was thinking about how soon he could knock her up with another egg. Soon there would be a latex glove, the teacher moving the mother aside as she pried the little dove’s body out from under her.
It’s a burden, knowing what’s going to happen when everyone else is still ten steps back, saying “ooh” and “aah” and calling it a miracle.
That’s the curse of knowledge.
* * *
SO HOW DID I end up on this plane? A friend who is a social worker invited me to a talk by another friend of hers, a doctor she had invited to speak about mindfulness. I went because my friend phoned me twice, and I wanted to show her I was open-minded, even if I wasn’t. I sat in the back row with my jacket over my shoulders. I said it was because I was cold, but really I was waiting for a chance to slip out of the room.
Except it was actually kind of an interesting talk. The speaker’s name was Mick Krasner. He was bald and looked more like a beat poet than a doctor. He and his colleagues had published a study in the Journal of the American Medical Association showing that their mindfulness program made doctors feel happier and more able to handle the stress of medicine. I had expected him to be a hippie or a freak, but Mick seemed like a lighter, happier version of me from a time before the connections between necessary pieces of myself got severed.
When the talk was over, my friend walked me up to Mick.
“This is the colleague I told you about,” she said to him.
Mick smiled. He gave me his card. He suggested I might like to come spend a few days with him and one of his colleagues at a retreat for doctors. There was one in April. He said they still had room at Chapin Mill. He hoped I could join them.
“Is it, like, a padded room?”
Mick laughed. “No, but it’s a Zen retreat. Lots of cushions.”
“I don’t think it would help me.”
He winked. “Only one way to find out.”
Normally this exchange would have irritated me, but that day Mick’s words hung in the air, stayed with me on my way home, and lingered that night as I was getting ready for bed.
I lay in the dark, and I knew: this was my Hawkeye/Clooney moment. Mick and my friend were throwing me the only intervention I was ever going to get.
A week later I told my husband I was going to spend five days with a doctor who looked like a beat poet, and I booked a ticket to Rochester.
I made the connection: the thing on fire is me. That’s why I’m going to Chapin Mill.
2
The Glass Cliff
The shuttle from Rochester airport is much smoother than death’s personal airplane. It travels over tidy roads through sleepy-looking smatterings of houses. Swings, empty of children. A geriatric-looking dog, too tired to bark when the shuttle slows down and turns onto a rural gravel road, descending into forest. I see a pond. A bridge with a mill comes into view, then a littler footbridge over a thin, sparkling stream, like the one where Siddhartha found the meaning of his life. The van stops in front of a wooden building that looks like a cross between a summer camp, Thoreau’s cabin and a rustic sanitorium.
I hoist my suitcase down to the ground. It’s heavy. There’s never a trip when I don’t bring more than I need. I’ve been up since 4 a.m. A halo of light surrounds everything I look at directly. I’m getting a migraine. I wheel my bag through the open glass doors.
A woman greets me at a small table. She asks my name, finds me in a sea of plastic nametags.
“How was your trip?”
“Hellish.”
She smiles. “Well, that’s behind you now. Your room is to the left, down the stairs and on the right.”
That’s behind you now.
There’s an eerie calm in this lobby. People are speaking in hushed voices. I’m stuck here for five days with what I’m going to guess is seriously crap Wi-Fi. I fear this might be a place for absolute weirdos.
My fear has nothing to do with meditation or Buddhists, by the way. They’re no weirder than anyone else. But how do you mix Buddhism with the reality of practising medicine? It’s like setting Hello Kitty up on a blind date with Darth Vader. That will not end well.
I go to the right, down the stairs, make a left and end up in what looks like Santa’s workshop. Damn, I had no idea American Buddhists were so into crafts. I go back up the stairs and make the left I was supposed to make the first time. I find my room. My name is on the door, on a little index card.
There’s next to nothing in here. A bed, a chair, a nightstand with a lamp. A wool blanket. A window with slat blinds that have diced the afternoon light into matchsticks. I pull the cord, and the slats rise, revealing a grass-covered hill. Behind it is dark, dense forest. I set my things down on the floor, open the binder the woman handed me at the desk.
Welcome to Chapin Mill.
No flesh foods.
Absolutely no alcohol.
Lights out at 10 p.m.
It dawns on me—I mean, really dawns on me.
This is Doctor Rehab.
> I sit down on the edge of the bed, perplexed. Then I’m perplexed that I’m perplexed. What did I think I’d be doing here? I keep looking out at that little hill, like the top of a viridian baby head. How did I get here? Via a plane unfit for any human. Literally and metaphorically.
But I know exactly what got me here. Twenty years of a toxic culture, twenty years of sleeping with the enemy, of saying “I’m fine” every time I wasn’t. Twenty years of shoving the snake back down into the can every time it popped up. Half a lifetime. Half of mine, anyway.
* * *
MEDICINE BEING AS difficult as I’ve said it is, nobody should be surprised that med schools need people who function like psychiatrists for students who need to be kept from running in the wrong direction or basically combusting in real time. At my school, for the last four years, that person, the associate dean of student affairs, was me.
Deans and university presidents are overwhelmingly men, but the position of associate dean of student affairs is one more frequently bestowed on women. I don’t know if this is because women are supposed to be more nurturing, or if it’s just assumed that we’ll put up with more. My colleague Joanne called it a “glass cliff” job.
But in some ways, when I started it was my dream job. I wanted to develop the character of students, to help build a culture of compassion and kindness, because I believed if I did, none of them would end up screaming at the mother of a little girl with a brain tumour that the girl had no brain left. I wanted to help students understand that if becoming a doctor is like climbing Mount Everest, medical school is only base camp. Their best shot at getting down from the summit alive involves learning to dress for the weather and finding out how to deal with the psychological pressures that rise as the temperature drops. Nobody taught me any of those things. I learned them myself, at the expense of parts of me that ended up frozen and left behind. As a dean, I wanted to be the sort who doesn’t make you feel the problem is all about you. I told students I had also struggled on that mountain, also had times when I didn’t know if I’d make it down, times when I thought, My God, what have I done?
I loved my students without reserve. I loved the hours when I got to lecture them about what being a doctor means to me. I loved supervising them on the wards, taking them from bedside to bedside, encouraging them to hold hands, listen with kindness, talk to patients like they would to cherished friends. I loved showing them how to broach tender subjects in difficult moments, coaching them to find the right words at the right time. I loved debriefing them after something went wrong or someone died, sitting with them in a corner of the nursing station, watching them choke back tears, telling them it’s all right to cry. Being an associate dean gave me a platform to protect students who were often vulnerable to systemic abuse in medical education, to offer them protection, producing a compassionate and emotionally intelligent result. I thought I’d found my life’s work.
What does an associate dean of student affairs at a medical school actually do? Provide career counselling. Offer crisis support. Grant deferrals. Meet with struggling or failing students. Sit on committee after committee, council after council. Meet with people who are suffering from anxiety, or depression, whose parents are ill, whose siblings are ill, whose spouses are ill, who have just had their first patient death, or made their first medical error, or delivered their first stillbirth. Encourage. Soothe. Ground in reality. Cheer and motivate. Advocate. Stand up and speak up for those who’ve been abused or harassed, go after the abusers. Prevent them from harming themselves. Prevent them from harming anyone else. Say things that they will not particularly want to hear, sometimes things nobody else will have the heart or courage to tell them.
My inbox bore witness to the unrelenting nature of the work. It was a constant flood of emails about anxiety and maxed-out credit cards and mental health crises and pregnancies and emergency relationship problems. I responded to it all, in real time. I sent out search parties for students who didn’t show up for exams, waited anxiously by the phone until I knew they were okay. I approved enough mental health days to fill a couple of calendars. I granted exam deferrals triggered by a mysterious number of car breakdowns, including some for people I suspected actually had no car. When they failed exams, they wept in my office. When their tears were dry, I helped them pick themselves up again. All this on top of being a clinician, looking after profoundly ill patients in the hospital, huge numbers of them, for weeks at a time, still taking students’ calls and answering their emails in between resuscitating people and telling other people they were HIV positive or were going to need dialysis or their cancer had returned.
Some days, my three kids and my husband were barely more than footnotes.
I also met with students who were not particularly wonderful or grateful. In fact, those individuals tended to request far more appointments than all the others combined. I had plenty of emails from those who clearly hadn’t heard of Google. They wanted me to help them sign up for Zumba, or clarinet lessons to enhance their “wellness.” There were emails to make me “aware” of a strong chlorine taste in the east wing drinking fountain and of fruit flies in the fridge in the student lounge. This associate dean didn’t give a flying fuck about fountains or fruit flies; she did very much care about the kind of people we were trying to turn into doctors.
* * *
THEN, A PALPABLE shift. A few years into the job, I started asking students to provide notes for exam deferrals because the number of requests was reaching double digits each week, wreaking havoc on the admin staff and the budget for proctors. Students didn’t like their exam schedules, didn’t like their exams. Felt that medicine shouldn’t infringe on their wellness, at any time or in any way, as if the associate dean’s job was not to help make medical education safer and more humane but to make it more convenient for them personally—not so much level the playing field as raze the mountain.
I was hearing about it from others across the country, but I was feeling it personally every time I set foot in a lecture hall: something was beginning to go rancid. I had always loved telling students the story of my vulnerable sister, how badly she had been failed by the medical system. Now, when students came to my lectures, they sat in the farthest seats at the back, blank faces bathed in white light reflected from laptops, browsers open to Facebook. Maybe it was my imagination, but I thought I heard whispers, saw smirks and snide looks on just enough faces to shut me down inside.
And the wards were no retreat. I’d spend two weeks leading a clinical team, bonding with them, teaching them to listen, to speak with humility, to learn about their patients so they could offer them the treatments that aligned with their values and lives, only to sign over on a Monday to another physician who might well admonish them for wasting so much time talking to patients on rounds when there was “real work” at hand, undoing everything I’d just done.
Education is not inevitably a one-way, top-down hierarchy. Any teacher can be undermined by a couple of colleagues or a big enough student mob, quickly reduced to a punchline. For a woman, there is an even bigger challenge than breaking the glass ceiling, and it is getting caught on the wrong side of a crack in the glass cliff.
My joy had been flickering, and finally it was snuffed out like a match. Suddenly, my work as a teacher felt pointless. My confidence in what I was doing, my certainty about why I was doing it, was obliterated. I lost any desire to make myself vulnerable, to tell the true story about my own climb up the mountain.
I sent the dean an email saying I was quitting. I brought in cardboard boxes and dumped the contents of my drawers into them. Teaching awards. Thank-you cards. “Thank you for always believing in me!” I didn’t always believe in you and I definitely don’t right now. “Thank you for always being there for me!” Too bad my husband and kids can’t say the same.
It didn’t take long to fill those boxes: a terminally ill houseplant, stale Fairmont tea, pictures of my children feeding pigeons in Vancouver, thirty or forty books: Jo
seph Campbell’s The Hero’s Journey and William Osler: A Life in Medicine, The Picture of Dorian Grey and Gray’s Anatomy.
On the way out, I passed students in the hallway, some gathered in groups, some not noticing me at all, others looking at me quizzically.
“Hey, you moving, Dr. H.?”
“Spring cleaning, Sam.”
“Dr. H., can I help you with anything?”
“Too late for that, Ali, but thanks.”
Was I ever that young? Had I ever written letters to my associate dean calling the number of parking spots designated for my program “unacceptable,” or the failure to fund sandwiches at interest-group nights a “critical situation in need of rectification, immediately”? No. I couldn’t afford a car, and I made my own sandwiches. I was far from perfect, but I never equated having to write two exams in a twelve-hour period, or being asked to name the bones of the hand, with a sentence in a forced labour camp.
And yet, some of the students were good kids. Such good kids. How many of them had sat across from me in those chairs in my office, so eerily like me, sending me messages in a bottle from ancient, earlier versions of my own life? Suddenly gifting me with the ability to see something about myself as I was back then—how tough yet fragile, how earnest, how vulnerable, how intent on making a difference. For every kid who treated me like a concierge, there were at least three students who didn’t even think they were worth my time, who thought their problems were best handled in silence, on their own, by themselves. Emailing me messages that always started with I’m so sorry to bother you, even though they were the people I had intended to be there for in the first place. I had been just like them. I hadn’t wanted to bother anyone either. When I was a medical student, it wasn’t even clear to me who I would have bothered. If there was a person, other than me, responsible for my overall well-being, I sure didn’t know who they were. If anybody had asked, I would always have said I was perfectly fine. It never occurred to me that I had the option to say anything else.
We Are All Perfectly Fine Page 2