We Are All Perfectly Fine

by Dr. Jillian Horton

  I remember his outline was blurry, my eyes barely able to focus because I was so sleep-deprived. I blinked several times, the way people do when they are going under anesthetic, catching a last glimpse of the world for what could turn out to be a very long time.

  It would be years before I understood the profound lesson of that moment: doing a good job, and knowing you have done a good job, are two separate skills.

  I only had one of them.

  9

  Answers Don’t Change

  We line up for breakfast in the kitchen. There’s a huge, comical vat of oatmeal. A pineapple and a watermelon, dissected. Boiled eggs. Bread and jam and a pillar of pats of butter. Pots and pots of coffee.

  The windows in the dining hall look out onto the stream and the old mill. There’s a hint of frost visible on the grass, the light around the trees still baby pink. Greg is behind me in the food line.

  “Hey, sorry for running into you.”

  “No problem. Woke me up.”

  “Thanks for not suing.”

  “I didn’t agree to that.” He uses tongs to wrangle an egg onto his plate. I pretend not to see when the egg slips and rolls under one of the kitchen cabinets. He takes another one.

  I fill a bowl with oatmeal. The kitchen smells like holiday: cinnamon and oranges. Jodie waves at me from across the line. I point the oatmeal ladle at her like a weapon and glare.

  “I’m guessing you’re not a surgeon?” I say to Greg.

  He pours cream over his oatmeal, dousing it with brown sugar. “Or diabetic?”

  Jodie calls over: “Is she bothering you?”

  “All under control. I’m an ER doc.”

  I hand him some cutlery. “I guessed that.”

  “Why?”

  We head to an empty table in a corner by the window, set our plates down.

  “You seem kind of unflappable.”

  “I just do my flapping on the inside.”

  “Doesn’t that sound like one of those consults that makes you want to kill yourself?”

  “Or somebody else.”

  “Totally.” I watch him take a sip of coffee. He cuts his egg in half, revealing a neon yolk.

  “So why are you here?” I ask him.

  He doesn’t answer right away. “I should know this, right? I had lots of time to rehearse last night.” He takes another sip of coffee.

  “Ok, so, Greg, I was buying a futon once when I was a student. I kept going to look at all the options. I guess I went into the same store twice by accident, and I asked the guy how much for a queen futon. And he points his finger at me and says, ‘You’ve been here before! Answers don’t change!’”

  “But answers do change.”

  “Or do questions change? Or does honesty change?”

  “This would be the line of questioning in a more existential futon store.”

  “Yes! Like, ‘What is sleep but non-awakening?’”

  “I remember when I was a resident.” He shakes his head wistfully. “I was always thinking how when I was done, I was going to get the best mattress money could buy, and blackout curtains so I’d feel like I was in outer space.”

  “I had that same obsession with perfect sleep. Like it was a narcotic.”

  “And meanwhile I’m still hitting the hay on a twenty-year-old piece of junk from Sears.”

  “Why didn’t you buy that dream bed?”

  “Don’t know.” He eats the rest of his egg. The sugar has mottled the surface of his oatmeal, like a bruise.

  “Greg, it’s melodrama, but do you think it’s like, it never really ended? You’re back home, but it still looks identical to the frontline. Why bother changing anything if you’re still at war?”

  He nods. “Nail on the head.”

  “Now there’s a classic ER problem.”

  Jodie slips into an empty seat next to us.

  “Pretty sure that’s a nail in the head. Greg, have you met Jodie?”

  They shake hands. Greg shows her his nametag. Then he looks puzzled. “How do you two know each other if Jill’s from Canada?”

  “Past life.”

  Jodie is still wearing her meditation shawl. She has it folded around her neck in a complex configuration, like a piece of origami. “How did you guys like Zendo?”

  “I thought it was a Game of Thrones kind of thing. I tried to take Greg out.”

  “She did.”

  Jodie pulls out the blue folder of information we all received when we checked in. “We’re all in an Affinity group together.”

  “Well, whatever that is, at least we’re not going to spoil three groups.”

  Greg looks skeptical. “Isn’t that a presumptuous name? What if we hate each other?”

  Jodie raises her coffee mug as if proposing a toast. “Then we can call it an Infinity group.”

  He clinks his cup against hers. “’Cause that’s what it will feel like!”

  The hall is full now. There’s a happy, camp-like din. Conversation, laughter, noise from cutlery and dishes. People are wearing T-shirts and sweatpants, moccasins and slippers. You’d never guess this was a group of doctors. We look like we’re being prepped to reintegrate into society.

  In fact, we aren’t actually part of normal society, not anymore. Medicine does something to us. It teaches us another language, one only other doctors can understand. Eventually it scripts our emotions, neutralizing them whenever they threaten to overwhelm the senses. This also happens to police and firefighters, coroners and soldiers and paramedics, a misguided Clockwork Orange rewiring of the motherboard. But it’s not by accident.

  Once, when a friend of mine was a resident in the intensive care unit, she was looking after a young woman who had a sudden, catastrophic bleed into her brain. Two little children were crawling on their mother’s motionless body, her brain in her skull liquefied by the pressure of blood with nowhere to go, tissue turned to mush, like an overripe banana. The youngest one kept saying, Wake up, Mommy. Mommy, it’s morning. It’s time to wake up. My colleague, doing a neurologic exam, checking for reflexes, prying open the woman’s eyelids to see massive, unresponsive pupils, black as oil, big and round like pennies. All the while, that little child was slapping her mother’s cheeks, pinching fingernails that still bore the jovial, piglet pink of what looked like a fresh manicure. Those nails. That was the thing that got her, just as much as the soon-to-be orphaned child. My colleague stepped out of the room and ducked into a storage area a few doors down, stifling a sob she’d only just barely been suppressing. She heard footsteps. The staff physician appeared and stood in the doorway. He looked at her, his face as expressionless as that of a corpse in the anatomy lab. He said: “This is an emotion-free zone.” He walked away.

  “Do you guys know if Mick writes all his own poetry?”

  Jodie looks at me over the top of her bifocals. “Mick writes poetry?”

  “What he read in the Zendo.” I feel my cheeks flush. “Wasn’t that his?”

  She giggles. “That’s David Whyte. Probably just the best-known living Buddhist poet in the Western world.”

  “Hey, no way,” says Greg. “That’s Mary Oliver.”

  “I didn’t know she was a Buddhist.”

  Jodie laughs through a mouthful of coffee, accidentally spitting some in my direction.

  “Gross, Jodie.”

  She wipes coffee off her chin. “Jill doesn’t speak American. We’d better explain everything.”

  “Look, morons, is she really a Buddhist?”

  Greg waves his index finger at me. “Answers don’t change!”

  Jodie leans in and whispers, “Can you imagine the three of us working together?”

  “More like not working.”

  “Where do I sign?” says Greg.

  10

  Little Green Shoot

  Noticing the breath.

  Breath is a vital sign. I was trained to notice other people’s breath. I notice if they’re breathing too fast or slow. It’s often one of the earliest,
subtlest clues that something is changing. A pneumonia is getting worse. Heart failure is brewing. Acid is slowly building up in the body and the lungs are working overtime to spew it out as carbon dioxide. If you’re going to avoid killing people, you learn to treat the breath with respect.

  But nobody ever instructed me to notice my own breath. I’ve noticed it before, but just barely. Like when you’re looking at a tree and suddenly discern a bird, hidden among the leaves. Or when you’re sitting on a beach, staring out at the water, and suddenly you really see the way the light dances on it, splintered into diamond ridges.

  We split from our bodies so we can learn to be doctors. Isn’t that ironic? We deal with corporeal failures, but we think we can program bodies, our bodies, to run without sleep, or food, or hydration. We learn to work through utter exhaustion. We dismantle the safety valves evolution built to keep us from doing anything important or dangerous on too little sleep. When our ancestors were apes, was it good for them to be out in the dark gathering bananas? No, they were better off in their ape beds, where they wouldn’t stumble over cliffs in the pitch black. Medical education says: You know why that ancestor of yours needed sleep? Because he was an ape. And by extension, if you can’t function without sleep, well, that can only mean you’re an ape too.

  The hilarious thing is that in recent years, medical organizations have begun using the same wellness buzzwords as everybody else, telling us to practise self-care. How can I practise self-care? My training was an apprenticeship in the art of self-immolation. I excelled at it; I strove to master it the same way I applied my full self to everything. You don’t just undo that overnight. If you ever undo it at all.

  Why didn’t we question it? We didn’t even have a language to describe what we would have been questioning. Words like burnout were reserved for people who were so ill they couldn’t work. Those people existed on the periphery of our consciousness, vanishing on personal leaves or mysterious, non-existent “research” blocks, because they were afraid to tell anybody what was really going on. We never knew what force was quietly picking off the people around us. We thought that kind of attrition was normal. And so, we experienced a slow drift away from normalcy, the tether giving way over not months but years.

  Once, when I was an intern, I was rounding, and on my twenty-eighth hour with no sleep, listening to the attending physician ramble about examining a patient’s spleen, while we interns, all post-call, tried to stay upright around the bed. A wall of intense nausea dropped in front of me like a curtain. I stepped out of the room and into the closet-like bathroom reserved for the nurses, where I threw up the little food I’d eaten the night before, then bright green bile. I paused, rinsed my mouth with tap water, and rejoined the others a few rooms down. I was gone for less than two minutes. The attending physician was still talking about the spleen. He hadn’t even noticed I was gone.

  Pride. That’s what I felt then. Pride at my own ability to take blows as they came, pride that I could suffer so secretly, so completely, while standing shoulder-to-shoulder with these men. Pride, too, the following year: sick with another virus in the middle of a call shift, vomiting so forcefully that I bled behind the white of one eye, but still staying on, shivering in the glassed-in fishbowl internal medicine room in the emergency department, still reviewing cases with the juniors. Pride, the next morning, not in the emergency department but in the call room, when one of the more senior residents slipped an IV into a collapsed vein on the back of my hand and squeezed in a bag of normal saline, both of us laughing like it was just a big joke. “You okay to get home on your own?” “Oh please, it’s just a gastro for fuck’s sake.” Pride, despite the utter self-neglect, the incredible, shocking stupidity of this on both sides.

  I flag that first day on rounds as one more stop on a long journey towards abandoning myself to a deep and smoke-like darkness that permeated everything, sowing the seed of a problem that grew deep, deep roots.

  You can mostly convince yourself that whatever you’re inflicting in that darkness, whether it’s an eating disorder or just quietly failing to provide yourself with the emotional and physical necessities of life, at least it’s not like you’re buying drugs on the street. You’re not going to be found blue, pulseless, overdosed with a needle in your arm somewhere in a seedy hotel.

  But it is still a way you kill yourself. Not necessarily the body, but the literal, precious self, the best part of you: the part of you that is real and authentic, the part that loves, deeply. That part can die. That part is a little green shoot. I thought it was supposed to take care of me, not the other way around. If I didn’t water that shoot for years, how did it survive? Or did it?

  Mick, I’m noticing my thoughts.

  I’m noticing my thoughts are very dark.

  11

  Things in Boxes

  Our Affinity group meets in the Zendo. Me, Greg, Jodie and a woman named Joss who looks to be the same age as me but is, damn her, a lot thinner.

  I said I was mostly over it.

  The bell rings in the main hall, our cue to begin. We’re studying a poem, doing something called “close reading.”

  This feels flaky.

  Jodie sighs. “I’ll read. One for the team.”

  Grace

  Those first few weeks were agony. July

  Sweated me into stupor. The ink not dry on my degree.

  The angels must have thought I was a dunce.

  I sat in chapels crying more than once.

  That maze of halls I barely knew, those wards

  My family a thousand miles away

  My things all still in boxes, as a day

  To take them out eluded me. It’s hard.

  It’s hard. Two words we never say enough

  To anyone. We’re rude, or gruff, or, worse still,

  Silent. We seldom know the grace

  Of love we stubbornly rebuff.

  We sit looking at each other.

  “Should we read it again?”

  “I will. Jodie’s done her civic duty.”

  Joss reads the poem a second time. There’s a long pause.

  Greg clears his throat. “I’m kind of drawn to the way she uses religious imagery. You know, the . . .” He pauses, scanning the poem again. “The ‘chapel.’ The ‘angels.’ The ‘grace of love.’”

  Greg, I’m kind of drawn to you, actually. Nothing seedy, totally platonic. You just have this presence, this energy that makes me want to sit and talk to you all morning. You’re someone I’d share jokes and meaningful glances with if we worked together in the emergency department. But I’d never guess that you’re flapping on the inside. Seriously, why are you here?

  “I’m just getting a feeling of this deep loneliness, actually,” Jodie says.

  Jodie, I’m drawn to you too. You’re another person I could go for a long coffee with every month for the rest of my life. Someone I’d like for a sister or an aunt.

  The group is looking at me.

  “Am I the only person here who feels like a moron? Seriously, I mean, I have a degree in English, but I feel like a fucking idiot doing this. Sorry, can I swear here?”

  Jodie rolls her eyes. “No judgment.”

  Joss says, “Fuck yeah.”

  “Now I’m at home.”

  “Is it Zen to swear?”

  “If it’s done with awareness.”

  “We should still talk about the poem.”

  “Yeah, let’s talk about the effing poem.”

  “Guys, the other line that jumps out at me is, ‘my things in boxes.’” God, Greg’s just so achingly earnest. How hard he’s trying is seriously breaking my heart.

  “What do you think that’s about?”

  “Well, we shove everything down, right? I mean, I assume this poem is about residency. It’s taken me almost thirty years to unpack all that, and I’m still not done.”

  Jodie says, “Nobody knows that about us.”

  “I feel like we all have one of those boxes.” Joss has stra
ight blond hair and an outrageously excellent vintage necklace set with turquoise and mother-of-pearl. “I’m afraid to even look at what’s still in mine.”

  “Like whatever’s in there might just jump out at you and eat your face.”

  “Like it did eat my face. Or maybe what’s in the box is what used to be my face.”

  “Do any of you guys ever feel like you’re the last person anyone expects to feel that way?

  “Jodie, you’ve been silent for more than thirty seconds. Are you okay?”

  “Now it’s Animosity group.”

  Greg keeps us on track. “Hey, so what’s the bit about ‘rude, or gruff, or worse still silent’?”

  “Don’t you think that’s how we treat each other?”

  “Some departments consider being a dick a core competency.”

  “In Canada? You’ve got to be kidding.” Jodie shuts her eyes, puts the back of her hand against her forehead and pretends to faint.

  It’s funny. I throw a cushion at her.

  “Were you both, like, the bad kids in medical school?”

  “Who said we went to medical school?”

  “Animosity group,” says Joss. “Let’s hear this puppy one more time.”

  She reads the poem again.

  We’re all quiet for a minute.

  “That was a totally different poem. I heard some of that for the first time.”

  “It’s kind of like, just validate this, right? It’s fucking hard.”

  Joss pauses, clears her throat. “You want to know what’s really in my unpacked box?”

  This time nobody makes a joke. Joss takes a long, deep breath. Her voice is quiet. “Have you guys ever treated near-drowning?”

  I have. But long after the fact, only in the ICU. The others are shaking their heads, no.

  “I looked after a kid once, in Pediatrics. Fell through the ice. It was just . . .” Joss pauses, takes off her glasses, cleans them on the tail of her shirt. “She was so cold it hurt my hands to touch her. Like, we couldn’t even draw blood.”

  “How old?”

  “Seven.”

  “God.”

  “Ice in her mouth. Like slush when we did chest compressions. Like a slushie, basically.”