We Are All Perfectly Fine

by Dr. Jillian Horton

  “Oh fuck.” Jodie has her hand over her mouth. “I take it she died?”

  “It was hopeless.” Joss is tearing up. “I actually wrote a poem about it, but I can’t remember how it goes. It was terrible.”

  “It sounds ghastly,” says Greg.

  She corrects him. “I mean the poem was terrible.” She fishes in her pocket for a tissue. “But yes, the case was ghastly. One of my top ten worst cases of all time. Mother screaming in the waiting room. Younger sister who’d been with her.” She blows her nose. “They were sledding.”

  Jodie lets out a low whistle.

  Joss wipes her eyes and points at the clock on the wall. “Thank you, Insanity group.” She blows her nose again. “Wasn’t expecting that.”

  Jodie gives her a hug. “Never are.”

  12

  Christmas Is Coming

  Noticing.

  Ron has a picture up on the screen. An explosion. A bunch of farmhouses.

  “Tell me what you see.” Mick walks around with the microphone. People are putting up their hands.

  “Crystal-blue sky.”

  “Grey stone.” Those are mountains.

  “Some kind of dark . . . puffy substance on top of it.”

  That’s smoke. You all know it’s an explosion. Call it a bloody explosion.

  “A building in the distance.”

  I know it’s a building in the distance. Could we stop the days-of-wonder thing?

  “Anything else?” Mick asks.

  “Maybe an . . . explosion?”

  Mick presses the woman who spoke. “What makes you say it’s an explosion?”

  Nothing, Mick. Everything is perfectly fine. Wait, is that a crowd of people running for their lives?

  “Light on the windows?” someone says. A woman, maybe my age.

  She’s right . . . a part of the row of windows on a farmhouse is illuminated in a straight line, a spear of pure light.

  So what.

  People keep chiming in. Don’t they feel the least bit self-conscious? Some of them are falling over themselves to sound clever. This is kind of an affront to my intellect.

  “There’s a . . . modern building in the distance.” Jodie.

  Excuse me, sister, but don’t you also think this is ridiculous? I thought I had your number.

  Somebody says the scene is of a tornado. Or a fire burning. There’s discussion about this.

  Ron points out how we go to interpreting right away, that we’re scrambling for an explanation before we’ve even noticed what we’re looking at. It’s Iceland, he adds, in 2012. A farmer woke up one day to find that a volcano he’d looked at every day for the last sixty years had blown.

  “Same thing happens with an aorta,” says one of the surgeons. The group laughs.

  Then Ron plays a video of people playing basketball. He asks us to count how many passes the players on the red team make. I watch, grudgingly. I count eight.

  Then he asks: “Who saw the moonwalking bear?”

  Oh, fuck off, Ron.

  Except then he replays the video, and there really is a moonwalking bear.* It shuffles right through the circle of basketball players.

  Okay, that was odd.

  He shows us a CT scan of the chest and asks us what we see. It’s up on the screen, a section of the midlung.

  He asks for the diagnosis. Some people notice a nodule. Maybe a pericardial effusion? A rib fracture? There’s some disagreement. A radiologist in the group says there’s a possibility of lymphangitic carcinomatosis. He gets up and points to a spot with his fingers. Everybody squints. Silence.

  Ron asks if anyone noticed the gorilla in the left upper lobe.

  He highlights it, with a small purple arrow. It’s true. There’s a gorilla on the CT scan.

  There are fifty physicians in this room. Specialists, generalists, surgeons. Every kind of doctor. We probably have five hundred years of combined post-secondary education.

  Not one of us saw a gorilla.†

  Ron says this is the concept of beginner’s mind. Seeing without expectations or interpretations. Seeing with a sense of wonder. Noticing.

  He asks us to take a few minutes to do an exercise called “Ten minutes of red.”

  “Walk around the room,” he tells us. “Just do it in silence. Take a piece of paper and write down everything you see that’s red.” The only rule is not to talk.

  We take sheets of paper out of our folders. I have a red pen tucked into the side of mine. I take the pen and write down: red pen. Underneath that, in tiny letters so no one can read it over my shoulder, I write: This feels like bullshit. I take a quick look around. This room is all neutral tones, like you might picture your grandma’s condo in the afterlife.

  But I get up and, along with everyone else, start circling the perimeter of the hall with my paper and pen.

  Fire alarm

  Fire bell

  Red light on the smoke detector

  Exit

  Somebody’s coffee cup

  Somebody’s scarf—silk

  Rose on windowsill

  Four more roses on windowsill

  Writing on Greg’s shirt

  This is stupid

  Ron and Mick run a cult

  I am noticing I feel totally stupid.

  Car lights outside of window

  Writing now so I look like I am participating

  Person who talks too much—her shoelaces

  That girl’s necklace

  Red on screen

  Light from projector

  Pool of human blood

  Gorilla meditating in corner

  Tall guy’s sweatpants

  Thing with Buddha on it

  Buddha’s wiener under his diaper

  Clock rim

  Kool-Aid

  Writing on emergency preparedness sign

  Ron rings his bell. We sit back down. He asks what that was like.

  Somebody I haven’t met yet, an Asian woman about the same age as me, says, “At first I thought there was nothing red in here. Then I could only see red.”

  The man who made the aorta joke: “I wanted to get the most red. I wanted to kick your asses.” Everybody laughs.

  Greg puts up his hand. “I was annoyed. It felt infantile. Then I noticed that I was annoyed. All this chatter was going on in my head while I was doing a mundane task. I was making it harder for myself by resisting what I had to do.”

  Ah, resisting. There we go. Bring on the Kool-Aid.

  Ron asks if that made it harder to focus. A bunch of people nod.

  Jodie calls out: “Plus I found myself wondering, what’s red, anyway?”

  “This pissed me off,” I whisper to her.

  She waves at Mick, points at me. I elbow her in the ribs but it’s too late . . . he’s already handed me the mic.

  “I found that I was, um, annoyed that you were trying to make me do this.”

  “Ah!” says Ron. Now he’s smiling. “Say more about that?”

  “Well, um.” I fiddle with the microphone for a second. “Just that I think I did a worse job because I thought, I’ll show him, I’ll just notice a few things that are red.”

  Everybody laughs again. Did I mean for that to be funny?

  “And do you feel like you showed me?”

  “I’m pretty sure it was the other way around.” More laughter. I hand the microphone back to Mick, glowering at Jodie.

  “The point here is that you can notice more than one thing. You can notice external stimuli and internal stimuli at the same time. You can also notice where you draw a line. Like Jodie said, What’s red? What if you’re tired? What if you’re well-slept? What if you’re not looking for red? What if you are looking for red?”

  I look down at the list in my lap. Was I looking for red?

  Maybe I’m here because I don’t see any colours anymore, Ron. I’m here because I’m having my own quiet emergency, and if anyone were looking for it, they’d see it too. But they don’t know what they’re lookin
g for, just like I didn’t know to look for the moonwalking bear or the gorilla or the flashes of red in this eggshell room. All those times during residency when I was stumbling around the hospital like Edvard Munch’s The Scream come to life. I wasn’t just struggling, I was disappearing into a sinkhole. I remember thinking, How come nobody knows? And then, more ominously, Obviously they don’t care.

  Doctors have the highest suicide rate of any white-collar profession. Why exactly is that?

  Ron is saying to find a partner. I don’t know if I’m up for this. It feels so syrupy to me, like next he’s going to whip out old magazines and assign a difficult feelings collage. If this gets too weird, I’ll ditch this place.

  Except where would I go? Into the woods? Cram myself under a toadstool somewhere and wait for the shuttle to come back at the end of the week? I feel a flicker of something again, the spectre of a deep gash of hurt. The other doctors look like they’re participating. They’re not writing Buddha’s wiener on their list of red objects.

  I guess I look like I’m participating too. And I don’t know what’s on other people’s lists; you never really know what anyone else is thinking. Intellectually, I can see every point Ron is making, can understand how each of them apply to me. I’m not a lost cause. Maybe he and Mick are offering me something here. Do I want to take it? Christ, it’s not lithium.

  I catch Greg’s eye. Go together?

  He nods.

  The group breaks up into pairs. I move over to Greg. We met yesterday, but there’s an intimacy between us, a lack of pretense. Maybe even a sense of urgency, because we like each other and there’s not much time. I think we might have the same set point, the same baseline levels of cynicism and vulnerability.

  Ron projects instructions up onto the screen.

  Think of a time at work when you made a difference or something went well. Notice what you find yourself thinking about as you write. Notice the associated feelings and whatever was going through your mind at the time. Write it down, then share it with your partner.

  “I don’t do anything well,” Greg whispers before we start writing.

  A Time I Did Something Well at Work

  Although the story begins with me doing something really badly

  BY JILL H.

  This was early in my career. I had just moved back to the prairies. At least half my patients were from the reserves. They had the shittiest lives you could imagine. No running water. Mould-infested houses. Third-world conditions. Child poverty and kids dying from totally preventable infectious disease. Ongoing trauma from the separation of families, the legacy of residential schools and cultural genocide. I thought I knew all this. I thought it was terrible and unacceptable. So I didn’t think I was racist.

  Mr. Raven had been in the hospital for a week when I took over his care. His family was all still up north. He was hard-living and hard-drinking. He’d been in and out of jail. Robbery, but never hurt anybody, the social worker said. It was just to get liquor. Always things he did when he was drunk. His liver was failing from booze, and he was constantly vomiting up blood. I went to say hello to him, and he told me to go away. I didn’t mind, because I had a lot of other things to do. I guess if I’m being honest, I was glad he let me off the hook.

  He swore a lot at the residents and nurses. I got calls that he was refusing bloodwork, refusing to let the nurses change his IVs. But one morning the ward paged me to say that his hemoglobin was 55—lower than usual. He needed more blood. I called the nurse and ordered it. She paged me back a half-hour later. “Mr. Raven said we can all fuck off and that he doesn’t want any fucking blood.” Her voice was full of disgust. “If you want him to have blood, you’re going to have to talk to him.”

  I sighed. I’d been called a bunch of times overnight about sick patients, urgent lab reports, a patient who left against medical advice. I was tired, and already behind in admitting people from the emergency department. I went up to the ward, where I found Mr. Raven in bed in his room, flannel blanket pulled up almost to his forehead, as if he were a dead man waiting for the porter to shuttle him to the morgue.

  “Mr. Raven,” I said, “I heard you told the nurses to fuck off. It’s not okay to talk to them like that. We’re just trying to help you. We need to give you blood.”

  There was no movement under the sheet. “Mr. Raven?” I said again. I was exasperated. There was a long pause. I could just write in the chart that he was refusing blood. That would be enough to absolve me of responsibility if he bled to death. You can’t force treatment on people. They have choices.

  Was he asleep? My pager was going off again. He curled up under the blanket, kicked his leg like a swaddled baby. I didn’t have time for this.

  “Mr. Raven,” I said impatiently, “are you going to talk to me at all? Will you let us help you or not?”

  I heard a muffled sound coming out from under his pillow. He was crying. It had never occurred to me that he might be crying.

  “Mr. Raven?” I said again, but this time I spoke softly, and it was a question instead of a command.

  “Nobody tells me anything.” His words were muffled beneath the blanket. “Nobody tells me anything that’s going on, just uses me as a pincushion. You never even told me why I need that blood.”

  I stood there for another moment. I hadn’t talked to him about his condition. I assumed my colleagues had. But it was totally plausible that nobody had, that each person had found him curled up, or heard that he always swore at the nurses and decided that a conversation was going to take too long and was ultimately a waste of their time. So maybe no one had ever come into that room and pulled up a chair and told him what was happening with his liver. Maybe he’d never asked for it. But why was that incumbent on him? And if the white doctor who can’t possibly imagine the shit you’ve had to deal with in your life is just going to come and stand by your bed with her arms crossed and see you as a criminal and a drunk and give you a tongue-lashing for swearing at the nurses, why would you ask for anything?

  I pulled up a chair. I sat down. I leaned towards him. I took his hand. “You’re completely right,” I said. “I’m so sorry.”

  We were both silent for a minute. Then his eyes overflowed with even more tears, all the grief he’d been holding in for God knows how long.

  “I’m stuck here like I’m in prison. It’s so far from home.” He took a long, deep breath in, choking on a sob. “And Christmas is coming, eh?”

  Christmas is coming. Mr. Raven and Christmas. Mr. Raven wanted to celebrate Christmas with his family. How embarrassing, how humbling, how horrifying for me to see that I’d never put those words or concepts together. And I’d made an even bigger mistake than that. I hadn’t known he wanted the same things as me. I hadn’t known he was the same as me. He loved his family, the same way I did. He had struggled with an addiction, and truthfully, albeit in a different way, I had too. I had just been luckier—so much luckier. No matter how difficult things had been for me growing up, my family and I always had each other. We always knew there was love. And while we had to deal with discrimination against my sister, none of it was ever because of the colour of our skin. My family had been written off and failed by the medical system. But the same government that had wanted my parents to throw my sister into a glorified dog kennel had done that very thing to Mr. Raven’s people. They had stolen everything from him. And here I was, the very person who should know better, failing him.

  Mr. Raven and I talked for a long time that day. I held his hand. I told him again I was sorry, that he was absolutely right, that he had taught me something important about racism and how easy it was to make assumptions about other people. I told him I’d work very hard to never do that again. I told him everything I could about his condition, in as much detail as possible. I asked him to tell me about his family, his children, what else I could do to make his life better while he was in the hospital. I came back the next day, and the next. He said he liked basketball. I brought him a stack of copies
of Sports Illustrated. I brought him some new track pants and a toothbrush and a couple of shirts that fit over his distended, fluid-filled belly. Each day I sat, and talked to him, and he let me give him blood transfusions, and he started taking his medicines when the nurse brought them, because now somebody had actually explained what they were for.

  A couple of days before Christmas, he was finally ready to go home. We had arranged a night at the boarding home, then a ride up north. I needed to give him his prescriptions. He was waiting for me at the front desk. He put his hand out for me to shake, and his eyes were yellow but his gaze clear and penetrating.

  I asked if I could give him a hug. He said yes. I saw how surprised the nurses were as we embraced in the hall.

  “Thanks, so much, Jillian,” he said shyly. “You’re a really good doctor.”

  There was something so intimate, so lovely about hearing him say my name in that moment. Jillian. I didn’t know he had noticed. A few days later, on Christmas morning, I thought again about him saying my name. I was glad we had both made it home.

  I read Greg what I wrote.

  He shakes his head. “Wow.”

  Ron has put up a slide with more instructions, prompting us to ask specific questions.

  Greg peers at the screen through his bifocals. “So . . . what was it about you that let you do that for him?”

  “What, give him track pants?”

  “Jill,” he scolds, “this is a story about seeing somebody as they are. What let you do that?”

  “What stopped me from doing that in the first place? Isn’t that a better question?”

  “Yeah, but that’s a different issue. We all have bias. We’re racist in ways we don’t appreciate without teaching and reflection, right? What about you let you put that aside so you could really see him?”

  I look down at my paper.

  “I don’t know, Greg. I don’t really think I should be patting myself on the back for seeing a person’s humanity.”

  “Well, maybe you should. I miss people’s humanity all the time.”

  “I doubt that.”

  “Oh, believe me, I do. In my head I was calling you Smurfette before you sat with me at breakfast.”