We Are All Perfectly Fine

by Dr. Jillian Horton

  Jodie is shaking her head. “That is so fucking sad.” Jodie motions towards the prompts on the screen. “So what let you be present with his suffering?”

  I think about her question.

  “I didn’t want to abandon him.”

  “More about that.”

  “I wouldn’t want to be abandoned.”

  “Keep going. I feel like it matters.”

  “Could you stop channelling Dr. Phil?”

  “Too late for that. What let you be there for him?”

  “I wanted to go with him.”

  “What does that mean?”

  “We all want someone who will go with us.”

  “Where?”

  I pause. God, Stan would have loved this place. The ritual, the formalities. Ron’s little Tibetan bell. Sensei Stan.

  “My dad told me a story once. He really likes Reader’s Digest. We used to have them all over the house. And for years I was in this terrible relationship.”

  “With Reader’s Digest?”

  “Fuck off, Jodie.”

  “I thought that’s what you meant!”

  “I was in a doomed relationship with a guy. Like, we made no sense. I’m trying to decide whether I stay with this person, okay? And I’m torn to pieces, and one day my dad is trying to be helpful and tells me, ‘You know, I read in Reader’s Digest that you need to ask yourself two questions in any relationship. Where do I want to go? and Who will go with me?”

  “Those are good questions.”

  “I didn’t think so. I told my dad he was old, he didn’t really know anything about my life, and I didn’t think I was going to find the answer to my problems in his stupid grade-eight level Reader’s Digest. And so I keep dating this guy, right? Things get worse between us, and I mean, like, toxic waste-dump ugly. It’s right before I start residency, and one day I pack up all my stuff and put it in storage, and I fly home for the week just to find the energy to break up with him, and then I go to my parents’ house and I cry.”

  “And the house is still full of all those copies of Reader’s Digest.”

  “Sure, Jodie. So I’m a mess, I’m in my pyjamas all week crying on the sofa, and one day my dad is trying to be helpful and he says, ‘You know, I read once in Reader’s Digest there are two questions you should ask in a relationship.’”

  “And you’re like, ‘Dad, fuck off with the Reader’s Digest.’”

  “Totally! I said to him, ‘You already told me that complete bullshit story about where do I want to go and who do I want to go with me.’

  “And he said, ‘You got the second question wrong.’”

  Jodie purses her lips. “But you didn’t.”

  “No, Jodie, I did. The second question isn’t Who do I want to go with me? It’s Who will go with me? Get it? It isn’t just who you want to go with you. It’s who will go.”

  She thinks about it for a few seconds, then nods approvingly. “Your dad sounds wise.”

  “He’s pretty smart.”

  “So you were willing to go with Stan. Into his suffering.”

  I nod. The memory of him fills the room. That wonderful, wonderful man. Frozen in space and time, his life cut off in mid-kick.

  “Why, Jill?” Jodie asks. “Put your finger on why.”

  “That’s why I’m here.”

  “You mean at the retreat?”

  “I mean in life. That’s what I’m here to do. I don’t know how else to explain it.”

  “Sounds like you need more Reader’s Digest.” Jodie frowns. “Hold on a sec.” She gropes for something in her pocket. It’s a phone. It’s my phone, the one she confiscated. She takes it out, looks at the screen disapprovingly.

  “Who’s Eric?”

  “My husband. What did he say?”

  She does her best classic horror flick voice. “The baby dove is alive.”

  For now, I think to myself.

  15

  A Life Sentence

  We get a break in the late afternoon. I put on my coat and running shoes, and head out to the grounds and the stream. It’s cold here for April. There’s a dampness that permeates everything, a chill I can’t shake no matter how much wool I’m wrapped in. We’re not supposed to have any food in our rooms, but I found an old granola bar in the outer pouch of my suitcase. It’s my only contraband. I cross the long driveway, walk to the half-circle bridge that spans the creek.

  My phone is back in my pocket. I sneak it out and glance at it, nestling it in my palm. Fifteen new emails. Something from my secretary. Something about a school concert I’m going to miss anyway. A collection of headlines from the New England Journal of Medicine. I skim it. Stuff I already know. Stuff I don’t need to know. Stuff I think I might be supposed to know. Stuff I have no hope of knowing. Something from a student. Dr. Horton, I’m sorry to be bothering you as your auto-reply says you are away but I am really struggling to cope right now. Hazel, do you read anything? How do you not know that I quit? I’m the one who’s struggling to cope right now, and half of it is because of you weasels. Not that you personally are a weasel. I ran into Hazel once in the grocery store with her mom and, aside from looking so uncomfortable I thought she might turn inside out, she actually seemed really nice.

  Just like that, I’m not here anymore. I’m back in my office with a waiting room full of panicked students, reliving those last lectures, the snickering in the back row. But even worse, I’m missing the water, missing the crispness of the cold, missing the red, red cardinal that just landed over in the grass. Missing all of it, because my mind has a dog’s tendency to lick wounds repeatedly. An instinctive, evolutionary behaviour—one that might have been helpful in the wild. But some dogs lick their wounds again, and again, until their flesh is stripped down to the bone by all that licking, and still the dog won’t stop. Yet another behaviour that no longer serves a purpose, creates a host of other problems.

  I put away my phone and open the granola bar. It has a waxy sheen to it, the gleam of elderly food that shouldn’t be eaten. I throw it into Siddhartha’s stream. I wait for the water to reveal everything in my life and everything I have done in my life. But of course, it doesn’t. The granola bar disappears beneath the uneven surface of the water, colliding with a floating stick before it’s gone for good.

  Leaning over the railing, I notice someone has tucked a note into the crack in the wood. I feel an irrational rush of excitement, like I’ve found an oracle. I pull it out, unfold the damp paper, and read:

  The stream of consciousness.

  It’s funny; it should make me laugh. But I’m affronted that someone like me has already been here and stolen my line.

  Did they also give up sherry with tutors, cackling with friends in front of a fire at Oxford? What if I’d taken that path instead, and hadn’t gone to medical school?

  That little knot again, the lump in my throat from the Zendo. That spot, that hurt, that place with no map.

  I start walking. Mud gums up my boots, the ground sucking me into wet earth. In the distance, by a small clearing overlooking a brown pool, there’s a bench and a statue of the Buddha. I can feel the smell of earth in my teeth and jaw. I reach the little clearing. I put out my hand to touch the back of the Buddha’s head, keeping my fingers on smooth stone while I circle around to see his face.

  But he has no face. What I thought was a sitting form is just a shape, a wide sphere with another sphere set carefully on top. For some reason this feels like a circus trick. I rap the back of the faceless Buddha head with my knuckles, which really hurts my hand. Okay, I just punched a rock for not looking like Buddha. Is that why I’m here?

  What if I could let go of expectations?

  The day’s sessions have steered me towards a little babbling brook of my own. I can hear what the stream is saying. It’s saying I was faceless when I was a resident. That nobody really knew me. That I abandoned myself, that I let myself be sacrificed to something I thought was greater than me. That the sacrifice I thought I was making for pat
ients was actually for a sick and pointless system, the necessity of particular types of hardship only an illusion. It had to be difficult; medicine will always be so. But did it have to be so difficult it made me sick? That’s the betrayal I’m grappling with right now, a feeling I don’t have to explain to one other person at this retreat. Imagine being told to swim across a treacherous river to rescue someone on the other side. You brave that river. You’re bitten, you’re maimed, you’re shuddering and waterlogged, and you almost drown. When you haul yourself out on the banks, you reach out to touch that person, the one you did all of this for; you say, I came. I’m here for you. And then you see the trick: it isn’t a person at all. It’s a column of stone. This wasn’t the emergency. The emergency is somewhere else, and you missed the whole thing, because you were busy swimming across the river. You could have taken a raft. There was a raft right there the whole time, on shore, but they made you swim to the rock pile, because that’s what everybody does, and now you’re supposed to tell the next ones, the ones coming up behind you, they have to do the same thing.

  You might feel conflicted about all this. You might wonder how you were talked into doing something so dangerous. You might feel angry, and misled, and devastated. You might have to make up a story about why you did that to yourself. But you did it because, in the process of becoming a doctor, normal dissolves like white powder in warm liquid. It’s not normal to go without sleep. It’s not normal to watch people die, then go drink a cup of coffee and talk about your plans for the weekend. It’s not normal to be blamed for not knowing what you couldn’t possibly know, to have to carry that weight by yourself across the river. You set off on what you think is a Hero’s Journey but turns out to be the Stanford Prison Experiment. Normal completely disappears from your life, melts away until it isn’t even a memory. Christina Maslach doesn’t come to stop it.

  Every one of us here has asked ourselves over and over, Am I the problem? Is the problem really just that I’m not cut out for this? When she hissed that I should stop telling people I was applying to medical school, was that girl I knew in university really seeing the real me? Maybe I wasn’t cut out for this. Maybe that’s why I’ve suffered so much along the way.

  There was another person who saw me, a boy in grade eight, and he was kind of nice and probably feels bad about this, because who would want to be judged for the rest of their life by the shittiest thing they ever did to somebody else when they were thirteen? He wrote a sentence in my yearbook that I might as well have tattooed on my heart—the truth nobody would tell me to my face, the reason everything in my life felt completely wrong. That boy’s words came back to me like a Saturday morning television jingle when the Dutchman told me there was still a way I could be perfect. Cancelling out all the nice things my friends had scrawled about me, that boy wrote one sentence in big, messy letters, an epitaph for my junior high years:

  You’re pretty smart, just lose some weight.

  There it still is. Moses on Sinai. A noble truth handed down to me in a grade eight yearbook. Things said in innocence, in the cruelty of youth, things we believe about ourselves our whole lives.

  In the session this afternoon Ron said to keep a notebook handy, so when thoughts come to us we can scribble them down, write narratives, notice who comes to visit. I have a tiny Moleskine in my pocket. I settle down on the bench and write the words across the top in capital letters.

  You’re pretty smart. Just lose some weight.

  You’re pretty smart. Just lose some weight.

  You’re pretty smart. Just lose some weight.

  Then I put a line through the whole page. I wait a minute, then write:

  Dearest Ron and Mick,

  I’m fumbling with some basic building blocks of life, some central incompetence that nobody has diagnosed. This isn’t how do I read a chest CT or how do I appreciate van Gogh. This is being forty and wondering, how come I don’t even know how to breathe?

  Kindest regards,

  Jill

  I draw a line through that too. I think about the step I don’t want to take. What was the word that elbowed me in the ribs in the Zendo? Forgiveness.

  My pen hovers over the lined pages as if they are a Ouija board, and from somewhere in the recesses of my mind, a name appears.

  The Terrible Story of Mr. Ripple

  A chilling tale of lifelong emotional disfigurement

  BY JILL H.

  Mr. Ripple was almost ninety. He came in to the hospital the colour of a bedsheet. We found several fist-sized masses on his liver and kidneys, his belly distended like the big end of a lightbulb, full of blood and cancer, both those organs failing. We met at three in the morning. We laughed over some silly things. I tried to comfort him. The only thing I had to do that with was words.

  When I told him the results of his imaging, he said, “Thank you for telling me the truth.” He asked if I could stay and talk to his wife. I’d been up for thirty hours, but I waited for her and told her what we’d found and sat and cried with her, my fellow standing in the corner the whole time, nodding in sympathy and agreement. He said I did a good job. I wiped tears out of my eyes and went home to bed.

  The next day, the staff physician suggested we consult a surgeon, even though she said it would be futile. She said the wife and children might be the ones who needed the consultation, that it would be for closure. I said he had no children. But I did what she wanted me to do. I put in the consult.

  The surgeon on call was a short, smug, greasy young staff doctor who always had a look on his face like the people around him smelled awful. The senior residents all said he was overly confident and had terrible judgment. He reviewed the case. He went into Mr. Ripple’s room. He came out and announced to the team and to my attending physician, “These could be abscesses. If they are, they’ll just melt away with antibiotics.” They just melt away! Like cotton candy! And who wouldn’t want cotton candy abscesses instead of the deadly cancer diagnosed by the stupid female first-year resident?

  The surgeon left. I went back to see Mr. Ripple. The whole feeling in the room had changed. Mr. Ripple was sure I had unnecessarily told his wife he was going to die, and now she was even having chest pain. Mr. Ripple screamed that it was totally wrong, that I was a person of unbelievable character, that he was going to write the hospital a letter about me and it wouldn’t be very nice, that he would never forgive me for what I had done.

  How to describe the scar of those words, the brand they left on the softest parts of me, searing my tender skin?

  Nothing could be less like cotton candy.

  I went out to the nursing desk, shaking. I told my fellow what had happened. I thought he would come back into the room with me, tell Mr. Ripple he’d agreed with everything I’d said, get me out of the line of fire, explain it was his opinion I had offered, not my own. He was very kind, but he didn’t like conflict. He didn’t want to deal with the patient’s anger, didn’t want it branding him, because he could see it looked painful. He shrugged and gave a cryptic half-smile; he said to me, for the second time that year, “This is how you learn.” He walked off the unit, whistling.

  What am I supposed to be learning? I was screaming inside.

  But here was the worst part: I still had to face Mr. Ripple each morning and sponge up his hatred of me, like the worthless, helpless dog I was. I was almost sick to my stomach going into that room. My senior, the second-year internal medicine resident who dealt with the logistics of how the team ran every day, wouldn’t assign somebody else to his care. He said continuity was critical. He didn’t know continuity was me getting crushed like a bug every time I had to walk into that room.

  From the moment the greasy surgeon had become involved, Mr. Ripple spoke to me like I was an insufferable handmaid. He shouted at me to tell him what antibiotics the surgeon had recommended and acted as if he’d caught me red-handed when, after a morning of running myself ragged post-call, I still had not been able to sort out the correct dosing with the pharmac
ist. In less than seventy-two hours, I had become persona non grata. I had cared about him; I had cried with him. And now Mr. Ripple was treating me like I was the person who had given him the disease that was going to end his life.

  I understand that patients and families have negative transference. I had it towards all the doctors who failed Wendy, doctors I never even met. I was angry at all of them, but it wasn’t just because I thought they made mistakes. It was because everybody had acted like it was no big deal that they’d made those mistakes. That’s what got me upset. But even then, I wasn’t sure I could imagine making those doctors scapegoats for every one of my grievances with the universe. Surely Mr. Ripple had to have known that if my staff physician had disagreed, she would never have allowed me to tell him he was going to die. Yet he and his wife continued to treat my staff doctor courteously, speaking to her about me with eye-rolls and stone faces; and for reasons I still don’t understand, everyone let me take the fall.

  I guess I was a safer receptacle for their hatred.

  Mr. Ripple, whose ghostly pallor was perhaps another sign of the suffering that lay ahead for both of us, spent the last days of his life angry about my perceived incompetence. His wife did too.

  Despite the antibiotics, he was dead exactly one week after we met. As everyone other than the surgeon had suspected, he did not have cotton candy abscesses.

  * * *

  “DON’T TELL ME we have homework?”

  I hadn’t heard anyone coming up behind me, but there’s a man, another doctor, to my left. He’s hovering by the faceless rock pile, watching me write.

  I’m startled. I can’t hide my unease. He sees this immediately, keeps a distance from the bench.

  “Sorry for intruding.”

  I study him for a few seconds. Tall, lanky. Hair in a horseshoe pattern, a little garden border of fuzz around his mostly bare head. Physique like a bat. A purple Patagonia jacket. Gloves. Whenever I see a man in the woods wearing gloves, it crosses my mind he’s a serial killer, but this guy looks like he’d injure himself twisting a cap off a bottle. Harmless.