We Are All Perfectly Fine

by Dr. Jillian Horton

  I loved watching you rise like Lazarus after you got those lungs. Hearing you make plans for a future that extended beyond the next twenty-four hours. You wanted to write too. You wanted to be a screenwriter. You had just started to scribble things down again, were just beginning to imagine a script about the story of your life. Before that, you’d been living in the space just in front of you, the way we sometimes think of writing: driving in the dark. You were afraid to drive in the daylight. You couldn’t even let yourself look that far ahead, because it felt sickeningly naive to be hopeful.

  Hope isn’t naive. It’s the only viable alternative. That’s what I’d tell you if you were here with me at this faceless rock, looking out at this small, shallow lake pricked with rain. I’d tell you life doesn’t owe us anything, but, as with my sister and brother, I still think it owed you more than you got. I’d tell you that you were one of my teachers. I’d tell you I’m sorry I failed you, I’m sorry to all the people I’ve failed, including myself, but I’m realizing that failure really is how we learn to do better the next time. I’d tell you I’m sorry I couldn’t be there for you at the end, that you were my friend, that I did love you, that there is a kind of love between doctor and patient that is more personal, more timeless than most people could ever imagine. It isn’t something we’re supposed to run away from.

  Something you wrote to me in an email: When I was really sick the social worker sensed “guilt” on my part that I didn’t feel I had the right to decide what happened in my own life ’cause what about the family?

  I wish I’d told you then what it’s taken me all these years to understand: that it was your life. That it really did belong to you, even if it didn’t always feel that way. That you lived it as well as any person could ever have lived it, under horrible circumstances. That if you’re only living as a camera operator for someone else’s story, you aren’t really living. And if that’s true for you, it must be true for me too.

  You know what else you said to me in one of our emails? You’re so not like a doctor it’s astounding. So where do you belong?

  I think I belong here, Michael.

  And I did not forget about you.

  Those are the words I’ve carried in my heart, like so many of us here.

  Five

  27

  We Did Not Fail

  The last day here is like the final day of camp, without parents. I can feel how everyone’s thinking about the time right after lunch when the shuttle is scheduled to show up. People eat slowly but wistfully. We’re worried about packing, whether flights are on time. We haven’t left Chapin Mill, but we’re mourning the place already.

  My Affinity group meets for the last time. Joss and Greg and Jodie. There’s a softness to each of us that wasn’t there before. We settle in, noticing the breath. Noticing, for fleeting moments, how we’re noticing the breath. Breathing, and breathing with one another, in and out.

  “I don’t care about reading the last poem,” Jodie says. “I was wondering if we could just sit.”

  “Actually,” Joss says, “can I read you guys something?”

  Greg says, “Of course.”

  Joss takes a paper out of her pocket. She unfolds it slowly.

  One winter’s day

  A crack appeared in all your lives

  We tried to stop it from spreading

  It was too late

  I pumped her little chest

  As cold as the ice she had broken through

  But it wasn’t any use.

  There wouldn’t be a spring.

  Her sister tried to fish her out

  But what a heavy burden for a child.

  I hope that someone told her

  What I had to learn myself:

  You could not save her

  And yet

  You did not fail.

  “Oh, Joss,” Jodie murmurs.

  “Don’t say anything else, please. I’m not a poet or anything. I just really wanted to share it with the three of you.”

  Greg leans over, takes her hand. No one speaks.

  Just being here in silence is enough.

  28

  Eighty-One

  Ron asks us to form a circle with the chairs. Everybody sits. We take a moment to settle. There is one last exercise. It’s called “Eighty-one.” Many people are crying.

  “Anybody can say a number between one and eighty-one. The only rule is the number you say has to be higher than the number the person before you said. And when someone says, ‘Eighty-one,’ the circle ends and we go home.”

  Some people look stricken. I can feel their separation anxiety hanging in the room.

  Ron starts. “One.”

  There’s silence for a moment. Everyone is processing.

  Greg calls out, “Three.”

  Jodie: “Three-and-a-half.” Everybody laughs.

  Joss: “Three-and-three-quarters.”

  Roy: “Fifteen.”

  There’s a little gasp. Roy shortened our last minutes together by an unnecessarily big interval! What an asshole! But his fifteen emboldens the psychiatrist from Northwestern, and he calls out, “Twenty-nine!”

  It’s fascinating to me, holding my own thoughts and noticing those of the others. I can see so clearly how they’re drawing this all out, longer than it needs to be, how in doing so, they’re not just adding to suffering but creating suffering.

  All those years at the airport, saying goodbye to my parents. Waving goodbye, then coming back to the glass to see if they were still standing there on the other side, all those final hours and minutes. The grief lodged so tightly in my throat it threatened to cut off my airway. My parents at train or bus stations, dutifully waiting on platforms while I sucked back mucus and tears, my jaw rigid and aching from my perfect “Don’t worry about me, I’ll see you soon” smile. Waiting to see that I was all right, willing me to be all right, because they needed me to be all right, because, after all their loss, it was still an act of faith for them to send me out into the world.

  All those minutes and hours when I dawdled at the school, waving at my boys, making the suffering of goodbye last too long.

  It’s not that the leaving doesn’t have to hurt. But I see now that in the name of love we create a separate problem, a whole other universe of a problem.

  Somebody calls out, “Forty-two.”

  “Forty-three.”

  “Fifty-six.”

  I can feel the deep tension in the room. There are people who are inclined to draw this out into tomorrow, to creep to the destination one number at a time. I can feel their near panic as we pick up speed. Their need for control. Or for the illusion of control. Or maybe just their need for an illusion.

  “Eighty-one.”

  That was my voice. Firm, deliberate. It’s over. Because I ended it.

  There’s a collective gasp, a hushed sigh. Ron and Mick stand up. Then everybody stands, and we hug and hold one another, laughing, weeping. A few people smack me on the shoulder.

  Joss is pissed. “Why did you end it so soon?”

  I put my arms on her shoulders. “I couldn’t take it anymore.” We lean in to hug, foreheads touching. “Then I realized I didn’t have to take it anymore.”

  Ikiru has an early flight; she’s getting an Uber with another doctor from California. It’s outside, waiting. She blows me a slow kiss from across the room. I put a hand over my heart and blow a kiss back to her.

  Jodie makes a beeline for me. “You’re such a bitch!” She folds me into her arms.

  “Don’t I know it.”

  “Where have you been all my life?”

  “I wasn’t born for the first half.”

  “Did I mention that you’re a fucking bitch?”

  “I think you left out the adjective.”

  She gives me a kiss on the cheek. “If you need anything, and I mean anything . . .” Her words trail off. She tousles my curls, moves on to say goodbye to somebody else.

  Greg is in front of me. His face is wet w
ith tears, his voice hoarse.

  “Thanks for doing that,” he said. “I couldn’t have ended it.”

  “I’m realizing we have to end it, Greg.” I hold him so tightly I can feel the roughness of his beard in the crook of my neck. “Greg, all this shit has to end.”

  “Yeah.” He sobs into my ear. “All this shit we do.”

  “That we didn’t even know we were doing.”

  “And the stuff we knew we were doing. All of it.”

  “I know.”

  He takes in a few short staccato breaths, the way my little boys do when they’re trying to speak through their tears.

  “Because we were just trying to survive, Greg. Because it is a fucking jungle out there, and we did what we had to do.”

  “You bet we did.” He steps back and puts his hands on my cheeks.

  “We’re saying everything we should have said out loud in the last twenty years.”

  “And we’re going to keep saying it, okay?”

  “Deal.” I press one of my hands against his, hard, into my cheek.

  “Christmas is coming, Jill.”

  “Any day now.” I start laughing through my own tears. “I have to eighty-one you, Greg.”

  I kiss him on the forehead. He touches my blue hair.

  I drift to the periphery of the hall, away from the group. I haven’t finished packing my suitcase. I need a minute to organize the rest of my things. I make my last trek to the spartan room. It doesn’t seem so small or empty anymore. I read the instructions on the back of the door that say how I’m supposed to leave everything. The wool blanket should be folded. Sheets should go out in a heap by the front entrance. The window should be closed.

  I’ve been hoping for a knock on my door, and there it is. It floats open, and there’s Roy, framed in the doorway like a familiar painting. We don’t say anything. I run to him, and he comes to me, and we hold each other for a few minutes, or for all of time, until both of our faces are wet with tears, and I can feel his lithe body shuddering with emotion.

  Finally, everything settles, and he whispers, “Eighty-one, Blue,” and lets go of me, walks out the door and disappears into the hallway.

  For a few minutes I stand looking at the empty door frame, but he doesn’t come back.

  Every time a patient is discharged, every time there is a death, housekeeping treks to the ward with their supplies and begins the ritual of wiping the room clean of all traces of the last occupant, preparing the room for the next one. How many patients have I cared for in the last twenty years? How many gurneys have I watched leave those rooms? How many people have I come to love and admire, their presence erased from the ward only hours after they left, or died, or were transferred somewhere better or worse? I’ll never know the point of any of it. But maybe it isn’t important that we know. I think of my beautiful sister and her short, difficult life. I think of my parents cleaning out her things after her death, her pictures and trinkets, her wheelchair and that stupid, futile brace.

  Now in this room, I say to myself, You don’t wear the brace because you’re going to walk again. You wear the brace because you are washing the bowl.

  Ritual is all we have. It’s what keeps us from the abyss.

  As I fold my blanket, check the drawers for things I might have left behind, then take one last look out the window at the little green hill, I realize something. Eighty-one. Eighty-one Falcon was my sister’s address, the home where she last lived and died. What are the chances of that? It seems like one more mystical coincidence, one more thing that exists just beyond the margins of what we can apprehend with consciousness. The falcon, the ancient symbol of war.

  Maybe I can say goodbye to that war now. Everything her life was and will never be, all the ways in which I failed and wasn’t good enough, all the nieces and nephews I wish I had, the cakes and balloons, the ghost family I still imagine every year at Christmas. Going forward, just the way I am, carrying all my failures and losses, just the way they are. People I loved, and still love. Maybe I’ve set it all down here, just like I left my blanket in a square at the foot of the bed.

  Acceptance isn’t the same as endorsement. Leaving all that grief behind doesn’t mean you loved anybody any less. But carrying it with you as you cross the river, drowning under its weight, won’t bring anybody back. It won’t.

  I’m ready to go home.

  My blanket is folded. The thin mattress is bare, and the pillow, ever so faintly stained blue after five days, is back at the head of the bed. I lift my suitcase. I turn out the lights. There is a tenderness in these preparations. I understand why the Buddhists pay close attention to such things. It’s comforting when you know what to do.

  What can happen in five days? It depends who you ask. But five days is enough to plant a seed. Five days gives you a place to start. It’s not an ending. Instead it offers another possibility: a new beginning.

  Epilogue

  A Cure for Miracles

  Most people experience major change in their lives as contemplative and incremental. This is how it was for me too. My first trip to Chapin Mill offered me a glimpse of how life could look if I found a way to reconfigure the parts of my psyche that were causing unnecessary pain. I came to the realization that reconfiguration was possible. But that realization had to dawn on me over and over again after leaving Chapin Mill. And I had to go back several times for the lesson to stick.

  Change started with practice. A few minutes of breathwork, every day, usually on a cushion in my office at the lunch hour, observing my thoughts and feelings. Off the cushion, I chipped away at the questions Ron and Mick had asked that made me the most uncomfortable: Why would I refuse this life? What would be wrong with finding a way to feel better? At Chapin Mill, I had the insight that I wanted to live differently. I held on to that small epiphany. I noticed my thoughts, noticed my thought patterns, began to see which of those patterns led to impulses or behaviours that were counter to my quality of life. In the months that followed, I became less reactive—not always, but often. More and more, throughout the day, I noticed myself breathing deeply. In time, with less cumulative effort than one might think, I began to experience the subtly life-altering benefits of these simple, restorative practices. They were not a panacea. But it is also not an understatement to say that they have transformed my life, and, to some degree, my experience of being alive.

  I also experienced a profound shift in my clinical life, a setting where I already felt emotionally capable and compassionate, a place where I didn’t think I needed any help. Somehow, applying what Ron and Mick had taught me, I began to feel the suffering of my patients even more acutely . . . but also their strength and joy. I talked even less and listened even more. When I did speak, I took time to wait for the right words to appear, and I spoke them from the heart. I was more attuned to families, nurses, ward clerks. I cried more easily, and now, when grief came to visit, it didn’t leave such a mess behind.

  I took a year of teacher training with Mick and Ron. I logged countless hours working with groups of doctors, helping them learn new skills. I became a version of myself that felt more fully realized. I had done something I never previously believed I was capable of: I rewired my motherboard.

  Then, in early 2020, just as I was putting the finishing touches on this book, COVID-19 changed all our lives forever. At my hospital, we braced for a deluge that we were initially fortunate enough to avoid. But in the late fall, our luck ran out. I had been off the inpatient wards, transitioning into a period of acquiring additional skills to support patients struggling with addiction. I waited to be called back in.

  But the calls and emails that poured in had nothing to do with providing care to patients. My colleagues were desperate for anything that could help them cope with the crushing anxiety of working during COVID-19. They needed support. They needed a place for open dialogue. They wanted to learn mindfulness; they wanted to learn to meditate. And they wanted me to teach them how to do it.

  So I di
d teach them. I am teaching them, helping as many of them as I can, supporting them in a way I could never have predicted, helping them manage their own stress and distress so they can take much better care of patients—and themselves.

  A friend of mine noted that I seem much happier since I embraced mindfulness. He said he wished he could find his own miracle cure. I told him emphatically that mindfulness alone can never fix the systemic and organizational problems that have long been driving medicine’s burnout crisis. But I think it can help us see things more clearly. And then, at least, we can stop waiting for transformation and rescue to come from the outside. In that sense, for me, mindfulness has been the cure for miracles.

  * * *

  PEOPLE OFTEN ASK me how my parents are since Wendy died. It feels strange to say they’re doing fine, because the truth is more complex. But they are resilient people, and in the aftermath of her death, they’ve managed to constitute a life for themselves. They’ve both survived cancer, have travelled a little. My dad putters around the house; my mother bird watches. They are loving grandparents to our sons. They tend to Wendy’s grave, and sometimes they run into one of Wendy’s aides coming to leave flowers there too. They are so outwardly normal that it is easy to forget all they have been through. They have continued to wash the bowl. It has kept them from the abyss.

  My brother, Chris, never recovered from his childhood illness. He was fully dependent on others for his care, distant, disengaged, long-suffering, until, six weeks into the COVID-19 pandemic, he died of unknown causes. A few weeks later, his ashes were placed next to Wendy’s.

  Heather is doing well. She has also had cancer. In light of our family history, she was beside herself at the diagnosis, inconsolable leading up to the surgery, predicting that cancer had spread inside her and that the end was near, even though there wasn’t any evidence to suggest this was the case.

  A few days before the operation was scheduled, she had a pre-op consultation with an anesthetist. The doctor told her what kind of anesthetic he planned to use. She said she didn’t care.