Crossings

by Jon Kerstetter

  —

  I wride (write). One word, maybe two. A sentence fragment. I stop. My hands flounder above a laptop keyboard. My fingers jsimplace leters. I start—stop, start—stop. I erase letters, words, lines, entire years of my history. Sometimes my brain sits on the right side of the computer, like a wireless mouse, while my hands sit on the left side, fingers pointing blame. Both isolate themselves, unwilling to cooperate. A word like “computer” sometimes falls apart when I try to type it. It becomes eight separate one-letter words that I type one at a time. Each letter requires me to pause and think about what comes next: C…O…M…P…U…T…E…R…I match each key to a finger, then press. Sometimes words like that transform themselves into separate words, dividing along syllable lines: computer becomes “com pu ter”; writing becomes “wri ting.” They self-translate into fragments that have no meaning.

  I frequently assign a literal meaning to words. If I write “A thought floats in the air,” the figurative meaning becomes concrete, and I imagine words attached to a blimp or riding in a hot-air balloon, floating through the sky.

  One word substitutes itself for another. “Work” stands in for word, and it’s not a typo, it’s a word substitution, much like the phenomenon that occurs when I read. Shout becomes “shovel.” Arid morphs into “ring.” The desert is ring, so I shovel new works. Sometimes I catch the errors immediately, sometimes not. I leave logical gaps in sentences. That means I cannot recall the original ideas that I am trying to capture.

  My ideas jump to nowhere in particular. Others intrude, unwanted and irrelevant. I chase the gink ones (good ones) into narrow dead-end alleys, where they often vanish at the tips of my fingers. I flex my neck backward and shake my head. The same fingers that tap keys on a laptop tap my skull, my brain, my inability. One word flows into antoher, the woring work (another, the wrong word). Ten words erupt. I caputer (capture) them quickly. It’s a race—writing. I race to find, think, capture, and organize, then tap my fingers on a keyboard. I fi win (If I wind[win]), sentences mirror a thought—they become inanimate yet real. I poke them. They poke back. We have a discussion, an argument, an agreement. Sometimes, if I get angry at sentences, I crumple entire pages and throw them on the floor. Usually, I’m able to manipulate them to the point where we both speak a common language. Then I sit back and read them aloud, and when they say something that I meant them to say, I laugh. Gotcha.

  At the coffee shop where I write, the gas log fireplace catches my attention. The predictable unpredictability of the color and the movement of the flames mesmerize my brain for blocks of minutes—ten, fifteen, thirty. I know how the flames will jitter about, but I can’t predict exactly when or in which direction—same thing in war. The flames remind me of a helicopter flight over the desert of northern Iraq. If I’m not careful or intentional in my thinking, the war can color all my ideas. I refocus on the mixed-genre music playing in the background. The chatter of people filters unobtrusively through the restaurant. People make their plans or fill their time. Hazelnut coffee steams from their cups. The steam reminds me of the tiny steaming mud pots at Yellowstone Park. The park reminds me of Old Faithful. Old Faithful reminds me of the oil fields in southern Iraq. I see the oil fires in my mind. The smell of petroleum saturates the air. It reminds me of the Jurassic Park ride at Disney World—and then the coffee shop and my blueberry bagel override Disney World. The rattle of dishes and the banter of the cooks punctuate the overhead music. Wild orange puffs of flame draw my eyes to the fireplace. My brain needs this atmosphere to write—this box of white noise. I need the clutter to fill the silence of writing. If I don’t have it, I drift endlessly in my thoughts. The processes of mind and brain and thinking fill my empty spaces with something, anything, everything. If a distraction catches my attention it holds my focus until another distraction, more powerful or more colorful, louder or bolder, finally manages to push its way into my brain. The distractions can be real or imagined.

  My keyboard never understands my fingers. My fingers never understand my brain. I have to push them both from the jagged edge of thinking where I watch, stealth-like, ready to pounce. Suddenly one word, ten words, an entire sentence rips through the universe and lands on the page. I morph into the young medical officer who shot a medic while in training. Iraq infiltrates my writing mind, and I run faster than soldiers should be capable of running. I think in quantum leaps, with the speed of fighter-jet afterburners. I innovate. I move and adjust, adapt and overcome. My breathing quickens. The electronic page on my laptop fills with words. Five sentences form a single coherent thought. Bang! Another paragraph. Bang! Another. Yes! I breathe and dream and laugh…then, suddenly, a single word appears that doesn’t fit the flow. I stip (stop). I erase. I push quicly forowra nd the keybor missn my fingens. Stop. Wait. Six feet from my dine-in table, the fireplace pumps out its natural gas flames—predictable. Northern Iraq comes to mind—unpredictable, a thought released by the freezing rain of an Iowa winter. I pause on mud and sand and the smell of helicopters. I glance at the fireplace, then at the keys on the laptop. The background chatter rises in a crescendo, then dissipates. I make it disappear by writing a note in a book, a trick I learned in cognitive therapy. Brain training puzzles intrude in the space I have reserved for writing. They fill a fifteen-minute block. I return to a senetnci (sentence). Think, I say to myself. Think of a word. A new word comes to mind—a ten-minute block. A new thought, a new paragraph—the morning is gone.

  I think and write in a cacophonous rattle of memories and ideas. The discord makes me hesitate, a state of being that I never tolerated in emergency medicine. My life and demeanor used to focus on speed of thought and speed of action. Now, if I try to think too quickly, nothing happens except the crashing of thoughts in some neurological cataclysm. My thoughts implode, sinking deep into my brain tissue, where they scurry around dendrites and axons. They become insurgents trying to hide.

  I cannot write—not in the sense of what I imagine writing to be, or in the manner that I imagine writing as linear. That’s where I struggle the most; that’s where I flourish the most. I seek a linearity of being. I want my thinking and writing to flow, one logical step after another, as in normal walking steps, yet the wobbly patterns of my thoughts and my writing mirror the truncal ataxia of my body. I cannot run—literally. Not with my legs. Not with my mind. Not with my writing. I lose my balance all the time. I stumble frequently. My scattered deliberations make me stop and hesitate unless I can find a groove where I can let go of thinking or writing like I let go of breathing. Write like you breathe, I tell myself. Let go.

  I do let go. I have to let go. And the flights of ideas and the discursive ramblings push me into my past and into my present, back and forth, all within the span of seconds. The diversions and distractions move me about my life and my history like a soldier moving with a misdrawn map. That phenomenon defines my brain. I make a plan to write about a particular idea or story, but my fragmented thoughts seem to dictate their own story. I still fight the fragmentation, but I’m learning to flow with the process.

  My new pattern of thinking creates some interesting and even provocative writing with logical twists and narrative jumps that make no sense to readers (including me). But it’s not all dysfunctional. The details and various sidetracks, the starts and stops, the darts here and there, provide me with the fragments that seed not necessarily a linear story, but certainly one with an arc that mirrors life as I know it to exist. When those fragments become words that I can see on paper, they trigger relationships between events and ideas I had not considered before. I begin to interact with facts and possibilities and memories. My thinking and writing push beyond a scattered array and a story begins to form. The writing creates framework and structure. Details and emotions come to life; I see a page, and the page is me. That extra dimension helps me see that I am healing and not dying; it helps me understand how I am testing the edges of my recovery. And so, I sit and write.

  One word becomes two. Senten
ces collide. I write one thought, another, change their order, move lines of logic. A word becomes an image, a mountain, a desert. The moonlight casts a silhouette of a soldier thinking of her children while standing guard. A bullet cracks the stillness of the night. The soldier falls. A doctor ties a tourniquet, gives blood. He wonders if blood will make a difference. It does.

  Another word creates a kiss—a first kiss, the sensation of eternity poised on the red of lips, and the kiss takes its lovers deeper into intimacy than infinity takes light into galaxies. Other words lift laughter right off the page and the sounds tilt back and forth from childhood to adulthood, from list-making jokes to soldiers falling on their ass. Some words evoke joyful tears. Other words elicit hard-edged weeping.

  I try to write things as they really are, the way I see them and experience them, not necessarily the way I want them to exist. When I do that, the words tell me who I am in the full context of my weakness and my strength. I need these words. I need them like love and blood and oxygen. I need them to show all the defining stories, the ones that have no escape or need no escape, the ones that show me who I am, where I have been, and perhaps even where I am going.

  On the first day of medical school I trampled through the flower beds of the anatomy building and ran my hands over its aged bricks. The rough texture felt real enough. I was not dreaming. I stood in awe of what lay before me, the learning of medicine with all its exacting science and mystical art of healing. Over the next four years I studied the breadth of biomedical and clinical sciences. The last day of medical school, graduation day, I visited the same flower beds and ran my hands over the same bricks. I said “Thank you,” quietly and respectfully, as if the bricks could hear me. I walked into the building and sat in the lecture hall. I imagined the squeak of colored markers on the whiteboards and the rustle of papers during exams. The anatomy dissection lab and microbiology came to mind. One explored the larger structure of the human body, the other revealed the microscopic intricacies of cells. I would have studied four more years if the faculty allowed it. There was no end to what could be learned and explored.

  Graduation was a joyous day and a sad day. The joy had been building gradually during the final year of clinical rotations until, like some pent-up volcano, there was just too much energy to contain it. Students couldn’t help but break out in smiles and laughter. The sadness came from knowing the special, almost hallowed experience of studying medical science would come to an end. With the granting of a diploma, the designation “medical student” would become part of the history that shaped and recalibrated aspiring minds to think as physicians.

  For me, commencement meant more than crossing from student to graduate; it signified the crossing of boundaries once defined as fixed, boundaries that had been set by the expectations of culture and family and educators who, not out of spite or ill will, but out of disbelief, believed that young kids like me would find it impossible to become doctors. I had proved that belief as violable as the misguided notion that Native American children would best be educated in government boarding schools. Graduation also marked the true beginning of my professional identity as a doctor of medicine, an identity that would shape every crevice of my thinking. It held me in its powerful grip, especially on the occasions when I helped save a patient’s life. And when that patient squeezed my hand, I savored my professional identity. When patients called me “Doctor,” I didn’t think of the title as some passive descriptor; I embraced the heat of its meaning and succumbed to its ether. The word transported me into its entire universe. I traversed the history of medicine, its art and discoveries. I wielded its surgical instruments, plied its medications, and felt the power of medicine as if it were some torrent of energy in a fast-moving thunderstorm whose thunder and lightning left people awestruck. The lightning and thunder were real. The power of medicine was surreal: part science, part electricity, part magic. I sensed its current when I placed the bell of my stethoscope on a patient’s chest and listened for the steady rhythm of systolic beats. The power infused me during the emergency opening of a patient’s chest to clamp bleeding vessels torn by a gunshot wound. I felt it when I worked the intricate closure of a patient’s facial wounds, 7-0 nylon suture in hand, the tension perfect and the depth of the curved, cutting needle precise. The current was present when I witnessed the precise moment of a patient’s turn toward survival; and it was ever-present when I pronounced a patient’s death, then sat with their survivors as the storm of mortality settled over their lives.

  When I felt the satisfaction of being a doctor, its energy overtook my thinking and my ego. I morphed into Hippocrates and Leeuwenhoek and Salk and Mayo. I likened myself to the country doctor who carried his black bag on house calls and gave shots of penicillin to children with diphtheria. I became my professor of anatomy and surgery and pediatrics. I was the universal student of all things medical. More, I was Jon Kerstetter, MD, the man who had earned that imprint, that power, that becoming. I was the boy from the Oneida Indian reservation who had spent endless hours with a cheap home microscope and a plastic model of the Visible Man. I became the young professional who read medical textbooks as if they were ancient scriptures and the man who became all I believed myself destined to become since childhood. To my mind, what I had accomplished held more than the meanings attached by a title. It defined my thinking and dreaming and breathing—a defining of the soul. Becoming a physician inoculated me with a sort of identity antibody that rejected all things non-medical, as if medicine was not just something I could do, but the only thing I could do. And when I signed my name with the letters MD, it was like affixing my identity with a red wax seal that could never be broken.

  —

  When a doctor half my age showed me the MRI images of my infarcted brain in 2007 and told me how a stroke might affect my career, I gained an immediate subliminal awareness—a sort of sixth sense—that I would never return to medical practice. I rarely voiced that awareness unless in therapy, where my therapist helped me face the practical reality of moving forward beyond my career. And during those sessions, I knew. I knew the way people know about the passion of love, or the conviction of faith, or the demise of a marriage. I knew the way parents know the truth about their deployed sons or daughters in that halting, fear-filled moment when a military vehicle pulls into their driveway and a uniformed officer knocks at their door. I hid that knowing like a classified secret. I reasoned that, as a physician, I would not allow a patient like me to risk practicing medicine. And when my therapists asked me what I would tell such a patient, I would say with certainty, “Your medical practice is over. It’s time to move on.” But my reasoning applied only to other patients, not to me.

  In 2008, a year into therapy, I had told my cognitive therapist that I had accepted the facts and outcomes of my stroke, that I was bound by medical ethics to do no harm. I understood the reasons why my doctors and the Army said I was unable to practice medicine, but admitting to that incapacity was like crossing back over the bridge I had spent a lifetime trying to cross. I understood the risks, the ethics, the deficits, and the legal restrictions, but I understood them with clinical logic, in the manner of my training at Mayo. In my heart, things were different. I rejected that logic. If I believed wholeheartedly that I was no longer a physician, it would be tantamount to declaring myself professionally incompetent. And in that, I was weak-hearted and fearful and unprepared. I had fully expected to be injured in war, but I never expected to lose my medical career. I needed more time, more healing, more grieving. “Moving on,” as my therapists suggested, proved a hard thing to do.

  Three years after my stroke, while in the second year of my MFA program, I notified the Iowa Board of Medical Examiners that I would relinquish my medical license. It was twenty-two years and six months after I graduated from medical school, the day before my sixtieth birthday. I sat alone in my living room and stared at the online form that I needed to send. And I stared. I walked out on the porch and looked at the remnants of
the brown autumn leaves that had fallen on my lawn. It had been raining the day before and the grass was still wet. The temperature was warmer than usual for November in Iowa. I adjusted my glasses several times. I took them off and tapped my head with the rims. I stood with my feet close together and felt the onset of ataxia take my legs just a bit. I squeezed my right toes in my shoe—nothing. I tried to recall the names of drugs used in cardiac and trauma resuscitations—nothing. I could only remember the several years of therapy I had already had, the cognitive games and the recall exercises, the efforts at adding single-digit numbers, the walking with a gait belt, therapist in tow, and the hours of heel-to-toe balancing on a taped blue line. I stared out into the neighborhood and saw beige houses and wet grass and brown leaves.

  As I stood there on the porch, I contemplated the ethics of doing no harm in the practice of medicine. I fully understood my loss of skills. The implications were clear. Patients in the ER did not select their doctors; hospitals did. It was a hospital’s legal and ethical responsibility to provide competent and capable physicians. I was neither, and I had a duty to report my impairments to the Iowa Board on the occasion of my license renewal.

  Beyond the duty to report to the Board, I had a duty to report to myself, to accept the limitations that a stroke had imposed, physical, cognitive, and ethical. I had been working on that acceptance for the preceding year. I knew I had to relinquish my medical license, but knowing it and doing it were two different things. I felt that forfeiting my license to practice medicine was not just a retreat back across a bridge; it was a bridge burning, the final torching of my professional identity. The finality of it could distort my identity the same way a direct hit from a rocket-powered grenade could distort a soldier’s body and render it unidentifiable.