To help ease the strain of it all, I told myself there was no point in paying fees for a medical license I could never use. Internally and silently, I fought it. And the fighting put me in a mood to resist everything related to my stroke and living in the wake of its damage. I fought the need to continue stroke rehab and physical therapy, to work on reading and brain puzzles and walking and balance. I fought the idea of becoming a writer, of changing my future. I fought just because I needed to fight. I pushed back against all the things that could help me because I needed to push against the strain of loss. And when I tired from all my internal battles, I looked to facts and external evidence, to the things that Collin and my therapist said were real. And as I stood to walk, or opened a book, or tried to think like a doctor, the truth would grab me like the shock from a cardiac defibrillator. Then, in the next hour or the next day, I would return to therapy and work the routines. I picked up my writing exercises and my reading tasks and worked them hard and fierce and unrelenting like I worked soldiering and doctoring. I pushed against boundaries and the boundaries pushed back. On particularly hard days, when I was alone in the car or at home in the living room, I would shout, “I’m still a doctor!” And when I heard that one word, “doctor,” it was enough to spin me back to the inertia of beginnings and the ballistic force of endings. Back and forth, first one, then the other. A beginning, an ending—defined, undefined. In one moment, a doctor; in the next, a wingless bird. Vulnerable. Earthbound.
In the same way that medical school graduation had signaled my true beginning as a physician, relinquishing my medical license signaled my true ending as a physician. Agreeing to do it required more than intellectual consent. It required an unbecoming; a physical and psychological violation of all the strength and esteem I had derived from the medical profession. There would no longer be patients to attend to, wounds to lavage and stitch, illnesses to diagnose, trauma codes to run. I would become nobody’s doctor in the future. No one would have the occasion to address me as “Doctor,” unless out of courtesy for my professional degree. The forfeiture of my license told my colleagues and hospital staff that I was no longer privileged to write prescriptions, to give medical advice, to place myself in charge of a patient’s care. It was as if all my medical credentials became nullified by a single piece of paper containing very few words, but just the right ones to tell everybody I was no longer a physician. That end was not simply the opposite of the beginning. It was far more. It held the force of being punished and shamed and ridiculed, all within the context of unbecoming the doctor I used to be, all within the action of having to store my stethoscope in a drawer, where it would become something of a museum piece. A museum piece. That’s what I had become. I would be relegated to standing in a Smithsonian diorama. Parents would bring their children. My family and colleagues would visit and stare. “Look,” they might say, “that man used to be a doctor.”
After an hour on the porch, I went back in the house. I filled out the form on the computer and hit “send.” Done. Finished. Time to move on. I had to follow that with a written notice, so I did. Mechanically, I wrote a one-paragraph notice, printed it, signed it, quickly stuffed it in a number ten business envelope and added a stamp. I took the envelope out to the mailbox. In a stroke of finality, I raised the small plastic flag to alert the mail carrier. As I did so, I felt like I was raising a flag of surrender. I took one last glance at the mailbox, then got in my car and drove around town. I eventually drove to the VA with the intent of seeing a counselor, but instead of going inside I walked across the street to the medical library at the University of Iowa medical school. I roamed the stacks and glanced at medical journals, mostly at the pictures. I pulled journals in surgery and anesthesia and emergency medicine. I sat for almost an hour with a textbook of anatomy, thumbing through the pages in the chapter on the brain.
Three hours later I drove home. Collin had been wondering where I was.
“Where have you been?” she asked. “I was worried about you.”
“I was at the medical library looking at books,” I responded quietly.
My quiet tone gave me away. She knew there was more.
“You okay?” she asked me.
“I don’t know. Not really, I guess.”
Then we sat at the table and I told her about my medical license and how I put the letter in the mail and how when I put the flag up it signaled the real, official end of my career. I don’t remember much of what she said except that she was loving and supportive and tried to give encouragement, reminding me that I had done so much in my career and it was time to move on. Her words were kind and true. I tried to focus on the solace and comfort she gave, but I seemed distanced by a sense of finality that was neither final nor comforting. I felt a disquieted emptiness much like the feeling that surrounded me the day after my mother’s funeral in the early spring of 1997 as I sifted through her belongings and photos and suddenly realized she was never coming back.
—
November 2010 was hard. It brought the culmination of several years of denial about the implications of my stroke. It also brought a non-negotiable acceptance of the end of my medical career. That was the toughest part of all my healing and therapy. It demanded the acceptance of externally defined limits, limits I had always challenged. But that acceptance also led me to a new understanding of myself. It helped me reflect on my greatest crossing—that of stroke survivor. That was a crossing magnitudes wider than becoming a physician or a soldier, far greater than going to war and coming home and certainly light-years beyond the grips of PTSD or physical war injuries. Crossing into the identity of a stroke survivor, believing it, tasting it, living it, redefined my life in the spaces large and small. It forced me to understand different kinds of boundaries, to distinguish between hard constraints and movable lines. In a larger frame of reference, that acceptance freed me to move beyond the still shots of therapy into a moving picture of myself, a self-renewal picture. And in that framework, I asked myself if writing might also function as a science of healing, an art of medicine. I answered yes. Not because I pretended it was the same as practicing medicine, but because writing possessed the power to change perceptions and make people think. It held the power to make them laugh and cry and scream in anger. And if I could become passionate in my writing, the way I was passionate as a doctor and soldier, well, then I had a chance at affecting a life or two, including my own.
I didn’t think it was incidental that I was studying in my second year of an MFA program when I relinquished my medical license. I came to think of it as the right timing—the gravity of one yielding to the buoyancy of the other. Writing pulled me up and into its strata and complexity. It gave me purpose and pushed me in directions that medicine had not. It didn’t displace my love of medicine but augmented it. It was not a new career but a new way of thinking and a new way of seeing. And it challenged me to capture all that I had done and seen and learned over all the years I had lived. That was a good thing and a complex thing, much like the practice of medicine.
—
What have I learned about the forces that have shaped me and the boundaries that tried to define me? In all my years of medical and military training, one thing became apparent: I cherished learning and exploring perhaps above all other human endeavors. When I was young, I always ventured near the edges of things. I was adventurous, with an inquisitive mind and spirit. I never tolerated boredom or stagnation and constantly moved forward while pushing boundaries. Learning was something I could always do. During the first year of my stroke, I thought even that had come to an end. I was wrong. And the lessons I learned over years of therapy have given me the greatest insight as to who I am. I am more than the sum of limits and forces, more than the accretion of things I have gained or lost, and certainly far more than the dust of failures and triumphs. I am that human complexity of soul and mind and body that holds the innate ability to preserve my life by making conscious decisions to change my life. I am that person who, by
the force of loss, has had to learn the force of resilience. That has not been easy. At times I was defeated and adrift. But I learned to keep pushing hard against the boundaries that emerged, the real and the imagined, crossing them where I could and reassessing them where I could not.
About the nature of therapy, I learned that healing takes far more time than patients and therapists allow. I also learned that in the midst of its battles there was a natural shift from fear toward hope. I changed from fearing my transformation to hoping in the possibility of recovery. That was a critical therapeutic movement for me. It took time. It was embedded in the exercises and routines of therapy and in the pain of stretching muscles and mind. It was layered in the hours of despair and in my curses and screams and moans. And on those days when I talked myself through pain as relentless and strong as a desert storm, I found a certain kind of release that allowed me to see beyond my fears. Those were the days when I began to redefine my life by the simple complexities of faith and will and insight and by words that were more than words. Once I understood the deeper meaning of therapy, I wanted more; I could take it all. I didn’t encounter the therapists—they encountered me. And that was another kind of crossing, the kind that empowered me to advance my own therapy and healing, to direct it and own it. That deeper understanding showed me that my various circumstances defined not where I was restrained but rather where I was destined to cross from one boundary to the next.
In all that healing chemistry of sessions and pain, and yielding and resistance, stood the therapists. At first they were devilish and scary. They pushed. I resisted. It was a contest of mental toughness and physiology. My mind and body were wild mustangs. I had to be broken. The therapists had to win. It was the only way. They grabbed hold and pulled me up through the deep waters of healing where slowly, eventually, I stood on my own, firmly and gracefully, water dripping from my fingertips. I learned to do things on my own again and I bragged to friends about how I kicked ass in therapy and how I lifted a five-pound dumbbell and walked on a line without falling over. That willingness to tell others about my small victories meant I was healing in spirit. It meant I wasn’t afraid to let others see who I really was: a stroke survivor.
—
As when I left St. Luke’s, I still continue to stumble and forget. I fight my brain, mind against matter, the brain I have versus the brain I want. My brain fights back. I never win the argument, but I do go the distance. And when I tire of fighting myself, I feel emptied, like the way I felt when boarding my medevac flight from Iraq. Sometimes when I feel like that, I wish my diaphragm would stop moving and my brain would stop racing and fighting. I want to flop right down in the middle of the sidewalk or the grocery store—right in the middle of a goddamned aisle—and just sit there, maybe watch the cans and the carts and think about absolutely nothing. I still get confused at times. I lost this chapter and for six months I wondered why the prior ending felt so abrupt. A writer friend said something was missing. When I heard the critique, I knew I had written another ending. I found it in the photo files on my computer. Those episodes don’t define me now the way I thought they did during the first years of therapy. They occur almost daily, but they are more like blips on a radar screen. Stroke blips. Nothing more. I have learned to assign them a different clinical significance, learned to move on to the larger image and purpose of my life. Sure, if my doctor gave me a stroke recovery pill, I’d take it. I don’t relish all the hard work of stroke therapy, but I do relish my life as I am remaking it, and I’m not about to wait around for medical research to develop that pill. Yes, I still miss being a doctor and soldier, but through war and injury, survival and healing, what has become more important to me now are the ways I choose to define my life. I use my survival as a vantage point from which to see things differently. And if somebody were to ask me about my stroke now, I would tell them what a remarkable recovery I’ve had and how much I have learned.
—
I gained another most powerful insight from all my crossings. One that liberates me. In all that I have experienced, the becomings and unbecomings, wars, childhood, education, love, family, and all the sundry crossings of my life, when I view them all from a perspective grounded in an attitude of discovery, I see that my life is not about what I have lost but more about what I have gained. And that insight has helped me finally understand the richness of a life beyond crossings. True, bold and risky crossings have shaped my life. But those were the minor parts. One crossing always led to another. Like learning, there never was a final crossing or a final lesson, only a continuum of discovery and becoming. That was a huge lesson. And I learned it not in a therapy session or a medical school classroom or an officer training course. It came by way of my willingness to look into a mirror after a profound loss and see beyond the image of my current self. I had to visualize the person who was not yet real—the one in the distance, barely discernible in the reflections of all else. When I did that, when I risked thinking about that ambient self, what I saw emerging was a different version of me with a new perspective I had never seen before. And from that perspective, I now see less black and white, more a range of possibilities.
About my future. Predictably, there will be new boundaries to cross. There will be boundaries that defy crossing. They will all be temporal—bound to a space in time—finite or infinite. They may come today, tomorrow, or next year. Who knows what the future may bring. It will undoubtedly bring unexpected turns of health and spirit and family. I might die early, suddenly. I might live beyond my imaginings. I might also learn to write poetry or dabble with watercolor paints. I could become a jazz musician or a puppeteer. I will certainly teach my grandchildren about the intricate beauty of human anatomy and take them to an air and space museum, explain the physics of flight. And when they ask me what it was like to be a doctor and a soldier, I will tell them. I will laugh and tell them just how much I loved each one. Then I’ll teach them about the different kinds of boundaries, natural and man-made, real and imagined, and I’ll show them how to find the best places to cross each one.
Notes about the form and structure of the book. First, I am aware of the difficulties inherent in telling a nonfiction story written years after the elements of contact have passed. By contact, I mean the events and people that we encounter, the scenes in our lives that impart connection, and the emotions we remember. And there lies the fault line—memory. What do we remember? How do we remember? How viable is memory after the erosion of time? How do memories change with the inevitable need to revise for clarity and literary finesse? In the telling of the events of war and stroke, I have recalled only the events that have most affected me, the ones I remember because they created such an emotional and cognitive impact.
I am also aware of my post-stroke cognitive impairment, the struggle I have in sequencing items, my persistent word displacements in reading and writing, and my general difficulties in managing complexity and memory. To counter those impairments, I have had to constantly revise and rewrite the content of this book, all the while committed to the veracity of the story. If you accept that a brain-injured patient can experience cognitive recovery to the degree that allows the accurate recall of complex events, then my rendering of such events is an accurate representation of what I remember—again, to the degree that my cognitive recovery allows. I can say that the more I have studied and revised my own writing, the more I have remembered, and the more I have had to relive some of the pain of those memories.
My goal in writing this book has always been to provide a real and unflinching representation of war and stroke as I have seen it and lived it. I have had to write past the point of self-censorship to write exactly the words that made me uncomfortable and even fearful. Doing so has opened my writing and my recovery. Initially, in my writing seven years ago, I lacked the confidence that I communicated anything accurately because I had such a hard time writing sentences that made grammatical sense and had literary impact. Many of my earlier drafts were scatter pl
ots of story, much like the scatter plots of my earlier recovery thinking. My many mentors and therapists have helped me with that deficit. What I offer you in these pages is my best attempt to tell the story of what I have experienced, with the caveat that the writing has been confounded by my brain injury and cognitive dysfunction and to a large degree by war and stroke itself. What you see is my reconstruction of what I remember, my memoir—nothing more—nothing less.
I am indebted to the men and women of the Iowa National Guard. I will always be grateful for their commitment to the profession of arms and the profession of medicine. I am equally indebted to those with whom I served during my deployments. The privilege of serving with them was indeed mine.
The team of healthcare providers who cared for me deserve my heartfelt thanks. Their dedication to the task of bringing me back to health far exceeded the medical standards of care. They offered encouragement, acknowledged my military service, and graciously took the time to listen to my stories. Special thanks go to Dr. James Nepola, Professor of Orthopedics at the University of Iowa Hospitals and Clinics, and Dr. Leslie Riley, Internal Medicine, University of Iowa Health Care—North Liberty Clinic. Their commitment to the profession of medicine and patient care is truly incomparable.
My stroke rehabilitation involved the skills of many therapists. I would like to thank Michael J. Hall, PhD, Cher M. Stephenson, LMHC, Gina Wiley, MA, and Heather Cochran, PhD, for their persistence and their gentle (and sometimes firm) pushing in my years of cognitive rehab. Their care extended from neuropsychology to psychology to speech and language therapy and vocational rehabilitation. I am truly grateful for them all.
During the course of physical therapy, I had so many physical therapists who went the extra mile to help me. Thanks go to Andy Gallo, MPT, and Peggy Saehler, PT, in Iowa City. Their work in my injury and stroke recovery was exemplary. They had many associates and assistants who also helped in therapy. They are not forgotten.
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