Dominic Thomas brought me back to the reason I had chosen to become a physician: Being a healer is the powerful gift of bearing witness in an authentic way that allows us to mindfully choose who we are. In this way, there is another path.
I choose to witness the tortured flesh. I support it in my hands and cleanse the wounds as gently as I can. I apply intention and salve to heal. I write about these moments so we always remember the power of our actions, so we always remember that beneath the most superficial layer of our skin, we are all the same. In that sameness is our common entitlement to respect, our human entitlement to love.
I hit Send on the email I was writing, packed up my stainless-steel water bottle, coffee mug, and uneaten granola bar, and tucked them all back into my lunch bag. I wanted to leave the day behind me.
Once home, I shed my scrubs and then showered, rinsing off the shift. Dressed in a robe, I propped my feet up on the ottoman, and my shoulders floated down to settle into the sofa. My boss had probably received and responded to my resignation letter by now. There was comfort in knowing that this was the end of the road here. My chair would give me the time I needed to line up another job before I left.
And so, I started the process of beginning again. I knew that there must be another place where, as a doctor, I could both practice medicine and climb the administrative ladder. After all, I was here to ascend. I was here to help as many people as I could . . . somehow.
SIX
Jeremiah: Cradle and All
Montefiore Hospital in North Philadelphia was my next stop. Here there was career mobility. Montefiore was like Mercy Lite. In this way, it was a homecoming of sorts, and like any homecoming, it was a temporary return to the nest to celebrate what was, to visit the comfortable haunts—old lovers and friends who used to fit before I molted into this new skin.
There were several similarities to my residency experience at Mercy Hospital in the South Bronx. Montefiore had a volume of more than 95,000 patients a year, and Mercy had more than 145,000. At Mercy, I had been a chief resident. In the Montefiore health care system, I was one of the assistant medical directors. Because I was hired to move into the director position at one of the hospital’s suburban locations, I was setting meeting agendas, writing protocols for treating high-risk medical conditions (such as acute stroke and heart attack), assisting in provider evaluations for staff, and sending out my own emails on blood cultures and medication documentation.
Prior to starting the position, I hadn’t fully realized that sending such emails in the role of assistant medical director didn’t make the work feel any more relevant. As I sat at my desk in my new position, with a list of administrative tasks about standard operating procedures, proper documentation in medical records, and risk reduction, I remembered the passion that had brought me to emergency medicine in the first place: sitting with people in crisis and helping them take the first steps toward healing. Mercy Hospital had stoked the fires of this passion and had prepared me well to address the challenges faced by the Montefiore population.
Our mission at Mercy had been to serve the community in a competent and culturally sensitive way, regardless of patients’ ability to pay. It was an especially noble mission, given that the population in the South Bronx was as hardworking as it was poor; in fact, at that time, it was home to the poorest congressional district in the nation. One-third of the patients the hospital treated were entirely uninsured, and many residents didn’t have a primary care physician. So, when the free clinics in the neighborhood were too busy or closed, we were literally their only hope for care.
Suffering from everything from gunshot wounds to malnutrition to stroke, patients lined up for triage at Mercy. Violence in this neighborhood was as regular as leaves falling in October, and its roots lay in battles over money, respect, self-esteem—all fed by deep notions of not having enough, not feeling enough; by geysers of frustration and hurt.
I remembered the moment during residency when I first realized the brambly nature of this violence and these social webs. At that time, the ER at Mercy was divided into sections: Adult Medical, Adult Surgical, Follow-up (for wound checks, suture removals, etc.), and Pediatric. On that particular day during my second year of training, I was working in the pediatric side of the emergency department. The next chart on the rack read, “13 yo male, head trauma.”
I scanned the triage notes: normal vitals, no medical history, a blow to the head. I tapped on the open door and introduced myself to the child, named Gabriel, and the two adults who appeared to be his parents. The boy sat at the side of the stretcher with his hands folded in his lap, his eyes fixed on his interlaced fingers. Behind him, a cartoon of a herd of purple elephants with rising red balloons decorated the wall. Mom stood near the cabinet, arms resting over her purse. Her hands were leathery and her mouth soft. Dad sat in the chair next to the stretcher. His eyes were weary, and an earthy odor emanated from his clothes.
I started by collecting the requisite information: past medical history, vaccination history, medications, allergies to medications, and so on. Then I moved to the matter at hand. The child told me that a classmate, “T,” routinely harassed him at school, picking on him about his appearance and threatening him. T was larger than Gabriel and part of a rough crowd. Gabriel didn’t know if the other boy was in a gang, but T’s crew seemed to be in and out of school as much as juvenile detention.
I asked what had happened, and Gabriel relayed the following story. He had earned good grades on his report card, was helping care for his little sister, and had completed all his chores, so his parents rewarded him with the sneakers he’d wanted for his birthday—popular and pricey shoes, which he proudly wore to school the next day. On his way there, T cornered him in the empty lot next to the school grounds and demanded that he hand over the sneakers. Gabriel refused and continued walking. T followed him, and Gabriel started to run. T then jumped on Gabriel, pulled him to ground, and proceeded to punch him about the head and body. Gabriel tried to defend himself, but the other boy pulled a knife and threatened to kill him, adding that Gabriel was lucky he didn’t have his gun on him that day. Terrified, Gabriel removed his shoes. T picked up the sneakers, spat on Gabriel, cursed, and walked away. After T left, Gabriel ran home shoeless on the hot, cracked pavement of the South Bronx.
He had not passed out, had not experienced nausea or vomiting, and had no abnormal sensation to his skin or any weakness. No neck pain, no difficulty breathing. He had visible swelling and redness on the left side of his face, his shoulders, and chest, and superficial abrasions and cuts to his feet.
What struck me about Gabriel was how quiet he was as he lay down on the stretcher for his examination. What’s remarkable about children is how receptive and resilient their bodies are: They are more likely to bend than to break. Even if a liver tears, oozing hemorrhage from blows to the abdomen, or a blood vessel bursts behind the eye from forceful shaking, nothing is evident on the surface but the beautiful cinnamon skin of their bellies, a regular pulse at their soft wrists, and normal color in their big, bright brown eyes. Kids don’t have the language to name the pain, neither physical nor psychic, nor the resources to address it. Just like adults, children house spiritual pain inside, where it sloshes around vital organs. But in children, the effects of trauma are stickier, shaping the contours of their viscera, the depth their diaphragm respires, the way their heart chambers fill.
“Okay, Mom and Dad, I just have to ask Gabriel a couple of questions alone,” I said, knowing I needed to complete the imperative abuse screen for any child presenting with injuries. Gabriel’s story made sense and sounded credible, but all too often the assailant can turn out to be a family member or another adult the child knows.
After Mom and Dad had left the room, I told Gabriel he could sit up, now that the physical exam was done. Then I pulled a chair up next to him and said, “Gabriel, I am so sorry about what happened. It is terrible and unfair. That s
houldn’t happen to anyone.”
Gabriel nodded once and stared down at his thumbs.
“Gabriel, I have to ask you some questions, to make sure you’re safe. Just so you know, everything we speak about is confidential. If it turns out that you’re in physical danger, then that’s when I’ll need to break confidentiality. It’s only because we have to make sure you’re safe. I want you to know that I won’t do anything behind your back. We’ll talk, and I’ll tell you if we are in an area where we have to involve other people in the discussion. Okay?”
“Okay,” he mumbled.
“We ask these questions of all young people, and even all grown-ups, because sometimes people are hurt by people they love, like family members, friends, teachers. Know what I mean?”
“Yeah,” Gabriel replied.
“Who do you live with?”
“My parents and little sister.”
“How old is your sister?”
“She’s seven.”
“Do you like your little sister?”
“Yeah, she’s cool. I mean, she gets on my nerves sometimes, but she’s my sister.”
“Yeah, she has to do that, right?” I said, chuckling a little and meeting Gabriel’s smile. “I hear you take good care of her, don’t you?”
He nodded.
“Do you get along with your mom and dad?” I asked.
“Yeah.”
“Do you feel safe at home?”
“Yeah.”
“Does anyone at home ever hit you? Or threaten you when you get in trouble or something?”
“No. I mean, I be put on punishment if I don’t do what I’m supposed to do sometimes, but nothing like being hit or anything.”
“And how’s school?”
“It’s okay.”
“Do you have a favorite subject?”
“Not really.”
“Do you like going to school?”
“Not really.”
“Why not?”
“So many problems there. Always drama. Always fights.”
“Do you feel safe at school?”
“Nah, but I’ll take care of things.”
“What do you mean?”
“I mean I will take care of things. This won’t happen again.”
“What do you mean?”
“Miss, I mean, I’ll handle it.”
Almost reflexively, I asked the question I didn’t want to ask because I didn’t want to know the answer. It was so much easier to choose to believe that the possibility of escalation didn’t exist here; easier to believe that this boy would leave the hospital and be able to go to school safely and survive to graduation; easier to believe that he didn’t literally feel his life was in danger every time he left his home or that his fear was somehow off base. I could have chosen to believe that and simply have posed a leading question—Okay, so you mean you’re fine? Everyone will be okay, right?—and he would have had the opportunity to nod in tacit agreement. We could then have been contentedly linked in a comfortable lie—a lie, like any lie, that would have required the active participation of both parties.
But I didn’t do that. Instead, I let the question jump from my lips. (I can’t claim any great insight in asking it. It felt more as if I were on the edge of my seat while watching a film on HBO and had just blurted out what I most feared right before my friend shushed me, “quiet!”)
“Are you planning to get even with him?”
Gabriel replied, “I’m just gonna take care of myself. If he leaves me alone, won’t be no issues.”
He sat there silently gazing at his hands as he rubbed his thumbs and tapped his foot.
Again, the impulse made me ask him the obvious and seemingly ridiculous next question. It was a question that felt foreign to me, given that I had grown up in Northwest Washington, DC, where people drove Volvos with bumper stickers reading BOOKS NOT BOMBS, COEXIST, and THINK LOCALLY, ACT GLOBALLY. When my classmates parked their BMW convertibles to go to AP English class, they never worried that they would be carjacked. When I walked to my car from my private school, it never occurred to me that I might be threatened for my book bag, loafers, or cashmere sweater.
My lesson on the impermanence of material items was a little different from Gabriel’s. Toward the end of high school, I learned that parents can spend more money than they have in order to give the appearance of wealth. But that appearance is belied when one by one bathrooms are rendered unusable because the plumbing can’t be maintained and the pool algae is so dense it looks like an extension of the unkempt yard. I didn’t know exactly when my family’s financial ruin was at its tipping point, but by then, I was well practiced at compartmentalizing.
The job of my youth had been to get out of that house and out of that life. So, when strange men knocked on our doors at all hours, asking for my father (who was invariably not there), and then left, giving no name, no message, I let it go. (Honestly, I was just glad he wasn’t home.) And when I heard my mother on the phone mumbling something about legal fees, when my father had to close his medical practice, and when they went on to lose the court battle over house number three in DC, I didn’t question any of it. Anyway, my graduation from high school was only months away.
Before my first year of college ended, I knew I could never go back home. Thankfully, my parents’ divorce was well under way, and my father was living God knows where. My mother hadn’t sued him for alimony—she’d just wanted the marriage over as quickly as possible. But she couldn’t afford to maintain that home in any way. Increasingly over that period the house lacked running water and heat. Various animals could be heard scurrying around in the attic. My brother moved out soon after I had, our sister followed, and our mother was at home only sporadically. Fortunately, my grandparents lived nearby. My mother wasn’t yet working, so she spent much of her free time at our grandparents’ home, but still used our home to sleep, eat, and deal with the final proceedings.
She should have lived with her parents, my grandparents, during this time. Years later, she said her reasoning for not having done so was because she didn’t want to impose on them, to crowd their already crowded house, which was also home to my aunt and a cat. But I never found this answer truthful. What’s more honest is that for my mother, most topics of discussion—whether it was why she picked abusive men (my brother’s father was her first abusive husband; my father, her second), why she valued money over health, where all the money was coming from, and where all of it went—were merely occasions for subterfuge. The real reason she couldn’t live with my grandparents was because she couldn’t risk their being witnesses to the truth of her life: It had been a sham. Because this truth of her life was a subject she would never broach, rather than risking my grandparents’ asking the obvious questions, she stayed in the dilapidated family home. It seemed easier to her, I’m sure, than being exposed to their scrutiny within their four walls. So, my mother preferred to dwell in the dark, in our home, until the matter was forcibly taken out of her hands. This was her well-worn groove.
During my first two years in college, I worked various jobs on campus (at the food court, bartending) to help support myself. My father would send me money, too. I’d siphon off funds from the money orders he sent and from my student jobs to forward to my mother until she had a steady job and had moved out of the District.
During my second year of college, my mother had a yard sale to raise money for herself. I wanted to get back to secure the items I cared about, but she said there wasn’t time to wait for a semester break. Besides, she added, someone must have already bought the ceramic fish I made in my favorite high school art class. (I’d fashioned it after one of the fighting fish I remembered from our fish tank, but toned down the hues to black and teal.) And apparently, it was anybody’s guess what had happened to the woodblock I carved under the same instructor and the pastoral prints I made from it.
Gone, too, were the ceramic mugs I’d made in elementary school.
I was glad when my mother left Washington, but the going was cruel. It felt like the void left after a fire, except there hadn’t been a fire. There had just been two adults who’d haphazardly collided just long enough to produce children, create decades of chaos, and then flee, leaving their offspring to pick up the scattered pieces however they could. So, I understood how things got lost and stolen. I “got” the pain of instability. I knew the pain of the kind of violence that happens privately, at home; the violence that’s not reported, much less discussed; the violence you can’t escape because it’s where you lay your head, until you can manage to pack up and secure a safe place to bathe, to eat, to sleep, to be.
Still, public violence was new to me. I hadn’t grown up with the reality of being unsafe outside the home, of not knowing whether you can walk to the store without being attacked, or go to school without being shot. I had only a hint of this insecurity while growing up with my brother in the 1990s. There were nights when I was worried about his safety driving while black. But that was during an era in DC when black men of affluence were spared the violence wrought upon poor men of color. Those times have since changed; in this one way, our country has moved closer to class equality.
Sure, there were other, rare acts of public violence in my community (a kidnapping in a park, a robbery in a grocery store parking lot), but these incidents were uncommon, so we felt safe at least outside the home if not within.
Still, I read the news and listened to NPR, and theoretically, I knew these things happened. So, a little embarrassed, I asked Gabriel, on that day at Mercy Hospital in the South Bronx, the question I had to ask:
The Beauty in Breaking Page 10