SEVEN
In the Name of Honor
If I hurried, I could still make the early yoga class. From my condo, it’s only a four-block walk to the studio where I cross the threshold from my outer world to the one within. The studio, in the heart of the city, has windows on three sides whereby light stretches through the room. When I arrive, I unroll my mat on the hardwood floor and am bathed in daylight. The flap of the mat’s far edge slaps the floor: my personal call to prayer.
Before I take my seat, I press incense powder, called Scent of Samadhi, between my palms and stroke it over my forearms and the tops of my feet. I collect my props (blocks, strap, and blanket), just in case: They sometimes come in handy as an aid to release my tight shoulders or elongate my hamstrings in particularly tricky postures. The scents of sweet and spicy sandalwood and clove root me as I sit cross-legged on the mat. At last I am perfectly still—until the moving meditation begins.
It is on this mat that I learn to let go absolutely, bodily. I let myself be fully present for the fifth sun salutation, and then the sixth, without anticipating whether there will be a seventh. Later, standing in a position named Revolved Triangle, I can see and feel the boundary as my hips fight to splay and my IT band (the thick band of fibers that runs from the pelvis down the side of each leg to the shin bone) screams its revolt. As I slowly and gently support my hips in alignment and refuse to engage the IT band in a fight, the pose blossoms. I take tender breaths and chant my legs into extension so that the fires yield to steam that softens, and my body glides into a deep, cleansing, and previously impossible twist. Revolved Triangle releases into Lunge pose, then I turn my back foot out and down and press the pinky edge of my foot and elongate out through my upper arm into Extended Side Angle. I’m careful to not let the gluteal muscles of my forward leg check out of the game, and knit and then rotate my rib cage up to liberate my trunk and shine my heart upward toward sky.
Then the choice to bind. Does it enhance the pose to twist deeper and farther? Does it enrich the posture to activate the core and draw inward to clasp hands around the body, thereby completing the bind, in Bound Side Angle pose? Can you expand within and beyond this bind while twisting and holding opposite limbs? And most important, can you remember to breathe all the while? These are the questions. This is the choice. The goal is always to breathe deep, sustaining breaths and to decipher which holds at which times will make the experience most nourishing.
Heart leading, I twist back my upper ribs and arm and extend my lower arm under my forward thigh—so difficult for me to maintain side body long as I maneuver my forward arm into position, but I try each and every time. I hold my hands behind me and pull: shoulders back, chest up and back. Extend backward and down through my back hip and foot, extend up and back through my chest and shoulders. Holding strong and long and letting go everywhere else: The wisdom to discern between the two is critical. Never forget to breathe. Always stay present to the gift of breath.
Some days the practice comes easily. Other days, my quads, already weary from yesterday’s run, quake from overexertion. That’s when my breath gets caught in my flank and squeezed in my chest. But force is never the way.
Here is where I learn to accept what is in the moment now in order to proceed reverently. Skip the pose and rest if the body needs that moment to replenish, if the breath requires it in order to flow seamlessly throughout the lungs. Pushing hard against contracted muscles will only cause the body to push back or tear. There is a maxim: We’re born bound, and we learn to free ourselves. One of my favorite yoga teachers puts it a different way: We are born free, and we choose to bind exquisitely.
It was for this reason that I found yoga soon after I moved to Philadelphia; it was for this reason that I’ve stayed with it. There is a saying that every new yogi finds her way to the mat in order to heal an injury. Sometimes the injury is sports-related, though most times it’s psychic—perhaps it’s a divorce, addiction, or sexual trauma that takes her out of her body as a way to cope when the trauma is too much to bear. After the acute phase of the trauma is survived, it starts to feel safe to integrate the mind and body again. Yoga is a way back to our whole selves. It rejoins the breath, the mind, the heart, and the soul, reuniting the broken pieces into beautiful postures that show us we’re rooted in something far greater than pain. The resultant “yoga butt” from regular practice is just a bonus.
On the heels of the New Year and the upcoming stepping down of the suburban site director, whose place I was expected to take, I realized that if I continued this administrative climb, this transition from my role as assistant medical director to that of medical director, I would simply be leaping from one hamster wheel to the next. Sure, I knew I could excel—I was good at my job; I was adept at the treadmill—but as Lily Tomlin says, “The trouble with the rat race is that even if you win, you’re still a rat.” Now, four years out of residency, after two years at Andrew Johnson Hospital and then another two at Montefiore, I found that this realization had become crystal clear.
My calling is to heal; that is my truth. While medicine’s current version of hospital administrative work can be both interesting and valuable, it wouldn’t ever bring me closer to being a healer. Most administrative duties involve managing minutiae with the goal of maximizing profits for hospital systems. Second to that is minimizing financial losses. Somewhere far distant to both those priorities is patient care. And way beyond what the mind’s eye can see is consideration for the wellness of the providers who are supposed to deliver that care with excellence. I just couldn’t be a representative for a mission that was so divergent from my own—even if that meant walking away from the comforts of a higher salary and a better schedule.
I didn’t know how I would do it, but I knew I had to rededicate myself to my true path. I knew it meant committing the apparent résumé sabotage of quitting my job, but I also knew that a lack of dedication never yields success. Every part of my being craved alignment. My work, as with everything I do, is a reflection of myself. I practiced yoga to stay on the path. I ate healthily to support my physical body on this journey. I would start meditation to keep my spirit clear. I made it a point to mentor medical students and residents who were women and/or from underrepresented groups of color to make up for the woeful dearth of physician role models for these groups. Medicine still suffers from the same discrimination seen in other fields—women are typically not promoted, while underrepresented people of color are blocked from admittance in the first place. I knew that my emergency medicine clinical work had to focus on underserved populations, as this had always been the medicine closest to my heart. I also knew that my healing work needed to transcend traditional medicine and extend beyond the ER.
For me, the best path was to leave administration. For the time being, it was also best for me to stop working in academic centers for emergency medicine, which required similar bureaucratic demands and diverted me from my focus on being a healer.
* * *
—
I left Montefiore to dock at the Veterans Affairs Hospital in Philadelphia. Just as I had encountered in my patients at Mercy and Montefiore, I met many heroes while at the VA. Victoria Honor was one of them.
She was steady in her chair, sitting cross-legged, each arm placed deliberately on an armrest, her fingers making soft imprints at the curved vinyl edges. Her grip was tight, her smile at ease. Her hair was parted down the middle, with one goddess braid on each side culminating in a thick rope of loosely kinked hair encircling her head. Springy rings of baby hair peeked out at the edges of her hairline. Her bright, almond-shaped eyes were free of makeup. Actually, she wore no makeup at all, save for lip balm that tinged the air with a hint of citrus. She looked about the same age as I was, both of us appearing younger than our years, but melanin has this effect. Her skin was a shade of moist clay muted by the ill-fitting midnight-blue paper scrubs that hung awkwardly around her shoulders and knees—they appe
ared to be at least two sizes too big, but they were the smallest we had for the psychiatric patients. This uniform wasn’t made for her.
She looked up when I rapped on the door. Leaning against the wall across from her, I asked why she had brought herself to the hospital.
“Hello, ma’am. I’m here to get cleared. I’m here because it’s time for me to get myself together. That’s all. It’s time.” Her smile cracked open, revealing so much hope.
It was strange meeting her here—that’s what I remember most. It felt as if I knew her already, as if we could have met as participants in the same noon yoga class on Tuesdays and Thursdays, or as volunteers with the annual Run for Peace 5K. This version of reality—our encounter behind the locked doors of the psychiatric unit in the emergency department—didn’t feel right.
“Ms. Victoria Honor . . . by the way, that’s a fantastic name!”
She laughed. “Yeah, well, I can’t say it was my idea. All thanks to my family. You can call me Vicki.”
“Well, Vicki, you sound strong and resolute. Excellent. Yes, I’m here to medically clear you.”
This was the standard process for a “psychiatric” patient, whether she was being admitted to an inpatient psychiatric unit for psychosis or being discharged home with a referral to outpatient services for prescription drug abuse treatment. Emergency medicine physicians have to conduct an examination to address any acute medical issue the patient might have before the patient is transitioned to the care of ER psychiatrists or nonmedical specialists.
“And today,” I continued, “what are we clearing you from? For?”
She recrossed her legs and raised the index and ring finger of each hand to her temples. She seemed to be focusing on something far away and hard to see, as if staring at shadows just beyond a noonday sun.
“I have to get my head straight. I went through terrible things in the military. Now it’s time for me to get past it all. So, I’m just here passing through to be placed in transitional housing for a while.”
“I see.” I didn’t really, but I said it partially out of habit—the habit of coming into the psychiatric ER and trying to get out as quickly as possible.
Upon badge entry to the locked unit, directly in front and to the right, the first thing you see is an arc of patient rooms. Unlike in the main ER, each room has a hospital recliner chair and most have a flat bed positioned against a side wall as well. Invariably, having opted to keep the lights off, each patient sits there in a separate dark room behind a closed curtain. The tracking board at the nurses’ station directly to the right of the unit’s entrance lists the reason for each patient’s visit, which is almost always some combination of suicidal ideation, homicidal ideation, psychosis, drug dependence, and alcohol abuse. Then you hear the click of the door’s metal hardware locking shut, reminding you that the unit is secured. Even after I’d entered this unit hundreds of times, that click still triggered in me the instinct to hurry my return to a place where the exit door wasn’t locked and the lights were always on.
“I see,” I said again. “I’m sorry, but I have to ask you the list of standard medical questions. Some may sound silly, but I just have to ask them for clearance.”
She nodded. “Sure, sure. Go ’head, Doctor. I’m here to be honest. I’m here for help, so ask me anything.”
“Any recent illness, infection, or anything?”
“No, no. I’ve been healthy,” she replied, knocking on the wood of the bedside table.
“Do you take any medications?”
“Nope.”
“Any allergies to medications?”
She shook her head.
“Any recent surgeries?”
I could see Vicki’s shoulders melt a little under the weight of her paper scrubs. After a pause, she continued: “No. No recent surgeries.” She rocked a little in her seat, moving rhythmically forward and back, touched her breast bone, and then cleared her throat. Then she appended: “Only one, but that was a couple of years ago.” She paused and looked at her hand as it lay on her chest, as if it could steady her, as if to remind herself that each word, each disclosure, was part of her process. She looked up and said, “Yes, one surgery, an abortion, years ago now.”
“Okay,” I responded. It’s tough to know when to ask a follow-up question. Clearly, something didn’t feel okay. We started off that way, with so much not feeling right about her presence here; her energy told me it had to do with the hesitation she had just displayed.
I told myself that she shouldn’t have been sitting there in blue paper scrubs, I shouldn’t have been in the psychiatric ER ten minutes before my shift was to end, and the hospital shouldn’t have been so packed that ten patients were boarding in the ER (that is, being admitted to the hospital but still waiting for beds to become available on the regular floors). The night doctor shouldn’t have been by himself, with me as his only support, and with only a few minutes before the end of my shift, so that he alone would have to care for twenty patients in the emergency department and another ten in the waiting room, because in this hospital, in contradiction to standard practice, it was the responsibility of the ER doctor to care for any boarding patient instead of the admitting inpatient team—the very reason I had ended up feeling guilty enough to see another patient right before I was to sign out and go home. I was here to do medical clearance. Follow-up questions could lead me into a fifteen-minute conversation, and honestly, that was the job of the social worker and psychiatrist. This young woman was the medical picture of health, and that made my job easy.
I continued with the standard questions. “Do you feel you want to hurt yourself or anyone else?”
“Oh goodness, no! No, none of that.” She smiled, raised her hand to her neck, and cleared her throat again.
“Now, if you don’t mind, just a quick physical exam. May I listen to your lungs and heart?” She agreed, and I completed the perfunctory exam.
“Well, everything’s good on my end. All clear! The psychiatrist and social worker should be speaking with you soon. Any questions for me before I go?”
I tucked my stethoscope back on my belt clip and swept back the rebellious locks of hair that had fallen forward on my face. Vicki watched me lift my deep brown hands to do this. I saw her scan my long, natural hair. I saw her watch me as I tied my dreadlocks to secure them neatly. She got it, and she smiled in gratitude for our similarities.
“No. I’m good.” She placed her hands in her lap. “It’s nice to see more of us here. I’ve been here at the VA a few times, and I haven’t seen many doctors of color. Before I started going to the new women’s health center, I didn’t see any women doctors, either. It’s really nice to see you. Thank you.”
That’s why I was there. The VA hospital had a reputation as the place where old doctors went to die. As medicine has evolved over time—or, more accurately, as the business of medicine has devolved over time—many physicians have thought of the VA as their medical home. True, some of the providers at the VA aren’t competent enough to practice elsewhere, but that’s not the case for all of us. The rest of us come here not out of necessity, but out of choice, to care for those who gave everything with the intention of service to our country and received so little in return. We come here to encounter again that lost heart of medicine. We come here, too, knowing the entrenched legacy of corruption of the VA hospital and still hoping to be at least a small agent of change anyway. While I knew this job would not be my last iteration of healing work, I knew it was an integral part of my path.
The dance of medicine these days is hard. I’m still of the generation that entered medicine to help people, not to be tethered to endless paperwork, bludgeoned by satisfaction surveys linked to nothing except ways to cut pay and staffing, demoralized by the expectation that we see more patients faster—not safer or better, but faster—and then taken to task when patients feel we don’t take the time to list
en. So, the big consideration in comparing hospital jobs is which set of bureaucratic nightmares will cause the fewest number of sleepless nights. As a hospital-based health care provider, you have the luxury of staying in one job as long as it makes sense—until your provider group loses the contract or you lose your patience. I knew intuitively that the next best choice would come because my growth was ongoing. For the time being, though, I felt deeply that the VA would mark a critical transition point for me.
“Thank you. It is an honor and a pleasure to be here. You’re right; we certainly need more. I think with time, little by little, we’ll see more positive changes, right? Like most things in history. Just like we’re both here today.”
We exchanged friendly good-byes, and I pivoted to open the curtain to leave. As I did, I caught a glimpse of her: She had leaned forward in her chair, one hand to her brow, the other tracing circles around a cup of ice water on the table next to her. I looked at her and considered asking The Question. She was entranced by the ice, drawing her fingers across a puddle of condensation on the table, so she didn’t notice my hesitation. It was late, so I reconsidered; I just wanted to go home. But I couldn’t; I had to ask. I knew the deep well of my sister’s pain. Human beings can always know each other if we’re still and courageous enough to do so. I, too, had spun in circles and circles of suffering. I had tied myself up in knots in search of liberation. To simply gloss over the violation I sensed in her today made me feel complicit in that silence.
I reclosed the curtain behind me. She looked up, lifted her head from her hand, and smiled.
The Beauty in Breaking Page 12