“Thank you, Doctor. God bless you.”
“Thank you and God bless you and us all. We all need it.” I shared one last smile with her, then turned to open the curtain and walk away.
The night psychiatric nurse, Pat, approached. “What are you still doing over here? Didn’t your shift end an hour ago?”
“Yeah, I have to skedaddle.”
“What the heck happened just now? You miss your calling, Doc?”
“Huh?” I asked, but I knew he had heard. The unit was small, with no doors except those for the bathroom, the psychiatrist’s office, and the social work office, so there was no privacy. You could hear every word from the patient rooms, every word at the nurses’ desk.
“Your calling as a shrink!” he replied.
I laughed. “Have a great night, guys. I’ll see y’all again in a couple of days.”
I swiped my ID card at the exit to liberate myself from the unit.
Vicki and I had both crossed thresholds that day. We had both braced ourselves and covered our heads as the walls of our glass houses had shattered around us. We had trod mindfully over the shards and escaped with nonfatal wounds to a new freedom, a new clarity, a new resolve. As I passed the full tracking board and the poorly staffed ER, I recalled that I still had five or six notes to complete before signing out, which meant I’d be there for another twenty minutes. But that was all right: I felt lighter and brighter, too. Vicki’s strength was a true testament to human mettle, a beacon.
I thought back on the things that had been upsetting me just an hour before—whether or not to move, the dismal social scene in Philly, the administrative problems in the hospital that were consistently infuriating, and most of all, the bizarre hospital politics that had shot down my proposal to start a complementary medical center at the VA to treat the chronic effects of trauma such as pain, depression, and anxiety. The center would have been modeled after centers of excellence at other VA hospitals in the country. Despite my having presented data from those hospitals and from the U.S. military showing improved outcomes from complementary treatments, treatments that lacked the detrimental side effects of the drugs comprising the bulk of remedies offered at our site, the proposal was repeatedly rejected without any specific reason. At one point, the vague explanation given was that there was some guy at the Philadelphia VA who did pain management, so if anyone should start such a clinic, it should be him—the same guy who hadn’t started one in over a decade.
The members of CAM, the Complementary and Alternative Medicine Interest Group (comprising committed internal medicine physicians, social workers, and psychiatrists who met monthly to discuss ways to safely improve the lives of veterans), had tried to warn me. They had tried for years to get such a center off the ground, but there had always been a barrier. One month, the hospital administration told them there was no space for it; another month, there was no funding; then, the next year, it just wasn’t the right time. Unable to effect change, one by one, the members of the group had left the Philadelphia VA. As for my center, its creation wasn’t foreseeable in any near decade, and unlike the CAM group, I was given no reason for this, so I could not prepare a counter pitch. The better part of valor was to take all of it as a sign from the universe that I should try something else.
Reflecting on my conversation with Vicki, I realized that none of my concerns was truly debilitating. I would get home eventually, and this would have been a very good day, a very good day in a very blessed life.
Standing in my kitchen that evening, as the steam welled up from my caramel tea, I was suffused with the lessons I’d learned from Victoria Honor and the reminder that, whether on the mat or off, we always have the choice to start again, to bind again exquisitely.
EIGHT
Joshua: Under Contract
It was early—well before 6 a.m. and still dark. To spend the entire day working and then leave the hospital in this same darkness was always disorienting, but I preferred arriving early to running in late to the doctors’ lounge, locs flying, ID swinging, after the unofficial ten-minute late mark. Anything up to ten minutes late was moderately irritating to people but not entirely unreasonable. That nine-plus-minute allowance was there in case we got caught behind a bus or were detoured by a freak accident. Today I didn’t need that buffer; instead, I walked slowly from the parking lot to the hospital and settled into the ER staff lounge to eat my breakfast of Greek yogurt with almonds and blueberries as I sipped myself awake with coffee.
The bonus in arriving early was that there was time to get caught up reading the latest medical journal issue. The hospital was still quiet—no footsteps; no rolling wheelchairs; no voices asking directions to a room; no police officer escorting a belligerent patient. The only sound was the night shift’s percolating coffeemaker, whose smoky aroma was wafting me alert. Sitting in the staff lounge, I looked up at the clock: 5:45 a.m.
Today will be a good day, I silently affirmed. Somewhere between shifts, I’d have to figure out the rest of my life. But not right now.
I had been practicing medicine long enough to know that wellness was much more than anything we prescribe from a bottle. If we humans were to expand our definition of healing, there could actually be a great deal more of it. For the time being, my complementary medicine center idea had crashed and burned. I had been so committed to this path that when I was turned down, I had even looked into starting a center outside the VA. After taking a number of courses through the Philadelphia Small Business Administration, and after months of meeting with my mentor from the SBA, and with many local professionals, I had learned that the market in Philadelphia would make it nearly impossible to earn a living with such a business for any time in the near future; it just wouldn’t be feasible unless I wanted to continue to work full time clinically and then use the alternative medicine business as an extremely expensive and time-consuming hobby.
But even with that disappointment, my career was faring better than my personal life. I was several years past my divorce and several years past an extremely brief (but still too long, at several months) and dismal interlude of online dating. I was still single. But there was an even more depressing truth: I had fallen into an impossible love. Just the week before, I had told Colin, the cop I was seeing, not to contact me again. His divorce was proving to be more difficult than he had initially presented to me, and far more difficult than he had allowed himself to believe. It was taking all but a military extraction for him to sever ties from the person who had stolen his phone, hacked his online accounts to steal data and post false information on him, stalked him, physically assaulted him, and mused about fabricating a disturbance at his work so he would lose his job. Oh, and then there were her repeated threats to set his property on fire. There was still time for her to make good on those last two threats, regarding the career assassination and the arson. Colin’s ex had promised him that “the only thing I want is for you to suffer.” If what Colin had told me and what I had observed were accurate, this seemed to be the only completely honest statement she had uttered in her life.
Strange how police officers frequently find the wackadoos. I suppose it’s just like ER physicians, psychiatrists, social workers, and all of us in the helping fields: We all nurse that same Achilles’ heel of cleaving to the damaged. What a critical life lesson: to learn to distinguish enabling from helping, codependence from love, attachment to reenacting the grief of childhood loss from allowing for the sweetness of self-determination.
To go into detail about my relationship with Colin would certainly bore even the most sympathetic reader. Suffice it to say, there was a lot about it that I appreciated. For example, it was more fun preparing dinner together than dining out in a fancy restaurant. Colin taught me how to cook the perfect stovetop steak and a reliably fluffy omelet (although, I still prefer to be the sous chef or, even better, official taste-tester for these types of culinary pursuits). While one of my all-time fav
orite solo excursions is devouring a weekday matinee at the local independent movie theater, the 1 p.m. film experience couldn’t hold a candle to the two of us cuddling up in front of HBO with kettle corn and tea. There’s no point in going into detail about all that because it’s the typical cheese.
What was singular was the connection—that was the stuff. When he and I met, I was half-hurrying to work—I say “half ” because traffic was moving well that day, which was never guaranteed in Center City, so I had time to enjoy the beautiful weather for a couple more minutes before getting into my car. Colin, in plainclothes, greeted me in the parking lot by saying I looked focused. He followed it up with “Are you working hard or hardly working?” I hadn’t paid him any attention until those words fell from his mouth. That’s when I looked up at him. There was no way I could contain my eruption of laughter following his hilariously terrible pickup line. Relieved at my willingness to engage despite his pitiful approach, he laughed, too, then stumbled backward. It was strange because he didn’t trip; there was nothing on the pavement. He just fell backward, then caught himself with an opportune step. We stood there staring at each other with an uncanny recognition. I squinted, then finally broke the stare by stating that I had to run to work, knowing the real reason for my hurrying off was that the prolonged gaze with a stranger felt inappropriate, although the description of “stranger” didn’t seem to fit him. From the beginning, we could talk about the meaning of faith until three in the morning. How, just by seeing the crinkle in my brow or hearing a three-second pause in my speech, he could read my mind. How, once, at 2 a.m., I woke up from a deep sleep feeling him, across town, thinking about me. I had been comfortable in bed—it wasn’t too hot or cold; I didn’t have to use the bathroom; there was no nightmare or particular issue—I just woke up with this sense. I looked at my phone to see that there was no voice mail message, no missed call, no text. I replaced the phone on the end table, fluffed my pillow, then rolled over for round two of sleep. That’s when the phone rang, and it was him.
Then he changed—the way desperate people sometimes change; the way hurt people can change. They don’t change from who they are, but they reveal what is deep inside. Yes, he was tired from divorcing a woman who fought dirty, but his bigger battle was within himself. He was angry that he had found himself with such a person in the first place. The trauma he was experiencing triggered old wounds of being abandoned by a mother who frequently left him in the care of an uncle who, when Colin was a little boy, beat him like a man. No one rescued him then. This same mother was verbally aggressive with him to this day; it was her well-worn coping mechanism. So, he had grown up to replicate his childhood abuse by finding toxic relationships that would remind him of his past, because he hadn’t yet resolved those wounds. Now he was fighting to rescue himself from all of it. He was in crisis, and this deserved sympathy.
But wounded animals can turn vicious as they fight for their lives. He became irritable, withdrawn, and unkind. It wouldn’t be fair to say he stayed that way. He didn’t—he got worse. He became someone I couldn’t like in a casual way, much less love in a romantic one. As I wondered which aspect of Colin would prevail in the end, and what that would be like, I realized that the most sensible question I should be asking myself was: What part of my unresolved wounds bonded with his trauma?
Then I saw it. His collapsing in times of crisis was my mother. His lashing out from a place of core fear was my father. His spiraling denial and now codependence was them both. Colin and my shadow selves reenacted familiar patterns from our common pasts. The experience with him reminded me that I had consciously chosen a different pattern for myself long before, so I needed to choose an action consistent with that decision. Furthermore, I wasn’t his ex, his uncle, his mother, or his wounded inner child. But if I stayed through that period, I would have been all of them, because in the midst of his battle, he couldn’t tell whom he was fighting anymore.
Timing can make or break the best of us, and for reasons that may be yet to be revealed. When I left him, which, unlike my divorce, took not only a series of conversations but eventually my quietly blocking him on every platform because there are, after all, only so many times it is reasonable to have the same conversation, he told me that he knew he would never have a relationship with this depth of love again in his life. We both knew that was true. He let me know, too, that he would come back for me, to see if he could make it right when he could make it right. If he could reach me in time, before life made his return impossible, before he heard of my living in some faraway place or with another man in another life, I knew that he would try. But life evolves.
“This lifetime or the next, my love, we’ll reunite,” I told him. “This lifetime or the next.” I meant it at the time. And while Colin was sold on neither reincarnation nor the delayed gratification of next-life reunification, he knew that what I said somehow rang true. It still makes me smile that though it was at times difficult for him to hear, he always believed everything I said.
I got it, too, how good people can lose their way during life transitions. How they can behave in self-destructive ways until they master another pattern—should they ever choose another pattern. In my life, I chose a different pattern from the one I was born into, so I would not replay my past trauma with anyone. It was worth creating good with the right person at the right time. I am worth being healthy with a person who also chooses health.
So, I blessed him and walked away. While I felt a forever connection with him even when I left, I knew that in time this would change. I couldn’t predict when the sight of fresh herbs wouldn’t make me think of the garden he said he’d plant for me; or when I’d stop waking up mid-REM sleep in a panic, knowing that somewhere he was staring at his phone and trying not to call. But I knew that someday, in a future I could feel but not yet see, I wouldn’t want him back. It didn’t matter where I lived or whether I was with someone else or alone: I knew myself well enough to know that when I leave, I leave for better and I leave for good. First comes the physical separation; the emotional disentanglement follows in time.
Life had to get easier. There had to be a day, and soon, when I could coast for a little while. I was exhausted.
Then I autocorrected to remind myself of a more effective affirmation: Today is a good day, I thought. (I breathed it in.) Today is a day of blessings and gratitude. (I breathed it out.)
I sipped my favorite coffee, Fair Trade French Roast, that I had ground fresh and hand-poured this morning, and kissed with coconut sugar and cream. Today is a lucky day. This moment is a blessing.
I folded up my half-read medical journal and headed over to the ER.
As I rounded the corner, I peeked at the tracking board. Six patients slated for admission, three patients up for discharge. One of the dedicated night physicians, Marlee, was just wrapping up her shift. She worked at the VA on a per diem basis, so we saw her only rarely. Marlee was also leaving the VA soon. (With the constant turnover of staff in the department, we were used to having colleagues come and go.)
“Hello, Marlee. How was the night?” I asked.
“Girl, same ol’ same ol’!” I never could figure out how Marlee did it. Every time I saw her after a night shift, she looked as bright-eyed and dewy and hopeful as if she’d just walked in to work. The chaos of the shift never left one hair out of place in her smooth ponytail. Her skin was still so fresh and well hydrated—presumably from the strawberry-infused water she always brought with her. She was a wonder to behold.
“You know this place really robs you of momentum,” she added. “It’s just so hard to get things done here. Four patients waiting for admission since yesterday—how is that okay? All the while, I’m here alone trying to see new patients while managing patients who are already admitted. It’s not right for anyone.”
I nodded. “I know. Always the same. We tell the powers that be,” I said, making air quotes around “powers.” “But for—�
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“Nothing!” she interjected.
“Oh, Marlee.” I sighed, smiling at her. “Maybe it’ll get better soon. You know we’re supposed to get some new administrators in the hospital. Maybe they won’t abuse the staff, and folks will actually stick around. Who knows? Maybe, instead of creating fraudulent logs of hours worked to milk the system, the leaders will actually work to improve the care of veterans. We might even get enough provider coverage in the hospital . . . So maybe . . .”
Marlee gave me a sideways glance. “Michele, you keep believing! You go right ahead and keep on believing those nice thoughts!” Then she joined me in the only thing we could control: laughter.
She was right. As emergency medicine doctors, we commit ourselves to evaluating patients who come in “sick” before their root illness is known. We assess these patients to figure out if they are acutely ill, and then we determine treatment plans to address their individual needs. We do not do the work of the specialty teams who narrow their vision to one organ, we do not do the work of primary care providers who coordinate five different services to work up a tumor over the next two months and chase minor abnormalities in a patient’s lab work for weeks. We are the ones who help people right now. We determine what is critical, what has to be addressed immediately, and then we address those critical issues before we send patients either off into the world, where they can manage it themselves; or to the hospital, where others will help them manage it for a time.
That is the understanding, the agreement, the contract that we emergency medicine physicians have with the patients, the hospital, our colleagues, and ourselves. When that contract is violated, it is a painful breach. Now, in an ER with so many patients boarding, in a department with a policy that the ER staff is to care for all boarding patients so that the ER physician now adds to her workload the duties of the other specialists as well as the general medicine teams until the patients are transported from the department to their hospital beds—despite this being in violation of VA policies and procedures, despite all the studies showing that admitted patients boarding in the ER have increased adverse outcomes—that contract had been violated.
The Beauty in Breaking Page 14