21 March 2011

Part of the Conversation

Eco-psychology, a modern term for indigenous wisdom, reminds us that absolutely everything, including tsunamis and nuclear meltdowns, is a form of speech, an immense conversation of which we are a part. If you have lost your voice out of shock, numbness or impotence you can begin to reclaim it by speaking this truth to another, be it tree, river, sky or receptive human.
Aninha Livingstone
PhD Candidate, Meridian University

Over the last two weeks I have often felt voiceless as I listened to “experts” discussing the global economic impact of the earthquake and tsunami, and then the continual problems at the nuclear power plant affected by these disasters. My voicelessness arises from not knowing what to do with my rage at being told what to focus on. How rapidly these experts shift their conversation from the thousands of people dead, or trying to survive after these events to the drop in the stock markets, to concerns about manufacturing being held up – to matters that seem to me callous in the face of the human tragedy.

I’ve spoken about this very little, in comparison to the amount of anger I feel. Why? Because each time I’ve wanted to talk about it, the response from others has been that economic concerns ARE human concerns. Since I cannot deny this reality, the conversation quickly draws to a close. Yet I’m left with my rage, with a sense of powerlessness I cannot seem to shake.

I do understand what this is about, in part. Our culture holds as axiomatic a belief that we should focus our time and energy on those things we can do something about, those situations we can fix, on keeping ourselves and our immediate families safe from the unknown. Yet shit happens. We spend our dollars and time on potions and exercise, on plastic surgery and weight lifting to keep ourselves young, and we’re encouraged in this at every turn. Yet we age anyway. And we will die eventually, or sooner.

Everything about the society in which we live wants us to seek security and safety. Yet the world offers neither. The playwright Tom Stoppard wrote, “Life is a gamble, at terrible odds. If it was a bet, you wouldn’t take it.” So we make the choice, it seems, to pretend we can change the odds, and in doing so, pretend we’ve reduced the risk. We become callous and cynical.

It seems to me that focusing our conversations on economics and production, on stock market fluctuations and nuclear meltdowns allows us to avoid participating in the conversations we really need to have. Conversations about what we do with our lives and our inner resources, in the every day, how we live with each other, are more difficult ones to have. Talking with our selves and others, even without words, about our fears and dreams, our failings and hopes, requires risk. And though I feel angry that, too often, our public discourse doesn’t include these conversations, I must admit that I too, avoid that risk. In avoidance I contribute to the very thing that generates my anger.

Maybe this is where my anger comes in handy, serves to teach me something. Maybe my anger too is a form of speech, a conversation that it’s time, and past time, for me to be more fully a part of.

17 March 2011

Perfect or Good Enough?

Yesterday - still cool, still winterish though sun filled, thank the Maker. Training for comprehensive clinical exams for third year medical students - very detailed and exacting - only the first of three training sessions. I generally enjoy these trainings, as they provide chances to ask questions and envision how the exam will intersect with our mission - to help make better doctors. Yesterday however I noticed a disconnect inside - something unsatisfying to me I couldn't identify.

Today - spring's arrival! - 75 degrees and breezy, even the trash blowing in the streets sparkling. A shorter training for comprehensive clinical exam for the second year students in the afternoon - and my balance is back. The connection between how we teach and how we test is made in me, and my comfort level returns to its usual state during the training.

OK - so what's the difference? I think it has to do with the difference in assumptions about students, even more, the difference in how individual faculty members see themselves. Doctors, I have learned (in part) through this work as a Standardized Patient, really aren't any different than the rest of us. Some of us are guided by an inner need to control, to strive toward "perfect." I know this driving need too well. Others of us have, or have developed, a belief in living and working within and through a reality that says "good enough" is really the best we can do.

When it comes to training future doctors these different ways of looking at the world and ourselves in it show up clearly, even harshly.

The training yesterday was conducted with an eye toward "perfect" - and from that viewpoint arises the assumption that we should not trust the examinees, nor should we conduct the exam with any forgiveness for nervousness or the pressure that students are under. Many would hold that view - that we are training them to hold the lives and health of people in their hands - that they should perform perfectly under pressure and in situations that push them to the edge physically and psychologically. Is this possible? Is this view consistent with how people learn? Even as I type these questions I hear a Gatekeeper hollering from way off - from out in the center of our society - "well it SHOULD be!"

Today's training arose from the idea that learning is process, that "good enough" at the given stage of learning really IS good enough, and that the examination of what has been taught is as much an examination of the teaching as an examination of the learning. Clearly, I resonate more with this view.

I'm sure that I feel more comfortable and capable of greater vulnerability (in asking questions and making suggestions) in the "good enough" view because I used to use the "perfect" yardstick both on and against myself. It still shows up, this idea that what I do and who I am has no value unless it is perfect. But nowadays I see it coming, and attend to its affect on my body, rather than jumping to obey its commands.

This surely was what happened during yesterday's training. The old familiar came to life in that room, where perfect beige was the color being painted in broad strokes over all of us, and over the students by extension. I couldn't meet the expectation of perfect - and couldn't as a result really focus either.

Today as we sat in that grey-on-grey auditorium, the breezes of mid-March spring wafted through the room, and even without a brush, the color of just-opening daffodils was visible in the corners and at the edges of our chairs. Maybe spring can help us see that we - like what we learn, like how we learn, how we take and do on exams, like what sort of people we become - are all, at best, good enough.

02 March 2011

In The Gap - Or - Lessons From a Heart that Broke

In the gap between desire and enactment, noun and verb, intention and infliction,
want and have, compassion begins.
Margaret Atwood

Late March 2008
I’d survived a “major” heart attack with no damage to that muscle, with two pieces of plastic, tinier than the tip of a fingernail in my arteries, the only physical evidence. I’d recovered some of my energy and strength with exercise, rest, diet, and knowledge. I was slowly resuming my so-called life, making plans to fly again to California for school in a few weeks, to return to work two weeks later. I’d begun to drive again for short distances. Today I was returning to my solo apartment to gather clothes, take care of mail, and simply spend time getting reused to being alone there.
In truth I looked forward to the solitude. I’d hardly been alone since the heart attack. Even this short journey back to normalcy was book-ended by my promise to the friend I’d been staying with, a promise I’d be back, or call, in two hours. Yes, I’d been knocked down, but I was getting up again.
Yet throughout the recovery, despite my hardheaded intention to prove that others could stop worrying about me, a continual yearning made itself known. Since the day I’d awakened in the ICU, with a tube down my throat and my hands tied to the bed rails, I’d been involuntarily looking back, over my right shoulder for someone. I longed to see there someone with eyes full of pride, compassion and love, someone to envelop me in their arms, to softly tell me I was OK, to take my fear and weakness away.
Of course no one was ever back there. So here I was walking up to my front door alone, another step along this particular path.

Inside the apartment smelled of dust and stale air. I walked through, dropping my purse on the bed as I passed it on my way to the kitchen. OK – first open some windows and then water plants – take it slow and don’t try to do too much.
Old apartments have heavy windows, but the one in the kitchen slid up easily with my push. The window in the living room is larger, twice as big and equally as heavy. I leaned into it, bracing my legs against the bookshelf at windowsill height. The window slid up easily but my legs jiggled the bookshelf, knocking off a picture I’d placed on top. It fell between the shelves and the wall.
I tried to reach that picture, but couldn’t get to it. I was squatted down at the end of the shelf, preparing to reach around when I heard the phone ring, in my purse in the bedroom behind me. I turned my head to the right, as if turning toward the ring could answer it, and there, again, instantly, was the longing, the desire to be held and comforted. But this time it was overcome by my sharp intake of breath, by sudden heat in my chest and throat, a surge of acid in my belly, and the smell of rain on a hot asphalt street.
I slid to my knees, then sat, leaning against the bookshelf, the picture forgotten, not fighting the fear, not even thinking it was another heart attack, because this was somehow more familiar.
The heat rose in my throat and became tears. Between one breath and another I felt something coming, sliding up from my belly, into my chest, down my cheeks like salty rain. As it came, I wrapped my arms around my knees, pulled my legs in and cried open mouthed as a child.
What came, without preamble or question, was - I won’t be able to take care of myself, and there won’t be anyone to help me. It rooted me to the floor.
Through the open window early spring breeze chilled my neck as I sat, sobbing, wrapped in my own arms. My face felt tacky, sticky and swollen by the time I rose to my knees, lifted the picture and replaced it on the shelf.