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.

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.

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.

Satisfying Soreness

We've been giving exams this week at the med school - first year students performing a head-to-toe physical on us (on me, and boy is my body sore). The students spend their hour trying to remember all 140 steps to the physical and do them correctly - and I spend mine cooperating with the "doctor", and wanting to "help" them when they forget something, but knowing I cannot.

How special though is this experience of being with "baby doctors" in their process - what a gift. Watching students (really students at all levels, but especially these guys who are training to provide us with care and healing) learn, observing how they are changed by what they learn, and being part of their development as humans and scientists, has always been something I get really juiced about. I can't seem to stay away from it, nor would I want to. I guess I have a facility for working in a learning environment, for being present with people in such a space. And I simply love it.

Yesterday I was the examinee all day, and my god how sore I was. You wouldn't think getting a physical would do that - though I got five of them yesterday. Today it was only three, same for tomorrow - and that is plenty, according to my body. I can take care of that and deal with the stiff and soreness though, because I love "watching the wheels go round and round" in their heads as they practice thinking and doing at the same time. The BEST part though, for me - is when they have "finished" and sit in the room going over what they've done - reviewing the exam. Some of them sort of walk their fingers over their own bodies as they recall their actions. Others talk to themselves, even to me, as they review verbally. I just sit.

Today one young woman sat in the chair and seemed to go into a trance - eyes closed, absolutely quiet and seemingly calm as she conducted her mental review. The exam room (which looks exactly like a doctor's exam room) took on a feeling of peace. I found myself noticing details - the way her gold-red hair shone in the lights, the air on my back where the hospital gown did not meet, and particularly the pale green "fuzz" that has appeared overnight on the tree limbs outside the window. The student sat that way for nearly ten minutes and it felt as if we'd shared meditation space and time.

What a fabulous, important, and transforming job I have found in this. And, in the words of the late, and great, John Hartford - "I get paid for doin' this."

The face in the two-thirds moon tonight looks quizzacle - is that a word? But maybe you'll know what I mean - sort of puzzled, perhaps a bit confused or questioning. I don't even know why I looked up and noticed that face, except that finally we've had a day of relative warmth and sunshine here in Louisville and I've been outside a lot. I just went out now at 7:15 pm to luxuriate in the fact that a sweatshirt is sufficient to the temp, and to ponder what I want to say to the world tonight. On looking up, seeing the raised eyebrows and scrunched up mouth on the face in the moon (and, yes, I DO understand that part of the "expression" has to do with the fact that the moon isn't full) I thought, "Yeah, quizzacle, just like me."

And here's why - day after tomorrow I turn 59 years old. I've been thinking about that lately.

It's always around my birthday, rather than at the new year, that I take stock of my life, . Lately I've wondered how any of us can really know what impact we've had in and on the world, what difference it has made that we have lived. Looking down the tube and seeing 59 (I mean, really, can't we just skip years like that and move on to the next decade?) getting bigger in the window does make me think - so what have I done with the years and the talents and skills.

I don't mean to sound morbid (though tomorrow I AM playing a depressed patient at the med school), but guess I've reached the age when such considerations do arise. Maybe more though I'm considering "what next?" You reach your fifties (which, yeah, I almost didn't live through) and I suppose it's logical to wonder what might lie ahead.

There's a lot I still hope to experience. Falling in love again, and this time with someone who also wants to be in love with me, is on the list. Traveling to one or more of the places I long to see (Alaska, Australia, and the list goes on) is there too, as is publishing in a really good literary journal. But I'm not talking so much about those discrete things - though love is truly more than that - more about what sort of old person I might be.

I want to be a Crone, a Wise Woman, an Elder - a woman who has that inner quality of sensual wisdom and that beauty of countenance arising from a life fully lived. And as I consider the possibility of that I wonder if I really HAVE lived in such a way as to really have a chance at Crone-dom. Not that I could undo or re-do any of it - or would if I could. But at this point in my life I gotta consider just what the past (my past) might be prelude To.

Yes, I get caught up in looking at times I've fucked up, made wrong choices, and taken dead-end paths as mistakes rather than learning ops. I tend to lose sight of the "teachable moment" nature of each of those times - to forget that it is NOT when things are going well and we're walking in tall cotton that we gain wisdom. Wisdom is gained when times are tough, when things fall apart. I forget that it's when we look around, realize that the path we're on doesn't go where we thought or where we wanted, and say "oh well, let's see where it goes" that we discover something that may change us forever.

Knock, Knock

I'm starting a new job tomorrow - always a bit stressful. Though it would interest me to explore the stresses here, I'm trying something new - trying to sit with the anxiousness about this and whatever else in life I have anxiety about (that I haven't even let myself in on yet).

We'll see how well this works - this inhabiting anxiousness on a grey, raining, February 1st - since what I usually do - and really, am SO good at, is distracting myself from what bothers me.

Robert Pirsig (Zen & the Art of Motorcycle Maintenance) has written - "The truth knocks on the door and you say, "Go away, I'm looking for the truth," and so it goes away." For today, partially in honor of tomorrow's Groundhog Day (the day AND the movie) I'm trying to sit still and say "come in" when the knock comes.

This Is It

Always we hope someone else has the answer, some other place will be better, some other time it will all turn out. This is it; no one else has the answer, no other place will be better, and it has already turned out.

- Lao tzu

One of my family members is, even while I type, moving toward the end of her life. It's an extended, not immediate, family member - someone I don't really know well to be honest because we live at a distance from each other. In truth I haven't seen her since the summer of 2008, just four months after my heart attack. Yet as I follow the e-mails from her immediate family, the updates on her treatment and, recently, the news of the discontinuation of that treatment, I find myself wanting to DO something for her and for the rest of the cousins I'm not [in truth] even that close to.

Ah, the legacy of growing up in an alcoholic home! I was the kid who tried to "fix" everything, the one who came to believe early on that I could rescue the drunk, could make others feel better, could - if only I tried hard and long enough - make it all different. I strove diligently and long, in my primitive child ways, to become the heroine of my family. When you're too young and too scared and too powerless to deal even with your own stuff - the best way to avoid trying is to take on the stuff that other people are only-too-happy to let you have.

Now, I'm not trying to either excuse or blame myself for this - just to express honestly that I know where the impulse to jump into a situation such as my cousin's comes from. Lao Tzu - smart guy - knew what he was talking about, didn't he? Always we do want it to be something outside of ourselves that we can take on, blame, hold to, fix, or whatever our particular defensive strategy spurs us to do - so that we don't have to sit with the unbearable roiling in the belly, the intolerable drunken monkeys that swing from limb to limb in the mind when fear and anger, and even regret combine in something we label anxiety. Always I want to rescue, fix, make it all better for others - be the heroine.

Accepting that what I CAN do is share the things I know to be true from my experience, share what my heart holds, share my honest words and express my emotions doesn't feel like enough to me. But accept it I must, and do. I don't have to like it - just accept it. This acceptance involves inhabiting that anxiety that pushes me to "do something," to consider that in this situation, as in most of life, all I can do is respond authentically. Which of course requires maintaining contact with what truly is authentic in me - including the desire to be the heroine.

My cousin's husband signed off on his earlier e-mails with the phrase "Cancer Sucks!" Sitting with our anxiety sucks too, as does this whole trying-to-be-a-grownup at times. Yet I'm finding, as I express, as I love myself even when I squirm as I look at myself, as I get to know that authentic me and share it with others, that life is comprised of more of what (as Anthony Bourdain would say) "doesn't suck" than what does.

Yours in continual confusion, along the journey.