what can killers teach us?

 

Like most of you, I was horrified to wake up on Monday morning to news of a second mass shooting in two days, over the weekend, one at Brown University and another on Bondi Beach in Australia. And, in case you missed them, the shootings that also unfolded under the radar in Greenville, N.C., in Brooklyn, N.Y., and in Cleveland, Ohio. As reality started to sink in, it occurred to me how many layers there are to these stories.

"Man is unique in

organizing the mass murder

of his own species."

~Aldous Huxley~

The unfathomable grief blanketing the friends and families of the victims. The shock. The anger, fear, and sorrow they will shoulder for the rest of their lives.

"No one ever told me

that grief felt so like fear."

~CS Lewis~

The aftermath of trauma the survivors face. The pain. The scars. The horror.

"I'm standing in the ashes

of who I used to be."

~Mallika Dodeja~

 

You have to wonder if the courage and resolve it took for first responders to act at the scene didn't falter just a bit. Maybe, a lot. You have to wonder how those images are carved into their psyches. Into their hearts.

 

And who doesn't want to know what drives a person to commit murder in the first place? Not to excuse them or to forgive them, but to understand how something like that takes root in a human heart. To fathom what it takes to plant the seeds of hatred, violence, and dispassion in the mind of someone who was born an innocent child?

 

What about the parents and families of these men? Mystery abounds. Speculation grows. Will we ever know the truth? Will we ever hear their stories?

 

"There is no greater agony

than bearing an untold story

inside you."

~Maya Angelou~

 

What about the nurses and doctors who dropped everything to tend to the influx of trauma patients on short notice. How did they get through it?
 

Does it help those of us who practice narrative medicine to tell our stories? Does anyone benefit from hearing them? What can we learn from victims and patients? What can killers teach us? Nick Flynn knows. Author of "Another Bullshit Night in Suck City" and "The Ticking Is the Bomb," his mother took her own life. Suddenly. So, he knows.

 

SUDDEN

~by Nick Flynn~

 

If it had been a heart attack, the newspaper

might have used the word massive,

as if a mountain range had opened

inside her, but instead

 

it used the word suddenly, a light coming on

 

in an empty room. The telephone

 

fell from my shoulder, a black parrot repeating

something happened, something awful

 

a Sunday, dusky. If it had been

terminal, we could have cradled her

as she grew smaller, wiped her mouth,

 

said good-bye. But it was sudden,

 

how overnight we could be orphaned

& the world become a bell we'd crawl inside

& the ringing all we'd eat.

 

jan

not so distant memories

I practiced medicine for over thirty years before I retired a few years back. I saw thousands of patients during my career. How is it, then, that the distant memory of one of them popped into my mind for no particular reason this week? After nearly fifty years.

"A memory is what is left

when something happens and does not 

completely unhappen."

~Edward de Bono~

The patient (I still remember her name) was admitted to my service with a classical case of bacterial endocarditis--an infection of one of her heart valves that resulted from a congenital defect. She was in her forties. Unfortunately, she experienced one of the dreaded complications of the condition when she suffered a stroke that left her unable to speak or move one side of her body. The stroke caused intractable seizures, so we ended up pumping her full of antibiotics for the infection, and antiseizure meds as she lapsed into coma. After a couple of weeks in ICU, the time arrived to make a decision regarding whether to continue life support...or not. Given her dismal propsects for recovery, the decision was made to start withdrawing treatment, little by little, to see what we ended up with. The first meds to go were the antiepileptic drugs. I can still remember the look on the nurse's face when the sedative effect of the antiseizure drugs wore off, and the patient opened her eyes for the first time. Long story, short...once the patient was awake, she made slow but steady progress until she eventually walked out of the hospital on her own. Taking her off life support brought her back to life. Her recovery was so remarkable, it has stayed with me all these years, and it just pops up every so often because it taught me a lesson.

"Somewhere, something incredible

is waiting to be known."

~Carl Sagan~

This is the thing: No one knows how memories are made, or where they're stored, or what they're made of. No one knows why some persist while others fade, or how they arise unbidden, complete with authentic emotion (sadness, anger, joy), and physical reification (shaking, nausea, sweating).

"Embodiment means we no longer say, 

I had this experience;

we say, I am this experience."

~Sue Monk Kidd~

We can, however, codify the context of memory-making and retrieval this way. Memories will be created and stored most effectively:

1. when the experience is associated with:

• fear
• pain
• anger
• sorrow
• joy 
• gratitude
• love

2. when the experience challenges us, or teaches us something new 

3. when the experience changes the course of our life, or our attitude toward it

4. when we are moved by beauty, or kindness, or a sense of calm

5. when the experience causes us to wonder, to question, or to seek an elusive answer or truth

The list goes on.

Memories foster and animate storytelling. They preserve experience, embody emotion, and teach us so we can teach others. Every so often, they re-emerge from no-one-knows-where to surprise us, to remind us where we've been, who we are, and where we're going.

"We are the universe 

experiencing itself."

~Carl Sagan~

jan

what if the tables were turned

Are you ready for Christmas? I think I am, as ready as I can be given the fact that this isn't the easiest celebration to pull off every year. A snowstorm can sweep in and ruin everything. A simple cold can lay a person low. People we love may be missing this year.

This is always a bipolar time of year for me. We can be full of eager anticipation one day...empty, the next. With the approach of Christmas, we enter a time of irreconcilable contradiction. Undeniable reminders of the dualities that coexist in our lives--joy and sorrow, poverty and wealth, anticipation and dread, indulgence and denial. Good health and bad. Which, when you stop to think about it, feels so unfair.

The problem is that I have friends who are sick...so sick, in fact, that this could be the last Christmas they see. I have friends who are grieving. I know people who are lonely. Angry. Depressed.

And most likely, you do, too.

The holidays have a way of putting life's inevitable struggles into perspective. The bright lights and merry carols that the rest of us enjoy can dampen the spirits, deepen the grief, and aggravate the loneliness that so many feel at this time of the year. 

 

www.personal.psu.edu



I wish everyone could be happy and healthy at Christmastime. That everyone was at peace. That everyone had hope. It's hard to know what to do for those who don't. What help are presents when pain is the problem?

I am left to reflect on what I think would be helpful to me if the tables were turned:

If I were sick, if I were the one receiving chemo, or struggling against pain, I would want a friend at my side. Don't bother bringing me fuzzy pink slippers or bubble bath or flowers...unless, of course, it makes you happy...in which case, bring it on! Even though it's your presence I really need.

If I were grieving the loss of a loved one--my spouse, or one of my children, or my best friend--I would want you to sit at the kitchen table with me and share stories--the sweet, funny, important moments that we enjoyed with them. I'll make the tea. You bring the cookies.

 

If my house turned to rubble in a storm or turned to cinders in a fire, I would need you to hold me up, to cheer me on, to shelter me if it came to that. Don't say, "Call me if you need anything." I would need everything, and I wouldn't have the strength to pick up the phone. Just come. Sit. Stay.

 

www.weheartit.com

 

One of the best presents we can give is exactly that--our presence. Our halting, not-sure-what-to-do-or-what-to-say presence. Our I'll-be-here-for-you-no-matter-what friendship. Our I-wish-I-could-do-more-for-you selves even though some of us may have been planning and preparing for weeks, now. Shopping. Baking. Wrapping. Tending. Caring. Hoping to make everyone happy...

...not that we have much control over it.

Still, if Christmas with your family is happy, loving, and peaceful, I wish you a merry one.

If not, I wish you hope. Courage. Friendship. Beauty. Time. Snow if you like it…sunshine if you don’t.

~What Gift Will I Give~

You have no idea how hard 

I've looked for a gift to bring you.

Nothing seemed right.

What's the point of bringing

gold to the gold mine, 

or water to the ocean.

Everything I came up with

was like taking spices to the Orient.

It's no good giving you my heart

and my soul because you already have these.

So I've brought you a mirror.

Look at yourself and remember me.

~Rumi~

jan

there is more than one way to tell your story

 

The approach of the holiday season has a way of magnifying whatever trouble we are dealing with in life. Just last evening I learned that the friend of a friend of mine was recently diagnosed with early-stage breast cancer, just in time for Thanksgiving. She opted to undergo bilateral mastectomy even though she could have chosen a more conservative approach. She is post-op and doing well now, though not with her usual holiday spirit. Others I know are not faring as well.

This week’s post presents a brief excerpt from my novel, The Bandaged Place. I wrote this scene years ago, but it still rings true today.

It goes without saying that this scene is fictional, but it could just as easily be part of a memoir. It connects the reader with a moment she may have experienced in her own life--when she had to share bad news with friends, when she needed their support, when she knew how hard it would be for them to come to grips with her predicament. The fact that it is fictional does not diminish its impact, suggesting there is more than one way to tell a story.

"One of the most valuable things
we can do to heal one another
is to listen to each other's stories."
~Rebecca Falls~

In this scene, the protagonist, a physician, has just told her two closest friends she has been diagnosed with breast cancer:

          My kitchen is as silent and as still as any place on the face of Earth has ever been—the deepest cave, the holiest shrine, the eye of the storm. I have just finished explaining to Sophia and Barb why I need them here today. It’s one thing to sit at your desk with a patient and break the news to her, “You have breast cancer.” It’s another thing entirely when you are seated at your own kitchen table with your best friends, saying to them, “I have breast cancer.”
          They’re sitting across from me stunned, expressionless, struggling in vain to access whatever words they need to say to me right now. But there are no words for this. Silence reigns.
          I am tracing the pattern of the grain in the wood on the tabletop. Sophia is looking out the window, her chin resting on her hand, gazing as far away as possible. Barb is staring at me, searching for some sign, some indication that would explain how she missed it, as though she should have known something was wrong. And I am having second thoughts as I watch both of them wrestle with this—as I watch everything change for them—knowing what I just unleashed in their lives.
          I break the silence, “Well?”
          Sophia slowly turns her attention back to the present. “Well what?”
          “Well, what’s going through your heads?”
          Barb turns to Sophia for help with this one.
          “Me?” Sophia sits forward and braces herself as if she’s preparing for turbulence, in full upright and locked position. “If it were my decision, Kate, I’d have them both off. And I wouldn’t bother with reconstruction. I mean, what purpose under heaven do they serve anymore?” She waves her hand as if she were scooting the dog away. “That’s what I think.” She sits back as if the voice-of-reason has spoken. Clearly, she doesn’t understand.
          Barb stares at my chest as though the answer is scrawled in capital letters across the front of my sweater. True to form, she sums it all up, “You know what I think? I think you're going to need a puppy. And lots of wine. Red wine. For medicinal purposes."
          Sophia closes her eyes and wags her head. “You’re impossible.”
          I have to giggle. I can’t help it. Barb would come up with something like that. Why is it, I wonder, that the worse you feel, the better bad jokes sound—silly, stupid, crude—as far from reality as you can get?
          “When I was ten,” I tell them, “I went crying to my mother because I had this little sore bump on my rib, right about here.” I point to my heart. “Mimi had just died, and I knew that she had breast cancer, so I was convinced that I’d caught it from her. At ten! I was so sure of it—so scared—I waited a month before I told my mother about it. By then it was even bigger, so I was certain I was doomed. But Mother just smiled and told me, ‘It’s part of growing up, is all. It’s perfectly natural.’”
          “That was natural,” Barb quips. “This is not.”
          Nor is it fair. Nor is it even conceivable.

*

And so the narrative begins with the physician as the patient.

"Stories are not material to be
analyzed;
they are relationships to be
entered."
~A.W. Frank~

The fact is that scenes like this unfold all the time in real life. If you have shared bad news with your closest friend, you know how hard it was. If someone made you smile on the worst day of your life, you witnessed a miracle of sorts. If you have a friend who was willing to sit quietly and patiently at your side, she helped you heal.

The point is that each of us has a story to tell. If you write, you can translate what you experience, think, and feel into words. But if what happened is too painful or too difficult to chronicle, try wrapping it up in a story or a poem. If you are an artist, you may be able to express yourself better on the canvas. If you compose, in your music. If you act, on stage.

There is more than one way to tell a story but tell it you must. Which way is right for you?

"Everybody's got a different way

of telling a story, and 

has different stories to tell."

~Keith Richards~

jan

when you just can't write and you shouldn't even try

 

Let’s face it. Old Man Life sometimes insists we take a break whether we want to or not...a break from work, or from serving as a caretaker, or from parenting. 

It might be an unexpected illness or injury that stops us in our tracks.

Anterior shoulder dislocation (image: compliments of my son)

A flood or a tornado might sweep through. Worse yet would be the death of a friend or family member. You can’t work and you shouldn’t even try.

Likewise, you may sometimes be forced against your will to set aside your creative efforts, whatever it is you’re writing, drawing, composing, or performing, your efforts to create something new and beautiful, or meaningful, or entertaining. You may be sabotaged even when you’re speeding along page after page, stroke after stroke, verse after verse. Just when the finished product is within reach, you may have to take a break and tend to the Old Man. Maybe you come down with the flu, or a neighbor needs your help, or your new puppy slips out the door and disappears down the street. It may be time to give your muse some time off. Tell her you need to take a break. Promise her you'll be back. She’ll thank you with new insight, inspiration, and passion as soon as you're ready.

Maybe you’re looking forward to planning a move, or you’re preparing for a wedding or a birth in the family, or you have an exciting vacation coming up. There’s a lot to do, not a moment to think about the masterpiece moldering on your desk or which chord sounds better. You may want to invite your muse to take the day off. Then, when you're ready to get back to work you can sit down together and share your memories of the event. 

"Muse:

that mischievous little sprite

that whispers inspiration in your ear

when you least expect it."

~Dale Kinkaid~

There are times you can’t work, and you shouldn’t even try…not because you’re blocked, or lazy, or distracted, but because Old Man Life has other plans for you…plans for you to gain experience, to grow in understanding, and to tackle your feelings about it. All of which will appear sometime later on, in a melody, or on the page, or on your canvas...when you least expect it.

"Taking time to live life

will only inspire your work."

~www.artofyou.com~

It isn’t always how much we accomplish, but who we become that elevates our work. A walk in the woods elevated my work last week:

This week, I hope Old Man Life is good to you and that you and your muse have a blast together!

jan

how to write like a horse

 

This past week, a lone horse in a pasture captured my attention. I spotted him running full speed ahead from one end of his football field-sized enclosure to the other--back and forth, back and forth. No one was chasing him. No one was cheering him on. He seemed to be galloping along for the pure joy of it. To feel the wind in his mane. To stretch his legs. Like this one:

~www.123rf.com~

When he'd had enough, he simply stopped and rested. Like this one:

~horseandrideruk.com~

This, I believe, is how we should write: for the pure joy of it. Letting loose on the page. Stretching our imaginations. Letting our spirits soar without anyone questioning our motives. Writing what we can simply because we can. Without prodding. Without apology. Without restraint.

"Writing is the most fun

you can have by yourself."

~Terry Pratchett~

And we, too, should feel free to stop and rest when our joy is satisfied and our energy is spent, knowing that we can take off again any time.

Go ahead. Write like a horse!

"Release your majestic mind,

embrace your untamed inner spirit.

Break free from captivity,

avoid society...

You were born to be free."

~Melanie Moushigian Koulouris~

jan

what are you afraid of?

If you are a healthcare provider, a caregiver, or worse, if you are a patient...you're probably all too familiar with the word "fear."

"It is both a blessing and a curse

to feel everything so deeply."

~Noah Weiss~

Patients probably bear the brunt of it. When they have to wait for the test results they know will determine their fate. When they face a painful or risky procedure. When the phone rings in the middle of the night, and it's the ER calling. Parents bolt out of bed, and they are on their way. Fear can show up as dread, as hatred, as shame. It can also alert you to danger. It can deliver a jolt of adrenaline. It can be a great energizer. A motivating force. 

Fear is also fertile soil for avoidance and denial. For procrastination. For the imagination. Take the case of the middle-aged man who presents to your office with chest discomfort he describes as "indigestion"...because he's afraid to admit it could be his heart. So he fails to mention that the pain gets worse when he walks uphill. That it radiates into his neck when he lifts something heavy. That antacids haven't helped. He's afraid, all right.

Imagine the fear a parent feels when his child is rushed to the hospital because of an illness, injury, or overdose. 

What is it like for a woman who is in labor if she lost her last newborn because of a heart condition or some other unforeseen complication at the time of delivery? What could be scarier?

"Be brave my heart.

Have courage my soul."

~attribution unknown~

As ordinary human beings trying to orchestrate our personal lives outside of the office or hospital, healthcare providers are prone to some of the same fears. I take good care of myself, so I don't worry unnecessarily about my health. But I will admit to a twinge of anxiety when I was asked to return for additional views on my mammogram last year. 

I wasn't worried when my PCP picked up a few irregular heartbeats on my physical and ordered an echocardiogram. I drink a lot of coffee, so what did he expect? I wasn't worried until the tech started spreading goop all over my chest. Suddenly, I was a bit anxious about what they might find. I had rheumatic fever as a child, by the way.

There's that...and then there's the fear that stalks us through the workday. Who hasn't felt it on the way to a "code"? Will the patient need to be intubated? Will we remember the dose of bicarb or atropine to give, and when to give it? Will we be able to save this life? Fear is never far away.

"The greatest mistake we make

is living in constant fear that

we will make one."

~John C. Maxwell~

What about the patient who shows up unannounced at the office with a bad laceration? Fear kicks in. Will I get the layers right when I stitch it up? Will it look OK when it heals? What if it gets infected? 

Will the delivery go smoothly? Will the baby be okay?

Will the Narcan work in time?

"Do what you can,

with what you have,

where you are."

~Theodore Roosevelt~

Patients would probably be surprised to know how fearful healthcare providers, even physicians, can be. Deciding which tests to order and how to interpret them. Afraid of making the slightest mistake. Worried we might miss a diagnosis or botch a procedure.

Fear is like a shadow on a cloudy day. It follows us from patient to patient, unseen. They may not know it's there, but it is. It might reveal itself as frustration, impatience, or disengagement. It can cause headaches, rapid pulse, nausea, sweaty palms, or shakiness. Even in doctors. Like everybody else.

"Great fear is concealed

under daring."

~Lucan~

What are you afraid of? What will you do about it?

jan