© Photo by Bertie
It’s been four months since October 7th and more than two months since my last confession - I mean blog post. Needless to say, the two are related.
What more is there to say when the world is full of lies, hypocrisy, and malign projection? When realistic options and likely outcomes range from bad to worse? When the current situation, awful as it is, may one day be seen as but a prelude to something much bigger, much darker?
Nothing to say that others can’t say better.
As for other topics, inarguably more appropriate than war to a doctor’s blog, while they haven’t gone anywhere, it has felt almost profane to dwell on them by comparison. To borrow from Wittgenstein, I find myself in a mental state where what I cannot talk about I must pass over in silence.
But then I remember the purpose of this blog - to give a glimpse into a doctor’s life. So why not share how I’ve been coping with all the psychological and emotional stress? After all, here we are, at the dawn of AI, where a doctor is still a human being - with personal, familial, political, financial, or existential pains and joys - sometimes large, sometimes small, but never absent.
In response to inner turmoil, I tend to direct my energy outward.
If I feel depressed, I’ll go for a run. If I find myself ruminating, I’ll reach for a journal article and learn something new. Watching my kids play sports is therapeutic wish-fulfillment - conflict and competition played out on a field with referees, fair play, and mutually agreed-upon rules of the game. Work - especially the patient-care part - directs my mind to other people’s problems, grants me the privilege to apply my skills productively, and quiets the internal noise.
Sometimes stress provides its own remedy in the form of the response that it demands. In other words, action. In other words, the answer to the question, what do I need? may well be the question, what needs to be done?
In other words, life goes on.
I learned this lesson when my daughter, Georgia, was found with congenital heart disease as an infant. The shock of her presenting crisis and initial diagnosis; the uncertainty and dread of her surgeries and prognosis; the constant care she required - replacing nasogastric tubes that she had pulled out in the middle of the night while she screamed bloody murder stands out in my mind (lucky I was a doctor - or unlucky?) - it all left little room for anything else.
And yet, what about her siblings? Didn’t they deserve normal lives? They forced Rachel and me to be present for them - with love and attention - providing a kind of respite that would otherwise have been completely out of reach.
I suspect that many doctors are the same - for better or worse, we are trained and biased toward action. We compartmentalize and externalize emotional stress rather than let it settle and spread internally.
I took a little poll.
A neurosurgeon family member describes having a pilot or quarterback mentality when it comes to stress - “eat, make the next decision, move on” (yes, first eat); a neurologist friend “surfed a lot in residency”; a cardiologist colleague takes “long walks with his dog” (nothing like a dog to draw you out of yourself); a gastroenterologist friend “turns off all electronics, goes to concerts, builds Legos,” and… plays with her dog.
It all seems pretty typical. Maybe doctors are not that different from “normal” people after all. Or maybe any difference is more a matter of degree than of kind. In any case, speaking for myself, I feel lucky that my inner self can turn to the outer world - which, along with infernal strife, mercifully provides solace in at least equal measure.
Not to mention inspiration.
Kobi, our youngest child, recently had his second ski race of the season, a Giant Slalom at Windham, our home mountain. Every racing parent is expected to volunteer for a home race. Since I am one of the most experienced, I offered to gate-keep, which means standing on the side of the slope, inside the red B-netting, to referee and help out in case of a crash.
Little did I know about the arctic freeze.
It was well below zero on the hill that day. There were 197 racers, each with two runs. By convention, girls go first, boys go second. A frigid wind whipped across the snow. Soon enough I couldn’t feel my feet. At the point when it felt like hypothermia was setting in, I expectantly checked the bib of the next racer: #19.
Of the girls.
Then I saw a favorite thing - a young racer outside her comfort zone, urging herself on as she hurtled down the slope, barely hanging onto the edge of control. Her voice reached me across the course, You can do it, Kristin! Weight over your skis! Come on, Kristin! Don’t be afraid…!
For a moment, I forgot my pain, as her valiant spirit won me over, and her skiing became about more than just skiing, and I thought to myself, or rather to her, Send it, Kristin! Harness gravity! Exploit the thing that drags you down!
I’m sorry for all the parabolic anecdotes about ski racing - I know that for many, if not the vast majority, it must be pretty unrelatable as a metaphor for life. But to me, ski racing is such a true and natural metaphor that I simply cannot resist - damn the torpedoes, full speed ahead. That part, at least, may be relatable.
One more before I let you go:
Our kids had a grizzled ski coach named Mergs. Tall and stooped, with a weather-lined face and unruly white hair, he looked like an alpine Ichabod Crane. His laconic advice to young racers crouched at the start - all eyes on them, nerves taut enough to snap - was simple and perfect and still resonates with me today.
“You got this,” he would say. “Just point your nose down the hill….”
I am old and I have been blessed with many friends much older than I am. Along with the joy of their shared wisdom and love has come a concomitant fear of the late night or early morning bleating of my mobile phone, with the inevitable news that one of these precious people has left us. Yet no fear prepared me for the urgent message left by my oldest brother two weeks ago, nor the glottal catch in his throat as he told me that our youngest brother, Michael, had died a few hours earlier during a brief vacation in Puerto Rico.
Michael was six years younger than I am, just 65. I loved him deeply and, growing up with our two older brothers mostly gone, he was my shadow, faithfully following me into a love of music, of our Jewishness and song leading, of activism and righteousness (and self-righteousness, and provocation), and love of children, Bob Dylan, Bruce Springsteen, Phil Ochs, James Taylor, and Joni Mitchell, among others. Identifying Michael on a gurney in a cold little room at the hospital in San Juan, when the sheet was pulled back from his beautiful face, his eyes still glistening blue, was about the hardest thing I've ever had to do.
Like Peter Pan, I am bereft at the loss of my shadow, and, unlike Peter, at the awful finality of that loss, which did not really hit me until a few weeks later, during Shabbat dinner with my kids and grandkids, that there would never be another Shabbat dinner or Passover seder with Uncle Michael.
So I'm thinking, as I sort through the responsibilities of executor of the estate, such as it is, of one who left a mess of a life behind along with the astonishing and expanding circle of people who loved and were loved by him, that stress comes in many variations and modes. Michael's death doesn't bring on night sweats the way, say, fear of job loss or a rent hike, or a divorce might do. It catches me in unguarded moments, such as when I realize I've been staring at the Yemenite shofar I brought home from his house and instead of wondering whether Amazon sells a proper cradle for it, I'm sobbing and remembering it was Michael who retrieved the ram's horn from our dead parents' things and made certain it (along with the brass Shabbat candlesticks) retained its honored place in our lives.
So: What now, indeed? I point my nose down the hill, but for the moment, I can't discern the trail, only that it is a black diamond run and I have no idea how to approach it.
Our Sunday mornings have been lonely, welcome back!