This fifth year, this in-between year of personal goals and time for self, has been a year of coming and going. Took a post-boards vacation in California, came back to living at the VA for my medicine subinternship, trekking cross country and living on a Navajo reservation for a month. Even having been back in New Haven for a couple weeks, the weekends have been spent elsewhere, in Boston then in Long Island/NYC. It was nice to dwell in bigger cities than New Haven, cities that are big parts of my past, and to share them with someone open to new sights and feelings. At the same time, because of the trips and because of the upcoming trip home for Christmas and because many friends are also coming and going and I see them in spurts of their being in New Haven, time in New Haven feels transitory, and the slight instability makes it hard to get down to the business of slowness. Instead of taking the time for what it is, it feels like filler until the next movement, when what I really do want is just to stay.
It's both helpful and frustrating to think of goals that stretch past these bumps in place. On the one hand, I find it really hard to work on things I know will have to be paused. On other hand, it's nice to have things to come back to, after an endeavor or a return home. Everything I want to do is a long-term pursuit, the pile of books to read and topics to read about, the work to run better after a setback from which I haven't recovered, maintaining friendships in the midst of a lot of transitions for all of us, being with him and exploring the newness of me and of my surroundings that he makes me feel, the list of stories I feel compelled to narrate. I want to give each of these things room, and it's hard when I keep moving around, but I'm trying not to so strongly associate internal and external spaces, to remember that what's best about these things and why I value them is their mobility.
Tuesday, November 30, 2010
Tuesday, November 23, 2010
rearrangement
[October 20 & 26]
In the same way they teach us how to derive a differential diagnosis from a history and physical, they teach us how to interact with patients, in patterns and algorithms. I have a lot of respect for the critical thought that the development of these structures entail, and a lot of admiration for the beauty of the forms they produce. But they would feel a little suffocating, get a little boring, if not for the fact that they’re applied to people who aren’t static, who move, who each move with different fluidity even if in the same space as everyone else, and so who make you move too. In a place in the country that feels like another country, you instinctively let go of some of your ground, and become more open to continual rearrangement.
And even without the backdrop of an entirely different culture, there are characteristics that inherently place distance between people. There is a lot of stretching to be done, to talk to people at different poles of age and experience and expressiveness.
I spent one morning at the teen clinic at Chinle High School, where teenagers can make their own appointments and see primary care doctors during the school day. There is a security guard both at the parking lot and within the entrance of the school. Not unusually, they mistook me for a high school student. Despite looking so much like a sixteen year old, the clinic made clear how far from those years I am, how much intangible can happen in ten years’ time. I spent most of my time talking to the patients about sex, depression, and sports—many of them came for physical exams required to play sports; these were often the same patients with whom I ended up talking about sex and depression.
For me, it’s hard to assess what teenagers absorb from their surroundings, because I think their capacity to feel progresses more quickly than their capacity to express, or maybe their desire to express. They’re so different from people just a few years younger or older, making this period of time feel rare and fragile. The subtle changes we all experience from moment to moment are more pronounced in them, but with perhaps less self-awareness. All of this can be frustrating if you try to tackle things too quickly, and so they almost therapeutically push you to take time and care to read them. And if they open just a fraction, they can be in different phases of so many processes at once, many that lack obvious linearity. If you want to do anything with that, you have to be okay working in rough pieces without knowing their sources or trajectories, not immediately and often not in the near or distant future either.
It’s a challenge for me to speak to the quiet girl with skinny jeans, converse sneakers, black glasses and thick black eyeliner, and a short boycut with all the hairs angled to the left of her face, making her face look strikingly straight in comparison. She is one of the students who’s here for a sports physical; she’s playing softball in the spring. She pauses before answering any question, then answers with as few words and movement of her face as possible. The stillness isn’t effortful; it’s without thought, as though the moment her eyes and lips move out of place they naturally fall back to their original state of clear and mute.
All adolescents are asked to fill out a screening form before their visit, which asks them about school, diet, exercise, sexuality, mood, home life, and so on. On her screening form, the girl indicates that she has felt down for more than two weeks and has once thought about killing herself. Talking to her more, she has almost all the symptoms of major depression: decreased appetite, poor concentration, interest in activities she’d enjoyed before, bad sleep, and of course depressed mood. Her mother moved to New Mexico five months earlier, and she misses her a lot. She isn’t at all interested in talking to anyone about these things.
The screening form also asks if the patient has any questions about any of the following: diet, exercise, sexuality, school, relationships. She had circled exercise, and when I asked her what her questions were, she said that I’d already answered all of her questions during the visit. I asked her what kind of questions she had that I’d answered. She responded, “Oh about being bisexual.”
It took me a moment to go with that. I’m already too far removed from high school to understand how teenagers process their environment and relay what’s internal. And I think sometimes we try too hard to really understand; I respect the effort, but I think the subsequent discouragement that comes with failure can be harmful. We get tired and closed. Maybe we can just accept that we don’t know how a person gets from one place to another; maybe we’re closed off from that hallway, but once they’ve gotten to a place we can try to enter that.
So even though I wasn’t sure how we got to this point in the conversation, I took this comment as a gift from the guarded 14 year old. She then looked at me straight in the face, with eyes finally visible behind her glasses and hair even though neither had shifted position, and asked with such earnestness that the numbness of all her past sentences struck me: Is it okay to be bisexual?
I’m not at all equipped to answer this with the sensitivity and exactness that a fragile person deserves; I’ve never been asked that before. All I can do is hope to reciprocate her earnestness. She talks about having told a friend, who then told everyone, who then treated her badly. They tell her to go back from where she came from, and as she describes this, she looks genuinely confused; strange how her strongest expression of emotion is one of not knowing how to feel.
The doctor knocks on our door to retrieve us so that we can complete the visit together. I welcome this reminder that I’m a student, that learning is an explicit part of my role, but I wonder what to do with what I’ve learned. At first the girl doesn’t want me to tell the doctor about anything we talked about. When I talk to her privately about the reasons for speaking to her primary doctor about our conversation, she nods. When we are all in the room together, I tell her that I’m going to tell the doctor a little about what we talked about, that I know it’s personal, and that if she wants to tell the doctor herself that would be all right too; again she nods.
The girl refuses any sort of resource offered, and it’s hard to see her go without much more than she came with, and knowing I won’t see her again. It’s really hard. The doctor feels it too, but she makes the point that now it’s known somewhere whereas before it was only in the girl, and she knows she can come back. It’s one step; it’s a different place, even if a lot of doors are still closed to us.
The transition between places can be jarring even when elicited and anticipated. It can feel sudden when traveled gradually by this quiet teenage girl, or when it pours forth from the outgoing middle-aged woman whose slight change in the folds of her face make me lean forward and ask, precipitating a complete reworking of her face. This woman with strong features and build, a carpenter who can’t imagine not working with her hands, who has gone through rehab for alcohol use, who had her first cigarette in a long time yesterday because that was “just how I was feeling,” who comes to us with questions about a colonscopy that a woman at forty years old does not need, begins to cry. This time again I’m unsure how we arrived here; this time not because the concrete steps were unlinked, but because she moves so steadily on a new path that I lose track of the steps that initially brought her there, and again it seems more important to just continue.
She talks about how she has just moved here last night from her hometown of Ganado, how she doesn’t know if she can go back; she wants to go back but things won’t be the same; she needs work but she can’t go back to pick up her tools; it is hard to find work in a new place; her partner is a woman who abuses her verbally and physically; her family tells her to leave her; she thought she’d been strong; she hasn’t talked to anyone. We spoke for some time. When the doctor saw her a little while later, he provides her with some resources that she seems interested in pursuing and schedules her for a follow-up appointment, a streamlined process that seems a blur compared to what came before.
Watching her leave with an effortful smile and half of the demeanor she’d carried into the room, I’m reminded of something a resident told me on my psychiatry rotation. He’d said that after you’ve helped a person break down part of their exterior to expose other coves, and have dwelled there for awhile, you need to help build them back up before you leave them. With this woman I felt she left more exposed, without much protection for open patches, and so I feel that it’s not just closed spaces that are tenuous. These interactions can be difficult, and so when there’s movement there’s fulfillment, but no guarantee of safety. But to be so lucky as to be given a choice, it seems to me worth the risk.
In the same way they teach us how to derive a differential diagnosis from a history and physical, they teach us how to interact with patients, in patterns and algorithms. I have a lot of respect for the critical thought that the development of these structures entail, and a lot of admiration for the beauty of the forms they produce. But they would feel a little suffocating, get a little boring, if not for the fact that they’re applied to people who aren’t static, who move, who each move with different fluidity even if in the same space as everyone else, and so who make you move too. In a place in the country that feels like another country, you instinctively let go of some of your ground, and become more open to continual rearrangement.
And even without the backdrop of an entirely different culture, there are characteristics that inherently place distance between people. There is a lot of stretching to be done, to talk to people at different poles of age and experience and expressiveness.
I spent one morning at the teen clinic at Chinle High School, where teenagers can make their own appointments and see primary care doctors during the school day. There is a security guard both at the parking lot and within the entrance of the school. Not unusually, they mistook me for a high school student. Despite looking so much like a sixteen year old, the clinic made clear how far from those years I am, how much intangible can happen in ten years’ time. I spent most of my time talking to the patients about sex, depression, and sports—many of them came for physical exams required to play sports; these were often the same patients with whom I ended up talking about sex and depression.
For me, it’s hard to assess what teenagers absorb from their surroundings, because I think their capacity to feel progresses more quickly than their capacity to express, or maybe their desire to express. They’re so different from people just a few years younger or older, making this period of time feel rare and fragile. The subtle changes we all experience from moment to moment are more pronounced in them, but with perhaps less self-awareness. All of this can be frustrating if you try to tackle things too quickly, and so they almost therapeutically push you to take time and care to read them. And if they open just a fraction, they can be in different phases of so many processes at once, many that lack obvious linearity. If you want to do anything with that, you have to be okay working in rough pieces without knowing their sources or trajectories, not immediately and often not in the near or distant future either.
It’s a challenge for me to speak to the quiet girl with skinny jeans, converse sneakers, black glasses and thick black eyeliner, and a short boycut with all the hairs angled to the left of her face, making her face look strikingly straight in comparison. She is one of the students who’s here for a sports physical; she’s playing softball in the spring. She pauses before answering any question, then answers with as few words and movement of her face as possible. The stillness isn’t effortful; it’s without thought, as though the moment her eyes and lips move out of place they naturally fall back to their original state of clear and mute.
All adolescents are asked to fill out a screening form before their visit, which asks them about school, diet, exercise, sexuality, mood, home life, and so on. On her screening form, the girl indicates that she has felt down for more than two weeks and has once thought about killing herself. Talking to her more, she has almost all the symptoms of major depression: decreased appetite, poor concentration, interest in activities she’d enjoyed before, bad sleep, and of course depressed mood. Her mother moved to New Mexico five months earlier, and she misses her a lot. She isn’t at all interested in talking to anyone about these things.
The screening form also asks if the patient has any questions about any of the following: diet, exercise, sexuality, school, relationships. She had circled exercise, and when I asked her what her questions were, she said that I’d already answered all of her questions during the visit. I asked her what kind of questions she had that I’d answered. She responded, “Oh about being bisexual.”
It took me a moment to go with that. I’m already too far removed from high school to understand how teenagers process their environment and relay what’s internal. And I think sometimes we try too hard to really understand; I respect the effort, but I think the subsequent discouragement that comes with failure can be harmful. We get tired and closed. Maybe we can just accept that we don’t know how a person gets from one place to another; maybe we’re closed off from that hallway, but once they’ve gotten to a place we can try to enter that.
So even though I wasn’t sure how we got to this point in the conversation, I took this comment as a gift from the guarded 14 year old. She then looked at me straight in the face, with eyes finally visible behind her glasses and hair even though neither had shifted position, and asked with such earnestness that the numbness of all her past sentences struck me: Is it okay to be bisexual?
I’m not at all equipped to answer this with the sensitivity and exactness that a fragile person deserves; I’ve never been asked that before. All I can do is hope to reciprocate her earnestness. She talks about having told a friend, who then told everyone, who then treated her badly. They tell her to go back from where she came from, and as she describes this, she looks genuinely confused; strange how her strongest expression of emotion is one of not knowing how to feel.
The doctor knocks on our door to retrieve us so that we can complete the visit together. I welcome this reminder that I’m a student, that learning is an explicit part of my role, but I wonder what to do with what I’ve learned. At first the girl doesn’t want me to tell the doctor about anything we talked about. When I talk to her privately about the reasons for speaking to her primary doctor about our conversation, she nods. When we are all in the room together, I tell her that I’m going to tell the doctor a little about what we talked about, that I know it’s personal, and that if she wants to tell the doctor herself that would be all right too; again she nods.
The girl refuses any sort of resource offered, and it’s hard to see her go without much more than she came with, and knowing I won’t see her again. It’s really hard. The doctor feels it too, but she makes the point that now it’s known somewhere whereas before it was only in the girl, and she knows she can come back. It’s one step; it’s a different place, even if a lot of doors are still closed to us.
The transition between places can be jarring even when elicited and anticipated. It can feel sudden when traveled gradually by this quiet teenage girl, or when it pours forth from the outgoing middle-aged woman whose slight change in the folds of her face make me lean forward and ask, precipitating a complete reworking of her face. This woman with strong features and build, a carpenter who can’t imagine not working with her hands, who has gone through rehab for alcohol use, who had her first cigarette in a long time yesterday because that was “just how I was feeling,” who comes to us with questions about a colonscopy that a woman at forty years old does not need, begins to cry. This time again I’m unsure how we arrived here; this time not because the concrete steps were unlinked, but because she moves so steadily on a new path that I lose track of the steps that initially brought her there, and again it seems more important to just continue.
She talks about how she has just moved here last night from her hometown of Ganado, how she doesn’t know if she can go back; she wants to go back but things won’t be the same; she needs work but she can’t go back to pick up her tools; it is hard to find work in a new place; her partner is a woman who abuses her verbally and physically; her family tells her to leave her; she thought she’d been strong; she hasn’t talked to anyone. We spoke for some time. When the doctor saw her a little while later, he provides her with some resources that she seems interested in pursuing and schedules her for a follow-up appointment, a streamlined process that seems a blur compared to what came before.
Watching her leave with an effortful smile and half of the demeanor she’d carried into the room, I’m reminded of something a resident told me on my psychiatry rotation. He’d said that after you’ve helped a person break down part of their exterior to expose other coves, and have dwelled there for awhile, you need to help build them back up before you leave them. With this woman I felt she left more exposed, without much protection for open patches, and so I feel that it’s not just closed spaces that are tenuous. These interactions can be difficult, and so when there’s movement there’s fulfillment, but no guarantee of safety. But to be so lucky as to be given a choice, it seems to me worth the risk.
Monday, November 22, 2010
first day meeting open space
Have finished my primary care rotation in Chinle Arizona on the Navajo Indian reservation, and am slowly backtracking in writing about the experiences. It will probably take awhile, but here are some thoughts of the first day.
*
[October 19]
I approached Chinle Hospital in the dark, turning left onto the first paved road after a long stretch of lightless highway. The past hour and half encompassed nothing behind or ahead, focusing on the few feet of sight afforded by my headlights and hoping hard that my car wouldn’t break down or run into livestock. I’m relieved to see a sign, and a building in the distance; my fingernails released slightly their hold on my steering wheel. The directions written by one of the physicians noted that we would pass over three cattle grates on the road to the hospital. I didn’t know what these were, but I soon learn that when the sounds of the ground and feel of my seat beneath the car’s wheels changed, that meant I’m going over said cattle grates. This is how I came to know Chinle, in pieces of sensations. In the dark, the expanse is immeasurable; the next morning, the immeasurement is visible.
When parking my car facing the hospital, the sky stretches behind. Every morning the clouds are a different kind of spectacular, still and nonchalant. When I ask employees who had grown up there where they were from, they point to specks in the landscape: that peak next to the dipping crests, this bend in the road. On runs and drives along the two roads that take me from my housing to the hospital and back, looking at what’s straight ahead is like looking down from above; this and the sharp cold reminds me of the 5000 feet elevation. On one day, a cluster of green trees on the side of the road are burning in transitional sunlight, between the day’s rawness and the modesty of dusk. The space above the grove is encased in thick creamy gray cloud, such that you have to face the other side of the road to find the source of the yellow cloaking the trees.
Against the open space, I slip into the interior of the hospital a little off balance. There I am surprised to find that at first the inside here is not so different from the inside back elsewhere. There are aisles of patient rooms equipped with computers, otoscopes and ophthalmolscopes, and hand sanitizer. I recognize these sights, but I’m newly aware of the air surrounding them. The first day of clinic is muffled, faintly familiar with a lot I couldn’t quite understand. The medical problems are not dissimilar from what I have seen: diabetes, hypertension, hypothyroidism, back pain, joint aches; nor were the services rendered: routine physicals, medication changes, laboratory tests. Despite the intimacy of our relation to our blood and hormones, it is normal to disengage them from ourselves to form concepts of illness. Reading the medical chart before entering the patient room, I feel no hitch in turning the wheels of listing these problems and considering treatment of them. But once inside, I’m struck in that compact space, as I was in the emptiness of Arizona desert, by a depth made foreign not only by its thickness but also by the texture of it layers.
Meeting a homogeneous patient population connected by their residence on the 26,000 square mile Navajo reservation, where the distances between homes are far in miles and close in experience, I’m worried that it is at first too easy to perceive things in broad strokes. I’m surprised to find that the backdrop doesn’t blur individual outlines; instead it places details in relief, some of which do converge into a large perception.
The town of Chinle holds a little under 5000 people; this had seemed small when I read it on paper, but encountering a dozen patients in a day feels the same here as it does in a city of 500,000. The patients I see on the first day of clinic make me wonder at how many people exist, how much experience lies in what’s considered a gap in life when driving across country.
On the first day there are several people who individually move me, and as a group make me question our separation of illness and person. Not separation in the sense that we forget there is a person experiencing the illness; we know this happens often and the danger of this kind of thinking is familiar to us. Separation in the sense that illness happens to a person by outside forces, and thus can then be taken away by outside forces. The people I meet today attribute so much of what they feel physically and emotionally to themselves, and this philosophy and practice of internalization is new to me, as someone who learned about disease first as subjects in school, then as objects people have the way they might own a winter coat, something not readily shed but is in principle detachable.
There is a 13 year old girl with very long, straight hair obscuring her pretty features, with glasses and crooked teeth still too large for a mouth still adjusting to the shape of her face. The oldest of six children, she is unsure of how she should stand. She’s tall, but skinny too such that she easily folds herself over at the waist and looks small. She’s here for her annual physical exam, and tells us that she often contemplates suicide. She admits to cutting her wrists, a process I hear a relative lot about over the rest of my time here. It’s hard for her to express why, her feelings spanning a spectrum broader than her vocabulary. On the teenage questionnaire that asks if you could change one thing about your life and yourself, she responds that she would choose to “be brave and emotionless.”
There is a middle-aged man who is here for management of his chronic lower back pain. He wears glasses too, but they don’t overwhelm his face the way the teenager’s did. He yells at himself when the pain is too much to take, because he knows he’s to blame for the source of it. Years ago, he fell off a ladder while intoxicated, and the impact to his back has continually flared since then. He yells at himself outside, away from his children, and defers from repeating his words here in the office. He doesn’t want counseling; he has had it in the past and does not think he is in a place where counseling is necessary. He is reluctant to pursue surgery for his back, because he won’t be able to take care of his children, and his wife who left him a year ago will then take them from him.
There is another middle-aged man with a cowboy hat, checkered blue shirt, and heavy brown boots, compliant with his medications and without any complaint other than fatigue after a bout of cryptogenic organizing pneumonia on top of severe heart failure. He says that a native medicine healer told him that this was due to his practice of killing and burning snakes during his childhood. The defiled spirit of the snakes has encroached upon his own, causing him physical illness. When asked why he killed and burned snakes, he replies that he was scared of them. He says that the healer believes this is also the reason why his face has been more swollen recently. It’s hard to be Navajo, he says to me. He says it not for his sake but for mine.
Each person responds differently to their respective self-blame: the girl tells herself cutting is stupid, the first man resorts to alcohol to soothe the injury first induced by alcohol, the second man participates in a ceremony to remove from himself the spirits of snakes killed. Successfully or not, they carry and shift and distribute the weight of whatever is disturbing them, in a way that I haven’t recognized before. I’m not sure how this new awareness, still a vague theory without real understanding, will help in handling the weight. But learning to be open to its presence and to the process of building a sense of its character made for a fitting first day.
*
[October 19]
I approached Chinle Hospital in the dark, turning left onto the first paved road after a long stretch of lightless highway. The past hour and half encompassed nothing behind or ahead, focusing on the few feet of sight afforded by my headlights and hoping hard that my car wouldn’t break down or run into livestock. I’m relieved to see a sign, and a building in the distance; my fingernails released slightly their hold on my steering wheel. The directions written by one of the physicians noted that we would pass over three cattle grates on the road to the hospital. I didn’t know what these were, but I soon learn that when the sounds of the ground and feel of my seat beneath the car’s wheels changed, that meant I’m going over said cattle grates. This is how I came to know Chinle, in pieces of sensations. In the dark, the expanse is immeasurable; the next morning, the immeasurement is visible.
When parking my car facing the hospital, the sky stretches behind. Every morning the clouds are a different kind of spectacular, still and nonchalant. When I ask employees who had grown up there where they were from, they point to specks in the landscape: that peak next to the dipping crests, this bend in the road. On runs and drives along the two roads that take me from my housing to the hospital and back, looking at what’s straight ahead is like looking down from above; this and the sharp cold reminds me of the 5000 feet elevation. On one day, a cluster of green trees on the side of the road are burning in transitional sunlight, between the day’s rawness and the modesty of dusk. The space above the grove is encased in thick creamy gray cloud, such that you have to face the other side of the road to find the source of the yellow cloaking the trees.
Against the open space, I slip into the interior of the hospital a little off balance. There I am surprised to find that at first the inside here is not so different from the inside back elsewhere. There are aisles of patient rooms equipped with computers, otoscopes and ophthalmolscopes, and hand sanitizer. I recognize these sights, but I’m newly aware of the air surrounding them. The first day of clinic is muffled, faintly familiar with a lot I couldn’t quite understand. The medical problems are not dissimilar from what I have seen: diabetes, hypertension, hypothyroidism, back pain, joint aches; nor were the services rendered: routine physicals, medication changes, laboratory tests. Despite the intimacy of our relation to our blood and hormones, it is normal to disengage them from ourselves to form concepts of illness. Reading the medical chart before entering the patient room, I feel no hitch in turning the wheels of listing these problems and considering treatment of them. But once inside, I’m struck in that compact space, as I was in the emptiness of Arizona desert, by a depth made foreign not only by its thickness but also by the texture of it layers.
Meeting a homogeneous patient population connected by their residence on the 26,000 square mile Navajo reservation, where the distances between homes are far in miles and close in experience, I’m worried that it is at first too easy to perceive things in broad strokes. I’m surprised to find that the backdrop doesn’t blur individual outlines; instead it places details in relief, some of which do converge into a large perception.
The town of Chinle holds a little under 5000 people; this had seemed small when I read it on paper, but encountering a dozen patients in a day feels the same here as it does in a city of 500,000. The patients I see on the first day of clinic make me wonder at how many people exist, how much experience lies in what’s considered a gap in life when driving across country.
On the first day there are several people who individually move me, and as a group make me question our separation of illness and person. Not separation in the sense that we forget there is a person experiencing the illness; we know this happens often and the danger of this kind of thinking is familiar to us. Separation in the sense that illness happens to a person by outside forces, and thus can then be taken away by outside forces. The people I meet today attribute so much of what they feel physically and emotionally to themselves, and this philosophy and practice of internalization is new to me, as someone who learned about disease first as subjects in school, then as objects people have the way they might own a winter coat, something not readily shed but is in principle detachable.
There is a 13 year old girl with very long, straight hair obscuring her pretty features, with glasses and crooked teeth still too large for a mouth still adjusting to the shape of her face. The oldest of six children, she is unsure of how she should stand. She’s tall, but skinny too such that she easily folds herself over at the waist and looks small. She’s here for her annual physical exam, and tells us that she often contemplates suicide. She admits to cutting her wrists, a process I hear a relative lot about over the rest of my time here. It’s hard for her to express why, her feelings spanning a spectrum broader than her vocabulary. On the teenage questionnaire that asks if you could change one thing about your life and yourself, she responds that she would choose to “be brave and emotionless.”
There is a middle-aged man who is here for management of his chronic lower back pain. He wears glasses too, but they don’t overwhelm his face the way the teenager’s did. He yells at himself when the pain is too much to take, because he knows he’s to blame for the source of it. Years ago, he fell off a ladder while intoxicated, and the impact to his back has continually flared since then. He yells at himself outside, away from his children, and defers from repeating his words here in the office. He doesn’t want counseling; he has had it in the past and does not think he is in a place where counseling is necessary. He is reluctant to pursue surgery for his back, because he won’t be able to take care of his children, and his wife who left him a year ago will then take them from him.
There is another middle-aged man with a cowboy hat, checkered blue shirt, and heavy brown boots, compliant with his medications and without any complaint other than fatigue after a bout of cryptogenic organizing pneumonia on top of severe heart failure. He says that a native medicine healer told him that this was due to his practice of killing and burning snakes during his childhood. The defiled spirit of the snakes has encroached upon his own, causing him physical illness. When asked why he killed and burned snakes, he replies that he was scared of them. He says that the healer believes this is also the reason why his face has been more swollen recently. It’s hard to be Navajo, he says to me. He says it not for his sake but for mine.
Each person responds differently to their respective self-blame: the girl tells herself cutting is stupid, the first man resorts to alcohol to soothe the injury first induced by alcohol, the second man participates in a ceremony to remove from himself the spirits of snakes killed. Successfully or not, they carry and shift and distribute the weight of whatever is disturbing them, in a way that I haven’t recognized before. I’m not sure how this new awareness, still a vague theory without real understanding, will help in handling the weight. But learning to be open to its presence and to the process of building a sense of its character made for a fitting first day.
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