communication

In skimming a description of what babies look like if their moms have had alcohol during pregnancy, I came across the word "philtrum." Wikipedia tells me that the philtrum is the vertical groove between the lips and the nose. It "allows humans to express a much larger range of lip motions than would otherwise be possible, which enhances vocal and nonverbal communication." It's derived from a Greek word that means "to love, to kiss."

One thing I liked about anatomy was learning the words for things, even if it doesn't often enhance your understanding of it. It kind of made my day to learn what the philtrum is, partly for that reason and partly because I've been thinking a lot about communication lately, and had already planned to write about it today.

So much that's important to me comes down to communication. The things I've been in immersed in as of late have been crowding my mind, all for reasons relating to this. With patients, learning how to talk to people from different backgrounds and struggling to bring down to earth those loose commonalities of health, respect, empathy. With friends, feeling such love for the big and small offerings of ourselves that we swap. With myself, reminding every day to be honest. With the outside world, fighting against the perception of people as simple to know, the categories, the dismissal of depth.

There is amazing variety in the kind of interaction healthcare providers have with their patients, and from the small bite of exposure we've had thus far, I've been better able to formulate in words what makes for real communication between people. I've always been awful at verbal articulation, but it's even harder than I thought to carry on a conversation that conveys both information and feeling. This morning my preceptor spoke to a mother in Spanish, who responded to a PA in Portugese, who then translated in English. The woman's toddler howled in tears. As students we have the perspective of naive eyes, and with those I wanted to put down what not to forget when our eyes get tired--

*Really wait for the answers when asking questions. Then listen to the answers, and ask follow-up questions. We pay attention to the factual answers about symptoms, but we fill in a lot of the how-are-you's ourselves without waiting for the response. *Speak half as slowly as you think you should, and remember that even in English we need to translate. I have two years of medical education (maybe half a year if you consider how much I retained) over most patients, and I have so much trouble remembering what was said, what people really have and how they got it and how they'll get better. *Acknowledge everyone. I've been grateful for the kindness that comes with a glance my way, sincere greetings, the shifting of objects to accommodate another's path. I think feeling each other's weight makes us more aware of our own, in a way that lets my hermit self retain its shell but also keeps us grounded in something more expansive. *Write legibly. Seriously, what's the point of writing something no one can read? *Move deliberately, not hurriedly. There's some illusion of efficiency dangling before all of us time-crunched busybees, the one that whispers to us to flip pages loudly, plop folders on the counter, walk briskly out rooms without closing doors, to speed-talk, to write illegibly, because it saves seconds, precious seconds. It might, but I've seen the steady hand say more and last longer.

These things can take a lot of effort (at all stages of the game--initially, once you get going, when you near the end). It's nice to come home at the end of the day or escape to during the weekends, to something I'm used to.

I have an amazing wife (my roommate; I can't actually remember how and when we started calling each other wife). She once said if this is really what marriage is like, it might be nice, and I agree. I'm always happy to see her, even if after we retreat to our rooms like the lone ones we sometimes like to be. She makes comfort Chinese food, including the best hot pot I've ever had. She's never once been mean to me, even when I'm neurotic or annoying or irritable. The few times I've gotten upset, she's sensitive, not defensive. She always tells me I look nice, and after a year of living together she's still considerate about washing the dishes. She listens to me struggle through being complicated, and what I see in me as the best and worst, she values. When I break things (often), she fixes them. She glued together one of my tea cups that I shattered. When one of the drawers detached from my desk, leaving a gaping hole, and the center slowly sunk from the weight of my books, she brought home another desk that looked almost exactly the same. When I complained about morning light waking me up and I was too lazy to get a face mask, she got me one. When I tell her an embarrassing story, she tells me one back. I can't describe how it works with a list of what to do and what not to do, but I know that a whole lot flows in the space between us, and each day we're at home I'm thankful for that.

Last weekend my college friend with the same name as wife came to visit New Haven, then I visited her in Cambridge. We don't see or talk to each other very frequently, but we caught up quickly at first and then slowly. She showed me the new stores in Harvard Square that replaced those familiar to me, and I had that sensation of things stretching and rearranging my skin. It didn't hurt like I thought it might. Instead it felt the way it does to see old friends. There's new growth to recognize, and old to unearth. J. has been through a lot and through it, became and remains one of the kindest and most genuine people I know. In reacquainting ourselves with each other's presence, I so admired the capacity to see and emulate good after having experienced not so good, a value I've only been able to articulate over the past few years. She's mindful of what's been given to her; yet she gives not out of obligation to give back but out of her nature. This generosity makes it easy to share, and in traipsing around our respective corners, things were exchanged through the pores and cracks--the confusion of the sliding doors at the subways where there used to be turnstiles, the way sunlight infuses the solid marble of the windowless Beinecke rare books library, the fatigue after walks in summer heat, the browsing for cheap clothes and purchase of matching bright checkered patterns, the fear of dodgy characters in the South End, the drives.

I know these are rare and to be kept close, because every so often I get mad at the tendency of the masses to paint over the cracks, the way I cover the sunken middle of a cake with extra frosting. Of the things that really bother me, among the top is people boxing other people up. I think of character as the full range of what a person can and will do and feel, and I've found that for most, this stretches quite wide. On a bigger scale, I dislike speculation about people from afar, the way classmates and colleagues are branded as such and such, concrete images built from smoke. Brushing aside mass perception--frequently misperception--can be tough in practice; I hate being misunderstood, and I hate that people settle for lesser explanations because the true one is complicated. So it's part personal, and it's part indignation at the substitution of gray for black and white. So I'm still learning to ignore all this, and rely on what I know, and in the end I'm thankful to be pushed to self-reliance.

On a smaller scale, but often a more potentially harmful one, is the boxes we create from actually really knowing someone. I do it too. I appreciate the positive qualities people attribute to me, but those closest to me have learned that nothing is defining, or I still remind them because I know it's hard to let go of what we've built up. Some who saw me as rational and together recognized a bit late how emotional and lost I can get with relationships. I don't blame them; I was stunned by it too at first, but once you step beyond borders, you need to make room. I do fight and I am mean, quite possibly meaner in those arguments than people you naturally assume are confrontational. This applies to more trivial things too, that don't directly bother me but indirectly do by nature of pigeonholing people. I do like some rap music, I've kissed boys recently met (for relativity's sake--two), I've stolen, I'm even more neurotic than you already know, I'm envious of others' talents, I actually do like some sports but have gotten myself stuck long ago in a self-conscious image of conventional girl and never developed the skills to now get over it, yes I do like to keep things but I throw certain things away. I like knowing these for myself because they've helped me give other people leeway, to know them more deeply, or to at least be more open to whatever they offer. This isn't to say that our understandings of each other are flimsy; they're obviously shaped from real things. I'd hope that some baseline qualities remain underneath it all, and I'm guilty of expecting people to know me well enough to predict or assume my actions or feelings, which might seem to go against this idea of malleability. It's more that things can be rearranged, and sometimes they can be torn down; you don't need to assume that they have, but you shouldn't assume they haven't.

I mentioned this to a high school friend, someone I've mentioned in my blog before as the one person in my life who is completely open to who I am, who is never surprised by anything I say or do because to her I'm capable of being anything. She wrote back something that I imagine she typed freely: "i can't even begin to tell you how much i feel i've been pigeonholed about issues and situations, over and over again, like ppl can't accept contradictions and opposites, and such a simple thing as change. their limitations end up limiting me, and i start being convinced of their perceptions, but i'm learning to be strong.. i understand ppl can be jaded. but i'm jaded too. i still think everyone is a mystery. fun mysteries."

The past few years have me seeing those fine rifts between nose and lip, that are attractive in the manner of the hollow that ends the neck, the slight indent that lends delicacy and nuance. I think of those babies whose moms consumed alcohol, whose philtrums are flattened as a result. Knowing what it is to be dulled, I trace these lines again from time to time.