Learning to ride, falling down, getting back on
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It was a perfect day, the sky clear, as blue and true as a pledge of love. On the campus, the magnolias were in bloom, the huge, creamy-white flowers richly fragrant. Spring was everywhere, shamelessly beautiful, wet lips laughing, hair unpinned.
I wanted it, like all perfect days, to last, though I knew it would last only in memory. There it might endure, as a celebration and a passage, a graduation day. For Norma, it meant she was now a doctor — in the eyes of the world, if not yet in her own. For us, it meant we had survived the rigors that medical school imposes on a marriage; we, too, had passed a test.
I wanted the day to last, as I wanted us to last: our pleasures; our worries; who we were now, never to be again, shaped by this moment, this unforgettable moment, which of course we’ll one day forget. I wanted to remember how rich these years have been, and how arid; the nights she wasn’t home; the bright moonlight on the empty bed. I wanted to remember this chapter in our lives we loved and hated, while we could still see it clearly, like the lines in each other’s faces.
I hadn’t wanted Norma to go to medical school. I argued fervently against the medical establishment; against science, great voodoo religion of the West; against the misplaced notion that people are like machines, reducible to their parts, instead of whole, flesh and soul, whose healing comes from within.
But the real reason I didn’t want her to go is that I didn’t want her to go. Away. From me. I didn’t want medical school to be more important to her than I was, more important than my irreducible soul. I wanted a wife I could turn to. I wanted shelter from the dark skies of worry and the days when everything went wrong. I didn’t want her to study all night. I wanted her beside me, where I could study her. I wanted to ask my question, and hear her breathless answer, and ask it a little differently, and hear her answer again. I wanted a shared life, not separate rooms in the house of ambition. I wanted her to believe not in a career but in our enduring bond. I wanted her to be my refuge. I wanted to be her comfort.
Oh fear, blowing a kiss and calling it love.
I looked to Norma as a sky of endless promise, the way a prisoner gazes yearningly from the window in his cell. Was it Norma I wanted, or freedom from my loneliness? Was it medical school I feared, or my own unruly self?
I needed to separate my love for Norma from my need for her. This was my challenge, as four years of medical school was hers.
Her first two years were spent in classrooms and in labs — and in front of textbooks each night. Histology. Physiology. Pharmacology. Embryology. The names meant little to me, like towns you pass from a train, stations that sit in the dark of the mind, foreign and strange. Norma would tell me stories about these places, in words she knew I could understand, in words even a ten-year-old could understand. Yet I rarely responded in the way she wished — with excitement, or an invitation to tell me more. I wanted to care about the intricacies of cells, the mysteries of tissue and organ and bone, but what I really cared about was when she would be done studying. Or whether she’d be home in time for dinner. Or how she could get that smell, that terrible smell of formaldehyde, out of her hair.
First-year students are given a human cadaver to dissect, the cold, gray body preserved in formaldehyde to keep it from rotting. For eight months, with scalpel and scissors and sometimes with just her hands, Norma laid back the veins, the arteries, the muscle, the fat, feeling into the inward parts, the secret rooms that once pulsed with a ruby glow, the darknesses within darkness now revealed to curious eyes. For eight months, she labored in that not-so-final, not-so-resting place for souls who lingered ghostly — who can doubt it? — while their bodies were treated thus. For eight months, in that drab, gray room that reeked of formaldehyde and death and nervous sweat, she labored in the heat and the stink, cutting and memorizing, cutting and cutting at the tough, cord-like muscles, at the bony skull that had to be sectioned with a hacksaw so she could get to the brain, cutting through the haze of death and mystery and ignorance, and through the haze of formaldehyde that clung to everything, the cold steel tables and the cold, gray bodies, and to her, no matter how much she scrubbed. So that at night, faint but unmistakable, that ghastly smell lingered. For eight months. In my lovely wife’s long, dark hair.
What bothered Norma most of all, she told me one night, was dissecting the hands. They seemed to her the most intimate part of the man, so that in touching his hands, she was touching what he had touched, was touching him, his life suddenly real to her, his body seen for what it was: spirit’s signature in flesh.
As she told me this, she held my hand, her touch astonishingly tender. She held me the way you wish you’d held someone when you still had the chance, held the woman or the man, the father or the mother, the daughter or the son, held them in awe, held them for a luminous moment in which grief and joy, death and life, are one. How we long for such a touch. How we ache to be known! Each of us will die, yet this we deny, and thus deny each other. And we do not touch, but play lightly with each other, like the grass that tickles our naked feet; or squeeze each other, meat to meat; or clutch each other, so our longing itself will disguise our need, so the long cry of the body cries out instead, “I love you,” “Kiss me,” “Kiss me again.”
Two years of facts, endless facts: facts about this and facts about that, illuminating parts but not the whole, while patients go on dying, despite the facts, or recover miraculously, despite the facts; facts that show why people suffer, but ignore insufferably who they are — how they live and where they work and why they suffer their broken hearts. Two years of lectures and textbooks and facts, and Norma was ready for the wards.
That’s how they train our doctors. For two years, they fill their heads with scientific knowledge that seems to explain so much. Then they send them out, with their white coats, with their knowledge. They send them into the dizzying complexity of a modern hospital, into the wards, to see real people, not textbook cases: the man clutching his chest, crying without shame and without hope; the woman moaning through early labor; the child lying listlessly in her bed, whose sheets are too tidy, too neatly tucked in, not a child’s bed at all but a bed a child will die in. Here, amidst the corridors that seem to stretch endlessly; here, where you can get lost looking for a room, or an answer; here, the curriculum changes.
In her white coat and her stethoscope, Norma was virtually indistinguishable from the rest of the staff — the interns and residents and attending physicians. Every few months, she rotated through a different service — surgery, internal medicine, obstetrics and gynecology, psychiatry, family practice — each a separate world, with its own rules and customs, passions and politics.
There was the surgeon from Texas, who insisted that country-and-western music be piped into the operating room. There were doctors who treated diseases rather than people; those who put money first; those who made mistakes and tried to hide them. And doctors who were sincere and caring, who still believed in talking with patients and in small, redeeming acts of mercy. The best of them knew that no matter how strong the medicine, healing is always affected by more than the intended cure: that we are affected by everything — what we eat, the weather, our dreams, our relationships, our faith or lack of it. These doctors knew how to listen to their patients, and to their own hearts. They honored the shimmering mystery we are — even as pain knots our insides, and our life leaks away. One doctor, asked by a student how he kept from being overwhelmed by all the suffering, answered: have you ever been in a great cathedral? Yes, the student said. What did it feel like? The student remembered the awe, the reverence, the sense of being in the presence of something greater than herself. The doctor nodded.
But such an attitude was rare. The real reverence seemed to be reserved for machines — for the CAT scanners and computers and diagnostic devices that have so transformed medicine and increasingly taken the place of a physician’s intuition and common sense. How impressive these machines; they do, after all, save lives. But in the service of a growing medical technology, how much of our lives is denied? What about the personal and social ills that don’t fit into the diagnostic categories? What about the radically different ways of understanding and healing ourselves, which the technicians reject? Prayer. Meditation. Herbs. Acupuncture. Diet. Yoga. Tai Chi. Massage. The data isn’t in, they say, or the data is meaningless. Yet the data is in on conventional medicine, and it’s hardly reassuring. How much they don’t know, these doctors rushing down the hall with their white coats and their stethoscopes and their clipboards and their harried commands. They’re on their way to a “code,” rushing down the corridor to save someone’s life. They’re good at this — at descending like a flock of snow-white birds on a tired old man whose heart has given out, at shocking the old heart back to life. Maybe tomorrow they’ll give him a new heart or new kidneys or a new liver. It’s become easier to replace broken parts than to explain why they’re broken; easier to condemn unorthodox remedies than to acknowledge medicine’s failure to deal with cancer or Alzheimer’s or multiple sclerosis or rheumatoid arthritis or stroke or AIDS.
Even when the doctors don’t have a clue what to do, when they’re lost in a diagnosis like children in a driving rain, lost and desolate and confused, they still do something. More tests are ordered; another operation is scheduled; one more piece of expensive equipment is wheeled in. In the face of human suffering — and in the face of their own ignorance — the hardest thing for doctors to do is nothing. That’s one reason hospitals are such busy places, such busy and expensive places. That’s one reason a medical education is so grueling, demanding of third- and fourth-year students sixty, seventy, eighty hours a week.
It’s an initiation of the crudest kind, like boot camp, or hazing: the broken sleep; the exhaustion; the worry about doing something wrong. Their lives slip away from them, like the words of a half-forgotten song. Working all day, then all night, they drift through the corridors of sleeplessness, on call for thirty-six hours at a time, wanting nothing more than to lie down in a cool, dark place and sleep, or weep. They become doctors by learning to deny themselves: their sleepiness; the slow length of their feelings; their quiet, dreamy knowing; the secret knowledge inside. The corridors lead them into the sunken kingdom of certainty, of technological wizardry, of drugs that plunge the body into war with itself, pounding it into a stupor with chemical fists. Yet all the while, they ignore what health really is, ignore the body’s rich inner life, its subtle energies, its mysterious strength.
Norma didn’t want to be that kind of doctor — perhaps none of them did — and succeeded in keeping intact her values, her suspicion of medical orthodoxy, even her health.
Certainly, she didn’t ignore her body. Trained as a dancer, she still moved the way dancers do, with a lightness that rose from her like mist. Whenever she had time, she exercised; she ran; she ate well-balanced meals. For years she’d taught natural foods cooking. To her, health wasn’t just the absence of disease, but a measure of our wholeness: mind and body; dark clouds and green fields. Intuitively faithful to nature’s cycles, Norma was happiest when outdoors — walking in the woods or gardening. Regrettably, being a student didn’t leave much time for this.
Nearly thirty when she entered medical school — a mother, in her second marriage — she was older than many of her classmates, and even some of her teachers. This gave her an edge in maturity, but meant she had to endure the startling arrogance of doctors who were younger than she, and who acted it. (One morning, the chief resident was leading rounds, interns and students trailing behind him. All that was on his mind was last night’s basketball game: the first half, the second half, the stunning rebound, the spectacular pass. He couldn’t stop talking to the doctor beside him about the amazing grace and self-assurance of the Carolina players, the way that final shot arched into the air. He kept on talking, even as students described this patient’s progress, that patient’s symptoms, the bland and boring roster of human aches and pains. Unaware, uncaring, the chief resident kept talking. Until Norma exploded, like Carolina in the last seconds of play. Shut up, she snapped, like a mother scolding a child. Students don’t talk that way to chief residents, but the point was hers; he did.)
For the most part, Norma endured silently the bad food, the bad manners, the fluorescent din. She endured the hodgepodge of fact and superstition — her scientific mind thrilled by medicine’s scientific rigor; her common sense agape at everything science omits. She endured the long hours, the lack of sleep, the fading light of the days she never got to see. But worst of all — worse than the seasons that kept changing without her, worse than new life springing up without her — was coming home to the man she loved, to his odd, unfathomable grief.
Norma knew how the past can pull at you, like the moon pulls at your heart. She knew how abandoned I’d felt as a child, how I feared being abandoned again. Knowing this, she still couldn’t fathom my sadness. Fathom the rain, collecting in black puddles at your feet. Fathom the wild lament in a man, the loneliness in his being.
She couldn’t fathom it, nor could she bear being blamed for it. After a day and a night at the hospital, looking at hideously deformed infants, at backs eaten away by bedsores, at every kind of woundedness, my accusing gaze was the last thing she wanted to see. It didn’t make it any easier that she also blamed herself. Part of her wanted to be the dutiful wife, the kind of wife her mother had taught her to be, who would make the rooms of my life a home. The voices of the past, the sighing hearth, called to her, but the future led somewhere else. She knew the road she had to follow; it meant leaving behind the part of her that would have sacrificed herself for my sorrows.
You might think I knew better than to ask. You might think I’d learned not to treat a woman as a sex object, or a love object. Then again, you might think I’d learned nothing — that, in my third marriage, I was as big a fool as when I first tried to kiss a girl and missed, my lips aimed at hers but grazing her nose instead and landing wetly on her cheek. What was it Ray Bradbury said? The first thing you learn in life is you’re a fool; the last thing you learn is you’re the same fool.
I grew up worshiping a jealous god, a tell-me-you-love-me god. A sacrifice is exactly what he wanted. Prepare a place for her, he said, at the towering altar; make her stay with you, until the long night is over. The idea that Norma owed me nothing — that the sweet, secret center of her life was hers alone — was blasphemy to this god, who knew a woman’s place was in the home.
It’s hard to turn your back on a god like this: to walk away without a backward glance at the house fear built. Yet this was my curriculum: to let go of what I imagined was my security; to trust that whether or not Norma was beside me, our bond would endure.
It wasn’t easy. Our heavens and hells, for being self-created, seem no less real. Fear of abandonment is a pale phrase, as gray and lifeless as Norma’s cadaver. But the troubled past isn’t dead; it moves through me like a dark hand. I may forget certain things, or deny them. The textbook phrases that “explain” me may be more familiar than I am to myself. But whether or not I acknowledge it, the past is with me, closer than the closest friend. I am the sum of my experience, a body of experience — some of it joyous, some of it unutterably sad.
Why did I love being alone in the morning, cherishing the solitude and the stillness, and hate being alone at night? Why, when I most needed them, was I reluctant to reach out to friends? Why, when I most needed it, was I unable to comfort myself?
My loneliness was like a letter I carried with me, and glanced at nervously, and folded and unfolded, but never read; a letter I gave instead to every woman who ever loved me, as if this clue to my longing were addressed to her, as if I didn’t recognize, in the rise and fall of the writing, my own boyish hand.
The child in me needed my love as much as I needed Norma’s; needed me to pay attention to him after all these years. It was my presence he wanted, not Norma’s sacrifice; my kindness, not the embers of someone else’s dream. Because Norma was away so much — because I had no choice, really — I started to befriend him. Perhaps the only time we grow is when we have no choice; when Life blows down the door before we can say, “Come in.” If, because of Norma’s absence, I learned to love myself a little more, shall I say I was sorry or grateful, that these years were a burden or a gift?
At the graduation, cameras were everywhere, as proud families tried to capture the fleeting essence of the day. Capped and gowned graduates, doctors now, were being posed by eager parents as though they were still kids. Everyone, it seemed, was being lined up for a photograph or taking one, smiling for the camera or fiddling with the camera. How godlike the camera, which seems to capture and preserve the moment — preserve it for that one day in the future when we want to hold in our hands the past.
I, too, had a camera, yet I doubted I would capture much of anything. Not the fleeting essence, that’s for sure. You take a photograph, imagining you’ve captured the moment; but when you reach for it, it’s not there. There’s just you, reaching. If forgetfulness doesn’t shroud the past, memory does, with its bewitching half-truths. Photographs don’t lie, but we do — about everything that’s left out of the frame.
It’s our nature, which is human. We each have a unique perspective, which is a blessing and a curse. We celebrate our point of view, but our point of view is always partial, the light in us eclipsed by ignorance and fear. What did I know when I tried to argue Norma out of becoming a doctor, or when I said our marriage wouldn’t last? What do I know now, except the importance of forgiveness? For we’re always leaving something out of the frame. As Wendell Berry wrote in a poem to his wife, Tanya, “We hurt, and are hurt, and have each other for healing. It is healing. It is never whole.”
I have a photograph of Norma accepting her diploma. I have another, taken a moment later, of her walking across the stage. I have a picture of her parents, beaming — at this grown woman, a doctor now, their little girl, oldest of eight.
I have another picture, which someone else took. Norma and I are laughing, but I can’t remember why. The moment is gone, like the four years that came before it — the laughter softening, forgiving, the faces in the frame.
Thank you for your honesty and openness. “Graduation,” in Issue 155, really touched me. I was feeling woggly about some symptoms of my aging body, watching the part of me that is frightened of my physical and ego deaths and the part of me that remembers and yearns for a rainbowed state of unity beyond any kind of love.
Probably I opened The Sun to interrupt the internal yo-yo ride, to ground myself. There was the glamorous window seat on the cover, and a promise from Jack Underhill, who is a powerful person himself. I opened to you and Norma laughing at the camera, and thought, “Oh, that’s what he looks like.” Your candor, as always, caught me; your empathy was overwhelming.
My father was a traveling salesman, and no matter how good I was, no matter how hard I tried for perfection, he always left. I savored my self-pity through yours. “Oh, poor Elizabeth. She’s really getting old, and weird things are happening in her body. Since she’s practically given up psychedelics, she doesn’t even have a religion anymore, nothing to hold on to. Everyone’s a vegetarian or something else with an ‘ian’ or an ‘ist’ after it. What’s going to happen to her after she dies — which can’t be very long from now. Other people believe in heaven or reincarnation or karma or for God’s sake something. Only Elizabeth woggles around.”
On top of it all, it was raining too hard to garden. Then I went on the air and did a Sy Safransky–type confession. Nothing’s changed. But the catharsis happened, some mysterious internal alchemy. It felt great to get home and have a bagel.
In your article you wrote that you and Norma are laughing in the photograph, but you can’t remember why. Did it ever occur to you that you might have been laughing because you were happy?
The photograph mentioned above is available as a PDF only. Click here to download.
Thanks for your piece, “Graduation” [Issue 155]. A decade ago, I lived for two years with a woman in her last year of medical school and first year of internship. We were going to be married. We never made it. It’s hard to say who was more absent from our relationship, the doctor on call or the sad, self-medicating manchild waiting for the world to recognize his epic stature, unable to acknowledge a feeling as pedestrian as loneliness. It is easy to say who saw things clearly, though: she left.
Your piece opened a few emotional files, I’ll tell you. One paragraph in particular is masterful: “My loneliness was like a letter I carried with me, and glanced at nervously, and folded and unfolded, but never read; a letter I gave instead to every woman who ever loved me, as if this clue to my longing were addressed to her, as if I didn’t recognize, in the rise and fall of the writing, my own boyish hand.” I’ve copied it out in letters to friends and onto a 3 x 5 card tacked to the corkboard over my desk. Thanks. We boys determined to grow up before we are entirely hoary of mien, whose faith, like it or not, must rest on the sometimes shaky assumption, “Better late than never,” need such focused and shared memories of our sullen shortcomings.
By way of personal introduction: I am a writer and teacher and husband and father of two. These days my work in the trenches is with teens recovering from addiction. My teaching and writing have become more and more centered on the difficult bonds between fathers and sons. I’m groping toward some synthesis of the themes that have emerged in my life, and trust they will be useful to someone else somewhere. At the heart of patriarchy, I believe, is a terrible loss turned to rage, which gives rise to sexual aggression, militarism, and addictive illness.
I found, by the way, much to object to in Jack Underhill’s essay, “On the Defense of Habits” [Issue 155]. You describe it as “provocative.” It provoked me to several questions. Is it possible for someone not recovering from addiction to address the devastating spiritual effects of addiction without sounding sanctimonious, abstracted, aloof, and bubble-blowing? Agh, it made me angry, that’s what it did. “Colds are almost a worse habit than cocaine,” indeed! It is insensitive at best to use the desperate life and death struggle of addicted people as one more bead on the string of a specious argument; at worst, it suggests that if only addicts would learn to accept love, they would be healed, presto, once and for all. On what planet does this miracle take place? I object vehemently, as a recovering addict and as one who works with young addicts, to such it’s-all-in-your-head nonsense. Another version of “Just say no.” I grant Underhill his provocativeness, and he says some interesting things about the dynamics of addiction almost despite himself, but he isn’t talking about alcoholism or addictive illness; he’s talking about habits. By not making the distinction, for whatever reason, he sets up a straw man — actually, a series of them — and proceeds to knock them down easily, glibly.
It occurs to me that the converse of write about what you know is also true. You have to have walked it before you can talk it.
I hadn’t meant to be so splenetic. But amen.
Thanks for The Sun.