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June 20, 2017

Reading : Books about Refugees

Since my parents and brothers are refugees, I obviously like stories about the refugee experience.  I feel both very connected to it because of my family, and disconnected because I was born in America.  In general I think most people are interested in narratives about movement and change, because we all experience and appreciate displacement to varying degrees. Here are some books I've read this year on this theme.


The Refugees by Viet Thanh Nguyen
This is a collection of short stories that I read after I tried unsuccessfully to finish his other book, The Sympathizer, which won the Pulitzer Prize and got rave reviews.  I stopped after about 100 pages of that one; I just couldn't get into the narration and it was taking me forever to read in ten page intervals.  So I tried The Refugees instead, which is a very quick read.  With stories that feel like vignettes, the book shares how people have experienced Vietnam and the Vietnam War from different perspectives: a family who escaped the communist regime by boat and lost a child to a pirate attack; an American pilot who fought in the war and visits the country after his daughter moves there to teach English; a young man sponsored to live in the United States by an American couple; half-sisters who grow up apart, one in Vietnam and the other in America.

I like how the book speaks very little about the war itself, which can feel distant to both the characters and the readers.  Instead, it describes the subtle ripples of that event on people living at that time and the people who followed. I generally really like story collections that do this, because it connects our day to day with the past, and puts our lives in the context of a spectrum of history (my favorite is Murakami's After the Quake about the earthquake in Kobe in 1995).  I wasn't blown away by the language or storytelling in The Refugees, but I really value the voice and intent.

(Note: I've started The Sympathizer over and trying to finish it this time, because everyone is saying it's one of the best books about the Vietnam War yet.  Sometimes, I feel like this hype is more related to the topic but I'll have more of an opinion when I finish it. If you have curiosity about the subject, I'd start with The Refugees or The Best We Could Do, below).

Exit West by Mohsin Hamid
I've read Moth Smoke (enjoyed) and The Fundamentalist (not as much) by Mohsin Hamid, and had heard great things about Exit West. It's my favorite of the three and would be my first recommendation if you haven't read anything by him before.  It tells the story of a young couple, Saeed and Nadia, living in an unnamed country where a civil war between the government and religious rebels forces people to flee their homes for fear of their safety.  

The dangers and violence are concrete, which contrast with the unreal way Saeed and Nadia escape their country and enter others: through magic doors that transport them to Greece, England, then America.  This seeming ease of migration is undercut by the obstacles of assimilation that Saeed and Nadia face in each place.  As their environment changes, they change as individuals and as a couple.  I love how intimate their story feels, even as they traverse large spans of time and geography:

"Saeed and Nadia knew what the buildup to conflict felt like, and so the feeling that hung over London was not new to them, and they faced it not with bravery, exactly, and not with panic either, not mostly, but instead with a resignation shot through with moments of tension, with tension ebbing and flowing, and when the tension receded there was calm, the calm that is called the calm before the storm, but is in reality the foundation of a human life, waiting there for us between the steps of our march to our mortality, when we are compelled to pause and not act but be."

Hamid is an amazing writer, and this book has the perfect combination of powerful story with powerful words.  He has this unbelievable skill of packing abstractions into sentences that feel close, real, and beautiful even when they are hard because they're so true.  The sentences are long, carrying along until you start to feel breathless too.  I listened to the book on audio, and as some of you know I tend to listen to audiobooks at increased speed.  But the language in Exit West was so loving that I listened to it at normal speed, and I often listened to it without doing anything else at the same time.  Also, Hamid narrates the audiobook and besides having the perfect voice to match the story's depth, it's always an added layer to hear the story told by the source.  If you haven't tried an audiobook before or have had bad experiences with it in the past, this one is rich and beautiful, and it's short so it's easy to get through (though I was sad it was so short).

A Constellation of Vital Phenomena by Anthony Marra
This book takes place in Chechnya, a republic of Russia I knew very little about before reading this. Chechnya fought two wars with Russia in the 90s and early 2000s.  Chechnens suffered awful brutalities that forced hundreds of thousands of them to escape.  There aren't many Chechnens in America, because we resettle very few refugees from that area.  Most of us probably first heard of Chechnya after the Boston Marathon bombings, orchestrated by two Chechen-American brothers, in 2013.  By then, Chechnens had been tortured and killed for decades.

In A Constellation of Vital Phenomena, the story goes back and forth in time and in characters' point of views, but its anchor is set at a hospital run by a surgeon named Sonja.  She's the only doctor for all the patients, who are rebels fighting in the war and refugees trying to escape the war.  A one-woman factory, she cuts off limbs and digs at wounds with rapid precision.  The immediate physicality of her work reminds me of how lucky we are here.  I often complain about how healthcare doesn't prioritize primary care enough, but we're really lucky that our society is structured so that it's even important to advocate for long-term primary care.  That we expect that we'll have time--years--with our patients so that their chronic illnesses matter.  I can't imagine a life where none of that even matters because thousands are dying daily from acute injuries and trauma.

Sonja reluctantly takes in Akhmed (another, much less skilled doctor whose real calling is art) and an eight year old girl named Havaa whose father, Akhmed's friend, has been abducted by the Russian government.  The plot is complicated as Marra introduces the nature of the characters in piecemeal and their connections take time to mainfest: Sonja's sister Natasha who is forced into prostitution and whose disappearance is one of several running mysteries in the book; Ramzan, the informant who is responsible for the capture of Havaa's father; Khassan, Ramzan's father who writes a thousands-page-long history of Chechnya that no one else cares about.  They each live and cope with their inhuman circumstances in ways that are never judged by Marra, only observed and shared.

The Best We Could Do by Thi Bui
I was lucky to receive a signed first-edition copy of this graphic novel, because the author is the sister of one of my co-workers.  This is the first graphic novel I've read (!), and whenever doing something for the first time it helps if there's a sense of familiarity (choosing a book you've already read for your first audiobook, writing your first story about something that happened to you in real life). I didn't get too distracted by the new medium of art in a novel, because it was so easy to personally connect to this book. It's an autobiographical account of the author's family history--her mother's story, her father's story, and how they converge into hers.  It reads the way we wonder: about who our parents were before us, how they brought us here.  In Bui's case, this is forcefully impacted by the Vietnam War and her family's escape from the communist regime.

The book couches the individual stories within the larger context of the Vietnam War in a way that feels like how it might have been lived: with the big explosions of war, and the quiet ones of family struggle.  There are so many details sewn into this story that are concrete parts of my family and my life: the way Bui's parents dealt with her live-in boyfriend situation by pretending it didn't exist (my parents did this for so long I started to think they really didn't know I was living with a boy), how people changed their birthdates at refugee camps to make themselves older or younger (my mom did this too).  As much as I relate on an emotional level to all sorts of books about all sorts of people, there's something extremely powerful about seeing these very specific details of your personal life and cultural background expressed in something published and public.  In my daily work, we're so focused on trying to understand our patients' lives that we forget that it's important for us to feel understood too.  I forget the effect of growing up in a way that can feel foreign to most people I meet.  I usually don't feel the absence of shared experience until I'm surprised by its presence.

I've been especially grateful this year for being able to relate to characters in books and TV (I could go on and on about my love for Aziz Ansari's Master of None, but luckily the internet has amplified this sentiment a hundred times over.  I might still go on and on about it at some point in the future).  Recently, I had a conversation with a friend where we talked about how growing up in a white-centered environment affected us.  I've always felt incredibly lucky to grow up in the Bay Area, which is not only diverse but values diversity.  Still, when I was a kid, I remember consciously wishing I were white because everyone on TV and in books is white and if I wasn't white, how could I be pretty and popular?

So I'm really grateful to Thi Bui to writing this story and making it visual, rendering tangible so many elements of my background that really are often kept in the background.


I'm happy that these books are popular in large part due to their foreignness, that people value and are interested in stories of lives grown elsewhere and among circumstances different from theirs.  At the same time I know that personally we're seeking stitches of ourselves.  For me, I want to stay connected to the things that led me here before I was aware of them.  Seeing how others followed the same trajectory makes it feel less unique in a way that's much more filling than being special.  And learning how the trauma of displacement can persist and resurface makes us remember that place isn't always grounded, that people aren't always whole, and that we need to be there for each other in whatever piece we find each other.

June 15, 2017

World : Environment

Last weekend I went to Yosemite, and being there always makes my heart break a little in a good way. This time, in the midst of withdrawal from the Paris Climate Accord, the heartbreak was more of the conventionally sad kind, thinking of just how much threatens our environment.

I know we've all been thinking lately about what we can do when so much is happening out of our control.  As I struggle with that, I consider what we can do in small ways in our daily lives.  For me that's been the motivating factor for being vegetarian. As most of you know, I stopped eating meat in medical school, last year started to cut down on seafood, and then after the election cut it out altogether.

One part I dislike about being vegetarian is making other people accommodate my choices.  I've never been a picky eater--before vegetarianism, I would literally eat and try anything, and now I sometimes feel guilty for being difficult, especially in meat-heavy cultures and groups.  So if I don't thank you enough for accounting for me, thank you!

The other part I used to dislike was sharing the rationale for my choice.  People ask all the time why I became a vegetarian, and I appreciate the curiosity if it's coming from an open place.  But I don't want to present the choice as something I think everyone should do, or make anyone feel uncomfortable with their preferences.  I really don't care what other people eat.

I also dislike when the question comes from a place of judgment, especially from people whose opinions I value.  I've had good friends and family shake their heads, tell me they could never do it, comment on how hard it must be.  I can feel their sizing me up as typical Bay Area, and while that stereotype is not untrue, it can annoy me in its dismissiveness.  I think in some ways, it's tied to the above--even though I really truly don't judge anyone else's diet, my reasons for vegetarianism can come off as a judgment of non-vegetarians and this creates some defensiveness.

Lately though, in light of how much personal greed is trumping respect for our environment, I feel less uncomfortable and more grateful for voicing the choice to not eat meat and seafood.

My choice started with reading a book called Eating Animals by Jonathan Safran Foer, lent to me by my good friend Caitlin.  It's a well-researched book about animal cruelty in the food industry, and the insane effects of the meat and seafood industries on the environment.  This wasn't new news, but what struck me most was the idea of being mindful about your daily choices.  Eating is a basic thing we do every single day, multiple times a day.  Because of its regularity, we often stop paying attention to it.  But because of its regularity, it's an ideal avenue for remembering values we might otherwise forget.

For me, the value I want to keep close and daily is that there is a world bigger and more important than my needs and pleasures. Honestly, I used to think that the environment was one of those impossible issues because at some point we're inevitably going to destroy it.  While I still believe that to a degree, I've stopped thinking that absolves us from mindfulness in the present.

People often say, what's the point, it doesn't make much difference, it's not like everyone is going to stop eating meat.  It's really not about any of that for me.  It's just nice to do something every day that makes you feel that your tiny slice of life can take into account the world in which it sits.  And that filters into the rest of my life.  Maybe it's what prayer is like for religious people--a way of connecting to a larger force, that removes you from yourself, grounds you into living for others.

People ask all sorts of questions about the difficulties: How do you get your protein? Your B vitamins?  How does it work with your family, partners, friends?  Isn't it hard?

I usually tell people that it's really not that hard, and it really isn't.  But yes, it does cause inconveniences.  And that too is part of it.  The reminder that certain values are worth inconvenience.  That when I'm this lucky to be so comfortable in so many parts of my life, I can deal with some discomfort that reminds me of my privilege and how to use it to stay connected to the many things privilege can obscure.

Another part of vegetarianism that's hard for me is its ties to my culture.  I feel bad that my mom can't nurture me in the way she knows best, by feeding me traditional meals.  I feel bad that other people enjoy signature Vietnamese foods while I choose not to.  I feel bad that other people judge me for sacrificing this part of my roots, considering it a privileged hipster thing to do, and subconsciously see it as selling out to another kind of mainstream culture.

It is a privilege to have this choice, and that's another reminder to me about our agency.  We all encounter different cultures in our lives, and they often conflict.  The most important thing to me about this is to be aware, to question aspects of each culture and know that I have the choice to own what I want and this doesn't make me any less Vietnamese.  (And on the day I'm writing this, I watched the Religion episode in season 2 of Master of None, where Dev questions why he can't adopt some principles of Islam, like kindess to others, while straying from others, like not eating pork.  Really relate, and recommend).

People then ask, well why not just give up everything that causes harm?  Stop driving your affordable Honda and bike everywhere (have you seen me bike? do you want me to die?)?  Become a vegan and join the protesters cheese outside of Cheesboard Pizza (mmmm, yes I can eat an entire one of those to myself)? Where do you draw the line?

It's true that it's hard/impossible to do everything.  The ask that I have of myself is to not let that overwhelm, and to consciously choose what I can and can't do.  And that's why I don't judge what anyone else eats, because I don't think this has to be the one way for everyone to live more mindfully of our environment.  Everyone has their own ways, and I'd like to write more soon about the individual ways I've learned from others.

For now, this is one way I remind myself that we're lucky to be able to choose, and that when a place like this is given to us, we can choose to give back.

June 13, 2017

People: All the People

Birthdays have gotten sweeter as the years pass.  Every year brings a sense of new things experienced, old friendships growing, the context of ourselves deepening.  In a world that glorifies youth, I feel really lucky to find this fullness in getting older.

So much of young life centers on your circle of friends.  Over the years, this circle loosens as people migrate and shift, geographically and personally. I have loved watching my friends grow over the years, and on birthdays it's the best gift to be with and hear from them. There's comfort in the persistence of the qualities they had when I first knew them, and there's the quiet surprise of how they've changed their lives from those we had lived together.  That the old remains true, and that there's always room for newness, has been a discovery that can only come with age.  Thank you to all the kind, loving, thoughtful people I've known through the years who give more every year just by continuing to be present.

My oldest friend is someone I know from elementary school. We've been friends since the fourth grade, and we've stayed in touch even though we stopped going to the same school after seventh grade.  While I see him the least frequently of the people in my life, our shared way of processing our separate lives has created a connection independent of shared cicumstances. And distance means that we rely on written communication, which has always been my preferred means of expression ever since I could write. From notes passed in class, to AOL instant messages, to snail mail (he introduced me to tiny letters), to rambling introspective emails, there have been long gaps in communication, but always bridges.

My friends from high school remind me of the beginnings of our self-identities.  In them, I see how much of what we valued back then persevered through years of personal challenges.  As vividly as I remember us as giggly girls, it's natural to see one become a mother and another build a home, because their capacity to nurture was in their bones before we grew to our full heights. And while much feels familiar, the shapes of who we were have become etched in more deeply and more has branched out from the roots, and I've been so amazed to be witness to that.  Through it all, we share the wonder of still trying to figure it all out, learning long past the concrete marker of graduation.

I really miss my college friends because most of them are on the East Coast, where I first knew them, and they are so much of the reason that a Californian like me has so much love for the other coast.  From them, one of many things I learned is the extreme privilege of those four years, and the desire to pay respect to everything we've been given by our families and the luck of life.  In a place that could be dominated by entitlement and ego, I met the most humble people who looked out for others often more than for themselves.  And over the years, we've let go more and more of all the stressful burdens of that time, seeing how those worries of our early twenties have proven insignificant against all the good that's grown.  It was with them that I first cried hard, like on-the-floor, carry-me-home hard (which we now laugh on-the-floor hard about). This vulnerability persists through all the slices of time since then, and for this I feel luckier with each year that we collect more moments, painful and happy.

In medical school we started referring to our group of friends as family. One of the best parts of my life so far has been having a home where people came in and out unannounced all the time. There's something so warm and loyal about spontaneous meals, kitchen conversations, treks to the waterfall (as common a hangout as our apartment). And this is a phase in my life that I most strongly associate with falling in love with being outside.  One birthday, one of our most nature-doting friends made me a waterfall, constructed from a tree log and rocks from our actual waterfall and a spout that actually streamed forth water. Every year I feel this sustenance more strongly, because it formed so much of the basis for everything else that's happened since then.  This water that's been the capacity to wash away, to carve out, to pool together.  I feel so glad for these people who helped build the elements of who I am, and for being the kind of people who constantly build for others.

I think that a big part of my unhappiness during residency was the lack of time and space to develop the same relationships, which mostly comes from my own trouble adjusting to the contrast between the freedom of medical school and the restrictions of residency. I'm immensely grateful for the people I did spend time with, who I've connected to differently and more deeply now that I'm out of the fog of residency.  I don't think there's anyone else who can really understand the loss of self that comes from this period of life that demanded so much sacrifice, and so with them I share the experience of now reclaiming ourselves and the reminder that we're much more than the structure of medicine.

Now post-residency, working at a real job, I'm incredibly happy to have co-workers who are also my good friends.  They give such good care to our patients at work, and to me outside of clinic (and many times during, at those moments after patient interactions or bureaucratic hoops when I feel my head or heart or both exploding). I really value the diversity of their paths to this work, and paths to where they are in life.  In a place where you often feel like you're constantly tending to the needs of others, it's so important to be around people with whom you swap everything, from book and music recommendations to stories about our therapists to drinks at happy hour (that's mainly me giving mine away because I'm an ultra lightweight).  It's not something I realized I should be looking for when I was interviewing for jobs, but something I'm ecstatic to have found.

And one of the best surprises of age has been forming connections outside of all these regimented phases, knowing that there's all this development and potential and newness well after people tell you you're done.  The people I've met climbing have opened for me a kind of generosity and support, different and just as strong as in other parts of my life.  I love that I've met people who are so different from me, who I never would have come across in my daily life, who share this common passion.  I've seen in so many ways how this commonality leads to a natural desire to share, and I'm always blown away by how people go out of their way to be there for each other, in climbing and life outside of it.  I'm not sure what I imagined after I finished my medical training, but I anticipated some sort of end to things.  And I think that as we get older, we subconsciously feel a little less appealing and less able to make new connections.  I'm glad to know that there's no end to interesting, giving people entering your life.  Old friends are so comforting in their persistence despite changes, and new friends feel so refreshing in the reminder that things can still change.

And of course, there's the family who have been there since the very first birthdays and early days that they remember more than I can.  On my birthday this year, a friend asked me about my favorite birthday party from childhood.  I think he felt bad when I said that we didn't really have birthday parties growing up.  But I didn't feel bad, and I never have.  Because everything good in my life started with the care from my parents and brothers, and each year older just reminds me of how far their sacrifices have gone.

Lately we've been getting into this routine of jokingly griping about getting older--more prone to injury, less able to heal, biological clocks ticking, earlier bedtimes, quicker hangovers or none at all.  And these are real annoyances, but more than anything else, I feel so lucky to have had another year of experiences with great people.  Not that all the experiences were great--this year was personally pretty painful, which makes me especially attune to what's kept me afloat--but that I can continue to make space for them, to become more.  And that depth has given me way more strength and energy than physical time can take away, making me actually really glad for the stacking of years.  Thank you so much for every person I know for being responsible for that.

May 17, 2017

Health : Climbing On & Off Rock

A few weeks ago, three other women and I took a climbing trip to Red Rock Canyon in Nevada.  We climbed for three days, in places like the Black Corridor where the dark textured rock lightens all other feelings other than gratitude for these formations, Sandstone Quarry where the landscape transforms into a windy dusty white, and the Gallery where we play musical chairs with all the shapes that rock can assume.  We lie on its flatness and occupy the same air.  We hide from heat in its craggy crevices.  We look at it from across the way, the scope crushing the small space between our ribs and lungs.  We climb its edges and pockets, finding ways for our hands and feet to fit.

Red Rock is where I first really started climbing outside, a year and a half ago. So coming back naturally made me reflect on what's happened in that space of time, both on and off rock.

There's a lot about climbing that naturally applies to "real life."  It's all very cliche and very true.  Look at the overall path of the route, but focus on each move.  Know where you want to go, but don't let the destination distract you from the present action.  Don't stop climbing until you fall, because you have more stamina than you think and you can lunge higher than you think and you have more strength to hang on than you think.  Take falls, because while it's terrifying, you will be caught and it will make you a better climber.

So much of why people love climbing has to do with how it's a physical mirror of our struggles and goals in our lives.  And it simplifies them, distilling what might seem layered and confusing in our personal lives down to a slab of rock with a path up.

And I think that's why so many of us turn to climbing when life gets hard.  I've heard so many climbers, women and men, use climbing as a counter to a personal issue (most often, breakups).  Some use it as a release: "After a bad break-up, I was angry and just attacked the walls."  Some use it as an escape: "It feels like I'm running away from something."  Some use it as a substitute, funneling the commitment to another person into a commitment that's independent of any person but themselves.  Some use it build what they feel like they're missing: "I wish I was as brave in other parts of my life."

It's interesting that while it seems healthy to use a physical activity to cope with stress, a lot of these people are a little ambivalent about whether it's the best tool.  That as much as you might progress in climbing, it doesn't always translate to moving forward in other areas of life.  That sometimes climbing actually becomes a crutch, making it hard to address what's going on outside of it.

This is a hard thing to recognize, because in so many ways climbing has helped me clarify and strengthen who I am/want to be as a person.  I've identified courage, adventure, openness, and gratitude as qualities that climbing nurtures, and that I now seek in my day to day life in a way that's much more active and mindful than I did before climbing.

Climbing rock is an awesome thing, both on its own and because of its applicability to all the other things we climb in our lives.  But I think it's important to see when something can no longer compare to real life, by pure nature of it not being real life.

So when I think about how far I've come in terms of climbing Red Rock from October of 2015 to April of 2017, I try to also reflect on what's happened outside of that and make sure that my focus on becoming a better climber hasn't overshadowed my goals as a person.  As with anything, it's good to be lenient and gentle and allow for lapses and non-linear progress.  Looking back isn't about lamenting things not done; I just like to be aware of what's happened and what's happening.

To that end, here are ways I'd like to do in life what I aspire to in climbing:

Face the fear of falling: I want to try more often things that are outside my comfort zone and that scare me, if I think I might enjoy them, or even if I don't, to do them for the experience of feeling discomfort.  I think this is actually easier to do in climbing than in other parts of my life, because the result is fairly predictable and you can practice it in the gym.  In other things, the fear and discomfort take different forms and it can feel new each time.  And I guess that's sort of the point.

Focus on the next move: When sport climbing, we're always looking for the next bolt to clip in our rope, because that's the next spot where we'll be secure, without a fear of a free fall.  One of our climbing friends always gives the advice of not focusing on that next bolt--sometimes it scares us if it's really far, or it worries us because we're not sure of the exact route of getting there. It can become so consuming that we don't move.  Our friend says to instead to focus on the next move; do one after another and we'll eventually get to the next bolt.  As a person taught from early age to consider long-term goals, I'd like to approach certain things in my life differently.  I want to remember that even as we get older, it's not all about reaching certain markers of adulthood.

Try things above your level: This is something climbers talk about all the time--getting on routes that are rated harder than what you think you can climb.  Often you surprise yourself, and at the very least you increase your skills.  Again I've found this easier to try in climbing than say, in work (or even in my domestic life, where I've convinced myself I'm just not built to be a technical or practical person and so let a lot of things go broken that I could fix).  But the times that I've committed to trying something I feel I don't know enough to do, I realize we usually work things out and if we don't, we'll learn how eventually.

Leave: One of my favorite things about climbing is that it takes us away from our small corners to new places.  I definitely thrive on routine, which sometimes limits my ability to venture out of my schedule.  I'd like to be more open to doing things unplanned--not filling up every evening ahead of time, leaving more space to walk around and enter new places.

Stay: It's easy to feel like the only way to get better is to climb all the time, but obviously that's not the case.  Resting is important, physically and psychologically.  Similar to thinking about things long-term, I often feel like everything I do has to be working towards something, when sometimes what I need is just to sit alone and absorb my life.

Until next time, Red Rock.

May 14, 2017

Reading : A Little Life by Hanya Yanagihara

Earlier I wrote about how much a person's self-worth affects their self-care, and that week I flew through this book that might be the best, most heartbreaking articulation of that sentiment I've ever come across.

A Little Life by Hanya Yanagihara is about four friends: JB, Malcolm, Willem, and the main character Jude.  Except for Jude who is a lawyer, they all pursue creative careers: JB is an artist, Malcolm an architect, and Willem an actor.  The book delves into each person's background and their respective struggles in finding what they want in their work.  Even though it's a common narrative, I love this common thread of working through selves by making art.  Especially because I can't imagine anything other than a novel doing justice to Jude's story.

The book centers on Jude and how his traumatic past shapes his self-identity.  We're first introduced to him as someone whose legs don't quite work, whose body causes him extreme pain; we're not told how this came about, and amidst the silence surrounding the circumstances is a crushing knowledge that the source of his pain might be worse than the consequence.

Yanagihara reveals the circumstances slowly over the course of the novel, mirroring some of the ways Jude processes his past in his own life.  It's not a secret to say that there's a horrifying amount of abuse.  While I think this is a book everyone should read and have already told everyone I see about it, I definitely would warn that it is so, so hard to read the depths of trauma that Jude experiences.

Harder than reading about Jude's past is reading how it affects his present, and I think this is deliberate, and important.  Despite speaking with patients on a daily basis who have suffered past trauma, I can't remember the last time that I really felt the searingly deep effects of trauma on a person the way I did while reading this book.  You don't generally have the time to read 720 pages of a person's life, and after knowing Jude in this intimate way, I feel like I know a little more about everyone.  Not that everyone's experiences are the same, but that so much trauma can be lasting in ways that can be hard to visualize.

What hurts most is how Jude continues to sustain abuse, from others and from himself, long after his past is physically gone.  Because he feels there must have been a reason these things happened to him--he's lesser, less deserving, damaged, diseased.  The more you learn about how Jude sees himself and the tiny slip of his self-worth, the more you also learn about Jude and the weight of his kind, intelligent, giving character.  This is the hardest thing, and it tears at the people who love him, who in so many ways tell and show Jude he's deserving.  Jude forms extremely deep relationships--I think if we all had just one of the several he develops in the book, we'd all feel complete for life--but withholds from them his past and who he feels this past has made him.

Some of this comes from the inherent inability to separate Jude's past from who he is now.  He wonders if his friends would feel differently about him without his disabilities and his dependence on others: "Who would he have been, who would he be, without the scars, the cuts, the hurts, the sores, the fractures, the infections, the splints, and the discharges?"  And I think everyone, especially care providers, can relate to how we are drawn to people who need us most.

One difficult thing I loved about the book is its sincere attempt to understand Jude on his terms.  One of his friends comes to realize: "The person he loved was sick, and would always be sick, and his responsibility was not to make him better, but to make him less sick."  As care providers with the goal to heal, we can become frustrated with the many inabilities to achieve that goal.  And we have set ideas about what it means to be sick and well, which can get in the way of bearing witness to what people actually experience.

And I think that's the one most important reason to read this book: to see.  No matter how hard it is, to really see what a person goes through.  There were parts of the book that literally made me sick and nauseated, and I had to stop reading.  I can count on one hand the number of books that made me cry, and each of those were limited to one moment--this one made me cry maybe half a dozen times.  I grew to love and feel for Jude so much that it'd be hard to sleep at night, thinking about his life (I got in the habit of watching a few minutes of the Gilmore Girls to recover from reading).  He becomes so real, and this fiction makes the lives of the patients I know, and those I don't, so much more palpable.

While saying this book induces nausea and insomnia might sound like a horrible advertisement, don't let that stop you from reading it.  Yes, it's very depressing.  Yes, it's very long.  It requires being in the right space that can accommodate these difficulties, but really, none of us are built (or should be built) to hold everything this book exposes.  So it made me imagine the many people out there who don't have any choice but to hold it all.  We owe it to them to see a small sliver of it, to carry some weight.

That's not to suggest that my love for this book comes from a sense of responsibility.  It is above everything else, really beautiful.  As hard as it is to read some parts of it, I couldn't put it down and read the 720 pages in less than a week.  There are, steadily throughout, incredible moments of beauty.  Besides the fact that the book is beautifully and lovingly written, it pays homage to beauty in so many forms: art, physicality, and most of all, the connections people make to one another: "And this reminded him that he, too, had to keep trying. Both them were uncertain; both of them were trying as much as they could; both of them would doubt themselves, would progress and recede. But they would both keep trying, because they trusted the other, and because the other person was the only other person who would ever be worth such hardships, such difficulties, such insecurities, and exposure."

One of my favorite passages is where one of his friends tells Jude:  "Being with you is like being in this fantastic landscape. You think it's one thing, a forest, and then suddenly it changes, and it's a meadow, or a jungle, or cliffs of ice. And they're all beautiful, but they're strange as well, but you don't have a map, and you don't understand how you got from one terrain to the next so abruptly, and you don't know when the next transition will arrive, and you don't have any of the equipment you need.  And so you keep walking through, and trying to adjust as you go, but you don't really know what you're doing, and often you make mistakes, bad mistakes.  That's sometimes what it feels like."

"They're silent. 'So basically,' Jude says at last, 'so basically, you're saying I'm New Zealand.'"

Having been to New Zealand (next to America, it's my favorite country so far), I agree that Jude, and this book, are New Zealand and more than worth the investment of travelling that far.
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