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October 1, 2018

People : 1000 Piece Puzzle

A text conversation circa summer of this year:

Me: Working on a 1000 piece puzzle while listening to this book is my dream as an introvert and I'm up until midnight as a result.
Friend: Probably the nerdiest text message I have ever received.

If we were counting in terms of number of concrete unpleasant events, I'd have to say this year has been my rockiest.  Now that the events are past, it's much easier to share.  But what I take away most from them is gratitude for the incredible support and care I received as they were happening, and every day from the people in my life.  Sharing now is less about relieving burden, because honestly with that kind of love it never felt like I was carrying too much.  Sharing now is about the process of putting together this puzzle.

During the thickest part of it, I was spending a week at my childhood home to be with my mom while she recovered from a surgery to remove part of her lung (she continues to recover well).  For us this was the least hard part of her being sick--we were all relieved to get past the uncertainties of diagnosis and treatment, and to see the surgery go well.  For her it was harder, to actually feel the physical reality of being sick, to cough and breathe and move differently.

I'd just been told some not-horrible but not-great news about my own health (unrelated to my ankle, which at the time felt both trivial and heavy), part of which meant getting minor surgery now and major surgery sometime in the future. Having never been put to sleep or incised, this freaked me out a little (a lot).  I tried to maintain relativity, as it wasn't even close to the realm of what my mom has faced.  My mom, who is 4'11" tall and less than 100 pounds light, has given birth five times (one C-section--me), underwent open heart surgery, had a quarter of her lung taken out, and still manages to look sixty at near eighty, so I figured I could channel some of her bravery.

During this week I spent time with my mom and dad, but they are pretty low maintenance and most of the day they didn't need much from me other than being around.  I was feeling really down, and I couldn't climb (no partners in Fremont) and I couldn't run (my broken ankle was un-casted but recovering at 1 percent pace I wanted).  So I started this puzzle.

I got this puzzle for my dad for Christmas.  You can choose a photo and have it cut into any number of pieces.  I love how happy everyone looks in this photograph my brother Stephen took of my parents and my niece and nephews.  My dad likes games like Sudoku and has excellent spatial skills, so I figured I would make the puzzle super challenging at 1000 pieces.  It turns out this was a little too much.  Dad: "I opened up the box and my vision went blurry.  I closed the box."

So I decided to give it a shot.  Anyone who knows me knows that unlike my dad I have very poor spatial skills, but I do have lasik-rendered perfect vision so I figured I had that one thing on him.  The border was easy, and then suddenly a flood of obstacle after obstacle: the huge swaths of monochrome without any outline, the five flesh-colored faces, the varying shades of red, that neon orange-and-green cake with loopy cursive.

But as I sat for hours with the puzzle, shapes and strategies formed both naturally and with effort.  As I searched for my family's eyes and teeth and hair and lines in these pieces, the thousand pieces soothed ragged parts of me.  There's this indiscernible mess, but I know for certain there was once a whole and there is another whole to be made, and I know I can make that happen with patience.  Which was like water to me while all these not-ideal things seemed to be happening to me.  My brothers and I had been fighting a lot in the past few months, and I could see that we were fighting for control over what was happening to our mom, for whom we could only do so much.  My body, which I so value for its capacity to move, which I've relied on when all else seems out of my hands, had been broken and was about to be placed in the hands of a seemingly random surgeon. Here, I finally had control.

While I worked for hours on end on the puzzle, I listened to The Nix by Nathan Hill. I couldn't have designed a better fit for the activity of my hands, the frenzy in my mind and the flurry of feelings.  It's loosely about a man whose mother left him as a young boy, and his quest to piece together the story of her life from very little: a photograph, stray details from his dad, a couple facts.  There are a lot of characters, but in the versatile voice of the narrator and the crafted language of Nathan Hill, each person stood out sharply and strongly.

I felt the same about my family the longer I looked at the pieces and saw more clearly the differences between the shades of Asian.  In some ways I've never looked so hard at these cheeks I've snuggled and kissed.  I'd barely given their teeth a glance.  Immersing myself in this single picture of them created a new kind of intimacy--not better than real life, but just not existent in real life.

I left that swath of black sweater for last.  There were literally a hundred pieces that were just black, nothing else on them to guide which ones might be in proximity.  I separated them into piles based on how many edges were a "lock" into which other pieces fit, and how many edges were a "key" to insert into other pieces.  And stared at them, until I started picking up on minute differences in size of the lock and key, and I can put these solid blocks of color together as they are unique enough to have their own place, their own neighbors.  I like using this dusty, wilted part of my brain.  There's still a lot of random testing; I take one piece and align it down a column of other pieces until something fits.  I like this mindlessness.

At the end of the week, the parallel narratives in the book tumble into each other and the puzzle is done with not one piece missing, and the beauty of these alongside each other just about kills me.  I'm not kidding when I say that this experience is special to me. Yes part of that is pure nerdiness and the love of sitting alone in that nerdiness.  Most of it is the sifting and putting together of something complicated and close, the comfort and the struggle of that.  When I'm puzzling, the difficulty is still deep and in some ways the intermittent frustrations of the puzzle (my vision does go blurry many times) helps me see just how upset I am.  But confronting it in this solid way unwinds, softens my feelings.

In the months that follow, life starts to heal too.  By the time my dad tires of assuming my mom's domestic role she's recovered enough to take the position back, I'm climbing stronger than pre-fracture, I'm grateful for what a small surgery teaches me about the patient experience.  All the while, the puzzle remains on our dining room table as my dad looks for a frame to fit its unusual dimensions.

Then one weekend I'm home visiting my parents, I find that it's not there.  Where is it?  Is it framed?

It is not.

My mom, who in the haze of her first week post-operation didn't notice me crouched like a madwoman over this puzzle for days, had taken it apart.

Up until that point, I hadn't cried very much.  Mostly on two days.  The day when I read the report of my mom's lung scan, translating the medical language I wished in that moment I didn't understand.  And the day when my doctor told me I'd need a minor surgery now, and a major surgery sometime in the future.  But both of those days quickly dissolved into days of organizing, rationalizing, and accepting.  Each one easier than the last, as we dealt with the practical and came to terms with the conceptual.

Then the puzzle came apart, and I came apart too.  I was so irrationally angry at my mom, my mom who never cries for herself, who never once cried that I could see during the months of appointments and procedures.  I cried over the puzzle, because all of the sudden I could touch the fragility of this picture, of all the pictures I have in my life.  I can climb and sort-of run again, and every step feels off and it may be that my ankle never returns to what it was.  My mom is steadily re-gaining her strength, and we live with the uncertainty of whether her cancer will return.  I can see my surgery as a kind of gift in the path to empathy, and I'd give a lot to not have to undergo the other one.  This knowledge lay dormant in me and it erupted with the loss of the puzzle.  You'd think that your thirties would loosen your hold on togetherness, but a physical puzzle can really make you feel that you alone can put things back together, and when that concrete framework is gone, so goes my image of structure.

My kind and generous friend who let my senseless self talk to him for two hours in the immediate aftermath of this sentinel event  (thank you) about the puzzle (the concrete one, and the metaphorical one) said to me: all the pieces are still there.

But they might not be.  Some could get lost or torn by the time I try the puzzle again.  And even if they are all there, the experience will be different, and so the end will be too.

Soon after the puzzle fell apart, so did my relationship and while that felt like the hard right thing, the parallel again felt obvious.  There's the heavy idea of starting over: it takes so much energy, and how do you refuel after a break?  After so many breaks--in bone, in health, in a relationship, in the idea of having your family forever--how do you have the faith to rebuild?

The thing about crying over a silly thing like the puzzle is that I haven't cried since and I don't feel like I'll cry for a long time after it.  I've all out mourned the loss of constancy and control.  While I'm sure that it will return in spurts because we're built to strive for stability, this full implosion freed me to love these breaks.  For what they are on their own: the serendipity of misfortune and the randomness of our narrative, which remind me how much bigger everything is than me.  And for the rearrangement that follows, for the renewed attention to different parts of ourselves and the challenge to heal differently each time.

Because it's kind of amazing that with the same set of pieces, there's so much new to be experienced.  It's never exactly the same, and that broader possibility is more expansive than our lack of control is limiting.  It reminds me of being in Japan and learning that they periodically intentionally tear down temples in order to rebuild them, because they value this mirroring of what happens in actual life.

I didn't share a lot of these things as they were happening, because after the visible ankle fracture that couldn't be hidden, I experienced somewhat of a sympathy overload.  Which is just about the best thing you could ever complain about.  Everyone has been so kind and loving, and I really felt it could last me through anything, that it wasn't necessary to ask for more.  I share it now not for sympathy, because there isn't actually anything to mourn. These breaks and losses are a reshuffling for newness and more range of perspective. I share it now for gratitude, that life can be this delicate and this worth breaking down and building back up.

September 26, 2018

Reading : Five Amazing Audiobooks

I've been asked by a bunch of people recently for audiobook recommendations, and I love that so many people are listening to books.  I love talking about audiobooks and why I love them so much.  I've talked a lot about it generally--the layers of tone and character that oral narration adds, the ability to integrate language and narratives during other parts of your day, the slowing down of story when you read it aloud.  But it's hard to describe exactly why they are so great without some examples.  Also, it really takes the right book to get you into listening. Sometimes people are worried about being able to pay attention, and I agree it takes some getting used to, and if you start with the wrong book it can be off-putting (the first I tried was, randomly, Faulker's Light in August and it took me years before I tried again).  There are some books that I really feel are better experienced on audio, and here are five of my very favorites.


The Art of Fielding by Chad Harbach
This holds a special place for me as the first audiobook I ever really loved, and one of the few I've listened to more than once.  It's about a college baseball team: the dynamics of the team as a whole, but more so about three individuals and some of the people with whom they connect.  Henry Skrimshander, whose small size masks his immense talent until he's recruited by Mike Schwartz; Mike Schwartz, the team's captain whose pursuit of success in sport and school wears away his body and mind; Owen Dunne, whose affair with the college president is deep and difficult.  I don't know anything about baseball and never watch sports, but I was blown away by how naturally Harbach creates emotional depth alongside, and within, technical descriptions of the game. Also, it's super funny. If I had to choose one thing I value most in audiobooks it would be the ability of one narrator to adopt the voice, tone and personality of different characters, and it is so good in this book.

The Nix by Nathan Hill 
Another really funny book with an amazingly talented narrator, who can embody both the ennui of an English professor trying to instill the love of literature in bored college students while he himself doubts the value of old stories, and the ennui of one of those bored college students.  The loose framework of the plot is about the English professor trying to unearth the story of his mother who left him in childhood.  But it's one of those books that has very little to do with actual plot and much more about the character and context in which it's written.  So that it becomes a book about American life through various historical eras (post-World War II, 1960s radicalism, post-9/11, the current age of tech), geographical areas (cities and suburbia), and through the lens of so many different types of people who find themselves limited and traumatized by our world.  If you're concerned about a book that's not plot based being boring, don't be--this is the funniest and most entertaining book I've listened to in a long time.  (Though if you don't have a lot of time or patience I wouldn't recommend it as your first audiobook because it is almost 22 hours long. But it's really the audio-equivalent of a page turner and I blew through it in a week).

Ready Player One by Ernest Cline
I know this book-turned-movie is old news, but even if you're read it or seen it, I would recommend listening to this because it is so, so funny and well-done.  (Yes, I do see all these recommendations are funny books.  While I don't consciously seek out humor in fiction, when it's there it's really special, and it's especially appreciated on audio).  I looked forward to my commute just so I could listen to this book, and was always bummed when the drive was over.  The story about living in virtual reality is innocently sweet and moving, at the same time it's honest about how dark life can get in the hands of humans.  Among the recommendations I give, people often choose this one, and it's definitely a good first audiobook.

Exit West by Mohsin Hamid
This book is not funny, but it is beautiful.  Even though one of the things I appreciate about audiobooks is the ability to listen while doing something else, I fell so hard for Hamid's voice that I would sit on the couch and just listen to him read his book.  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.  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.  

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 have a habit of listening to audiobooks on increased speed, but the language in Exit West was so loving that I listened to it at normal speed.  It's also short, which makes for a good first venture if you're in the mood for a more somber book. 

Echo by Pam Munoz
Because music is central to this book, listening feels the most experiential way of reading it.  It tells three distinct stories of children growing up in different places at different times, who are connected by their possession of a special harmonica and their gift of playing it.

Friedrich is a twelve-year-old boy growing up in the throes of Nazi Germany. The birthmark on his face and his family's anti-Nazi politics make him a literal and conceptual target of Hitler's regime. His only source of power comes from his unique ability to play a harmonica, an instrument small enough to keep close at all times and with sound loud enough to give him voice in a world that otherwise wants to shut him out.

The harmonica makes its way to a young orphan named Mike living in Pennsylvania during the Great Depression.  His main mission in life is to find a family and home that will keep him together with his younger brother Frankie.  Again it's music, and the harmonica, that play a literally instrumental role in trying to achieve this. 

Later, the harmonica is in the hands of Ivy, the American-born daughter of migrant farm workers from Mexico. As her father takes over the farm of a Japanese-American family that has been sent to an internment camp, she witnesses the fear-driven racism resulting from Pearl Harbor.  And as she is segregated into an inferior school as part of an "Americanization," program, she experiences the racism personally.  Like the children before her, she finds space for herself with her harmonica.

I love how each child's story is narrated by a different voice, and how the sound of the harmonica throughout wordlessly connects all three stories.  Each person is vibrant and full in character, and each has a uniquely touching relationship with music.  Sometimes the music plays like a soundtrack and sometimes it takes center, and it all feels very organic in the way that noise and melodies shift in and out of view in real life.  Because you get so immersed in each person's individual story, you don't realize until the end how expansive the book is--covering so many World War II themes of persecution and capturing so many different arenas of suffering.  At the end, the stories come together with ease and heart, in a way that only a children's book can.


These are all fiction because besides that being what I love most, I think audiobooks lend more nuance to fiction than nonfiction.  But I do listen to and love non-fiction audio too, and books I've really enjoyed include Missoula by Jon Krakauer about rape culture in college towns, Nothing to Envy by Barbara Demick about North Korean defectors, and We Should All Be Feminists by Chimamanda Ngozi Adichie (narrated by the author whose voice is at once unique and speaks for all of us, and the short 40 minute running time makes for a good introduction to listening).

And if you don't already have this, get Libby!  Don't pay $30 for an audiobook when you can borrow it from your library.  It's true that you often have to wait for the popular ones--every week, I just put a few on hold (don't place too many at once because then they'll all come at once and you won't have time to listen to them all before they're due in 21 days).

Happy listening, and please give me recommendations too!

August 2, 2018

Health : Identity Through Injury & Illness

The last few months have been a succession of physical changes and abnormalities, each one progressively a little more difficult.  For me and for a number of people very close to me, injury and illness have shown up with sudden briskness (we are all relatively and fortunately fine).  Each one has challenged me to embrace the value of having the full spectrum of experience, which includes the stuff that sucks.  I started out pretty positive, have tried hard to sustain a reserve of patience and insight, and recently realized that getting worn out is a real, honest part of what people are. In that fatigue is the opportunity to confront things as they are, to unravel how to remain who we are in our daily routines when these routines are disrupted.  And how to be better.

Up until now, my life challenges have been primarily emotional and abstract.  This year, faced with changes in physical health, I'm learning a lot.  Despite spending the last decade in hospitals and clinics seeing people with acute and chronic illness, it's been shocking to me to confront more personally the fact that our bodies often operate independently of what we want, what we imagine.  I'm grateful for this very humbling reminder that for all our good intentions and wide exposure we never really understand what it is like: what it's like to be given bad news, what it's like to sustain and heal, what it's like to have a surgery, what it's like to live with risk and uncertainty. 

Physicality is something I've relied on as a constant source of strength through emotional difficulty--in my personal life and in work.  So when I stopped being able to push myself in that way, to maintain the movement that's been so crucial to getting unstuck, I didn't want to admit this loss.  I did everything (physical therapy, yoga, acupuncture, sauna, sports massages) so I could will healing into being.  I'm sure all of this is helping to some degree, but the majority of it is really up to my body, not me.  I think that part of why doctors make the worst patients is that we're trained to consider ourselves forces of change.  We acquire these tools and knowledge to make people better, and even though practice has proven to me the smallness of our scale of agency, underneath it all we hope that we have power.

During this whole tug of war with my body, I've thought a lot about what is defining for myself.  While climbing in a cast and then with a stiff foot, I developed a stronger appreciation of what I love about climbing that's independent of the level I'm climbing.  But I realized that even those things could disappear if someday I can't climb at all.  And until recently I couldn't run at all, which is something I've never been great at but has been an integral part of my identity and life.  I do it for pure pleasure and for coping with difficulties.  Without the things that you concretely do, you start to re-consider your conceptual self , and you question if there is anything about you that can remain constant.

This became even more prominent when faced with more permanent, life-altering physical changes in people close to me and in myself. Knowing that the broken ankle was temporary obviously made it much easier.  It was also the outcome (a fall) to an activity I chose to do (climbing). In contrast, when things happen to your body as a result of its own course and not from your direct action, this is another level of our lack of control.

What I've held most close through all this is that there's only so much I can do for myself.  We can want and will, and sometimes our bodies and our environments just say no.  So what is it that can stay true through all the things we might lose, all the aspects of ourselves and our surroundings that might change?

What I've found is that although there are limits on what we can acquire for ourselves, there is always something we can give others.  The degree and depth of gift fluctuate, but the presence is constant.  I love the malleability of this, our ability to adapt what we can offer depending on what we acquire and lose. The most important thing to me before injury and illness remains the most important thing to me now, which is the capacity to share. This isn't to say that I don't frequently forget and fail at that, only to say that it's the primary goal. 

I think that so far in life it's been easy to declare that a goal because I've been so extremely lucky in so many ways.  When things are good, it's easy to see the huge discrepancy between what I have and what others don't, and to strive toward more balance.  But on one particularly rough day, I found myself unable to provide and I was shocked at how quickly I could stop caring.  It's much harder to be giving when you're struggling too, when in moments of shock you feel not just like you're losing something but also that something has been taken from you.  I generally avoid framing things like the latter, because externalizing makes happiness hard.  But I recognize our natural tendency to do this, to feel why is this happening to me.  It's important to me to recognize without judgment our inherent inclinations, to better connect with each other and encourage each other to resist unproductive thought processes even as we know it's human to have them.

It was also hard that a certain number of events happened one after another, making me ask the contrived and real question of why this was happening.  We often talk about whether our lives really have an inherent narrative, or whether we piece the parts together to make sense.  As with many things I think the truth lies somewhere in between. If the former isn't naturally clear, I feel a certain responsibility to do the latter.  Given a set of circumstances, we're bound to move through them with some purpose.

And while at first this all seemed to be bad timing, some re-framing of perspective made me consider how things have aligned for the best.  That these things happen not to cause suffering, but to learn better how to ease it.  In the midst of all this, I received parallel gifts from an old friend and a new friend.  Neither of them knew about all these thoughts I'm just now putting down, couldn't have known that their sentiments came to me at a time I'm most able to absorb them, in most need of thoughts that take me outside my own needs.

I had just written most of the above when an old friend sent me this quote from Lincoln in the Bardo by George Saunders: "His mind was freshly inclined toward sorrow; toward the fact that the world was full of sorrow, that everyone labored under some burden of sorrow; that all were suffering; that whatever way one took in this world, one must try to remember that all were suffering (none content; all wronged, neglected, overlooked, misunderstood), and therefore one must do what one could to lighten the load of those with whom one came into contact; that his current state of sorrow was not uniquely his, not at all, but, rather, its like had been felt, would yet be felt, by scores of others, in all times, in every time, and must not be prolonged or exaggerated, because, in this state, he could be of no help to anyone, and given that his position in the world situated him to be either of great help or great harm, it would not do to stay low, if he could help it."

A new friend took me to the East Bay Meditation Center, where they spoke about the concept of a gift economy, where we give based on the fact that we all have something to share, not for trade or for acquisition. I read a little about it afterwards, and it turns out to be a complex topic of debate in economics and anthropology, but practicing the idea of giving without expectation of return resonated with me.

These fresh gifts recall the ever-giving value of the incredibly supportive and loving people in my life, and remind me that it's this sense of giving that I want at the core of my life, through changes in my emotional and physical identity.  So at these times, maybe the best way to maintain my sense of self when experiencing loss is to: bring to the surface what I've been given in the past; stay mindful of how much I have now; search for what even these challenges give me--for the purpose of giving all the above back and around always.

June 19, 2018

Reading : Underground by Haruki Murakami

If you know me just a little you know that Haruki Murakami is my favorite (not just favorite writer, but a favorite thing in life) and if you're one of the several people to whom I've recommended him and didn't love him as much as I do, I first apologize that I disappointed you.  Then I ask that you suspend those feelings and consider this book in a new, different way.  This book being Underground: The Tokyo Gas Attack and the Japanese Psyche.  Because while it capitalizes on so much of what I love about Murakami (his sensitivity, curiosity, and insight into individual people), it's a very different kind of narrative.  First because it's non-fiction and second because it contains primarily the words of others.

Like most Murakami fans, I know and love the motifs he loves: cats, delicate physical features like moles and ears, loner protagonists, loner characters hanging out at bars, mysterious women, disappearing women, Radiohead and the Red Hot Chili Peppers, islands, wells and underground worlds.  (I left out jazz because I don't know anything about jazz other than Murakami is obsessed with it, so can't claim to love it).  I also love that he writes lines like "The pillow smelled like the sunlight," which might be my favorite sentence in the world.  

The other thing I value so much about Murakami is his interest in trauma and its obvious and subtle after-effects.  In his short story collection After the Quake, he explores the lives of different individuals after the 7.2 magnitude earthquake in Kobe that killed over 6,000 people.  His characters didn't experience the earthquake themselves, but Murakami is sensitive to the idea that such impactful events can send out tremors, touch anyone, disrupt the flow of our psychological processes and concrete behaviors and daily routines.  All without any tangible connection to the event itself.  He really appreciates how subtle and sensitive humans are, how much we absorb and retain.   

I think that memories and how someone experiences the past are some of the most important and interesting elements to a person's self-identity and how that person moves in the world. (At least, I think that about myself so it must be true about everyone else, right?).  I've found that so much of our interactions with patients have less to do with who they seem in the present moment, and much more with who they have been in all the scenes preceding the one in front of us.  And equally, how they will continue to process their past in the future.  

In our current culture of scrolling facebook feeds and streaming podcasts (both of which I indulge), it's easy to experience a million presents without considering how what's happening now will continue to affect us and others, tomorrow and years down the line.  There's so much new shit that makes it easy to forget that the old doesn't disappear, that old tragedy re-presents itself over and over in new forms to those who experience it.  Not only that, narratives on trauma are inherently less accessible to people who haven't experienced the same.

This is why I really respect writers who commit to giving voice and remembrance and attempted permanence to these narratives (Missoula being another incredible example and a book that taught me an enormous amount).  In Underground, Murakami interviews sixty-two people connected to the 1995 Tokyo gas attack in which members of a religious cult released sarin on three subway trains, killing thirteen people and injuring over six thousand.  The terrorists placed plastic bags of liquid sarin on the trains and poked them open with the tip of an umbrella, injuring passengers through direct contact as well as by inhaling evaporated gas.  Sarin is a organophosphate pesticide that causes continuous muscle contraction that ultimately paralyzes you, that kills by paralyzing the muscles that move your lungs in and out to breathe.  Before that it will make you cough and vomit uncontrollably, will make your eyes get smaller so that things close in on you.  The subway passengers had no idea that sarin was the source of their symptoms, and subway workers trying to restore order handled the sarin directly without knowing what it was, resulting in their deaths and severe injury.

The book is divided into two parts, the first focused on the victims of the gas attack, and the second (published later) focused on members of Aum Shinrikyo, the cult that perpetrated the attack.  It's the first that Murakami was more driven to write, and the more compelling. 

Murakami divides the stories by the three subway lines that were gassed.  First we learn a little about the men who planted the gas on the subways, then about the people who inhaled the gas. Each section is titled with the name of the person who experienced the attack, preceded by a quote from his or her narrative.  Murakami introduces the section with some details about the person, and then the subsequent story is narrated directly by the person largely without interruption or authorial voice from Murakami.  The interviews focus on memories of the attack and what happened on that day, and how it has affected the person since that time.  Most are just a handful of pages long, so that the story before stays fresh as you move to the next one, and it's easy to get through a dozen in one sitting.  

The repetition of the same event experienced by different people creates this organic effect where each story is layered on top of one another.  The commonalities become deeper in color from being told over and over, while the variations are bright in color in contrast to the established patterns.  In this way, we gain a sense of how widely this gas permeated the community, and also how heavily it weighed on individual people.  It makes for a really unique reading experience, and I found myself wishing I could learn about more current events in this way.    

A picture of Tokyo emerges that isn't surprising, but is more palpable when described by its residents.  The trains are so incredibly packed that the force of crowds separate a man from his briefcase, trample the glasses of another.  The commutes are long.  People have a routine for the exact train they take and the exact car of the train they board and the exact door of the car they use to board.  

A picture also emerges of what is lost after the gas attack, small and large punctures in people's lives even as some routines resume. Or what is displaced, as emotions like confusion and anger consume space not meant to house that kind of intensity for that long. Some people continue to have problems with their eyesight, headaches, memory.  And some people died, leaving behind families shocked by this sudden senselessness.  There is the woman who lives in a vegetative state, whose story is told by her brother (who travels an hour every day since the attack to be with her for an hour) and by Murakami who visits her in her nursing home.  As moving as these stories are, the most heartbreaking is the narrative that's not there, the one she should have been able to tell herself.  

Murakami relates to the victims in the same way I feel we relate to our patients every day: "I came to them from the 'safety zone," someone who could always walk away when I wanted. Had they told me, 'There's no way you can truly know what we feel,' I'd have had to agree.  End of story."

But even if it's true that we can't fully know their experience, these people did choose to share, and most don't focus on hatred or revenge as their motive.  They ask us to reflect and remember, so that this doesn't happen again, and so that we respect the psychological aftermath as much as the physical event.  I'm grateful to Murakami for asking for their memories, for a slice of what they carry so that it doesn't remain underground.     

May 15, 2018

People : Family

Lately, as I've adjusted to a life in a cast and on crutches, I've been alternately angry, annoyed and resigned at the fact of losing my independence.  Every so often (every ten minutes) I want to throw the crutches out the window, and then I internally rage at the thought of how hard it would be to go down the stairs to retrieve them.   

All my life I've considered independence as something to constantly cultivate, something I was always at risk of losing.  Growing up as the youngest sibling and only girl with four brothers, then living most of my adulthood in long-term relationships, I was worried that being positioned against men meant that I had to actively fight for my own space.  Luckily, my thoughtful, generous brothers raised me with the sense that my gender was a gift and that I could be the same and different; that the limitations can be overcome and that there are advantages to be found.  Still, it can be easy to lose the volume of your voice when so many have spoken before you.  And in relationships, when you are continually weighing someone else's needs, your own can become hazy. So I've made it a conscious point to do as much as I can for myself, and while I have my own reasons for it I know that the desire itself isn't unique to me.  It's what we all clamor for in our adolescence, what we struggle to sustain in adulthood, and what we mourn in old age.  

Recently, as I've had no choice but to rely on others for both basic needs and overall purpose, I see how dependent I've actually always been.  And more crucially, that this is actually something to celebrate.  If I envision connection as a foremost goal in life, why would I not want to be connected to other people deeply enough to need them?  As I've let my mom stack the pillows under my leg (thanks for that third one), my boyfriend arrange everything by my bedside (thanks for thinking of items I didn't realize I'd need), and my friends feed me one dessert after another (thanks for the best gelato in the city which I can't believe I didn't know about)--I realize: this need for others is really what lets me be everything else outside of them.  Including, hopefully, needed by others.  

Coincidentally, I read this today: "The self without sympathetic attachments is either a fiction or a lunatic.  Yet dependence is scorned even in intimate relationships, as though dependence were incompatible with self-reliance rather than the only thing that makes it possible." (From On Kindness by Adam Philips and Barbara Taylor, as quoted in Maggie Nelson's The Argonauts, which I loved a lot).

As we often do when we're considering how best to evaluate something for ourselves, we think about patients.  Almost more than I like getting to know our patients as individuals, I like seeing their relationships to the people in their lives.  Coming from a large family where each of us interacts with every other of us differently, I can relate to the strong bonds created from dysfunction.  It's interesting, and important, to see what this is like for others.  It's tempting to perceive a person just as she sits in front of you, and forget that she exists within a web of relationships that can support or loosen her.  

We see so many incredible sources of care from family members, that remind me that for all our man-made medicine, it's often best to capitalize on what's naturally there.  There are the elderly brothers, one taking care of the other ever since a traumatic brain injury in his senior year of college.  The homeless grandmother who fights daily to secure nourishment and shelter for her grandson.  The couple in their eighties who still hold hands.  The 19 year old, newly transitioned teenager-to-adult, who answers every question with hesitant flatness, except when asked about the baby on his phone, then come a drawn out smile and three fast happy words: "That's my niece."  Their natures are quiet, their love full of force.

Then there are a lot of people who don't have anyone, whose primary sources of stability (case managers, social workers, health care providers) try hard but can never be as present as family.  The woman whose time is marked by the hours between drinks, who stops by our clinic every few days to ask for a medicine or a place to stay.  We don't have anything to relieve her pain, and the waiting room eventually closes.  The man who needs an important procedure, but can't get it done because he has no one to drive him home.  It took several visits to realize this, because he was embarrassed to admit he didn't have any friends.  We have so little to offer these people who don't have a foundation of dependence.

And for others, who we might be able to offer something small, they're often (reasonably) skeptical and mistrustful.  They're not used to having people to (reliably) rely on, and sometimes would rather withdraw than to displace hopes.

Seeing people who have been neglected and disappointed, who are now wired to expect little from others, I can understand the appeal of caring for children.  There's more malleability and room to restructure, more chance to instill each action with a sense of trust in the world.  To create family, that which will be your crutch, of the physical and of the emotional kind.  

But after my injury temporarily reverted me to a childlike state (thanks again to everyone for feeding me, transporting me, consoling me), I think it's possible and important to re-enter this mindstate in adulthood.  Especially for people who grew up without the support every child should be able to depend on.  Adults generally don't want to re-enter this state of dependence (I didn't); it's scary to be vulnerable and it sucks to be let down.  Maybe it's part of our job to break down this resistance.  It's really difficult but I think possible over time, and at the very least worth trying (over and over).  We talk a lot about empowering our patients to care for themselves, to see their own strength and capacity.  But maybe first they need to know that there's still space for them to be someone's child: to voice their needs, to be on the receiving end of a relationship.  To know that dependence makes self-reliance possible.

So on this Mother's Day I'm grateful to my family for giving me so much to depend on, for making my needs so easy that I can make the choice to care about other things, other people. And on this Mother's Day, I'm mindful of the many people who don't have the gift of this family, this dependence.  It's for you that we show up, hoping maybe once or twice that we are there in the right moment and space.

So thanks to my crutches for revealing all the places I stumble and how much support I'm lucky to have; for reminding me what we all want to be for other people.  I guess you have a purpose in my life.  (But I will still happily throw you out the window when this cast is off).

* This is one of the few photographs of my mom with all her kids.  She's 7 months pregnant with me so I count my presence, and that is also probably why my youngest brother looks so unhappy.
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