Monday, May 31, 2010

Daddy, What did You do in the War?

Official DOD Guide for observances of the Days...Image via Wikipedia

As a kid, I was sort of disappointed that my father didn't have a lot of great, heroic tales to tell about his experiences in World War II. You know how it goes, the "Daddy, what did you do in the War?" kind of thing. He was a military policeman and when I asked him why he'd chosen that duty, he explained it was because of his accuracy with a .45 caliber sidearm. He'd qualified as an expert marksman, largely because he'd shot handguns on the ranch since childhood, and the military police wanted men who were "good with a gun."

As an adult, I've come to regard it a blessing that he didn't ship out overseas, because I have the sense, had he done so, his tales may have been more disturbing than thrilling. He enlisted when he turned 18 -- six days following the date his son would be born a few years later -- and finished basic training during the last six months of the War in Europe. One of the tasks of the military police at that time was to manage prisoners of war and to assist with victims of the Holocaust. I'm so glad he never had to have those memories.

Although he was adept at hiding it most of the time, my father was tenderhearted. He wasn't sentimental in a syrupy sort of way, but he'd draw my attention to baby animals, especially horses, in a field we happened to drive by. I've mentioned a saddle he made for my fifth Christmas -- turns out, all those evenings he came home late that month were spent in the shop, preparing for Christmas morning. Under the tough cowboy, man-among-men, exterior, was a nice guy who wouldn't speak badly about a person unless they were severely deserving. And even then, he never seemed to enjoy it.

Had he lived at the same time as his grandfather, I think he would have been a town sheriff. He could restore order where there was chaos and people whose lives were chaotic seemed to find him, even before he became a minister. They found him like kids find me. His shop was an informal counseling suite where truth was often found lying among scraps of leather or dancing to the tune of the hammering racket of his industrial sewing machine.

Dad was good at picking up the pieces and helping others do likewise. Because of that, I don't think he'd have brought PTSD home with him, had he gone away to war. If he'd been older, if he'd had a slightly different background, I think he'd have gone into the chaplaincy or medicine. And if medicine, I think he'd have found his way to psychiatry. And if psychiatry, he'd have been a healer, since that's what he was anyway, and the scarred from war would have been his patients -- or his congregation.

Happy Memorial Day.

Sunday, May 30, 2010

Lessons from the Dance Floor

Ballroom dance lesson
"How do you let the woman know where you want her to go?" I asked. In any other context, it would have sounded chauvinistic, at best a little cocky. On the dance floor, however, it's critical if you're going to lead, and by cultural convention since I was the man, I was also the leader, and I needed a hint. The steps I could do, but how to communicate my intention to my partner?

"Ah! Good question! Watch me," said my instructor, as he simultaneously lifted his left hand and gently nudged his partner into a spin with his right. We were practicing making the waltz more interesting and as I imitated his movements, the lights began to come on. It's not a matter of whispering, "Okay, now we're going to turn," but rather of placing my hands in a position that draws my partner out of her usual pattern and into a new one.

I can't get over the subtly of what I'm learning from week to week. I still feel like a clod sometimes, an overgrown country boy clad in a too-large-for-his-feet pair of his father's boots, stomping around the dance floor. I feel sorry for my partners and apologize for misplaced steps that leave them wondering if they're dancing with the poster child for ataxia (staggering, stumbling gait). I watch my instructor -- he makes it look effortless -- and wonder if I'll ever come close.

It's so hard not to approach dancing like a medical student, analyzing everything and evaluating my performance as if a life hangs in the balance. "Close your eyes," my instructor admonishes, telling me, in effect, I'm over-thinking. I do, the step falls into place, and once again I apologize to my partner, this time for not looking into her eyes.

In the midst of it all, I get a glimpse of what's happening to me. I'm learning to lead, adjusting the power in my arms to match my partner's, too much for one and too little for another. Women are miracle and mystery embodied; the tension transmitted by the way they carry themselves speaks volumes and most men are too busy to listen. I'm learning to be a man with women in a way that's new, that doesn't care how many languages I read or how well I converse. I'm not sure I can describe it, but I like the way it feels. Sigh, lessons from the dance floor...I mean, who knew?

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Saturday, May 29, 2010

False Assumptions

The reverse of the state quarter of New Hampsh...

Well, I've gone and done it, i.e. set a date for a repeat performance with board exams this year. June 22 at 8:00 AM in one of the seacoast towns across the Maine-New Hampshire state line. I've held off intentionally, wanting to schedule when it felt right and preserve some sense of control over the process or at least my responses to it.

If I've got any advantage this time, it's due to having taken boards once before; I'm a veteran. I haven't slept in the trenches or slogged my way through muddy marshes, but I've seen my enemy face to face and lived to tell the tale. Board exams are an eight to nine hour marathon combining brain-strain with physical endurance. Even with scheduled breaks, it's exhausting.

So, how does an older student prepare for an experience like this? The assumption you run into is that age somehow slows down the mechanism. Biology is supposed to work against you like moisture on a piece of metal left out in the barnyard too long -- you got it, rust forms. It's hard to convince those who've never been in your position that things don't have to turn out that way. Common assumptions can easily be false ones.

You start like anyone else with a lick of sense, as my father used to say. Make sure you're in shape. Exercise, lose some weight, build stamina, and eat better. Add more fruit, lose the refined sugars (I don't mean chocolate, but maybe cut back a little), and drink more water -- it keeps you hydrated and improves learning and memory retention. The exam itself, however, involves sitting for two hours, then a break, then two more hours, etc. It makes sense to try to simulate those conditions, so that E-Day (exam day) is like any other, at least where your backside is concerned.

Regarding the material itself, instead of trying to review the whole of medical school in the next three weeks, I'm using a question bank that evaluates my progress and shows me which specific areas need work. "High yield," I'm discovering, doesn't necessarily mean trying to outguess the test designers as much as shoring up my weaknesses. The main thing is to feel confident and capable based on practice and adequate preparation, since boards, in the words of one of my classmates, are first and foremost, a "head" game.

"That's all well and good," say the assumers, "but it still has to be harder, being older." Truthfully, I wouldn't know, since I never tackled medical school and board exams when I was younger. I have nothing to compare this to. Honestly, it's tough for all of us. And even if it was tougher, that only makes the long-term rewards all the more precious and the celebration, when you walk across the stage with degree in hand, just that much sweeter.

(Public Domain image via Wikipedia)

Friday, May 28, 2010

The Bear's Daughter

"I wonder if Leonard Cohen has this much trouble tuning his guitar?" I asked wryly, to the delight of my date and the couple sitting next to her. We were attending a concert by Judy Collins in Denver and she was having the hardest time getting her guitar in tune while introducing a song by Leonard Cohen, the title of which I forgot long ago. My date, however, I've never forgotten.

She was an older woman -- a high school senior, I was a junior -- and the daughter of one of my instructors. They were Pakistani and she had the most beautiful black hair and dark eyes. I thought a gentleman refrained from kissing the girl on a first date back then -- she did, we didn't, nor did she ever go out with me again. Oops.

It's not that I wasn't interested, because I was, but I think I was a little ahead of my time. See, I wanted to generate curiosity and imagined her leaning back against the door as I drove away, wondering what it would have been like, the magic moment our lips met and the stars all sighed in unison. If a guy follows the advice of the various love advisers on the web and in print, we're supposed to keep women guessing. Uh-huh.

The shy "Would you like to come in?" followed by a tantalizing "My father goes to bed early" as she dimmed the lights, a few years later would have had her in my arms at light speed. Back then, however, I stood my ground. A man has to have his convictions, by golly, even he does live to regret it.

I consoled myself after receiving her curt, "No thanks, not on your life," response to my request for a second date a week or so later, by reminding myself it probably wouldn't have worked out. I liked her father, he was a good teacher -- he was also big. Very big. Much bigger than I was. Besides, even if a bear hibernates, he has to wake up sometime and with my luck, just as I was reaching for his daughter, he'd have decided it was spring.

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Thursday, May 27, 2010

Not a Near-Death Experience, But Close

a champ at holding his breath

It occurs to me, no one seems to have near-death experiences anymore. Have you noticed that? I don't know if they've gone out of style, the bright light needs a replacement bulb, or we've gotten so good at resuscitation that people don't have a chance to notice they took an unexpected left at the corner of Hit and Run and Myocardial Infarction.

They used to be hot, especially in the late 70s. I don't know, maybe they were a carry-over from the 60s -- kind of like the ultimate acid flashback. And naturally, Hollywood snatched up the concept like my cat after a mouse. First, there was Ghost, a tear-jerker of a date flick if there ever was one (I needed three hankies myself) and then Frighteners, a great little Down-Under film with Michael J. Fox. I love Michael -- he reminds me of James Cagney with a 21st century attitude -- and Frighteners is well worth a peek, if you haven't seen it.

What continues to intrigue me about these experiences isn't the idea that something supernatural has occurred since, frankly, they're so idiosyncratic I doubt we'll ever know until it comes our time to "take the plunge." I'm interested in the changes that result in the lives of persons who've had them. They're kinder, more understanding, more eager to love. The knowledge that there's more to come sets them free to live with abandon.

You might think I'm off on a theological binge this morning, and I suppose it could be interpreted that way, but I'm really thinking about my classmates who graduated last Saturday. One of the things that I noticed about all of them, or at least those with whom I spent any time and I did that with as many as I could, was a quality of peacefulness. Now, they may argue that I must have slipped out during the ceremony for a visit with Cheech and Chong, but I'm serious.

Relief is one thing and there was plenty of that to go around, but they really seemed to have arrived at a place where they felt more themselves. The tension was gone from their faces and in its place was (exhaustion? Well, yes, that too) something I had never seen before. It was like running into someone you've known for years and yet, you feel as though you're meeting them for the first time. Maybe peace isn't quite the right word, but whatever they had, it was contagious and I received a double dose.

Medical school isn't a near-death experience, but it comes right close. Somehow the process of getting through, assuming one does so for the right reasons (see 5/26/10), sets a person free to live as though eternity was not only a reality, but it's dropped down into your lap and you've got all the time in the world. True, there's residency ahead, along with packing, moving, and saying goodbye, but four years of holding their breath is over and they've finally come up for air.

(Creative Commons image by Pfau via Flickr)

Wednesday, May 26, 2010

Earning the Name "Doctor" -- Part Two

The Doctor, by Sir Luke Fildes (1891)

The other day, while writing about earning the privilege to be called "Doctor," in the back of my mind I was going in a different direction than the essay itself took me. Madeleine L'Engle has said writing is a matter of following the story and she was often as surprised as anyone else with what came out on paper. I had planned on contrasting those who earn the title with those who do not and I'm glad the essay turned out like it did. But today, I'd like to backpedal a bit and take another look at the subject because not everyone who wears the title has undertaken the task of earning it.

The ones who have, reveal a commitment to taking personal responsibility for themselves and their training. The further along you go in medical education, the more you'll encounter opportunities for failure -- it goes with the territory. It may sound so obvious as to be a waste of space mentioning it, but how we deal with failure and adversity in medicine is even more critical than how often we succeed.

Someone who is resentful about owning up to mistakes or acts as though they are entitled to have them overlooked, has serious problems with assuming responsibility. This is a major thing for me, as you know if you're a regular reader of this blog. It partly stems from the fact that, at age 13, on those rare occasions when my father was ill, it fell to me to run the family retail western store on my own. It was scary, sure, but it was also an adventure in growing up and I learned how to be relied on in a pinch.

So, when a person experiences failure, we want to know they will be the first one to admit it and take steps to correct it. This is one of the primary reasons why we have procedures in place in medical school for helping students cope with failure. We aren't simply trying to help them "pass," we're trying to teach basic principles that can be applied in clinical situations.

For me, one of the defining characteristics of the physician's calling is a sense of yearning. This is more than desire; it's something that comes from down deep producing a willingness to suffer and endure. It turns medicine into a passion, one that my graduating classmates would likely say they'd practice for free (if they didn't have student loans to repay. that is). There are some who just don't have it, though I can't imagine being a doctor without it.

The nature of our legal system permits anyone who completes the requirements to be called "doctor," and that's the only way to fairly approach the matter. But aside from the factual elements, there are other qualities that can't be borrowed, begged, or stolen. They come from within and represent integrity. Passion, honesty, dependability, and devotion to something larger than oneself, in this case the field of medicine, are among the things that distinguish those who've earned the right to be called "Doctor" from those who haven't and very possibly, never will.

(Public Domain image of "The Doctor" by Sir Luke Fildes (1891) via Wikipedia)

Tuesday, May 25, 2010

Therapy Like Soliloquoy

Brillant morning light

He honestly didn't think anyone knew. For as long as he could remember, he'd had the feeling he was living in a kind of one-way bubble that allowed him to see out and prohibited others from seeing in. He could take on any role, changing his demeanor with the evolved skill of a chameleon, and no one would be the wiser. Privately, he laughed at the naivete, the gullibility, of people who were easily taken in. They have no idea, he thought, what's happening right before their eyes.

Women posed a particular challenge. Too attractive and they'd be more interested in themselves; unattractive, they were of no use. Besides, his mother taught him well. She was beautiful, he told me, like no other. Long, wavy hair he described poetically as the color of a desert morning (photo), that brushed against his face when she kissed his cheek. The scent of her cologne -- Chanel -- sank into the fabric of his shirt and he smelled it for hours afterward.

Her pride and joy, she called him, he could do no wrong. But neither could he do anything quite right. His best efforts to please always seemed slightly shy of the mark and "You could do better" was her highest praise. No, beautiful is too much trouble, it requires too much effort, it's too much like her. Pretty is good; pretty enough to get attention, but just a little insecure at the same time. Responsive to flattery and his was always sincere.

It took some doing, investing his time and energy in someone, but like Donald Trump in The Art of the Deal, when he found a winner, he stuck with them. The payoffs could be huge. He remembered the day a so-called friend asked him about love. "Oh, sure, I love so and so," he said, reassuringly, "isn't it obvious?" And of course, he lied like he always did. "Doesn't everyone?" he asked. Love wasn't something he really understood and he knew it, but it didn't matter because getting what he wanted was the best thing of all.

I hesitate to call our time together "therapy," because that implies a two-way conversation. This was more akin to soliloquy. I almost felt guilty taking his money, since it's the audience who should pay for a seat, but if I didn't, there was no way I could have justified our arrangement. I mentioned this to him once and he brushed it aside magnanimously, telling me I underestimated my abilities. He smiled and winked, "Everybody plays some game," he said.

Sometimes, he'd look away and talk to himself, like an actor who draws the audience in with a stage whisper, sharing a secret just between them. Then he'd turn back to me and continue as though nothing had happened. If I hadn't known better, I'd have called it a psychotic lapse -- it certainly felt like reality had suddenly whistled for a cab and headed downtown without me -- but it was mostly evidence that, for him, I didn't exist as a separate person. I was just one more prop he felt he needed to prop up his world and, for a while longer, keep on going.

(Creative Commons image by CFBSr via Flickr)

Monday, May 24, 2010

Earning the Name "Doctor"

At what point does a person earn the right to be called "Doctor?" So asked one of my classmates on Graduation night and as usual, when he casts a line into the water I can't help myself, I have to rise to the bait. It's self-evident that he, along with the rest of my classmates, received this right with their degrees and the swearing of their oaths. By the law, that's it. Black and white, no questions asked, you are or you're not.

But he knew that already. He wanted the big fish and sensed they were to be found in deep water. When did I earn this right is another question altogether. Starting with the obvious, he, I, and the rest of our classmates began earning it four years ago when we walked into medical school orientation, wet behind the ears and brimming with anticipation.

Personally, however, I believe it goes even deeper. Let me begin with an example that I honestly feel a bit self-conscious about sharing. On my last day of psychotherapy internship, a psychiatric resident and I were talking, as good friends will at times like this, about our experiences together and what the future might hold. As I got up to leave, he said, "Beggar, just remember, you are a doctor, no matter which degree dangles behind your name."

As much as his affirmation of my inner physician meant (and it meant a great deal, coming from him), I felt like any other degree would be a betrayal of the person I could have become. As it is, it still took two deaths and my father's terminal illness for me to get up the nerve to act. Yet, all of this was also part of my process. Earning the right to be called "Doctor" begins long before a senior classmate places our first white coat around our shoulders. And we do so in ways that may have nothing whatsoever to do with academic performance.

For some, it's like navigating the switchbacks on Utah's Green River (photo), while others follow a path straight from college, but it's difficult either way. What matters is being true to our vision of a life in medicine. That one is willing to make hard choices, sacrifice, work like a demon, and thereby develop maturity and character, is an essential part of rendering the person on the outside congruent with the one on the inside. To put it another way, the physician within must become visible, and not merely to those with eyes that can see.

It's a metamorphosis that doesn't happen overnight and doesn't become evident without effort. It must be earned -- by blood, sweat, and tears, and sometimes a lot of tears -- but you realize how worthwhile it has been the first time a patient looks you in the face and asks, "Are you my doctor?" And, after miles and miles of everything you've been through, at last you are free to respond, "Yes, I am."

Creative Commons image of the Green River Switchbacks in Southern Utah by BitHead via Flickr)

(Note to the reader: The Green River doesn't cut through the ground beneath it, forming the switchbacks you see in the photo. Instead, the ground beneath it rose upwards, forcing the river to deal with changes in its environment. This symbolizes the way in which life can interfere with our plans, changing our "course," and forcing us to adapt in order to arrive at our destination. For some, this process results in a different destination than one might have imagined. For my classmates, the uplift of the "soil," the stresses it produced, and their responses, have turned out a group of people who have clearly earned the title of "Doctor.")

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Sunday, May 23, 2010

Graduation: Wishing to Remember

Well, as my father used to say, it's all over but the shouting. The majority of members of my entering class are now, and ever will be, Doctors of Osteopathic Medicine. For all of us who were present at graduation, it was truly a triumph -- everything we've shared and suffered together has paid off in spades. It's hard to know where to begin this morning, because at one point yesterday I thought I must have gathered enough material for a week's worth of posts, and it may just turn out that way.

Two things, however, are perched at the forefront of my mind and it's probably best to start with them. One advantage of being an usher at these ceremonies is, you usually have your selection of the best seats. In my case, I was able to choose one right next to the steps that led onto the stage where hooding was to take place. As a result, I had the privilege of shaking hands with every one of my classmates as they passed by.

With each, memories of our first year came unbidden. Sitting in lecture with a future colleague who initially wanted to be a family doctor. Since then, he's come to love psychiatry with a passion that rivals mine, and we've formed a warm and lasting bond. Three with whom I spent long hours bent over a cadaver and so many others whom I've touched and who have touched me in OMM lab. In some cases, we cast aside formality like crumpled paper and hugged and kissed freely. I wouldn't have been anywhere else in the world.

Near the end of the ceremony, my classmates stood to take their osteopathic oath and I stood with them off to the side of the auditorium. I couldn't have sat at a moment like this, my legs wouldn't have permitted it. We've gone through too much, shoulder to shoulder, to merely be an observer. Like Stephen Hopkins, delegate from Rhode Island at the Continental Congress, who wished to remember the faces of the signers of the Declaration of Independence, I wanted to see the faces of my friends as they spoke. I, too, wished to remember.

As family members gathered round during the reception that followed and I was introduced to parents and siblings, it felt unusually familiar, almost as though I was meeting members of my own family for the first time. And it only makes sense, since coming to medical school for me, has been like coming home. Later, as I walked to my car, one of my classmates passed with his fiance, and he waved a roll of nondescript cardboard in the air that could have been photographs or a movie poster, but it wasn't. "There's one of these with your name on it, don't forget," he said with a grin.

It was his diploma and he's right, there is.

(Photo by the author, copyright 2010)

Saturday, May 22, 2010

Graduation Day: What Took You So Long?

PhD doctoral hood for different universities a...

It must be like having sympathy labor pains. Some guys get them when their female partners are close to delivery. This is psychosomatic, of course, the brain creating the sensation of cramping under the influence of a profoundly psychological motivation. The intimate connection between mother-to-be and her male partner becomes incarnate in a mutual physical experience. I think it's really quite wonderful when it happens.

This morning, I'd planned on being asleep at 5:30 and finally gave up the ghost and climbed out a few minutes after 6:00. At first, I thought it was because I was anxious to get a head start on the day and then I remembered. My incoming class has the first of two graduation ceremonies at 9:30 -- their alarms were probably set to go off right about now. Whatever wag said my class goes through medical school as though joined at the hip, got it exactly right.

I know it sounds unusual to have two ceremonies, so let me explain. The first is for the entire university, and while this is something new for us this year, I'm told it's pretty common elsewhere. The second is the one we care most about, when hoods are placed on our gowns symbolizing the doctoral degree, and we take the Osteopathic Oath, formally becoming osteopathic physicians. This is the point at which parents get out the tissues.

It's traditional for hooding to be done by someone who is either a physician or has a doctoral degree, representing the "passing on of the mantle" of responsibility. I've seen physician-siblings and parents in this role as well as professors who've been instrumental in one's career. Two years from today, my best friend, an MD psychiatrist, will do the honors, along with many others present in spirit.

There is a sense in which all of this is anticlimactic, because, although my classmates will be licensed physicians, they can't simply hang out a shingle reading, "Open for Business." I've heard it said jokingly, we give you a degree but we won't let you do anything with it until you've completed residency, or at least not without supervision. But the degree is their admission ticket to residency and from my own experience with residents, this is when the real fun begins.

You know, I've been an usher for two previous graduations and this will be my third, but I've never before had the feeling that one of them was mine. This morning I feel that way. It's as though, being a part of this incredible group of people, I'm crossing the threshold of a vast room -- a spiritual space, if you will -- the length of which will take two years to traverse. At the other end is a tiny, intensely bright light -- so bright I can barely look at it without squinting -- and when I reach it, my friends will be there, not a single one of them asking, "What took you so long?"

(Public Domain image via Wikipedia)

Friday, May 21, 2010

Shake Your Booty

The song "Witchcraft" by Frank Sinat...

Cat: Yawning and stretching, "So, how'd you sleep?"

Dog: Yawning and stretching, "The question is, did I sleep? I think so. How 'bout you?"

Cat: "Are you kidding? I'll nap later, as usual. Beggar ever come to bed last night?"

Dog: "Yeah, and it wasn't last night, it was more like this morning, early this morning, around 3:30."

Cat: "And of course, you stayed up with him. That's what you get for being 'man's best friend,' you know."

Dog: "It's an occupational hazard. The worst part was waiting until he got home to take me out. I think the water was half-way up my eyeballs before he walked in the door."

Cat: "I keep telling you, use my box if you have to. House-trained doesn't mean you've always got to be a hero."

Dog: "Thanks, but no thanks. Toughing it out keeps Beggar conscious of the time, though by 2:00 I was beginning to wonder."

Cat: "Well, he enjoyed himself, that's certain. Walking in with his coat slung over his shoulder like Frank Sinatra and humming Strangers in the Night was a good sign."

Dog: "Sure was, and staying up to write about it all was an even better one. Every time I dozed off, he'd wake me up and tell me about another one of his friends, where they were going for residency, how good they looked, and how much fun they had visiting. Made me feel like I'd been there."

Cat: "They'd never have let you in the door."

Dog: "He mentioned that -- said something about a 'dress code,' and a sign at the entrance to the restaurant that read, 'No Tails Allowed.' Beats me how anyone was going to play 'shake your booty' all night without one."

(Public Domain image of Frank Sinatra via Wikipedia)

Thursday, May 20, 2010

More than a Bonfire

I can't believe it. I missed the bonfire last night, the one in which my entering classmates burned their medical student white coats. I got engrossed in studying board prep materials one of them had sent me, lost track of time, and was brought back to reality when photos were posted on Facebook, such as the one you see here. Oddly, I don't think my absence was completely unintentional, though it was certainly unconscious.

What I mean is, I wasn't consciously planning not to attend, but forgetfulness isn't always accidental. Some things this week are theirs by necessity -- pre-graduation financial aid meetings and so forth -- others by right, and this was one of them. Watching those sport coat-length jackets curl and smolder was a privilege they've paid for by long nights on the wards and sweating through end of service exams. This was their time and while it may not have obviously seemed so, it was a sacred time, as well. And sacredness requires protection.

We've done this before, all of us together. During our annual cadaver memorial service, it's traditional for the first year class to stand on a hill, in a semi-circle, at a distance from the second year class which is seated with family members. In part this arrangement stems from the fact that the cadavers are those of the previous year. Because the new class is still immersed in the rite of initiation that is gross anatomy, they are not yet ready to fully understand its meaning. Accordingly, their role is to act as guardians of the moment. Their presence shields those at the center from intrusion, preserving the solemnity and dignity of what is taking place before them.

So, in a certain sense, being present last night would have felt somewhat incongruous. We can and will celebrate our mutual accomplishments and toast our friendships at this evening's cocktail party and Saturday's graduation, but what took place around the fire last night was for them, the initiates, and them alone.

I can imagine one of my pals poking me in the ribs and saying with a laugh, "Lighten up Beggar, it was just a bonfire." And he'd be right, but not completely. It was that and more. And the "more" is what my friends will carry with them, in some quiet corner of the heart. It was their time and I'm honored to have stood at a distance.

(Photo courtesy of and copyright 2010 by Christina De Matteo, MS-IV -- soon to be D.O., Doctor of Osteopathy.)

Wednesday, May 19, 2010

What No One Else Can Do

After switching on the computer in the morning, I first check email. Then I look at overnight blog stats, take a few minutes to read something inspirational, and then start writing. This morning, however, something drew me back to the email box one more time and I found this:

Dear Beggar:

You and I have never met, as far as I know, but your essay entitled "What Would Holly Say?" struck a chord. At first, I was disinclined to write -- naturally, I was flattered that you should mention me -- and then, at the urging of my writer-husband, felt you would appreciate a response. Now that I'm on the other side of where I used to be, I'd like to offer the following. Feel free to print it if you wish.

You wrote that I was intent on finding a rich husband at one point in my life, and you are correct. My brother and I grew up in poverty, and following the deaths of our parents, lived on our own, sometimes eating whatever we could beg, borrow, and often, steal. If this sounds tragic, it was, but I learned how to survive and I learned you can't rely on anyone but yourself. That's what I told myself and when I made my way to New York City, I was determined to use any means at my disposal to make certain I was never so vulnerable again.

But, as luck would have it, I met a struggling writer -- you may no doubt identify -- who was honest, forthright, and I tried very hard not love him. I didn't want to risk disappointment nor did I wish to find myself scrubbing floors while supporting his dream. Oh, and he couldn't dance either, just so you know.

He was insistent, however, and refused to allow me to play the kinds of games that were essential for relating to the cocktail party set. To this, I wasn't accustomed, but you might say he won me over by his genuineness -- I suppose there's no greater aphrodisiac for a woman than being loved truly. Perhaps, for men as well, though not being one, I can't say.

As to your party, I hope you have a lovely time, but permit me to say, please don't give up being yourself in order to do so. If there is anything I've gained from my own experience, it's this. There will always be those whom we consider more handsome or beautiful, more sophisticated, more adept at everything, but when they've all gone, we're left only with ourselves.

One of my writer's favorite authors is Mark Twain, whom he's fond of quoting, and especially this one: "Dance like no one is watching, sing like no one is listening, love like you've never been hurt, live like it's heaven on earth." I notice you've used this line before and find it meaningful. If that is true, remember then, to dance, sing, love, and live without hesitation. No one else can do these things for you, nor can they do them quite like you.



(Note to the reader -- the "letter" above is a work of fiction, with a tip of the hat to Truman Capote. It's the letter I imagine Holly writing, if she could.)
(Creative Commons image by mix2012 via Flickr)
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Tuesday, May 18, 2010

What Would Holly Say?

And I said, "What about Breakfast at Tiffany's?" She said, "I think I remember the film, and as I recall, I think, we both kinda liked it," and I said, "Well, that's the one thing we've got." ~ Deep Blue

Whenever I think about cocktail parties, the archetypal opening scenes from Breakfast at Tiffany's, come to mind. Narrow-lapel jackets with pencil-width ties that are, thankfully, out of style and I hope stay that way, women wearing pillbox hats that appear to have come back in style, and upbeat Greenwich Village jazz. Faces distorted through martini glasses like reflections in a carnival fun house mirror. Holly Golightly desperately trying to land a millionaire.

Until recently, I thought I was the only one who referred to "cocktail parties" anymore and that seemed pretty retro. I kind of felt my age was showing, rather like a silk slip cautiously creeping from behind a skirt's hem -- you do remember slips, don't you? It's Victoria's Secret that she has, and hopefully, still wears them. But I guess they're making a comeback -- cocktail parties, that is -- because my entering class is having one this week as part of Senior Week festivities and calling it just that.

What goes around, comes around, they say, and it feels good knowing I'm "in" like those pillbox hats, once again. Ordinarily, by the time I've decided I like a particular look, no one else remembers it. I'll hang on for dear life because I'm comfortable if somewhat dated, and a few years later, sure enough, the rest of the world gives me a gander and says, "Mm, he doesn't look half bad -- let's try that." Or at least that's what I tell myself.

The real challenge about this party is there will be -- you guessed it -- dancing. Nothing like the "Electric Slide" from today's The Argyle Sweater, I'm sure, but it's hard to tell in advance. I'd like to have the Fox Trot in my repertoire but we haven't covered more than the basic step in class, so I'm left to my own resources and online demos. In any case, this will be my public debut and with a little luck, the floor will be so crowded no one will notice my toes counting out the rhythm. Sigh, what would Holly say?

(Creative Commons image of Holly Golightly by Jonas de los Reyes via Flickr)

Monday, May 17, 2010

More Than Just a Letter

A map of the Imperial Powers of the Pacific, 1...
For the past few weeks, I've been following the HBO series, The Pacific, a drama similar to Band of Brothers, dealing with the 1st Marine Division in the Pacific War from 1942-45. Last night was the final episode and it depicted some of the difficulties three of the main characters experienced, trying to reintegrate themselves into peacetime.

One of them I found particularly appealing on several levels, and that is the story of Robert Leckie. For one thing, he was a writer and his memoir, Helmet for My Pillow was one of the primary sources for the series. He was also thoughtful and reflective, an intellectual in many ways, caught up in a war that didn't make distinctions between educated or not. Before shipping out overseas, he made contact with a young woman he'd grown up across the street from, and told her he'd write. It's not entirely clear why he chose her and we're left to assume he must have carried a torch privately for a long time.

In any case, he composes letters whose content is surprising. They don't shield her from the things he sees and the brutality he witnesses. They are frank and honest, revealing his inner self in ways one would scarcely expect. I wondered about that and how she might respond, reading a soul unfold she'd barely known previously.

It turns out she never read a single one -- he never mailed them and finally, they were lost in the rain on an island whose name would mean little to her but a great deal to him. His character explains this over dinner upon his return. There is a silence, he looks away and we get the impression their conversation would be much easier if he had a pencil and paper and simply wrote and passed notes to her on the other side of the table. Then she asks, "Tell me what was in them."

When talking about ways of meeting the opposite sex and trying to be more interesting than anyone else who might be standing in the wings, awaiting their chance at whomever we're with, I found the interaction between Leckie and Vera really quite moving. She wasn't willing to let him get away with not revealing himself to her. Whoever he was, or had become, she wanted to know.

It isn't that he was mysterious or tall, dark, and handsome so much as he was genuine and had found a way of getting through hell by telling her about it. And now, she wanted to know, perhaps not so much the content of the letters themselves, but the person who wrote them. The scene changes, the story moves on, and yes, at some point she says, "I do." Watching the two at dinner, however, all I could think was, did he ever find the right one. I guess you could say, he did, too.

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Sunday, May 16, 2010

What Crazy Means

don quixote
Pray look better, Sir...those things yonder are no giants, but windmills. ~ Miguel De Cervantes, Don Quixote

I've often wondered if Don Quixote knew they were windmills all along and decided not to say anything because he thought it was a good day for tilting. Sancho, his trusty sidekick (most heroes have trusty sidekicks who provide comic relief), pointing out the obvious, misses the obvious point, namely, reality is flexible for those who are adaptable. It's rigidity that gets us in trouble.

For instance, have you ever noticed how religious or political extremism isn't usually characterized by a membership desperate to convince the rest of us to be more open-minded? Nor do you see guys parading around the street during times of crisis with signs reading, "Today is the First Day of the Rest of Your Life." I realize certainty can be comforting, but none of these folks seem intent on providing comfort or being supportive. Somehow they strike me more as rub-your-nose-in-the-dirt types. Things are bad and if you pay attention to me, I'll make you feel even worse.

Of course, the story of Don Quixote, despite my casual musings, ends in tragedy. Hidalgo (he really had a first name) falls victim to depression, having become convinced his pursuit of knightly virtue was a delusion, and dies in despair. But what if it wasn't? Not in the literal sense, but metaphorically speaking. Where was the fault in attempting to better himself and exert an influence for good on his environment?

But it wasn't real, one says, life isn't like that. I suppose not, but neither is every man a used car salesman nor every woman saintly. We're all mixtures of the best and worst we can imagine, but we try to behave in ways that highlight the former and minimize the latter. It's not psychotic, it's what makes us civilized. Giving in to rigid adherence to one way of being doesn't make us realistic, it makes us unhappy, unhealthy, and generally miserable to be around. Maybe Don Quixote was delusional, but at least he tried to make a difference and if that's what crazy means, I'll take it over negativism any day. 

(Creative Commons Image by Lamerie via Flickr)

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Saturday, May 15, 2010

Go and Find Your Friends

There is a grace to life, an unwarranted, unmerited generosity that brings things our way when we least expect it. Take yesterday, for example. You know already that I had to make a quick run to the doctor to have a tick bite addressed. Well, after the nurse had completed her initial assessment, asking about my "chief complaint" (the clinical term for what I was doing there in the first place), and taking vital signs, the doctor walked in. So far, it sounds pretty typical.

Except for the fact that it wasn't the doctor, it was a medical student, and not only that, but one of my entering classmates whom I hadn't seen in two years. It was his last day of rotations and better yet, it was his last day of medical school. For the past several weeks, I've been following similar announcements on Facebook, but I haven't actually been with anyone, in the flesh, to share their good news. The look on his face when he told me, was worth the price of a tick bite, several times over.

I'm not saying the reason for the bite and apparent subsequent infection was to get me to the clinic in order to participate in the moment with him, but I confess I have to wonder. What are the odds? He had two weeks of elective rotation left and decided to do extra time in family practice at our university's community clinic. My regular doctor was busy teaching classes, so I agreed to see anyone who was available. Was Mr. Tick following instinct or did Life intervene to propel him with the intention of higher purpose? Was he supposed to bite me in order to initiate the cascade of events that culminated in meeting up with my friend?

Your guess is as good as mine and I'm still scratching my head. All I know for certain is, we had a good time and it was great catching up. He's where I'll be in two more years and I could see myself in his place, anticipating residency, happy to be moving on. While I'm still preparing for board exams, it was encouraging to have a few minutes with one of those with whom I'd begun this process.

Graduation is seven days away and I'm looking forward to seeing all my friends again this week. We'll party, reminisce, talk about the future, and reinforce the bonds we formed in the beginning. At the end of gross anatomy, we had a bonfire in which we burned scrub suits that were stiff with dirt and stank of formulin. Wednesday night there will be another, this one to burn the short white coats of medical school, marking the passage of my classmates from students to physicians-in-residence.

I think I'll keep one of mine as a reminder of all that it cost me to get here, a symbol of a struggle I hope I never forget. The other, I'll throw into the flames of 2012, and watch its ashes rise into the night sky mystically joining those burning this week. And what will I do then? Well, then, as the character Lilly instructs Captain Jean-Luc Picard in the final scenes of Star Trek: First Contact, as he is about to risk everything to rescue Data from the Borg, I'll go and find my friends.

(Creative Commons image by mountsutro via Flickr)

Friday, May 14, 2010

Take That, Mr. Tick

Two mornings ago, I woke up with tenderness in my right shin. Sleepily, I reached down, felt a little bump and assumed I'd scratched myself and it was only now beginning to hurt. Drawing my leg closer to my face, I noticed the "scab" shifted as I rubbed my finger across it, and when I pulled it away, realized it was a tick. Drat, I thought, a blasted Ixodes tick, the notorious carrier of Borrelia Burgdorferi, the bacteria that causes Lyme Disease.

Curiously, the little guy looked dead; he wasn't moving, nor had he managed to engorge himself with blood, as one might expect. Still somewhat groggy, it took a second for me to remember I actually do have blood coursing through my veins, so why he failed to get breakfast was a mystery. I got up, put the carcass aside for safe-keeping, wiped the spot with alcohol and applied bacitracin, a topical antibiotic, thinking I'd watch it for a few days and see what developed.

Fast forward to this morning. I was taping The West Wing as usual, when I glanced at my shin and saw the bite mark had developed the appearance of a small target -- bull's-eye rash or erythema chronicum migrans, the initial telling symptom of Lyme Disease. It wasn't as obvious as the examples we'd been shown in bacteriology, but close enough to make me uncomfortable. So, I wasted no time in arranging a quick visit to the doctor who agreed, it looked sufficiently suspicious to warrant empirical treatment with doxycycline, the drug of choice for adults.

The remaining question, however, is where did the little guy come from? I think it's likely he hitched a ride on my dog -- a fatal error in judgment. You see, my dog wears a potent flea and tick collar while we're walking, and I think Mr. Tick got a good dose of canine hemlock. Nauseated, dizzy, and delirious, he fell into the bed during the night and staggered toward my leg, muttering, "Must...bite...human, fulfill...purpose...must...bite...human."

With an effort that would make Shakespeare envious, he heaved himself onto my leg and thrust his fangs (or whatever ticks have) as far into my skin as he could. It reminds me of a scene from Star Trek II: The Wrath of Kahn. Ricardo Montalban aka Kahn aka Mr. Rourke from Fantasy Island, attempts to destroy Captain Kirk one final time. As he reaches for the button to engage the Genesis Device, he says, quoting Moby Dick, "To the last, I will grapple with thee...from hell's heart, I stab at thee...for hate's sake, I spit my last breath at thee."

Yeah, well, here's the thing. Poetic or not, you're dead, I'm alive and starting doxy. Take that, Mr. Tick.

(Creative Commons image of Ricardo Montalban as Kahn by MHJohnston via Flickr)

Thursday, May 13, 2010

To Have Loved and Lost

5 stages of grief ( anger) #3
"She said she was leaving because I loved myself more than her. How could she do this to me? She's the one who's selfish."

"It sounds like you're angry; anger is part of our normal response to loss and the experience of grief," I told him.

"Oh, I wouldn't say that. I'm not nearly as angry as I am disappointed. I chose her carefully, thinking she could appreciate being treated like someone 'special.' Obviously, I made a mistake, and it's one I won't make again."

"You feel let down by the breakup, naturally. Surely, this must hurt a great deal."

"Not really. It's mostly that she refused to live up to my expectations. I really thought I'd picked the right one this time."

This is an imaginary dialogue that reflects conversations I've had with narcissistic persons of both genders, who've gone through the breakup of a relationship. What has baffled me, consistently, is the way they respond. While most persons feel sad, heartbroken, or become emotionally distraught, they seem to be offended. It's as though a breakup is perceived by them more as an insult than a loss.

I've wondered if their anger isn't defensive, an attempt to protect themselves from the emotional impact of the breakup. It certainly functions like that for most people to some extent. Lately, however, I've begun thinking the problem isn't that they don't wish to feel pain, but rather that they can't. For a loss to be painful, one has to have a sense of attachment to something or someone else. If an individual is unable to form emotional bonds with another, however they describe the experience of loss, it's not going to be painful in the same way most of us conceptualize it.

Depending on the role of the significant other -- a decoration or a resource -- their absence will be experienced, more or less severely, as a blow to the narcissist's self-esteem, suggesting s/he is somehow unworthy of undying adulation or unlimited support. And their response is, how dare someone deprive them of that to which they feel entitled? The inability to put themselves in the place of another, renders them unable to imagine how that individual might think of them differently from how they think of themselves.

This is not to say narcissistic types are unfeeling, but they do appear to feel differently about interpersonal losses. In a sense, one could say, it's not that they don't hurt, but they hurt for reasons that have less to do with being deprived of love than experiencing a wounded self image. Reflecting on this, it occurs to me how much more fortunate one can be, to have loved and known the distress of loss, than to never have realized what was before them. Perhaps, not even after it's gone.

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Wednesday, May 12, 2010

Scouting Surgery

Square Knot

Little did my grandmother know what she was doing when she placed needle and thread in my hands, saying, "Some day you'll be glad you know what to do with these." She thought she was enabling me to take care of myself as an adult, by showing me how to repair torn clothing and darn socks. What she really did was get me ready for this morning's clinic on suturing techniques.

Now, it's true that stitching together two halves of an open wound or surgical incision isn't quite the same thing as hemming a pair of pants or applying decorative buck-stitching to saddle parts in my father's shop, but at least the concept is familiar. And, fortunately, you don't have to run a tiny piece of nylon monofilament through an even tinier needle's eye first, or patients would bleed to death before we even got started. Can't you see it? Some poor guy's lying on a gurney, crying, "Doc, you gotta help me!"

"Yes, yes, I know. Just be 'patient' -- pardon the pun -- it will be a few more minutes while I get this thing threaded," replies the doctor, squinting and poking with gloved fingers at a target s/he needs a magnifying glass to find. No, sutures come ready-made with nice, curved needles that pierce the skin easily -- including yours, if you're not careful.

The trick involves learning to place them while clamping the needle with a pair of forceps in one hand and holding the skin with tweezers in the other. It's like standing in the batter's box with a bat in each hand, trying to hit the ball with both as it passes over the plate. Ambidexterity would be helpful at a time like this and the truth is, when coordination was passed out, my left hand was out to lunch. Obviously, I need practice -- a lot of practice.

Knot-tying is easier and I have Boy Scouts to thank for that. The technique is slightly different, but a square knot is a square knot, whether it's connected to a bridge constructed of rope or securing a suture in place. They don't give out merit badges for the best surgical knots, but after banging my head against the wall through three years of basic science, it will be fun playing "Scoutmaster," once again. Don't tell my surgical preceptors I said this -- they'll probably expect me to start a fire by rubbing two sticks together and that's just too much like work.

(Creative Commons image of Square Knot sculpture by jcarwash31 via Flickr)

Tuesday, May 11, 2010

You Don't Look Like a Puppy

Happiness is a warm puppy

There is no psychiatrist in the world like a puppy licking your face. ~ Ben Williams

"I thought you were supposed to make me feel better," he said, with a twinkle, but his tone suggested he meant more. "How come I feel worse when I leave than when I got here? I know, what do I think is the reason for that. Humor me, why is it that way more often than not?"

"Because, for the last hour, you've been breaking down some of the illusions you have about your life. They worked pretty well for you at one time, but lately, as you know, they haven't been working at all. It's one of the reasons you're here. Now you're confronting what you used to conveniently ignore, and so you feel worse afterward. Sometimes we have to feel badly for a while before we can begin to feel good again."

He nodded and, as he rose to leave, added, "Ben Williams -- you know him? It doesn't matter. Anyway, he once said, 'There is no psychiatrist in the world like a puppy licking your face.' You don't look like a puppy."

"No, I guess not," I said, chuckling, "and I seem to remember my training supervisor advising me against face-licking. But you're getting better; there was a time, not too long ago, when humor wouldn't have been something you used to help you cope. I'll see you next week."

Williams was right and so was Linus when he said, "Happiness is a warm puppy." Facing our demons and breaking through the deceptions they've thrown up to prevent us from seeing them for what they are, is far from easy. When we seek help doing so, we're going to have days when we feel lousy because we're eliminating the comfort denial creates. And that's what we have to do if we're going to live meaningfully. And for some, that means really living for the very first time.

(Creative Commons image by Soggydan Dan Bennett via Flickr)

Monday, May 10, 2010

Someplace In Between

Neon rainbow

I think I know why I'm not a fan (gasp) of American Idol. It's the idea that a person can start at the top and essentially circumvent paying their dues by playing in the bars and chasing that neon rainbow. This is not to say there's no scratching and clawing, grasping and holding onto what remains of one's self-esteem in the process of competing, because there is. What comes about the other way, however, is growth. I'm fond of growth. Growth is a good thing and short cuts to obtain it, like taking anabolic steroids to build muscle, usually have unpleasant side effects.

For one thing, starting at the top doesn't leave a person anywhere to go but down. Down isn't always bad, but I've been there and I'll tell you a secret: up is better. Even if you're on the way up, it's still better than being down, because at least you've got direction.

For another, starting at the top has no memory associated with it. One minute you're nobody and the next you're a household word and all you can say about how you achieved it is, "I won American Idol." It's like the lottery. We'd all like to win, but many who have, have also gone broke. Climbing up the hard way brings with it the reminder of all that we learned in the process. What to avoid, who to trust, and what it's like to be at the bottom.

Don't get me wrong, I'm sure some competitors have stories that would curl my hair and I don't begrudge anyone giving it all they've got. The gal or guy who was laughed at when they announced they were trying out deserves every break they can get. There are definitely different ways of paying one's dues and putting up with doubt and ridicule are among the hardest. The important thing is to keep them current and not forget what it cost to get where we are, because that's how we remain human. And remaining human is the most important thing, whether we're at the top, the bottom, or someplace in between.

Creative Commons image by mag3737 via Flickr; Chasin' That Neon Rainbow words and music by Alan Jackson and Jim McBride, copyright 1995, WB Music Corp.)

Sunday, May 9, 2010

My Three Moms

A Mother's Kiss  [123/365]

That I've been learning to dance would delight two of my mothers -- the third would probably fold her arms, frown slightly, and tell me, "Well, you're a grown man, you can make your own decisions. Just remember to be considerate and a gentleman, and you'll make me proud enough." The first two were related by blood: my biological mother and her sister. The third was my paternal grandmother.

I never saw my mother or her sister dance, but I grew up hearing the stories of them tearing up the floor until the wee hours when they were younger. Those were the days of Glen Miller, Benny Goodman, and Harry James, and my mother loved to do the Jitterbug. My aunt preferred the waltz and she'd be thrilled to know that was the step I learned last night.

My grandmother was raised on a ranch in Montana by parents who lived well-nigh to the century mark. They were serious people, my great-grandparents, and took religion just as seriously. So did my grandmother and I suspect my sense of spiritual discipline comes from her. As far as I know, she never danced, except perhaps, at her wedding. The pursuit of "worldly pleasures" never had much appeal to her, but she loved life, and taught me to value stability.

My aunt taught me to have fun and God love her for it. She carried more responsibility than her small frame ought ever have had to bear, but if she couldn't find the silver lining in a dark cloud, she made one. I learned from watching her there are some things no one should tolerate and finding a way free is just as important as being able to endure. And how we do both is a mark of character.

My mother taught me to cook. "You may marry a girl who knows how and then again, you may have to teach her. In the meantime, I don't want you to starve." Thanks, mom, I got the message, especially when it comes to baking. She also taught me to stand up for myself and take calculated risks going after the things I believed in. "You'll never have any of them if you don't at least try."

I'm very fortunate to have had my three moms and I wish all of them were here to dance with, even if my grandmother typically blushed and wanted to beg off. They're not, and yet they are, and always will be.

Particularly on Mother's Day.

(Creative Commons image by Lab2112 via Flickr)

Saturday, May 8, 2010

A Rainy Saturday Morning

Lawn Mower Racing

It makes good fiction to say, "it dawned raining this morning," but the fact is, I wasn't awake to see it. All I know for sure is it's rainy now and the clouds were moving in late last night. Have you ever thought of all the different ways it rains? For instance, it's probably accurate to say we're having light rain at the moment, which is nothing more than regular rain without all the fat and calories. Sometimes it falls in sheets, at which point I get to replenish my linen closet, and when it pours I find out what a mug feels like, standing under a beer tap.

In any case, I'm glad I finished mowing the yard yesterday. Until I moved to Maine I'd never driven a riding mower. Growing up, those were the toys of the rich and famous. Here, if I had to depend on pushing Old Bessy, that's all I'd do from sunup to sundown. The one I have is a hand-me-down from the previous owner, replete with torn seat and manual choke. It's loud enough to wake the dead, tips eerily going sideways down the hill toward the hayfield, and it will never win a lawn mower race, but it gets the job done.

I've grown rather fond of that mower, actually, and I've taken to giving it a pat and "good job" at the end of the day. I don't suppose the encouragement will keep it out of the shop, but it makes me feel good anyway. Speaking of feeling good, I've noticed something the past few months.

When I moved here, I brought my Colorado tradition of waving to everyone who passes, with me. I figured country folk are the same everywhere and since this is the country, things shouldn't be any different. Well, it turns out they were and I was the only one who did it. At first, I felt like a fish out of water, but I decided if it was good enough for Colorado, it was good enough for Maine, and a little change never did anyone harm. So, I waved and pretty soon, everyone was waving back. If I'm driving down the road and forget, they wave anyway. It's not much, it probably won't change the world, but it makes people feel connected, a little less alone, and that feels good.

(Creative Commons image by matt.wagers via Flickr)

Friday, May 7, 2010

Breathing Room

Original Winnie the Pooh stuffed toys. Clockwi...

"What are you doing, Beggar?" asked my mother .

"Nothing," I replied.

"What's 'nothing?'"

"Nothing special."

"Well, if it's not special, why are you doing it?"

"Because there's nothing else to do."

Samuel Becket, the playwright, must have been a fly on the wall during that conversation, because he wrote, "nothing is more real than nothing." A. A. Milne, too -- it sounds like something Christopher Robin would say. To me, it meant simply, "I'm playing by myself, I'm happy; please, don't insist we stop and analyze it." How a kid like that turned out to be an extrovert, beats me, but he did.

At some point, even the most lively writing collaborations turn into late nights at the computer, all alone. At least they do for me. I've mentioned before how Lynn Smith and I burnt up the phone lines and closed down the restaurants putting our book together. But when it came to unscrambling the notes and wedding words with ideas, it was solitary work.

Interestingly, I don't think writing is necessarily introverted. I "hear" these words as they appear on the screen. In courses on rapid reading, one of the skills a person learns is how to see the lines without hearing them at the same time. Reading a novel, you naturally want to become part of the story, but plowing through a tome like Kaplan and Kaplan's two volume Textbook of Psychiatry, you want to get to the point.

I suppose it's like the difference between singers and entertainers. A singer focuses on interpreting the song; an entertainer is trying to capture an audience and bring them into the experience as participants. I can't write without conceiving of someone reading and listening to these words, spoken their own voice, just as I hear them in mine. This not imagination; I don't daydream you into flesh and blood. More akin to conversation than a letter, writing is delayed dialogue and the space between what I'm doing at this very moment and you're doing when you read this, is called breathing room.

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