Monday, June 11, 2018

Suicide is a Meme

Anthony Bordain.  Kate Spade.  Young doctors plunging from towers.  Such high profile cases grab our attention, but they are merely tips of an iceberg:  the epidemic of suicide.  What’s going on?  What were these people thinking? 

I wasn’t.  Thinking, that is.  I was far beyond thought.  I had no choice, no other option.  At the tender age of 20, life was unbearable, and I had to make it stop.  Everyone I loved would be better off without me. I remember exactly what I felt, with laser clarity, as if it were yesterday.  Feelings are to belief as facts are to knowledge.  Was there a suicide hotline, 50 years ago?  Would I have called one?  I doubt it. 

My descent into depression was gradual and mundane.  No unique tragedies, just the usual assortment of disappointments, romantic conflicts, a genetic family curse, and a general disillusionment with mankind.  The world was in turmoil:  King and Kennedy assasinations, childhood friends coming home dead or crazy from the Viet Nam War, Kent State, violent demonstrations everywhere.   Graffiti in a toilet stall in the student center read:  “Committing suicide at Rice is redundant.” 

Not everyone who feels sad commits suicide, but contemplation is nearly universal.  Some inciting stimulus is required for actual commission, like a match tossed into the pile of straw.  For me, it was the suicide of a family friend.  She had invited us over for dinner, shortly after her husband left her.  Despite her changing circumstance, she was upbeat and charming, totally devoted to two adorable children.  We shared the same name, spelled the same way, and she understood me, encouraged me.  Less than a week after that nice evening, my parents didn’t show up to meet me for dinner.  That was the time before email and cell phones, so I got the news of her death from a payphone in a dark parking lot.  If I close my eyes, I recall the sound of the nearby surf, the warm, humid air, and the diamond studded black velvet sky. 

Fortunately, I had no access to a lofty ledge, so I couldn’t just take one small step into oblivion.  I didn’t own a gun.  And my room mates came home early.  I have a vague recollection of a large tube pumping out my stomach and waking up to my mother sitting on the side of my bed, wiping my face with a cool cloth.  After a few weeks of therapy, the psychiatrist, threw in the towel.  I wasn’t compliant.  But I was better.  Time and family support lifted the fog of depression.  Here was the big takeaway, the overarching lesson:  my family would never have recovered from the pain of my death.  The real tragedy of suicide is the desolation of those left behind.

It wasn’t grief over the loss of a friend that drove me.  It was simply her act of smashing through the mysterious wall at the outer boundary of life, leaving a gaping hole in reality, like a gash in the side of an airplane at 30,000 feet.  She was the queen of hearts pulled from the house of cards, the domino falling against me. 

Suicide is an impulse that can jump from one life to another, like some viral meme, or a spark from a wildfire that flies across a river or highway to spread the inferno.  If someone else steps over that line, the act is no longer unthinkable.  Maybe the urge to shoot people in a school or a club is a similar germ.  I feel immune now, as if I have been vaccinated.  Still, at the first news about Bordain’s death, before I heard that he had taken his own life, I had a weird random thought.  The world is in terrible shape.  He’s lucky to get out before it gets worse.

Suicide is contagious.  It is a tragic epidemic.  Like any public health crisis, we need more research, more knowledge.  We can’t just build safety nets to catch the falling.  It is just not possible to deliver the a critical message of hope for redemption on a need to know basis, at the crucial instant of decision.  We need to address the forces that drive people to the narrow ledges of skyscrapers.   

Thursday, May 31, 2018

(One of) My Worst Nightmare(s)

An old medical joke compares the strategies that different types of doctors would use to stop a closing elevator door.  The internist would use his hand.  A surgeon, would be more leery of a hand injury, and so he would block it with his foot.  An orthopedist would put his head into the gap.  As a surgeon, my worst nightmare has always been getting a hand mangled in a garbage disposer.  I never dreamed that my cat could be a far greater threat. 

Denial of peril is a natural coping mechanism.  How else does one continue to function?  Like when I was Christmas shopping on Oxford street.  I found it a bit odd, but not worrisome, that there were suddenly guards at the entrance to Debenham’s, inspecting all the purses.  I didn’t find out until much later that the Wimpey’s next door had been bombed.  My mother, at home in Texas, watched it all unfold on television and thought I should come back home immediately.  That was back in the early 80’s, and the IRA was always blowing something up.  But I never felt personally threatened during my year in Britain, even when they blew up the Horse Guard parade an hour after our picnic in Regent’s Park.  The nurse from Northern Ireland said she felt much safer back home than in London, because in Belfast, you knew where the shooting and bombings occur.

Back to the cat.  His name is Amarillo and he has black and white tuxedo fur.  To be fair, he gave me ample warning.  We were changing planes in the Philadelphia airport, in one of those “Companion Care” rooms where you can lock the door.  I let my pet out of his carrier, so he could stretch his legs.  The old bathroom had been retrofitted with electric photo sensing faucets and soap dispenser, and a crude wooden box under the counter hid the plumbing and wires.  I didn’t notice the opening at the end of the box until it was too late.  Curiosity compelled Amarillo to leap through the perfectly cat-sized portal.  I reached in and grabbed him by the scruff of the neck so that he wouldn’t follow pipes and wires through a gaping hole into who knows what kind of netherworld.  When he slipped free, I grabbed his leg.  That must have hurt.  He growled and hissed, but I refused to release him until his teeth plunged into my hand.  Then, he was the one who wouldn’t let go.  Think of the Dune Trilogy pain box conceived by Herbert’s sadistic imagination.  When I finally managed to extricate my hand, it didn’t look that bad.  A little blood, a few poke marks, but everything worked.  Amarillo, to his credit, seemed genuinely stunned and remorseful, and retreated into his carrier. 

It was a three-hour layover and by the time we boarded the plane, my hand looked like a baseball.  My pain score was 9 out of 10.  It was worse than labor, because the agony was continuous.  Back in Florida, I had to take the cat home, empty the litter box, and fill up his food dispenser before taking myself to the Emergency Room.  They sent me home with pills, but by the next morning the swelling was half-way up my arm, with pus pouring out of a few orifices and red streaks approaching my elbow.  I spent three days in the hospital on IV antibiotics.  My right hand was useless, and for some reason the nurse in the ER put my IV in the bend of my left arm, so that side wasn’t much use either.  I couldn’t write, couldn’t type, and eating was a chore.  I watched a few bad movies and 6 consecutive episodes of Law and Order Special Victims Unit. 

I did get better and by the next week, I was back at work.  On Saturday, enter the tortoise.  My hand was 90% better.  It was still stiff and tender, and I was guarding it.  But I saw this reptile, a gopher tortoise, to be exact, trying to escape my back yard.   He was wedged against the fence. Who knows how he got in.  I ran out and carried him through the gate and watched the tall grass shudder in his path as he lumbered across the field.  On the way back into the house, I stopped to pull some weeds among the lantana.  Big mistake.  Searing pain.  I couldn’t see my attacker—probably a yellow jacket, maybe a bee.  Within an hour my hand was once again a throbbing orb and the itching and swelling extended above my elbow.   My sympathetic cat tried to lick it and make it better.

The hand is 99% normal today.  My husband, who was out of the country, has returned home.  I am back at work, able to perform surgery.  Still, I am apprehensive.

There is an old medical superstition that bad things come in three’s.  You see two stab wounds in the ER and you know it’s just a matter of time before someone comes in with a gushing jugular.  I feel like Sleeping Beauty on her 16th birthday, dreading an encounter with a spindle.  I have decided that if I see any animals in distress, they can just do without my help.  Even if a bird flies into the window, or a baby squirrel fall out of the tree.  But what if the neighbor’s pig escapes again?

Saturday, May 19, 2018

A letter to my Father

May 17, 2018

Dear Dad,

I had a nice trip up to Baltimore for Susie’s retirement party.  As you will recall, retirement is a bittersweet process, unplugging from a career that provided purpose and friendships.  I was so proud of my little sister.  People said so many wonderful things about her.  They didn’t just talk about what a good job she had done or how effective she had been as a leader.  They appreciated her subtle, dry humor and her patience and fairness.  Some recounted stories of how she had made them feel welcome when they were new to the job and to the city.  She had encouraged many through tough times, and regularly celebrated accomplishments.  One person said that she was the kindest person he had ever known.  Susie, in her typical self-deprecating manner, said to me, “It’s amazing how easy it is to be perceived as kind.”  She is so like you.
We spent the next two days at her house, sorting, tossing, packing, getting her house ready to put on the market.  She will be moving back to Texas.  Of course, our family home was sold several years ago.  Still, she is still going home.  It has been said that “Home is that place where, when you go, they have to let you in.”  But a place is not necessarily a specific a building.  Home is family–people who love you. 
I helped her install a new tile floor in the bathroom--something you would have done, if you had been here.  I found a box of photos that you took 20 years ago, when you helped her to move into this house.  And in another box, I found a letter that I wrote to you in 1979.  Back in those days, before email, before texting, when we actually hand wrote letters.  I will never forget that you wrote a letter to me every day during my first year in college.  This particular letter had to do with Aunt Frances.  She had recently been discharged from the hospital after a prolonged illness.   The nature of the illness wasn’t stated in the letter, but I recall that she fell and broke her arm.  In the hospital, she had a seizure, and it became evident that she was in withdrawal.  For years, she had taken a “stomach medicine” that contained phenobarbital, and she was addicted to it.  We joked about how this sweet little old lady with matching purse and shoes was a junkie.  Frances was very sick, nearly died.  She was never what I would call a pleasant person, and the withdrawal made her much worse.  She said some very hateful things to Mom.   But she was your sister, and you loved her and took care of her.
The old letter that I found was apparently intended as an apology for seeming unsympathetic to Frances.  I said that I was glad that Frances’ ordeal was over.   I said that I had been more worried about you than Frances—that it was such a strain on you. You always know what to say to make people feel better, to help them see the answers to problems.  I said that it was a rare talent, something that I wished I had.  I went on, at some length, to tell you what a wonderful person you are. 
I said that I was sorry that the letter was not more cheery.  But it must have touched your soul, because you kept it, all those years. 
You used to have this saying, “A successful family is a self-destructive unit.”  You meant that in reference to a nuclear family—that children grow up and build home of their own.  But in a larger sense, a successful family is bound together by the kind of love that endures. 
I can’t mail this letter to you.  The postal service does not make deliveries to heaven.  But I can feel you reading over my shoulder.  Give Mom a hug for me.
Love always,

Monday, February 12, 2018

The Shape of Toilet Overflow

    I have not seen the movie, THE SHAPE OF WATER.  It wasn’t on the airplane playlist.  But It’s a very catchy title, so I have adapted it for my purposes. 
I’m not talking about the icky mess that requires a plunger.  The floaty ball in the tank failed to shut off the inflow.  Anyway, the shape of the water that greeted us after a long day in the operating room, was a flat, giant amoeba.  We propped the door open so that we could sweep out the water.  Some flies got in, but we don’t really care about that.  They are annoying, but don’t carry malaria.  Only the night mosquitoes do that. The skinny cat with the big ears, who always seems to turn up when we are around, came to the door, desperate for some tuna or at least a hot dog, but he was reluctant to cross the thin waterfall over the threshold. 
It’s ironic.  At breakfast, this morning, I said, “Well, at least we still have water.”  That was just before the woman called to us through the kitchen window, announcing that she was the electrician sent to repair our water heater.  I had to inform her that it would futile at that moment, since the power had been off since sometime after 10 pm last night.  And no, it wasn’t that we hadn’t prepaid the power company.   We had 110 credits when I checked the meter before going to bed.
We had encountered a Goldilocks moment when we arrived back in Tanzania.  We were the bears.  Someone had been sleeping in our house, and he left his stuff.  A receipt indicated he was off climbing Kilimanjaro.  When a young man from Oregon returned on Saturday, intending to stay another week, we told him we were surprised to find someone in our house.  Hands on hips, he declared, “Well, they didn’t tell me you would be here.” He wasn’t aware that had been assigned to the wrong house.
We hired a man from town to repair the fridge on Saturday.  The electrician says the hot water heater is fried and maybe tomorrow he will have the right part.  This afternoon, the power was restored, so we plan to heat up water in the electric kettle for a lukewarm bath.  Tom just announced that he is wading back to the bedroom for a nap.
A little voice says that maybe someone is trying to tell us we shouldn’t be here.  But a great big voice says, “Don’t be ridiculous.  This is exactly where you are supposed to be.  Have you ever felt happier, more alive?” 
There’s the way Kilimanjaro glitters in the sunrise, the rope of ants across the kitchen steps, the grapefruit size tumor removed from a young man’s face (and the three similar sized tumors scheduled for next week), the emergency trach in a baby who choked on gravel, the six-hour throat reconstruction in a woman who has been unable to speak ever since she slashed her own throat 7 months ago, in the throes of post-partum depression.  Monkeys are jumping on our car, coming to beg for bananas. 
We’ll have plenty of hot water when we get home.

Saturday, June 3, 2017

Road Trip: The Adventure Begins

The open road beckons:  a six-week odyssey, wending our way from Florida to the east coast of Newfoundland.  We travel in a Tahoe towing a trailer, in the company of two dogs and a cat, visiting friends and family along the way. 
I admit to mixed feelings about this trip.   On the one hand, I am apprehensive and at times my anxiety rises to the level of a sense of doom.  But another part of me says, “Hey, get a grip.  How bad could it be?  Let’s just get it over with.”
The roots of my apprehension are my memories of a family vacation in a recreational vehicle during the summer of ’63.  I was twelve years old and paid close attention during the orientation.  One point that particularly interested me was that you could hear the pump kick in every time you turned on the water.  If the pump ran unceasingly, it meant you were out of water.
 We spent our first night in a campground in Bastrop State Park, in central Texas.  There were no RV hookups.  In those days, such things could only be found in a trailer park.  It was hot that night and my mother wanted to run the air conditioner, which required running the generator.  This was not very popular among the people around us who were sleeping in tents.
In the morning, my father announced that he was going to take a “Navy” shower.  “First you get your body wet, turn of the water,” he explained.  “After you get soaped up, you rinse off.”
He stepped into the tiny bathroom, with the shower head projecting from the wall over the toilet, and we all listed as the water pump kicked in for the first phase of his shower and then stopped.  A few minutes later, the pump kicked in again.  But it didn’t stop.  It droned on as he emerged from the bathroom dotted with soap bubbles.  He didn’t seem that grateful to me when I reminded him of what the man had told us about the water pump.
We did not have a hose to refill the tank.  None of the people around us would lend us a hose.  Generator noise had made our family a pariah.  We drove to a gas station where my father, still coated in bubbles, refilled our tank with water.  When he got back into the driver’s seat, his hand was wrapped in a bloody towel.  My mother asked “What happened?”, but she could not understand his muttered response.  The third time she asked, he shouted, “I cut it on the license plate!!”
I wish I could say that the rest of the trip went smoothly, but the best I can say is that nothing worse happened.  Despite that negative experience, I am taking the plunge once more.  My husband and I bought a third-hand trailer for this trip, and recently took it on a trial run go a campground a few miles from our home.  Facilities for trailers and RV’s have come a long way since 1963.  The sites have water, sewage, and even wi-fi!.  The water hookup was on the wrong side and so we had to run the hose over the picnic table and under the RV, but otherwise things went smoothly.  We only had to return home twice for things we left at home, and then went out for dinner.  There was only one tense moment:  My husband tripped over the water hose, and guess what—cut his finger!!  After a trip to the drug store for band-aids, we decided that one night in the camp was a sufficient trial. 
My parent’s marriage survived that trip more than 50 years ago.  With luck, Tom and I will stay married, too.

Friday, April 21, 2017


“Want to go to Jordan with me?”

This was September, 2013, and so my answer was swift.

“Are you crazy?  We just invaded Iraq.”

Her answer was equally swift.  “So?”

Linda is a New York Speech Pathologist.  She had been invited to lecture at a conference in Amman.  The doctors there asked her to recruit an ENT surgeon to come along to teach them a procedure that restores voice to patients after removal of a cancerous voice box.

It was a worthy project and I wasn’t too busy to go.  I had just relocated to Springfield, Illinois, and my practice hadn’t ramped up yet.  No State Department advisories about travel to Jordan.  So, after a few days of equivocation, I agreed. 

Getting there was easy:  A direct flight from Chicago O’Hare to Amman.  On landing at Queen Aliah airport , I spied three Iraqi passenger jets, grounded since the onset of Desert Storm. 

A couple of other activities had been added to my agenda.  I was immediately whisked from the airport to a conference at the Jordan University of Science and Technology, about an hour north of Amman, near the Syrian border.  In the midst of a sea hijabs, my long blonde hair was exposed for all the world to see.  At first, I was embarrassed, intimidated, thought that I must look like a harlot to them.  But I was received warmly.  I was told that the hajib is a choice, not a commandment.

I lectured in the morning.  In view of my jet lag, I was humanely excused from the afternoon session.  After lunch, when everyone else returned to the conference, I was instructed to wait outside for a driver. 

I stood on the sidewalk, near the curb, gazing at the new and modern buildings that gleamed in the bright sun.  I wasn’t wearing my watch, so I don’t know how long I stood there.  It was long enough for me to be concerned. 

The car that screeched to a stop in front of me was a far cry from the sleek Mercedes that had collected me at the Airport.  This car had seen better days—had a dented fender and needed a paint job.  The driver leapt from the vehicle, grabbed my rollerbag, and motioned for me to get in.

As we sped off, I thanked him for picking me up.  No response.  He leaned forward, gripping the steering wheel tightly.  I couldn’t see the speedometer, but we were moving very fast, and the wind was doing a number on my hair.  I struggled in vain to close the window, but the hand crank was broken. 

I started to wonder, maybe I shouldn’t have gotten into this car.  Who was this driver who would not speak?  What if I’m a hostage?  Visions of beheading videos played out in my mind.  Would I ever see my family again?

My chest felt tight and it hurt to breathe.  I had felt this way once before, when our two year-old son disappeared, briefly, from our home in La Jolla.  We called 911 and searched desperately for what seemed to be forever.  I couldn’t stop thinking, “My son is going to be a picture on a milk carton.”  Within 10 minutes, he reappeared, pedaling up the sidewalk on his tricycle.  He had just toodled off, right under our noses, as my husband and I stood in our driveway, consulting with an architect about a wall to secure our front yard. 

I wouldn’t be on a milk carton.  Worst case scenario, maybe on the news.  And as the car continued southward, I convinced myself that my fears were unfounded.  I resolved to dismiss the dark thoughts and put my trust in the kind people who had arranged the transport. 

Until the car began to decelerate.  As far as I could tell, we were in the middle of nowhere.  To add fuel to my paranoia, a large sedan was parked on the roadside ahead and it was clear that we were pulling in behind it.

The driver of that car got out and turned to face us as we approached.  Two figures stepped out of the rear doors, one on each side, each clad from head to toe in light gray gowns and hijabs.

“My handlers?” I wondered.  My heart pounded in my throat.  I only hesitated a moment after my driver yanked my door open.  What options did I have?  Out in the middle of nowhere? 

As I climbed into the back of the sedan, a bright, voice called to me from the front passenger seat, “Hello there!” 

All was explained.  The passenger in front was a Professor of Midwifery from Australia who had also been lecturing at the same conference.  The sedan was already en route to take her back to Amman when the decision was made to send me back to my hotel, so a second car was dispatched to catch up .  It was a perfectly logical plan.  The only flaw was that my driver didn’t speak English.  Or that I didn’t speak Arabic.

The remainder of the drive delightful.  The two women who flanked me in the back seat were also midwives.  They were charming, intelligent, ardent feminists.  Not as in free loving bra burners.  They were strong and vocal advocates for women’s rights:  education, health care, autonomy…  We arrived at my hotel too soon.

My husband and I have made multiple visits to Jordan to help care for patients and have forged strong friendships with our colleagues there.  It is not a wealthy country—no massive mineral resources—but is the most compassionate and hospitable place I have ever been.  Consider the ratio of refugees to the general population.  At my last visit, the Iraqi jets were still on the runway.

Tuesday, March 28, 2017


Dusk and dawn are two sides of the same coin—sunlight refracted by the atmosphere, the same colors and intensity of light, but in reverse order of appearance.
I have long been a fan of sunsets.  We hear a lot about rainbows—the Bible says they are a sign of God’s promise not to destroy the world by flood again.  He seems to be leaving that task up to us, now, as we saturate the air with CO2, melt the ice caps.  I think sunsets are a much more hopeful sign.
You never know what the sky will look like as we rotate in andout of sunlight.  Sometimes it is gold and rosy, sometimes clouds completely blot out the spectacle, and sometimes the sky is so perfectly clear that the sun just plops under the horizon.  But a beautiful sunset, when you get a chance to see it, can fill you with peace.  If you’re not starving, and you have a comfortable bed somewhere, a sunset gives hope that tomorrow will be better—if not immediate tomorrow, the very next day, then the future, however distant.
Dawn was not often my cup of tea in the first half of my life.  I preferred to sleep in.  And when I did arise early, it was because I had something to do.  I was full of purpose, on a mission, no time to meditate on the horizon.  As a child, I clung so stubbornly to my bed that I never had time for breakfast and was often late for school.  As a solution, my father took to waking me before sunrise, to engage me in some task, feeding the chickens, tending to the horses, milking the cows.  That was fun, and I was ready for school on time.  One summer, I joined the swim team, and the sun was usually a bright red ball on the horizon as my mother drove us to practice.
I have become more of a dawn person in my later years, in retirement.  A major activity each day is a long morning walk with my husband and our dogs, before the heat of the day sets in.  But I still prefer sunsets, looking across the Indian River Lagoon with a glass of wine, as we look forward to a good night’s sleep, with pleasant dreams.
Dusk and dawn look very different, depending on where you are.  From the west coast of Zanzibar, sunset is breath-taking.  But on the east coast, it is dawn that inspires awe.  Long before the sun rises from the sea, its light can play through tall thunder clouds and patchy rain showers.  The orange orb turns yellow, then becomes too bright for our eyes, as it burns away the mist, bakes the sand on the beach.

Dawn is a fire breathing dragon, that cremates last night’s dreams and nightmares.