Wednesday, September 29, 2004

Remembering John Mack

(Photo: Stuart Conway)

When John Mack's face flashed on the TV screen of the 11 o'clock news last night I had the same instantaneous, wordless intuition that I had when Anne Sexton's had decades ago -- that he'd died. I was correct. He was run over by a drunk driver in London on Monday night. I was shocked and speechless, and incredibly sad.

I'd always imagined I'd be surprised by his death some day -- he was, after all, slightly over two decades older than me, and apt to die first. In fact, I've long harbored the morbid expectation of encountering news of his death in the Boston Globe some morning, over coffee and toast. Where, of course, it was this morning. I was not prepared for the immediacy of his dear, familiar face amidst the vulgar prattle of the nightly news. And, to paraphrase the song, I always thought I'd see him again.

I was in therapy, then psychoanalysis with Dr Mack for decades.

Weeks after I'd begun medical school in 1973 I suddenly declared to my parents that I wanted to quit. They'd weathered their queer daughter's shyness and sullenness and even her harrowing dalliance with anorexia without calling in an expert, but this was the last straw. So I was taken to a kind psychiatrist of my mother's acquaintance, who, in turn referred me to Dr Mack.

On Thursday, September 27th, 1973 I wrote in my journal "I have to call a Doctor Mack in Brookline." Dr Mack died on September 27th. September 27th is also the anniversary of my car wreck. It's a strangely, arbitrarily, overdetermined date, yet still, like a dream, significant. Analysis is about interpretation, about meaning and significance. It's about uncovering meaning, creating meaning out of the stuff of one's life.

It's also about process. Dr Mack once called the therapeutic setting a "holding" environment -- a lovely metaphor for a safe and protected space in which one can confront dark and dangerous conflicts and impulses. The analyst guides one though the underworld, or at least that's how it felt to me. He was a wonderful guide -- tall, thin, slightly stooped, soft-spoken, dignified, handsome. I remember his hands -- long, pale fingers that always had bandaids on them. What were those bandaids all about ?

For long, bleak stretches of my life Dr Mack was a constant, faithful, supportive presence. I'll always carry with me the image of the shadowy basement office in his home -- his big, untidy desk, the ceiling-to-floor shelves overflowing with books and journals, and, of course, the couch. It was a dark, warm, cave-like space. And, out in back of his house, beyond the small, rain-scooped zen stone under a downspout, was a long deep garden. I called it The Garden, as in Eden, as in pre-lapsarian paradise, where knowledge does come, after all, and from which one is inevitably ejected. Holding and explusion coexisted.

Is that possible ? One of the most stunning and memorable moments of my treatment with him was long after the analysis was over. It was the mid 1980's, I was divorcing, had a small child, and had returned to face-to-face treatment with him.
And I was drinking like the proverbial fish. Time after time I would agree to stop, promise to stop. How can we possibly work, he'd ask, when you alter the basic stuff of your brain, the basic fabric of your mind and self, with alcohol ? But I would not, could not stop. So finally, after yet another broken contract, he gently pointed out that my attachment to drinking was more powerful than my attachment to him and the therapeutic process. Which we would, therefore, have to abandon.

I was truly expelled from the Garden.

And I was aghast. Aghast at my own infidelity. At the incredible power of the drug that had overcome my deep and fundamental connection with Dr Mack.

Two days later he telephoned to see how I was. It was completely unexpected. I was shocked, and profoundly moved. I'd assumed I'd blown it, ruined everything, would have no second chance. Deserved no second chance. It was the example of his constancy and care that helped me, finally, then and there, to stop drinking and get on with my life and resume our work together.

In 1992 I returned to complete my long-unfinished medical residency at Cambridge Hospital, the same hospital where I'd had some of my analytic sessions with Dr Mack many years prior. He still practiced there, and, in fact saw me for a series of sessions during a particularly stressful patch of my tenure as world's oldest medical resident.

He never sent me a bill.

This morning it struck me that the example of his therapeutic, physicianly constancy might, even now, offer me a key to my own conflicted life as a doctor.

One of Freud's enduring insights is that of transference: how the analysand relates to the analyst as if to a parent. Dr Mack spent many years hosting the imago of my powerful, dominant father. To this day I relate to the world in a slightly subserviant, reverential, daughterly manner. And yet today I'm remembering lying on the analytic couch in his office in Cambridge. It was on the second or third floor under a tall window that looked out upon a tree. Gazing at the tree I would think of the lullaby Rock a bye baby, in the treetop/when the wind blows, the cradle will rock -- he was both my paternal tree and maternal cradle, and today I feel orphaned. The image of tree and cradle, as homely as it is, is an image of peril. Of impending fall. Life is peril, impending fall --

When the wind blows the cradle will fall./Down will come baby, cradle and all.

Falling, midair, the baby is still cradled, still held.

Metaphor and transference aside, he was a brilliant man, compassionate, erudite, and accomplished in many spheres. He wrote a Pulitzer winning biography of TE Lawrence, was a prominent and effective anti-nuclear activist, and, later in his career, courageously explored the boundaries of psychiatry and spirituality. He died horribly, and way too early.

The world is richer for his sojourn upon it, and poorer for his loss.

And so am I.

Wednesday, September 22, 2004


I opened the crisp, white envelope -- an interoffice missive from somewhere deep within the corridors of administration -- and extracted a handsome invitation, professionally printed on good quality cardstock, to the grand opening of the newly renovated ICU. I opened it. On the inside cover I read

"Without a sense of caring, there can be no sense of community."
-- Anthony J. D'Angelo

There it sat, italicized text in a graceful font, enclosed within quotes and dutifully attributed, floating beige on a blue background at the center of its own page. It was clearly a sentiment to be reckoned with, an utterance of great authority, which left no room for discussion.

Without X there can be no Y. Pristine as mathematics, crying out for symbols of formal logic.

It annoyed the hell out of me.

Who was this "Anthony J. D'Angelo" fellow, and in what context had he uttered this phrase ? Was he some sort of medical ethicist or philosopher of medicine from whose oeuvre someone had culled this proposition ? And what did it mean, anyway ?

What is a "sense of caring" ? Is it different than "caring" ? By the same token, is a "sense of community" different from "community" ?

Could he have said, for example:

Without caring, there can be no community.

But couldn't there be a community of the uncaring, bound by the motto "We just don't give a shit" ?

And, furthermore, can a "sense of caring" exist without actual care ? Or a "sense of community" exist without actual community ? As in an erroneous assumption that I am cared for, and a feeling of kinship with people who actually hate me ?

What about the reverse -- "Without a sense of community there can be no sense of caring." Does that apply as well ?


I knew where the quote came from, conceptually. Our hospital's own little slogan is equally fraught with deconstructive pitfalls:

Caring where you live.

Now obviously this is intended to promote the concept of medical services -- medical care plus the more ethereal "caring" -- available near one's place of residence. We are a group of community hospitals, after all, in contradistinction to the big, impersonal tertiary care facilities inconvenient miles down the turnpike in Boston. But "caring where you live" also means, does it not, "it matters to us where you live." Which of course it doesn't, other than maybe it did when the consortium downsized a while back and a whole hospital was set adrift to re-consort with a different community of community hospitals. But that's another story.

That ambiguity aside, the D'Angelo quote seems handpicked to echo both the "caring" and the "where you live" of our own little slogan. How did our PR team ever find it, and who is this Mr D'Angelo anyway ?

So I fired up Google.

And got pages of hits. The "sense of community/sense of caring" quote is everywhere. Am I the only person in America not currently uttering and living by this maxim ? Where have I been ? Has it replaced "in God we trust" on the money yet ? Why hasn't anyone told me about it ?

Next I Googled Mr. D'Angelo. Expecting to find, oh, maybe a medical ethicist, or some sort of medical pedagogue. But no.

He writes quotes. Ready made quotes. Lots of them, apparantly. Booksfull. I suppose one could call them aphorisms. But I won't. He's a youngish guy who embarked on the quote biz in 1995 at the age of 23, and now is director of something called the Collegiate EmPowerment Company, Inc..

Apparantly, upon graduating from college, he suddenly became inspired and these "quips and quotes," these "snippets of timeless wisdom," began to flow from him, quasi glossolalically, into his cassette recorder and from there into his first work, "The College Blue Book," and from there into several other similar inspirational volumes and into a host of self-improvement seminars. Including, to his credit and my surprise, a volume specifically for gay collegians. I noticed that on his company's website Nearly Everything's Capitalized. That must be part of the EmPowering Process. And that his company's maxim is: Helping You Take Higher Education Deeper. Which reminds me, for some reason, of our Dear Leader's infamous "Make the pie higher," and "Put food on your families." The "higher/deeper" dichotomy, clearly intended to provide a rhetorical flourish, seems, well, a wee tad silly. At least to my cynical ear.

It didn't help that I'd been reading Basho's haiku. They, with their clear, concrete, sensual images, are the antithesis of Mr D'Angelo's abstract exhortations. In fact, doesn't this haiku speak of Intensive Care more elegantly and evocatively than Mr D'Angelo's ponderous aphorism ?

From the edge of death--
these chrysanthemums somehow
begin to blossom

(Matsuo Basho, tr. Sam Hamill)

Sunday, September 19, 2004


I am not alone on the river path.

There was the turtle man -- tall, thin, with a gray ponytail -- who told me I must watch for the turtles. They're this big, he said, making a cirle with his arms in front of him.

There was the man on the moped, cheerful, older than me, a bit beat looking, who told me how once, drunk, he wiped out on his little bike and landed in the sluiceway.

There was the heavily accented man, middle aged, who explained that there were sweet berries that taste like yellow peaches near the soccer field. I found them. They looked like tiny, dusty plums. I didn't taste them.

Then there was the retired cop who got off his bicycle to tell me about the incredulity of the Audubon Society woman whom he'd called to report seeing a yellow headed blackbird. I am a retired cop he said, pleading his case to me, and I've testified in many trials. I know what I see.

And then there was the man, quite elderly, who told his birding stories -- I once saw five cardinals by the Moody Street Bridge ! -- with such urgency that he reached over and touched me, lightly, repeatedly, on the shoulder. But that was a long time ago. The birds were better then.

What about the woman with the camera ?

She listens attentively, politely, but is always a bit impatient to get back to her weeds.

Saturday, September 18, 2004

Beings and Nihilists

"I stand for a culture of life," brayed W. to the cheering crowd," where every person matters and every being counts."

These were, of course, anti-abortion code words and nothing more. A previous speaker at the rally, a fundamentalist football player, had provided the flagrant Jesus talk, and the obligatory shrill reference to the "slaughter of innocent children." The crowd went wild.

Bush's watered down stump speech boilerplate could have come from the invocation at a Vegan Buddhist pot luck supper. Did he really say "Every being counts ?" What about all those cows who've died for his red blooded Texan barbecues ? What about all those pheasants and quails who were rounded up for Mr Cheney and his cronies to shoot ?

I found myself, as I usually do when our Dear Leader speaks, screaming at the radio.

"You lying asshole, you don't GET to talk about BEINGS, you don't GET to even SAY culture of life ."

Our president epitomizes the culture of death. Consider his childhood delight in blowing up frogs, a bona fide DSM IV diagnostic criterion for childhood conduct disorder, and the undiluted relish he seemed to take in his role as Texas' Lord High Executioner. This would seem to be enough to garner him full Prince of Darkness status, hands down, no questions asked.

Alas, these were just warm up exercises.

"Ah am," W. growled, "a Wo-ah Prez-dent." How did a born-and-bred Connecticut Lad ever get such a Texan drawl ? Am I mistaken, or does that drawl deepen when he's at his most bellicose ? We saw film footage for the first time the other night of his famous "Mission Accomplished" aircraft carrier landing, of him dressed up in that crotch-magnifying costume, grinning, strutting about, looking awkward and foolish. I winced, ashamed for our country.

Of how many deaths can he boast ?

"We don't do body counts," sniffed one of his generals, when asked about how many iraqi soldiers -- persons, beings -- had died.

He does love his little morulae and blastocysts, though. Never mind that the pain and fear experienced by a slaughtered cow or quail or executed prisoner or soldier is leagues greater than that which a clump of cells feels. Never mind that he mounts no objection to discarding the unused embryos of God-fearing possibly-Republican-voting patrons of infertility clinics. But let someone suggest those same embryos be used for stem cell research -- a life enhancing pursuit -- and he's all over it with the baby-killing rhetoric. This is our War President's "culture of life."

Never mind that beings who are fair game for medical research -- primates, chimps -- are as sentient as a human infant. And far more sentient that a human embryo. The secret is that W's so-called "culture of life," insofar as it is a culture of life, which isn't very, applies only to humans. Male humans, especially. (Viz. no "life of the mother" exception in their anti-abortion playbook.)

How can this man be in charge of anything, let alone the United States ?

Consider Dr Bill Frist, the loathsome fundamentalist Republican Senate Majority leader and thoracic surgeon, who admitted to having lied to obtain cats from some Boston animal rescue shelter when he was a resident in order to practice on them.

Today we read in the Globe that our presidentially-aspirating impeccably-coiffed Governator, Willard "the Mitthead" Romney, has wielded his fiery red pen of manly veto on an obscure clause of the budget -- a clause that would guarantee students the ability to opt out of dissection and chose another more animal-friendly modality of learning biology.

"Over my dead body !" he screamed on the schoolhouse steps, arms crossed over his impeccably suited breast in the traditional, manly gesture of gubernatorial defiance.

Well, no, he didn't really do that. He bleated some incomprehensible thing about how the dissection alternative option "would send the unintended message that animal research is frowned upon" in Massachusetts, thereby discouraging entrepreneurial and business activity. Which, as we all know, is what counts. Is what trumps everything. Except, possibly, the well-being of human embryos. Oh, and by the way, I'll have the veal marsala. Do you like my new mink coat, my baby seal earmuffs ? My new leather sofa ? These eggs from painfully debeaked hens who lived -- suffered -- eight to a small cage so that we might have our morning scramble ? This milk from cows whose babies were wrested from them minutes after birth ? Then penned, hobbled in darkness and rendered anemic so that they might make a succulent cutlet ? These tender chops of baby lamb ? Can I interest you in another dollop of pate de foie gras -- from a duck force fed through a hose until his liver nearly burst from the fatty accumulations ?

Welcome to the Republican culture of life. Where every being counts.

As in body counts.

Friday, September 17, 2004

As The Year Turns

Two one year anniversaries nearly coincide -- I nearly said collide -- in September. My blog anniversary, and the anniversary of my broken neck.

I still drive as if the malevolant vehicles in the oncoming lane -- all monster SUVs from hell with drunken cell-phone-yammering drivers -- were all about to veer and smash into into me.

When I turn my head left it makes a crisp ka-ch-chik sound. When I turn right, there's a little crepitant, sandpapery sound like hair rubbed between fingers. Queer little aural scars.

My blogs also have the textual equivalent of broken necks.

Anita Rust, DOB 9-20-03, began as a repository for poimz. Then Anita broke into a borrowed lament, crying, a la Hamlet, "words, words, words !" Then, even more dramatically, "voids, voids, voids." And now, abandoning the whole poitic arena for good -- for her and its own good -- Anita proclaims her new manifesto, "weeds, weeds, weeds." So be it. Plow the poems under. To fertilize the weeds.

The House of Toast, est. 9-24-03, remains under the same squinchy proprietorship. It has outsourced, for the time being, some of the transcendental stuff to the resident of the backyard hermitage, a neologic, ascetically unillustrated little hovel, Affiction.

This reeks of compartmentalization. Ear-Nose-Throat. Body-Mind-Spirit. Id-Ego-Superego. Breakfast-Lunch-Dinner. Name That Triune.

Freudianly speaking, I have always considered myself more of an hysteric than an obsessive. More oral than anal. This is the house of TOAST, after all, not the house, say, of prunes. But I have a deep streak of the neat freak about me. Ergo my voyeuristic fascination with the Daily Office and the Liturgical Year.

O blessed rage for order, pale Ramon.

See ?

I haven't done much meta-blogging.* I'm a little embarrassed to be blogging at all. I finally confessed to DK, my dear, patient husband, that I -- dieu forfend -- kept blogs. (Darling, I've been raising pirhanas in the basement, you don't mind, do you ?) He took it in stride. He's a tolerant man.

So is my triune Words Weeds and Voids ?

*This would be an example of meta-meta-blogging.

Saturday, September 11, 2004

Let's Do Lunch

It was one of those small awakenings.

It had been a chaotic morning in the clinic. Charts and lab reports and patients were everywhere. The exam rooms were full, and the waiting room was boiling up toward insurrection level. I'd been rushing about like a madwoman. Was I wrong, or were the day's patients even more inarticulate than usual ? First there had been the 90 something woman who'd signed in with a "sore mouth" who suddenly was describing waking at four AM with burning chest pain that radiated to her arms. OK. Swell. Cardiac work up. No problem.

Then there was the dizzy man.

Tell me about your dizziness, sir.

Well, I was sitting there, and, well, suddenly I felt, uh, you know, dizzy.

What did the dizziness feel like ?

Umm, well, my head, uh, it was really, really -- dizzy !

Can you describe the dizziness ?

Uhh, it was, you know, uhhhh, I was in the kitchen and I'd just had my cuppa coffee, and I was talking to my wife, and all of a sudden I, well, it was sort of like I suddenly got really, really ... dizzy.

I found myself pacing back and forth in my office eating lunch.

But it was less "eating lunch" as the civilized world construes it than trying to see how fast I could push a jam sandwich into my mouth. I was chewing the first quarter, wondering how few chews I could get away with before I could swallow and push the next quarter in. Without needing a Heimlich. Chew, damn you, chew ! I admonished my jaws, impatient, grinding, gulping, reaching for the other half sandwich, pacing all the while. Crumbs sluiced down my white lab coat. A red dollop of strawberry jam clung to the corner of my mouth. Still chewing, I wiped it away with the back of my hand. I pushed the third, then the fourth quarter in.

I'd pounded down that sucker in under a minute, I'm sure. I was a veritable eating machine.

Suddenly I had an insight. A disgusting one. I'd put that sandwich away as if I were in an eating contest. I thought of voracious fairground contestants pushing hot dog after hot dog into their mouths, or rooting, face down, in a bluberry pie. I'd always stared at films of such events with a mixture of revulsion and fascination.

The only difference was that I had no more strawberry jam sandwiches. If there'd been a pile of them on my desk would I have, like an insatiable automaton, kept shoveling them in ?

The thought made me dizzy. As in spinning -- we're talking true vertigo, doc -- on the edge of a sheer cliff.

I sat down and took a breath.

I remember once thinking, after a similar lightning lunch, that it would be much more efficient simply to have a large-bore feeding tube hitched up directly to my stomach. Right through the abdominal wall. Bypass the mouth totally. I could probably inject a blenderized jam sandwich through one of those things in 10 seconds, tops. While talking on the phone and signing lab reports.

Something was seriously out of balance. And it wasn't just the dizzy man.

Wednesday, September 08, 2004

Runaway Bunny, II

Empty Nest

... either the empty I is stuffed full of world or it is submerged in the flood of the world
-- Martin Buber

Amidst last winter’s restless, unswept ash,
behind the cinder-laden grate, she found
a bird’s nest, tumbledown and skeletal.
It fit exactly in one upturned palm,
its hollow in her hollow. This is mine.

Her chimney, newly capped, no longer rang
with twittering calls and canticles; the sky
at vespers teemed with swift congregations
darting for shadows, evicted from the street’s
mute ranks of endstopped flues. Leave the light on.

She took the brittle nest, teased out the tracts --
cord, hair, skin slough, milk teeth, old-moon nails --
and wove them through another nest, her own,
her thicket of flux and synapse, swatched with ghosts.
Anions, cats’-eyes, blinked. I. I can’t sleep.

But she will. The porchlight flickers, fails.
Moths scatter, drawn toward other numina.
Swollen windchests finally exhale.
and voices, not human, not angelic, lift
through soot and brick into the terrible octaves

where, twig by twig, the empty nests unweave.


Saturday, September 04, 2004

Transcendental Etude XIII

Who has no house now will never build one
Who is alone now will long remain so,
will stay awake, read, write long letters
and will wander restlessly up and down
the tree lined streets, when the leaves are drifting.

-- from Rilke, "Autumn Day"

It was Sunday morning, that time of the week when the unchurched feel their unchurchedness most acutely. Overnight a chilly wind and clouds had moved in, making explicit what the palpably shorter days had already implied. Autumn was fast approaching. She thought of Rilke's poem, "Autumn Day," and the lines that had always moved and unsettled her. Who has no house now...

House of worship, house of God. She was, and would always be, she'd come to realize, spiritually homeless. Churchless. Pushing her shopping cart overflowing with religious miscellania along the river path. Zafu, rosary, Book of Common Prayer, breviary, Shobogenzo, Catechism, plus an Anglican to Zen list of the local shelters where she was welcome, she knew, to come in from the cold.

There was a word for it. Corporate worship. It was pretty central to the whole Christian project. The Eucharist, after all, represented an assimilation into the Body of Christ. The creeds pledged one explicitly to church, a holy apostolic one no less. And in Buddhism sangha, or community, was, along with Buddha and dharma, one of three official spaces of refuge. She suspected she could not just choose two out of three, thank you, any more than she would be allowed to whittle the Trinity down to Father and Holy Spirit.

She knew she was setting herself up for accusations of spiritual pride, or for a scornful dismissal as just another fickle spiritual consumer, flitting from tradition to tradition in search of the coolest new age accessory, or the latest short cut to the Kingdom of Heaven or anuttara-samyak-sambodhi.

But she wasn't even aware of being particularly interested in salvation or enlightenment. She certainly felt, though, as if she were on a pilgrimage. What was she wandering toward, then ? Can there be a pilgrimage without a set destination or goal ? Maybe search was a better word, although it made her cringe a little, as did much religious vocabulary. She didn't think she could utter the phrase I am a seeker with a straight face. And, again, what was she seeking ? There was no specific answer to that, nor was there any one specific question she was asking.

It was more like, how does one comprehend and live within the basic Mystery of being here at all ?

Plus, she was a loner. A serious, confirmed, card-carrying loner. The landscape between the twin hermitages of womb and grave was fraught with danger. Loud, hungry crowds. The rabble, babbling. Shoving each other aside to get at the goods. Competing. Competing for everything -- stuff, space, prestige, entertainment. She knew her Darwin. Survival of the fittest. She was unfit for the fray. It went against her grain. And, as much as possible, she had fled the arena.

But certainly church would be a refuge from that roiling appetitive world. Was her alienation so profound that even church, even a hall filled with silent rows of meditators repelled her ? Church had this moment now, she'd learned, when everyone is instructed to turn and greet their neighbor. Oh great, she thought. Now I have to shake the hand of and look into the shining eyes of a confirmed believer, someone who has no problems with saying I have accepted Christ as my personal savior and who will immediately recognize me as the confused and insincere poseur that I am. With a look of scorn and horror, or, worse, pity.

Why can't they just leave us loners alone ?

Or, absent that, make a few paltry accommodations for us ? It's the way we are, after all. It's written in our brains and neurohumors. There are laws that address access for the differently abled. There are sidewalk ramps, braille on ATMs -- why can't there be a church for the unchurchable ?

She sighed. It had come down to this. A destinationless pilgrimage. Aimless wandering. It was where she had started and it was where she was. By definition, in fact. Which could also be, she realized, the definition of being lost . Was she so lost she was unaware of being lost ? She had to admit that it could be so. Or maybe there was no such thing as lost, she was simply where she was. And where was that ?

Unchurched, alone, reading, writing, wandering through the cold streets' leaf drift -- the poem pretty much described where she was. She imagined an unspoken, unofficial sangha of churchless hermits. There was a certain comfort in that thought. A slight moderation in what she had to admit was deep, spiritual lonliness.

Looking out the window of our hermitages, we see the faint light of each others' lamps through the trees.

Meeting on the path, we recognize one other instantly, nod slightly, and move on.

Bon Appetit

I've been reading the river trash. As the season ripens, it piles up like fallen fruits. It presents a narrative of appetite and thirst, a text of careless snacking. One could apply quantitative methodologies, and chart the relative prevalence of the sweet, the savory, the salty. Even create maps -- a cluster of Skittles packets beside the footbridge. A Pringles cylinder upended in the knotweed. A Slim Jim sleeve draped over a barberry branch. Would a pattern emerge ?

But how can one possibly interpret a 30 pound can of lard, White Champion Lard, no less, scoured absolutely clean -- good, apparantly, to the last drop -- thrown into the thicket beneath the railroad trestle ?

Is there a hermeneutician in the house ?