Saturday, November 16, 2013

Wayfaring Stranger

Friday afternoon, the last day of a seemingly interminable week, I surfaced for air. I was working for the first time in a new office across town, my new Friday gig until a new doc arrives in January. The morning had been non-stop busy, but the afternoon had trickled to a halt thanks to a handful of patients who'd apparently decided they had better things to do than keep their appointments. I sat down at my desk and sighed. 

I was tired of leaving for work just after six and arriving home at eight, more often than not with tasks still undone. I was tired of writing notes, reviewing paperwork, seeing patients, taking phone calls; my eyes were bleary from the endless pointing and clicking in our cumbersome and counterintuitive beast of an EMR, working on templates with eye-crossing arrays of multicolored tabs and buttons and boxes and bars ostensibly designed to accommodate every whim of every provider, thereby becoming useful to no one.

I was tired of the logarithmically increasing administrative complexity of every minute step of my workday, from the increasingly Byzantine and ever changing layers of passwords required to access everything, to the fiats and ukases issued by the hoardes of chipper, stopwatch-and-powerpoint bearing consultants who stampede through the office in their loud shoes chanting efficiency ! excellence ! optimization ! flow ! patient satisfaction ! market share ! good corporate citizenship ! leakage ! poaching ! mergers and acquisitions ! ACO ! P4P ! Patient Centered Medical Home ! Meaningful Use ! Virginia Mason ! Toyota ! Gemba ! Seizan ! Lean !

I have taken up a mantra -- maybe even a prayer -- that springs to my lips dozens of times a day: kill me now. Just kill me now, now, now --  I chant it squatting in the subbasement of the towering and tottering, grinding and groaning Rube Goldbergian contraption of contemporary medicine, simply trying to get through the day.

I remembered a little medical office where I did a rotation one summer in med school: it was a one woman private practice in a little house in the country, an all-woman office, in fact. I'd bicycle to and from work, and we'd all eat lunch together at a little table on a screened in porch.

Now lunch is a PB&J  horked down in solitary, while I keep on pointing and clicking, pointing and clicking, pointing  and clicking, yammering into the malapropping Dragon hoping that I don't miss its more egregious transcription errors -- like the recent patient who was spotted eating "Roman Numerals" rather than ramen noodles. Or the one who was drinking "homicidal coconut water", wherever that came from.

(I have, come to think of it, lately been subsisting on a diet of Roman Numerals and homicidal coconut water.)

In short, I am frazzled;  frazzled since last spring when my job (as they often say about patients in the movies) took a turn for the worse. I missed the summer, I am missing the fall, and I am swimming furiously toward winter which sways like a bell buoy in a trackless waste of work, hoping it contains a secret passageway back to life.

So when I looked up Friday there I saw the long array of windows of my borrowed office. Beyond a small parking lot, there were  the back porches of  houses. Beyond the houses, a fragment of a small pond, and a street with kids walking home from school. There were trees, weeds, shrubs.  Everything was bathed in a sublime, late afternoon autumnal light.  It was as if  I'd surfaced from a long underwater sojourn. Sun ! Vegetation ! Passersby !  In my other two offices, the windows look out onto rock walls, one natural, one manmade, but both presenting views of de facto twilight,  unless one cranes ones neck to find a patch of blue sky. But this office -- look ! -- there was the world ! The world from which I'd been exiled ! The world about which I'd been muttering during my tos-and-fros in darkness: this world is not for me.

It was a moment of pure grace -- unmerited, unbidden, there it was: the world, reminding me of itself. All would be well. All was well, in fact.

So I woke today and decided to go out early to take pictures of weeds. The morning was still and overcast, my favorite type of light. I decided to go to the conservation land around the shuttered state school and state hospital.

Dead and dying weeds, my favorite subjects, were in their mid November glory. My eye and lens was drawn to everything in the familiar act of looking --  familiar act of love -- of photographing. A love suspended between letting be and holding on.

I wanted to revisit the little cemetery, clumsily named "Metfern" after the two state institutions that had furnished its corpses between (so said the sign) 1947 and 1979. A makeshift altar had been constructed in the middle of the walled-in field of mostly anonymous graves -- plastic flowers, a sacred heart of Jesus, a billed cap, some coins.

In front of the plaster Jesus someone had, as if in prayer, placed a black, heart-shaped stone.

I immediately thought of the passage in Ezekiel that I had often enough rephrased as a petition --

A new heart I will give you, and a new spirit I will put within you; and I will take out of your flesh the heart of stone and give you a heart of flesh.

Over three hundred hearts of flesh lay buried beneath markers in this small hillside field. 

The plaster Jesus gazed over the numbered graves, some designated C, others P --

 -- Catholic and Protestant -- each group clustered in a seperate sector of the field, living out the Reformation 400 hundred years later and even in death.

So it's fall, l'ange du mort in ascendence, daylight shimmering like water cupped in the two hands of night --

I wonder again why I am so drawn to black mold streaming up the veins of a brown maple leaf

or stippling the cellular terrain between

or splashed everywhere like blobs of paint.

The appeal of evergreen is intuitive: life, persistence, a color that somehow gladdens

even in its mitigated autumnal iterations.

Then there are the things that please from shape -- who doesn't love the cascading rush ?

or the precise, stellate empty seedpods of the hardhack, sometimes known as steeple bush ?

And then there are the things unaccountable and mysterious like this little stone egg or urn in the dry bracts of this Queen Anne's Lace,

and things so spare that they beg to be rendered in black and white.

And the mouths opening to sing inaudible songs -- if only I had the ears !

If only I had the heart !

If only I had the grace to dance like a stripped but greenling branch !

Even the empty cradles are beautiful --

Progeny disseminated absolutely everywhere --

Empty cradles pointing upward like bronze flames !

Tough as stalks and feathers bound to overwinter and survive.

I flee again and again to the arms of the woods to escape what can't be escaped: human affliction -- no, not my own peevish frazzling which is, on a scale of things, a trifle. I mean the rest of it --  the stories the patients tell me, their sudden tears (oh please don't cry !), the vaster afflictions of the world,  natural disasters, genocides, interpersonal violence,  absurdity and alienation, rigid systems of oppression and exploitation, of environmental depredation, trivialities and idolatries and manipulations abounding in every public square --

oh, to spiral away through blackening seedheads toward oblivion !

Maybe my petition is really the opposite: take away this goddamned heart of flesh and install that other model -- pure stone -- incapable of the sorrow that can do nothing at all but mourn, and mourn and mourn.

No, I suppose that won't do.

There is, after all, the realty of the mitwelt, the world-with-others, the navigation of which I am, alas,  constitutionally deficient. A hermit in a crowd --

what, then, shall I do ?

What shall I ever do ?