childhood trauma

In my work I often see adults who have similar, disturbing, and depressing stories, varying mainly in the matter of degree. In childhood they experienced trauma - physical abuse, sexual abuse, emotional abuse, neglect, imparted by parents, neighbors, babysitters, relatives, priests, other kids. They then went on to find solace in drugs and alcohol, and grew to adulthood with armloads of difficulties. Some survived relatively well in school, only to have problems surface in their marriages, in parenting, in employment. They become depressed, suicidal, have personality disorders which no treatment can successfully quell. In my skewed population of people with emotional problems, the story of abuse runs rampant.

So when I volunteer at my son's first grade class every couple of weeks, I can't help but wonder how many of them might also be exposed to abuse? On the surface they all look sweet and open and happy. Some are good readers, some are not so much. Some have trouble sitting still, most do not. Some are "goofy", according to my son, some are serious, some whisper, some yell with excitement. When I'm with them, they tend to be compliant and trusting.

Do you worry about the kids who draw their families and don't put smiles on everyone's faces? Two kids had pictures like that. What I know of their families seems happy and normal. Do they just not possess much artistic skill? Or are their pictures some kind of warning sign?

I don't know that any of these kids have tortured animals or tried to hump a teacher's leg, or set the kid next to them on fire, behaviors that would betray an obvious emotional disturbance. But what signs are there that Daddy drinks too much, or that the parents fight, or that an older brother is curious about his little sister's anatomy? Should those events even be cause for worry? How protected do our kids need to be in order to grow up healthy and happy? Do we need to worry that they are too protected?

I've been reading The Life and Times of the Thunderbolt Kid, Bill Bryson's memoir of growing up in the Fifties. It is funny and engaging and informative. And between the lines it depicts a childhood filled with neglect, at least by our standards. His parents both worked, so he had plenty of time to run, unsupervised, all through Des Moines, Iowa, with his friends. He was ardent in his search for sexual experiences, was smoking at a young age, drinking as soon as his friends could figure out how to steal the alcohol, and, at my count, participated in setting at least two houses on fire. He lived at a time when nuclear annihilation seemed possible at any minute. Foods were crammed full of chemicals, and doctors promoted tobacco products in the media. A little unsupervised play time with friends seemed benign in comparison.

And somehow, without much influence of an education or involved parenting, and lots of influence by friends who seemed to enjoy more than their fair share of illegally acquired alcohol, tobacco, and explosives, he grew up to be a wildly successful travel writer, with an engaging sense of humor and the ability to generate substantial income. Does this mean we don't need to worry so much about our kids? That short of heinous and rare crimes against our children, they will grow up to be just fine? Does it mean, instead, that there's a hidden, very personal, story of emotional dysfunction that Bill Bryson isn't telling us? Or does it simply mean Bill Bryson was damned lucky?

Planting the Dahlias

Just returned from Vermont today with J where we dug 240 holes, planted 200 dahlias, pulled up a ton of catnip and other far worse weeds, and got hot, sweaty, and tired several days in a row. J says he LOVES gardening. Getting paid for digging holes in the dirt is heaven for six year old boys. His idea of taking a break from digging holes was playing tennis, which we also did several days in a row. Mommy appears to be getting in shape despite herself.

We stopped by an amusement park for the second time in a week on the way back home yesterday. J won no less than 8 stuffed animals which he added to the six he won the other day. He had lots of company in the car today for the remainder of our trip. That, and listening to 8 straight hours of Harry Potter on CD kept him amazingly contented.

I've been asked to tell 7 random things about myself.
1. I love reading Harry Potter
2. I've had 18 surgeries to reconstruct my nose.
3. I like to write my chart notes with thin pens that have very dark ink.
4. I love flowers, especially when they are in my garden blooming all at once (like all my peonies going crazy right now), but any other context is pretty great, too.
5. I hate being fat.
6. I am often incredibly insecure.
7. I feel obligated to practice medicine in order to please patients, make money for my family, and to fulfill my dead mother's wishes, but it is writing that I would really like to do. I feel awfully guilty about admitting it, and too insecure to actually do it.

There, my random self.

Now to bed so that tomorrow I can forge on, meeting the needs of son and husband, and feeling guilty about most everything else.

flower arrangements, literature and medicine

I am an official businesswoman. I have a web site to show off my flower arrangements: hsquier.tripod.com , have an official tax ID number, and yesterday sold three flower arrangements. Yeah! Hopefully, I'll be able to participate in the Meridian Artisan's Market this summer. In the meantime, I'm dodging Y's wrath at the "mess" I make. Perhaps he's suspicious of the time I spend doing flowers that isn't spent doing the things he wants me to do! But I LOVE the flowers. Even though they aren't real, they are so beautiful. I love how they turn heads when I deliver them. I love how they are so delicate and glorious and exuberant. I love their colors, their life. I love how alive I feel when I'm putting them together.

Otherwise, I'm putting together a poetry-based death and dying curriculum. Sounds morbid, after those great flowers, doesn't it? But these poems are trying to make sense of life, as they try to make sense of death. I do need some essays to balance them, though. Even I can get too much of poetry. Fun having an excuse to do so much reading.

Best of the bunch: Poetry 180: A Turning Back to Poetry edited by Billy Collins
A Broken Heart Still Beats: After Your Child Dies edited by Anne McCracken
Intensive Care: More Poetry and Prose by Nurses edited by Cortney Davis
Body Language: Poems of the Medical Training Experience edited by Neeta Jain et al.
What I Learned in Medical School: Personal Stories of Young Doctors edited by Kevin Takakuwa, et al.

I'm changing the way the class is structured and taught. First, I want the students to get a voice; the main benefit of the humanities in medicine is to help the students feel human, to retain their humanity. And isn't that what we really want from doctors? Not a sense of dominance and automation, but a sense that they are listening, connecting, caring, and then applying what they know to us in particular.

So the class starts with the student's perspective on death and dying. It starts with their fears about seeing patients, their fears about making mistakes, of missing diagnoses, of causing harm, of feeling incompetent, inadequate, alone, and terrified. Notice how these last fears sound a lot like what we, as patients, might feel? In acknowledging these fears, and sharing them in a safe place, the students can find connection, permission to be human, permission to be imperfect. Only then can they move on to productive conversation about a patient's experiences. Only then can they appreciate how their emotions can affect their ability to care.

Well, enough lecture. Back to the course pack. I'm hoping to put together a literature and medicine course design website. I'll keep you updated.

Writing

I am dreaming of writing again. Dreaming again; not writing again.

I did write a novel once. I wrote sporadically for five years. I would set aside a block of time - six weeks one year, 4 weeks another. For the first three weeks of each session I would try and try and fret and pace and finally get totally frantic. And then finally it would come in one huge blast. I would think the scenes, hear the characters talk, and what was in my head came out my fingers onto the typewriter.

I thought the thoughts of my main character, during those writing moments. Disconcerting. Complete empathy. My self faded away and my focus was complete. And then, with the completion of whatever 50 page section I was working on, it would screech to a halt and stop. Done. Nothing until my next block of time, until the next year.

And then I finished it, proofread it, sent it out, and never looked back. The agent knew it would be a "hard sell;" knew I should revisit it, reimagine it. Fred Busch said I should be true to my vision and how dare anyone tell me it should be the way I wrote it. But I think I knew in my heart that what I had written was basically a first draft. It was too intense, too painful, both to be read by others, or rewritten by me. I had imagined what I would be like as a different kind of woman doctor who happened to have the same medical problem that killed my mother. I went there, I did that, and I didn't want to do it again.

That's not to say there wasn't anything good about the book. Editors wrote nice things as they rejected it for publication. Friends also said they like it. I never sat down and read again myself.

But that character isn't dead in my mind. And I've mapped out her extended family, going back to the nineteenth century. A distant ancestor was nurse to a blind man; she knew all the herbal medicines there were. A grandfather was a country doctor who adopted all the unwanted children he delivered. A cousin lives on a Vermont farm. Her daughter is fifteen (and has been for the last several years, since I conceived her) and has issues with another distant relative who builds a house on her favorite piece of land. And the character of the first book could appear in this second book, or maybe even the third, which is about a medical student who had worked with the first woman doctor. Or maybe there is only one book and they are all in it.

But now there is no book, except in my head. I've waited for that pressured rush to appear, that drive to write that even I can't resist. But it hasn't happened. I teach creative writing, but that doesn't prime the writing pump. Part of me suspects I'm busying myself with teaching so I don't actually have to do any writing. I've been thinking about Montessori schools, thinking about developing a writing program in the new medical school, getting an MFA, teaching literature in hospitals, revising course readings in literature and medicine, writing articles about teaching creative writing, preparing presentations for a conference. Perhaps there is a faint reason to expect some paltry income from some of these things. But really, aren't these just busy work? Are these really my life's work?

During my bleakest hours I think about writing my novel. I don't dream about teaching another course. I don't grieve if I forget to revise a course section or can't figure out the next reading. But I am upset when I read over a scene from my book and can't figure out where it should go next. And when I experiment with point of view and realize I could write it from any perspective but they all have problems. And when I can't decide where the book even starts, although I have an idea of where it ends.

Right this minute I feel better. At least I wrote something. No, it isn't the novel But now the novel feels more real. And writing about it at least helps be believe that it is a real thing, that maybe it will be something I might hold in my hand. That maybe it is about these characters and about me. If it is they who exist then I might disappear again, be unselfconscious, and simply flow. And that would be wonderful.

silk flower arrangements

Flowers and Medicine and Stuff















I got my fill of crazies today. Actually the three hundred pound orange haired screaming cussing drug seeking former prostitute pretty much ruined my day. All my other patients were great, but they kind of pale in comparison with her.

Anyway, it is nice to imagine escaping to the basement and my flowers. I have six storage bins of silk flowers waiting for me. I have baskets hanging from the ceiling, vases on the shelves, foam, wires, leaves, all I need to make as many arrangements as I could ever want. Great feeling of comfort and escape. Wonder if there's any demand out there for flower arranging creative writing teaching family practitioner psychiatrists.




The other thing I imagine is working on the novel I'm thinking of in my head. There is an old lady in it with a huge flower garden; maybe she'll do some flower arranging as well. By the time I get home from medicine, part time though it is, my head is so scattered it is all I can do to get myself to bed (or write on the blog). I tell myself that some day I will get to the writing. Some day I may believe that writing matters. Some day, "some day" may actually come.

In the meantime, I have those flowers in the basement....

creative space

Man how time flies. Thought I wrote the last posting a few days ago, not last year. Work has restarted, tennis classes for junior, diet for me (yeah!), and work and more work and all the little things I have to fit in amidst the regular work.

And it is all ok. Elderly dad is creaking along. He has his routines and they comfort him. I send him flowers and those comfort him, too. Hubby's family has its ups and downs, but I connected with his daughters (by making them cry - I seem to have that knack) and things are up and down there all at once.

And I'm toying with the idea of being a housecall doctor. I don't know - three full time days a week with the possibility of benefits mainly seeing elderly housebound patients (like my dad?!). I'd have to pretend to be an expert at cardiology and diabetes and heart failure and all that. I guess I could brush up on it easy enough. My main plus for the patients is in collaborative care - working with them and their families to better define their goals and to fine tune things without the illusion of curing anything. Just don't want to hurt anybody or mess anything up. Guess I'll explore it.

Psychiatry is going ok. Some weeks, especially before Christmas, I felt especially incompetent. Nobody seemed to be getting better. But yesterday everybody was better and today they were half better. That was more like it. Wish I could get paid to give hugs and encouragement and not feel like I actually have to fix anything. coaching, maybe, rather than doctoring.

I've also been thinking more about an idea that L and I have tossed around. To have a woman's creativity center where women can go to rent quiet space for writing, research, study, arts, crafts, as well as a center where women can collaborate, network, or just hang out and relax. Rooms to work in could be rented by the hour, day, or month. A receptionist would take all messages, and renters could check them periodically, but would not be interrupted except for emergencies. A lounge would provide coffee, tea, and comfy chairs as well as meeting space for readings, talks, support groups, even therapy sessions.

I wonder if there are state or federal arts or humanities grants that might provide some startup funds for such an enterprise. I also wonder if writer's spaces in the larger cities could provide some information about how they started, fees they charge, services and facilities that they provide and maintain. Quiet space for writing, thinking, etc, is important, but hard to come by and even harder to create. It may be easier to provide white noise to block out sound than to soundproof a building that has normal construction. I wonder how on earth anyone who is busy can find time to work on such a project. I wonder how anyone who is busy can find uncluttered space if such a facility does not exist.

I was talking about this idea with a woman therapist colleague of mine, pondering the issue of gender separation. She suggested that men seem to have less difficulty working at home; they do not feel as pressured to meet everyone else's needs. Women tend to feel they have to get family work attended to and have a harder time focusing on their work in the face of others' needs. She felt there was no need to apologise for a womens only facility.

So what now? Any ideas out there?

frazzled and flowers

Tonight I am frazzled. Was told I had to come in to work early to meet with the boss. Now what did I do wrong? Turned out he just wanted me to see a patient quickly. That was fine, but the guy wouldn't shut up. And my schedule looked hideous, two hours of extra patients scheduled, a new patient scheduled in half the usual time. Then the new patient turned out to be a seven year old. I'm sorry, I do adult psychiatry ok, but there's no way I can do child psychiatry, and the therapist know that, but the therapist with ADHD and anxiety has been dropping the ball lately and so I had to cancel that appointment, and then patients' cancellations started piling up and I went from a full schedule to a lame schedule, and then back again. It took me almost an hour to get the last lady to stop crying. Finally I talked her into positive options instead of "I can't do it", and when she was able to admire my flower arrangement I knew she was good enough to go home (with enough drugs to numb her almost to oblivion, just in case). Wasn't as black and white as it sounds, and I do think the meds will help and all. But just as I was thinking my day was over and I could relax, I went out for coffee with the receptionist. She toldl me how she thinks her husband is developing alzheimers, how she has urges to cut herself, and how her multiple personalities slow her up at work and at least her coworkers don't notice "the one that is almost like me." I told her we weren't going to talk about all that stuff, because if I listen to her then she'll have to listen to me, and she really doesn't want to go there.

Oh Maaaaaannn! as they say in Captain Underpants. One more day and I can think about vacation. Right now the trip to Vermont just feels like more work. Part of me is hoping for a nonstop seven day blizzard so we won't have to go anywhere and J can spend all his time digging tunnels and we won't have to lug a car full of presents to Vermont and pretend that Santa tracked us there.

I made two flower arrangements this morning in a pressured burst of creativity before work. One is a tall vase of roses that looks almost really good. The other is a remake of an earlier arrangement. It had spiky yellow fake gerber daisies that looked fine in the box, but make the arrangement look like it had been electrocuted when it was put together. So I took out the daisies and replaced them with pink roses and baby's breath and now it looks like a bridal bouquet. Oh well. Hope A likes girly flowers.

I've promised two more arrangements by Wednesday - one for a table and one for a long shelf for medical assistants I work with. Seems like when I have to do it, I wonder what others will think and it gets harder to sense what is right. Maybe that's what the difference is between me and a professional - they know how to do it right because they learned it; I just have to use intuition to figure it out, and that doesn't always work reliably.