Healing. But First, Grieving

Individually and collectively we need a time of healing, physically, emotionally, and spiritually. 2020, the Year of the Metal Rat, has been a year like no other. The multiple upheavals and uncertainties have taken a large toll on us. We need a time for grieving all that we have lost and continue to lose. Not only the hundreds of thousands of Americans who have already died of COVID-19, but also the mounting job losses, increases in domestic violence, gun-related violence, and social isolation, especially for our elderly and other high-risk people. As we enter the darkest days of the year here in the Northern Hemisphere, alongside a second wave of COVID-19 infections and deaths, we need ways of staying hopeful, strong, resilient, and resistant.

What we are experiencing is not simple grief. It is complicated grief. As the Mayo Clinic writers put it, “Complicated grief is like being in an ongoing, heightened state of mourning that keeps you from healing.” Risk factors for complicated grief include social isolation, past history of depression and PTSD, adverse childhood experiences, and other stressors like financial hardships. Medical treatment for complicated grief includes, not surprisingly, grief counseling and cognitive-behavioral counseling. But other treatment interventions known to build resilience and lessen the negative effects of complicated grief are arts-based therapies, narrative storytelling, and other meaning-making activities.

The feminist environmental health and justice writer Terry Tempest Williams, said recently in an interview with Pam Houston, referring to both the very real effects from climate collapse (fires in the West and unrelenting hurricanes in the South) and the pandemic, “We haven’t grieved for it, for the people lost, and if you don’t think that won’t come back at us sideways (well, you’re wrong).”

Key references/sources:

Martha Kent , Mary C. Davies, “Resilience Training for Action and Agency to Stress and Trauma: Becoming the Hero of Your Own Life,” in The Resilience Handbook, eds. Kent, Davies, and Reich, (Routledge, 2013), 227-44.

Josephine Ensign, Soul Stories: Voices from the Margins, (University of California Medical Humanities Press, 2018).

Pandemic Summer Reading

Since I have posted a summer reading challenge (with a health humanities/social justice focus) beginning in 2015, I continue the tradition this year. Please support your local independent bookstores because we need them to survive the COVID-19 pandemic. I miss being able to visit in person my favorite local indie Elliott Bay Book Company.

Thirteen books, left to right in the photograph above.

1-3. Margaret Atwood’s MaddAddam Trilogy: Oryx and Crake, The Year of the Flood, and MaddAddam. Because Atwood can teach us so much through her writing.

4-6. N.K. Jemisin’s Broken Earth Trilogy: The Fifth Season, The Obelisk Sky, and the Stone Sky. Because I am sadly remiss in reading this important sci-fi trilogy.

7. Giovanni Boccaccio’s The Decameron. Because I have never read this bawdy classic of imagined tales by friends escaping the Black Death of 1348 in Florence, Italy.

8. Barbara Ehrenreich’s Had I Known new collection of essays spanning her four decades of journalism. Because I am a big fan of Ehrenreich’s acerbic wit and observations on our society.

9. Tara Wetsover’s Educated. Because I am interested in her take on the power and pitfalls of higher education.

10. Emily St. John Mandel’s The Glass Hotel mainly because I recently finished reading her prescient dystopian (flu pandemic) novel Station Eleven.

11. American Birds: A Literary Companion, edited by Andrew Rubenfeld and Terry Tempest Williams. Because watching birds in my backyard during the pandemic shelter-in-place spring have entertained and soothed me.

12. Brian Doyle’s One Long River of Song, a collection of essays. Because I miss the compassionate and lyrical voice of one of my favorite contemporary writers who died in 2017 from a brain tumor.

13. Louise Aronson’s Elderhood. Because I have heard good things about geriatrician and writer Aronson’s book. And because this is the summer I officially enter elderhood. And because as a society we suffer from extreme ageism as highlighted by our seeming indifference to the high death rates from COVID-19 among our elders. (see Aronson’s article “Ageism is making the pandemic worse” in The Atlantic, March 28, 2020.

What if? What now?

Life is surreal in Seattle in the midst of the COVID-19 epidemic, with our rapidly mounting fatalities from the disease and steady upticks in people testing positive (for the fortunate ones who even have access to testing). The bizarre and awkward dance of social distancing with people walking out into our near empty streets to avoid passing other people at too close a distance. Children riding their bikes in circles outside their houses while frazzled-looking parents yell “Keep riding! You need more exercise!” Most everyone who can basically sheltering in place. An ever-expanding menu of options for homeless people to have safer, uncrowded shelter and medical respite services.

Yet the seasons turn, cheery trees blossom along with Wordsworth’s “a crowd, a host, of golden daffodils.” Life goes on. That is part of why it is so surreal. We now have whatever the opposite of the Shakespearean “pathetic fallacy” should be called. Our current sunny, blithely beautiful weather in Seattle does not reflect the ominous, sober, frightened, shocked, and mournful mood that hangs like a dark and virus-laden cloud over our city.

In times of great stress and grief (this is, after all, a time of collective grief for everything we have already lost and anticipate losing), and trauma—of disaster— we need to support all of our first responders. Not just medics and frontline nurses, physicians, public health workers, emergency shelter staff and janitors. To self-plagiarize (from my book Soul Stories: Voices from the Margins):

“Artists and writers are cultural and spiritual first responders in a disaster: they aid in the attempt to make meaning out of catastrophe and chaos, to find ways to not only survive but also thrive in the midst of adversity.”

Room for Complex Stories

Is it an uplifting story? Does it have a positive ending? How did you end up homeless as a young adult and how did you get out of it? And whatever happened to your son?

These are a few of the intriguing questions I am asked about my 2016 medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net. This is why, at least in part, I wrote my second book on trauma and homelessness, Soul Stories: Voices from the Margins (University of California Medical Humanities, 2018).

Meghan Daum, in her NYT book review “New Memoirs Show How the Other Half Lives” (October 10, 2016), included a review of my book, Catching Homelessness, along with J.D. Vance’s Hillbilly Elegy: A Memoir of a Family and Culture in Crisis and a much earlier memoir by a Southerner, Wilma Dykman’s Family of Earth: A Southern Mountain Childhood. In her review of my book, Daum assumes that I lost or gave up custody of my son and that I must be under a “gag order” because I do not write more about my son or my first marriage. Neither of these are true.

The truth is I maintained joint custody of my son, maintained a good relationship with my ex-husband, and I raised my son full time from the time he was ten—once I had a stable job and home for him here in Seattle. He now is finishing his PhD at the University of Washington, is happily married, and is an amazing father to my first grandchild. They are all very much a part of my current life. So yes—an uplifting story (in the end) and also a complex story. My life is not a neat and tidy Hallmark Moment sort of life. It is messy and complicated and I wouldn’t have it any other way.

This all came back to me this past week through a podcast interview with Janet Perry for Nonfiction4Life.

Loneliness Kills

Living on my own in the kingdom of loneliness for over three months has made me more aware of the pernicious effects of loneliness on health and wellbeing. It does not surprise me that the U.K now has a Minister of Loneliness, and that Prime Minister Theresa May has recently released a loneliness policy report: “A Connected Society: A Strategy for Tackling Loneliness—Laying the Foundations for Change” (October 15, 2018). May calls loneliness a “great public health challenge” and plans to have GPs within the NHS to be able to refer patients to community programs geared to ease loneliness.

Yesterday, I visited a long-standing (36 years) community cafe in Edinburgh that has been successfully combating loneliness among the elderly and people living with mental health challenges Located near the Royal Edinburgh Hospital, a long-standing mental health facility in the Morningside area of the city, the Open Door Cafe is a most welcoming place. From the high school student volunteer, Hamish, who greeted me and served me a great cuppa’ and scone, to the friendly regular customer/patrons who shared their stories with me, this was a place that warmed my heart. It also gives me hope that we can open the community Doorway Cafe in the University District of Seattle along similar lines. They use a pay-it-forward model and also have a robust group of volunteers to keep the place sustainable. In addition, they receive some funding from the NHS.

It also warms my heart to have discovered that the Open Door cafe was founded by an Edinburgh nurse, Peggy Hunter, all the way back in 1982. She said, “I have a dream to turn loneliness into fellowship, isolation into recognition…” and she has done just that.

I love their statement on their website in which they succinctly describe their cafe championing of diversity: “Of course, many people who use our services have a variety of support needs, so you may find having a cuppa is a different experience to that of your usual coffee shop. Can you open your mind to share some space with someone who is different from you?”

A Cheeky American Nurse

P1020873 Immersion experiences in another country, another culture, can bring out the best—and the worst—in people. While living abroad you cannot help but make moment-by-moment comparisons between where you find yourself and where you call home. Seemingly little things: if they drive on the left instead of the right as they do at home, which side of the sidewalk should you walk on? (Answer, at least here in the UK: there are no sidewalk etiquette rules. Expect complete chaos.) To deeper comparisons such as “Why are all British nurses forced into one of four possible specialties (Adult, Pediatrics, Mental Health, and Learning Disabilities) from the very beginning of their education?” Is this Florence Nightingale’s legacy?

As a cheeky American nurse (and nurse educator) living and working in the UK, this British approach to nurse education is something I sincerely hope that American nursing never tries to adopt. There is much to admire about the UK healthcare system, with the prime example being the existence of the NHS—although imperfect, as are all healthcare systems, it is much loved and functions so much better than the US healthcare ‘system.’ It occurs to me as ironic that while the US healthcare system is more fractured than the British NHS, British nurse education is more fractured than is ours in the US. Or at least that is how it appears to me.

This British nursing forced specialization practice is a holdover from the days (not so long ago here) of hospital-based apprenticeship, diploma-level nursing. Of course, in the US, we have also had this form of nurse “training” that is fast being phased out. In the UK, there continue to be debates about the value of a higher education degree for nurses, with some people arguing that university degrees are responsible for the apparent diminishment of empathy among British nurses. Empathy cannot be taught, but it certainly can be encouraged and modeled. I do wonder: how well can that happen in any nurse education model based primarily on traditional lectures with a class size of upwards of 700 (or more) students and multiple cohort intakes and graduations each year? That is the current reality of nurse education in the UK. Mass marketing of (or attempts to teach) empathy not only do not work—they have the opposite effect.

Notes:

The photograph included with this blog post is one I took in London last month at the excellent Wellcome Collection Museum. Even if you cannot visit this museum in person, check out their website for amazing online resources, including their six-part series, “The History of the NHS.”
Although I am currently situated at a UK School of Nursing, I first learned about the strange (to me) structure of British nursing from two non-fiction/memoir books: 1) The Language of Kindness: A Nurse’s Story, by Christie Watson (London: Chatto and Windus, 2018 and 2) One Pair of Feet, by Monica Dickens (yes, related to ‘that’ Dickens), (Middlesex: Penguin, 1946). Monica Dickens’ book is based on her brief stint as a hospital nurse apprentice during WWII. Christie Watson’s book is based on her twenty years’ work as a pediatric nurse in London hospitals. I highly recommend Watson’s book, but not the one by Dickens unless you are a WWII buff of some sort.

Empathy: Walk in My Shoes

Shoes are powerful markers of a person; shoes tend to hold the presence of the person who has worn them. In The Year of Magical Thinking, Joan Didion addresses this phenomenon. After the death of her husband from a massive heart attack, she finds herself holding on to his shoes. She writes, “I could not give away the rest of his shoes. I stood there for a moment, then realized why: he would need his shoes if he was to return. The recognition of the thought by no means eradicated the thought.”*

(…) It was the red sneakers Essie was wearing that drew me to her at the women’s shelter earlier that day. This was the second time in the past several months I had run into Essie at one of our foot care clinics. She wore an orange polyester shirt with a green chiffon scarf tied around her dreadlocks, a pink pleated skirt down to her ankles, and the red sneakers. She told me she only dressed in bright, Caribbean colors: “They keep me happy. I can’t be all down in the dumps when I got these colors on.” Essie had a perpetual and slightly crooked smile, the crookedness perhaps the residue of a stroke.

The women’s shelter is located in a church basement in downtown Seattle near the main shopping district. It is a day shelter, a safe zone for women and children, that serves homeless and marginalized “near homeless” women, especially women dealing with domestic violence. The shelter has multiple case managers, social workers, and volunteer nurses who try to connect women with health, housing, and social services. The shelter workers lend the women a hand, bend an ear to hear their problems, offer a leg up the socioeconomic ladder, a toehold on life. Empathy is their main tool. Empathy is what we try to cultivate in our health science students.

Empathy is “feeling with” as opposed to “feeling for,” which happens at arm’s length sympathy. “Walking in another person’s shoes” is how empathy is most commonly described. But can we ever walk in another person’s shoes? And is it always a good thing to try?

* quote is from Joan Didion, The Year of Magical Thinking (New York: Vintage International, 2006), p. 37.

Note: The above excerpts are from my essay, “Walk in My Shoes” in my book Soul Stories: Voices from the Margins (San Fransisco: University of California Medical Humanities Press), pages 11-12.

Why Write?

From the 2017 Northwest Network for Narrative Medicine Conference, Portland, Oregon

Recently, in a writing workshop on social justice issues, I was given a copy of Terry Tempest Williams’ essay “Why I Write” and in response to the reading of that brief essay, was given the writing prompt, Why do you write?

A simple enough (and in some ways too simple, as in a middle school level) writing assignment, but one that I happily took on. Beside my desk at home hangs an excerpt of George Orwell’s 1946 essay, “Why I Write.” In this essay he includes a list of “four great motives for writing” and they include (here in abbreviated form):

“Sheer egoism. Desire to seem clever, to be talked about, to be remembered after death, to get your own back on grownups who snubbed you in childhood, etc., etc.. It is humbug to pretend that this is not a motive, and a strong one.
Esthetic enthusiasm. Perception of beauty in the external world, or, on the other hand, in words and their right arrangement. (…) Desire to share an experience which one feels is valuable and ought not to be missed.
Historical impulse. Desire to see things as they are, to find out true facts and store them up for the use of posterity.
Political purpose—using the word ‘political’ in the widest possible sense. Desire to push the world in a certain direction, to alter other people’s idea of the kind of society that they should strive for.” pp. 312-313 in, A Collection of Essays by George Orwell, London: Harcourt, Inc. 1946.

So here is my prose poem, “Why I Write”:

I write because my fingers are ink-stained. I write because if I don’t, my pen will explode.
I write to make sense of the world. I write to court chaos.
I write until the rivers of my mind run clear. I write until glyphs are superfluous babble-brook praise.
I write unless there are enough reasons not to. I write unless it is unsharable, and then it stays inside, inscribed, worm-tracing scars.
I write journals, research proposals, reports, patient chart notes. I write poems, blog posts, essays, chapters, books, and marginalia.
I write personal mission statements. I write to humanize health care for patients, providers, and communities.
I write my name. I write my different names beneath the kitchen cabinet of my childhood.
I write because I was here. I write because I am here.
I write to remember. I write to forget.
I write. I am a writer.

I opened this post with a reference to the social and environmental justice writing of Terry Tempest Williams. I close with one of my favorite passages of her writing that I stumbled upon this summer. It is from her book An Unspoken Hunger: Stories from the Field (Vintage, 1995). It reminds me of why I write; it reminds me of the importance of women writers in our world:

“As women connected to the earth, we are nurturing and we are fierce, we are wicked and we are sublime. The full range is ours. We hold the moon in our bellies and fire in our hearts. We bleed. We give milk. We are mothers of first words. These words grow. They are our children. They are our stories and our poems.” p. 59

Find and Defend Our Quiet Places

P1020274 — Summer 2017 solar eclipse in Seattle.

Summer is an excellent time of year to focus on finding and defending our quiet places—not so much hammock, family reunion, and beach time (although those are important), but quiet places necessary for reflection and evaluation.

Reflection and evaluation are both terms we banter around and oftentimes use lightly and imprecisely. So, turning to the clarifying Oxford English Dictionary:

Reflection; Senses relating to mental activities

a. The action or process of thinking carefully or deeply about a particular subject, typically involving influence from one’s past life and experiences; contemplation, deep or serious thought or consideration, esp. of a spiritual nature.

Evaluation

1. The action of appraising or valuing (goods, etc.); a calculation or statement of value.

But turning to a different source, from Maori community activists Tamati and Veeshayne Patuwai (husband and wife powerhouse duo), I learned that in Maori the terms for evaluation and reflection are combined. Several years ago when I visited them at Mad Ave* in Auckland, New Zealand, they told me that the Maori word for evaluation means, “To go to a still pond, reflect, be still, look closely, and then tell the truth—first, to ourselves and then to others.”

No matter what our work, professions, families, and communities may be, pause a moment to consider how much better we’d all be if we could find and defend our quiet places. And then tell the truth, first to ourselves and then to others.

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*Mad Ave in Auckland, New Zealand has been instrumental in finding creative, asset-based youth and community-building solutions in an area of North Auckland that had received the negative label of “Mad Ave.” They have the terrific tagline “Activating Community Potential by Any Means Necessary.” Here are some photographs of their work that I took in September, 2015. Community wellbeing through haiku, monster makery, stream restoration, music-making, and public art. That suspended metal bird sculpture in the community/town square is an indigenous version of our Western phoenix rising from the ashes.