I Count My Days

i count my days
weeks lose their meaning
the month is one third gone
then half, two thirds,
accelerating
to much time to pass
and not enough at all
my days are read from checklists
my checklist reads
to check on her again
and so I do
so still and shrunken
i double check that she’s not dead
her pulse is there
but no response to pain
she barely gags.
the fabric of time shifts
slowing to accommodate
her fading days
good-bye mrs. T, i say,
leaving, then to the nurse apologize
for talking to the almost-dead.
oh she heard you, she smiled,
i almost imagine it’s true.

Departures

1. The backpack fits my body like a second skin. It feels good against the curve of my back. as it settles against my hips one hundred masks fall away. I won’t be a stylish new yorker, I may become a doctor but that won’t be all of me. But I can put on this backpack and walk for a long time.

2. The backpack fits my body like skin, like an exoskeleton, and home is where I lay my head, or where i have a friend, or nowhere. I met a woman who can’t return to her mother’s house unless she stops wearing dresses and calling herself Darlene. She just wants a place where she can live, with her cat. She has a friend upstairs in the hospital who’s in a bad way. She warned her friend “that is not working out for you.” “That” was cocaine. Her friend’s family drove up from Savannah to be with her, they aren’t allowing visitors, so her friends are worried. I know just how bad shape her friend is in from morning report; I say nothing. “I’m learning,” Darlene says, to take life one moment at a time.”

3. When the backpack is filled, I hoist it up and tighten the straps, but it still sags under its weight, pulling back against my hips, the buckle presses into my belly. My body sags under its weight.

4. It’s a stormy month to be here. The winds ground small aircraft and turn the Bering Sea into a milky green froth, like dishwater. The earth is gray with volcanic ash, coloring the mud that oozes and tracks everywhere when it rains, and coloring the dust storm whipped up by a cold wind blowing in from the interior. The wind grounds the commercial plane that was supposed to bring a sick baby in from one of the villages. The doctor orders the medevac. Wearing all of my clothes, I stagger forward into the wind like a drunk. The wind grinds dust and gravel against my skin.
On the way to the airfield, the paramedic tries to scare me. “They have polar bears where we’re going.”
From the Cessna Caravan configured with a stretcher, I watch the sun set over the Bering Sea and the snow-dusted bare hills of the Seward peninsula. Between the heavy bank of clouds and the low arctic horizon, the sunset is a long wedge-shaped streak of crimson shot against the surroundings.
When we descend, the pilot dances with the wind, dipping the plane from side to side until we hit the runway. I later learn that this is to prevent the plane from flipping over when it lands in such high winds. I want to snap a picture, but there’s no time- we’re picked up ATV to drive to the clinic.
The baby is fine. We medevac him anyway, stuffed down his mother’s jacket. The ride back to the plane is the coldest I’ve ever been. The paramedic is still trying to scare me about polar bears.

5. When it’s time to leave I find my skin has turned translucent in the subarctic light. Beneath it small blood vessels tangle like roots. My belly softened with winter’s lethargy. And my body has hardened to the backpack.

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A Garden in New York: Thoughts on September 11th

A few days after I arrived in New York, I walked past a startlingly beautiful garden.  It was only a few yards long, and not carefully manicured but filled with an overflowing bounty of flowers and plants.  It filled the narrow strip of space between the sidewalk and a fire station, and on the wall of the building was a plaque dedicating the garden to the memory of the listed firefighters.  Then I understood why there was such a beautiful garden wedged in there.

There are circles of grief, circles of how close you are to the center of us.  When the US reacted in horror and outrage to September 11th, most of us were in quite peripheral circles.  This garden was built by people who had lost friends, colleagues, and probably family.

The TV in the hospital cafeteria is reading names, slowly working its way through the alphabet.  They are up to the “W” names.  Sometimes relatives are speaking for moment about the people they miss.  Others use the old clichés, tired meaningless phrases we assume we ought to hear.

What can I say. What can anyone say.  There is nothing to say after a massacre. 

Rage is an anesthetic, so it hatred.  I think about the outrage in the US in 2001, about the hatred, particularly the vile Islamophobia that took root (and also the vile rumors about Jews that I won’t repeat so as not to give them life).  These are such human responses, though often they responses of people in the outer circle, the people least affected.  The people most affected are often trying to get through the day, and the next day.  The TV is up to the “Y” names now.

I think about the day I realized that the number of civilians killed by the US in Afghanistan had surpassed the number of Americans killed on September 11th.  That was over a decade ago, the numbers have only gone up.  I don’t mean to weigh one group against another, I just want to say: enough.  I am deeply opposed to the idea that the American killings of civilians in the Muslim world justified the September 11th attacks, and I am deeply opposed to the idea that the killing of Americans, in the past or in the future, justifies the continued attacks of drones bombing, killing, civilians in Pakistan and Yemen.

Is there a worse memorial we can build than to continue the killing in their name?  Let’s plant more gardens.  Let’s make sure the families who lost loved ones continue to receive whatever help and support we can give.  Let’s make sure that the traumatized survivors, particularly rescuers, received the support that they need.  And in memory, and in honor, of those who were killed, too young, let’s stop the killing. 

It doesn’t have to be this way: on homelessness, healthcare, and attributes of the city of Sodom

My first elective of my fourth year of medical school will be in pediatric emergency medicine in a poor neighborhood of a big city.  My favorite joke now is that it will be an elective in primary care, American style.  I’m not even sure that I’m joking.

After three years grappling with Israel and Palestine, I feel unprepared for American-style problems, and the inertia and complacency surrounding them.

You know the ragged characters who are a constant presence in American cities, sleeping rough.  Homeless.  In DC, the face of homelessness is black; of course years and decades and centuries of racism contribute to this.  Go to Seattle, the face of homelessness is white, and Asian.  Someone’s always at the bottom and when they fall through the cracks there is very little to catch them.

It doesn’t have to be this way.

You walk down the street, and someone asks you for a dollar.  Maybe they’re the third person to do so that morning.  Your choice is between giving them the dollar, or walking on.  Maybe you’re out of dollar bills, maybe you’re worried that they’ll drink it away, maybe you just want to walk down the street without being asked for money.  Maybe you want a more meaningful interaction than just to give a dollar.  It’s a lousy choice, between giving and withholding the dollar. Of course it helps, but it doesn’t even come close to the changes that need to happen if we want the luxury of walking down the street without being hassled for dollars, or the luxury of sleeping at night while others are cold, unsafe.

Vagrancy is a crime.  That means that wandering around public spaces because you have nowhere to live is a crime.  When my friend Amit, who is not the from the US heard about vagrancy laws, he called them midat Sodom, characteristics of the city of Sodom.  Jewish tradition has a varied list of reasons as to why the city of Sodom was destroyed, it’s not the gay sex so much as raping strangers.  The rabbis add to that other examples of cruelty elevated to an art form: offering a guest a bed, and then, if he is too short for it, stretching his joints with rope until he fits, if he is too tall, chopping off his feet.  And Amit is right: putting people in prison because they have so little their choices are between sleeping in a doorway and sleeping on a park bench, would fit in fine among the other examples.

It doesn’t have to be this way.

They can go to the shelters, where TB is rampant, along with scabies and lice, where the pipes explode on a recurrent basis.  The pipes with *outgoing* sewage.  Yeah.

I’ve spent that last few years living in a country that is poorer than the US, in a poor city in a poor region.  I have seen people making their daily rounds through the dumpsters looking for things to scavenge, I’ve been asked for spare change, but I’ve never seen anyone sleeping rough.  I know it happens here, (especially in Tel Aviv, especially among asylum seekers, whose claims are not considered or are catergorically denied, which gets back to my point about homelessness being a structural problem) but it happens much, much less here.

I just finished my psychiatry rotation.  Not everyone who is homeless in America is mentally ill, but it’s not uncommon.  One of our professors here asked us if we knew what the “psychiatric rehabilitation benefit basket (sal shikum)” was.  “We’re from America,” I told him, “we don’t have those things there.”

He explained that it included a stipend, supportive housing, supportive employment.  My sister worked for a non-profit in Maryland that provided some of those services, and non-profits are part of the patchwork in the US, together with homeless shelters and jails, church basements, doorways, and underpasses.  It isn’t enough.

We can have organized, pro-active, wrap-around services for the mentally ill, options between the street and the psych hospital.  That would be low-hanging fruit, but also a radical change.

We can reduce the gap between what one earns on a minimum wage working full-time, if one is lucky enough to work full time, and the cost of housing in most cities.  It is currently obscene.  Some of the patients I knew at the homeless clinic were mentally ill, others were working as construction workers and at supermarkets and still couldn’t make a go of it.

Meanwhile, maybe ObamaCare will increase peoples’ access to health care other than the emergency rooms.  It will help if doctors don’t refuse to take these patients, because their insurance isn’t “nice” enough, as often happens with Medicaid.  Or we can just go back to agonizing about whether to give a dollar to the guy on the street.  Just, remember that for people on Medicaid, the co-pay for prescriptions is a dollar.

Some stories for world refugee day

I worked with Z at the free clinic in Washington D.C. She and her husband were from the Ogoni tribe in the Rivers state of Nigeria, where all the oil is.  She told me how Shell has caused oil spills all over their land and water, with no clean-up efforts, with no resources coming back into the community.  A group of activists were protesting this, including Z’s husband.  One day, Z arrived at the hospital where she worked as a nurse, and was handed a message: grab your baby son, and go into hiding in the bush.  They are coming for you and your son to get to your husband.  They hid in the bush for three days, and were smuggled into Benin.  Ten leaders of the activist group were hanged in a public square by the country’s military Junta.  Z and her family eventually were given asylum in the US.  They could not return home to see family until the junta fell, years later.  She still will never buy Shell gas.

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When Issa decided to flee Darfur, he and a friend flew to Cairo, and then hired smugglers to take them to Israel.  At the border fence, Issa was shot by Egyptian soldiers, and impaled on the barbed wire.  He was later found by a joint Israeli-Egyptian patrol, who according to the story I heard, first argued over whose responsibility the body was, before realizing that he was still alive.  He was medevaced to Soroka, and underwent emergency surgery that saved his life, but some things cannot be repaired and he was partially paralyzed below the waist.  Some BGU students found out that he was due to be released, in a wheelchair, with nowhere to go, no access to rehabilitation services.  A Christian missionary hostel for recovering addicts agreed to take him in.  A family doctor from PHR took on his medical needs.  A physical therapy student created a rehabilitation plan for him; my friends and I from the international medical school took shifts helping him with his physical therapy exercises and showering.  A group of Israeli students wrote a letter to the Ministry of Health begging them to give him health care.  When that failed, they wrote to the newspapers.  A social worker from Tel Sheva would come and visit sometimes, just to see how Issa was doing.  Issa would answer his questions with “illhamdul’la, illhamdul’la,” thank God, thank God.

One day, his friend from Darfur, with whom he’d tried to cross the border, came to visit.  His friend was working as a farm laborer, with one day off a month.  The friend took a six-hour bus ride to visit Issa, and a six hour bus ride back. The Sudanese refugee community in Arad heard about him and tried to help him out as they could.  Issa’s roommates in the hostel helped him out too, and also stole his pain medications.  Issa’s request for asylum in Israel was denied.  An anonymous donor read that article and paid for Issa to go to a private rehabilitation hospital.  Eventually, he was given asylum, in Sweden.

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I was volunteering at the front desk of the refugee clinic at the Tel Aviv bus station.  A middle-aged woman demands that we help her; there are others ahead of her in line and we insist that she wait, she is not particularly pleasant about that, and keeps pressing us.  We finally get to her, she is here with her mother’s ID and paperwork, her mother lives in Yaffo but has only a Palestinian ID.  Her mother also has suspected cancer in her abdomen. The daughter’s behavior is suddenly more understandable.  I look at the paperwork, the mother’s doctor ordered a CT and she has no insurance.  We can help her set up the CT, we cannot help her pay for it, which seems to be the real problem.  And we cannot help pay for the treatment and drugs that will follow.

And Who Will Help the Helpers?

“Look to the helpers” Mr. Rogers says,
And to where do the helpers look,
When the job is done the numbness stays
And what they saw remains on their retinas
And the smell of burning remains
And someone says “I smelled metal burning” and you say
“that wasn’t metal.”

To where do the helpers look?
To the mountains, where there is no help.
To the moon that shines oblivious of what’s below.

They don’t find help, their blessing is
That time continues on inexorably.
And the sun will shine tomorrow on their skin,
and the next day,
the waning moon peeks through occluding trees
and clear air.
And the cattails will sway loyally like soldiers,
purple-tinged under the streetlamp.

Peace,
Sarah