Identity that refused to fade

Identity that refused to fade

“Who is changing this TV channel to cooking shows?” a nurse was asking, exasperation evident in her voice. “Every time I turn around, someone changes it, and I am sick of it.”

The voices from the ICU patient room were audible in the hallway. I stopped to listen before I entered the room.

“But the patient…” – the nursing student couldn’t quite get the word in. “What about the patient?”, the nurse interrupted. “I am sure the patient doesn’t want to watch some boring cooking show; here, I am changing it back to the news.”

I’m a hospital based cardiologist who does a lot of consultations. Today, 88-year old African American Mr Jaafir, very sick all over, including lungs and heart. A ventilator had been breathing for him for about a week and it didn’t look like he would be able to get off any time soon. Still, he was mostly awake; when people asked him questions, he was able to write the answers on the paper – the ventilator kept him from talking. During one of my earlier visits, I had run into his large family at the bedside – a younger stylish wife and several verbose sisters, all of them clearly attached to the patient, and eager to pass on his life stories.

The family had told me what the current nurse Marcy did not know – Mr Jaafir had been a chef, and a famous one at that! I had listened as they told me of his famous dishes – the ones that people traveled distances to sample, and were featured in local newspapers and TV shows. Not only was he well known for his restaurant cooking but his home was a central location for the whole neighborhood. I had also learned that being the center of attention had resulted in an interesting life with several marriages and numerous children and grandchildren.

I told all of that to Marcy.  She knit her eyebrows for a second to think and then chuckled, “So, Mr Jaafir, this is why you have been banging on the bedrails when the channel was changed?” The patient glared. Having been an authority figure to numerous family members and friends all his life, he did not take kindly to the loss of control. The cooking channel stayed on for the rest of the day. And for Marcy, Mr Jaafir now had an identity apart from being a random patient on the ventilator.

Over the next couple of weeks, the family and friends came and went. Mr. Jaafir stayed opinionated – the bedside table was littered with sheets of paper,  his directives with exclamation marks and triple underlines readily visible. However, his strong opinions could not sway his weakened body, and it finally gave up. He knew it before it happened, and his writing changed from “I want to go home” to “let me go”.

I stood at attention with the rest of the staff and his family when his body, covered by the American flag to honor his service to our country, was taken away to the morgue. I had admired the way this man had lived – with a strong sense of self, touching multiple lives on his way, taking care of his family, commanding strong respect in his career. Even more, I admired the way he had died. The formidable sense of self had accomplished a rare feat – retaining his identity while helpless in the ICU. He died as he had lived – strong, surrounded by family, firm in his insistence to choose his own path.

Version 2

Self-care tip: You are you. Don’t let people change that. Keep your identity.

Question: Have you felt your identity fading in difficult life situations, such as depression, sickness, and/or stress? Tell us your story.

Old and Dying – Why We Are Still Alive

geriatric lady

Sweaty, well-worn, in bike-ware, she was eating comfortably with her friend.  I kept trying not to stare and just had to fight it!  I wanted to imprint her shiny wrinkled yet blooming geriatric status and break down what I saw into categories of self-care moves to grow old by.  She looked really good.

I managed to finish eating at, (Oh my word! Yum! My new binge and bolt location,) Zinc Cafe, without ruining her appetite with a big hug and smooch from crazy-staring-stranger, me.  I almost congratulated myself, it was so hard not to do.  Nevertheless, when walking out I did stop and tell her she was beautiful and that I wanted to grow up to be her.  She bloomed even more, right there and then.  It was swell.  Good food.  Good role-model to remember.

We think it is our best years that people will identify us by.  But they do not just do that.  They think of us as how we are now too.  More importantly is how we think of ourselves – of Me.

It is different for everyone.  Why we want to be here.  Understanding why, is a universal interest.  It is the other side of value in the aging process.

My parents are getting old.  I am.  My patients and their parents are getting old.  We are dying.

My dad is old.  He just turned seventy-nine.  He is not wearing bike shorts.  He is not a blooming geriatric.  But I value him and saying why, well, I realize starts with “Me.”  It is not because of him thirty years ago. It is about his life these last thirty years.  It is about his Me, now.

The present does not prove nor negate the past.  Our value is more than that.

Sometimes I visit community practitioners.   Please visualize that all of this is in the middle of their busy clinic day, racing between exam rooms to meet patient needs.  I am standing at a nurses station perhaps, dressed in something über professional, (to hide the gypsy in me as well as I can.  But if it were you, you would not be fooled by the cut of my lapel!)  I catch the eye of the clinician and receive a strained smile, almost hearing her say, “Come on!  I’m dying here!  I have three patients waiting!”  But generally they do not actually say it, generally.  And sometimes, they are snagged by the magic of connection, take my elbow and draw me away into a private space where they can share their story.  In a matter of moments.

We are skilled at shaving moments here and there.  Skilled at putting as few words into a fat minute that can convey the large concept needed just Now!  We learn this over brow-beating years of managed care medical practice, personal choices, convoluted expectations and need to please – self, other, insurance or what not.  When clinicians share stories, we do it like we are late catching the train to heaven.

From these visits, I get more to my quality of practice.  I get known, and get to know.  Awesome.  It is a newer part of my “work,” that I have been doing this, and I am loving it.  I meet the people who are the other side of our patient’s treatment team.  I meet people who are both human and medical clinicians.  Realness surrounds them.  Life stories come from them.  In a fat minute I hear about their past, gain some understanding of their present and from that, I am given much.  One physician told me of his beloved daughter who suicided, another of her husband’s chronic brain illness and how their family struggles.  I shared how my young cousin hung himself and that part of me who is groping toward that space and time before he died.

To know who we are despite our changing emotions and behaviors, our changing identities, improves our understanding of life value.  Somehow, Dad has known that, without bike shorts.  He continues to mentor me in that.  I do not know about the beautiful geriatric at breakfast, but who is to say she does not know her value?  Not Me.  But I am going to explore my own, for my sake.  I am getting old.

Self-Care Tip:  Look and look some more for why you are valuable.

Questions:  What is valuable about you, even though you have lost so much in life?  Why are you still alive?  Please tell us your story.

Related articles

 

The Tabouli Song

Oh my freaking word! This is so funny. I am crying over here.

My Brother and his family came over today to visit with sweet moves and perfect middle-eastern minor cords coming off them. The great GoRemy is now a favorite.

I wish I had seen this before reuniting with my family from Lebanon yesterday at my parents home. They are just in from Beruit and, my word! The stories they live. I am glad GoRemy will bring a smile to their faces. They are in a terrible war and live yet with hope, although death is all around them.

“Why are you going back?!” I asked them.

I wanted to wrap each them up in some filo dough and take them home with me forever.

I cannot explain exactly why they are going back soon. Who can explain the reasons why we each want to be home. Reading, “Sarah, Plain and Tall,” by Patricia MacLachlan, with my kids the other day, I remembered their fight with the land that betrayed them during the dust bowl. I remembered their dad, as if he were my own, running out into the hard weather to save what he could. They were hungry, overworked, thirsty and looking at each other for meaning. Their fear of losing what they loved was as intense as their fear of any disaster.

“Caleb Witting: Seal was worried. The house is too small, we thought, and I am loud and pesky. Anna Witting: We thought you might be leaving us because you miss the sea.
Sarah Wheaton: Well, I’ll always miss my old home, but the truth of it is, I’d miss you more.”

And I guess for my relatives, it is no less of a conflict.

I hope you enjoy “The Tobouli Song,” with us and think about your own story. Keep on.

Self-Care Tip: Explore what makes you go back.

Questions: What makes you return… Or not? What do you call home and why? Please tell us your own story of what is worth it to you.

A Young Man’s Wrenching Journey

Children!

On Jun 18, 2013, Anon wrote:

Hello Dr. Sana L. Johnson-Quijada,

Thank you for coming to talk to share some of your experiences and views associated psychiatry. I am sorry I have not emailed you sooner.  This was my first year taking three sciences and when it came time to study for finals, I pretty much ignored everything except school.

Thank you for giving the class and myself some exposure to psychiatry. Your talk was very intriguing, especially how you see a person, in particular how their brain health affects their personality. When you started to talk about homelessness it brought back painful and confusing memories from my childhood.

My parents divorced when I was seven and the majority of my time was spent with my mother because my now deceased father had a difficult time keeping a roof over his head and doing the activities of daily living. When I was a little older I even loaned my dad some money when his car was impounded. I could not understand why my dad was in the situation he was in and why I was seemingly more capable than him. I loved him very much and wanted to help him in any way I could.  But in the end, I could not make any of his decisions for him.

My older brother is living in a shelter and he reminds me of my dad in so many ways. When we lived together, before my parents divorced, my brother was just about as hard to get along with as my dad, and my dad was physically abusive to him. I was so confused and could not understand why we could not love each other or ourselves. My dad’s incessant fear of doctors and my brother’s fervent choice to self medicate only complicated the situation we were in.

My heart goes out to my family and people like them and I have a strong desire to help people. Your short talk resonated with me and I was intrigued by psychiatry because I thought it might be a way for me to help. How do I learn more?

Sincerely,

Anon

On Jun 18, 2013, at 5:16 PM, Sana Quijada wrote:

Hey. So good to hear from you. I remember you well. Sniff. Big hug. You are not alone, dear man. 

How to learn more?  Hmm. I would start by attending some local NAMI meetings. Follow up with me in a bit after you do and we can keep the lines open and ideas flowing. It is an honor to connect with you. 

I celebrate your focus and completion of finals. 

I would love to post your email letter on FriendtoYourself.com … 

Your story is seriously powerful.  As my six-year-old says, boom! Smile. 

Till next time,

Sana Johnson-Quijada MD
www.FriendtoYourself.com

On Jun 24, 2013, at 5:00 PM, Anon wrote:

Yes you may post my email I feel honored. It took a lot of courage to write and I am glad you were receptive.

This is a "thought bubble". It is an...

Questions:  How would you recommend a young person find out more about psychiatry, before pursuing years of study?  How did you investigate your profession before committing?  

How do you talk about your family of origin history?  How do you find the courage to share these things, to find community in what hurts?  Please tell us your story.

Self-Care Tip:  Find the courage to connect with others and your story.

RELATED ARTICLES

You Are Valuable, Even After Losing So Much

You Are Valuable, Even After Losing So Much

Artist Forrest King artismoving.blogspot.com

We all might take what we have lieft and love it.  We have this remaining and losing self.  The now person and the person that is losing something else on top of it all again and again.  Another tooth chipped.  Now it’s hard to find words.  Now training takes longer to get the same time.

We have what is left.  More or less, we have this.  This here in this moment in this person we might love, we have.  We have these with indefinite value, yet to be described by what passion and friendship we bring.  We have the bigger experience.  We have the slower pace.  We have the deeper understanding.  We have another night of rest.  We have breasts that have been remade.  We have a cancer free day.  We have a way of making bread like a story baking in a pan.  We give the value or spend our emotional bank on taking it away.

Whom of us hasn’t seen the little child’s vulnerable eyes taking a verbal slap,

“You are such a f—er!  Why did you do that?!”

The value was placed so low on that potential.

What do we do for our remaining selves?

Let us join together, lean in and enter the unknown space of discovering this person we have and are becoming during and after loss and gain.  Let us grieve together what and who has died.  Let us discover together what we have left.

Self-Care Tip:  Discover the value of what you are after losses.

Question:  Tell us your story of loss and gain in your remaining self.

 

Tenuous Connections – Where is Our Rock?

Skógafoss waterfall

Skógafoss waterfall (Photo credit: big-ashb)

So thinking more about Alena and her alien psychiatrist-poser

Why is Alena known, or recognized, by Alien?

Where Alien came from, brain illness isn’t sustained by the stress of living on her planet.  Those with brain illness either adapt to the primitive resources they live in or they, (pause,) “don’t.”  The community doesn’t know this is happening consciously.  They just know that some people are able to do what earthlings consider magic.  Those with brain illness evolved to survive.  Alien was one such benefactors of time and stress on biology.  She was not there for the process, but for the product

Earth was alarming.  It was the first time she’d ever seen someone with a broken mind.  Knowing where she came from gave her mixed feelings….

I’m getting my hands into this Time-play playtime!  Woohoo!  I have been rumbling over the beauty of all the beloved connections I enjoy, the cherished anchors and reflectors that I’ve used so long to stabilize my identity with.  My heritage, my profession, my employments, my interpersonal relationships, family, my body, currencies, and so much more gives me a sense of security.  A sense, however, in truth and not Time-less.  As so many of us know what the other side of that water-fall looks like – divorced parents, physical/sexual/emotional abuse, illicit drugs, loneliness, poverty, a bone spur or arthritis.

If Time is an arrow, what gives the increasingly obvious wispiness of our securities power?  What is our strength from?

I remember back when we discussed our Essence, the bit of Me that isn’t lost to death, suffering or brain illness.  According to, From Eternity to Here: The Quest for the Ultimate Theory of Time, by Sean Carroll, he’d say this can only exist if this Essence in Me is connected to space and Time.

Question:  Where does your connection come from?

Self-Care Tip:  Discover where you security comes from.

Discover Your Sweetness – Value, That is To Say

English: Casimiroa edulis, White sapote fruit ...

Image via Wikipedia

My kids look at fruit as if they are inspecting a diamond for flaws.

Is this a good one Mommy? 

My daughter was pointing at a blemish that comes from fruit grown outside in dirt and not genetically engineered.

My huffing sounds are barred by something almost like maturity, just in time.  I pick up a different White Sapote with broken skin and beak marks where it is half eaten by whoever got there first.

After spitting out the seeds, I remembered bits of my filthy self as a daddy-chasing kid.  The words dusted off and important to me again, I heard Dad say,

Pick the fruit that the birds have pecked at.  They know what’s good better than we do.  Here Sana.  Take this one.  This is really sweet.

The fruit turning in my daughter’s hand, the cast-offs still in the basket, her anxiety about finding the best and my dad’s words came at me like the sounds between Broadway and 42nd Street.  And out walked Jean.

Jean was a patient I had known, particular to me despite common problems.

Abuse since at least my daughter’s age or younger.  Neglect.  Disgusting trauma survived.

Jean who, after getting picked on for the first thirty years of her life, came to me, insisting on living.  She resisted being a White Sapote in a bowl on the counter, inspected by passerbys.  Her community had tried to declare her value, her second chances and hoped to cast her off.

Pick the fruit that the birds have pecked at.  They know what’s good better than we do.  Here Sana.  

Jean’s face was in my memory.  Her white scar on her black skin shocked me; a large keloid.

Take this one.  This is really sweet.

I gave my daughter a squeeze and told her what Papa had said.  I’m so glad my daughter reminded me about this in we who have been hurt.  (Okay.  That’s all of us, see it or not.)  The way Jean grew, looked for light, the courage she answered to, the newness that came out of used up and shabbiness – Jean was teaching me about value.

Even when we are not behaving well, when we don’t look good and when we drop the market price, we have value.  Somehow, being chosen for life is more important than being chosen to suffer.  I wish I could explain why and how better but it’s just something each of us will have to experience for ourselves.  We will have to in humility and wisdom, like Jean’s or my dad’s wisdom, find the sweetness in Me.

Questions:  What is it about you that is particularly sweet?  Do you perceive your value?  Per what measure or qualifier? Please tell us your story.

Self-Care Tip:  Discover your sweetness.  Be a friend to yourself

Related Articles: