Coming Home

It has been hard to get a handle on settling back into our routine here in Minnesota.  I think that is because, in part, I haven’t had the chance to collect my thoughts on our last few days there, and in part because everything seems to be life as normal here in Minnesota when life as normal isn’t normal anymore. 

Do you remember when you would go home from college for a break or a summer, and your home wouldn’t seem to fit anymore?  You would have taken a life changing course from a new mentor, made completely different friends, had an incredible volunteer or service experience, or just lived more life.  In short, you would be different, changed, possibly on the exterior but more probably just inside.  But your home, your family, your friends from High School, would be expecting the you that left a few months ago, not the you that felt so different inside.  And so, over a course of time, a disconnect would develop, and soon you would just be waiting to go back to school, back to the environment where you felt real and authentic-  where you weren’t either pretending to be someone else from six months ago, or struggling to drag everyone else along with you.  Maybe being at school was difficult, and maybe you were going through a lot of changes and challenges, but it was what you knew, and what knew you.

Well, that is sort of where I am at right now.  Being in Haiti was very difficult at times – it was hard feeling like we could not get outside of the compound walls very often, like we couldn’t freely walk around.  It was difficult not really speaking the language, but that was something I was trying to remedy.  It was heartbreaking being surrounded by extreme poverty and need and not having the skills to directly meet any of those needs.  It was unsettling to me sometimes to not really be doing anything down there except for being present and experiencing and doing what I normally do – parent Lucy and occasionally write. 

Haiti is a place where people from America go to do things – build schools, work in hospitals, provide clean water, dig wells, build churches, etc, ad infinitum.  While Don and I had talked about this extensively beforehand, and agreed that while I may not be able to participate directly in any actual work, it was still valuable for us as a family and a sign of our commitment as a family to always having Haiti be a part of our lives, it was still difficult not to have any tangible signs that I had been there.  True, I had been extremely blessed to be able to use my knowledge of nonprofits to help Naomi file for tax exempt charity status for Kado…so maybe I will feel better once we get those papers in the mail!

I think the crux of the problem is that experiences and relationships and the changes that those make in you are harder to show, harder to explain, to the important people in your life that haven’t been on the journey with you.  They have not forged the same neural pathways in response to the smell of burning trash in the Port-au-Prince morning air, or the taste of fresh mango, or the sight of a group of street kids playing baseball in an abandoned lot at dusk.  Your loved ones, for the most part, want to know what you have experienced, want to hear your stories and live in the moments with you, but you lack the ability or perhaps the energy to take them there with you.

D and I had a good talk the other day about how our experiences of coming home have been different.  For me, the different in what I do day to day has changed little – it is the environment and the context that has shifted.  D is experiencing that same contextual shift in addition to a drastic change in his day to day work, in the very way he practices medicine. 

In Haiti, when practicing medicine, as in many other professions, one learns to work with less.  Your patients come in, they present with certain symptoms, your job is to ascertain the needs of the patients and treat them.  You have done your training in an American hospital, arguably the best hospital and healthcare system in the United States and the world.  So now you learn how to ascertain the needs of the patient when your x-ray machine is working but the developer is not, so no x-rays, and a CT scan is out of the question, and you can get certain lab tests done but not today.  Your skills of physical diagnosis are developed, and you learn to work with what you have. 

And then you move on to working on your treatment plan within the confines of your current resources.  What drugs do you have available?  Are any of the four monitors open?  Is there any oxygen available?  You start back at the very basics – Airway, Breathing and Circulation – and sometimes you realize you cannot even address those very basic needs.  What you do have to offer is your humanity, your presence as a human with another human being in need or even as they die.  You return to an even more basic practice of medicine, to a greater reliance on human connection.  That is sometimes all you have to offer.

Now, back at home, safely enfolded in the bosom of western medicine, you can still be overcome by indecision, but one that stems from a very different source.  Here, you have everything available to you.  You start with the ABC’s but you have to move forward quickly with a veritable assault of specialists, drugs, and tests.  Back at Mayo, being a good doctor is standard; if you can also bring your humanity to your practice, that makes you a great doctor.  Unfortunately, in the fast pace of medicine here, especially Emergency Medicine, this is often the last thing you have time for.  Something you have to make a special effort to achieve.

The meat of it is that I am not sad we are having a hard time being back here, and I don’t think D is either.  I would be sad if we slipped seamlessly back into our old routines and walked away from our experience without any scars at all.  Like the story of the Perfect Heart from the Christian inspirational email that goes around, our hearts are full of scars and patches and holes.  We are the better for every time our hearts have been broken open and re-mended, for every time we have loved and been hurt.

This past year, since Riley died, our hearts have been worked over time, and because of that I thought we would have been a more guarded than we were.  Much more reluctant to meet new people and love them, to witness pain and suffering with or without being able to relieve it.  That was not the case. 

I believe it is because our hearts are still broken open, still gaping with the loss of our brother, that we were both unable and unwilling to shield ourselves from further scarring.  Unable, because although we seem to function regularly to the outside world, inside we are still struggling to come to terms with the new “normal” of our lives.  The everyday ache of absence.  When faced with things with the potential to harm us – more changes, new friends, Haiti in general – we haven’t the energy to form barriers. 

Unwilling, because D and I have made the conscious decision many times in our lives not to let pain and the fear of pain keep us from loving.  Not to let an already broken heart keep us from breaking our hearts open again.  Not to walk away from a heated “conversation” that could lead to hurt feelings and instead making the effort to work through the pain and the misunderstanding to the other side.  Not to let tests and referrals to specialists and prescriptions be enough, but getting to know the person inside the patient because sometimes just talking will make all of the difference.  Not to gloss over the last month of our lives with a standard “it was great” response because we assume that people cannot understand.

It’s a difference I have noticed in myself since those early days of returning to college frustrated with a family and friends I felt I had grown apart from.  Some drift is natural as people take separate paths in life, but a great deal has to do with making the effort to make yourself vulnerable to those you love, and show them how your heart has changed.  Chances are, theirs has changed too, and they were only waiting for the opportunity to share it with you.