Deep Breaths, Everyone

Me, a yoga instructor? What could go wrong?

IMG_5234Quite a lot, according to William J. Broad in The Science of Yoga: The Risks and the Rewards. The chapter called “Risk of Injury” talks about strokes from extreme neck contortion, disk ruptures in the neck and back, ribs popping out,
rotator cuff tears, torn Achilles tendons and even bone fractures. According to one survey of 1300 practitioners, “The largest number of injuries (with 231 reports) centered on the lower back. In declining order of prevalence, the other main sites were the shoulder (219 incidents), the knee (174) and the neck (110)”

My women physicians’ group, Balance for Women Physicians (no pun intended), holds a yearly conference in Colorado. We always start the day with yoga. This year, our long-time (and marvelous) yoga teacher couldn’t join us. The group knows that I have been doing yoga for almost twenty years. So, they asked me to lead the practice.

But, I do yoga, not teach it! Doing yoga and leading yoga are two very different

IMG_5232
Downward Dog

propositions. As a practitioner, I keep fairly focused on the instructions, But sometimes, even as my body is in Downward Dog, my mind is on what I need to buy at the grocery store. When I zone out, I can always get back on form by looking at what the teacher is doing.

As someone just doing yoga, I never need to say anything. As the instructor, I will be the only one talking. I am used to the back and forth of conversation. My style as a doctor was to crack jokes with the patients. I am a bit lost without feedback to what I say.

My normal speaking style is to talk loud and fast. During the yoga session, I would have to speak in a calm, soft, soothing voice and, at the same time, with enough authority so that people will do what I say. “Begin on all fours.” “Slacken your jaw.” “Bend your knees, put your hands on your hips and slowly come up.” “Lift your arms above your head.” “And breathe.” I am giggling even as I write this. I’ve never had to modulate my voice this way.

Then we come to the poses, the asanas. I know what to do when I’m told to do a Bridge Pose or a Boat Pose or a Cat/Cow or a Fire Hydrant. (You don’t really make a pose like a hydrant. You start on all fours and lift a bent knee leg up and down. It should be called the Dog at the Fire Hydrant Pose). See, this is my problem. How am I going to concentrate and not let my mind be distracted by inappropriate asides?

I have never paid much attention on how we transition from one pose to the other. I need to organize sequences of poses to make logical transitions so I don’t make people sit, stand, lie down, get on hands and knees repeatedly. My teacher is very creative, and flows in and out of asanas as smoothly as a magician handles silk scarves. She’s gotten us into Triangle Pose from a Warrior Two Pose, and from a Wide-angle Standing Bend and from other poses too.

I’m not sure I know how to explain to a room of people where to place your feet and

IMG_5238
Warrior Two

arms to get into Warrior Two. (Something like: “Put your right foot toward the front of the mat. Bend that knee. Move the left foot back in line with the instep of the right foot. And shake it all about.” Oops, wrong activity! Let’s try again. “Lift your arms parallel to the ground, right arm in front, left in back.”) I need to explain the poses in short, concise phrases, which I should memorize. And in between, there are those calming reminders: “Soften your neck.” “Relax your shoulders.” “Breathe.”

I always chuckle a little when the yoga teacher confuses her right side with her left. Now, making this mistake has become my worst fear. From a supine position, cross the right leg over the left. Then, move both legs to the right while turning the head to the left, or is it the other way? Is it the right index finger and thumb around the left wrist and then lean right? Or lean left? My teacher, like Ginger Rogers dancing with Fred Astaire, does everything backwards. She mirrors us. She tells us to raise our left arm while raising her right. I am so not gonna do that.

An underappreciated aspect of teaching yoga is the balance of extension and flexion poses. When we do a extension pose, like Bridge Pose, which involves a back bend, the good teachers will immediately follow with an opposing pose, like Child’s Pose, in which we bend forward. I have visions of my twisting people up without remembering to have them do the opposite stretch. They’ll just get more and more pretzeled.

So why don’t I do a Nancy Reagan and just say no to my group? For a bunch of reasons. One is that the program already promises that we offer yoga. Another is that yoga is such a positive thing—good for the body, mind and spirit. The Science of Yoga debunks a lot of false yogic benefits such as increasing the oxygen level to your brain and promoting weight loss. But even that book talks about enhancing flexibility and lifting mood.

In my own life, I’ve experienced two benefits of yoga. The first is body awareness. If I need to step on a series of stones to cross a stream, I am confidant that my legs and feet can cover those spaces. The second is mindfulness. To spend an hour a couple of times a week focusing on my breathing and my body movements is a meditation. As a Harvard Medical School scientist said in the Science of Yoga, “Yoga brings you into the moment. It brings a feeling of joy or energy with activity, a kind of mindfulness.”

Actually, I am looking forward to learning a new skill, especially because my yoga teacher has graciously offered to help me. I also know that my colleagues will appreciate my efforts and enjoy doing yoga with me. My fellow women physicians are really good at friendship.

Tell me: Have you ever agreed to something that was outside of your comfort zone?

Mending the Living

“There’s been a car accident. The ambulance is taking your son to Barnes Hospital,” said an unfamiliar male voice.

On the way to the hospital, I tried to block out the “What if’s,” but scenarios clicked through my brain like a photo slideshow. Fractures, casts, crutches. Scars. Or the more ominous “internal injuries.” Or worse yet, brain damage. Being a doctor doesn’t help in cases like this. It just makes your worries more specific.

My voice cracking, I said, “Don’t you think it’s a good sign he was able to ask someone to call us?” My husband Bill only nodded. I blinked back tears. Could all my efforts at raising this kid end like this? I tore my mind away and just looked at the winter scape along the highway.

IMG_5218 copy.jpg

In the novel The Heart, by French writer Maylis de Kerangal, translated by Sam Taylor, the worst does happen to 19-year-old Simon Limbres. He and two surfing friends drive off in the early morning to catch an exceptional wave off the Normandy coast. On the way home, the driver falls asleep, runs off the road and hits a post. Simon, sitting in the middle seat of the van and not belted in, is thrown into the windshield.

The Heart takes us through the next 24 hours and all the lives affected by Simon’s accident. Marianne and Sean are the parents. She is French. His background is Maori. They are separated. The hospital finds Marianne first. She goes to the hospital and is met by the ICU doctor. He tells her that Simon has had cranial trauma. He is in a coma. It is irreversible. She cannot see him just yet.

Marianne leaves several messages for Sean. When he finally calls back, she realizes that he is still in a world where Simon is okay. As she breaks the news to him, she hears that “his voice has defected now, leaving the land of the innocent and joining Marianne, piercing the fragile membrane that separates the lucky and the damned.”

They go together to the ICU to see Simon. Other than the bandage on his head, he looks intact. Marianne can hear his heart beating and thinks back to hearing his heart in her womb on an ultrasound. Sean takes his son’s hand and says, “Simon. We’re here. We’re with you, you can hear me, Simon, my boy, we’re here.”

The parents’ grief takes many turns. Marianne thinks of all the times she’s heard of people coming out of comas. Maybe it’s some computer glitch, his brain scan. Sean blames himself for making the surfboard for Simon. In his grief, he bangs his head again and again against the car steering wheel. Marianne blames Sean for giving Simon a love for the sea. Even as they are sharing the sorrow with their young daughter Lou and Simon’s girlfriend Juliette, a part of them thinks about what the day might have been like had the accident not happened.

As the sorrow of Simon’s family grows wider and deeper, another set of people goes into action: the transplant teams. Their job is life-and-death important and urgent. Simon’s organs can save many lives. But, the organs need to be harvested as soon as possible.

The parents must be treated with utmost kindness but also utmost truth. The ICU doctor tells them that the latest of several serial EEGs shows that Simon’s brain continues to show no activity. With sensitivity but also brutal frankness, the transplant coordinator, Thomas, who had been in the room with the ICU doctor, brings up the subject of organ donation.

He asks for their consent “to the removal of his organs for transplant operations.” The parents are stunned. Sean declares, “Simon’s body is not just a box of organs that you can help yourself to.” The parents leave the hospital, walk near the sea, and after some time, decide for the donation. Marianne realizes, “They won’t hurt him. They won’t hurt him at all.”

This decision triggers a cascade of activity. Thomas calls the Biomedical Agency, a central data bank for organ transplants. Marthe, who takes the call with all of Simon’s medical information, searches for recipients who are compatible with Simon’s blood type and immune system. They even need to be compatible with the shape and size of Simon’s heart. She feels the weight of the responsibility, knowing the tornado of activity she will generate, and the hope.

She decides on a 51-year-old woman in Paris for the heart. “Strasbourg takes the liver (a six –year-old girl), Lyon the lungs (a seventeen-year-old girl), Rouen the kidneys (a nine year old boy).”

Claire Mejan, the heart patient in Paris, has three grown sons and a mother. She is a translator. She has myocarditis, an inflammation of the heart muscle, which causes heart failure. She struggles to breathe and tires easily. She has had this for three years. She moved into a teeny, dark apartment in Paris because it is across the street from the hospital. A heart transplant is her only option. She is aware that for her to live, someone has to die.

Thomas, the transplant coordinator at Simon’s hospital, had promised the parents two things. Just before they clamp the blood vessels to remove Simon’s heart, Thomas whispers into Simon’s ear that “Sean and Marianne are with him, and Lou and Grandma, he whispers that Juliette is there by his side.” Then he places ear buds into Simon’s ears and plays a track of sea sounds that the parents had given Thomas. Then, the removal proceeds.

Thomas’ second promise to Sean and Marianne was, “Your son’s body will be restored.”

Thomas exhorts the surgeons to close up with as much care as they used in their retrieval of the precious organs. They fill out the hollowed out spaces with fabrics and compresses. When the surgeons leave, Thomas and Cordelia, the young nurse who has taken care of him since his arrival into the hospital and who assisted in the surgery, clean Simon and wrap him in an immaculate white sheet, knotted at the head and foot.

“Tomorrow morning, Simon Limbres will be returned to his family, to Sean and Marianne, to Juliette and Lou, to his loved ones, and he will be returned to them ad integrum,” (restored to his previous appearance). In less than twenty-four hours from the time Simon got up from bed to catch the big wave, his heart beats in Claire Mejan’s chest.

***

The Barnes ER was spacious, brightly lit and impersonal. We were told to wait. We waited. When we saw Alex return on a gurney, presumably from X-ray, we followed him to his room. He gave me a smile that conveyed mixed feelings—glad to see me but not sure if I’d be mad. I looked him up and down. A scraped knee, torn jeans and stitches across his left eyebrow. “That scar over your eye will look dashing someday,” I said. Alex gave a deprecating shrug.

The doctor told us that Alex had no broken bones. He gave us instructions on wound infections and told us to check Alex every two hours for signs of head injury, such as lethargy, vomiting, or seizures. To my great relief, the doctor mentioned that a blood test for alcohol and urine drug screens were negative.

Reading The Heart reminded me of the word “catharsis,” that I learned in high school.

The purpose of the Greek tragedies, according to Aristotle, was to cleanse the heart through pity and terror. He called that release of emotion “cartharsis.” Reading Simon’s story, I felt like I had dodged a bullet that time with Alex. I had landed on the side of the lucky, and I was grateful beyond words. Not that I didn’t have nightmares and anxiety for a long time afterwards. Even now, whenever Alex, who has two sons of his own, leaves my house, I tell him “Drive safely.”

Tell me: What play, movie or book has been a cathartic experience for you?

Shake It Off: How to Escape From Your Pain-Body

“You are going to tell me that you didn’t say anything, but I can tell what you’re thinking,” I say through gritted teeth.

“I’m sorry,” is my husband’s reply, but his face shows puzzlement and the resentment of the wrongly accused, not contrition or concern.

He does his curious head-turning move, which is a full turn from right to left with a little dip of the chin. It’s like shrugging with your neck. Then he turns away, like the conversation is over.

In a voice trembling with fury, I accuse him, “You just don’t care, do you?”

His voice takes on a blaming tone, “Now you’re just trying to hurt me. What do you want from me?”

“You should know.”

What are we arguing about? It really doesn’t matter. Here are some real-life subjects we have fought over: golf, tennis, too much courtesy, restaurant choices, laundry settings, what time to leave the house, you name it.

In my rational moments, I admit that there’s probably nothing Bill could do that would satisfy me when I’m in that “spoiling for a fight” mood. But I would never give him that satisfaction. HA!

Eckhart Tolle, a spiritual teacher and author of A New Earth: Awakening to Your IMG_5201Life’s Purpose, finally explains what’s happening when I – and you too, maybe? – get into such a deep funk that nothing can mollify me. I was taken over by my pain-body. The pain-body consists of old emotional pain, traumas from the past that never had a chance to heal. “The energy field of old but still very-much-alive emotion that lives in almost every human being is the pain-body. “

The pain-body can lie dormant for weeks, months, sometimes years, but when the proper triggers are pulled, when one’s buttons are pushed, the pain-body awakens and goes looking for trouble. It feeds on negative thinking. It creates drama. “The pain-body is an addiction to unhappiness.” Not only that, but the pain-body wants to make everyone around it unhappy.

There are two ways of escaping from the pain-body and its effects. One is to wait it out. After days or weeks, the pain-body, like a tick that glommed on you, is full and quits. By that time, you are exhausted and your relationships are in tatters.

The second way is to just shake off the pain body. Tolle compares this process to the way ducks behave when they squabble. a_new_earth_quotes_ducks_flapping_wings-resized-600After two ducks fight, they swim apart, each flapping its wings vigorously to release excess energy, and then float off. It’s over.

According to Tolle, “[t]he beginning of freedom from the pain-body lies first in the realization that you have a pain-body.” Then, it is necessary to notice, at the time it is happening, the process of being taken over by the pain body. Be aware of your negative emotions, anger and hostility in real time. “Yes, I am mad. Yes, I feel unjustly treated. Yes, I don’t feel understood.” Such awareness, or Presence, as Tolle puts it, promotes “dis-identification” with the pain-body. Mindfulness is the key to achieving awareness.

Each person’s pain-body, as expected, has different components and triggers, as many as there are thoughts. Mine include being Chinese, not speaking English when I first came to America, being a woman, being in a hyper-competitive family, having various hang-ups with men, needing a hysterectomy at age 33, and more. The exciting and revolutionary aspect of what Tolle is teaching in A New Earth is that one doesn’t have to slog through all of that. No years of lying on the couch dredging up old stories and old hurts. It is enough to become aware, and then disengage, with those thoughts and grudges, with the old earth, with the Ego.

I want to give you an example of an incident from this morning. Bill and I were walking in the neighborhood. We came to a spot where ornamental grasses narrowed the walk so that only one of us could pass at a time. He, as he often does, stopped in his tracks, maybe even took a step or two backwards. Besides breaking my walking rhythm, it annoyed me that he was telling me in this way that I should walk ahead. “Control through courtesy,” I’ve often charged.

This whole cascade of thoughts and feelings zipped through my mind right there on the sidewalk. This gave me a chance to consider my reaction. I realized that I have a choice. I could be mad that he’s directing where I should go or I could flap my wings and float off. I chose the latter.

Tell me: What pushes the triggers on your pain-body?

The Little Prince and Me: It’s Complicated

IMG_5186

Everybody loves The Little Prince by Antoine de Saint-Exupery. Except me. Every time the name comes up, there is a universal “Oh, I love the Little Prince,” accompanied by a wistful, faraway look. I’m never sure if they mean the book or the character. I quite like the little guy myself, especially from his pictures: the blond curls, the simple tunic, the flare-legged pants, the jaunty yellow aviator’s scarf. Adorable.

IMG_5188

But by the third paragraph of The Little Prince, I knew I wasn’t going to like the story. Here’s why.

The narrator, as a child, had decided to dismiss all adults as unworthy of his attention because they were unable to figure out that his two drawings are of an elephant inside a boa constrictor, one from the outside of the snake and one from the inside.

 

When I read this, I was about 14, not yet an adult. Even then, though, it seemed unjust to write off a huge swath of the population on such a flimsy basis. Sister St. Remi, my high school French teacher, assigned The Little Prince to pique our interest in things French. We were moony teenagers and it sure didn’t hurt that the author had this oh-so-Frenchy name and had been a pilot killed on a reconnaissance mission in WWII.

In the real world of a Catholic girls high school, I couldn’t decipher how or why the other girls coalesced in their shifting permutations throughout the day. I found gaggles of them fogging up the lavatory with hair spray. They, seemingly spontaneously, knew where and when to gather at lunch. Everyone knew just how far to roll up the waists of their uniform skirts to the exact same hemline length. Even on the school bus, everyone but me had her place.

No one was mean to me. No one was nasty. I was invisible. Maybe that’s why the narrator’s exclusion of people for not being able to figure things out hit too close to home.

A lot of people only remember the pictures and have forgotten the story. So, a short recap. The narrator becomes a pilot and crashes in the African desert. There he meets the little prince, who had fallen to earth from his planet, Asteroid B-612. They bond over the fact that the little prince immediately recognizes that the pilot’s pictures were of an elephant inside a boa constrictor.

On his tiny planet, the little prince rakes out his three volcanoes, uproots baobab shoots so they don’t over run the planet and takes care of his rose. His rose is a bit vain and a bit temperamental. She is proud of her four thorns and coughs to make the little prince put up a screen to block the wind. She is never quite satisfied with what he does. The little prince felt put upon by the rose and decides to leave. He explores several other planets on his way to earth and meets a series of adults, who all seem foolish to him. So, the little prince, like our narrator, also decides that adults are unworthy of his concern.

In my late 30s, I thought I should give The Little Prince another shot. Maybe it was because by then I had a little boy of my own. I was divorced from his dad. I had graduated from medical school and residency and was struggling to make it in the business of medicine. I was also struggling to find a new man in my life. Few men were interested in dating an “older” woman with a child and who had to take phone calls, or even leave for the hospital, any time of the day and night.  The Little Prince made me feel even less hopeful of a lasting relationship.

Back to our story. The little prince meets a fox. The fox tells the prince that he must tame the fox if he wants to have a relationship. The fox says, “If you want a friend, tame me!”

IMG_5191

“ ‘What do I have to do?’ asked the little prince.

“ ‘You have to be very patient,’ the fox answered.

‘First you’ll sit down a little ways away from me, over there, in the grass. I’ll watch you out of the corner of my eye, and you won’t say anything. But day by day, you’ll be able to sit a little closer….’”

“The next day the little prince returned. ‘It would be better to return at the same time each day,’ said the fox.”

Reading this scene with all of the fox’s relationship proscriptions, I felt my frustration with my so-called love life boil over. Why do people play games and have such elaborate and opaque rituals? Who makes up these rules? And why didn’t I get the memo? Again, this book made me feel isolated and lacking.

I thought it was only fair to reread The Little Prince before writing this piece. Right before meeting the fox, the little prince walks into a garden full of hundreds of roses. His rose had told him that she was the only flower like that in the universe. And here were hundreds of them. The little prince was distraught about this betrayal until the fox explained to the prince that his rose will always be above those common roses because of the care he has lavished on her. The little prince wonders if his rose has tamed him. The fox also tells the little prince, “One sees clearly only with the heart. Anything essential is invisible to the eyes.”

The narrator, the crashed pilot, finds out bits and pieces of the little prince’s story during their time together. He is charmed by the little prince. They share an adventure looking for desperately needed drinking water. During the search, the little prince tires and falls asleep. The aviator picks him up and carries him. They find the well and take pleasure in the squeal of the rusty pulley and the effort of pulling up the bucket. When the little prince drinks the water, it is delicious because of the shared adventure and the shared effort.

When it was time for the little prince to return to his planet, the little prince consoled the aviator by telling him that, because he knows that the little prince is on his planet in the sky, all the stars will be special to him. And the little prince will be looking at the sky as well, and it will remind him of the delicious water.

On my dining room wall is a Chinese landscape painting in the blue-green style. The theme is fairly conventional, a scholar and his acolyte, enjoying nature. This painting IMG_5195belonged to my dad, who died in 2011. He lived with my husband and me for three years before his death. He had suffered a devastating stroke. We moved him from room to room in a wheelchair. His speech was garbled. During those three years, it was my routine to show dad one or two Chinese paintings from his collection because he got such pleasure from them. One day, as we were looking at this particular painting, he pointed to the scholar in flowing white robes dancing on a mountain overlook and then put his finger on his own chest. Then, with a huge effort, he croaked out, “That’s me.”

IMG_5196

Like the stars to the pilot and like the water to the little prince, there is a special meaning in that painting that is mine alone. When I see the scholar in the painting, I see with my heart, and it’s like a part of my dad is still with me. The little prince is right in this respect. But unlike the little prince, I don’t think we should ignore or reject people who are pre-occupied with worldly things. They need our compassion and patience. I think in time, the little prince will come to share my view. He is still so young….

Tell me: Is there a book, TV show or movie that everybody loved except you? And why?

A Moment in Paradise

 

IMG_5183.jpg
Part I of 66

I am sitting on the back porch of my son’s home in Charlottesville, Virginia. I am seeing my four-week-old grandson Edin for the first time. My daughter-in-law tells me that Edin means “delight” in Hebrew. I’ve taken Edin downstairs to let his parents sleep. As we sit together, I watch.

I inspect the faint bruising over his right eyebrow, left from scraping against pubic bones. I watch him yawn, lower jaw stretching first to the right side, then to the left, exposing the ridge of his gums and the tiny hollow of his upper palate. I read his brows like an Oklahoma farmer scans the sky for rain. His snuffling and total-body shudder followed by a huge exhale sometimes signal contentment and sometimes mean wakefulness. His is an existence outside of intention and thought like the clouds that come in and out of my view.

There’s a primordial feel to Charlottesville. Crepe myrtles here grow tall, with red and magenta sprays sticking up like firebrands. The insects’ drone is constant. Vines overgrow everything. They cover the wide girths of century-old tree trunks. They snake over and through fences and around trails and walks.

Edin is full of personality. He is a squirmer, like his dad. Karate jabs, head-butting and body surfing please him. He enjoys the motion of going up and down stairs. He prefers sleeping on his stomach. He loves the sound of singing. When he startles himself awake, his arms and legs stiffen and fling out, like an inverted scaredy cat. But he is quick to be comforted, willing to relinquish his anguish to a breast, to arms enfolding him, to a rendition of “Don’t Fence Me In.”

Two days ago, on a fall-feeling day with a cool breeze on my bare legs, suffused sunlight on leaf-dappled grass and the clear song of a wren, I sat watching Edin’s sleeping face in my lap. Even though I knew we were perched on the precipice of change, as we always are-–the seasons, the shadows across the lawn, Edin and myself—it felt like time was standing still. The sun would always shine and Edin and I would stay just as we are.

That illusion is broken by changes in Edin in the few days I’ve been with him. His stick-figure arms and legs are muscling out. Just last week, he fit easily in the crook of one arm. He’s become lanky, requiring both my arms. Already he is less easily startled and can often settle himself back to sleep. Most of all, his cobalt eyes are gaining focus. That stare into outer space is disappearing.

Experts say that babies cannot focus or smile until they are six weeks old. We adults hope to speed things up. We peer into their faces. We grin, nod, coo and try to coax a smile. Yet, once the baby responds, it will change our interactions with him forever. There will be expectations on both sides. These lingering gazes I love so much will disappear. It’s a loss of innocence.

When I first learned the story of Adam and Eve, I was very angry. By eating the fruit from the Tree of Knowledge of Good and Evil, Eve ruined my chance to live in the Garden of Eden. But, on further reflection, I believe a part of Paradise is still with us. We can glimpse that same innocence in the first weeks of every life. That is why thousands of years after Genesis, a young couple thought to name their child “Edin.”

I now recognize the story of Adam and Eve for the brilliant metaphor it is. What makes us human is that very knowledge of good and evil, that knowledge of our own nakedness, that awareness of our “self.” In two more weeks, Edin’s eyes will lock on to our faces as surely as Eve had to bite into that apple.

photo 4Tell me: Who or what or where is your Eden?

First, Do No Harm

“We need you to pronounce someone,” said the voice over the phone. I was a third-year medical student on call overnight at St. Louis City Hospital. It was 1978 and I was 31 years old. I had only been out of the classroom for a few months and had never been asked to certify someone as dead before. I had been to two “codes” where the patients had “crashed” and lost vital signs and everyone rushed in to try to resuscitate them –to pump air into their lungs through a tube, to do chest compressions, to give them epinephrine, to shock them with the paddles. Someone with more training than I, usually a resident, would end the procedure when the EKG showed sustained non-activity. “Pronounce someone Dead?” I asked. The nurse gave a “what can you do with the medical students” sigh and said, “Yes.”

This patient must have been a “No Code” – Do not resuscitate. Her room was dark and deserted. A florescent tube stuttered at the head of the bed. She was an elderly woman whose long, gray braid had come loose. Only her right arm was outside of the sheet. She looked asleep.

I drew a deep breath. So, this is what a dead person looks like. But what if she’s not really dead? How can I be sure? I walked around the bed, searching for any movement. I stuck my silver tuning fork, used in neurological testing, in front of her mouth looking for condensation. I touched her arm; it wasn’t stone cold. I listened with the stethoscope. Heard nothing. Feeling remarkably foolish, I dragged the EKG machine from the hallway and ran a strip. Flatline.

I filled out the form at the nurses’ station, looked at my watch and wrote the time of death as 2:55am. Really, someone isn’t dead until I, a third-year medical student, say so? I had thought of my future job as a physician as one of helping patients solve medical problems, suggesting good health habits, and giving emotional support. I would avoid troublesome side effects and counsel the least invasive surgery. First, do no harm. I was learning everyday to distinguish “normal” from “abnormal.” I didn’t know until then that I had to learn how to be sure someone was dead.

Last summer I read Sarah Helms’ 2015 book Ravensbruck: Life and Death in Hitler’s Concentration Camp for Women in preparation for a visit to the camp itself in IMG_5164Germany. As I read, I remembered that night so long ago and the terror of being the one to pronounce that woman dead. Helms’ book educated me in even more terrifying ways. I never knew that the Nazis had insisted that only licensed doctors could pronounce and certify the deaths of the people they themselves had murdered. And doctors were often the ones to designate who was next to be killed.

I visited Ravensbruck in July 2017 with my husband and two long-time friends. The camp was situated in a beautiful rural area with trees and a lake. There were hardly any visitors about, and the whole complex was eerily quiet. It reminded me of the quietness of some Civil War battlefields I have visited. This was the sole women-only concentration camp in the Nazi’s empire. Even though the original prisoner’s barracks were gone, many structures from the camp remained. The barbed-wired walls, the crematorium, the SS men and female guards’ living quarters and the foundations of some other buildings gave a good idea of how things might have worked in this place.

IMG_3946
Rusty remains of barbed and electrified wires along the walls
IMG_3933
Long abandoned SS housing
IMG_3967
Crematorium oven, one of three

We know that the Nazi began their murderous spree by killing people they considered physically and mentally defective. The idea of that is so repulsive to me that it had never occurred to me that they would use real doctors to certify who was “qualified” to be killed. Even the “Final Solution,” the evil blueprint for committing genocide on a mass scale, was partially conceived by a licensed psychiatrist.

Doctors were integrated into the grisly camp routine. Helms writes that, “One of the camp doctor’s duties was to rule on whether a prisoner sentenced to twenty-five lashes on the Bock [a sawhorse-like devise] was physically strong enough to survive.” At mass shootings, “A doctor had to be there because ‘one bullet doesn’t always kill the prisoner immediately and his duty was to certify death’.”

I was horrified by the role that doctors played in the entire Nazi death-dealing system. As a physician, I felt the weight of judgment against the medical profession and against me. And I wondered how I would have behaved had I been a doctor during the time that the Nazis were in power. As wartime living conditions worsened and as Hitler and his gang grew more insane with their demands for killing, the jobs of these physicians often spiraled down into condoning, authorizing and even committing murder.

At Ravensbruck there were doctors and nurses, most of them prisoners working under SS doctors, who, worked hard to relieve the suffering all around them. But their power was very limited. One doctor who helped a lot of people was Loulou Le Porz, a French prisoner doctor. She was able to do more good because, ironically, she worked in the “death block,” where the “neglect killings,” as the war trials called them, took place. She was there because the SS required a bonafide physician to sign the death notices. Decades later, being interviewed by the author, 93 year old Dr. Le Porz could still name each of the patients, their families and their diagnoses.

Even though this book overwhelms you with the pile-on of cruelty, pain and suffering, most of it systematic and intentional, I also marveled at the innumerable acts of kindness and bravery, the implacable resoluteness to resist to the Nazi prison system, and a determination to survive and to keep their humanity.

Helm tells of Himmler inspecting some Jehovah’s witnesses who had been locked into a punishment bunker. Helm writes, “Himmler and [camp commandant] Koegel peered into the darkness at a huddle of starving, freezing women crammed inside a wet, stinking cell. The women were praying….Now he spoke. ‘Don’t you see your God has left you? We can do with you whatever we like.” One of the Jehovah’s witnesses in the cell responded: ‘God will save us. And if he does not –we will not serve you.’”

Else Krug, a prostitute, not a political prisoner, defied Koegel who ordered her to flog some Jehovah’s witnesses. “‘No, Herr Camp Commandant,’ said Else. ‘I never beat a fellow prisoner.’” Even though this meant punishment for her.

And resistance, it seems, was everywhere. Polish victims of medical experiment exhaustively documented their torture. They smuggled this information out at great risk by writing on scraps of paper using invisible ink made of urine.

The workers at the sewing factory run by a tailor who regularly threw the machines at the seamstresses’ heads and kicked them with hobnail boots, committed acts of sabotage. Everyday, the tailor checked religiously that all the buttons were sewed on securely and the buttonholes over sewn correctly. However, he never checked that the buttons and their holes were aligned. (He was tried and executed for his crimes in the post-war trials.)

Despite the intentional degradation, the female prisoners of Ravensbruck tried to live like human beings. Women nursed the sick and injured with folk remedies. Poets wrote poems and read them aloud. Others spun stories of love, sex or tragedy. Still others lectured on their area of expertise: Romanticism, anthropology, literature, ethnology. Olga Benario, who is said to be the model of the statue overlooking the lake of a woman lifting another in her arms, drew maps of battlefront happenings from information in smuggled newspapers. Hannah Sturm, a carpenter, found a copy of War and Peace –probably meant to be used as toilet paper – and read it to her compatriots.   Work gangs sang songs, including Mozart, Brahms, Bruckner. Sculptors carved little objects on toothbrush handles. Sunday’s ration of a dollop of jam and a pat of margarine were saved up to make birthday cakes.

Most of these activities were punishable by whipping or the dark, cold and hunger of the punishment bunker or worse. And yet, they persisted — with courage and with humor. In a way, Sarah Helm’s research and writing of this story is also an act of courage as she raced the clock to talk to survivors, now in their 80s and 90s. On leaving the gates of Ravensbruck, we saw dozens of plaques and memorials put up on the outside of the concentration camp wall.

IMG_3963
In memoriam — plaques and flowers

In a strange way, my faith in humanity and my optimism for the future – even given our own government’s unfair treatment of immigrants, poor people and people of color – were bolstered by this book and by my visit to Germany. What I learned was that from the beginning, there were thousands, tens of thousands, hundreds of thousands of people who resisted Fascism and Hitler all across Europe. (The original reason for the concentration camps was to imprison resisters.) And these resisters, which the book shows clearly, included women across age groups, across ethnic lines and including every educational background. And even when they had paid the price of their resistance, with imprisonment and torture, they persisted. Even in the nightmarish environment of the concentration camp, they “lived out” their resistance — with kindness to others, with making literature and art, and by remembering.

Tell me: What unjust systems have you resisted and what did you learn from your resistance?

IMG_3929
Statues representing Ravensbruck prisoners

A Birding Guide to “War and Peace”

A1aDb5U5myL

To say that War and Peace by Leo Tolstoy is about a bunch of aristocratic Russians during Napoleon’s 1812 invasion is like saying that Games of Thrones is about politics. This is a grand, epic story. There’s war and peace, love and death and a cast of thousands. But wait, there’s more! Here are the reasons I love this book.

I want to tell you my favorite passage. It’s when Pierre, fat, clueless and near-sighted, decided that he wanted to see the battle of Borodino. Because he is socially prominent, he is allowed to wander around the battlefield while others dodge bullets and shoot cannonballs with purpose.

He finds himself on a fortification looking far off at the battle. “The officers said that Napoleon or Murat was there. And everybody looked eagerly at this bunch of horsemen. Pierre also looked, trying to guess which of those barely visible men was Napoleon. Finally, the horsemen rode down off the barrow and disappeared from sight.”

This passage excites me. I want to, and have, read it to perfect strangers. Nothing in my life has described how I feel when I’m bird watching as well as this. Like Pierre, I am very near-sighted. Also, at five feet, zero inches, many things, including branches and other people’s heads, block my view. So, I’ll be out with a group of birders. Someone will spot an interesting bird, which, I remind you, is much teensier than Napoleon. It might be an elf owl, a Colima warbler, even something as big as a zone-tailed hawk. They ooh and aah among themselves.

“See the white eyebrows and cinnamon at the edge of the facial disc?”

DSCN9421
I am the one in pink on the left

“There a small rufous spot on the top of the head.”

“I can see the two white bars across the black tail.”

I can’t even see the bird, much less the markings. I try to walk around the edge of the group as there’s no hope of looking above anyone’s head. This makes their kindly attempts to describe the spot –“see where the two branches make a V?” — even less accurate because the angle is different now. Then, someone will chime in, “Oh, it flew.”

Of course, in a story as long as War and Peace, many events happen. The remarkable thing to me is that people’s feelings change dramatically, but not necessarily caused by the events. As an example, Natasha as a teenager, falls in love with Andrei. They become secretly engaged. She is then seduced by the villainous Anatole, almost despite herself. “As soon as Natasha saw him, she was seized by the same feeling as in the theater, of vain pleasure at being liked by him, and of fear because of the absence of moral barriers between them.”

When her plan to run away with him is foiled, “… she sobbed with that despair with which people weep only over a grief of which they feel themselves the cause.” Shortly afterward, she discovers that Anatole was already married. She becomes distraught with guilt and loses her will to live.

For months, doctors visit and give her all sorts of medicines, “pills, drops and powders.” Natasha is thin, pale, withdrawn. She doesn’t eat. She doesn’t sleep. Then Tolstoy writes, “despite the absence of her accustomed country life, youth had its way: Natasha’s grief began to be covered over by the impressions of ongoing life, it ceased to weigh with such tormenting pain on her heart, it began to become the past, and Natasha started to recover physically.” (The doctors, and the family, believe that the medicine finally kicked in.)

Something like this happened to me. During college, I had been dumped by a boy from Connecticut. It hurt to hear that word. “Christmas in Connecticut” was a movie I couldn’t bear to see listed on the TV Guide. This guy drove a Volvo. Every time I saw one on the road (thank goodness they were quite rare in those days), my grief renewed. Some months later, I was driving and realized that I wasn’t paying attention to the makes of cars any more.

This book makes me wonder if life isn’t more arbitrary than I think. Sometimes, things just change. Most books tend to ascribe cause and effect to what the characters do. I tend to see my life in those terms too. All the major characters, Natasha, Andrei, Pierre, Nikolai make sharp turns in their lives. Sometimes, there are reasons. Sometimes, not. For myself, it’s made me less judgmental of people who seem to make illogical decisions. I give myself more slack too. Consistency isn’t some moral prerogative, I tell myself.

Tolstoy spends an inordinate amount of time writing about his theory that history is caused by millions of individuals doing what moves them: survival, greed, glory, love. Yet, put all these people with free will together and you get a historical movement. OK, OK, I get it. Like the characters’ actions, events are not pre-determined. It’s the mass of little people who make history, not Napoleon or Tsar Alexander I or General Kutuzov. He hits you over the head with this one idea, like he’s trying to convince himself.

War and Peace tells a spellbinding story, unwinding over the breadth of Russia in a time of turmoil. It also expresses the inner workings, desires, hopes, thoughts and connivances of the myriad characters in the most charming and unexpected ways. You never know what people in it will do. At the same time, Tolstoy marvels at the mystery of how the collective actions of these same people can seemingly become a mass movement.

I think each reader will also have his or her own takeaways in charming and unexpected ways. It’s sort of like when you strap on your binoculars, stuff your field guide in your pocket and go bird watching. You never know what you’re going to get.

TELL ME: What actions or decisions have you made that, on the face of it, wasn’t logical?