May 15, 2018

People : Family

Lately, as I've adjusted to a life in a cast and on crutches, I've been alternately angry, annoyed and resigned at the fact of losing my independence.  Every so often (every ten minutes) I want to throw the crutches out the window, and then I internally rage at the thought of how hard it would be to go down the stairs to retrieve them.   

All my life I've considered independence as something to constantly cultivate, something I was always at risk of losing.  Growing up as the youngest sibling and only girl with four brothers, then living most of my adulthood in long-term relationships, I was worried that being positioned against men meant that I had to actively fight for my own space.  Luckily, my thoughtful, generous brothers raised me with the sense that my gender was a gift and that I could be the same and different; that the limitations can be overcome and that there are advantages to be found.  Still, it can be easy to lose the volume of your voice when so many have spoken before you.  And in relationships, when you are continually weighing someone else's needs, your own can become hazy. So I've made it a conscious point to do as much as I can for myself, and while I have my own reasons for it I know that the desire itself isn't unique to me.  It's what we all clamor for in our adolescence, what we struggle to sustain in adulthood, and what we mourn in old age.  

Recently, as I've had no choice but to rely on others for both basic needs and overall purpose, I see how dependent I've actually always been.  And more crucially, that this is actually something to celebrate.  If I envision connection as a foremost goal in life, why would I not want to be connected to other people deeply enough to need them?  As I've let my mom stack the pillows under my leg (thanks for that third one), my boyfriend arrange everything by my bedside (thanks for thinking of items I didn't realize I'd need), and my friends feed me one dessert after another (thanks for the best gelato in the city which I can't believe I didn't know about)--I realize: this need for others is really what lets me be everything else outside of them.  Including, hopefully, needed by others.  

Coincidentally, I read this today: "The self without sympathetic attachments is either a fiction or a lunatic.  Yet dependence is scorned even in intimate relationships, as though dependence were incompatible with self-reliance rather than the only thing that makes it possible." (From On Kindness by Adam Philips and Barbara Taylor, as quoted in Maggie Nelson's The Argonauts, which I loved a lot).

As we often do when we're considering how best to evaluate something for ourselves, we think about patients.  Almost more than I like getting to know our patients as individuals, I like seeing their relationships to the people in their lives.  Coming from a large family where each of us interacts with every other of us differently, I can relate to the strong bonds created from dysfunction.  It's interesting, and important, to see what this is like for others.  It's tempting to perceive a person just as she sits in front of you, and forget that she exists within a web of relationships that can support or loosen her.  

We see so many incredible sources of care from family members, that remind me that for all our man-made medicine, it's often best to capitalize on what's naturally there.  There are the elderly brothers, one taking care of the other ever since a traumatic brain injury in his senior year of college.  The homeless grandmother who fights daily to secure nourishment and shelter for her grandson.  The couple in their eighties who still hold hands.  The 19 year old, newly transitioned teenager-to-adult, who answers every question with hesitant flatness, except when asked about the baby on his phone, then come a drawn out smile and three fast happy words: "That's my niece."  Their natures are quiet, their love full of force.

Then there are a lot of people who don't have anyone, whose primary sources of stability (case managers, social workers, health care providers) try hard but can never be as present as family.  The woman whose time is marked by the hours between drinks, who stops by our clinic every few days to ask for a medicine or a place to stay.  We don't have anything to relieve her pain, and the waiting room eventually closes.  The man who needs an important procedure, but can't get it done because he has no one to drive him home.  It took several visits to realize this, because he was embarrassed to admit he didn't have any friends.  We have so little to offer these people who don't have a foundation of dependence.

And for others, who we might be able to offer something small, they're often (reasonably) skeptical and mistrustful.  They're not used to having people to (reliably) rely on, and sometimes would rather withdraw than to displace hopes.

Seeing people who have been neglected and disappointed, who are now wired to expect little from others, I can understand the appeal of caring for children.  There's more malleability and room to restructure, more chance to instill each action with a sense of trust in the world.  To create family, that which will be your crutch, of the physical and of the emotional kind.  

But after my injury temporarily reverted me to a childlike state (thanks again to everyone for feeding me, transporting me, consoling me), I think it's possible and important to re-enter this mindstate in adulthood.  Especially for people who grew up without the support every child should be able to depend on.  Adults generally don't want to re-enter this state of dependence (I didn't); it's scary to be vulnerable and it sucks to be let down.  Maybe it's part of our job to break down this resistance.  It's really difficult but I think possible over time, and at the very least worth trying (over and over).  We talk a lot about empowering our patients to care for themselves, to see their own strength and capacity.  But maybe first they need to know that there's still space for them to be someone's child: to voice their needs, to be on the receiving end of a relationship.  To know that dependence makes self-reliance possible.

So on this Mother's Day I'm grateful to my family for giving me so much to depend on, for making my needs so easy that I can make the choice to care about other things, other people. And on this Mother's Day, I'm mindful of the many people who don't have the gift of this family, this dependence.  It's for you that we show up, hoping maybe once or twice that we are there in the right moment and space.

So thanks to my crutches for revealing all the places I stumble and how much support I'm lucky to have; for reminding me what we all want to be for other people.  I guess you have a purpose in my life.  (But I will still happily throw you out the window when this cast is off).

* This is one of the few photographs of my mom with all her kids.  She's 7 months pregnant with me so I count my presence, and that is also probably why my youngest brother looks so unhappy.

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