Books I hope you read: The Neapolitan Novels

My Brilliant Friend by Elena Ferrante

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Have you heard about these books yet? They are a series of four novels following the lives of two Italian girls (Lila and Elena) in Naples for six decades. I finished the last one weeks ago and am still processing them, still finding words and feelings they left me.

These books celebrate womanhood while lifting up an alternative to traditional femininity in Lila, a character so sharply singular you feel her cutting through each page. To Lila, compromise is like a sulfur flame, and she’ll never allow herself to be burned. But this character being unlike anything or anyone else also becomes its own magic, because also in her agony I think all women can see some of their own experiences. The end result is that by knowing two women, you get an image of the whole world, you know all of humanity. And possibly the best marker of this book’s impact and Ferrante’s skill: I still can’t believe it’s not real. I’ve read all sorts of questionably-sourced materials searching for evidence that this is the true story of a woman reaching out in love and longing for her lifelong friend. I’m almost certainly wrong, but that’s how captivating it is. I hope everyone reads these.

Grief: Day 269 -- Fear Laps At Me

Today was my first day back after another precious vacation week. I went home to Austin, the first time since February, and it was the center of that bitter buzzing in my ear.

I think everyone in my family is melted into their elemental pieces and trying to put themselves back together – but of course in the meantime some of us are held hostage as everyone else’s container lest they leak away, dripping through loose floorboards.

I visited my father’s grave, the tombstone now in place and reading “Ubi caritas et amor, Deus ibi est”, and I felt that all I could taste was bitterness, all I could see over my father’s grave was bitter dirt, all I could remember from those weeks in February was a great mountain of bitterness given that life had done to us what it had. In reality there was bittersweet, there was grief as rooted in a foundation of love (as an inevitable part of it); but I didn’t remember that, only bitterness.

Lumberjack and I flew back to Seattle on Thursday. Saturday we were meant to go out and explore a park or something. But early in the morning I turned to see the window assaulted with rain and it struck a flame of fear into me. I slept for several more hours. I can sleep and sleep and sleep this year. I get so little good sleep when I’m working but even when I’m not I sleep for 11 hours at a time, which I’ve never consistently been able to do before.

Instead of going out we sat on the couch and read and watched TV all day. I think the cats were pleased. We skyped with Lumberjack’s parents and they told us about a car accident his father was in – he’s fine but the car was totaled.

When we finally left for dinner my fear gained remarkable substance in the ballooning quiet of this city the non-city, in the sirens that landed across the street, in the terrible lighting on the bus, in the scrubbed silent streets in the neighborhood of the restaurant. It’s still so weird to me that I can feel so uncomfortable, so creeped out, outside in a city, on a bus, etc. How different it is from the city I know. What a warm blanket familiarity makes.

Yesterday morning I drove Lumberjack to the airport again and I am realizing that fear laps at me. When Lumberjack’s parents told us of that harmless car accident I see it as a lucky near-miss, further evidence the universe waits around the corner to hurl further damage and destruction and despair at us. I worry that every time I let Lumberjack leave my side I am tempting fate to make it the last time I get to see him (even writing that I have to knock on wood). And so the current life, in which nothing I live is really real because I’m away from my partner, which brings a whole new level both of exhaustion and responsibility, which took so much from me and expects such an unprecedented amount, which precludes joy and fullness – in this life, I also must spend precious energy quashing interminable sparks of neon fear. And the cycle keeps on turning at an increasing rate, a steady acceleration. A year ago today I posted an instagram a photo of the Christmas lights on a tree downtown (I spend so many moments going back through my instagram pictures, gazing greedily on that Before Time), which filled me with so much joy. Here I ride past a small lake on my bike and realize that at that speed the water reminds me of water I know, frames-per-minute slowed, a suspended animation. It makes something flicker alive in me that I recognize when I look at that picture of the lights a year ago. Everything here is almost entirely too insipid. Perhaps I will adapt.

Books I hope you read (or not): A Little Life

A Little Life by Hanya Yanagihara

Disclaimer: I don't think reading this review would ruin the book for you, but please note that it is not spoiler-free, and I am a person for whom spoilers don't ruin books.

Content warning: suicide, abuse.

It ended how it always was going to. I am frustrated by it, and deeply saddened, of course. And also, somehow, essentially unaffected and I think this is because I feel this story is one I’ve played out before in my own head. Its prose even felt like how I talk (or at least how my thoughts feel to me) – so many words and adjectives spooling and spilling, rambling and yet with such a vibrant steel thread within it, all sewn through with meaning, each word imbued and glowing with it – essentially, rich. It was a book about in some ways the intimacies of life, between people, and so this vacation week with Lumberjack has not only been blanketed with languor but also all those small comforts between us have been stained by the pain of thinking of Jude and Willem and JB and Malcolm. And I’ve woken every night the past few nights soaking wet from their world, clutching my husband and feeling the sadness of A Little Life. It was a truly beautiful book, and an expansive and extraordinary one.

(I think one of the knives in the back by this book is that I know I am JB. Self-involved and essentially insecure and a hardship poser. I like to hope I am also a bit of Willem.)

(Digression: for the medicine people, note that there’s a really fun surgeon character in this book that I really appreciated.)

I was uncomfortable with how comfortable with the topic of suicide I have become. Line of work casualty, I guess, as a psychiatrist. Suicide looms early and colossal in the story and I knew it was there even though I hoped it would slunk away somewhere along the line. It feels sometimes inevitable, both in real life and in the book. After a major tragic blow in the novel, I was dejected but not sobbing, not surprised. Ultimately I guess my feelings about these things was resignation. I’m at a point in my life and career where resignation takes up too much space in me and indignation not enough and I hated that this book reinforced that with its litany of terrors. (Early in my intern year I took care of a patient about whom my attending, on her discharge day, said, “She’ll suicide one day. There’s just no way around it.”) I felt, resigned, like the grainy grey of the cover, staticky - the pain from this book was like sandpaper rubbing over an old lingering open wound and not like a hand plunged Indiana Jones-style into my chest to take out my heart. (Though that’s not to say there weren’t times when, sitting next to my husband, I gasped in horror, I clapped my hand over my mouth, I squeezed my eyes shut against sudden tears and felt the deep sadness.)

This book has been criticized for almost fetishizing abuse, for overdoing it. Not for describing a life with too much of it, but for describing the details too liberally – at a certain point it becomes fascination with the abomination, it becomes voyeuristic, sensationalist. And I think, but I’m not sure, but I think I agree with this. I’m reluctant to say that there was too much terror for my poor privileged heart, and so I’m careful with this criticism. Especially because maybe too many privileged hearts spend too little time considering the terrors that this world – and the people in it, and privileged people especially – put humans through.

But there’s something to this criticism. Because I wanted to know Jude better. I think we were meant by the author to understand that Jude was wrong in his understanding that he was made up just of his sufferings, but the book showed clearly and best the peripheral indications and only murkily and in small servings the direct evidence of Jude’s personhood-beyond-suffering. I just wish that the proportions were different. I wish I had read less about the exact details of Jude’s abuses and more about Jude making Willem laugh, Jude intimidating associates at the firm, Jude’s way of thinking about math. We got to know so much about the personhoods of Jude’s posse through the stories of how they cared for (and didn’t) Jude, and in this we knew them better than Jude, because not only did this clarify their characters but it also obscured Jude’s by reinforcing the archetype of the long-suffering, the cared-for, the lost soul. And this was the archetype Jude was fighting his whole life, so in this way this obfuscation by the novel is meta – and a mistake, in my opinion. I wanted to know Jude.

And through Jude weren’t we supposed to know better the rest of the lost souls in the world? Weren’t we meant to have better aching hearts like Willem did? And for this reason I resented not just the obfuscation of Jude’s character but also the caricature of it – he was remarkable, written somehow to be loved. He was brilliant and pliant and loving and extraordinary, with hurting hands turned only towards himself. I resented him and the author for this, for how deliberately lovable he was when that’s not often the characters a long-suffering life creates (but my patients still deserve love).

And then the book ended, and not only that but it ended with Jude apologizing, with him not having learned he was loved. With Jude not at his core moved by Willem and Harold and Andy and etc, etc, etc. How awful. What an awful rebuke of my career. He was a great steel ball we hoped to melt into warmth and yet we only got the outer few layers, coming off onto our hands, pretty, sweet and beautiful, we fooled ourselves, where he stood cold and unhappy still.

And actually I realize that I got that last feeling/image from my own experience with rewarming cold balls of pie dough. Pie dough is finicky, so finicky. It can be really good, just perfect, a few days after you’ve made it and put it in the fridge. But the tricky thing is that it can never get too warm before you shut the oven door on it, because you want the butter to be rubbed into the flour but never really married to it, and that’s what gives you those glorious flakes interwoven with lovely flavors. So there’s this moment when you’ve taken the dough ball out of the fridge and you have to warm it enough to roll it out but not too much to ruin it. So you roll it in your hands. And if your dough ball got too cold in the fridge, you’ll find that the outer half inch or so will get nice and soft and probably too warm far before the center of that dough ball isn’t a rock. You might think you’ve got it just about warmed and ready because the outer layers are squishy and pliable in your palms. But you’d be fooling yourself.

Ultimately, I realized that the story this book told was one I had learned to stop telling myself years ago. So I spent all the week I was reading this book under a dark cloud, yes – but I think I will come out from under it easily. Because I’ve been coming out from under that cloud my whole life, and I’ve succeeded.

I think the real triumph of the story was that nobody else ever turned away from him. To the very end, Harold and Andy and presumably Willem and JB and Malcolm were still there figuring out how to love Jude.

And you know what? If you work that ball of pie dough just right, it’ll soften and stretch and come together into itself so you can roll it out. You can even ruin the outside by getting it too warm and still make something work. There’s never an irrevocably frozen center.

I don’t know what to say about how A Little Life should have ended. It was an incredibly beautiful book. It was aching and the prose rolled the narrative out bleeding all the way. Its characters – Jude as mentioned above aside – grew life-size before me in perfectly described moments, in many small imagined acts witnessed by the others. It really shows us that humans are found in the spaces between us – we hold each other. And so the book was excellent and I know that it was never going to be written to end any other way than the way it did, and also it was awful. I don’t think it wasn’t true to the story or the characters. But I think the story itself as it was conceived was inherently flawed. St. Jude is the patron saint of lost causes. What does it mean to have a saint of lost causes? What has the Catholic church decided is a lost cause? Because fuck that. We have to reject that narrative. That’s not a way to live in this world, so fuck it.

(My patient, by the way, is still alive. And I think she can find some love for herself in this world. I really think that’s possible.)

Grief: Day 183

I've just passed the six month mark since my dad died. Six months since getting that phone call. Six months since the cosmos was acutely destabilized by his leaving.

And I say that as if I mean it figuratively but in reality the way a vice tightens around my chest even still makes me believe some thread connects my dad to the rest of the universe’s pace tromping forward, a knot tied on that day six months ago whose frayed threads tug at various places along these new present moments causing them to hunch forward with the weight of his vacancy. What I mean is that it still hurts. What I mean is that it’s not right. Everything I encounter seems like further evidence that all is off-kilter.

The vice has been tightening around my chest for six months and each time I bleed and bleed until I turn myself to something desiccated and brittle, my dad’s favorite shortbread crumbling. When Lumberjack visited we poured our hearts into a common vessel where I felt safe to bleed again and he said words that filled me back up just to leak.

Alone again yesterday, I went to work desiccated and brittle. I had an experience with a patient with spinal trauma, which is a particular challenge for me given my dad's injury. After that day I brought my desiccated and brittle self home, where I could reflect on the way the universe’s axis has been tilted since my dad left, leaving all of us stumbling around off balance because some other version of earth’s magnets pull us the wrong way. I thought of the lake we visited this weekend and wondered if my dad had been there, years ago. I strained my ears to hear his voice through these threads that tighten around my chest and fray off that knot tied six months ago.

Heart to Heart

Today my med student was looking really dysphoric on rounds so I asked him what was wrong. He told me he was feeling really hopeless about how hard it is to help the people under our care on the inpatient unit.

I decided to sit him down to talk about it. He brought up time constraints, space constraints, financial constraints, energy constraints. He brought up a lot of the very real constraints, challenges, and cruelties of inpatient psychiatric care and his own feelings of hopelessness and helplessness related to those. He spoke, as an example, about his patient that he just feels would really benefit from hours of daily psychotherapy from a really skilled practitioner.

And my first instinct was to come up with ways in which this patient didn’t need that, and to combat it with the small list of support items we do offer. Because those are the answers that have been given to me for years when I ask the same questions. Because those are the answers that help us sleep better at night and come into work easier in the morning. Because those are the answers that alleviate our feelings of horror and guilt.

But I stopped myself. Because I don’t think those answers are true or acceptable; I’ve been rejecting them for years. There’s never been a time in my life other than right now when I’ve longed to internalize them more. And that’s a big part of the reason this first month of internship and especially these last few days have been so tough. And it was really surprising to me how in that moment – talking to a student, someone I’m meant to be mentoring – it suddenly would have been much easier to say that stuff, and for a split second I almost did. But I can’t.

Because let's face it  medicine has got a lot of issues. Psychiatry has a lot of issues. We've got a lot of work to do before we should feel, as a society, proud of the work we do trying to take care of the sick and vulnerable.

So I said, “I know, right?” and “It really sucks.” and “I’ve struggled with these feelings too, for a long time.” I told him how it’s especially hard now as a resident when I’m in a position of slightly more power and responsibility but with even more red tape to wade through. I told him how hard it is to find a balance between perpetual outrage/frustration and self-care, but he had to try.

And then I told him that even though it sucks, that doesn’t mean it’s hopeless. Every day we can be better for our patients: I talked about two examples of improvements in my own practice with specific patients that I’ve worked on already in this first month. And every day we can keep our eyes on the long-term goal: we can work together, slowly, for real progress in the way we treat patients.

After this conversation I realized in medicine we don't have this conversation nearly often enough, if ever – I certainly missed out as a med student. So even though it’s monumentally frustrating to call this my biggest success of the day when I wish it was something bigger and directly related to patient care, I’m gonna take what I can get. And besides: helping take care of our med students and ourselves really should be considered a big win.

Grief: Dark Shadows

Every day, at least once, it comes back to this: I’m tired of this being the worst year of my life.

It’s just that all in this world seems so marred by the dark to me lately. Everything so heavy, dark and brooding, thick and bitterly saccharine like molasses. All seems to be pressed on on all sides by something very monstrous and diffuse. I can’t seem to think about anything except my patients, whose lives have trailed themselves through such tragedy. The spectre of my father’s death hangs always. I can’t escape sirens, always right outside my window, ambulances in front of me any time I step out the door representing either the weight of expectation on me as a doctor or the burden on this world of new tragedy or both. I always seem to be walking up a hill in this city and even when I’m walking down it’s not buoyant or good – characterized by nothing more than being not-uphill. And negative in its own way, a tumbling. Even when I try to look for the good in this world it feels weak and without power – brought down by the mud its feet are stuck in. And I am unsurprised by each new piece of horror brought to my attention, though still dejected. It seems there are shadows in every corner.

I miss my lake. I miss my husband. I miss soaring on runs and feeling at home. I am so, so tired.

After my first call shift, which was terrible and similarly filled with horrors and harbingers, I slept for the most restful four hours in weeks. When I woke I felt fugued, feeling briefly like I had pulled myself up through the dark clouds by a great force of will and obstinance, a gasp of fresh sunshine on my face, a muscle-up through the muck. I looked around at the bright and beautiful restaurant I had chosen for brunch by myself, where I had been a few weeks earlier with Lumberjack. It was soaked through with sunshine.

But soon the coffee and mimosa started to dig their sharp edges into my belly.

I am mincemeat. I am the raw bloody face of someone punched then pushed across the gravel. I am shaken to broken pieces in my fragile glass innards then set back down with my vessel intact.

I ordered something spiced and biting but wished for that warm melting I had had with my husband sitting across from me, weeks ago. At the restaurant’s store I browsed the cards section with tears coming to my eyes at the casual relevance of sympathy cards. I wonder if there will ever be a time that those don’t feel like they apply to me. I meticulously sniffed $12 soaps and picked the thing softer and warmer. I carefully chose five stems for a bouquet, pouring myself into the bright and tangy ones, hoping to bring forth again the joy I used to feel from being made of passion and fury. A dahlia, a dark daisy. Two peppered support stems and a single pure white tapering one to make me feel like I could bear holding onto this vision of myself – intensity – which lately feels dark and frightening and unstable.

I feel rattled like I’ve been other times I’ve been on inpatient psych but I don’t remember how I put myself back together before. Then I had Lumberjack by my side, listening with an open face as I got home every day, holding me on our couch. Then I had runs on the lake. Then I had a father.

Everything feels so different now.

I don’t know that I see the way out now. But I will try to paint myself with sunshine. I think the way out now will be a different way.

Grief: The Universe Takes

My last name has started to feel swollen in my mouth. It’s one of the most important gifts given to me by my father and now it makes my tongue feel like cotton. I’m choking myself on it. I’m worried it, too, will be taken away from me. Is that what this is, this swelling of the second syllable behind my teeth? Is that this malicious universe’s doing, turning something precious rotten inside me?

Burnout and "The Good Ones"

I’ve been thinking a lot lately about the kind of burnout that happens in people that come into medicine with eyes wide open, thoughtful and informed and generally pretty intolerant of the kinds of cognitive dissonance that help most people get through.

I’ve heard too many stories of “the good ones” quitting – the ones renowned for empathy, advocacy, patience – the people that still get mad about the ugly way things are, and try to be better. There’s even a Scrubs episode about it (or several).

We’re all starting our intern year in just a few months. Residency (along with the third year of medical school) is notorious for making jaded cynics out of the most doe-eyed baby docs. It’s daunting.

There’s a classmate I’ve been getting to know much better the last couple weeks (dissection makes fast friends) and I feel we have a lot in common – he goes on some of the same rants that I do, for example. During one of his particularly snarky rants something really struck me. I realized I’m so worried about this friend losing his hope. I’m so worried about him feeling overwhelmed by the isolation of being the one that cares all the time. I’m so worried about him quitting.

What struck me, I guess, was that with all of his rants I’ve been seeing myself in him. I’ve really related, really connected, to his anger. So, this really begs the question: am I worried about myself?

I worked very hard for my hope early on, and that hard-won optimism is something I see as essential to my identity. Cynicism is so unattractive to me now. It dresses up truths in dissonance and distractions until what looks logical is excuses and rationalization. I see the familiar hipster misogynist nihilists that pride themselves on loving Fight Club as children more than I see them as edgy or smart – they haven’t yet developed into real humans with sophisticated understandings of the world and real-life experiences with humanity.

So, to me, there's some honor in quitting, if it comes before or in the face of cynicism. In fact, I always had given myself permission to quit. The decision to give myself that permission was conceived under the angst over whether I would go to medical school – I had met too many bad doctors that hurt patients. I didn’t want to become a cog in that machine. I knew that doctors that hated what they were doing were bad at it – they hurt patients – and so I gave myself permission to quit as soon as I hated it, and I’ve checked in with myself frequently in that regard. If I’m not doing my job better than another premed/med student/resident/physician would in my place – if I’ve become another cog in the machine – I might as well leave and let someone else do it. I’d rather quit than be adding more to the balance of harm.

But what that decision (to give myself permission to quit) looks like has evolved interestingly in these four years. What was once a judgement-free opportunity for reflection is now a scary window to a distinct, and unsavory, possibility. I know what quitting would look like for me now. I know what things might happen in my experience with medicine and what kind of person I would be, and I also know, deep down in my gut, that I don’t want that to happen. I want something out of medicine, and it’s not quitting.

It’s really hard when you feel like you’re the only one around to care about something. My third year of medical school, for this reason, was extremely, soul-crushingly isolating. And on top of that isolation, I felt this intense pressure to get really really mad about everything terrible I saw because nobody else was doing it. Somebody had to, at the very very least, notice. And when I looked around there was nobody but me to do it. Somebody had to care. So I felt the weight of thousands of witnessed traumas – I bore a lot of anger on my shoulders.

I remember coming home one day ready to go on yet another rant about something that had happened at the hospital, and Lumberjack saying to me, “Monica, you don’t have to get mad about everything. How can you do that to yourself? That’s unsustainable.”

And it was. But who else was there to notice? If I didn’t, it felt like letting a multitude of bad things slide. It felt like condoning them.

Isolation is so dangerous. I can’t muster the rage that’s called for in medicine by myself – I have a lot of feelings, but not that many. There’s strength in numbers.

And this, I guess, is what I need from my peers and colleagues. I need someone to co-rant with me. I need someone else’s gaze to meet when something terrible happens. I need to feel like at least one other person would back me up if I spoke up about something.

We really have to support each other. Resilience is relational.

Giving a shit is a 24/7 job. It requires constant vigilance to defray participation in a corrupt system that mediates daily oppression and institutionalized damage. The easiest way to get through medicine is the one where we fall into a state of cognitive dissonance that allows us to tell ourselves things aren’t so bad, it’s not our problem, hope is impractical. Avoiding that is really hard. And when you do avoid that, the unending effort required to maintain your humanity and your hope requires a lot of social support.

This is why I’m so grateful for my co-ranters within medicine.

I don’t like thinking about the possibility of quitting, but I also think it’s important, because it allows me to start building now a network that will allow me to spread some of this rage around. Supporting each other is a vital part of maintaining our humanity, of cultivating our hope, and of therefore effecting meaningful change. I’m really grateful to all the people that have helped me in those ways. Please stick around. Let’s have each others’ backs, as fellow humans facing a monolith together. Stay loud. Stay mad. Stay hopeful. Fight on.

Grief: Triggers

Cervical trauma is triggering and the Cubs are triggering.

Cervical trauma, of course, comes up often on this radiology rotation. More than one lecture, lots of films that look like my dad’s did, classmates saying things like “cervical trauma is so fun!” – etc. When it happens my brainstem reacts first. Somewhere behind my xiphoid process a knotting, gnawing discomfort starts. Then the chills: every 20-30 seconds, my hair stands on end, all up and down my arms and legs the sensations prickle. Of course I know I will be triggered whenever the subject comes up, but it’s not until a minute or two later that the cerebral sensations kick in: something recognizable as sad, as vulnerable. I look around hoping nobody can tell I’m upset, and also looking for someone to fight.

Ultimately, I feel breached. Grief is an egg cracked over my head and running down my spine.

The Cubs are predicted to have a shot at winning this year. My family is a Cubs family, and my dad was especially a fan. Last year they did really well and we thought maybe the curse was broken, but I really can’t muster any interest in sports, and I kept up my jokes about how I couldn’t care less. This year for the first time I’d like to have a Cubs hat or shirt to wear. They’re predicted to have a shot at winning, and that’s the saddest thing in the world to me, but I also hope they do. If they do, though, I’ll fall apart. My mom sees it as evidence of the afterlife – “There’s no way your father would miss this.”

Ultimately, I feel betrayed. Grief is a water balloon popping in my chest and widening my mediastinum.

Books I hope you read: Bad Feminist

Bad Feminist by Roxane Gay

Roxane Gay is an inspiration, and a really good example of how heroification isn't necessary to feel in awe of a person. Her book talks about tough, often academic feminist issues while never forgetting that feminism is personal. This means she schools on intersectionality, brings pop culture into it, and makes hard questions accessible. Above all, though, she never leaves out humor and never leaves out the profound. It's a hopeful beacon in a conversation that's way too often cynical. I cried on the bus...twice. I can't wait for what it might do for humans, i.e. you. Read it!