Intensive Care, Intensive Caring
When TV reality shows first emerged they had some shock value in that they weren’t scripted to perfection. It was refreshing to watch a situation unfold without laugh track or canned dramatic music; it could be edifying to watch an unadorned “day in the life” of the personalities at hand. Decades later, the word “reality” now seems diluted in the context of pop culture. What else can possibly be filmed in “real time” in an effort to inform, enlighten, or stimulate us? How many of these shows are, in fact, swinging back to staged scenarios edited to heighten titillation and designed to go to commercial just before a dramatic apex?
My reads this week were grounded in reality at a much deeper level, and often they included truths I didn’t want to think about. The authors I read, even those who wrote fiction, were informed by their intense immersion in fields that are alternately daunting, grueling, sanity-testing, discouraging, or heroic, according to the events of that particular day. These are people who are called to witness life at its most acute intersections, places many of us would rather ignore. This reality doesn’t benefit from previews or reruns; it evolves on its own schedule and gradual enlightenment is won by those embedded at the center, who are putting in serious, largely unglamorous time.
Anderson Cooper’s Dispatches from the Edge: A Memoir of War, Disasters, and Survival gave me more than I expected. I have a generally positive impression of Cooper, but his association with the mass media made me expect to read something calculated and produced. There was a lot I didn’t know about Cooper, starting with how he took a home video camera and fake press pass to war-torn regions to get his start in foreign corresponding. A friend of mine commented that, because of his rich family, Cooper could afford to take this risk. But how many wealthy twenty-four-year-olds do you know who would choose Niger, Palestine, or Somalia over the path of least resistance? Who can “afford” to be in places where shrapnel flies and villages are dominated by crazed rebels or cruel regimes?
Cooper starts his memoir with a statement of loss. His much beloved father died suddenly when he was ten, and later his brother committed suicide before anyone figured out how very deeply troubled he was. These losses left Cooper restless; he needs to be on the go, to remain in the present tense. He writes about relating to how sharks literally have to keep moving in order to live:
I hit the ground running, truck gassed up, camera rolling—“locked and loaded, ready to rock”, as a soldier in Iraq once said to me. There’s nothing like that feeling. Your truck screeches to a halt, you leap out, the camera resting on the space between your shoulder and neck. You run toward what everyone else is running from, believing your camera will somehow protect you, not really caring if it doesn’t. All you want to do is get it, feel it, be in it.
The book’s a catalogue of jarring images and perspectives—abandoned bodies that must be stepped over, malnourished children not yet considered starved enough to be camera worthy, an amputation at a rebel camp in the jungle. The immediate aftermath of Hurricane Katrina in New Orleans is perhaps the most upsetting scenario; it was shameful to see how far America could fall. It’s toward the end of the book, and by then I completely believed Cooper when he likened its horrific intensity to what he experienced in Sarajevo.
I didn’t get the sense Cooper set out to shock the reader with the visuals, smells, and sounds of tragedy. Rather, Dispatches is Cooper processing his own place in the madness, his own feelings of loss and powerlessness, glimmers of faith in humanity that arise from the debris despite so many messages to the contrary. We watch his struggle to separate from unfolding destruction and his ultimate conclusion that it can’t all be compartmentalized, sanitized, and subjected to journalistic objectivity. What has him returning to the chaos are the moments of connection that supersede the surrounding insanity, the opportunities to pay tribute to people and communities who might otherwise be forgotten.
Writer, M.D., a new anthology of fiction and nonfiction by doctors, is another volume that provides a glimpse of what it’s like to be on the front lines of life, whether as practitioner or patient. In the foreword Jerome Groopman comments that, “A physician works at the border between science and the soul,” and the stories that follow prove this true. Like Cooper in his war zones, physicians, especially new ones, find themselves in hyperreal scenarios of pressure, fear, and loss armed only with textbook facts. The patients, of course, don’t even have the textbook knowledge to provide thin comfort or a frame of reference.
Many characters in Writer, M.D. recount a challenge that ultimately offers wisdom beyond the task at hand. For Pauline W. Chen in the nonfiction section, it’s her first cadaver. Danielle Ofri struggles with an exceedingly harsh and sarcastic instructor. Atul Gawande depicts the awful, sweaty hurdle of central line placement and the unavoidable need to practice new skills on unwitting patients. Chen could be Cooper when she describes how fledgling doctors must find a way to distance themselves from the cadaver, as well as the real patients that follow the practice run, by thinking of it as not “one of us” but as “one of them.” But, even with the cadaver, there’s a powerful potential for emotional connection, a pull to look more closely. There’s a fine balancing act in bearing witness but not becoming engulfed, in being most useful by separating oneself. There’s an art to using a technique like Abraham Verghese’s time-tested percussion (skillful tapping with fingers) while attending fully to the person beneath your probing hands.
The fiction section of the book is smaller but no less compelling in its ability to invoke meaningful reality. Ethan Canin tells the story of an aging married couple, complete with very real aches, pains, and confusion, who find a way to reconnect. Jacinta Halloran captures the haunting legacy of a young son’s suicide. John Murray witnesses the decline of a young girl’s father and her first impression of illness, departure, and caregiving. All of these stories are enhanced by the intimate knowledge of details that come from the writers’ chosen profession—a doctor’s schooling in subtle cues that fails to register in her own family, the private last rites of a man who knows he is dying, the capability we all have to exit our delineated roles and personas, surprising even ourselves.
In both Dispatches and Writer, M.D., the authors cared intensely about what was happening around them and their own part in the drama, despite their training to be detached and objective above all. It seems there is no escaping being human, in finding and recognizing our brothers and sisters in the struggle. Both books were worthy doses of reality. Neither read held back; the authors honored reality by facing difficult questions and working hard at finding meaning even, or perhaps especially, in the most chaotic places.
Books mentioned in this column: