D. Brendan Johnson
Minneapolis, Minnesota, United States
|Selvportrett i helvete [Self Portrait in Hell]. Edvard Munch. 1903. Munchmuseet. Via Wikimedia.|
“Would you like the new patient?” My senior resident offered me the next admission, a patient being stabilized in the emergency department after a suicide attempt. As a fresh medical student in the beginning of my clinical education, I quickly said yes, plucked up my courage, and went to meet him as soon as he arrived on our unit.
Our first meeting was not easy. I asked the one-to-one sitter for a moment’s privacy so that we could talk alone. We came from the same state and region, spoke the same language, and had similar ages, hobbies, and backgrounds. Yet despite these similarities we felt worlds apart. He would not give more than one-word answers to any of my questions. Wary and guarded, arms crossed and sitting upright in his bed, he looked straight ahead at the TV while not watching it at all. His coolness was like the dark of his room, shades down despite the brightness of the day.
My first reaction was frustration. Weren’t we trying to help? He should open up. He was obviously in a world of pain, and we were not given entry. He wanted to go home and get back to his life. But we needed to ensure his safety and arranged to transfer him to an inpatient psychiatry floor.
On the second day, he began to pry open the door to the fortress of his suffering. He began, tentatively, to answer more of my questions. I caught his eyes flitting to the side with the faintest smile when I cracked a joke. He flatly told me about his life: relentlessly bullied for things he could not control, parents so preoccupied with their own hard lives they could not attend to him, and few friends at school or work. Moreover, his low-wage job meant underinsurance in the inhospitable American healthcare system: he had tried to access mental health care but was rebuffed by barriers at every attempt. His insight heightened his suffering. His awareness and vulnerability were perhaps signs of health, but he was still on a hospital bed in a dark room, his mind locked in that dark kingdom.
No one ever told me that by watching trembling hands, hard or pained eyes, and a wrinkled forehead, you can watch someone battle their demons. I am not sure how his fragile body was able to contain the bitter war for survival being waged inside of him. This is perhaps the strange vitality that French philosopher Gilles Deleuze recognizes when he describes the “moment that there is no longer anything but a life playing with death . . . a life of pure immanence, neutral, beyond good and evil.”1 My patient’s pain was a living pain, the kind of all-consuming immanence that keeps you alive, a stubborn vitality that accompanied him in those moments when hope was impossible.
He could not have known that his pain was also my pain. Depression—though the clinical exonym cannot touch its true lived meaning—had also welcomed me into its dark kingdom, and I was struggling to see the light. Though to him I was just another white coat asking prying and patronizing questions, I was struggling to put on the white coat identity as easily as I put on the coat itself. I had just returned from two years away from medical school, pursuing a master’s degree in another state. I returned only to begin with one of the most difficult rotations. My peers had started medical school the same year I had stopped; they had just completed the preclinical national licensing exam and were fresh where I was rusty. The imposter syndrome was overwhelming. I went from a place where I felt assuredly capable to spending most of each day feeling acutely bad about my competence. This transition was made more difficult by a lack of social connection caused by the pandemic and my old medical school friends graduating just as I returned.
My transition was not going well. Though I could cognitively recognize it, I could not feel and embrace the true privilege it was to be caring for the bodies and minds of my patients. I was struggling to get through each day. My mind was clouded, my memory and concentration fuzzy. The future felt absent. If someone complimented my work, I could not believe them. I was behind on my studies and woke up at three AM night after night, my mind anxiously swirling with disconnected medical facts, stress, and questions I felt I should know the answer to but did not. I felt everything going dark.
Depression is not just a clinical diagnosis, it is a slow-motion train wreck of the soul. Though I was in a white coat and my patient in a hospital gown, we sat side by side, sharing words until they stopped. Then we sat in silence, staring straight ahead as the minutes went by. We sat alone, together, in the wordless camaraderie and thousand-yard-stare familiar to rusted factories, Christmas trees at the curb in January, or bodies in a mausoleum. Slowly penetrating my fog was the troubling realization that I identified more with my patient than I did with my medical team. Perhaps I stayed in that room longer than I should have, but it was a sacred space, one that I did not have the power to simply exit. In that room, we shared something that was not—indeed, could not—have been expressed in words, and something that was outside of either of our control.
Sharing my story and struggle with others opened a door for me. Depression, along with other forms of significant suffering, is common in medical training. Thankfully, the dam of tragic and isolating silence is showing its cracks. Friends and mentors began to tell their own stories: A friend who passed all his end-of-rotation exams by a razor margin and lots of prayer. A successful physician who had been seen as incompetent for years after she was wrongly accused of making a clinical mistake. Classmates who failed their licensing or end-of-rotation exams. A beloved mentor who did make a clinical mistake—and who was eaten alive by it—until she began to tell her story, embrace her humanity, and move past shame.
So, my story is not unique. But though the ubiquity of suffering allows for solidarity and community, it does not negate the suffering within and around us. Indi Samarajiva, writing about widespread social tragedy, provides helpful language:
Today I assume you went to work. Bad news was everywhere, clogging up your social media, your conversations. Maybe it struck close to you. I’m sorry. Somewhere in your country, a thousand people died. I’m sorry for each of them. A thousand families are grieving tonight. A thousand more join them every day. The pain doesn’t go away, it just becomes a furniture of bones, in a thousand thousand homes.2
There is no easy answer for the pain that creates our “furniture of bones.” I do not want to offer easy answers or cheap hope, if only because the story is ongoing and my healing still in progress. As organizer and abolitionist Mariame Kaba reminds us, hope is not an emotion, and is not simply related to optimism, positivity, or favorable odds. Instead, “hope is a discipline,”3 a communal activity in which we can hold the future open for one another. In my own healing, I have been helped by the solidarity of a loving community, by pharmacology, and the food that my mother drops off weekly. (Who said love was invisible?)
I have also been helped by the words of Pema Chödrön, a Buddhist nun and founder of Gampo Abbey, who writes of “the great need for maitri (loving-kindness toward oneself), and developing from that the awakening of a fearlessly compassionate attitude toward our own pain and that of others.” She goes on to write about “the dualistic tension between us and them, this and that, good and bad,” which can be avoided by “leaning into the sharp points.”4 Her words brought me back to sitting with my patient, where, on account of our shared pain, the division was indeed gone. It was not a glamorous moment for either one of us. Yet, it was in that hidden moment that we offered our humanity and vulnerability—life itself—to one another in open and trembling hands. This, I know, must be the root of all healing.
- Deleuze G. L’immenance: Une vie… Philosophie. 1995;(47)4-7. Cited in Smith DW. Introduction: “A Life of Pure Immanence”: Deleuze’s “Critique et Clinique” Project. In: Deleuze G. Essays Critical and Clinical. Smith DW, Greco MA, trans. University of Minnesota Press, 1997:xi-liii.
- Samarajiva I. I Lived Through Collapse. America Is Already There. Medium. September 26, 2020. Accessed October 10, 2021. https://gen.medium.com/i-lived-through-collapse-america-is-already-there-ba1e4b54c5fc.
- Kaba M. We Do This ‘Til We Free Us: Abolitionist Organizing and Transforming Justice. Haymarket Books; 2021.
- Chödrön P. When Things Fall Apart: Heart Advice for Difficult Times. Shambhala; 2016.
D. BRENDAN JOHNSON, MTS, is a student at the University of Minnesota Medical School and a graduate of the Duke Theology, Medicine, and Culture Fellowship. His work lies at the intersection of social medicine, religion, philosophy, and medical humanities. He can be found @dbrendanjohnson and co-hosts the podcast “Social Medicine On Air.”