Sometimes It’s Difficult To Say All You Think and Feel

[Photo: Res ipse loquitur]
13 November 2016

My car isn’t running so well. I had it tuned up but it just doesn’t run like a new Porsche. Of course, I didn’t buy a Porsche, I bought a used Chevvy. But I see others driving Porsches. Maybe if I drive it off a cliff into the sea its performance will improve.

Wait, a self-aggrandizing, multiple times failed businessman who actually made money by filing for bankruptcy and letting his investors and students hold the bag, a man who objectifies and sexually assaults women, a racist, a xenophobe, a man whose near-constant lies have been repeatedly and impartially documented, a man of blustering and impulsive temperament, a man who already vows to lower the tax rate on the highest earners, who plans to turn your health care premiums over for the insurance companies to plunder (25% overhead vs. 4% for Federal Medicare and 5% for Kaiser Permanente)? He’s going to improve your lot? Once again, as with the last Republican president (recall the Great Recession?), the working class poor will suffer mightily. What I don’t get is the 37% of college-educated women who voted for him. What do you imagine he can do for you or the country?  Other than that he isn’t “part of the Washington Establishment”. And how, precisely, will that help? Because if you don’t think that Donald Trump is a crony capitalist, I have an amazing bridge to sell you.  A once in a lifetime opportunity!

I saw a 39 yo woman in clinic at Queens this week. She is a Tutsi from Ruanda. When 17yo she watched her parents and 6 siblings hacked to death in their home with machetes. She ran and fell, pretending to be shot. Her legs were tied to two stakes in the ground and she was repeatedly raped, even violated with a stick so that she lost a lot of blood. Later she actually was shot in the abdomen but survived. Somehow she got to Malawi, to the Dowa Refugee Camp, where she has lived for the past 20 years. She married and has 3 children. The last was born by Ceasarian section, reason unclear, and a sponge was left inside. Her abdomen was later re-opened, the sponge removed, the pus drained from the huge cavity, and the wound healed by secondary intention, leaving a large, unsightly and tender keloid scar. She is largely mute and cannot focus to care for her children or do her housework—too many unattended suppers burnt. Her 11yo daughter is caring for the two younger children while her husband travels from church to church, begging for money and food. She is among the most traumatized people I’ve seen. The regular lunchtime gathering of an evangelist and his small congregation visible and audible out the window 300 yards away on the hospital grounds terrifies her, as does any noisy group. She is largely destroyed. As was her Guardian, a clinical officer from Ruanda who was there at the time, raped at 11yo, saw her family die, and couldn’t stop herself from trying to expel the memories while with me, saying “But I’m here for her.” She cannot work because her mind just goes blank at times.

Not as traumatized was a darling 12yo boy I saw the same day. A friend of his borrowed his bicycle one day when he wasn’t at home. My patient went to collect it and the other boy’s mother hacked him so hard with a panga knife (machete) that she fractured his skull, giving him a subdural hematoma, cut him deeply on the head, the left arm, the left side of his thorax and his left leg. She fractured his tibia with the last blow. She spent the night in jail and will be on probation for 6 months. This little boy is having nightmares, a pronounced startle reaction, and cannot focus in school. I’ll see him in therapy and try to help him reconstruct things through drawings, since he is remarkably expressive with a pen.

“Vicarious trauma” describes what happens to people who witness other’s trauma repeatedly. It is certainly so for healthcare workers; the not infrequent callousness of Emergency Department workers is a common example. Here, because of the lack of resources, the frequent and common unnecessary deaths in hospital, and examples like the two above, all the healthcare workers are subject to it. Including yours truly, I realize from my pseudo-objective perch.

I watched two pied crows land on opposite ends of our front lawn and walk towards each other. They are smart and playful, wonderful birds to observe. Well, they came right up to each other, the male cooed and bobbed for a bit, and then the female settled down on the ground. The male mounted her and they copulated. He was flapping his wings and calling out in (Pleasure? Accomplishment? Triumph?). Then he got off and, as if choreographed, they both flew up onto the roof. No grabbing of genitals, no stealing kisses, just a sweet, mutual, familiar pleasure ingeniously designed to replicate their DNA.

What a peculiar and potentially destructive species we are, accumulating goods and attacking those with whose views we disagree. Hillary, you’re not perfect and you lack your husband’s smooth, natural ability to seduce, thank god.  However, our country has missed a very great opportunity to let you soar, to elevate those who need a boost, as you have prepared yourself so well to do. I know we haven’t heard the last from Ms. Rodham.

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