Anger and shame

What would they do if I told them the truth?  How would they see me? How would they think of me? Would I be disgusting to them?  These thoughts swam through my head as I sat in front of Melissa, our trainer,  for a demonstration.  It was the start of our weekend Hakomi training and my mind was seething with all the possibilities of what might happen.  Behind my eyes there was a push to simply tell it all, leave no secret unsaid, and let the chips fall where they might. Then there was the catch in my chest, the fear of what would happen if I just did this, if I just disclosed all my shame.  In the end, I censored what was presented during the demonstration, but in her eyes, I could tell that Melissa had seem so much more than I had said, her tears reflected what was in my heart, unspoken in that moment.

For the last two weeks, things have been a bit unhinged.  I have had crazy dreams that seemed to be small life lessons taking place.  Not like the usual amusing dreams, but small dreams where I was faced with behavior that was repugnant, and I had no way to turn away from it. In one dream, I got mad at Nancy for no reason, turned and stamped on her foot so hard it broke.  I immediately woke from this dream, only to fall back asleep into the same dream to ‘live’ with the aftermath of this action. In another I was working in the ER and a woman came in pregnant and in trouble.  I began to systematically do the wrong things for her again and again.  I knew that what I was doing was wrong, and I could see that in the dream, but I could not stop myself.  I kept on screwing up until she and her unborn child were dead.  I woke up and got physically sick from that dream, only to return to sleep to face her husband to whom I had to confess my malpractice.  Several of these dreams I do not recall, but I woke from each dream with the distinct feeling I had been taught a valuable life lesson.   It rocked my heart and my head for the days leading into the training weekend.

As I sat in the demonstration, I wanted to share what was in my heart.  In that moment,  something held me back, the fear around the shame I felt for all that I had been, for all that I had done.  It was there, all the sorrow that was in my heart clamoring to be free.  So simple, just take that step toward liberation, release all the suffering, but there you are frozen, unable to do the very thing that will bring your healing.  The next day I found myself with two fellow students for work, students I know to be strong, unflappable, the two-perfect people to help me unpack this shame; tough, generous, loving, they could hold all the debris that was littering my life, hold it and hold me.  I opened the flood gates, and let it all flow, everything there was.

I spoke about the cruelty of medical training, the ways that students are hazed and bullied through the training cycles. Of the way that you are taught to put you compassion in a safe place lest it be crushed by the onslaught of anger.  During the second year of medical school I found my-self having a test every 8 days, a test that felt like it would determine your future.  Books and lectures, and more books and lectures, then tested, tested, tested, the first two years rolled on.  I had no idea how stressed I was until Christmas time I found myself in the apartment kitchen screaming at Nancy, screaming noises, not words, noises that expressed fully my pain and anguish over all the things that were happening.  And trapped in the kitchen I could see her scared and helpless while I yelled and yelled and yelled. As the year progressed, the morbid humor came on line more and more.  When Jimmy came to ask me what he needed to take with him to the Scottish Rite Hospital for Children (specializing in Orthopedic and Neurologic Illness), without missing a beat ‘a crippled child of course’.  He was speechless, and so I followed it up, ‘Well, Jimmy, if you can’t laugh at dead babies and crippled children then you have no business being here’.  It was hard, cruel and cold, and for some of our class, it became an inside joke used to describe how insane life had gotten.  Rolling into the clinic years, things got more macabre.  HIV hit Dallas hard in the 1990s, and by 1993 when our class entered the medial wards, they were filled with dying young men who had no one to care for them, no one to stand with them.  They had families who responded to our calls about their condition ‘This is God’s punishment for their sins’, and so they were alone in their suffering.  We knew nothing of palliative medicine or hospice care, in fact if you had asked me about it I would have had to look this up to know what it meant. We did what medicine does best, we worked hard to keep these young men alive.  We worked to treat their dying bodies so that they could live another day, another week, another month.  We did not ask them if they wanted this care, we assumed they did.  We did not question if it caused more suffering, it was clearly less suffering than being dead.  This crazy thought process did not stop with the care of the patients, the teaching rounds were no less insane.

Within the medical hierarchy, there is the attending physician, the doctor ultimately in charge of what happens, below them there are the residents in various stages of their training.  The interns are the last of the ‘real doctors’ who have graduated medical school and are extending their medical learning.  Then there are the students, the most untrained of the lot.  In this ‘tribe’ there is an understanding, that if the students look stupid this reflects poorly on the intern, and poorly on the residents. If the intern looks stupid this reflects poorly on the resident, and if the resident looks stupid, then they are hardly fit to practice medicine.  A natural consequence of this behavior is that everyone is trying to be the smartest person in the room, and they do this with the tools of shame and belittling.  If you do not know the answer to the question, rather than move to someone else, they will drill down on your weakness to really expose it to everyone, and once exposed, the attending then reprimands with varying venom the residents and interns for failing to teach the students, and the students for failing to have the initiative to learn.  Cruelty flows up and down this chain of pain, and when I hear patients today tell me they just don’t understand why doctors have no bedside manner, no compassion, I quietly nod, and I know, I know deep inside that it has been crushed within them step by step in the process of educating them.

We reduced the people we were caring for to medical process, and eliminated the empathy and compassion from the young doctors working with them. The view point of patients becomes more industrial.  We think not of people but of disease processes, ‘the 24 year old HIV patient with PCP in room 929 had a fever last night, blood and urine were sent, labs ordered, WBC count falling, chest x-ray shows generalized infiltrates consistent with his PCP, his oxygen requirement is increasing, will change antibiotics today’ click and chunk the data pieces fall into place and decisions are reached about what to do and when, the humanity of this patient, this person, never really enters into the equation beyond pain management choices.

So much of this process is automatic, the need to protect yourself from pain just happens, it is not something you think about.  When you touch the hot stove, you pull back instinctively without thought, you do not pause to ponder the things that are lost from pulling back, you just pull back.  It is the same way in medical training, you just pull back parts of yourself that are always getting hurt.  You do to think about it, there is no rationalization, there is just a reaction.  You suddenly find yourself no longer thinking of the patients as people, they are patients.  In surgery, they drape everything of so that when they cut, they are not cutting into a human, they are cutting into a piece of flesh that is exposed from beneath the surgical sheets. It is automatic, and it is protective.  However, there are tradeoffs from this behavior, and one of them is the anger that grows from the unconscious action of shutting a part of our humanity away.  Anger arises when boundaries are violated and when needs are not met.  Fundamentally we have a need for contact on a human level.  It can be seen in the small child who cries to be held, or the soldier reaching for a comrade during the Remembrance Day ceremonies.  We need to feel our humanity, when this is cut off from us anger develops.  It proceeded apace, this growing anger, it exploded in little ways here and there when too much would accumulate.  Being snappy, harsh, judgmental, all outlets for anger that was not being expressed.  Never once did I yell at the system that was causing me pain, no, I yelled at those around me who were supporting me through the pain I was bearing.  Those who loved me most were the recipients of my anger.

I unpacked it all, the myriad ways that this anger had spilled out of my life and contaminated all that surrounded me.  I spoke of the ways I hurt others in my life, the cutting commentary, the razor-sharp wit, using my mind as a weapon.  I held nothing back, example after example of what I had become, and moving on to the cruelty that was there before medical school, after all, in my mind I was damaged goods, likely from the beginning.  I talked about how I had hurt people who loved me, taken advantage of them, used them.  It all came out, every last bit of it, until I was there, bare, with nothing left to hide of the shame I was carrying.  I sat there weeping over all this pain inside me.  I could not look up, I could not meet their eyes, I was sure of what I would see when I did this, I would see their revulsion, the repugnance in their eyes would not be hidden, I was damaged goods, and it was about to be clear to me. And then something happened that I did not expect, a gentle voice, tinged with sorrow reached out to me through the haze of pain. This simple voice reached out and touched my heart directly, it saw what I had shown, it felt what I had felt, and within that voice there was love. There was love for who I was, in that moment, broken and sad, there was love for the one who had been broken over the years, and there was love for the one who was trying to make things right.  That love held me together as I tried to fall apart.  That love pulled me forward from the pain, and held me in tenderness, and the healing began.  This voice was joined by another, and together they propped me up, held me close, and began to help me look toward rebuilding a view of who I might be. They began by telling me of the version of me that they knew, of the version of me that they had seen, alive and at work in the Hakomi sessions.  They told me of the other side of who I was, the one who had survived this pain, and who was working so hard to become helpful for others.  They helped me to see how I had held my compassion safe during those years so that it would be available and unharmed when I had emerged alive from the process.

Here I sit, much like the doctors of old, a sad and thoughtful actor in this play.  I can feel those parts of me from back in the day, and I can love them as they are knowing they did what they had to do to survive.  They did the very best that they could, and I know that if they had any ability to have done things better, then they certainly would have.  Knowing this, I want to keep those parts close, I want to keep in my heart the feeling of this pain, the feeling of this process, so that I remember always, and most especially when sitting with others in pain, the feeling of this cycle of anger and shame.  I am a more fully human for this work, and from this weekend, and am grateful beyond word for those who helped me through this moment, they will always have a special place within my heart.  And this is the work, the work of becoming fully alive to our lives.  It is hard, it is messy, but it is the way to the freedom.

“Your vision will become clear only when you can look into your own heart.  Who looks outside dreams; who looks inside, awakens”

‘There is no coming to consciousness without pain. People will do anything, no matter how absurd, to avoid facing their Soul.”

“The privilege of a lifetime is to become who you truly are. Where wisdom reigns, there is no conflict between thinking and feeling”.

-       Carl Jung

If any of resonates for you, and you happen to be curious, and wish to study it more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me.  I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes)  and Facebook (gilgrimes) about whatever arises from my meditation each day.  And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).