Risa Denenberg

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• Write every day
• Volunteer my time somewhere that has nothing to do with healthcare
• Learn to speak a second language
• Study philosophy
• Get at least one more degree
• Work on my Jon-poems and get them published
• Do a unit of clinical pastoral education, volunteer as a chaplain
• Do a re-write of my novel, Vivian’s Disorder
• Draw, paint, write poetry
• Make collages from old pictures
• Read a million, no a zillion, novels
• Get rid of things I don’t need
• Plant things in places that I don’t live
• Visit people I love
• Sell my home and make a new life in a new place where I can grow old manageably
• Retire and work part time for my son in Miami
• Spend a lot of time at the beach
• Live in a city I have never lived in before
• Visit Ireland and Italy
• Burn my journals
• Do something with my therapy tapes
• Open a cafe-bookstore
• Eat outdoors as often as possible
• Stargaze on clear nights
• Be ready for whatever is to come

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>I saw a psychiatrist in February because of the persistent disengagement from life I’ve been experiencing. Engaging brings up issues of interrelatedness and interdependence that flummox me. Issues of dependency comprise a huge part of my work-life. We are programmed to travel a path from total dependence at birth to functional independence as adults. For elderly, disabled or chronically ill persons, transitioning gracefully from independence back to various levels of dependency takes an enormous amount of courage, trust, faith, good will, acceptance, and humor. I tell my patients that letting others do for them is a gift that they can give freely or stingily to their caregivers. But I am no expert on this terrain. Unfortunately I have long been entrapped in a vortex of counter-dependency–opposition to any state of dependence for myself. Instead, I trudge through life expecting little from others, causing me to cringe when I have to ask for anything or admit to any weakness, experience despair rather than outrage when I feel mistreated. I take care of others as a way to compensate, I speak out against injustice and advocate for others as a way of sublimating my own needs. I’ve worked on this, in particular, I admit that it’s an arrogant stance, my reliance on others is a profound fact of my living. But something in my work-life repeatedly triggers a retreat to my past, raising dust clouds of anger, frustration, exhaustion, hopelessness, anhedonia. I always hope for meaningful relationships with co-workers (and thankfully have encountered many precious connections with both colleagues and patients) but in the health care institutions where I have worked, the day-to-day atmosphere is a formalized, distant, closed hierarchy that limits my perceived choices to either acting out or inhibiting myself. I can’t seem to figure out how to provide healthcare in this atmosphere.

Medical encounters forge relationships, potential opportunities for health or illness. In deciding to see a psychiatrist, I tried to select someone that I hoped I could connect with (within the limits of my insurance coverage, that is). I did my research as best I could. I waited almost three months for the appointment. He was a decent guy, listened attentively, spent almost an hour with me, gave reasonable advice and another medication to try. I have nothing negative to say about him really, but at a second visit last week, lasting about 12 minutes, I just didn’t feel any presence. From him–a nice smile, the right words, but … what? A mode of conversation that sets our roles in opposition–doctor and patient? A tone of voice that signifies: this is a professional encounter? An unwillingness on my part to go where I needed to go, to ask for what I needed, to make the connection stick? There was a falseness, an inauthenticity similar to what I dread daily in personal encounters. What was it? Why do I always feel unsatisfied and ashamed of my needs? Do I just expect too much, is that why I’m so readily disappointed? Do I lack the ability to connect on a level that feels real to me, or do I just lack the ability to accept the distance that exists between persons, the roles that determine relationships, our too-sensitive psyches and seeming lack of toleration for bringing our real selves into our encounters? As I left his office, he said “take care of yourself”.

I couldn’t help thinking about other medical encounters: how comfortably I converse with my primary care doc, yet how I felt like a piece of meat at my routine mammogram appointment when the receptionist asked for my driver’s license and made a copy of it. I understand her job is boring and repetitive, but nothing in her tone of voice came near to suggesting she was speaking to a human being. (And why did they need my driver’s license? I didn’t even bother to ask.) I had a stress echo test last week, and the doctor was charming and curious about me; a similar test that I had about 8 years ago left me in tears, when the doctor didn’t even bother to speak to me. I know that I probably have better medical encounters that most people. I have health insurance, I am a health care provider, I’m not easily intimidated by professionals. This deepens my discouragement about the limits of health care, the lack of connection and caring that might actually make a difference in a life.

So many questions arise from this meditation about healthcare and human relationships. What is the truth of relatedness? Is our primary mode of existence a deep hiddenness covered by a false presentation of self? What is the self we offer in relationship? Are we simply alone, unable to help each other, without reasonable hope of connection for the vast majority of moments of existence? Can I do any good as a health care provider without forming a deep connection, spending enough time, following the patient’s lead instead of ticking items off of an agenda? Although I visit patients in their homes and work primarily with palliative or existential issues, I know I speak for many healthcare providers in other settings who want their efforts to make a real difference. Who want to work in a manner that discovers healing through relationship. Many of us are becoming more and more resentful of being asked to see more patients than we can reasonable care about in a day. Yes–care about–we think of that as our job. In my own job, I don’t fix much, I don’t have a magic wand or substantial resources to offset the suffering I encounter. What I do experience is finding that offering a not-false presence and time does seem to matter. And I know that there is a limit to how much of that inner resource any one of us has to offer in a work day.

I don’t fully know what it is like to be unable to get out of bed without a helper; to not be able to read or listen to music because of sensory losses; to not be able to prepare a meal for myself or use the toilet in privacy. I don’t truly now how finally alone we find ourselves at the end of life. I do know that life feels like a pretty lone venture most of the time. And the adage to “take care of yourself” is a mountain of truth.

>Yesterday, driving to work, the meditative-creative state that I rely on for sustenance re-appeared. Hallelujah! When something is amiss, you feel absence, but can’t always pinpoint what is missing. Without access to that state of mind, I don’t write and I feel a type of distress that is hard to shake. It’s been a difficult time at work and I have been thinking in my sleep instead of dreaming–always a bad sign. I was operating under the totally dumb illusion that the ever-worsening economic downturn wouldn’t affect me emotionally. I have a job, a home, a car and can cut out the extra unnecessaries when I need to without becoming gloomy. But of course it’s all connected. The hospital is cutting programs, demanding more “productivity” of fewer staff, and placing a hold on new hires. Rules and regs are being enforced as a way of displaying tough times ahead and demonstrating who’s in charge. Anxiety is infectious and shit rolls downhill. In my own team, I’ve been censured for my disquieting, anti-authoritarian style and handed what feel like ultimatums about my attitude and behavior. I realize that like anyone else, I could lose my job in these times. Or more to the point, I could reach unrelieved distress levels that typically cause me to flee. My ten-year plan that was to deliver me to a reasonable retirement could dissolve.

I saw a psychiatrist in February, after a year of sluggish depression, and a 3-month wait for an appointment. He was a nice guy and offered simple, but accurate, insight into my depressed state which I agree is choked with undigested fury. He just said: speak up for yourself, ask for what you need, tolerate the anxiety that prevents you from these behaviors, stop substituting others’ needs for your own. He added another drug for me to take. Last week, I turned in my mileage reimbursement request for February after not managing to do so since last September, to the tune of about $300/month. I had a cardiac test that tells me I’d better take care of myself–it’s sort of now or never at this point. I’m thinking about what I need and how to avoid becoming one of my own patients–old, ill, miserably dependent.

As always, I’m looking for a new narrative, perhaps a new metaphor for how/why I am living. I feel that I’ve been called to declare myself, safeguard myself from harm, so that I can persevere. In my introverted, loner life, I claim a internal peace that feels intensely connected and precious. When I am writing, or driving contemplatively, or walking in the woods, I become intensely aware of the interconnections and intuit my tiny place here and feel the “enough-ness” of my life. I find grace in watching snow fall or listening to naked trees offering their branches upward in prayer. And for some reason, I am able to capture this quiet when I sit with my patients and help contain their fears and grief and sorrows. But at the office I am one big mess of energy, anger, and argument. In social settings I lose my quiet self and pick up the emotional energy surrounding me, offering it back in my own version of disquiet. In brief, I don’t connect, or even cause sparks, I blow fuses.

So here is the metaphor/simile that I wish to embody: the hyoid bone. The hyoid bone is the only bone in our body that does not connect with any other bone. And its function separates humans from other primates. By its suspension above the larynx, it supports speech. I want a meaningful life, where connection is present without so much close contact. I want to support important functions in the universe, but still be allowed my own little place here. I want the quiet that allows me to actually be useful and add to the cup of peace that is continually drained by violence and greed. Is that too much to ask?

>I’m quite serious when I say I’m blogging to save my life these days. I have a large file cabinet drawer full of volumes of handwritten journals, dating back to my adolescence, and they too have kept me afloat during treacherous times. I am an introvert, perhaps a bona fide loner, and the act of fully entering my inner life renews and supports me in ways that being an actor in the world simply doesn’t. For some years, instead of journaling, I wrote letters to my therapist, sending them by email. Later, I tried keeping a journal in word documents on my computer, but that never really worked. Once I’m typing rather than hand-writing, I am self-conscious enough to need the writing to be good, hopefully very good, and at minimum, as good as I can make it.

I started blogging on myspace about 18 months ago, and found the experience tremendously satisfying and freeing. I’m sure it is knowing that my words are being read. This is the relationship I crave. Writer to reader, a life observed, God watching over me–but not in an engaged, intrusive way, just watching. Someone to watch over me. This is what I need: to be seen absent the need to be engaged or interfered with. Psychologists call it the observing ego. For me, the idea of being seen makes me labor over the words I choose, makes me take great care with sentences and punctuation, makes me strain for a perfect paragraph. Makes me a writer.

I’m thinking that, unlike journaling which is a private matter, blogging has both inhibited and disinhibited me. I can destroy the handwritten journals with no one the wiser. (But will I?) I suppose exposure becomes the writer’s dilemma once one assumes she is being read. Parts of self get embroidered into the text and parts of self involve others who also show up disguised or otherwise in the writing. This happens whether the writing is fiction, poetry, blogging, or creative prose. Readers may know me or come to know me through the writing. Readers may see themselves, or others that they have relationships with, drawn with my sensibility and interpretations. You can say too much, or not enough. For example, I know exactly what triggered the depression I entered a year ago now, but don’t feel comfortable sharing it in a blog. Truth is, I have gone back to early entries and deleted certain events that I feel that are better left concealed.

The essence of blogging for me is digging down to find authenticity within myself. When I feel a need to censor, I get furious. But when I let go of a truth that may cause harm somewhere, I feel deep shame. It is in the gap between fury and shame where the writing is strongest.

I am not saying what is on my mind tonight, hoping that it will be revealed in time. And yet I need to speak, to write, to make something of what I cannot speak. So let it be this: I blog. I am blogging. I will continue to blog. I am blogging to save my life.

>A thought, driving through the silent falling snow yesterday morning, wanting to stop and have a look, frost-style, but urged forward by an impatient honking soul, ran something like this:

sudden beauty laced
with sorrow, conjoined twins
our inheritance

Missing a syllable, and not sufficiently precise, the thought that humans know beauty, have always known beauty, our uneven trade-off for the burdens and tribulations of daily human consciousness.

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For weeks now, I have been wintered in and feeling depressed again, without an interval of cheer. But when I drove home later on, after about 4 inches of fluffy accumulation, wondering if I would make it up the drive~~lo and behold!~~someone had plowed my driveway. I swear I smiled for about 20 minutes. I have no idea who did this for me, obviously a neighbor, but I don’t really know any of my neighbors. I love the secret good deed, wish that I could learn to posses the humility to pass on good deeds without looking for gratitude, reciprocation, credit.

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Today I feel like an impostor. I am so estranged from my own spirituality, other than snow-watching (which does count, I suppose). Working takes things that I have no right to give and can’t really live without. I have to get this right at some point. I am longing to re-discover a place that I have at least visited where mystery is wonder, history has meaning, I am nothing, silence is everything, and life is precious.

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I am truly blogging to save my life these days. And trying to revise my manuscript, incorporate some exercise into my day, fit in a haircut and take my car in for service and get my refrigerator fixed, and hold on to a bit of equanimity.

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Ah, equanimity. I long for nothing so much as this.

>I had a meltdown at my office this morning. Over the weekend, a new program was installed in everyone’s computer, and this morning all of our “My Files” had disappeared. Wiped out. I’ve spent hours putting together a census list of my patients: phone numbers, diagnoses, prognosis, physicians. Gone, just gone. Templates that I use when writing patient notes. Nowhere to be found. PDF files of articles that I use all the time. Lost. Pictures of my grand-babies. Shot to hell in a canon. Or so it seemed. My colleagues corroborated: everything gone. I really lost it, screaming and cursing. Loud and ugly. Someone had to tell me to chill, and then I just started crying. Then felt terribly embarrassed. I hate to be seen crying at work. Not to mention that my face shows the effects for hours. Literally.

Why? Why did this enrage me so? It only took about 30 minutes for someone to locate the “ghost drive” where our personal files were stored temporarily. They’ll be back on our desktops tomorrow. No big deal, right? But shouldn’t someone have prepared me for this, so that I would not have to feel like the bottom of my world was sagging, imminently threatening to fall out from under me? No, the relevant question is, why did I feel this way? Don’t I trust anyone or anything to look out for me? Apparently not.

Driving up to my poetry workshop a few weeks ago, I felt the need to stop feeling so angry all the time. I was quite surprised at the thought, I hadn’t really admitted to myself that I am holding a great deal of anger. I don’t mean the chronic, constant anger that I feel about the woes of the earth; I can’t undo that and wouldn’t want to. This anger that I am holding is very specifically about me. About being tired and depressed and unable to get what I need. Anger at specific people. A chronic sense of feeling thwarted and obstructed, of turning the corner and finding someone standing in my way, making my life harder than it should be. A paranoid sort of anger where I know that no one is trying to frustrate me, but I feel as if there was something deliberate or at least uncaring going on, some one knowingly causing me pain. So there was this thought that I should try to release this anger, let it go. Try instead to imagine the other’s vantage point, consider that their annoying–or worse–behaviors are connected to some pain or sadness or difficulty of their own that I am unaware of. That for all of my own trials and tribulations, they may be, often are, suffering in ways that I know nothing about, but could try to imagine. It wasn’t difficult to practice kindness at a poetry workshop. It’s never hard to practice empathy when I am in a patient’s home.

But this anger, this morning. It took me back to another place, another job, another computer. 1998. I was promised (at least I thought I was) a new computer, mine was driving me crazy with malfunctioning. I was overworking and feeling exactly the way I felt this morning, but every day, bleeding into nights, weekends, vacations. I was chronically depressed and having panic attacks. When I found out that I wouldn’t be getting a new computer, I had an authentic psychotic break. The felt experience of kicking a door down and then pushing my boss to the floor and kicking her over and over again felt so real I later had to call a colleague to ask if I had actually committed this assault; I had not, but there it was, still is, inside of me somewhere. At that point I had an emotional breakdown and couldn’t work for several months.

I’m thinking about the tractor beam. The one they used on Star Trek to pull another spaceship into their orbit and imprison it. This is what these sorts of experiences are about. The computer today triggered a failure of defenses (“our shields are down”) that allowed my psyche to be trawled into the orbit of a past experience. I know this, I spent a lot of money and time and effort in therapy to understand when I am living in the past instead of in the present. But it doesn’t always seem to stop the power of memory to enslave me to the past. The way that sliding backwards on the ice in my car this past Friday pulled me back under the truck that totalled my car last June.

It is particularly hard for me right now to encounter so much anger inside. For some years now, I have skated along in a peaceful, accepting, tolerant state. Something goes wrong, I think: no one is dying, it will work out. I lose something, I think: it’s not lost, it’s just not here anymore. I’m late for an appointment or someone cancels a date, I think: it can wait, I can adapt. I liked that person a lot more than I like this person who breaks down when things don’t go her way. I know that I’m working too hard, making unreasonable demands of myself, not finding time to take care of myself in ways that allow that person to live and to work. I know that I foiled depression for 8 years, but it didn’t really go away. I know what to do. The problem with being angry is it is a loud voice inside that says: I won’t do what I should do just for spite.

This is why I say I need a new narrative. A new story about myself that carries me past this boulder that stands in my way, jeering at me, taunting me to stay angry and exhausted. I am the hand that is not reaching out to lift me.

>It’s certainly a case of the februaries. Dark when I awaken, puffy grey skies above, overdried indoor air and moisture-laden outdoor fog, limited visibility all around. Then there is the rain-ice-rain-ice cycle we are enduring here along with news of weather-suffering all about–China to California.

I returned from my poetry workshop energized. Not sure if I have a publishable manuscript, but feeling more like a poet, less like a drudge. But where imagination is the currency and vehicle of the writer, weariness seems to be my coin, sliding on ice my transport. I can’t invent time or place. I sit idly at the computer when I should be shoveling snow and spreading salt; cross-hatch the ice on my walk with a hoe when I long to put pen to paper; type novel-worthy notes about my patients into a inhuman electronic medical record when I would rather be sharing stories with one over a cup of coffee. This morning I couldn’t drive down the ice-hill to attend the funeral of a beloved patient. Hugging her memory instead. Listening to music that warns me of how little time is left. Wanting to sleep, not being able to rest. Feeling out of control, like a car sliding backwards on ice down an embankment. Which is an image, but also an experience.

Water is dripping along the eaves. If I don’t walk down the frozen dirt road in the next hour or so, I won’t be able to rescue my car from ice-sloughs until another day. There are messages that I don’t know how to read, tasks that I can’t find the tools to perform, days that slip into frozen time, regrets–yes, regrets–that take my breath away and leave me trailing the crowd, panting out wordless messages to no one. I listen to lungs everyday, the crackles, the wheezes, the quiet sounds that are so treacherous, the collections of fluid that squeeze breath from lung tissue–pleural effusions, we call them. Effusions. Pouring forth. Ice-water-fog. Water in lung tissue. The sense of drowning inside. My patient–this woman that I loved, who reminded me in sweet ways of my mother, died of lung disease. But died peacefully, I am happy to report. Didn’t die alone, I am glad to say. Died in a warm bed in her husband’s arms. Still, I am sad and icy today. Both.

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(Will I write poetry
when I’m old
or am I already old?)

The old narrative
isn’t holding, it’s sliding.
Using a hoe
to crosshatch the ice.
Tacking foothold as I descend the slope.
Falling anyway. Bruised.
My thumb, ruddy tumescence.

Inner fatigue, anhedonia
Paresthesias. Surface irritability,
Meanspirited outbursts, easy tears.

Ah, but now I can’t
drive backwards.
I’m so afraid that
in this story, my deep
becomes a shallow nothing.