Thinking about the book "A Constellation of Vital Phenomena" by Anthony Marra

One of the great things about a brand-new fresh book from a young author is that no one has said much about it yet.  One can consider what it means, without overlays of other people's interpretations already coloring the landscape.  This book is extremely rich, luminous, full-bodied.  It is a once-in-a-great while achievement.   I am still compelled to think about it, all the parts of it, as well as the whole.  It has not faded, but is like the glowing embers of a fire, which was a bonfire of sumptuous proportions.

I  must say that I love to read.  I have re-read Anna Karenina 4 times, and War and Peace twice.  I have read Checkhov's stories at least 3 times,  Doestoevsky (the Brothers K)  twice.  So the potential connections to Russian literature, which were what drove Anthony Marra to visit St. Petersburg in school, and possibly to writing in the first place, are not completely lost on me.  And I will also say that I love children's books, and am a big fan of the Harry Potter books by J.K. Rowling.   What I love about the best books is how they help hone one's consciousness about what it is to be a human being.  Tolstoy is the greatest writer, still, because of his ability to show so many textures and colors to any scene that it comes "alive"-- his cinematography shows us when a smile is enigmatic, when it is delighted, when it is ironic.  And he is able to follow the thoughts of so many persons, of so many psychological bents,  so amazingly well!  But the depth charge is always to ring the bell of the conscience, to hone recognition of the soul, the needs of the soul, the peculiar growth of the soul.
The big theme in this book, for me, is the story of Abraham and Isaac.  It is all the more interesting because the culture he writes about in Chechnya is Islamic.  The people are Abrahamic.   He is writing about the way humans behave in a time of war, in a fringe area of a terrible devastation, with a huge sense of defeat, and invasion, and bullying.  There is no victory, there are no victors, there is no "rightness' to the geopolitical landscape in which the story is set.  One could call it a wilderness, with brambles.  It is very post-modern;  the landmines, the urban orphans scavenging, the hopeless question of whether it is federal troops or guerrilla warfare-revolutionaries doing the bullying, and how in so many ways, it doesn't matter.  It is also very post-modern in that the main character for "stability" is a woman surgeon, trying to keep a hospital going, and who has calluses on her hands, from using the bone saw to amputate all the victims whose legs have been blown to smithereens.
The two stories of the child-parent bond, are Dokka and his daughter Havaa;  and Khassan and his son Ramzan.  They amplify and resonate and clash with each other.  The amazing amazing thing, is that the ultimate question is whether to help a child live, or to destroy the child.  It is this fundamental question, which I think is the underpinning of the JK Rowling books also.  And the question is the soul's question.  And I think for all of time, I will see that small piece of paper which Akhmed has left for Khassan, with the word "mercy".
We are absorbed, many of us, with the problems of PTSD, of torture and its sequelae.  We are also absorbed with prostitution, drug-addiction and the hellish power of the procurers of whatever can be sold;  guns, drugs and people.  Against the backdrop of a time-immemorial landscape of the hills one heads for when there's political trouble (the Caucasus);  where there are forests, snow, no electricity, minimal roads, and minimal access to modern conveniences, there are only the ballast of story-telling, hearsay, rumor, memories, and the ways we treat each other.  The landscape helps throw the human behavior into stark relief.
There are severe mercies, in this book. There are immense beauties.  The writing is like a summer field full of fireflies.   The memory Khassan writes, of Dokka peeling plums is shimmeringly lovely.  It is then even harder to bear the crippling of his hands.  I love the description of Havaa's birth, and of how Natasha comes back to life as she helps mothers with birthing, with new babies.  I love the way Akhmed gives his wife a bath.   The soul lessons are about the simplicity of kindness, the costliness of compassion, and the gift of freedom from bullying, from becoming the thing you hate.  And even at the landfill, dancing for joy, as we know that the child has been saved.  There are things about friendship, and love, and the things we hold dear, even through immense suffering.  And I think one of the great gifts of this book is to recognize that the ones who are tortured can still refuse to become the torturers.  We can understand the reasons, and still say no.  It is in this that Marra's book resembles the way Tolstoy wrote,  to me.  There is the old-fashioned kind of honor in it, which is durable, time-immemorial.  When I went to the bookstore reading here in Santa Cruz, a lady said "I resent you for making me understand and care about the bully."  I thought that was a great compliment.  We cannot drop down into black-and-white thinking, and we need to pray for mercy, for humility, for help to reach for the better way to be.

garden photos

Obstetrics, Gardening, and the ribbon of Time

I have been thinking about time.  I started thinking about it when I was in college, and read a book by Henri Bergson, trying to talk about how time is one of the most important construction elements in our minds, our experience, our sense of ourselves in the world.  Time is what makes history a progression, a sequence, not just an endless morass.  I realize now, as a middle-aged obstetrician, that most of the day I am thinking about the future---  about 9 months from the beginning of the pregnancy of the woman in front of me--- I am aiming my thoughts at that date.  Right now, people are coming in who are due in 2014,  in the spring.  I have one dear young woman who is due in January, so I was just saying to her that she could be Mary in the Christmas play this year.  I start thinking about Christmas, and the fullness of time, of delivering the baby.
I have decided to publish my book of poems "the Rose Windows in the Cathedral of Mary".  This set of poems was written in 1994, just before the death of my father.  He was able to hear them, listening deeply to me read them.  He loved them, and loved that I was finally able to reclaim the metaphorical side of myself, to make this collection of poems.  I read the last one, "the Assumption of Mary", at his funeral.   I was thinking about the life of Mary, who is a paradigm of women, women having babies, women trying to be good mothers, and to discern what their children need.  This year was the year of graduation from high school of my nieces, Katherine and Margaret.  It is the end of the era of raising children, in my generation.  Now they are all adults, and ready to embark on careers, marriages, ongoing educational goals.  Time marches on.
My husband is reading about John Montgomery-- and the beginning of the era of flying machines.  Montgomery was a great inventor, and invented the propeller, and the curved wing, for airplanes.  One of the buildings at our university (Santa Clara) was named for him.  They tore it down, several years after we left, to make room for the theatre.  One hundred years has changed California so much!  I am thinking often about my grandmother, and her songs, and the era in which she was raised.  It is that same time, when Montgomery was building flying machines.  My grandmother was born in 1892.  History is unique,  and themes repeat themselves over time.
What I meant to say was that obstetrics is like gardening, which is always aimed at the seasons, the potential for growth, and when things may flower or bear fruit.  We need to put things in the right place, to get water and light, and sufficient nutrients, and then keep an eye on them as they grow.  I have a little dwarf Meyer lemon tree, which we bring inside when it is cold, so it won't freeze.  I was ecstatic that this year, as we carried it back outside, it has two little yellow lemons on it.  I have been reluctant to pick them-- watching to see when they are truly ripe.  Obstetrics is like this too--- waiting for labor, waiting until the cervix is ripe, and the womb begins to open, to be ready to deliver the baby.   This is different from other fields in medicine, in which it is the NOW which matters-- the problem is acute, and needs to be addressed urgently.    I am looking at the bridal plum tree, outside my window.  It is mid June, and the plums are green.  It usually is late July when they are so ripe, and so loaded on the tree,  that I go into anxiety about making jam, and can not rest easy until I have tried to deal with the fruit.  I cannot just let it fall and rot.  Maybe when I am older, I will be sitting here, and be willing to let them fall and rot-- but most likely I will be begging someone to come and make jam from them.   No one else near me seems to feel this urgency about the fruit on the trees.   For this reason, I believe it is from my maternal lineage, from the Native Americans or Mexicans, from the mitochondria in my cells, that I have this insistent alarm clock about the time for ripeness.  I wake in the night, knowing it is time for a baby to come.  The nurses ask "how do you know?"-- maybe it is from attending many, many labors, but I know people in my field who don't seem to have this acute sense of the time of labor.  Right now is the time of petunias blooming full-bore.  I love to be on the deck looking at them.  My dad was a person who loved wild colors in the garden, and who tried to make the garden look like a painting.  When I saw Monet's garden in Giverny, it was like saying hello to my dad.  There is a kiss in it-- for the eyes, for the heart, of one who loves color, light, texture, blossoms, amazing color schemes and overlapping shadows.  I will post a photo, of the blooming petunias, and of last years' ripe plums.  Sometimes, the time stretches out, like Isis on the deck, and labors sometimes take a long time getting into high-gear.  Time is not always with the same amount of weight, of gravity, moment by moment.  And there are times when it is just like "A Hundred Years of Solitude" by Gabriel Garcia Marquez, when it is all confluent, and the same thing over and over, in comforting familiarity, but with just minor differences, like trying new spices on a favorite dish.  One does not have to be bludgeoned by future shock, strangeness and newness.
I have been reading off and on, a book called "Poets and the Psalms".  This is an interesting book, with different poets talking about how the psalms have affected them, run through their lives, with little ribbons of repetition;  of comfort, of challenge, and occasionally, the perfect words for the particular agony we are experiencing.  Perhaps, because of this, I have come to love my cd of the music of Palestrina --- "Gloria Dei Cantores" the most of all the music I listen to.  It is overlapping, shimmering rainbows of sound, which is actually a mass being sung, but there is a feeling of timelessness.  It is like ripe fruit, holding everything-- a hologram, a sacrament, a quintessence, and it opens that wide eternal NOW, breathing room for the soul.

Photo of me in my apron, in the office

Today is Memorial Day.
Diane Lindsay is visiting.  We have been talking about that deep prayerful connection to the God who is beyond all telling, who is the upwelling of the creative and healthy and joy-filled Spirit.  It is a miracle to have a friend come to visit, to have such a conversation,  to sit on the balcony, to listen to birdsong, to watch the hawks over the redwood trees, to be able to walk on the beach with Isis, and to eat grapefruit which is ripe and juicy! Yesterday Diane played Nana's piano for me-- it is a Chickering, and about 100 years old.  The insides got rebuilt about 15 years ago, by a lovely piano-builder here, named Beth.  It sounds so great!  Diane played my grandmother's songs.  They are also 100 years old, and they belong with this piano.  It is a waking dream, a miracle, that I am here, listening to this music, which I so dearly love.  I am remembering, and I am remembering all the soldiers who have given their lives for our country.  God bless them!  I hope for them a true heaven, a place of infinite fun.  Not just peace, because for some, peace sounds boring.  But for the kind of peace which is fun, and  truly heavenly!  Today I am feeling that grace, which is the joy and peace and miraculous fullness.  I so wish it for everyone, especially for those who have given their lives in service.

Compassion in Medical Care

"What is to give life must endure burning".  Viktor Frankl

I read a story about a woman doctor in labor,  in the online medical magazine "Pulse" which  makes my heart crumple and cry.  I want to STOP it!   I want to punish the docs; a whole team who did not attend to her needs in labor-- as though it didn't matter,  as though the woman and family's complex needs during this intense time of pain and worry are not important. What does it make me, if I become as violent and indifferent as they are?  What has angered me most in my life,---where I kneel down and beg forgiveness, is this kind of insensitivity and callousness to suffering, especially in women.  Women who seem invisible to the treating doctor.  And my great terror is of becoming like this, having it rub off with the precious training.

 I worry that there are people like this in the training institutions. I worry that the whole 3rd world is still full of this kind of autocratic behavior, even though the need for doctors is so overwhelming that the patients must stand our cruelty, and even though the greatest cruelty may be to just be indifferent to  suffering, and turn away and refuse to try to help.

 I am completely raw from reading Abraham Verghese's book, "Cutting for Stone".  The beginning of the story is the completely nightmare-frightening delivery of the conjoined twins and the death of the mother.  Later,  there is the issue of vesico-vaginal fistulae, and the need all over Africa for repairs.  My heart was in my throat for the whole book!  And in my own life, to justify having a middle-class life, here in the USA, where I really try my best to take care of my poor Mexican and Mexican-American patients--- even though I am getting paid for it, it feels like
missionary medicine;  the issues of women everywhere are similar, and pregnancy makes almost all women aware that they are vulnerable and have insufficient resources, because it takes a whole community to raise a child, and stability is so hard to achieve.

This doctor (in the story in "Pulse") had her whole community of doctors let her down.  It is comforting to read my friend's words, about the essential goodness of the medical students.  It is good to remember that there are teaching physicians who model respect and compassion.  It is good that there are docs who have maintained the trust of their patients, and been faithful to the injunction to "first, do no harm."  And it is still so harrowing to read these stories, and know how vividly the person who
experienced that will remember it, her whole life.  And that the
stories reverberate through the culture, making it harder for patients to trust that we will "do the right thing"-- respond with love and care and competent action to their needs and sufferings.
I have heard that many patients are getting experiences of sitting in a room with a doctor typing on a computer, without eye contact through the whole visit.  And physicians who have gone to a doctor who has not EXAMINED them, not even touched them-- listened to their heart, checked their pulse, put a hand on their shoulder.  I can understand not doing a pelvic exam, but I cannot understand not touching the patient.  This story just blew all my fuses again.  I pray and hope to never be so callous.
Since medicine is a PRACTICE, we need to begin again each day, and we can so easily fail to meet the daily need--- we miss the mark.  But bleeding and labor insists on our immediate emergency response, and critical skills.  In the novel, "Cutting for Stone", Dr. Stone vomits before each day's first surgery.  He is so scared of making a mistake.
Once he touches the flesh, he knows where he is, and he can do it.  I understand that terror, of walking into the surgical lounge and vomiting, each morning, unsure of what will need to be faced.
I hope this story provides a background of a cautionary tale. It is a good starting place, and I wish to God it would never happen again.

--
Psalm 139
You have traced my journey and my resting places and are familiar with
all my paths.  If I take my flight to the frontiers of the morning or
dwell at the limit of the western sea, even there your hand will meet
me and your right hand will hold me fast.

My Grandmother Singing

I Remember Nana Singing

I remember her voice, coming from the back of the house, when Dad started to play--- she floated toward the piano, and her voice was like a large bird--  white wings gliding through a wide blue sky;  a rich mezzo-soprano building a crescendo as it rises toward the sunlight, banking against the high wind;  perfectly descending to a soft landing, with a flutter, to the branch of a sturdy tree.   My grandmother's songs are still breathtaking to me: the emotional vulnerability in them; the strength of the love in them.  "Forgotten", "Love, here is my heart",  "Because", "Sing me to Sleep", "Your song from Paradise".  Dad found the last two, which were from her era, and carried the nostalgia we all felt for missing her voice, her songs in our lives.  Dad could play perfectly for her voice, allowing the needed pauses, so her voice could soar-- and glide through several bars on long notes--- with full-throated ease, like honey in a warm summer sun.   My grandmother's name was Ave Maria-- she renamed herself at age 5, because she loved to sing the song for Mary.  She sang every version of the song, but she especially loved the Bach-Gounod version of it.  

Reading Keats' "Ode to a Nightingale" makes me think of my grandmother singing.  

Looking back now, I can be amazed at the magic of it, the gift of it--  one could say, the miracle of it.

My grandfather died in 1952, when I was two.  They met just before WWI.  My grandmother was born in 1892, (and my son Sebastian was born 99 years later, in 1991).  My grandmother's life spanned the time in California when the bridges and roads and dams were being built, and my grandfather was an engineer and a surveyor.  He contributed to many of the big projects, like the Huntington dam.  I found a copy of Omar Khayams's "The Rubaiyat", which he signed and gave to her on Nov. 1, 1914.  I never knew him, but I felt my grandmother's love for him in the songs she loved to sing best---and I think he must have known himself to be a lucky man, a blessed man, to be loved by a woman who could sing like that.  My aunt Geraldine, their daughter with the perfect memory, told me that they met at the Ventura hotel-- where my grandmother was singing for a benefit just before WWI.  My grandfather was in the audience, and asked to be introduced to the girl with the lovely voice.   An Irishman, one thinks he understood the value of a voice for singing.  They married in 1914, as he was leaving for the war;  and my mother, their first child, was born in 1921.  

I suppose when people ask now, what Love is, and mull about it, and ask "what's love got to do with it", I fall back onto the absolute shimmering recognition of the love my grandmother felt for George FitzGerald, that went into the songs she loved to sing.  No matter the shadows and suffering and pain, the love was a magnificent thing.  I also know that the love between my dad and his mother-in-law was deep and true and coherent because of those songs--- how he played the piano for her, and loved to hear her sing them;  and he loved to give my mother, her daughter, the gift of hearing her sing them.  My mother had no voice for singing, but she also had a deep reverential awe of her mother's voice, and she would stop whatever she was doing, and come to the piano room to listen.  The songs from WWI were influenced by the operatic and complex songs sung by professional singers in France and Germany, songs written by gifted composers.  But they were made to be accessible to the public, with unforgettable lyrics, and relatively easy melodies.  Radio made them move faster through the culture.  

Later, Dad would play her songs, and I would sing them-- but my voice is not as grand or fine as my grandmother's-- not as rich and creamy and sure.  Still, the habit between us was to sing them, often in the late afternoon, as shadows were falling, honoring her memory, recognizing her absence, and carrying the melody for her.  

I went on, learning more songs, singing with Dad-- hoping to be as full-throated and to do as much for presenting beautiful songs, as had she.  Later I thought of all I have learned through music;  everything I know of heaven and love, and truth starts there.  "Love, here is my heart, one rose for your hair; whether you echo the tune, whether you tire of it soon; whether you laugh as you depart, or hear it again; something to listen to yet, or forget, here is my heart".