By Fabrizia Faustinella
You are very organized. This world is full of distractions and inevitably declines into disorder. Entropy always increases with time, resulting in randomness. Therefore, it is critical to stay organized.
You are a list maker. Lists help you to compartmentalize. Everything is placed in the right column and the right box: things to do for work, things to do for home, things to do for the family, things to do for friends. You are on the list too, under “things to do for yourself,” but you are on a different page and at the bottom of it. In fact, your list is the one with fewer check marks. Things don’t get done there as quickly as they do in the other columns, as more pressing matters often require you to reprioritize.
You have learned to compartmentalize as a strategy to stay focused and be efficient. Compartmentalization is also a strategy to maintain sanity. So when your scheduled time for relaxation comes, you won’t let anything penetrate the walls of that compartment. Otherwise, your mind will wander away and start thinking thoughts that don’t belong there, and lure you into other compartments. It’s extremely important to avoid interferences between the different compartments. Compartmentalization is a skill and can be learned. It’s like meditation. You know what they say about meditation: when your mind wanders away, gently bring it back and stay focused.
Stay focused. You have to coax your neurons and your synapses to form pathways and boundaries around the various compartments and discern what and when is allowed in and out of each compartment. You have to coax your neurons and your synapses to quickly choose where to store the information, where to retrieve the data from, and also to un-think and un-react, if such things become necessary.
It’s now time to get in the car and go to work. You have to focus on driving. You hate driving, but it’s a necessary evil. The freeway traffic is scary to you and makes you anxious. The flight-or-fight response to danger leaves you no choice but to fight, as you cannot escape the freeway. You don’t understand how people can drive that crazy that early in the morning. Where are they going? If it was so important to them to get there on time, they should have planned their day accordingly and left earlier. It occurs to you that people don’t think that way. They’d rather cut in front of you and drive recklessly than plan. They’d rather cause havoc and accidents on the freeway than think. Thoughtlessness is a dangerous state of mind. You even wonder if some of these drivers might already be under the influence of drugs or alcohol, or if they are just prey of the anger and aggression that motor vehicles seem to naturally bring out of people. Some of your students and residents have told you that they come to the clinic “the long way,” i.e., using city streets, because they can’t take the stress of the freeway.
You remind yourself to stay focused, aware of your surroundings, and refrain from displaying your own outrage at the inconceivable acts of aggression of your fellow drivers. They carry guns too. They don’t even need a permit to carry guns in your state. Not only are you trying to avoid being caught in a car accident, but you’re also trying to avoid a bullet in your head so early in the morning. Anger is stored in a high-security compartment. You consciously avoid opening that one up at all cost. Behavioral science and personal experience have taught you that when anger is triggered, it’s very difficult to rein it in, and there is no telling where that could take you and what it could cause.
Your heart is still racing when you enter the parking lot of your clinic. You feel overheated even if the air-conditioning was on. You inhale deeply and exhale slowly. It’s time to wear your coat, your masks, two of them, one on top of the other, and your face shield, which always feels somewhat tight around your head. Comfort is not a priority. You think that it never was, not throughout your entire medical career and training. You were the giver, not the recipient of care after all. Physical and mental comfort was never part of the job description and was not expected. You were expected to adapt to the job, adaptation being the number one rule of survival and evolution. You think that progress has been made since. Your resident told you the other day that his work schedule is pretty good, allows for plenty of leisure time, and he would not have considered becoming a doctor if he had to work the way we did. You think that it would have been a loss for the system if he didn’t decide to become a doctor because of the rigorous training, but you are also cognizant of the fact that you are who you are precisely because of that.
It’s time to move on and enter the clinic. You ask nurses, security guards, janitors, and colleagues how they are doing, how is it going. It is not easy. By now, everybody knows somebody, friends, friends of friends, family members, acquaintances, who got sick with Covid or died of it. This doesn’t even amount to the totality of the hardship, as you listen to stories of broken hips, metastatic cancer, dementia, renal failure, cardiac arrhythmias, pain and suffering, directly affecting the people you work with and their families. What was happening before Covid is still happening now and to a worse degree, caused by the many delays in workup and treatment during the pandemic. You offer words of comfort, encouragement, and hope.
You settle down in your office, and shortly after you start seeing patients, some in person, some via Telehealth. The stories keep on repeating themselves. Loss of health, unemployment, living on the edge of collapse, Covid-19, cancer, limited access to care, a fall, broken bones, memory loss, anxiety, depression. You do all you can. It doesn’t feel like much. You offer words of comfort, encouragement, and hope.
Your workflow is challenged by computers and systems malfunction. The telemedicine app loses connection to audio and video. The electronic medical record can’t be accessed. The Hindi interpreter is not available at this time. Frustration starts to mount but you know better. There is a compartment for that too, and you are quick at storing frustration away. After all, professionalism implies being able to rise above our own frustrations.
You are now on a break from 1 to 2 p.m. Your list says there are phone calls to make. You call home, overseas. Your mother is scheduled for a procedure at the main hospital. A disc herniation has been causing bothersome symptoms of sciatica and has to be fixed. You are worried about the outcome. You are worried about possible complications. You are worried about Covid infection at the hospital. You are worried about the steroid and anti-inflammatory drugs that will be prescribed for sure after the procedure, because you know she has a delicate stomach. You are worried, but you tell her absolutely not to worry; that everything will be just fine, piece of cake, in fact. You make jokes. You tell her how well she’ll feel after the procedure and how fast she’ll be able to walk. You offer words of comfort, encouragement, and hope. You hang up and reach for a bottle of water because your mouth is dry, and your throat feels tight. You tell yourself to have faith. You tell yourself not to think about it again until your next call. Compartmentalize, remember? You must put up the “do not enter” sign at the entrance of the anxiety compartment. Problem is that while the sign can keep you from entering, it can’t keep the thoughts from trying to escape and infiltrate other compartments. It takes some effort on your side to keep the compartments separate, keep them from reaching into one another and turning everything into an entangled mess, like hastily stored Christmas lights.
You have one more call to make. This one is to offer your condolences to the family of your good friend who had Covid in January and fell at home, after a dizzy spell. He hit his head on a glass coffee table and ended up with a busted forehead, a neck collar, and a pacemaker; then, as he was feeling better and stronger, already making plans for the future, he called a neighbor for help. He didn’t explain what was happening to him and was found dead on the bedroom floor, his closest companion, a sweet black cat, howling on top of him. You offer his sister words of comfort and encouragement. You can’t offer words of hope because it is too late for that.
You know that one of the greatest challenges to successful compartmentalization is your smartphone. You would be better off not looking at your smartphone at all, but you have to. You need to access work-related apps that allow you to quickly and efficiently perform specific tasks, like taking photos of a patient’s physical finding, followed by immediate transfer into the patient’s EMR, or approving narcotic prescriptions with the touch of a button, or completing your daily, mandatory Covid-19 screening questionnaire. Therefore, your cell phone is an extension of you, and you have to learn how to live with it. He is your inseparable frenemy. You remind yourself that you are in control after all.
The automatic news updates are a double-edged sword. They help you to stay current, but there is a price to pay for that. You have another compartment to keep in check: the news compartment. This particular compartment is filled with items that can overwhelm your synaptic networks, maybe to a larger extent than anything else. This is the compartment that makes you feel even more helpless, like the world is far gone, like it might be too late, like even good people who continue to work very hard can’t make a difference. After all, you are working hard, too, to make a difference. You are even donating your time and money to the causes important to you, the causes that align with your moral principles. But you feel like neither your time, nor your money are enough to make any difference. You deeply wish you were a ninja warrior with magic powers to fix all the wrongs in this world, but you are not a ninja. You have not found any evidence of magic in this world either. You keep looking for it though, and have created a compartment for that too.
The flash news announcements on your smartphone come at you like a tsunami. You read titles about the latest mass shooting; the devastation of Covid-19 in India; how this new variant might threaten the world, and your vaccine won’t protect you; you read titles about how the acidification and warming of the oceans is causing the rapid decomposition of the coral reefs and turning them into massive expanses of white bones; the latest act of police brutality; the loosening of gun control; the new unrest in the Middle East; airstrikes killing children; the en masse death of manatees and whales; stories of marginalization and discrimination; deadly plastic mazes in the oceans; melting polar ice caps; species extinction; elderly abuse and neglect, child abuse and neglect, sex trafficking, dehumanization, pollution, emaciated polar bears drifting to their deaths on thin slivers of ice, violence, war, injustice, voting rights suppression, lack of access to health care, raging wildfires, floods, extreme weather, the threat of new pandemics, endless human suffering.
“Unprecedented” is now a word that has become part of your own vocabulary. You stop and think how bizarre it is to believe that after the many horrors of the past centuries, we can believe that what we are experiencing now is something unique. In fact, you find yourself thinking that, despite everything, we still have better lives than our ancestors. It occurs to you, though, that we are no longer spectators. We are not just reading from history books, watching documentaries, or listening to distant accounts of war, injustice, and despair. We are now feeling the pain firsthand. We have become protagonists. We have become the main subjects of future history books and documentaries. As you try offering yourself words of comfort, encouragement, and hope, you are unable to fend off the deep sorrow and concern over the current state of affairs. After all, you thought that progress had been made since Dr. King’s times, and then you watched a Black man being executed, choked to death, in front of you, over and over again, and you never saw remorse in the eyes of the killer. After all, you hiked all the way up to the Grinnell glacier several years ago, and that glacier is now extinct. You remember looking at the photos you took. Then looking at the photos in National Geographic, showing the vanished glacier. You remember how you could hardly control the sinking feeling that now continues clawing at you. The planet is damaged. Human beings are damaged. Earth is a desolate landscape. Is there a way back? Or a way forward? Science and technological advancements can’t possibly remedy our countless moral failures. Your resident told you that he’s afraid humans will find advanced life forms in other planets. He’s afraid because he is one hundred percent sure that the humans will exploit, enslave, and destroy the extraterrestrials. He also said that he doesn’t believe the pandemic has brought us together. He believes it has made us worse. In fact, he says that he and his wife don’t even want to have children anymore because they don’t feel comfortable bringing new, innocent life into such a selfish and harsh world. You offer him words of comfort, encouragement, and hope. You tell him that maybe his child will be the one to save the world, the one to bring glaciers and justice back on earth. You tell him to never give up. You tell him that a dear friend of yours just had another baby, a beautiful girl, and how that has brought joy to you too. Temporary joy. You never store this kind of joy into a compartment. There is no need to box joy. Joy shall not be contained but allowed to flow freely, like a floating device, from synapse to synapse, and to come in and out of whatever compartment it wishes. On the other hand, happiness has to be contained in its own compartment because, in times of pain and hardship, thoughts of previous happiness can be hurtful and make the sadness even more profound.
The afternoon starts the same way the morning did. You stay focused. You do all you can. Occasionally, you remind yourself to smile more and be kinder, to keep it together for everybody else. After all, you know what they say of you. You are the man for the job, except you are a woman, but it doesn’t sound right to say it like that. The clinic staff even gave you a made-up award: “The Cool, Calm, and Collected Award” for keeping your head tightly screwed on amidst confusion. This is who you are. This is what you do.
It’s now time to go home. You have to negotiate the trauma of the freeways one more time. City streets are not an option for you. That would be an admission of defeat. You remind yourself to stay focused on the driving, not to wander off into a different thought compartment until you are safe within the walls of your own home. And yet you find yourself thinking how intertwined our lives are, how inescapably entangled by death and disease. You see clearly how everything affects physical and mental health, from known illnesses, to pollution, gun violence, discrimination, racism, poverty, loneliness; how even just witnessing an act of injustice has a negative impact on the unwilling spectator. The different compartments lose definition. Their content spills into one another, making it impossible to discern which box things exactly belong to, as they mix together like drops of different color dyes into water. You wonder if fighting against everything that is wrong in this world isn’t in fact a way to improve, directly and indirectly, health for all humanity and for the single individual. You wonder why it is so hard for human beings to respect each other and do the right thing. You know that the why belongs to a specific compartment, and you are working hard at categorizing and storing information in it. You have also created a solutions compartment, where you keep a list of how to. You even think you have found the answer to the many evils that are choking our society, but it’s not an easy fix, and you seriously doubt anybody will listen to you.
It’s now time for you to un-think, un-react, and lock all the compartments before you get home, where there is more waiting for you.
As the garage door starts automatically shutting down, a gust of wind finds its way in, and you feel it on your mask-less face and your hair. A few leaves blow inside. You see moths fluttering next to the garage ceiling light. You wonder for a second if the high-pitched buzzing sounds you just heard were caused by synaptic interferences carrying an electric, clandestine flow of hope between your tightly secured data compartments.
Fabrizia Faustinella is a physician and filmmaker. She practices as an internist in the Texas Medical Center in Houston, Texas. She has published numerous research articles and educational books. More recently, she has been inspired to write about her personal and professional experiences in a number of essays, which have been published in literary magazines and medical journals.