Category: Nonfiction

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Education Lessons Medicine Nonfiction Reflection

We Want to See Them Better.

When he and I first met he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!”

I did.

The next week, he answered my questions about the pencil drawings on his walls.

“My name is John Doe,” he said, the words spilling out of his mouth. “You all think my name is Peter Pan, but it’s not. It’s John Doe. See my name up there?” He pointed at the “John Doe” he had written in two-foot high letters on his cell wall. “That’s my name. My people call me John Doe. I am the leader of all the people. I am the leader of all the Asians. I am half-Asian.”

Nothing about him looked Asian.

More weekly visits occurred.

“I can speak 13 languages,” he said again. “Tingee tongee tai tai—;”

“You’re making fun of me,” I interrupted.

“I’m not,” he said, smiling. I’d never seen him smile before.

“No, I’m pretty sure you are.”

“I’m not. Aichee aichee—”

I walked away.

“Hey! I’m a doctor! I own the jail! I CONTROL ALL OF THIS!” he shouted at me.

I kept walking.

One week I was trying to speak to a man in a nearby cell. John Doe was shouting: “The police are pigs! They don’t know anything! I hired all of them! I own them!” His vitriol bounced off of the concrete surfaces of the cell block; I couldn’t hear anything but his reverberating voice.

“Excuse me,” I said to the man. John Doe was still shouting when I arrived at his cell door. He fell silent.

“Could you please not yell for ten minutes so I can talk to another guy here?”

He nodded.

“Thank you,” I said, returning to the man.

Two minutes later, John Doe started yelling again. I sighed.

“That John Doe—he really pushes my buttons. I don’t know what it is about him—people have said and done much worse things, but there’s something about him….” I said in exasperation to my colleagues. “I mean, I know he’s ill, but…!”

He declined to take medications. He followed his own prescriptions of daily showers, three meals with extra fruit if he could get it, and daily bodyweight exercises. He rarely slept.

Another week the same situation occurred again: I wanted to talk to another man in the same cell block as John Doe, who was shouting.

John Doe stopped yelling when he saw me approach his cell.

“Could you please not shout for ten or fifteen minutes so I can talk to another man here?” I asked, resisting the urge to shout at him.

He nodded. I didn’t say “thank you” this time.

I completed my interview with the other man. John Doe remained silent the entire time. I was surprised.

“Thank you for not yelling. I appreciate it,” I said to John Doe on my way out. He nodded.

As I walked out of the cell block, I heard him shouting again.

More weekly visits occurred. John Doe still declined to take medications. He stopped speaking to me in faux-Asian languages, though would occasionally speak in gibberish that I did not understand. He stopped shouting whenever he noticed that I had entered the cell block.

“You’re not a real doctor,” he said one day. “You must be a nurse.”

“What makes you think that?”

“You’re a woman. Women aren’t doctors. Maybe you’re a clinic assistant. A really smart clinic assistant. But you’re not a doctor. Women can’t be doctors. I’m the president of all the doctors and hospitals. I own all the hospitals and jails—”

“Okay. Is there anything I can help you with today?”

A few weeks later, John Doe was no longer in jail. A judge declared that he wasn’t competent to stand trial due to his psychiatric symptoms. He went to the state hospital to receive treatment.

More weeks passed. He eventually returned to jail once his competency was restored, but he didn’t return to psychiatric housing. My colleagues who evaluated him upon his return, however, shared news about John Doe with enthusiasm.

“He’s taking meds now and he’s better. He’s polite. He answers questions. He doesn’t talk in fake languages. He doesn’t shout. I mean, he’s not warm or friendly and he doesn’t talk much, but he can hold a conversation. He’s definitely better.”

“What?” I exclaimed. “Are you serious?”

I wanted to see him. I wanted to see him better.

Despite that, I never did: He would not have found my visit therapeutic or helpful. The only person who would have felt better after that visit was me.

One of the greatest rewards in health care is helping and seeing people get better. This is particularly true when people have severe illnesses. We want to see them better. It gives us hope that other people who have comparable symptoms—symptoms that scare us, worry us, sadden us—will get better, too.

“How will [action x] change your management?” That’s a question we often talk about. If that lab study won’t change what you do, don’t order the lab. If the patient’s answer to your question won’t change how you proceed, don’t ask the question.

John Doe was no longer my patient. He was better. I didn’t need to see him to believe it.

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Nonfiction Observations Reading

King Solomon’s Ring.

I often smiled to myself while reading King Solomon’s Ring by Konrad Lorenz. In this delightful book he shares stories of animal intelligence and character that humans often disregard. It reminded me of the botanical garden at UCLA.

The botanical garden at UCLA is not large, but it had tall trees with thick trunks and rugged bark, ferns with luxurious leaves that stretched along the edge of a small stream, and bright hibiscus flowers that beckoned butterflies and hummingbirds. Footpaths wound through the garden to quiet corners and pockets of shade. The garden offered respite from urban university life.

During my last year of college at UCLA, I helped with research projects in a behavioral ecology lab. One project I worked on involved scrub jays. They are related to crows, which means that they are intelligent birds.

Near the entrance to the botanical garden were two small chessboard-sized platforms, each on a post. This is where I did experiments with the scrub jays.

Prior to working with the birds, I prepared peanuts. Some peanuts I did not open; I merely painted them in one of four different colors. Other peanuts I opened, but took only one or two nuts out before gluing the shells back together. For some peanuts I removed all the nuts before gluing the shells back together. I also painted these manipulated peanuts.

Scrub jays can distinguish different colors. A bird will shake a peanut in its beak to discern how much food is inside.

I don’t remember the exact experiments, but this was the general procedure: I would place two peanuts, each a different color, on a platform. Scrub jays, their legs marked with rings, would appear one at a time to select a nut. Part of the task was to see if scrub jays could learn what specific colors meant (e.g., “red peanuts never have nuts in them; green peanuts are always full of nuts”). Another part of the task was to see how quickly scrub jays learned to adapt to changing circumstances (e.g., “something is different—now the green peanuts are empty and the red peanuts have some nuts in them”). I spent about 15 to 20 minutes several times a week putting pairs of peanuts on the platforms. The scrub jays would land on the edge of the platform, look at the peanuts, pick up and test the peanuts, and then fly away to a nearby tree with a peanut. I scribbled down my observations and readings from my stopwatch.

I did this for several weeks, maybe a month. It was fun. (Scrub jays usually learned within two to three trials what different colors meant and could retain this information over time.)

Once my time at the lab was over, I still took walks in the garden. Scrub jays saw me enter the garden and followed me, often for over ten minutes. They flew from branch to branch, sometimes trailing behind me, sometimes flying ahead of me on the path.

This occurred for months after I had stopped leaving peanuts for them.

I took walks in the garden before I joined the behavioral ecology lab. Scrub jays never followed me around then. I can only assume that the scrub jays learned to recognize me and hoped that I would leave peanuts for them.

My experiences with the scrub jays pales in comparison to Lorenz’s work, but it felt both magical and eerie to see scrub jays following me around—always in silence and never too close—as I took walks in the garden. I can only wish that everyone will have such an experience at least once in their lives.

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Nonfiction Observations

The Golden Rule.

People in the meeting room returned to their seats: The Governor was about to enter the room!

The judge, wearing a smart blue suit, rose from his seat. He fastened a button of his single-breasted jacket and ran a hand along both lapels.

An urgent whisper: “Are we supposed to stand up for him?”

The judge looked around: Nearly everyone had sat down, but a few were standing.

“I’m going to stand up,” he murmured. “People stand up for me.”

The judge adopted his best posture. The door to the room clicked open. The Governor walked in. Everyone but the judge was seated.

“Ladies and gentlemen, the Governor,” the seated host announced. The audience burst into applause.

Smirking, the judge sat down with haste.

“I guess I was the only one,” he mumbled.

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Nonfiction Observations Systems

Commute Through the Jail.

To get in, out, and through the jail one must go through a series of locked doors. The doors are both taller and wider than standard doors; they are also thicker and made out of metal. Next to each door on the wall is a small silver panel, perhaps the size of two playing cards, that has a small silver button and a flat speaker. Several cameras are bolted to the ceiling near the doors.

“Central control” monitors all the doors through the cameras and speakers. Pushing the button on the silver panel alerts central control that someone wants to pass through. After central control looks you over on the camera, they unlock the door. When the bolt disengages, a loud and jarring “CLICK” bounces off the cinderblock walls and concrete floor. You may then pull or push the door open.

People can wait several minutes before central control unlocks the door. We’re all accustomed to adding five to ten minutes to our commute through the jail.

When I first started working there, I was advised to be patient:

  • “The officers will yell at you if you push the button too much.”
  • “The officers learn who is patient and who is not, and if they know you’re not patient, they might make you wait longer.”

If you wish to call an elevator, you push the button as you would with any other elevator. However, you’re not actually calling the elevator; you’re asking central control to bring it to your floor. As with any other door, there is a silver panel with a speaker and button nearby.

“What floor?” a voice usually asks through the speaker.

You answer into the speaker and, when the elevator arrives, the button to your floor is often lighted. If central control didn’t ask you what floor you wanted before you boarded the elevator, there is also a speaker, paired with a camera, inside the elevator. The floor buttons are “placebo buttons“; nothing happens when you push them.[1. Everyone shares the elevators: Officers, inmates, ancillary staff, visitors. That is why the elevator buttons are “placebo” buttons.]

If central control recognizes an officer in the elevator, sometimes central control becomes mischievous: The entire button panel will light up simultaneously and the elevator looks like it will stop on every floor. After everyone has chortled, all the lighted buttons will darken except for the button for the floor the officer wants.

During my first few weeks in the jail, I often was unsure where I was going, particularly when I was trying to exit the building. (There are no “exit” signs and all the doors and corridors look the same.) Upon stepping out of the elevator, I would look confused and lost.

“Over here,” a voice would call through a panel ten feet in front of me.

“Thank you,” I would say as I tread through the empty corridor. If I didn’t know where to go next, the same voice would call through a farther speaker, “Down here. Go through this door, then turn right.”

These were creepy reminders: People are watching you.

Now that I know how to get in and out of jail with confidence (which helps boost one’s sense of competence in general), central control rarely talks to me through the speakers.

A few weeks ago, central control was extraordinarily attentive. Every door unlocked as I approached it. I didn’t need to push any buttons. I preemptively spoke into the speaker at the elevator to request the floor I wanted. The elevator doors slid open a few seconds later and the button for the floor I wanted was already lit.

It felt like victory: I did not have to wait. I did not have to stop walking. Doors literally unlocked for me.

For a moment, it almost felt like God was watching, that God was opening doors, that God was showing me The Path.

Except it wasn’t God. It was an officer in central control who, for whatever reason, decided that it was worth his or her time to make my trip go smoothly.

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Lessons Nonfiction NYC Observations Reflection

Living in New York, or Assertiveness Training.

Over three years have passed since I moved out of New York—or returned to Seattle, however you want to look at it. I have had the good fortune to visit New York every year since my departure, though I was unable to last year due to my mother’s illness.

Whenever people ask me about my time in New York, I usually say something like, “I’m so thankful that I had the chance to live there, but I ultimately found it too overstimulating.” Sometimes I comment how I found myself laughing when I realized the number of people who seemed to take everything, including themselves, so seriously. I didn’t laugh because I found their behaviors funny; I often didn’t know how else to react.

When I was an intern in Seattle, one of the fellows told me about the year he spent in Boston earning an Master’s degree in public health. “Living on the East Coast is like going through assertiveness training,” he quipped.

Indeed, I found my three years in New York to be a course in assertiveness training. This training did not occur because “people are rude in New York”. To be clear, there are rude people in New York, but not more so than anywhere else.

People learn to assert themselves in New York City because of the constant crush of people and what seems like scarce resources. (“Resources” isn’t limited only to money; I refer also to time, attention, and space.) If you don’t assert yourself, people overlook you. And I’m not even talking about people overlooking you for promotions, relationships, or praise. I’m talking about crowds overlooking you while you try to get on a subway car[1. Here are photos of men taking up too much space on the train. Many of the photos feature the New York City subway.], taxi drivers overlooking you as they race down the avenues, or the guys at the pizza counter overlooking you when you’re trying to order a slice.

You learn to change the way you walk, the way you hold yourself, the way your form occupies space. You learn to arrange your body and face to announce, “I am here.” You don’t send that message because you want to be the center of attention; you just want to get stuff done.[2. Because you learn how to adjust your body and face to make your presence known and felt, you also learn how to turn all that off. Sometimes you want to disappear into the crowd; you just want to watch what is happening around you without having to take part.]

You learn to speak up. Speaking up doesn’t mean speaking more; you learn how to get enough attention for enough time to say what you need to say. You learn that if you don’t speak up, people

  1. may not realize you are there
  2. may not realize that you have something useful or helpful to offer
  3. may develop wrong opinions about you, what you think, or what you’re about

You learn to speak up and make your presence known because you witness someone else speak up and advocate for you. You pay that forward and notice that, for whatever reason, that karmic system works.

You also learn to assert yourself because sometimes you get attention you don’t want. There are all the irritating men who catcall you[3. I am an N of 1, but men in New York catcalled me way more than men in any other city I have lived in. That video resonated with me.], the taxis that trail you as you walk on the sidewalk, and the disgruntled people you happened to interact with at the wrong time. You learn to ignore the unwanted attention without showing discomfort or fear on your face. You arrange your body and face to announce, “I am here, but not for you.”

You learn that people respond to you—favorably!—when you assert yourself. You learn that when you speak up and deliver your message in an envelope of good manners, people often change their behavior. You learn who respects you. You also learn that one of the best ways to show respect to others is to tell them what you’re thinking and feeling. You learn that they can handle it. You also learn that you can handle it, too.

I remain grateful to New York for teaching me how to sharpen my assertiveness skills. I’ll be visiting the great city soon and trust that I will have no choice but to review the coursework.