Post Mortem

I entered medical school at the University of the West Indies one year out of high school, when I was 19 years old. My life up to that point had been relentlessly dedicated to getting accepted to medical school; it has always surprised me that my medical school years were among the worst of my life. My recollections are predominantly of death and horror: a small boy’s body in the perfect arc of a tetanic contraction; maggots writhing and falling out of the infected scalp of a man who had upset sulphuric acid on his head; the stump of an amputated leg like a piece of raw meat; the blistered oozing, stinking skin and orifices of a young woman suffering a reaction to antibiotics; and at the morgue, the bodies of an old woman, a young girl and a small boy tied together and executed gangland style. Their faces were shot away and the inside of the girl’s skull was smooth and pink as if it had been cleaned out for an exhibit.

I do not for one moment believe that this was all there was, that no one lived, that no one was healed, that no one was cured. If I search my memory, turn the images over, look in all the cracks, examine all the shards and fragments, I can find pictures of life. But even then . . . look at this one: There were two young men who had beds beside each other. Both were awaiting heart transplants. I remember Absalom, the one who died, his face, his laughter, the sparkle in his eyes. The other one, the one who lived, the one who I am presenting as an image of life, is shrouded in mist. Of him I remember little except the fear on his face the day he watched Absalom die. I remember him only in relation to Absalom’s death. But this is what I mean. Almost everything I remember from that time is connected to death, even the pictures of life.

I try to avoid it, but I cannot think ofmedical school and death without thinking of my mother. I try to pretend the story of my time in medicine is all mine, but it is not. I will tell you now that my mother has severe Alzheimer’s disease. She lies in a bed, immobile, her body rigid, her arms and legs twisted, unusable appendages. She is unable to do anything without the help of her caretaker. She no longer has recognizable speech and her mind is long gone. She does not recognize any of her children. I tell you the way she is now because I have to remind myself that my mother was once very powerful. A career in medicine was her choice for me.

Medicine was the only profession my mother respected. This had something to do with her growing up in rural, colonial Jamaica in the 1920s and ‘30s when people with professions, usually whites or very light skinned blacks, were accorded god-like status. My mother grew up in Duncans, the capital of the parish of Trelawny, over 100 miles and many narrow winding roads away from Kingston, Jamaica’s capital. It was a typical country town, with one paved main street, a market, maybe a courthouse, a small post office, a few small, dark shops and dust everywhere. Breadfruit, mango and ackee trees were close to the road. Most of the people worked as laborers for the sugar cane and banana estates in the area. My grandmother, a single parent, owned one of the shops in the area, and from the proceeds raised her two children, my mother and her sister Dorothy, to consider themselves as a kind of rural gentility. They did not do manual labor, they had a maid, they went to private schools in Kingston.

I have gathered this information in bits over the years, listening to conversations of my grandmother, my aunt Dorothy or my mother’s cousins. My mother was a secretive woman who did not tell many stories of her past; I do not know what shaped her and I cannot accurately track the origins of her insistence that I become a doctor. Medicine might have been the highest pinnacle of social achievement she could imagine.

I do know that she told me often that when I was 5 years old I said I wanted to become a doctor. I have no memory of this, but I imagine I must have made the sort of comment small children make . . . when I grow up I’m going to be a fireman . . . a nurse . . . a policeman . . . a doctor . . . changing profession from day to day. Fortunately or unfortunately, I loved books and reading and I learned quickly, all “evidence” that I was meant to be a doctor. I grew up knowing I was going to be a doctor, but cannot remember wanting to be one.

There is a difference between knowing and wanting. Knowledge can simply be there, tumbling, turning, resting, waiting to be used for any number of purposes, to move in any number of directions. Wanting something . . . well, that provides focused direction, force that drives you to get the thing. My mother’s wanting was enough to drive us both.

To get me through the doors of medical school, she managed every other detail of my life as well—what I ate, how much I ate, when I was hungry and when I was not:

“Put that food away. You’re not hungry and you don’t need anything to eat until I tell you!”

Whom I talked to, where I went. What I wore in what styles and what colors:

“What do you know about what looks good on you?  This is what I say you are wearing, and this is what you will wear.”

I couldn’t get a drink without her permission:

“Did you ask me if you could go into that refrigerator?  Anything in there belong to you?  Did you buy anything in there?  Go and put that back.”

I couldn’t pick a mango off the loaded trees in our yard without her permission. If I had a summer job, the money was hers, not mine; she’d decide how much, if any, of the money I should have:

“What do you want money for?  Don’t I provide all you need?”

I couldn’t have friends, because they might be the wrong sort of influence. Life was a round of school, studying, home and back to school. I used to think my mother was so powerful she knew what I thought, but the truth was I told her everything, because I didn’t know there were some parts of me to which she had no rights.

My mother’s dream for me was not just that I become a doctor, but that I become a doctor with my own nurse and my own pharmacist. My older brother was to be my pharmacist, and my younger sister my nurse. That way we’d always stick together. My having my own nurse and pharmacist meant my brother s and sister’s lives were managed as rigidly as mine, but that is their story to tell. The nurse and pharmacist idea came from mother’s memory of doctor’s offices in rural Jamaica, where when she was growing up doctors had their own nurses and on-site dispensaries (as pharmacies were called then) filled with rows of bottles of pink or white medicine. The patients lined up respectfully, waiting patiently while the nurse (my sister) handed the prescription to the pharmacist (my brother) who finally handed back a bottle of pink or white medicine, and the grateful patients smiled and curtsied their obsequious thanks before they went on their way.

My mother liked the idea of doctors because of the power and prestige she thought they had, not for their ability to heal. When she talked about my life as a doctor, it was always about the respect people would have for me, the money and therefore the independence I would have. Most important, my having money and independence meant I could get married on my own terms, or—and this she seemed to prefer—not get married at all. Money and independence would mean I could buy her a house and take care of her too.

My mother’s dreams for her life?  Who knows what she dreamed of when she was young, or what she wanted. She was not happy in her marriage to my father. Early on she discovered he had lied about many things—he did not have the property, the money, or the engineering training he’d said he had. He had magnified his assets to persuade her to marry him, she had been too willing to believe. By the time I was 5 years old she would have been in the beginning of her lifelong bitter disappointment with my father, and would have begun the redemptive focus on her children which consumed her life.

Usually my mother’s face wore a tight, frozen look rarely altered with a smile. She seemed preoccupied and she shouted at us when we inserted our needs into her reverie. She was tense, harried, and very, very rarely relaxed and in a good humor. She had huge plate-like scars all over her arms and legs. As a child I thought she looked like she had been bitten by a wild animal, but she insisted that the scars came from a childhood illness misdiagnosed and mistreated by a local doctor. I never believed her, perhaps because I needed to find a reason for her constant unhappiness, but her mother and cousins all insisted the story was true.

She was a heavy woman, unhappy with her weight. She dieted, desultorily and unsuccessfully throughout most of my childhood, often lamenting the birth of her children which had destroyed her once remarkable, hip-heavy figure. When I knew her, her black hair was already thin, showing scalp; another beauty sacrificed to child-bearing. She vomited for hours each time she tried to take the vitamin supplements that would have protected her hair, teeth and nails. The doctor warned her that her hair might fall out if she did not take the supplements, but what was she to do? A good mother, she always told me, will sacrifice anything for her children, even her body.

My father was at least 20 years older than my mother, a very muscular, strong man, who had once been an amateur boxer. Neighbors were careful with him because he looked, and sometimes acted, as if he were murderously angry. Potential acquaintances would not come to my house, because they were afraid of him, but at night he polished my school shoes for me so I would have time to study. Sometimes he baked fragrant, sticky buns bursting with fruit.

My mother excluded him from discussions, ridiculed him, his ideas, and his competence, at first subtly, then more and more overtly. She reduced him to a caricature of a man, a bumbling buffoon, worthy only of our contempt. I remember a scene from our life in Jamaica of father trying to assert his authority after an argument with my mother.

“Now you just listen to me. I am the man in this house. I demand respect. I am the man and what I say goes!”

I sat on the floor beside her chair, sensing her body shaking the way it did when she was trying not to laugh. Then the laugh burst out and she laughed at him until the tears rolled down her face, everything was in that laugh: contempt, ridicule, dismissal. I laughed too. She flicked her hand in a dismissive gesture and turned her face away.

I don’t remember what he did; I guess he just walked away. For me the result of all this was that she, and she only, was the sole source of power. Whenever I think of my father, it is as an absence, a diminished space, a lost possibility.

I write all this from a great distance, the distance that allows one to see shapes, shadows and patterns. It is hard for me to explain how much I loved my mother and how important she was to me. We were interpenetrated and intertwined with me growing along the trellis she provided. Her body, her mind, her soul providing the frame and I the roots, branches, twigs, stems, flowers to be torn out, chopped down, pruned, trimmed, cut, so that I grew into the perfect fruitful vine. For most of my youth I grew as she directed—porous, pliable, accepting—bent, swayed, twisted—perfectly, beautifully fit to her frame.

I believed my father was the reason she was so unhappy, and thought doing what she wanted was a small price to pay for making such a wonderful woman happy. I believed her when she said over and over and over that she had sacrificed so much for her children, that her children were all she had in her life, all she lived for. All of this was very obvious to me then; of course she was right: If we did the right things, she would be happy.

There were signs in my body that things were not well, but of what use are signs that have no interpretation, of language that no one can read?  By the time I was 11 years old I had trouble breathing, tightness in my chest, pounding of my heart. I had trouble sleeping and began to have bad dreams. The summer before I entered medical school I virtually stopped eating and began to obsess about my weight and body image; fears of death invaded my dreams. All of this sounds terrible, but it wasn’t really. These things—anxiety, fear, insomnia and so on—symptoms—-just happened. I thought they were a part of who I was, like the color of my eyes, my muscles, my bones.

My mother hated Jamaica. Who knows why. I always thought it was because she couldn’t be independent of my father while she lived there. When I was 14 or l5 she began the lengthy process of emigration to the United States, and by my 18th birthday, every member of the family possessed a resident alien visa, which meant we could now leave Jamaica for good.

By the time I entered medical school, the family was beginning to fray. My mother had been to the U. S. several times making preparations for the time we all would live there. I was still her lieutenant and confidante, isolated and protected from all outside experience. I had been to one movie, maybe two parties, had no friends. I would have told anyone that my mother was the center of my world. My sister had a year to go in a nursing school in Jamaica, and all indications were that she did not like nursing. My older brother had already flunked out of pharmacy school and left for the U. S. on his resident alien visa; no one was quite sure where he was from week to week. My mother was frantic with worry, but my brother did not call often.

There were about 100 students in my medical school class, from all over the West Indies . . . Jamaica, Trinidad and Tobago, Barbados, Belize, Bahamas, Guyana, Grenada. For the first 18 months we studied the “pre-clinical” subjects—anatomy, organic chemistry, biochemistry, microbiology—the cornerstone of all the other learning we would accumulate. Anatomy was my favorite.

I remember the anatomy lab in medical school as a poorly lit, low-ceilinged room, saturated with the smell of formalin. The only significant features of the room were the six or seven slab-like tables, each surmounted by the shrouded body to be dissected. Only the bodies of the unattached and unclaimed turned up in the anatomy lab, a gift for often unappreciative students. The life in the room came from the students in white lab coats, mid-sections stained with the brownish yellow grease that leaked from the preserved bodies. No amount of washing ever rid the coats of the stain or the acrid smell. Each time we left the lab, it seemed we took a smear of death with us on our dissection manuals, our skins, our clothing. We moved about the anatomy lab like ghouls dressed in white, cutting into the bodies, unraveling their secrets, building from these deaths the core of a new life for ourselves.

Next door to the lab was the room where bodies were prepared. When I looked in, I could see the bodies lying there, naked and vulnerable, with formalin, the preservative, dripping into a vein. The man whose job this was looked the part. He was tall and husky and one of his eyes looked as if it were placed as an afterthought. The malfunctioning eye was coated with a yellowish film, and it swivelled and twisted independently, giving the man a sinister air.

I lived in a suburb named Meadowbrook, a good distance from the medical school which was near the foot of the Blue Mountains, in a section of Kingston called Mona. Sometimes in the early morning on my way to class, I walked from the bus stop, past a market, and down the road to the campus. A mist came down from the mountains and sat for a while in the valley where the school was. I walked past the bulky bodies of the market women, their loads balanced on their heads, the mist softening their contours. I listened to them calling greetings to each other as I moved into the relative silence of the section of the road that led to the school. Some mornings there were footsteps behind me, and when I turned around I saw the man from the anatomy lab striding toward his job. He emerged from the mist, behind me, beside me, before me. He carried a bag with the lunch I might see him eating later as he sat with his bodies. A macabre man who worked with death and handled it with such aplomb.

Until I went to medical school, I had seen only two dead bodies. One was a boy named Wayne who drowned in the University of the West Indies pool. Wayne was his parents’ oldest child, the kind of boy every family dreams of. You knew he was going to be something special, do something special, and that is what made his death so incredible. I saw him laid out in a coffin, wearing a nice suit, his dark skin blue-black, much darker than I remembered it, eyes calmly shut, his resisting, disbelieving mother being gently led toward the coffin. Wayne was the center of his parents’ dreams, but he had a younger brother named Omar. Their father was a preacher, and at the service he stood in the pulpit and said he’d been in Canada when he got the news of his son’s death. He told the mourners that he said: “Oh my God, not Wayne. Not Wayne. Omar, but not Wayne.” I remember the grief stricken Omar sitting in the front row, wearing a beige suit that looked too large for him. I remember my own shock at his father’s comment, and wanted to ask Omar how he felt about the only words I remember from the funeral service.

The other body was Anesta, my grandmother’s sister, whose end I witnessed. I remember the scene: the bedroom of the house in Jamaica, concrete walls painted cream, the room lined with wardrobes and a heavy mahogany, mirrored dressing table. Her children, all adults, stood and sat around talking about funeral arrangements and whether anyone had been able to contact the brother and sister who were not in the room. Anesta and my mother read the Bible and prayed together, then mother helped Anesta to the bathroom and back into bed. Anesta lay on her back, raised her right hand and waved to the people in the room. Goodbye. Goodbye. Thank you. Thank you for everything. I’m traveling. I’m traveling. And she put her hand back to her side and lay still. Her children screamed because they knew “traveling” was another way of saying “I’m dying now.” The whole thing, from her return to the bed to finally closing her eyes, took about two minutes.

Sometimes moments are so intense they consume everything within them. The room, the sunshine, the mango trees outside, her children’s wails all seemed to disappear into a vast silence, and there were only the gray images of Anesta’s frail body on the bed, her uplifted hand, the contorted faces of her children, and then, as if with the exhalation of an unseen breath, color and light and sound returned. An old woman, full of years, dying a “natural” death. A gentle, almost choreographed death.

In the anatomy lab, death was a building block of learning, the foundation of a yet to be constructed edifice. The essence of death, its connection to life, was ignored. We spent a year dissecting a body in sections—Head and Neck, Thorax, Abdomen, Pelvis, Extremities. Over the year the body took on a frayed, untidy look as it gave up its secrets. Flaps of skin cut back from the neck so we could examine the veins, nerves and arteries which passed from the thorax through the neck and into the brain; the muscles of the chest and arms and legs, cut open so we could examine their striations, and see where they attached to the bone; the abdomen slit, all the organs cut into and removed after we had carefully observed their relationships to each other; pieces of greasy fat and slivers of leathery brown skin on the floor and dissecting table; little pieces of soft, gray brain where a careless student had squeezed too hard.

I loved anatomy. I thought it was mystery, magic and the source of knowledge. Sometimes I would pick up a femur, the bone of the thigh, from the pile of human bones kept in the lab and marvel, just marvel at the perfection of the thing. How smooth and firm it was along its shaft; narrow and elegant. The cool ivory color, ridges and prominences for the attachment of muscles. I imagined the bone in my hand clothed in muscle, being moved this way and that. I loved the smooth rounded head of the femur where it fit into the pelvis. Or I’d marvel at the symmetry of the bones of the rib cage and the way they hung on either side of the vertebrae like semi-circular shutters, bony protection for the lungs beneath.

I remember cutting open the abdomen and standing in wonder at all that fit, and so neatly, so perfectly, into the space. Stomach, liver, coils of intestine, spleen, pancreas, kidneys, blood vessels running up and down the posterior wall of the abdomen on their way to or from the heart. All neatly packed and partly covered by a sheet of tissue called the greater omentum, which hangs down from the stomach. Or I remember following the course of a dissected nerve, in mounting excitement that its path was exactly as the dissection manual described. Anatomy is after all about order, sequence and connectedness, and it reveals the human body a marvel of tidy organization. The command center of the brain and spinal cord at its center, sheathed by its protective bone, the muscles and joints that move in coordination with the signals from the nerves, the way the whole thing forms a cavern for kidneys and liver, gut and womb. A whole system, internal and external milieu, regulated, functioning by age-old secret signals. Effortless.

It seems obvious to me now that a large part of the reason I liked anatomy was that the bodies were, well . . . dead. When I cut into the body with my blade there was no blood, no cry of pain, no need for me to respond. For me, human interactions were marked by uncertainty. There were too many variations, too many possibilities, too much confusion, and I had been too isolated by my life to know how to cope. The lack of human responsiveness provided me a certain ease and power in manipulating the bodies, while the form provided a certain familiarity. Anatomical dissection is a very concrete way of beginning the exploration of the temple of the self.

In the early days of anatomy we had lectures on the specialized language of anatomy, which is often a language of positioning: It is important in anatomy to know where things are. If I cut into the arm above the elbow, or in the middle of the forearm, or near the wrist, where will I find a particular nerve?  Its path varies in each section of the arm. What structures lie on either side of the nerve?  Over what section of which muscle does the nerve pass on its way through the arm to the hand, for example?  The new knowledge brought with it a feeling of growing mastery, of magic and of power; I felt I had been initiated into a mystery cult that I could take on more and more. I began to have an inkling of what I might be able to do.

The sense of power, of being changed by knowledge, opened me up to other kinds of learning, and I began to connect with other students in the class. At first my contacts were all linked to studying, but soon the interactions became more social. Visits to Jennifer’s house; lunch with Clive, or Upton, or Mitzie. Staying late to talk to Valerie. I had a boyfriend. I went out at night. I talked. I listened. And I began to realize that my life was different from theirs in some very important ways. For one thing, none of them seemed to have a mother who demanded the absolute submission so familiar to my life. I don’t remember how he said it, but my boyfriend, whom I’ll call Raymond, was the first person who suggested that my mother wielded more influence than might be good for me. I still remember hearing but not understanding what he was trying to tell me.

My social contacts were possible because during some of this time my mother was still going back and forth to the U. S. making preparations to move, and my father, who remained behind, did not restrict my activities. He thought I was supposed to go out, meet people, have friends and boyfriends. I had spent so much of my life ignoring him, I had not realized he might wish me well.

Whenever my mother came back from one of her trips there were scenes, usually because she realized I’d been off doing things she would have prevented had she been there. Raymond was a particular problem. She was concerned I was sleeping with him (I was), but she was never one to discuss intimate matters so she couldn’t really say what she was worried about. Supported by Raymond I shook in my shoes and used language he had given me: She was trying to dictate my life, she was acting like she owned me, did she think I was going to live with her and do what she said forever?  But they were his words, not mine, based on something he saw clearly, and which I was still too wrapped in to see. It went nowhere.

The language of our arguments became stylized, a language, powerful, but full of pain and ignorant desperation: I didn’t love her; I was putting other people before her; I was not to forget who had worked so hard to get me where I was; I was not to forget that no one would love me the way she did; why did I want to have friends?

Why wasn’t my family enough?  I was not to forget that friends were enemies in disguise and would turn on me soon; I was in medical school to learn, not to have friends; too many friends were not a good thing; I could have all the friends I wanted when I came to live with her in the U. S.

I listened to her in sullen silence. My sense of having betrayed her was deep, yet I was angry she wouldn’t see things my way. But what way was that?  I could see from her prostration and tears that she was deeply hurt and frightened. When she said I didn’t love Raymond, I was just using him to destroy my relationship with her, she was right, but at the time I couldn’t see what she meant. She might have realized what I only guessed at: I had enough knowledge of her to cause real pain.

Every new piece of knowledge, every new relationship, every friendship was the blade ofa knife, cutting me away from her. No guide, no dissection manual, just cut and rip the flesh away. See where it bleeds; bandage the area; cut some more, while you have the knife, cut before you have time to think too much. We both bled, and walked around in constant pain flapping our bloodstained bandages around us.

I had the upper hand now. I could have stanched the flow by doing what I always did. I could retract the blade, sheath the knife, let things go back to the way they were. But I did not, at least, not as much as she wanted. I pulled back enough to stop some of the bleeding, mine and hers. I hated hurting her, and sometimes it seemed, as it had for most of my life, that life would be easier if I did as she wanted. I still don’t know why I didn’t pull all the way back; there were probably many reasons. This was the first time I had been able to discomfit her and maybe I enjoyed the sense of power. Maybe I was just beginning to learn that I could have a life that was not hers. Maybe I enjoyed meeting new people, moving into a larger world and just did not want to pull back. Maybe I realized my life was at stake. I have no clear memory of what I thought then; all these things, some of these things, none of these things. I think all of them when I look back.

The body I dissected, along with a group of three or four other students, was of an old lady, thin, possibly malnourished. Her face was thin and wizened. When we dissected her arms and legs the muscles, deltoids, biceps, triceps of her arms or the quadriceps, biceps femoris, gastrocnemius of the leg, were small and insubstantial. Her breasts were small and flattened to her thin chest, with very little fat beneath the skin we cut away. Her pubic hairs were scant and gray. When we dissected her pelvis and examined her uterus and clitoris we saw that she had given birth more than once. What was the story of her life? Ignorance of her life story made learning much easier.

To enhance the illusion of “pure learning,” to divorce the bodies from the taint of illness and death, the university selected bodies with no obvious abnormalities or deformations. The bodies appeared so normal that sometimes it seemed almost incongruous to think of illness and these bodies in the same image. Death ought to have some visible marker, an ulcer, a tumor, an eruption of a surface. We students were never told what diseases or situations had resulted in death, and to tell the truth we did not really care. The information would not necessarily have been relevant. The anatomy lab functioned mainly to familiarize students with the map of the human body—what we would find in this area or that, where one structure was in relation to another.

Naturally, we came across disease in the course of our exploration. I have a memory of feeling the creamy, chalky accretions of plaque beneath an unnaturally yellowed section of the wall of an artery, and the anatomy professor explaining about cholesterol and calcium deposition in the walls of arteries and what the presence of such a plaque might mean: hypertension, heart disease, the blockage of arteries, stroke.

One can no longer be young once a certain threshold of knowledge is passed. Now and then a member of the group might wonder what illness had brought the body before us, but our youth made it easy to put such questions out of mind; death was not our concern. Too early and too frequent an experience with death, or serious illness for that matter, removes the exuberance of youth. And what is youth, if not a state of ignorance about the world, about life, about illness, and about death?  I know that 18 months into my training, when anatomy and the other pre-clinical courses ended, I was not ready for intimate communion with the presence and the knowledge of death.

I don’t remember the sequence of their leavings, but by the time the pre-clinical training was over, everybody in my family had moved to the U. S. and I was alone in the four bedroom house. For the next three and a half years, except for brief visits to the U. S., I lived apart from them. We would reconnect when I graduated medical school.

In the clinical years the student melds the more theoretical learning of pre-clinical with observations of real patients, and this is where death begins to connect with life. Something that people rarely mentioned about medical school is that death in all its forms accompanies you. They tell you how wonderful it is to learn to heal, but they rarely tell you about the physical reality of illness and death. I guess they assume that it’s obvious. Maybe it is.

On one ofmy first rotations on the medical wards there was a slim, well-dressed, white-haired older woman who came every day to sit, silently and longingly, beside the bed of a bundle of unconscious skin draped over protruding bones. The body was/had been her husband who was/had been a brilliant professor. He had contracted a particularly virulent form of encephalitis, an infection of the brain, and had become the wasted, unresponsive body on the bed. When does illness change us from what we are into what we were?  He reminded me of the skinny old woman’s body I dissected in the anatomy lab. Only an infusion of formalin separated his body from hers and from the knowledge he could impart to a student with a knife. Every day his breathing grew harsher as his body became more diaphanous. I used to think that the substance of him was being breathed away, breath by labored breath.

A much younger man sat in the same ward. He had an incurable disease which turned his lungs from pink, moist, pliable stuff that did its job of exchanging oxygen, into stiff fibrous tissue which made breathing virtually impossible. He sat all day on the edge of his bed struggling to breathe, his body hunched, his hands on either side of him resting on the bed, his eyes fixed on the floor. He looked up only when his wife and small daughter came to see him every evening. No one spoke. He lifted his right arm and touched first his wife, then his daughter with a stroking, lingering touch. His hand returned to the bed, and the family sat in absolute silence, listening to the noise of his breathing, watching his body shaking and straining with the effort.

I had begun to have more trouble breathing. I noticed my chest was always tight, as if I was trying to breathe against the weight of the world. Night after night I jerked awake from my troubled sleep gasping for breath, feeling as if all the air had been sucked out of the room. I sat on the edge of my bed struggling to breathe, my body hunched, hands on either side of me, holding onto the bed.

I called my mother in New York once, twice, so many times in panic. She’d say My God!, My God! What is wrong?  and I’d say / don’t know, I don’t know and we’d go on like that for a while until my breathing became more normal. These conversations always ended the same way. She’d say I don’t know what to do . . . are you still studying . . . doing all right in school?  And I’d say yes, I’m doing OK and she’d say Well keep studying, keep working. The time will pass, you will finish there, and then you can come here. You’ll see. Just keep studying. You want me to send you anything?  Books or anything else?  Clothes?  We’d say our goodbyes and hang up. I’d think how right she was. I’d turn on all the lights in the house and stay up the rest of the night studying. In the morning I’d go to class, choosing to forget for a while how bad the night had been.

I remember Absalom, for his name and for his youth and for the way he died. Absalom was terrified of death. His terror marked him, set him apart from the other patients. He refused to sleep, refused to close his eyes, because, he told me once, sleep and darkness were too close to death. I never told him that I understood him all too well. He waylaid and talked incessantly to any human being who walked by his bed, so we learned to avoid him, wanting to avoid, perhaps, the ever present imminence of death. He did anything he could to stay awake. Absalom was young, very handsome, rippling with healthy muscles on the outside, but inside, the muscles of his heart were almost useless. The secrets that bodies carry, the deceptions—the way that, often, nothing outside reflects the chaos inside. Absalom did not look like he was close to death, but he was. A heart transplant was his only hope. He asked often about Marie, another patient with a useless heart. Marie was from Guadeloupe, a frail, beautiful girl, with high cheek bones and startlingly brilliant brown eyes. She did not survive the attempt to transplant her heart. When Absalom heard of her death, he opened his eyes wider, talked more, grabbed more at passers-by. As if we could, through our words, infuse him with life, strengthen his weakened heart, guarantee the success of his transplant. A few days after Marie died, Absalom lay on his bed, talking to his favorite surgical resident. Suddenly the resident noticed Absalom had not responded to something he’d said. He looked down and Absalom was dead. We tried to resuscitate him, but it was no use. Broad daylight. Eyes open, talking even, and still, still death comes.

Death followed me outside the hospital too. Jamaica was going through a virtual civil war at the time, and reports of death and violence dominated the news. The two political parties, the Jamaica Labor Party and the People’s National Party, had heavily armed their supporters, who were mostly the ghetto poor. The nights were filled with violence and the mornings with reports of the dead, gang violence, shootings, police stations held hostage and rescued by soldiers. Body of a young boy with gunshot wound to the head. Body of a man, gunshot wound to the chest and abdomen. Body of a man. Body of a woman. Body of a child. Bodies of a group of people. The three tied together bodies I had seen at the morgue were victims of political violence.

Most of the violence stayed in the ghetto, but a feeling of anarchy pervaded the country and I was afraid. I rarely went out. At night, alone in the house, every sound filled me with terror. Every swaying shadow of the trees outside my window meant the presence of an attacker. Many nights I lay awake watching the shadows on my walls, afraid to move, my body rigid, my pulse pounding. One morning I stood on the verandah and watched an orange glow in the sky to the south. I learned from the news that gunmen had set fire to a housing complex, then stood outside the ring of flames, guns in hand, shooting at the residents who tried to escape. How long before the flames covered the distance and engulfed me too?

Every day gunshot victims turned up in the emergency room. A young boy who bled to death from a small wound on his thigh, his mother screaming, screaming, screaming when she came in; a group of men all with leg wounds: they had been drinking at a bar when a gunman entered, knelt and shot from the floor up; bodies with what looked like small entry wounds, but which had gaping wounds in their heads or legs or abdomens when I turned them over; a 16-year-old boy with a gunshot wound to the chest and on and on. And all of this mixed up with the “regular” stuff. The little boy who accidentally penetrated his heart when he fell on a knife; a man who fractured his liver when a car he was working on fell on him; the girl who fled in terror from the maggots that fell out of her nose while she brushed her teeth one morning; the boy brought unconscious from his home in the country, where he had been in a coma for two days.

At night I drifted into a twilight zone filled with terror. My sleep worsened and sometimes two or three nights went by without sleep. I had nightmares, more and more terrifying, flooded with vivid images of death and destruction. Bodies drifted towards me, nerves and arteries floated free; Absalom warned me I could die at any moment; he fell, got up, fell again; amoeba-like animals grew on my skin, and when I tore them off, I bled and bled and bled.

I moved to the house of a friend, the one person from that time whose memory is an oasis of light and beauty. (I might have told her I was afraid to be alone because of the violence. She knew I had trouble sleeping, but I did not tell her or anyone else how bad my nights were.) Her house was a haven from my fears, but even there, I could not sleep. A half bottle of Harvey’s Bristol Cream sherry put me to sleep every night. More accurate is to say that it made me unconscious. Anyone who has used alcohol to sleep knows the cycle. Drink brings unconsciousness, but in two or three hours it also brings wake-fulness. I prayed for morning to come so that the shadows would take on solid form. Every morning, once light penetrated the blackness, the world was revealed whole and intact, as I last remembered it. Night-time fears were replaced by a now familiar anxiety which I considered a part of who I was.

Most days I walked around trembling inside, heart pounding, muscles so tense and tight I thought I would explode. Sheer will power prevented me from fracturing into a million trembling pieces. Will-power and all the studying I had to do. The masses of information I had to learn became the new frame I tried to grow around. I sat in lectures, I took part in tutorials, my exam results proved I was doing well. My body kept its secrets and nobody was the wiser.

I am puzzled that I remember so much death and horror. I have but to think of medical school and the pictures flood my mind. And yet I know there was more. I know my memory is selective. For instance, my boyfriend took me on trips around the island. Where did we go?  I know we went to visit his family in the country. I know we went to Montego Bay. I know we went to Dunn’s River Falls. I know we went to Boston Beach to eat jerk pork. If I try to write images from those trips, the foam-tipped waves in the distance as we drive along the coastline, water roaring and plunging off the rocks in the falls, boys selling oranges by the side of the road, people walking home at dusk with baskets balanced on their heads, pigs squealing as they are led off to be killed and turned into jerk pork, I will be using images from recent trips to Jamaica to fill in the gaps. I will not be using genuine memories of what happened then. I will in effect be lying, although all the information will probably be accurate. What I have written about medical school . . . is it accurate?  Is it true?  It is a very one-sided picture, true only because always, always, these are the things I remember. The other things, the things hidden in the mist, I know, but I do not remember. And I cannot explain the contradiction of knowing something I do not remember.

Moving to my friend’s house did not help. The fears and nightmares continued. And still I called my mother in New York expecting her to have some answer, expecting her to tell me what was wrong. I tried to explain the problem, but what I did was give breathless, inadequate descriptions of my feeling states. My insides felt like jelly; I had to think before I picked up a pencil so no one would see my hands shaking; I felt the parts of me were coming apart; I had to, literally, hold myself together by wrapping my arms around myself as tightly as I could; I had to keep my attention focused on keeping myself in one piece; I spent so much energy paying attention to myself that I had no energy left over for anything else; I was frightened all the time; my thoughts raced; I could not breathe; every night, I thought I was going to die; I was so isolated, so alone I thought everyone on earth was dead and I was the only person left alive; sometimes I could not tell if I really existed. I listened to myself spewing these words to my mother, desperate for her to understand, and after a while my voice trailed off. It was ridiculous. I was ridiculous. I sounded silly to myself. After months and months of calling her long distance I finally figured something out. She didn’t understand, didn’t know, didn’t feel, what I was talking about. How could she? She wasn’t me. There were some things I was going to have to deal with on my own.

It seems to me that all training, professional or otherwise, is the learning of a language which makes sense of a set of experiences. I had no language then with which to make sense of what was happening to me emotionally. But from the distance of time, I can say this: the core of me had moved to New York, and, deprived of its directive force, I was floundering. The vine had collapsed without the support of the trellis. Porous, pliable, accepting, I took everything in, and I sprawled in all directions, a chaotic jumble of unsupported leaves, branches, roots—unpruned, uncut, unshaped. I had no center around which I could organize. There was no one to tell me how to respond. No one to tell me what I should think or feel. Nothing between me and raw experience, the sharp blade that sliced me away from my mother, cut me open, dissected my body into its constituent parts. I was aware for the first time of the elements of me, naming them as mine, looking for a way, but not yet knowing how, to shape myself around a new frame.

I know all this now, but I did not know it then, so no, nothing improved. I do not remembering learning any “coping skills” which made my inner turmoil any easier to manage. I spun and twisted and twirled and I made it until the end of medical school. Failing or giving up or giving in, never had been in the plan. Odd, but I have my mother to thank for that. I did well. I graduated.

About the Author

Norma V.L. Clarke

Norma V.L. Clark was born in London and lived in Jamaica prior to moving to the United States. She is currently completing an MFA in creative nonfiction at Goucher College.

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