there will be moose

So we bought this house in New Hampshire. And we are moving there. Soon. And it's not in the city. And it's quiet. And beautiful. And the last time anyone got shot it was by their drunk cousin Bubba with a skeet gun, not by a police officer during a routine traffic stop. And we have one store. One. It's a Country Store. The kind where you say to the guy, Earl, hey I'm looking for a lumber jack and he'll say oh yeah, call Johnson over on Wheelbarrow Road. His number is blah blah blah blah blah and the next thing you know the whole town knows two crackers from New York City have moved up country. It's the kind of place where you haul your own trash to the Transfer Station on Sunday mornings. It's the kind of place where # of cows > # of people. It's the kind of place where you wake up in the morning and all you hear are birds and the clicking of dog feet. It's the kind of place that sort of makes you need to vomit, it's so beautiful. It's the kind of place I never, in a million years, would have imagined I'd end up, yet it's exactly the place I want to be. It's the kind of place that makes a girl like me feel the need to get a Ford F-250 and some sheep. 

Don't even get me started on the moose.

So anyway, to drive the point home, here are some pictures. In New York, I wake up to this:

In New Hampshire, I wake up to this:

Most of the people we know here think we are batshit crazy. I think, if I have to commute an hour on three trains just to go sit in Central Park with seven hundred thousand other people for any length of time, maybe I jump off the Empire State Building.

on further review

There is always this option.

diametric

In Manhattan my patients are healthy. They make their appointments in advance. They make appointments, period. They have allergies, muscle injuries and viral infections that don't require reports in triplicate to the CDC. They are all very nice. They kindly tolerate my young ineptitude. They like me, I think; they listen to me. They require astonishingly simple solutions. A prescription for Allegra, Xanax, Ambien. Felxeril for the back spasm. Cipro for the urinary tract infection. Zithromycin for the viral infection that won't respond to antibiotics but for which we dispense without pause. Because they are white? Or well enough off to....what? Write a letter to The Times? My doctor wouldn't prescribe me a drug for which I have no indication? Because it's easier? 

But it is. Write, scribble, sign, satisfaction. 

The nurses say good morning to me, every single day. They know everything and they steer me through the inanely simple without need for pride or humiliation. The entire office is so nice I hang half frozen, waiting for the shoe drop. They are actually urinating in my coffee. They spit in my yogurt. My challenges are now to recall the more mundane trivia about medicine. What is the name for an infection in the bed of a nail? What do you call an uncomplicated infection of the sweat gland not colonized by flesh eating bacteria? What is the ideal range for a well control diabetic's HgB-A1C? Well controlled diabetics. Uncomplicated infections.

It alternately amazes and terrifies me.

Across the water, over the bridge and into the streets of loud trash and music, just simple miles apart, I am small and white and invisible. Across the East River, down in the black streets of Brooklyn, my patients have not had their colonoscopies, do not get regular mammograms and are not well controlled diabetics. The cannot, or do not, or will not make appointments in our small clinics, waiting instead for the stroke to arrive, the foot to become gangrenous, the cancer to grow completely through the large intestine. Across the water, on the unblanched roads admist the red brick projects, I struggle to understand the words and accents of my fellows, my peers, my attendings. I am powerless in every way I can think of: there are no simple solutions, no uncomplicated infections, no well controlled diabetics; I have to wait until those who I rely on to help me feel like getting around to the task at hand; I have to decipher cryptic medical records delineating dense medical histories and differentials; I have to proceed without the benefit of typed reports or adequate information; I do not walk into a room to find instant, intact respect because I am in a white coat with a stethoscope. I have to work against my gender, my age, my skin color and my dress. I have to sift through the tangled mass of five comorbid diseases in patients no less human than those across the river. 

In Manhattan I come home calm and dry. In Manhattan I come home well fed and on strong footing. In Brooklyn I come home diaphoretic and suicidal. In Brooklyn it is a struggle to stand up hard enough against everything crashing down around you. In Brooklyn I can offer very little in the way of simple solutions. In Brooklyn I am the one who needs Xanax. In Brooklyn I feel hopeless, helpless. In Manhattan I feel guilty. 

And yet, at the end of the day, if given a choice, I would cross the river and take the bridge. Helpless, hopeless, pale and invisible, I am no more visible than my patients. Powerless against the enormous forces of race and culture and religion and habit. Against socioeconomics and education and regional mores. Against myself or them or the system. In Brooklyn, because there are no simple solutions, we all come out of it distinctly different humans. In a place of uneasy options and all of us messily swept up in it, we are in it together, divided as we may be.

cluttered heart                                           

I used to think that melancholy was a byproduct of being younger, leaner, less steady with our compasses, all the terrain in front of us uncharted; a direct metabolite of intentional disillusionment and green ache. I used to think I would out grow it, some day, like shoes. And I would keep it around as artifact, like a tumor taken out and put into jars, to show to myself: look, look at that, you used to carry that around with you. As if I were cured. 

Driving the green miles of my new roads in New Hampshire, surrounded once more by big, empty beauty, quiet finally inside, something comes on the radio and I am suddenly, unexpectedly nostalgic. And it is a hard grasp to see that I have come so far from there, that I have already gone so long, when sometimes nothing on the inside seems changed. And just like that, in the middle of my life right now, I'm back again and younger, drunk on liquor and life and cigarettes, looking up at the sky, mending a fragile heart, counting stars.

low definition 

My mother in law sends me this as a link from The New York Times and immediately I am angry. I am angry and annoyed and small childish. Because this is my life, in a nutshell, although in some ways even less glamorous and more chaotic, as this is not my hospital. My hospital does not have translators, or computers or sinks. My hospital is even more poor, even more dense, even less dazzling. To write up an article on the hospital I work in would be to outline an exercise in failure, a fall out of our humanity. 

And I am angry. I am angry because never has she asked about what I do, what my day is like, since it is unattached to Important Names and Things To Brag About. Because all New York is about, at this level, is attachment to Enormously Important People and if you are not attached, well...  I am angry because I have, for the past two years, bounced between both upper sides of Manhattan and the underserved in Brooklyn and the stark contrasts have made me schizophrenic. I am angry because as I share meals with them, they laugh and roll their eyes, as if we were talking about a stain on a shirt somewhere that won't come out; as if it were nothing less than a nuisance and when will I learn to choose a better cleaner? As if to say it is somehow my fault, or my patients. I can almost somehow hear the word that's what you get for working in the ghetto. And I am consumed by undifferentiated rage.

And since I am passive aggressive and an impostor of a New Yorker, I send her an email back. I want to say "goddamn you for only paying brief attention because someone finally got it together to write an article about it in The Times. Goddamn you for being so specifically clueless. And goddamn you for rubbing it in my face". But I do not. Instead I write something terse and childish like, Now you know what my life is like every single day. Minus the computers, the translators and the sinks. And yes, my patients are also very, very sick. 

Because I am ill-equipped to live like this.

the beautiful people

At first, in the beginning, I wore fitted, tailored pants. I added in heels and cashmere sweaters. I began my training in an enormous hospital in Manhattan, funded to the high beams with a surfeit of money. The hot, gay social workers wore Paul Smith, the receptionist had an amazing colorist, the doctors had corner offices. With doors. Bookshelves. Plants. The even the nurses wore kitten heels. 

My patients were the clinically insane and woefully addicted. And, with the exception of one, exclusively male. Soft broken hungry humans living as they could in the system that kept them in place and accounted for. I had my own office, with computers, a phone, a window. These men had twice weekly meetings to complain about the discomforts of their hospital stay: the DVD player didn't work over the weekend; my roommate snores too much, I need a private bed; the pizza we ordered for pizza night wasn't from the right pizzeria how could we be so moronic, they are living in a prison here, the least we could do is order real pizza for fuckssake. I conducted psychiatric interviews, timid and bold and unaccustomed to their short attention, their stock answers, their eyes on the buttons of my shirt. Staring them down, unremitting, sweaty heart pounding inside, tailored pants still neatly creased and fitted. 

In the ghetto, at my next hospital, along the blaring streets of Brooklyn, one does not wear kitten heels, cashmere or anything remotely fitted. One does not arrive for work in hand me down Prada and, if one is small and white and inept, that one in particular should not wear sparkly, glinting, gawky engagement rings because one's patients live in the projects down the street and the nurses ride the train an hour in from Queens and one will never survive if one parades down the halls clicking, coiffed, and conspicuous. 

Which is why, last night, when I ended up at a Chelsea art gallery last night for the opening of a friend's latest installment and meeting Andy's friend Zac Pozen (!) I was wearing loafers. 

Loafers. LOAFERS. Zac Pozen. Chelsea art gallery. Loafers.

No, no. Please. It's not okay. Really, it isn't.

*****

Addendum: thank you, Flutter, for pointing out that it's Zac Po-Sa-en, Ssssssen like Stupid Girl in Loafers Who Doesn't Watch Enough Sex In The City or Gossip Girl not PoZEN like Stella.