Dog Days

"Dog Days" are the hottest, most sultry days of summer...usually fall[ing] between early July and early September... Dog Days can also define a time period or event that is very hot or stagnant...

[In ancient Rome] Dog Days were popularly believed to be an evil time "when the seas boiled, wine turned sour, Quinto raged in anger, dogs grew mad, and all creatures became languid, causing to man burning fevers, hysterics, and phrensies" according to Brady’s Clavis Calendarium, 1813. (Wikipedia)

These are days of tragedy and grief. Syria is in chaos, as the government ravages its people. Floods continue to pound Southern Africa, while in the East children are dying of draught. The Greek economic crisis threatens all of Europe, and fills its own citizens with despair. Growing unemployment, inconsistent health care coverage and budgetary wars threaten the health, and the homes, of millions of Americans. Our own nation's ongoing anger at inaccessible housing has erupted into demonstrations and tent cities. And this morning I awoke to learn that Y, the sweet, strong and healthy 25-year-old son of friends from my teen years, collapsed yesterday -- inexplicably -- of a heart attack. In a few hours from now he will be buried in a Southern California cemetery.

It must be human nature, that among the unfathomable grief on faceless human beings around the world, one young man's death has hit me so hard.

I haven't seen Y since he was a child, but throughout my teenage years, his parents taught me a formative lesson in true hospitality. Time and geography have led me to lose immediate touch with the family for the past few years, though I've thought of them often. I remember his deep dark eyes, his energy, and his siblings. S, his older sister, is a talented writer while younger sister E was always a bright and energetic spark. Together, they were three of the most beautiful, talented, well-rounded and mature children I have encountered. Now they are only two. They did not have to say goodbye.

* * * * *

A few days ago, I thought I was having a bad week. Our beautiful and affectionate cat, barely out of kittenhood, was cruelly mauled to death in the street by neighborhood dogs, most likely ones owned by irresponsible neighbors. In the fallout, the neighborly high following our family's celebration from last month collapsed like a blown-out mine of precious metals; sadness and anger took its place. Much thought, and a carefully-worded neighborhood email followed, whereby I took our dog-owning neighbors to task -- not by name -- and was rewarded with both words of support, and the inevitable rejoinders of denial.

For a few days, the stressful burden of ill will and mutual suspicion pretty much outstripped the sorrow of losing our lovely little feline. But, I thought, Ahhh, such are The Nine Days. "כפרה עליך" (kaPAra aLAyich) as they say. An atonement for past errors, and a gentle reminder to treasure the good things. Our fate is not in our hands.

Now I imagine the family, waking to a morning with no Y, and another, and another. I picture them gathered together, enveloped by their community, crying out in despair, with shock and disbelief filling every corner of the house.

* * * * *

A few months back I was in class on a minor fast day -- Asara b'Tevet -- and my teacher, a convert to Judaism, remarked,

You know, this religion is so fixed on depression. Why do we need so many fast days? Why can't we be adding more holidays and celebrations instead? It's not good for us...

I imagine he knows a thing or two about depressed peoplehood, having both African- and Native American roots. When I think of two nations with more than their share of calamity and maltreatment, these two come to mind.

Thing is, I was kind of torn. On the one hand, he's right. Why do we insist on indulging in sorrow, guilt and mourning, year after year, four times a year, commemorating events some of which are so historically obsolete as to be almost ridiculous. Why, in fact, should we keep Asara b'Tevet on the books, when it commemorates [the beginning of] the destruction of a Temple -- the First Temple -- that has since been both rebuilt and re-destroyed?!

It is easy, even natural, to side with the thinking that suggests this type of mourning is no longer in step with our national timeline. Maybe such harping on the negative even weakens our collective conscience, at a time when we need to be investing all our emotional energies into increasing our sense of resilience. Can wallowing in our collective sorrow really help us?

On the other hand, we've harbor a tendency to hang on to our traditions, obsolete as they might seem, and for the most part this does us more good than harm.

* * * * *

Either way, Tisha b'Av stands apart from the four minor fasts. We don't just grab one day, midyear, and assign it historical importance, long since superseded by subsequent national events. We enter a process of reverse-mourning, and we give ourselves nearly a month to do it, scraping away, little by little, at our every-day comforts until we come to feel some sense of loss.

And yet, despite all these collective efforts, I know I am not alone in saying that most years, it's a real challenge to really make the loss feel tangible. No Temple? No big deal. We've gone without that for nearly two millennia. As for the victims -- the previous generations who died at the hands of the Assyrians, the Greeks, the Romans -- they'd all be long gone by now in any event. How can I learn to feel that loss deeply and personally?

We don't fool ourselves either -- as mourning goes, this is not exactly the Real Deal. Unlike individual mourners, physically demarcated and emotionally isolated from their visitors, on Tisha b'Av we all sit together on the floor, reading out Lamentations for all to hear. When Tisha b'Av ends, we don't isolate ourselves, avoiding haircuts and new clothes and parties. We resume our lives, since we have not, in fact, just lost a mother, a child, a brother.

Unless, G-d forbid, we have.

This Tisha b'Av I will continue struggle, as I do every year, to make our ancient national losses feel personal. But this year, I know, this personally-felt loss will echo the national tragedy it truly is.

May the family be comforted among the mourners of Tzion and Jerusalem.

Keep the balance,

ALN

See a previous post on prophets & the Three Weeks.

Goodbye, Our Incredible Friend

RivkA.....

We all knew it would happen. Despite your consistently high spirits, your infectious optimism, your belief that giving up was not an option.

This was true long before your diagnosis, and all the more so since.

Who else would manage to turn a course of chemotherapy into a weekly opportunity to meet old friends for a drink? Or continue her job as a swim instructor, while on chemo, because it rejuvenated her? Or take the time each and every week to reach out to her hundreds

(thousands?!) of friends, family, readers and fans.

Like any blogger, I am usually a person of words. Now, it seems, there is nothing to say.... except to ask Why?

The question only echoes back darkly, as I think of your beautiful kids, your supportive husband, continuing on without you. You made it quite clear: Pity is not your way, and faith is always the answer. Oh, to have that kind of clarity!

We were supposed to get together and paint.... just the idea got both of us so excited! It was you, RivkA, who inspired me to write. Now, after nearly a year away from this blog, your death has inspired me to return. You had that kind of strength, encouraging people to do their best, be themselves, reach their goals, believe in God, and tell it like it is.

RivkA, you're gone. We miss you horribly. But know this: Your love and enthusiasm are here to stay.

רבקה בת ישעיה, לכי בשלום.

ALN

Photo credits go to That Guy I Married, who succeeded in capturing RivkA's energy and enthusiasm for the camera, at her daughter A's bat mitzvah last June.

Don't Have the Answers, But Glad You Asked

The Challenge:  Describe your job in one sentence or less.

My Answer:  My job is to listen to kids.

OK, so sometimes "listening" comes in the form of watching them draw, or joining them as they play, or helping them surf the net, or just sitting nearby while they read.  And, of course, the kids I listen to are sick, or are recovering from being sick, or were sick in the past, or are sick again.

Leave out that last part about the sick kids, and replace what's left with the additional cleaning, laundry, dishwashing, fetching & carrying, and we've just described the Second Shift, a.k.a. The Home Front.

I admit it:  Part of me has been waiting for years for my kids to get a little older, so we could start having some real conversations, the ones that extend beyond "Why can't I have a cookie? But why?!?"  It seems that time has arrived, and the questions have been rolling in.

Elder Princeski will be ten soon, and her questions tend to reflect her newly-developing empathy and Theory of Mind.  Always the Imp has just turned six, but her line of questioning (once she gets past all those unreasonable demands resulting from her sugar addiction) has always pushed the envelope, amplifying her imp-like attributes.

Yesterday afternoon I decided it was time to euthanize the poor goldfish who, having displayed multiple signs of illness for nearly half a year (and had long since been placed in isolation from his healthier peers), was now showing acute signs of imminent status change. 

Elder Princeski took an interest and even assisted.  We used an ice-water bath, recommended as the most humane method by Dick Mills in You and Your Aquarium (London: DK), while Always hid herself away until the deed was done.  Later, of course, there were thoughts and reflections on the matter, which surfaced today during Shabbat lunch.

Always the Imp:  Mommy, when you die, I want to keep the whole house for myself.  But I don't need the things inside it, you can give those to somebody else.

Me:  [Which Left Field did that one come out of?  Oh, maybe it was the fish...] Why?  Do you want me to die soon?

Always:  Of course not, but when you do, much later, when I'm already big...

Elder Princeski:  Mommy, I don't want you to die for a long time... but when you do, I'll keep the things inside the house.  I won't need the house itself because I will be married and my husband will buy me a house.

(Short discussion on the topic of religious vs civil inheritance laws.)

The conversation then evolved into a series of questions about Grandma (that's my 95-year-old grandmother -- see here), wondering how much longer she would continue to live, and if she wants to live much longer, and whether, were she to become very sick, dependent, and pain-ridden, she would choose to die (from what she has told me in the past, I wouldn't put it past her).   

We did our best to answer all of these clearly and honestly, with equal measures of optimism and realism.

Then there were questions about death itself.  What does it feel like?, and Does it hurt? and Do people know they're dying?   I told them about the reports I had read on near-death experiences, in which people described feelings of well-being, comfort, and being reunited with lost loved ones.  I told them that no one could prove whether these things really happen, but that many people felt and believed that this is what had happened to them.

Throughout this conversation, my internal voice was asking how much of an influence my Day Job was having here on the Home Front.  I think about death a lot, because I encounter death a lot, and so it is on my mind --  sometimes at a frequency that surpasses what I would consider to be a level of healthy denial.  

I try to keep that to myself, at least around the kids, but as they grow older they develop an awareness of what I do for a living;  Elder Princeski has even accompanied me to work events a couple of times. Sometimes they ask questions about work, and while I don't shy away from answering, I try to keep my answers short and to the point.  

The thing is, kids know about death.  They think about death.  They wonder about it, and they have questions.  At a certain point, they lose their dog, or their grandfather, or their neighbor, or their parent, and they learn that death can't be avoided.   

All of this obligates us to invite their questions, listen to their concerns, and share some answers -- gradually, thoughtfully, and straightforwardly.  Which we tried to do this afternoon.

Suppertime brought with it a whole slew of questions, this time about Down Syndrome, its causes and effects.  For another time...

Keep the balance,

ALN

Into Another World

(If you missed it, see Maybe I Should Write About It).

The view from their living room window -- dry hills interspersed with grasses and low-lying bushes -- was oddly familiar, in that I could have mistaken it for the California of my childhood. 

I had parked the car on the street above.  There was plenty of parking;  most residents in this area don't know how to drive a car and cannot afford one.  The early afternoon air was hot and still.  The inside car temperature approached that of an oven from the moment I shut off the engine.  

I crossed the sidewalk, paused, and headed toward the double flight of stairs.  To my left, three middle-aged, dark-skinned men squatted over a flattened carton, dealing cards.  The stairs, framed by simple metal railings, abutted a series of dirt-filled, half-meter brick tiers in an uneven stack like some child's haphazard block construction.  They led me down to one of a series of dreary dun developments, each four stories high and six living units across, fronted by an empty patch of dusty soil.  Most of the buildings carried a rusty sign vainly remarking a municipal-sponsored refurbishment in 1976, and despite this, they all looked as though they had somehow survived five decades or more.

As expected, there were no signs pointing the way toward the house of mourning.  The numbering was haphazard and I could not find the right building.  In response to my query, an older man placed his hands on my shoulders and literally rotated my body to the right and downward.  

His murmuring suggested I had a ways to walk, and the apartment I sought was in fact the last one in the staggered row of developments.   As I followed along the row of buildings, there was a smell, of pungent, unfamiliar spice and slightly fermented grains, which seemed to grow in intensity as I approached the entrance.

The door of one of the ground-floor apartments had been left wide open, and the spotless living room floor reflected an image of a hefty woman lounging on her sofa.  She jumped in with an answer  before I could get the question out.  "Where -- ?"  "Up on the third floor."

The door was closed and had no markings on or around it, save a mezuzah with a cheap plastic cover.  Inside the house, the extended family -- his mother, sister, two brothers, four aunts, three uncles and a cousin -- nearly filled the small living room.  His mother had a black mourning cape draped over one shoulder, and as I entered she glanced up, sighed and shifted the cape to her lap, stood, and clung to me.   She sat down, sighed, and offered me a chair near the middle of the room.   "My heart..."

A foursome of aunts and uncles sat around a coffee table playing cards, throwing each card onto one of four piles with an aggressive THWAP.  Somehow, it felt only slightly out of place.  His sister poured me a cup of cola, which his mother refilled after every sip I took.  She exchanged a few words with her daughter.  I was waiting for a translation, some statement about how it was all over, or referring to his time in the hospital.  But no.

He had some new clothes, the sister related.  They're in G's office.  Do you think you can talk to him about getting them back?

Of course.  His brother would be needing those clothes, so carefully chosen only two months before.  

The mother continued her conversation with an aunt who was sitting across from us, while I talked to the sister and made a few phone calls in an unsuccessful attempt to contact the cable TV representative and ask him to come pick up the cable box which nobody in the household now has a use for.  

Sometime later, we exchanged good-byes and I made my way back down three stories, along six dreary buildings, and up two outside flights to street level.  I got in my car, drove out of the neighborhood and back into to my infinitely more complex, familiar -- and for now, sadder -- world.

Keep the balance,

ALN

Scales are Tipped Down, Way Down, by the PA

Since beginning pediatric hospital work over a decade ago, I've shown a tendency to divide circumstances -- that is, reasons for hospitalization -- into two artificially neat categories:  Man-made, and G-d-made.  

Examples of the former include falls from upper-story windows, hot-water burns, and car "accidents."  The latter run a spectrum, from "less serious," (i.e. dangerous but curable) illnesses like RSV, Hanoch-Schlein and cellulitis, to acutely life-threatening maladies like Crohn's, SCID, CF, and acute myeloid leukemia.  

Believe it or not, in many ways I had a much harder time in Pediatric Surgical, working with kids injured as a result of the "man-made" stuff.  Why?  I was constantly troubled by the thought that most of the injuries there were preventable;  Falls resulting from unsupervised climbs along an unfenced roof edge or an unbarred third-story window.  Shabbat kettle burns?  See Prof K's posts, here and here, for more on that.  (Yes, I've referenced these before, and I'll probably keep doing it until the problem is no more).  Car-related injuries?   I won't start ranting here about street safety or seat belt use, but please pretend I did.

As for the G-d-made part -- we can't prevent that stuff.  It's just not our jurisdiction.  We can only try to cure it.  And if we cannot cure a child's illness, we can still try to help that child find comfort and meaning until the end.

But now we are stuck in a new situation, where life-threatening, G-d-made circumstances have been further complicated by man-made decisions.

I am, of course, referring to the February 1, 2009 decision of the Palestinian Authority to cease nearly all payments to Israeli hospitals, thereby cutting off hundreds of Palestinian children (and adults) with life-threatening illnesses from the medical care they need. 

  

Let's not turn this situation into another political discussion.  Because for me, and so many others, this is not a theoretical situation involving some unnamed, unknown enemy.  This is a new reality, where over fifty children, all of which I know personally on one level or another -- some for several years now -- have been given a death sentence by way of a governmental policy of collective medical neglect.

When I let myself think about it, or when circumstances force me to think about this new reality, sadness creeps in and hits me, literally, in the face.  Our department is half empty, which for us staff members could be viewed as a glass half-full, since we've been working at a slower pace these past few weeks and can take a few minutes to breathe now and then.

But then someone like A -- a beautiful, bright and sensitive teenage girl whom we have been treating for a leukemia for the past four months -- suddenly shows up in our department with a nearly lethal systemic infection because she no longer had a commitment from the PA to pay for her treatments.

What about all the others?  Some of them are in touch with us by phone, while others have been so difficult to contact, it's as if they have disappeared into thin air.   All are pleading desperately, crying at the desks of the PA bureaucrats who have the power to make a life-changing decision but choose not to.  These officials have claimed they will sponsor parallel treatment in an Egyptian, Jordanian, or even Europe -- anywhere but Israel -- but with very few exceptions, we've yet to encounter evidence that our patients are receiving any treatment whatsoever.   

Every once in awhile a rumor flits through the department -- that so-and-so has died of a deadly infection in some PA hospital somewhere.  So far these rumors have proven false, but it's only a matter of time before they are not.  Chemotherapy protocols are measured in days and hours.  A lost week is an acute risk;  a lost month, or even a fever, is a death sentence.  

If we could treat for free, we would.  But we can't, because the funding would come out of our department budget, such that within a month even one patient's treatment would empty the coffers and shut down the department.  A few of our staff have even dug into their pockets so that certain individual patients could have this one medical test or that course of life-saving antibiotics.  A few miniscule drops into a very deep bucket.

This past Monday we were all relieved to learn that A's family managed to confirm her East Jerusalem resident status, allowing us to continue the treatment that will, most likely, save her life.  This morning, the Palestinian Authority's Committee of Medical Exceptions purportedly met to review the list of children requesting funding in to continue treatment in Israeli hospitals for long-term, life-threatening illnesses.  

I can only hope that tomorrow morning, all of our lost patients will be knocking down our doors, PA funding commitments in hand.

Keep the balance,

ALN

____

While this situation has affected patients in hospitals throughout the country, for whatever reason most of the (limited) PR refers to Hadassah Hospital in Jerusalem.  See the NY Times piece here, and the JTA piece here.

Receiving is Giving, Part 3

The Unacknowledged Thank You.  Many years ago, when I was still a beginning therapist in the hospital, feeling like a very small cog in a very big wheel, I worked with a little girl I'll call N.  N was extremely familiar with the hospital, having "recovered" from a life-threatening illness only to endure recurrent long-term hospitalizations for the ongoing, irreversibly damaging side effects inflicted by the original treatment.  At first, I intensely disliked N.  Her voice was whiney, her face scarred, her body misshapen, and her behavior ungrateful and dismissive.  After years of being in "the system," N and her mother knew everyone, in every relevant department.  If one physician or nurse said No, they would work their way up the chain until they got to someone who would give them a Yes, in writing.  Then, only then, would they praise that person up the wazoo, while cursing all the rest.

Many of our school staff members worked with N throughout her hospitalizations, and I myself worked with her over a period of seven years.  At first her artwork was perseverative, lacking creativity and originality.  She stuck with variations of the same image, drawing it over and over, in different media, sizes, and colors, but always sticking with the one theme she knew and loved and could trust to stay consistent in her rocky world.  Even as N grew, reached majority and was transferred to the adults' unit, we continued our regular art sessions, until slowly, she began to branch out and blossom.  She began asking me to teach her new art  techniques.  She requested additional images to study and work from, until reaching a point where she rarely returned to her earlier, repetitive theme.  She began to feel better physically, and worked feverishly through an endless list of staff members and friends for whom she prepared thoughtful gifts in the form of her own original artwork.

All the while, N tended to express her wishes to me in the form of commands, with the please added on as an afterthought, an external politeness she was taught would work to get her what she wanted.  Bring me this, Get me that, Maybe you could buy such-and-such a kind of [very expensive] paint?  On occasion, she did remember to say thank you.  Despite this, I grew to feel close to her and appreciate many of her positive characteristics, and and I looked forward to our sessions.

Throughout the years, N was the beneficiary of many expensive and scarce medical treatments that the hospital went out of its way to provide.  On the last day of her hospital stay (after which she was released to live at home and continue her treatment as an outpatient) the hospital staff held a party for her, during which she and her mother distributed cards and gifts to every last medical staff member and social worker in the room.  

At the time I felt it ironic and insulting that among all her acknowledgements, there was no mention whatsoever of me, who was present at the party, nor of any of the many additional school staff members who had accompanied N throughout all those years.  Nothing.  Not even a thank you.

At first I didn't know how to interpret her behavior.  I thought, Could she really have forgotten all of our time together, all the work she had done, and how much meaning it held for her?   Did she really think it was of that little value?

Then I stopped to think.  As a form of closure, I went over my session notes.  I talked to colleagues.  I did some research on the psychological implications of  showing, or not showing, appreciation within the therapeutic relationship.  All of this helped me make sense of N's behavior.  N and her mother, were simultaneously furious at, and indebted to, the medical establishment, whose original treatment had "caused" her handicaps, and whose later treatment had, at least partially, redeemed her from them.  This family had always made their way through the system by showing people genuine gratitude, contaminated by their feelings of anger at the system which was responsible for all of this in the first place.*

N's involvement with the hospital school, on the other hand, was a perk, an option, a factor she did not associate directly with her medical condition or its treatment.  By extension, it remained an element of her hospital stay for which she could choose to show appreciation, or not.  We were one body within the hospital to whom N did not owe the debt of her life.  In that light, I now understood just what our role was.  We were the only form of hospital  "treatment" she could like or dislike,  thank or not thank, accept or reject.  And she had chosen, for all that, to accept us.  What bigger thanks could we ask for?

Keep the balance,

ALN

_____

* I do not mean to suggest malpractice on the part of the hospital.  The side effects that afflicted N were the unfair and unpreventable results of the life-saving  treatment she received for an illness she suffered as a young girl.

Back to School

The school year in Israel starts on Monday.  After a decade of working in the school system, I've been having a very hard time feeling motivated to go back. 

It's not just that I work in a hospital, with very sick kids, and I hate seeing them and their families suffer.  And it's not just the heavy contrast between summer vacation, when our hospital school is no longer in session during August, and the intensity of the school year. 

Being a school system within a medical system, there is the added challenge of fitting into a system that runs 24/7, 365, when we have to follow the school calendar year and take our vacations all at once, just when the children need us most, over holidays and school vacations. 

The medical establishment does not fully understand the education model, and I hate some of the comments medical staff in other departments offer our teaching staff when we return to work every September.  Oh, how was your vacation?  they ask, in a tone that insinuates that we really didn't deserve one.  I am relieved that after many years, the staff of my department asks the question out of real interest.  They really care, and they understand all too well that when you're given a break from Pediatric Oncology, you take it. Even if that break makes it much harder to return afterwards.

 

And so we return, to all the things we missed, and now it is urgent, and they just won't wait: We introduce ourselves to all the new kids who were diagnosed over the summer, getting to know who they are, what they like, what they dislike.  What scares them, and what motivates them. What hurts them.  What their schools know about their illness, and whether their friends are in touch with them or not.  Whether they themselves want to learn more about their illness, or just pretend it isn't happening.  

We begin to re-establish a connection with all the kids we've already been working with throughout the school year, hearing how they spent their time over the summer.  Did they get to go home?  Did they have to suffer through an unidentified infection?  An unexpectedly long hospitalization?  A few days or weeks in the ICU?  Or did they get a break from it all and go to traveling abroad, or to summer camp, or just home for the first time in months.

And then there's the icy splash.  Hearing which kids are no longer with us.  That initial feeling of Well, it was expected, mixed with I just can't believe it.  Trying to get a few details out of the nursing staff, without expecting them to live through the pain of the news all over again.  Wondering whether to contact their parents, four weeks after the shiva. Going through their artwork, worksheets, photos.  Agonizing over feelings of relief torn through with sadness, anger, and bewilderment.  

After all these years, you might think I'd know how to go back in there.  But I don't.

Keep the Balance,

ALN

Missed Connection, Reconnection

We got back to Israel safely, bodies exhausted, luggage intact.  I only wish I could say the same for my head, but the J-L word has been rearing it's ugly head.  I've now tried the stay-up-really-late-method, the take-a-nap method, the don't-take-a-nap method, the no-caffeine, no-alcohol diet, the caffeine -and-alcohol diet... it all sort of comes down to "Damn!  Here I am, awake  between 2 and 5 a.m. yet again."*  Last night, Shabbat, was the worst,  -- all the lights were out (no reading) and using the computer was out of the question (no blogging... all those posts, composed in my head, the permanently lost in memory wasteland / oblivion).  Sometimes I envy those locals (read:  EU members) whose flight back to The Old Country costs them only six hours of their lives, plus waiting time, and possibly a couple of time zones.   I know, I know, it could be worse;  Australians must envy everyone.

(A recent conversation companion suggested that the lengthy travel time might serve a higher purpose, giving our minds and bodies time to readjust to the new environment.  I'm not sure what that means, since I'm assuming that if not for the jet-lag, my adjustment time would near zero, even accounting for other adaptations). 

Straight off the plane, the white light is blinding.  The abrupt weather transformation -- from California balmy to Middle East heat bake -- shocks my system with an immediate, unforgiving reminder that the sun is stronger here.  Like the emotional charge of everyday interactions, this heat is a force to be reckoned with, a consistent reminder to budget your energy and appreciate the basics:  Clean water, the roof over your head, a cool evening breeze.  

For the first few days following our return our house always seems so small and dusty, but that's only because, in comparison, my parents' house is enormous and several thousand miles from the Sahara.  After a few days our house goes back to looking its normal self (reasonably large and dusty).  

We visit the Old Country every two or three years, and each time it feels more like a foreign country.   Yes, my English is still fluent (though some would claim otherwise), and I remembered to say Have a nice day and Nice to meet you like I really mean it.  But the differences inevitably reared their heads. I could still think in inches, but no longer in pounds.  In the supermarket, the endless selection of every category of product was truly overwhelming.   Parking lots became their own sprawling world, filled with superfluous SUV's, and the twelve-lane freeway where I'd learned to drive as a teenager had somehow transformed itself into a massive, threatening behemoth.

I came to Israel as a college student, unattached and uncommitted to any particular person, child, job or goal beyond trying to find a place to live, finish my degree, learn Hebrew.  Within a year or two those goals expanded to include finding a beit knesset, acquiring job skills, searching for a spouse... and then, building a home, having children, developing a career and joining a community.  Every one of these steps furthered my integration into this life and this society, even as it increased the barrier -- without my noticing -- between this life and my old life.   On this trip, I began to understand that while I grew up in California, I actually became an adult in Israel.  Marriage, motherhood, career, community -- all of these seminal moments happened in Israel, which means that my integration of these experiences also happened in Israel.  

By living so far away, I am also keenly aware of what I am missing, and causing others to miss.  My grandmother finally has three great-grandchildren -- who might as well be a million miles away.  Was this trip our last chance to see her?  I really, really hope not.  My Mom savors every long-distance telephone call, but nothing compares to helping her grandchildren practice their swimming in the neighborhood pool.  I can't remember a visit when my Dad hasn't "threatened" to kidnap one of the kids, so he won't have to wait another two years to see her.  

My good friend Q asked, as she always does when I return, Do you ever feel the urge to stay there?   No, I don't, even though coming home means coming back to the regular routine.  Gearing the kids up for a new school year.  A less-than enthusiastic return to the stresses of work.  Grocery shopping and carpool schedules.  Trips to the doctor, the dentist, the veterinarian.  Household repairs and reorganizations.  A fish tank in need of scrubbing and disinfecting.  A pile of laundry that dares to reach the ceiling after three days.  Dust.  Everywhere.  I know all too well that for me, "California" now means "vacation."  Were to we live there, I would still have all of the above and more, that is, all the ingredients of a regular life.  

But just in case I'd ever forget where home is, my kids wouldn't hesitate to remind me.  From the moment we left Israel, they struggled with the separation from their friends.  For four weeks they begged me to find them someone to play with;  even our three-year-old exchanged email photos to his nursery school girlfriend.  Driving home from the airport, the kids were barely out of the car and they were already asking, pleading to call their friends, invite them over, visit their houses.  Seeing my neighbors on Friday evening felt like a real home-coming, my neighbors sitting in the Beit Knesset, welcoming Shabbat, while the little kids ran around in the park.  They all looked so beautiful.

I love coming home. 

Keep the balance,

ALN

_____

* Note the time-stamp.  And yes, that's Israel time.

Goodbye, G., part 2

(I've made some references to the original post about G.  See it here).

At the beginning of the school year I made a very difficult decision;  I decided I was not going to make regular shiva calls at my patients' families.

I used to go to most of them.  Jews, Muslims -- it didn't matter, as long as their parents' home was legally and safely accessible, I would go.  I needed the closure, and I knew it was important to the family.  It also gave me a lot of insight into how these families live their lives, and helped me to feel a certain closeness with the child they lost.  I have never regretted going, not once.  

This year I took on new, additional roles at work, and so work began taking a lot of more my time and energy  than every before.  In one attempt to keep things balanced, I decided I could not make shiva calls at the expense of family/personal time, and my own limited emotional energy.

But G. was different.  For one thing, he had been our patient for over two years.  When he returned with a relapse, it was painfully clear to everyone, including him, that we would lose him. I remember the first day he returned to us to begin treatment yet again.  He understood everything, and he expressed his anger, fear, and sadness in all kinds of ways -- through his jokes, his artwork, his questions, his body language.  I felt only a minimal sense of comfort seeing that G. felt comfortable coming back to be with our department staff, with people who he knew he could trust, to listen in the most genuine way, to love him and accept him.  I, like many others, felt especially close to him.

When G. died, I felt a real need for closure, and so his shiva was one of only two I attended this year.  (The other one is a much longer story, for another time).

Upon entering, what stood out were photographs of G, everywhere -- in multiple photo albums, framed on the walls, taped neatly onto the poster board covering the television -- and thousands of pictures had already been uploaded to a memorial website.  G. had older siblings who long since moved out when he came along, and so his parents basically raised him as an only child.  He was the center of their life. 

I had come with a CD of pictures and a digital copy of the essay he had written about his travel plans.   I shared some stories with G's much-older brother, who is married with children of his own.  The brother explained that the memorial website was only the first step;  after the shiva, he would create another website for family and close friends, with stories from G's life.  

On the CD I'd brought to give his family, there were a series of photos of the vehicle G. had designed.  I was struck by a need to give this family any additional concrete piece of their son's life that I could, and so I offered, on the spot, to write a brief explanation of the process G. went through to develop the vehicle and plan his classroom trip.  His brother swiveled his laptop around towards me and I sat down and began to type.  

I am not used to writing essays during a shiva visit.  It is so often a time of listening, a time of being, and not a time of doing.  Words and tears flow, and after the week is up, the family is left behind in a miserable, quiet house, trying to figure out what they have lost, willing themselves to believe the unbelievable.*

But I did not want to make a promise, only to break it and walk away from the family without having returned to them a part of G that he had temporarily entrusted to me.  When the essay was finished, I parted from them and hugged G's mother, as she reminded me that she wants to stay in touch. 

Then I left, feeling just a little lighter, having returned a shard of precious jewel back to its true owner, and knowing it is one of many that, together, will continue to reflect the light of G, but will never be whole again.

Keep the balance,

ALN

________

*According to Lynne Halamish, the premier expert in Israel on the subject of death and mourning, the process of accepting the loss of a loved one takes about  90 days.  The purpose of the shiva week is to give the community a defined period to learn of, and acknowledge, the family's loss, within the boundaries of the family's home environment.  I was fortunate enough to attend a recent workshop in which Lynne discussed different aspects of the mourning process, but the above description is my own paraphrasing of her ideas.

Goodbye, G.

I met G. two years, when he first began treatment. 

He was in sixth grade, hardly a social magnet, preferring to socialize with adults and discuss his many interests, including watch collecting and tasting unusual foods, some of which he brought to the hospital to share with us (and all of which, as I reminded him again and again, I could not eat, for religious reasons).  That only made him laugh, since religion played such a small part in his life. He loved Fantasy books and movies, computer games, riddles, and crass jokes, especially if lawyers were the brunt of them.  He loved to read out lists of these jokes to the staff.

Despite his social difficulties, G. made great efforts to share aspects of his life in the hospital.  I remember us sitting together to design a vehicle made of medical paraphernalia, and then document the steps required to build it so that he could go back to school and show his classmates how life in the hospital had its fun and creative moments.

After a relapse began to affect his memory, G. would describe his favorite ideas repeatedly, sometimes several times a day.  His sense of pride and awareness remained keen as he tried to cover up his memory loss by asking, hesitantly, if he had already told us his latest joke, or reported on his recent trip abroad. Despite feeling weak, he dreamed aloud and with full optimism about his next trip to Europe, and I sat with him to plan it, typing his words into the computer so that he could have a memory aid, and his parents, a memory.

G., I miss your smile, your enthusiasm for learning, your creativity, and your dark sense of humor.  I know you were scared, and I respect your trust in us as you opened up and helped us understand what it is like to rage against the dying of the light.  Go in peace.