I bought my first digital camera in October of 2001. And the photographs I have of New York before then are pretty scarce–film cost money, after all. So most of the day-to-day life that I remember of the city live only in my memory. With every trip back, I keep trying to find remnants of that past and photograph them, in perhaps an act of preservation, or even resurrection.
All I usually end up with, however, is evidence of how much the city has changed, and while this evidence of the ever-changing urban landscape would otherwise mean that I could never want for things to photograph, I leave the city feeling even more distant from the New York I remember.
The essence of life in the city has not changed, however, and even though the backdrop may change, with the landmarks I remember long disappeared and new exteriors in their place, I think I’ve managed to find examples of it and capture it.
I used to work summers in the financial district. A few of my classmates did, too, and every so often we’d get together during lunch breaks and find somewhere outside to sit, eat, and chat. We were surrounded by the thousands of other workers doing the same thing. Any place that can be sat on, will be sat on, turned into an ad hoc meal table. It’s something I think is quintessentially New York, made unique by the sheer density of humanity that’s found on a summer day anywhere in Manhattan. Sometimes, we sat in the plaza of the World Trade Center for our lunches. A perfectly common activity, unworthy of saving it on film.
It’s okay that I don’t have photographs specifically of those moments. The memories, the feelings they evoke, are the key. But I’ll continue trying to save proxies for those memories, for their potential to trigger those memories. I guess you could say that’s just my motivation in general, why I photograph what I do.
Fifteen years ago, I was studying in New York to be an engineer. Were I any other place, were the Towers not to come down, maybe today I’d be doing just that. But because I was so close to tragedy and could do nothing to help, could not help with communications despite having become a licensed amateur radio operator for just that reason, last night, on my last night float shift for the month, I was directing resuscitation for a young patient in shock and close to dying.
I do miss engineering. But this… this is a privilege. The sum total of my four years in New York helped steer me here, shaped who I am, and for that I don’t need a photograph to remind me.
I’ll be up front. It’s been a painful year. No big surprise—residency has a tendency to suck, intern year especially. No one who goes into this enterprise is unaware of this. Coping mechanisms are essential—hobbies, friends, family. Alcohol’s in there somewhere, too. Social media tends to be a double-edged sword — I would feel on some superficial level connected to the family and friends I’ve left behind, but my conclusion after checking my Facebook or Instagram feed for the twentieth time that day was that everyone is spending all their time vacationing in exotic locales and eating exquisite food. (That’s an exaggeration, of course, because no resident has time to putter around on the Internet that frequently. But the end result is the same.)
The first half of the year wasn’t too bad. Catching babies, practicing intubations, practicing ultrasounds. Getting past the hump of “I should check with my attending before I order fluids/Tylenol/that hand X-ray for a guy who clearly injured it.” A short vacation to see an old friend. The days were still long enough that there was still plenty of sunlight waiting for me when I went home. I would go back to Chicago when I could. Spend time with Mom and Dad. Making up for lost time.
Depending on where you start counting, it was anywhere from thirteen to sixteen years that I’d been gone from home. I missed out on a lot of the day-to-day with them. There were the semi-regular visits when I lived in Waukesha, but it wasn’t until moving back to Chicago for medical school that I was able to see them more often and, in comparing them now to my memories of them as a kid, see just how much time had passed. With every visit, all I would see is how much they had changed, all I would think about is how sad I was to see this. The thoughts consumed me so much that I could never be in the moment with them and really truly enjoy the time I was being gifted with them.
Medical school gave concrete goals to work toward, tasks to get lost in, distractions from the reality of parents with less spry in their step. In the end, it paid off—in a time where a common refrain from emergency medicine residents was “I’m glad I’m not applying for residency this year,” it’s no small thing to match into EM, let alone at your first choice. It was an intense relief after spending much of fourth year worrying. Mom and Dad and my brother were there at Match Day, my parents proud at their son becoming a doctor, and Robert just overjoyed that his little brother, long separated for over 20 years, would be close by again. I moved away again, though Milwaukee had never felt too far away (according to the sign outside a pub near Wrigley Field that I spotted one day, Milwaukee is Chicago’s largest suburb) that I couldn’t visit when I wanted to.
So I did the 90-minute drive when I could. I’d also text one or two med school friends to see if they were free, knowing more often than not the answer would be no. And every once in awhile, I’d also get to see some of my other “age-appropriate” friends, the ones here in Wisconsin and also those still in Illinois. Those visits came with their own baggage, in the form of reminders of things I wasn’t doing with my life—marriage, kids, home ownership—which nurtured an intensity of emptiness within. And every visit with Mom and Dad compounded a sense of guilt—guilt at not being able to provide the kind of support they need, guilt at not being able to be the dutiful son.
What was turning out to be a severe existentialist crisis had an added dimension from grinding, grueling inpatient months kicking off 2016, with a single month in the emergency department providing the sole interruption. It promised to provide some respite, a reminder of why I chose this profession, but it failed to deliver, instead only bringing frustration, exasperation, a growing cynicism, and feelings of failure. Cap off intern year with two intensive care months that reinforced the truth of the fragility of our existences, and apply that lesson to your own life, and to the lives of those you love, and you feel exquisitely the pain of every precious moment you are missing out with them.
When you see people your parents’ ages with their life’s fortunes turned on a dime, struck suddenly with infection, with head bleeds, when every intervention only puts them through more pain and you are praying their families realize the same; when you see yourself starting to resent the people that come to the emergency department that make you ask, “Why are you even here?,” when there is no end to the people who demand more from you than you’re able to give, when you see yourself depersonalize in a desperate attempt to stave off a complete internal emotional collapse, when you fear waking up because you dread the thought of what awaits you at the hospital, when you wonder what it was that led you to abandon your first career, a career that took time to get good at, that provided a measure of security and stability–
I want to leave this all behind. Run away home and take care of Mom and Dad. With every day I waste in a role feeling less than capable, I wonder what was the point of it all.
Oh. Hi, burnout. Yeah, I saw you coming. I saw you when one of the staffers in the ED remarked to me, “You’re not as chipper as you usually are.” I know you’re there. You are what makes me resist falling asleep, because sleep brings another day on the hamster wheel. But fatigue wins, and it’s not long before I plead with my alarm clock for a few minutes more, it’ll be all better with just a few minutes more; but it never is.
Coping mechanisms are essential. Hobbies, family, friends. My photographs have been uninspired and I’ve barely had time for family and friends.
Then Orlando happened, and—okay, I think I remember why I thought this might be worthwhile. Maybe I remember the nurse who stopped me to relay a family’s thanks for the care showed to their father, who had to make the impossible decision to let go of his wife of so many years.
I suspect, I hope, that it will get better. Yes, my parents are getting old; and who knows what each day will bring for them; but for right now, if I scrutinize the picture I took of them on my last visit home, they are happy with what they have, they are happy with what their younger son is doing with his life, and they are even happier when he comes to visit, and I have to treasure the moments I do get to spend with them. I have to keep myself open to the experiences that made me choose to be an emergency physician, and let that be what motivates me to go to work in the morning.
First year. It started out as a joke. “I left my career for this?!”
Med school and I were still on our honeymoon. There was a lot to study, but I remembered enough from my prerequisite science courses and I learned enough physiology on the job that it was bearable. There was still free time, time to volunteer, time to hang out with friends and family. It was almost like being in college again.
Second year. The fire hose of knowledge that one is expected to handle was wide open. The stack of pancakes that is daily studying grew high enough to rival the tallest buildings. People were unhappy with the recent changes to the curriculum. Negativity was everywhere. The stress of studying for our first board exam was wearing everyone down. I was worn out. “I left my career for this?!”
It wasn’t that I loathed my job or that I wasn’t good at it. I was good at it. My manager’s manager told me up front, in an effort to get me to stay, that there would be an irreplaceable void in the team when I left. But the truth is that it took me a long time to get to that point, to develop competence and credibility.
And here I was starting all over again.
It was easy back then to rationalize it. There was only me. I didn’t have a wife, children, anyone, who would be impacted by my decision to start all over again, to trade in a good-paying job with good benefits so that I could accrue an amount of debt equivalent to a decent home in a reasonably affordable mid-sized metropolitan area, to trade in my nights and weekends of freedom for nights and weekends of working and studying until my eyes bled, to trade in a life (albeit somewhat temporarily), all because of the notion that I could accomplish more doing something different. Hell, I was still in my twenties. Things looked different on that side. There was still a lot of time. Lots of time to do everything I want to accomplish. Be a doctor. Get married. Have kids. Buy a house. The usual.
I turned 30 and then a few months later left my career as an engineer behind.
Third year. Over halfway through it. Days spent essentially working at a job. Nights spent studying. Learning, learning, learning. Getting the tiniest bit competent. Once that happened, it was time to move on to a new rotation. Like clockwork. Time to start all over again. And so that feeling of “hey, I think I might know what I’m doing” has been nothing but fleeting. It has been a losing battle to not let the anxiety and worry over looking like an idiot in front of the people who write my evaluations render me insensitive to those meaningful moments when I might actually contribute something positive to someone’s care, to the point where “burned out” feels like an understatement. And now that I’m approaching the phase where I need to start thinking about what I want to specialize in and applying for a residency and all of the advice people give you basically distills down to “be better than everyone else” and I’m earning passing grades in my rotations but is that really enough because my board scores weren’t stellar and I swear everyone’s better and smarter than me and residencies are getting more and more competitive will I really succeed?
…I left my career for this?
oh hell I’m going to be turning 33 soon and why do things look so differently than they did four years ago and dear god what the hell have I been doing with my life when will I ever have time to do everything else I want to accomplish*
I’m not going to quit, but maybe this is as low a point as I’ll ever reach.
* * *
Lately, though, maybe the universe has been dropping me messages to suggest that I might be doing all right:
Night float week on pediatrics. Last day. I have a new-to-me intern. We get to talking. Turns out she also majored in engineering, still has the engineer’s mindset, had the studying mindset of an engineering major: problem sets. Lots of them. Full of math. Lovely math. Calculus and linear algebra and all the wonderful things. Logical and algorithmic.
She related to me her own experience in med school, the paradigm shift involved in studying through reading and memorizing. It was like she was recounting my own story. We talked about ways the engineer can find a niche in medicine. She described an attending she once had who was a former engineer and how he would articulate his thought processes on rounds and no one else seemed to grasp it but she did because she had the same mindset. It was reassuring.
Thanksgiving dinner. Curious to see how much of my aunt’s piano lessons still stuck, I sat down in front of my brother’s keyboard, confronted with “Jingle Bell Rock.” Slowly, tentatively, I sounded out the notes and chords in front of me. My fingers weren’t used to playing more than one note at a time, and they clumsily moved about from key to key in a way that reminded me of painfully awkward grade school dances.
My brother came into the room. “Do you want to borrow my keyboard?” I shrugged.
“You should.” He paused. “You have an artist’s heart. I can see it in your photography. And I can hear the joy in your voice when you sing. … You’re going to be entrusted with people’s lives. It’s going to be stressful. You need this.”
Pediatrics intensive care unit week. Last day. In the middle of morning rounds, we hear, rather loudly: “CAN I GET SOME HELP HERE?!” We start to hurry in that direction. The attending asks which patient it is. On hearing the name, she runs quickly ahead of us. It was a patient of hers that she’s taken care of for his entire life, a baby who’s only ever known the hospital.
I had been running towards the call for help for a couple of seconds before remembering the right people to help were on their way. I found a spot where I’d be out of the way but where I could still observe and provide manual labor if an extra pair of hands was needed.
In those minutes the team worked together to give a critically ill child every chance at living.
Tragedy, I think, tends to whitewash the canvas of our memories, leaving only itself in its wake. The fun times I had in New York are hard to remember through the filter of September 11. My memories of a dear friend of mine from those days are discolored by the time I spent in earnest with him during his final days in the hospital. I promised myself I would write a remembrance of him, as so many did when he passed, but I was never sure what to write. Two years later, motivated by an excellent memorial penned by another good friend of his, despite the piles of studying awaiting me once I finish this post, I figured I should just sit down and recover what was lost before another year goes by.
***
Summer, 1998. Excited to live in the big city, I reached out to an alum from my high school that I knew lived in New York. We hadn’t met in person yet, but I knew of him thanks to the internets. His name was Scott.
Though I was but a green college freshman and he was already a few years out into the working world, having gone to the same high school meant we already had a lot in common. He took me under his wing as both friend and mentor and introduced me to the New York he knew, despite the great wilderness that separated us (Central Park), despite my gross inability to foot my end of the bill. It was the city of incredible cuisine, the city of immense culture. His love of the city was infectious. I’ll forever have this chronic disease of missing New York (and a love of Guinness and an appreciation of Scotch) because of him.
During those many days and nights spent out on the town, he would pass on to me the life lessons he’d learned, colored in no small part by the health problems he was born with and the recent breakup with his fiancée. When I knew him, he was a self-proclaimed evangelist of the bitter, and our shared pessimism and cynicism was doubtless a reason we were good friends, but the way he led his life betrayed his inner self–a more tempered realist, I think, with streaks of optimism that compelled him to do good. Whether these qualities that I also see in my own self were because of him, or it was because we also shared this same unspoken philosophy beneath the protective layer of the cynic that we got along so well, I can’t say. Maybe both.
Scott drifted out of my life rather literally, packing his things for Arizona to seek the love that had been missing from his but which in turn meant leaving the city he was so fond of. It wasn’t that long after he left that the towers came down, and I know a part of him hurt. Not only out of concern for the friends he had left behind, but also because his city was hurt, and, quite possibly, the fear that he, too, might have perished if he were on shift with the city’s emergency operations management located in 7 WTC. That was probably the last time I kept in regular touch with him. Although some years later we both found ourselves back in the Midwest, we managed to meet up for dinner only a couple of times.
***
Christmas, 2009. Possibly because he was still relatively sprightly when we both lived in New York, possibly because he (back in the day) hid his physical impairments so well, it was easy to forget that every day spent with him was a day his physicians weren’t predicting him to have. And so while it wasn’t completely unexpected when I got the call about Scott’s deteriorating health, it was still jarring. At first, I believed it to be just another fight he’d successfully win, but that soon turned out not to be the case. In those last days, though… to see all of the people that came to visit (and as it turned out, say goodbye), to see everyone who was touched by Scott’s presence in their lives, was truly incredible. To see the friends he made at IMSA that spanned multiple generations was remarkable.
Scott passed around 7:45 pm, on 11 January 2010. It was a quiet night in Streeterville, and a light snow was falling.
***
On one of the many days spent visiting him in the hospital, I remember jokingly chiding him for not waiting until I became a doctor to get sick. Fast-forward to two years later, almost to the day he left, and I’m a first-year medical student learning about the heart. In anatomy lab, we dissected those same structures that caused so much pain for him, and I couldn’t help but spare a moment of anger at how such a crappy manufacturing process that gave rise to such ridiculous defects that afflicted Scott would even be allowed to exist. But it was that same flawed design that informed who he was, and though I’m not given over to believe in invisible hands, I couldn’t help but think there was a reason why I should be holding a human heart so close to the anniversary of Scott’s passing…perhaps to remind me that, despite it all, I and all of his family and friends are lucky to have had him in our lives for as long as we did. Thank you for all you’ve done, Scott, and wherever you are, I know you’re walking carefree.
“Why did you decide to be a doctor?” she asked. “And don’t tell me you wanted to help people.”
I was exhausted. I sat on the edge of Mandi’s bed. “It’s true,” I said. “I want to help people.”
“Ha!” She poked a mound of vanilla pudding with a fork. “That’s what they all say.”
–“A Fire, Deliberately Set,” Peggy Sarjeant
I was reminded of the long, 5,000-character essay I was required to write on why I decided to become a doctor. Superficially, it probably boiled down to that same clichéd declaration. “I want to help people.” But I really tried to get beyond that.
I’d always wanted to do something useful, something that mattered. … Simply put, I believed God had given me gifts that I was expected to use. Helping others through medicine had somehow become the obvious choice.
That is probably closer to what I wrote. But I read on, and I wondered if there wasn’t something more.
I finished the story of the pediatrician who learned she could never be distant and be a doctor at the same time. I finished the story of the resident, dealing with his first malpractice suit, realizing the detail he missed that could have saved a life. I finished the story of the med student dealing with her cadaver in anatomy lab, and on and on. Nineteen stories of becoming and being a physician; nineteen stories of what awaits me. Nineteen stories written by the doctors themselves.
As I read them, I felt something. It was the same feeling that drew me to take a poetry class in high school, that drew me to acting while in college. Each was an expression of the human condition; authors, poets, and playwrights, illuminating the drama of life, beckoning, engaging. I came to understand that what I was feeling was that connection, a belief that I had found the meaning of life, a notion long absent in a staid existence. It was stronger than before, knowing that these were not mere stories, but snapshots of autobiographies.
Maybe that feeling was the reason I was looking for.
i remember not knowing what to do with myself that afternoon. stuck in queens. going to the nearest hospital to donate. directed to a blood center on long island. getting there. a man asked me if he could borrow my cell phone to call his family. he was heading home from manhattan. long line. couldn’t get to all of us today, come back tomorrow. wrote an email. went to church. the songs. that was the last day i could sing them.
school was closed since access to everything below 14th street was cut off. in the spirit of carrying on, sachin and chuck and i ate at daniel. 65th between madison and park. that damned stench carried all the way uptown. later that week we hopped on a bus to sachin’s parents’ house in eastern pa for the weekend. subway service was spotty. suspicious packages and whatnot being called in. a guy working for bell atlantic was waiting for the bus. said they finally restored service to lower manhattan. said the commuter lots along the way would be full of cars waiting for their drivers who would never return.
on the notesfiles. “thank god no one we know was there.” except one of us did have someone. i’m so sorry, matt. i won’t forget.
later. the memorials everywhere. flyers and posters on seemingly every available space seeking information on loved ones. anger. sadness. fear. but also thanks and gratitude. new york’s finest and bravest. friends who were in class on that day. friends who lived blocks away from the towers. friends who were stuck in traffic on the williamsburg bridge on their way to school, conscripted to bear witness. all of us getting calls from family and friends present and past wondering if we were okay. we don’t live or work near the towers. kind of surprised.
But don’t you understand? For those of us who lived in NYC, conducted our business and our lives in that place, we know how often life seems to inexorably draw us to that area. The subways, the sheer number of companies in the buildings, the hotel with its conference rooms… How many meetings, seminars, visits did I have down in WTC? How many times in the last week, the last month, the last year I was there?
And now I was 3000 miles away, in a land of eternal sun and blasted heat and rebirth and death and constant nothing and all of the sudden my friends were in danger and I had no idea about their lives, where was class today, who had what meeting where, was somebody meeting someone for an interview…
And I had to know, then, right then. Was Tony okay? Was Sendhil okay? Were Bill and Laura okay? All my friends, all my compadres of five years that I barely even remember anymore… the mass death, the totality of obliteration, and who the fuckall knew who was alive and who was dead and who was dying and who was trapped and….
The City is a big city, but it’s also a meshed city. You can be anywhere. One hour you’re at Lincoln Center enjoying a string quartet and the next hour you’re at dba slugging down beers made by monks in a country you forgot existed.
Dammit, don’t wonder why we called.
We love, and then we were afraid we lost.
Scott was also attached to the Office of Emergency Management in addition to his employment at CTW. The operations center was in 7 WTC. Much later, he would confess to me his own form of survivors’ guilt; that he thought, had he still lived in the city and been on duty that day, he would most likely have died then. Scott, I hope you are taking care of all of them.
Sometime soon after that day, the call came for amateur radio operators to help provide communications support at Ground Zero. Rather obviously, they wanted hams with handheld radios and enough battery packs to last at least a full shift. I couldn’t go. I only had my mobile radio in my car. There I was, in the very situation I wanted to be prepared for, to be able to help…and I couldn’t.
I will never be as unprepared to help as I was that day.
Flipping through the TV programming guide tonight, I saw the familiar 9/11 documentaries and movies popping up in the listings, reminding me that, on Thursday, it will have been seven years since that day. I have little in the way of comment except to say that, as always, remember to treasure your loved ones every day.
I located an email I sent to friends and family the day after, having been reminded of its existence because of the proximity of September 11, and also from having had the chance this weekend to see an old friend whom I hadn’t seen in nearly four years. Its text follows below.
