London

what you have is the forward march of time
these rains come and they pour
the three black-coated strangers with blue plastic bags
on a foggy street punctuated by cars going the wrong way
guffawing, barrel-chested, smokers in the winter

for those fleeting seconds you wish your souls could trade places
transiently escape things that drain you
but you are stuck with leaves in a gutter after a thunderstorm
browning, rotting, an unanticipated natural decay
in this place you thought had no seasons

the only respite from self-smothering angst is
one foot in front of the other
the forward march of time

Then and now (and then again)

Times change
like handwriting, painstakingly
formed straight lines deliberately dragged
perpendicular to two solid green lines
and one dotted,
metamorphoses into scribbles, illegible scrawls
on napkins and post-its and prescription pads,
cursive the nuns would have rapped your knuckles for
but now you lost the will
time, precious time, has robbed you of the discipline,
the neatness, the straight laces and the luxury to sign your whole name.
"What a shame,"
your father says, as even he
behind the fog of cataracts
perceives that something has been lost.

Times change
like love in its infancy, replete with letters and melodies
dripping with rainwater and snow and sleepless nights of poetry whispering itself into your idle ears
romances fade with distance and masochistic employment
until sweetness is gray and kisses
are neutral clouds that may rumble emptily and carry storms out west or simply
dissolve into bland blue skies
(until the seductive lock of hair caresses your temple
like fingertips whose ridges you never forgot
and you wonder
if your heart will ever be more
than a music box,
a curiosity in an antique shop
with a cracked lid
a scar from when containing yourself
contained you.)

oh unlucky thirteen

oh unlucky thirteen, they tell me the next one
will be better but I don't believe in stars anymore.
the rigmarole was finally too much for the spark of
hope to bear and like an anvil it squashed the whites
of my pupils. that bright light is buried, much as
the one who loved me, cradled me, birthed me by proxy
told me, warned me for the last two decades and now his
sorrow has strangled him into silence. below this
interminably gray sky and the incessant mist of a confused
foggy threshold between seasons I beg you to usher in
a different ode to the new year that the flame of my soul
might shine through, resurrect his beloved toddler and
wash away the disappointment we have etched into his face.

I accept peace

when the air starts to bite
your lungs like horseradish
your breath goes only so far before your chest
stops rising against imaginary hands

block's a ghost town and that
industrial wasteland by the post office tumbles even more weeds.
step by step, one sneakered foot
hopscotching its way in front of the other
--step on a crack and you'll break your mother's back--
until the chalk like fairy dust encounters a used condom
sandy, gritty, the residue of cement and a bright blue
wrapper a few fractures later.

the gray sky rumbles over the games we play
but our daring paws call heaven's bluff
and we pad up to those streets with the big
houses and trees and ivy snaking up bricks
curvy vines hissing like a snake's tongue
--look, but don't touch--
go home to your dead neighborhood
because here the anaconda strangles
the fat man who walks his tiny dog
the viper's venom intoxicates
the anorexic mermaid staring out the green glass window
wasting down to the floating ribs
of the turret of your childhood dreams

if you're here after dark they release the hounds
so your cobra traces its spiral
downwards into the woven basket towards
a quiet cul-de-sac
where quiet crimes
and broken windows
and boarded-up doors
and rotting porches
disintegrate in stilted
stifled time
companions to a sullied rubber who resists a million years
of the flautist's invocation
to biodegrade

Y ahora que...?

I've been working in Guatemala in various capacities on and off for the past 6 years--as a community-based health worker, a qualitative health researcher, a fledgling medical student, a language school director, and an ethnographer--the direct result of which is a very complicated relationship with "the field."

In anthropology, "the field" is the site where we conduct our research, and it's often far away from home. The unspoken rule of academics is that the farther you go from home to do your research, the more legitimate of an anthropologist you are--a philosophy that betrays the colonial origins of our discipline. So if you're from the US doing anthropological research in Melanesia, you're golden.

My field site is not that far away from home, but it feels a million miles away at times. And it's certainly exotic in many of the ways that tend to pull anthropologists in like magnets. There's a history of colonialism and genocide, and poverty and oppression are tangible in daily life. These themes, the bread and butter of much scholarship about Guatemala, are always ripe for political economic analysis. And furthermore, the majority of the population here is indigenous, which translates to opportunities for rich (and often overly dramatic) explorations of local symbolism and Maya cosmovision.

I didn't know I'd end up here. It happened by accident. I learned about Guatemala and the United Fruit Company and the US CIA-staged coup of the 1950's in high school, but never did I suspect then that I'd be spending a good chunk of my life working in the land of eternal spring. Through chance connections, I began to work with an NGO here and haven't stopped since. Guatemala is enchanting, and I mean that in the best and worst senses of the word.

Many of the formative moments of my twenties happened in Guatemala: sharing nauseating glasses of corn gruel with impoverished coffee pickers, feeling human spirits float out of dying bodies in sterile hospital wards, breathing in the grime of a dirty third world capital in a state of hyperaware insecurity. I'm not sure what there is left to experience or that I want to go on experiencing it at this liminal phase in my life, in which I lack the skills and power to remedy any of the injustices I've been silently bearing witness to on a daily basis.

Some anthropologists, after learning the ways of a new culture, mastering a local language (or not realizing what was lost in translation), and developing meaningful relationships in "the field," never go back. I vowed to never be one of them. More often, I'd like to hope, anthropologists find ways to stay engaged with their research site. They go back periodically to visit old friends, conduct service projects, or (very typically) unearth new research avenues that will position them well on the path of "publish or perish."

I have many friends here. I have many acquaintances. There are many people here that I care deeply about. But I also feel spent, exhausted, tired--gastada, agotada, cansada. My dissertation research (which has entailed many an interview with cancer patients and their family members) has been emotionally tiring. Within and outside of my research and medical work, portraits of suffering await me at every corner, at every turn, whether they are unleashed as an avalanche of pain in a medical history, or whether they are puzzle pieces of a troubling life history that are slowly handed to me by my closest friends. Surely, there is more than suffering in Guatemala. There is much more. But it is much of what I perceive on a daily basis, and it has hollowed me out.

I'm ready to go home. But the hard part of leaving the field is not knowing when I'm coming back or in what capacity.

I've done research here for some time now. It's important, I love it, and yet it's not enough. Now--as long as my PhD committee members agree that I've done my time--I'm not obligated to make another trip to Guatemala to continue interviewing people about cervical cancer. And I really don't want to; the sorrow from all those encounters has seeped into my bones and I'd like to recover and sponge it out.

Yet I still want to come back to Guatemala.

And do what?

I'm no longer in the mood to be an anthropologist in the field. I still haven't mastered being a conduit rather than a container, and all I can anticipate is more sad stories that I can't do much about.

But then am I supposed to be a physician in the field? My fieldwork has filled me with doubts about who should be providing health care to the rural poor, what high quality care entails, and what being a responsible practitioner of social justice medicine means in the short and long term. Does Guatemala really need another gringa physician traipsing between villages for a few weeks or months every year, counseling diabetics, deworming malnourished children, and providing prenatal care? The selfish part of me says yes, yes, let me do that! That naive part of me that strives to emulate a young Paul Farmer, hiking through the Haitian mountains with a backpack of medicine, is still alive. The part of me that has matured over the years says no, there must be a better solution than a single socially conscious foreign doctor providing care for the Guatemalan poor, even if she is working with local staff in long-term programs. Where is a single individual to direct her efforts to make the field a better place?

In the end, I have no answers, only doubts. I'm not sure what path the MD/PhD treads to get back to the field or what she does there. It is a lonely path and there are many forks, and it is a big field.

MD/PhD Epithets

I couldn't fall asleep last night so I ruminated over some post-colon and parenthetical phrases that could go after MD, PhD:

My experiment with mediocrity
Jack of all trades, master of none
When your best just isn't good enough

How you come to envy a cat

Each morning, I gaze at her cradling her head in the crooks of the couch, limbs splayed out in luxurious comfort. I watch her rub her neck against anything sturdy enough to take the abuse, and I admire how she scales the furniture and the walls to torture little moths and grasshoppers. She laps up water and crunches up her kitty chow, lovingly provided by these human hands each morning. Her life is so simple.

She’s my only friend. And I often wonder what it would be like to trade places with Poppy.

When I was studying for my first licensing exam during medical school, I remember a similar sort of feeling. It was an all-consuming process. My eyes were in a constant state of numbness, anesthetized by the glowing haze of endless multiple-choice questions on a computer screen. Periodically, I’d get paper cuts from leafing through First Aid, the medical student’s Bible of “high-yield” information likely to show up on the exam, and the fleeting pain would wake me from my studious stupor and remind me what it felt like to be alive again. Glancing outside the second-floor kitchen window, I’d see squirrels scurrying between the branches of a grand maple tree, their bushy tails tracing perfect little arcs, taunting me with their freedom.

How I envied those squirrels.

Whenever I found myself imagining the Freaky Friday version of me and nature’s tiny creatures, I’d decide it was time for a break. But guilt would overwhelm me as I’d lace up my running shoes to head outside into the summer heat. Perhaps it wouldn’t hurt to bring along my mp3 player and try to passively absorb the lectures of Dr. Goljan, a famous pathologist who had trained many a med student to pass the boards. As fate would have it, I only ended up retaining his lewd jokes. Ask me how to keep straight all the different hematological disorders whose abbreviations end with “L”—CML, AML, CLL, ALL, etc.—and no can do, but if you’d like me to provide a detailed rendition of the time Dr. Goljan ran a marathon and pooped on a sapling in someone’s front yard, that’s well within the realm of my capabilities. (I’m going to be a great doctor.)

Now, years later, I am holing myself up in a social science archive on a daily basis, sifting through volumes of the mundane and the captivating thoughts scholars have had over the last fifty years about health care reform in Guatemala. It’s a different kind of consumptive process. It’s the anticlimactic ending to a long stretch of travel here in the “land of eternal spring,” during which I’ve been collecting people’s stories and watching life and death unfold on a regular basis. How does it feel to be a poor indigenous woman dying of cancer? Where do you look for help when there is none? And what drives people to look for care when they are pretty sure that all of the grains of hope have fallen into the bottom half of the hourglass? These are the questions I sought to answer, and empathizing with the sick and the dying took its toll on me.

I retreated to the library.

My life here is relatively cushy. I’m in a tourist town where I don’t tower over the locals as I do in the countryside, but rather, my stature makes me all the more anonymous. I have potable water, a large bed, and nighttime silence. These things ought to help me recuperate from months of physical and emotional exhaustion from acting as a container, rather than a conduit, for the words of the suffering.

But there is something ultimately draining about the rigmarole of self-care and the yellowing pages of a repetitive history. My only task is to read books all day, to relate them to the answers I thought I found, yet this merely leads me down other lines of inquiry until there is an overwhelming amount of text and self-questioning. As I ravel and unravel my thoughts, I find myself craving home—the conveniences of the United States or the inconveniences of rural life, but not this.

This is certainly a different type of voluntary drowning from preparing for the boards, but it is a voluntary drowning, nonetheless.

Every morning, I wake up and pour boiling water on top of a half-cup of oatmeal. And I watch Poppy the cat, and I think to myself, wouldn’t it be nice to access her simplicity of being, and not thinking so much?