Inside each of us is the sum of all of our experiences and interactions, which, combined with our congenital reality, makes us who we are and who we can be, and enables us to see the same in others. We can only truly understand in another that which resides in ourselves. From our own fluctuating melancholy, to ineffable wisps of perception, to catastrophes in our distant or not-so-distant past, we can know without thinking or understanding the world in which homeless, psychotic, depressed, and intoxicated people live. The story below speaks for and depicts the one and the many and is based on multiple actual encounters I have had.
Summoned to the emergency department to evaluate a “suicidal patient,” I walked into the institutional room, which had been reduced to bare essentials, to find hospital gowns draped in resigned surrender over the figure of a young man who looked as if he, too, had been minimized somehow. I became aware of the weight of my legs, emaciated by the physical demands of my residency, yet strengthened by the same gravity that seemed to have drained all expression out of the patient. In a monotonous tone, like a vaporous and nauseating utterance of the room itself, the patient spoke: “I came here by taxi cab, because I didn’t know where else to go.” He had spent the only $100 he had to take a taxi to this room.
Not long into our talk, I saw in my patient the erudite and worldly Renaissance man who had graduated from college with honors. I saw that life, which had almost been extinguished by his other life as a soldier; for at war, he had lived, witnessed, and been infiltrated by the most debased and raging impulses and states of humanity. Out of self-preservation, he had no alternative but to become like one of the walls in the room—stark, bare, unmoving, monotone. Inwardly he wanted to hurt himself and to kill himself, for the war continued to rage within him now. How could he come to terms with what he saw, when he saw into each of us?
He had lost everything. When he told me his car was now his home, I imagined soldiers clustered for warmth around a tank at night. I imagined how one can feel so alone in an army—to not exist as an individual in order to be part of a collective, and to conceal one’s true self, or to stand alone and have to deny what one has seen and known in order to remain a part of the collective.
Recently his dog had died. I think this tragedy penetrated his despair, somehow accessing a wisp of a perception, and as he pursued that feeling he cobbled together $100 and made his way toward help.
I offered him admission and he agreed. As I walked away, I thought, “The two of us are not very different. Life simply has taken us in two different directions.”
The artwork on the cover of this issue reflects the isolation I have recognized in my patients, and the isolation that resides in all of us. To recognize it in others, we must first experience it—if only for a moment—in our own lives. It is through sharing and exchanging such experiences that we may all feel the bond of humanity.
Acknowledgments: The author would like to thank Dr. Greg Gurnick for his assistance with the essay.
Maryam Soltani, MD, PhD
M. Soltani is a third-year resident in family medicine and psychiatry, University of California, San Diego, San Diego, California; e-mail: firstname.lastname@example.org.