Ode to Avoidance: Part 1

A guest post written by Husband

You have met my husband here before in glimpses. He is the one who listens to my drafts, offers wry commentary, and occasionally rocks a floral Mrs. Roper-style kimono. Today my husband is taking over the page. In his own words, he is stepping from “object” to “subject” and letting you in on a part of himself that has shaped his life in medicine, in grief, and in our marriage: the part that keeps feelings at bay.

This is Part One of Ode to Avoidance, his first guest post. I have not changed a single word.

Hello. My name is Husband. Well, obviously my name is not Husband, but that is how you’ve come to know me here on Substack. You might know me as the fellow who listens to and occasionally makes recommendations about Wife’s posts. You might possibly know me as the guy who rocks a floral Mrs. Roper-inspired kimono, blithely and implausibly confident about his appearance. And I suppose that I am those things. But I’m here today in a different role. I’m going to try to take a turn as subject rather than object.

Quite some time ago, Wife asked me to write a guest entry here. I smiled, but didn’t immediately jump at the chance–for so many reasons. First, and most obviously to me, I don’t think of myself as a writer. It has never come easily to me to put words onto a page. I have some critical voice in my head that tells me to pause after each sentence, and question what I've said. But if I'm going to be honest, and this Substack account is all about honesty, then I’ll admit that there is something else going on. Quite a bit more. And though I am cringing with discomfort about this, I’m going to try and share this experience with you.

In order to do this, I guess I’ll have to share some background with you. Who is this kimono-wearing, confident person who exists in the periphery of this series? Well, I’m in my late 50’s. I have had the privilege of a supportive family, decent health, and a good education. I love to sing, and to listen to all kinds of music. I’m most comfortable when I’m walking in the mountains or floating in water.

I’ve had a long career as a physician. I spent almost all of that career taking care of people in the hospital. I would meet 4 or 5 new people per day in the Emergency Department–folks who were often having the worst day of their lives. My role was to care for people who were too sick to return home. I don’t know much about who will be reading this. Maybe you’re lucky enough to have never spent time in the Emergency Department. But maybe you have been there, in that windowless room with the ammonia smell. Maybe you’ve been fortunate enough to only be there for a sprained ankle or an ear infection. But possibly you were there for something much much worse. That would be the situation when you would have met me.

In the Emergency Department, there is always crying. Picture a middle-aged woman with a dislocated fracture howling in horror and pain, eyes wide staring at her deformed leg; or an older man who is whimpering at the bedside of a woman who is struggling to breathe. The worst for me were always the cries of a child; her screams seem to express both her pain,and her feelings of abandonment. That was my office.

My role was to see only the truly sick folks; to calmly assess the disaster, and then triage. Triage–that’s a word that sounds beautifully efficient and clinical. But since this is a space where we are going to talk honestly about feelings, let’s call triage what it really is; a way to separate out those who are definitely dying, from those who might die really soon, and those who might have a bit more time to avoid disaster I would see each person, and decide. Are you stable enough to survive on a medical floor where a nurse can check in once every four hours? Maybe you’re ill enough that you won’t last the day without someone to look in each hour. Maybe the situation is hopeless. You are not going to leave the hospital alive. Somebody needs to explain this to you, or maybe to your mother, or your spouse, or your child. Somebody needs to honestly and directly tell you what’s going to happen. That person is me.

At the risk of sounding proud, I’m going to tell you that I am good at this. 30 years ago, a mentor told me that the first step in every emergency is to take your own pulse. It’s kind of flippant. Most hospital aphorisms are. But the point is that it is only once you are calm and dispassionate that you can help the patient. I have learned to do this well. I know what to look for in a person’s breathing and pulse; I know how to interpret the labs and the images. And then I can put that information together and see a coherent picture; I can see the dangers, and I know the likelihood of those dangers. I do all of this quite quickly. I walk briskly and gather the data coolly and efficiently.

Then, I toggle a switch. I sit down with your mom, your sister, your son, or you. I take a breath. And for a little while, I stop using the word “patient" in my head. I start to talk about you. About your values, your joys, and what you might have expressed in the past about what you would want if you were to find yourself in this grim situation. For a short time, I allow myself to share in, and to feel the sadness, or the fear, or the dread. I do this for just a short time. I hold a hand; I tear up. But only for a moment. Then I am off to the next person. Well, more honestly, the next patient.

There is a good chance that you are reading these last couple of paragraphs, and that you maybe don’t like me very much. I mean, who is this guy who can make life vs death decisions and then turn on or off emotional connection at will? Is he a robot? A sociopath? I don’t think that I am either of those things. But it’s pretty clear that when I am faced with pain, I have the ability to squelch my feelings. That feels like the only way I can keep moving forward.

So let’s get back to the matter at hand. Why have I been cringing with discomfort at the thought of guest posting for Wife? In fact, why is it that I cannot always read through her posts without needing to take a break? And for that matter, why have I had full-fledged panic attacks at times when Wife is reading to me her essays–essays which I fully recognize as thoughtful, poignant, and sometimes joyful.

I think the answers to those questions are longer than this format is going to allow. But if you are reading this, then you are likely familiar with the language of Internal Family Systems (IFS). I imagine you’ve heard the idea that people have parts. I am only just learning about this particular protector part. He is the part who stifled my sadness and fear during countless nights in the Emergency Department. He is the same part who squelched the horror when my sister, my brother-in-law, and my nephews fell from the sky and burned. He left me numbed, but functional enough to figure out the grim business of returning their bodies home. He no doubt existed long before I ever went into medicine. He protects me from feelings that I cannot handle. That isn’t correct. He protects me from feelings that he thinks I cannot handle.

About a year ago, when Wife started to write, I was enthusiastic. Her embrace of honesty (with herself, with her friends, with me), it was nothing short of transformational. To be clear, I am still enthusiastic. I love that Wife is facing her past and her present head on, with clarity and honesty. But her past and her present have quite a bit of overlap with mine. When Wife writes a book chapter or a post, my avoidant part is a cornered animal, panicked, afraid. He knows the feelings are strong. He believes them to be intolerable. And so he flees, and sometimes he fights.

Avoidant part (shall we call him APme?) means well. He is looking out for me the only way he knows. And there can be no doubt that his techniques have carried me through some truly tough spots in the past. But Wife is dead set on an honest accounting with herself and with the world; she is crashing into the towers of our joint past. My Avoidant Part sees that as horrifying and scary. But I will keep doing my best to soothe him. I am going to try to keep my eyes open. Because me, self me, I’m taking a breath. I can handle this. Maybe I can do more than just handle it. Maybe I can even be excited for the ride.