All Aboard! Little Red Train

Benedict Blathwayt

Random House Group

<p>Chapter 1Storehouse of TearsThe lines are straight and swift between the stars.The night is not the cradle that they cry,The criers, undulating the deep-oceaned phrase.The lines are much too dark and much too sharp.The mind herein attains simplicity.There is no moon, on single, silvered leaf.The body is no body to be seenBut is an eye that studies its black lid.—From Wallace Stevens, “Stars at Tallapoosa”The story Mateo told could only be held in my mind if abstracted, if I flattened the mental image like a collapsible gurney and slotted it in among all the others I had seen. It helped me to not acknowledge how long he had been suspended by his seatbelt in the flipped car, to not consider the feeling of helplessness as his family died around him, considering instead only an instant of time, a still.Or instead, simplifying Mateo himself, I could reduce his dimensionality, the space he occupied—in my own mind compressing flat his human texture into a simple plane. Then I could bind his story together with others like it I had heard or seen—together they became like a stack of old newspapers, all borne together without individual features, fused in a rain of tears. In this way suffering could be summarized as a tractable single object of ten or ten thousand lives. I don’t know why I can’t cry, he began, and when it was all told and bundled, it was not more, or less, than any other ending of a human world.There is no formal protocol in medical training to protect a doctor’s exposed heart in these particularly devastating moments. Physicians and nurses, warfighters, crisis workers—they all come to learn defenses on their own, in order to live among the extremes of human suffering. It is not just the magnitude of the pain but also its incessance—the unrelenting descent into the abyss, day after day, year after year—that without some safeguard would be unsustainable.Our natural impulse is to connect deeply and broadly with someone in a state of personal loss, to try sensing inside our own minds a full and complex representation of the other, to fully understand what the tragedy means. But in the extreme context of horrific suffering, it can be helpful to instead narrow our perspective to preserve empathy, finding a point to experience within the broader tapestry of the patient’s life, focusing on one spot of interlocking threads creating local shape and color It is important to know that the full perspective is available, but feeling fully does not make sense of —and depths of emotion do not seem to help us with precision tasks in the agonal moment, whether performing an artful lumbar puncture of the spinal column or a difficult psychiatric interview to elicit inarticulable feelings. Our perspective widens when it can, sometimes without warning—on the drive home, or among our children with a sudden sob. Until then, out of view but always accessible are the trajectories of the patient’s threads with all the scope of life and its dreams, from their anchors and origins, through the journeys and relationships that came together in that instant of catastrophe and strife.Each tragedy is still felt intensely, and each suffering human being is held in the heart carefully no matter how many more come over the years—every stunned and bereft father after a car accident, every mother struggling to form words as she hears her child’s brain cancer diagnosis. And care is needed; when the cases accumulated are still few, early in the life or training of a doctor (and sometimes still later), a single experience can storm and overwhelm the inner self, in the part of us that sees and feels representations of human beings, textured images of valued others, positioned carefully like tapestries in the innermost fire-lit halls, the hidden spaces of the self. In the keep, if we were castles.I should have been better prepared, but there had been no warning that the keep was vulnerable. Until meeting Mateo (in my role as the on-call senior psychiatry resident</p>

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