The AC is on the fritz at the house, so last night was a bit on the steamy side, thanks to our summer-is-here-get-over-it May Indiana weather.  My wife and I are on the opposite ends of the temperature spectrum, so while I want the fan blowing directly on me, that’ll put her under the covers with a blanket, even.  So sleep was not top on my agenda last night, and I ended up on the porch, at least cool–and in the dark, lest Sasha the wonder-mutt awaken and engender what ought ne’er be engendered past midnight.

As is my wont, I glided around different websites based on my fancy of the moment, and I had this notion to google Clint Van Winkle, the author of the book Soft Spots, which I mentioned in my Friday post, Is It Something I Said? Van Winkle has his own website, and on it he advertises a documentary that he has produced, The Guilt, the story of one of his best friends from the early invasion of Iraq, a fellow Marine who was struggling with the guilt of living (thanks to a medical retirement) while his best friend died during a second deployment.

The documentary was on a site entitled In Their Boots, a place for film makers–and especially combat veteran film makers–to produce films depicting all aspects of life post-deployment, for veterans, for the families, for their survivors, no sweet-coating, just real, very, very real.

I cannot recommend this site highly enough.  It was 1:00 AM, and I was hooked.

Before sleep finally pigeonholed me, I was able to watch not only Van Winkle’s story, but also the story of a widow who found a way to reach out to other widows/widowers (We Regret to Inform You), a fascinating study in wire and clay, believe it or not, on addiction and combat trauma (Enduring Erebus), and a heart-rending story of an intense (to put it mildly) Marine whose perfect body has protected him from so much, just as he protected his two younger brothers growing up, but could not protect his heart from the pain that resonated from the streets of Iraq to the streets of his infancy (The Way of the Warrior).  The way that latter Marine held a couple of superhero action figures, speaking of them, to them as the boy in the man and the man in the boy: I tell you, at around 2AM, that just about did me in.

That’s when I remembered Helen.

Helen Gurin was a social worker at the Judge Baker Children’s Center in Boston, where I did my training in child and adolescent psychiatry in the mid 1980’s.  The wife of a distinguished Brandeis professor, Arnold Gurin, she was one of my principal supervisors for both my years of residency there.  She was the Jewish mother of Jewish mothers, a little, shall we say, on the plump side–and she had no apologies whatsoever for that, believe me.  She had trained under some of the finest in the mid-twentieth century field of child psychoanalysts/psychotherapists, including Anna Freud and, for an extended time, Donald Winnicott, one of the key theorists and practitioners of play therapy–and apparently a wonderful man.

Soon after I moved back to Indianapolis from Boston, Arnold died after a short illness.  Helen sat shiva for him, and then she somehow let her body know that it was time for her, too.  I still remember receiving the letter from her secretary, now twenty-one years ago.

Helen was anything but brash or self-promoting.  Quite the contrary: in our team meetings on the inpatient service (and usually throughout the rest of the services, I might add), she would always bring her knitting and sit there and hook, hook, hook while the rest of us (including one very brash and self-promoting young resident from Indiana) tried to outdo each other in our brilliance and clinical acumen.

But then suddenly, a point would be reached, and Helen would put her knitting down in her lap.

Absolute silence.

And then she would simply say something, a phrase or two, an observation.

And she was always a). dead-on right, always, always, and b). just slightly miffed that she’d had to interrupt her stitches in order to get us all to realize what we should have realized a good ten minutes earlier.

So why did I remember Helen as I saw that man hold that toy, that woman take her toddler daughter to visit Daddy in the cemetery, that husky guy look out that window of a diner, somewhere toward Fallujah, Anbar Province, maybe?  As I thought about evidence-based, metrics, recovery, therapy, recovering, hope, terror, what-nexts, what-nexts–and, a brash, self-promoting, now-not-so-young, now-attending physician from Indiana?

This is why.

Dear Helen,

Can it really be twenty-seven years this July that you and I first met?  Lord, I’m treating combat veterans who weren’t even born yet.  What time has brought.

Sometimes I look back at those two years I spent at the Judge Baker Children’s Center and the Boston Children’s Hospital, not even yet thirty myself, and wonder: who was that guy?  I never see kids any more, never work with families.  You wouldn’t even recognize the world of child and adolescent psychiatry these days, Helen–and you wouldn’t be pleased, but you saw that coming, didn’t you?  I still remember your turning your nose up at Ritalin all those years ago.  Good Lord, if Ritalin did that then, one can only begin to imagine what you’d be doing now.  It’s a new world, Helen, a new world, maybe a brave one–in a Huxley way, I sometimes wonder.

Yet at other times, like yesterday, today, I feel those hallways–and all the support and, yes, admonitions that I received in them–as if I had just tread them earlier this week.

I sometimes wonder where those children are now about whom you and I talked.  They’re all in their thirties now, none more than in their early forties.  I hope.  I mean, I hope they’re all living somewhere, in their thirties or forties.  We both know there are no guarantees of that.  Did anything I did with them make a difference?

Of course you remember my asking that question so many times even back then, don’t you.

I’m still asking it, Helen.

And I’m still hearing your answer: “Dr. Deaton, haven’t you known certain people only briefly, yet they changed your life forever?”

Sometimes it’s hard to meaningfully remember the “yes” answer to that question at the end of certain days.  Yet thank you, Helen, that the “yes” is still as true today as when you asked me.

All these years later, I sit in a coffee shop, hooked up for free to a knowledge base that you would have mined like nobody’s business (of that I’m sure), and I ask myself: what do I want to say to you, wish I could ask you?  It’s a beautiful day here in Indianapolis, a little on the warm side, but not bad, really, so much like those days I’d lollygag up to the hospital from the Longwood station on the Green Line, nervously, confidently, cluelessly walking into a world that was so much beyond the dreams of a neurotic lad from western Marion County, Indiana, pah-king my cah in Hah-vahd yahd, and all that–yet also into the world of the hurting, the sad, the helpless of Boston, Jamaica Plain, Roxbury, New Hampshire, the Cape.

That’s it, of course, Helen.  It was there with those hurting, sad, helpless children that you taught me in a such a visceral, human way how at least some of us psychiatrists, psychologists, social workers must be willing to stick around for the long haul, to put ourselves willingly at the whims of the lives, fates that our patients must endure without choice, never guaranteeing them that we will be there forever, yet guaranteeing that while we are with them, we will never hold them back, will always let them leave us even when both they and we know they would rather not, should not, would give anything not to–always guaranteeing to keep the door open for them as long as it’s ours to open, just in case.

I draw on that visceral, human knowing every day.  I will need it tomorrow.  I will need it until the day I pass my work on to another, just as you did to me.  I remember wanting to give up on that work so many times back then, sitting in your office, staring at your Mona-Lisesque smile, knowing that you’d never stop me from some half-baked scheme to go to Harvard Law School, knowing that you knew that, yes, I’d come back.

I did.

There are always hard times, Helen.  You had yours.  I have mine.  You could have made your times much easier, could have settled into a quiet little consulting practice in Brookline, Newton, been the slightly overbearing, yet always right, always patient Jewish mother that you were, at a price the wealthy of Concord, Hamilton, the Back Bay would have shelled out without a thought.  Yet you stayed at the Judge Baker because that was what you did, a social worker from the old school who simply believed that one stays where one is needed, that Hillel had it right:  if not us, who, if not now, when.  No drama, just faithfulness.

As I sat there last night and watched those documentaries, saw that women gently rummage through the drawers that hold the only remnants of her husband’s scent, watched the eyes of that man who had to decide who got his buddy’s dog tags, the man’s wife or his mother, saw the look of that man’s eyes as he desperately prayed that he could get better enough to face his younger brothers, the men who once had been frightened boys who had so needed their big brother, who had been his life, his reason for being, his charges to protect from the monsters in their lives, under a table, quiet, shhh–when I saw them all, Helen, I thought of you.

How did this chubby kid from Ben Davis High School end up pouring out his worries, his passionate confidence, his testy wisecracks to you, a student of Winnicott’s?  How did he get so lucky as to experience a transitional space with you, just as I suspect you did with Winnicott, just as I am going to try to provide tomorrow, Tuesday, next week, to these men and women who have seen so much, knowing that they saw what they saw, did what they did out of the same honor, the same Hillelian words you taught me: if not us, who, if not now, when.  No drama.  Just faithfulness.

All times are hard, Helen, yet my colleagues and I who learned from you and your colleagues? We’re behind.  Really behind.  So much has changed in the years since you died: new medications, new technologies, new ways of understanding age-old problems, new approaches clearly outlined, clearly focused.  So much good is happening to relieve so much of the emotional pain that we once merely had to watch.

Yet what was it the French say, plus ça change . . .?  The more things change, the more they stay the same?  Still so much of the “holding environment” that Winnicott taught you, so much of the patience you and your colleagues taught us is so necessary as we sit with these combat veterans, even when we are teaching deep breathing techniques–or desperately in the moment trying to practice them ourselves, living them with those who are needing them most.

Yet I’m not quite sure, Helen, how many are ready for the other truth you taught me:

“We stay faithful.  We’re here for as long as we can be.  Remember, Dr. Deaton:  life is always going to be harder for them than it is for you and me.  They have seem more than we have, hurt more than we have.  We must be thankful that we have not seen, not hurt similarly–and therefore we must give in return.  That’s why we do what we do.  They need our steadiness.  They need to know that we’ll somehow find a way to be fine even when they feel that they never will be.  Nothing ends at the end of the hour except the hour, doctor, remember that.  They have to live, have to hold on long after they’ve left our offices.  We have to do the same:  live with them, hold on with them, at the next hour and the next, for as long as we and they can, just so that we can live, hold on inside them, inside their minds, their hearts, hour to hour, in all those hours before we sit together again with them.”

And I’ll never forget what you told me, so straight-in-my-eye honestly, so caringly:

“It’s hard for all of us to hold their pain, Dr. Deaton.  But I know, it’s so hard for you.  You want to use your mind, your words, that smile of yours to say just the thing that will make everything better, just like that.  You’ll be a father one day.  You’ll never be a mother.  Fathers want to do.  We mothers want to do, too, but it’s easier for us to hold.  Not easier on us, mind you, but easier for us.  But you’ll learn, Dr. Deaton.  You’ll find your way.  You’ll learn.”

Helen, I’ve only got fifteen years or so before I too have to turn over the reins, just as you and your colleagues had to turn them over to me and mine.  I actually am a Dad now, Helen (I’d say believe it or not, but I know: you knew).  It’s still hard for Dad to hold.  I want to, Helen.  But I still try every day to remember: I can’t change the past.  I can’t guarantee the future.  I can merely be faithful and–well, how about hold on, even if holding still ain’t my forte?  Good enough?

Thank you, Helen, that if you were still here to hear that question, you would just look back up at me from your knitting, never dropping a stitch, smile that babushka smile of yours, with your hair always in that bun, and merely say, “It’s time, Dr. Deaton.”

And then with a wink, “Back to work.”

They’re great men and women, Helen.  They’ve seen so much.  They’ve had to do so much that they never in their wildest dreams ever knew they’d had to, ever wished they’d had to.  They’ve had to make decisions about life and death, about perfumes and dog tags, about when they’re ready, finally, to come out from under hiding under the table.  Some weren’t even born when we met.

There’s so much left to do.

That’s why you did it for so long, though, isn’t it, Helen.  For the future.  For life.

L’chaim, eh?  Yes, I can still hear you say it.

To life.

Thank you so much, Helen.  Thank you.

Rod