“SAM has a birthday party he’s going to this afternoon,” Sally said. “John wants to invite a friend over to play.”
I’d just gotten home from a night shift, dealing with every unlucky and unloved soul in Durham. I should be exempt from further decision making. I poured boiling water onto the decaf coffee in the single-cup filter.
“I haven’t told John yes or no,” Sally said.
I tossed the coffee grounds into the compost jar.
“It’s been a while since he’s had a friend over,” Sally said.
“Who’s he want to invite?”
“Lewis,” she said.
Lewis was a good kid, but a little too energetic. And too loud. “As long as they stay outside, it should be okay.”
“Are you sure?” Sally asked. Neither of us wanted a repeat of the scene on the front porch.
“As long as they stay outside.”
“Fair enough,” Sally said. “I’ll get Sarah up before you get in bed.”
I rinsed my bowl and cup, put them in the dishwasher, and went upstairs. In our bedroom, I stripped off my scrubs, underwear, and socks. My underarms felt sticky. I took a quick shower, then slipped into bed.
A few minutes later, I heard Sally talking with Sarah. I couldn’t make out the words, but Sally’s voice was reasonable and firm. Sarah’s was strident and stubborn.
I was tired of having a daughter with an extra chromosome that dulled her intellect and made her, at times, obdurately stubborn. I loved Sarah, but hated the unending daily struggles. Having a preteen around is one thing; one with Down syndrome is another.
I pulled Sally’s pillow over my head.
“No!” Sarah yelled.
Poor Sally. Trying to get Sarah out of bed without disturbing me was a classic no-win endeavor. I had a few days off, so it wasn’t mandatory that I sleep. Maybe I could just tough it out, stay up all day.
“Mom,” Sarah yelled, “just leave!”
I needed to pee.
Tossing the blankets to the side, I rolled out of bed, slipped on a pair of jeans, and went to the bathroom. I looked at myself in the mirror, yawned, and sucked in my stomach. I stretched, then walked down the hall to Sarah’s room. I lightly knocked on her door and cracked it open.
“Sally?”
She came to the door. “Sorry, Buddy,” she said in a low voice. “Sarah’s being stubborn.”
“Don’t worry,” I said. “I think I’ll get up, maybe take a nap when the kids are all out of the house.”
“Thanks,” Sally said.
“Sarah,” I said through the crack in the door, “you want me to help you get dressed?”
“No,” Sarah said loudly. “Mom can help me.” In spite of her Down syndrome, Sarah had developed a high degree of modesty.
“How can Mom help you,” I asked, “when you’re being so stubborn?”
“I won’t be stubborn,” Sarah answered in a softer voice.
“Thanks.” Sally winked, and closed the door.
I put on a flannel shirt, stepped into a pair of house slippers, and went downstairs to the kitchen, with its lingering smell of coffee. I sat at the table and looked at the paper. The words on the page began to blur. I crossed my arms on the table, and put my head down.
Sarah clomped into the kitchen. “Mom” she said loudly, “Sam and John ate all the Honeycomb cereal.”
I jerked awake.
Sarah stood next to the trash can, clutching an empty cereal box.
I sat up and stretched. Maybe I’d go back upstairs.
“Do you want to put it on the list?” Sally asked, from the front room.
Sarah walked over to the small clipboard next to the refrigerator, and wrote something on the grocery list. It probably said, “Hony Com Cerel.” If you knew what we were out of, you could make it out.
Sally walked into the kitchen. “You okay?”
“Sure.” I got up and went to the half-bath. Beside the toilet there was a magazine rack, filled with out-of-date magazines and clothing catalogues that lagged a season. As I sat on the toilet, I flipped through a New Yorker, but I’d looked at all the cartoons so many times I knew the punch lines before I read them. I dropped it into the rack, and pulled out a magazine-sized publication, Wellness for Emergency Physicians.
I didn’t remember sending off for it. It seemed like it had just shown up in the mail one afternoon. I’d already read the articles entitled “Using Circadian Principles in Emergency Medicine Scheduling” and “Financial Planning.” They were well written, as was the one on “Health, Diet, and Exercise.” An article called “Violence in the Emergency Department” was excellent. “Violence and the fear of violence is a regular concern of virtually every person who spends regular time in an emergency department,” it said. It was a relief to find out that I wasn’t the only one who found the ER stressful.
In another article I read that “An emergency physician often is required to manage a diverse patient population within a very short period of time.” Well, yeah. “Some issues troubling emergency physicians can be traced to a sense of relative powerlessness.” No shit. “Shift work is the bane of the existence of the emergency physician.” Yes. It just felt good to hear someone else say the same things I’d been feeling. If I came home physically, emotionally, and spiritually depleted, maybe it wasn’t because something was wrong with me.
I took the magazine with me back into the kitchen.
Sally was unloading the dishwasher. “Why don’t you go back upstairs? It should be pretty quiet from here on out.”
“I think I will.” I snuggled into bed with the Wellness guide and opened it to the piece on “The Medical Family.” I read a few lines, and felt myself fade away. I slept until lunchtime, got up, and went downstairs. Sally had the boys in the yard, picking up sticks and sweeping the walk. Sarah was swinging on the swing set.
John walked over. “How’s it going, Dad?”
“Sleepy,” I said. “A little grumpy, but not too bad.”
“Oh.”
“Mom said you were going to have Lewis over?”
“If it’s okay.”
“Sure,” I said. “But can you guys stay outside?”
“Oh, yeah,” John said. “Don’t worry about that.”
“You’re going to a birthday party?” I called out to Sam.
“Yeah,” he said, bending over to pick up another stick. “It’s gonna be great.”
I walked inside, and ate some pre-washed carrots and a cup of yogurt. I started reading the piece on “The Medical Family” again. There was a section on “Perils for Children,” which I’d skimmed previously, because the possibility that my kids could be “in peril” seemed absurdly remote. This time, after chasing my family out to the front porch, I read it more carefully. “Although having a physician for a parent is not a prescription for disaster, there are some perils to recognize.”
When I’d finished the article, I put the magazine down on the kitchen table. It was obvious there were two things I needed to do: I had to get good sleep when I was working night shifts. And I needed to get some help. The part about getting sleep would be easy. I could stay in a hotel if it came to that. It seemed extravagant and self-indulgent, but it was better than chasing my family out onto the front porch. The second part, getting therapy, was a harder step for me. It’s not like I had never seen a therapist before. After Sarah was born, Sally and I went to couples’ therapy, and that had been helpful. Working on a marriage after a baby is born with Down syndrome seemed like good preventive maintenance. But me, personally? Getting therapy?
I hesitated because getting therapy seemed to be an admission of a deep flaw in my personality. I’m embarrassed to admit it, but I also worried that it would seem effeminate—not something a real guy would do. I wished they had a more palatable name for it; something like “Getting a guy to show you how to keep from making the same mistake over and over.”
The idea of therapy was unappealing, but I couldn’t hide from the fact that I was miserable when I failed to get enough sleep if I was working the night shift. I was also making my family miserable, month after month.
I put the bag of carrots away, and wiped off the table with a sponge. Maybe I should call Karen, the co-pastor at church. She’d been helpful after Mr. Kelly died after I’d sent him home. And if this problem looked too big for her to help with, maybe she could refer me to a therapist. I called the church. Karen was there, and said I could come over right away.
I went outside and told Sally where I was going.
“Good.” She rubbed her hand against my arm. “Good.”
Karen referred me to a guy named David Townsend. His office was a few blocks from our house, in a yellow house with a green roof. Jasmine vines twined up the turned porch columns. In the waiting room, I looked at the notices thumb-tacked to the walls: “100% Cotton Meditation Clothes” were advertised on paper that was printed to look like parchment. A neon blue flyer about a workshop in “Polarity Therapy” informed me that “Energy is the vital force in the body.” Another flyer said, “Empower yourself with Reiki, an ancient form of Natural Healing.” I didn’t see any workshops for workaholic fathers of three. There were notices for Tai Chi, Kripalu Yoga, and Zen classes, but nothing about handling stress at work. The only thing I saw for men was a flyer on impotence. At least that wasn’t the problem.
A chunky man dressed all in black marched into the waiting room and sat in the center of the couch. Black turtleneck, black baggy cargo pants with pockets, snaps, and zippers up and down the legs. Black combat boots, black goatee. I glanced at my watch. He must be scheduled for one of the other therapists in the office. Unless this was David Townsend, and he was using the time to watch me unobserved. Seemed far-fetched, but so did Polar Therapy, Reiki, and the need for a specific set of meditation clothes. Karen wouldn’t send me to a therapist who dressed up like a Ninja G.I. Joe. I glanced over at the guy, but he kept facing forward, with a scowl on his face. No matter how stressed I got at work or at home, I was better off than this guy.
Feeling better, I looked at the assortment of Celestial Seasonings tea in a homemade rack on the wall. I thought about making a cup, but was afraid it was for the staff.
A bearded guy with close-cropped hair walked out into the waiting room. “Paul?” he asked, making eye contact with me.
“Uh, yeah.”
He smiled and shook my hand. “David Townsend. Nice to meet you.” He turned, and walked down a short hallway.
I followed him.
In his office, he motioned to a couch as he settled into a chair facing me.
I sank into the cushions, feeling nervous, guarded. When Sally and I had seen the therapist after Sarah had been born, it wasn’t like there was a problem with me: the problem was how Sally and I would deal with our new daughter’s Down syndrome. Going to see David was different. By sitting down on that couch I was admitting that I had a problem.
I was verbally skillful enough to keep things superficial at first, avoiding anything that would bring emotions into the discussion. I’d go in once a week, and David and I would spar. He’d try to elbow me into a corner with questions about my feelings. I’d dance around, show him some quick footwork, and slip off to the side, peppering him with staccato words of multiple syllables.
I was dazzling, but David was relentless. Of course, he had an edge on me: it was his game, and he’d been doing it for twenty-five years. Workaholics with compartmentalized emotions were nothing new to him.
David seemed inordinately interested in how I felt. I had to learn a whole new syntax to talk with him. Meeting responsibilities? I could talk about that. Getting the work done? I’d been doing that for years. Meeting a goal? I could discuss that with confidence. But whether or not I was happy? It just hadn’t come up before.
I don’t know what to say about my therapy. Like the conversations you’d hear when telephones were still on party lines, the sneaky pleasures of listening in would soon give way to boredom. I’m embarrassed that the things I learned sound so much like the bullet points in the self-help magazines: before I could take care of other people, I had to take care of myself—I had to get enough sleep, exercise regularly, and eat reasonably nutritious food.
But the real insight was about joy: the amount of joy I’d be able to feel would be in direct proportion to my willingness to feel sad. That was a tough one. For thirty years, I’d been incessantly striving and keeping myself too busy to feel any of the loss and sadness that we all experience from time to time. I’d learned to keep things in tight little compartments. The emotional distance I’d developed in the ER had become habitual, shielding me from negative feelings until they bubbled out as anger.
I’d become facile at the pretense of forgiveness, but I had to learn to really forgive other people, and myself, for the human errors we all make. And as I learned to open up to feelings of joy and sadness, I began to experiment with feeling gratitude.
I started working with David to ensure that I’d never chase my family out of the house again. As it turned out, I became more productive, and happier.
Getting sleep between night shifts proved to be a lot simpler than the therapy. I checked in at the Hampton Inn, a half mile from the house. The relief of standing in that hushed hotel room was delicious, and physical. The air conditioner quietly hummed, and a fringe of light glowed softly at the bottom of the drapes pulled across the window. I hooked the DO NOT DISTURB sign on the door, closed it, and slid the chain lock in place. Sally was the only person in the world who knew where I was. No one would call and no one would knock on the door. I stripped out of my scrubs, took a shower, and tossed the damp towel onto the countertop rather than hanging it up on the rack. I was, after all, in a hotel. The sheets were crisp and clean and unslept in. I slipped into bed, and went to sleep, like a load of gravel sliding off the back of a dump truck. At one o’clock, I woke up, hungry. I walked across the street to Shoney’s for lunch. Back in bed, I stretched, and felt guilty pleasure as I drifted back to sleep. I woke up at five o’clock, shaved and showered, and checked out of the hotel. At home, Sally and the kids were eating toast, yogurt, and carrot sticks for supper. They were doing fine, and seemed glad to see me.
“Want some yogurt?” Sally asked.
“Thanks,” I replied, “but I was thinking I may eat at the Broad Street Diner.” I was on a roll. A man who sleeps at the Hampton Inn doesn’t eat raw carrots and yogurt.
“Sounds good,” Sally said, smiling. “Take a book.”
I felt a rush of gratitude for Sally’s generosity. I still felt guilty, eating out while Sally and the kids were eating at home. But Sally and I had talked about it, and she’d encouraged me to go ahead and indulge myself. “Buddy,” she’d said. “Night shifts suck. You should do anything you can to make them better.”
She’s always known that people should take care of themselves. Sounds selfish saying it, but I’ve come to think it’s true. I was glad that she took dance classes, and joined book clubs, and I encouraged her to take yearly vacations with three close friends she’d made, working in an ICU twenty years earlier. But I used to resent it when Sally got a babysitter just to get some time to herself. I’d be scheduled for a 3–11 shift, knowing I’d get my ass kicked at work, and Sally would mention she had a babysitter because she needed to take a break. But to go out for dinner by herself, while I was clawing my way through a shift?
I imagined her tucked into a booth in the corner of Elmo’s Diner, sipping a glass of Pinot Grigio. She’d open her book and smile contentedly. I’d be in the ER, twelve charts behind. She’d have a leisurely meal, glancing up from time to time to thank the waiter when he filled her glass with water. Patients would be mad and EMS squads would be lined up at the loading dock. She wouldn’t have dessert at the diner. She’d stroll down Ninth Street to Francesca’s, a little dessert shop, and have a scoop of sorbet. Probably raspberry champagne. About that time, I’d be doing a rectal exam on a GI bleeder. She’d keep reading, until she was sure the kids were in bed, asleep. If I really hustled, I could clear out a twelve-minute space to wolf down my food. Then she’d go home, pay the babysitter, set up the coffee for the next morning, and get into bed with her book. I’d be in the ER, wishing I had time to pee. She’d read till she got sleepy, then doze off. I’d still have an hour to go before I could leave the ER.
But after I’d slept all day in a hotel, she was suggesting I go out to eat while she looked after the kids. Gratefully, I went to the restaurant, ordered my food, and read Get Shorty. I glanced up, from time to time, to thank the waiter for refilling my coffee. I enjoyed this reprieve from the demands of work and family, and finally understood why Sally had needed time away. When I worked the afternoon, late evening, or night shifts, I wasn’t there to help with the bedtime routine or the breakfast routine—I got to bed late and slept late. For a significant part of each month, Sally functioned as a single mom. Or worse, a single mom with a sleep-deprived ogre upstairs, ready to spring out of bed at the slightest noise. As I gained insight, I saw that she’d been struggling for years to mitigate the effect my shift work had on our family.
After supper, I went to a local health food store and bought a pound of dark roast coffee and made a salad at the salad bar. I went to work that night well rested and well fed. I brewed a pot of the gourmet coffee, and left a note by the pot so people wouldn’t think the coffee was stale just because it was darker than usual. I enjoyed sharing the small treat of good coffee. When Dr. Holt came down to the ER for an admission, I offered him a cup. “Magnolia Grill Blend,” I said. “Fresh pot.” He followed me back to the small break room adjacent to the locker rooms.
“Thanks,” he said, toasting me with the cup, and took a sip. “Delicious.”
Ricky, the respiratory therapist, liked coffee, so I gave him a cup. The ward clerk, nurses, everyone seemed to like the special coffee. It’s become a trademark. “Dr. Austin’s on duty,” someone will say. “We’ll be drinking good coffee tonight.”
As I started getting solid sleep and treating myself to a pleasant dinner and an Elmore Leonard novel at the start of each night shift, I began to hate night shifts less. Sally and the kids noticed the difference. I was happier. They enjoyed being around me.
I don’t know why it took me so long to figure out I’d have to treat myself better if I planned to stay at such a stressful job. When I was a carpenter, I kept my tool chest filled with Craftsman tools, the best I could afford. I kept my chisels sharp: I could shave the back of my wrist with them. And I knew that every dollar I invested on tools, I’d get back. I finally came to think that if I had to spend $60 a day on a hotel just to sleep, in order to keep my job, fuck it. Pay the money. I could see it as an investment in job longevity—a cost of doing what I do. Other people who work rotating shifts may not have to go to a hotel to sleep, but I did. And if it would keep me in harness for another ten years, it was a bargain.
I work between two and five night shifts a month. Usually three. Sleeping in a hotel cost $180 a month. That’s $2,160 a year. It would buy a set of braces for John, a family vacation, or a couple of writers’ conferences for me. I hated spending that much money just to sleep.
Finally, Sally suggested I sleep at her mother’s house in Chapel Hill, about twenty minutes away.
“Would she mind if I just came in and went right to bed?” I asked my wife. “I wouldn’t feel like making small talk.”
“You should ask her.”
The next time Sally, the kids, and I went over to visit, Betty asked me if I wanted to sleep at her house when I was working night shifts.
“I’d love to,” I said, “but I’m not very good company when I’m working nights.”
“Don’t worry about that,” Betty said, gesturing toward the door. “You could just let yourself in and go right upstairs.”
As it turned out, it was even easier than staying at the Hampton Inn. I’d get there between eight thirty and nine in the morning and whistle as I let myself in, so I wouldn’t scare her. She’d whistle back, and I’d tiptoe upstairs. That was it. I could sneak out for lunch and back without talking to anyone.
The house was set back in a heavily wooded lot. As I pulled my pickup truck into the circle drive, I felt as if I were entering a refuge. Geese waddled up into the backyard to eat the dried corn Betty scattered for them. Hawks circled lazily overhead. Beavers gnawed trees into pointed little stubs. And a depleted ER doc stumbled upstairs to sleep.
At Betty’s house, I slept soundly until I woke up for lunch. I’d leave, go to a diner, and read a novel as I ate by myself. After lunch, I’d go back to her house and sleep all afternoon. On the first day of a string of nights, I’d still be on a “day” sleep rhythm, but I needed to rest up for the night ahead. I’d lounge around in bed all day at my mother-in-law’s, reading, dozing off, reading, and dozing off again. At about five in the evening, I’d get up, shower, shave, and go downstairs. Betty and I would chat for a few minutes, then I’d drive twenty minutes to Durham, rested, ready for my shift. The other docs in the ER envied the undisturbed rest I got at my mother-in-law’s, and would jokingly ask if they could sleep there, too.
My mother-in-law helped save my job and my marriage. I’ve never been comfortable about accepting gifts, or favors. I’m always afraid I’ll be asked for more than I’m willing to give in return. But Betty never asked for anything and didn’t mind my coming and going like a house cat. Once I started getting enough sleep, making exercise a priority, and eating well, I found that I was also glad for Sally to take time for herself. Not just for dance classes or the book clubs, but to have a couple of hours to relax and read a detective novel.
I still don’t really understand what I learned during that period. I know it involved opening myself to the feelings I’d always suppressed—mostly sadness and loss—in order to experience the joy. As I gave myself permission to pull away from my family when I needed to, trust, intimacy, and laughter began to flourish.