The Shame

This is the shame.

It starts with you. It starts with the heat in your face when you forget. When it’s not the way they asked, or even if they didn’t ask, but it feels as though you should have known. It’s the same. This is the shame.

It works its way up when you realize you’ve been to college, medical school, damn, maybe you’ve even gotten a masters or for the really fool-hardy another doctorate, and you find you can’t staple a packet of papers the right way. You can’t line up the lab values the right way. The urine output is from the day before, not the last 24 hours. There is dissapointment, the team bends a little with these small stresses you put on it. The morning feels longer, doesn’t matter that you woke up at 4:00AM. What good is any of that if you can’t tell the difference between an X-ray taken this morning, and one taken yesterday. This is the shame.

It has a smell, the shame. It’s fear sweat. You can smell it when they ask you if the labs have been collected. Its got the metallic tang of failure in it. No you don’t know if the labs are collected. How can you know? Should you have collected them? The questions pile on more just questions marks under a dull roar of the blood rushing to your face, what blood vessel does that, makes that roaring sound that is the sound of the shame? You should know. But you don’t. This is the shame.

It has texture, the shame. It’s your slippery gloves that make it impossible to grab the stitch you’re trying to tie, it’s that ache in the small muscles of your palms, especally the one between your pinky and wrist, that is siezing up like it is holding onto this thread for dear life, why is that muscle even working? It has no business in tying this knot. It should relax. But it won’t. Your body even, your own body disavows you. The shame comes on full when your fingers slip and fail. You’ve tied your shoe laces three hundred and sixty five days a year for twenty eight years but you cannot tie now. This is the shame.

It has a tension, the shame. It’s your aching forearm, your aching back, it’s your aching arch of your aching flat sole of your forsaken flat foot. It’s the burning in your shoulders when they say “Pull a little more” it’s the numbness in your thumb when you are holding the gallbladder and you can’t understand why that is the only way to hold it but it makes your finger numb, but despite your age and your education you can’t cluster together the necessary neurons to figure out how to hold something so it won’t burn in your muscles or make your hands go numb. This is the shame.

It has a taste. The shame. It’s the bile acid taste in the back of your mouth when the patient dies, leaks, bleeds or spirals into a tachycardic, hypotensive, beeping, buzzing, inflammed, hypothermic hurricane of your own faults and mistakes. It’s the dry spit and salt taste when you say the words, “I should have done better.” Maybe someone else can do better. Better without you to send their family members to an early grave. This is the shame.

It has a sound. The shame. It’s the sigh, a short, heavy sigh of being discarded because you are unable and incompetent. The sound can change. As you float outside of your small one-man show into a slightly larger play. The sound is the heavy sarcasm that puts a bowling ball in the center of your guts. You realize you’ve been searching for ways to make this about you, but it’s not, and it never has been. The shame is you never saw that yourself. You always held up your failures as a mirror. But it’s a small window, a cracked and broken one, and you can see finally just beyond yourself, you can see everyone and everything trying and reaching for a little better, and here you are stumbling about in the dark like a drunk, looking for gold stars to put on a report card that’s no longer coming, when all you needed to do was to give a damn about anyone but yourself. This is the shame. The shame is, if you cared enough about anybody but yourself, you’d be doing the things, learning the things, reading the things to make sure you can help. This is the shame.

It has an end, the shame. It stops in the small puddle of the anxious sweat and tears you cried for yourself, the ones that were shed over your minor dramas. The shore is just beyond. You can step on that edge and out onto a bigger, scarier, more humbling vista. The large landscape of human suffering stretches out, some people so mired in their own delusional tragedies they couldn’t hope to be aware of the others. That is the real shame. The shame of self pity. The echoing loop of it. You can scramble to the edge of your self pity, and try to see the purposes that stretch out on either side of you forever. So many purposes. Can I help someone? No shame in that.

“Maybe I can be better than I was yesterday.” No shame in that.

“It’s not about me.”

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I see them bludgeon each other with it. It’s hard to watch sometimes. They try to bury you in it, hoping that enough pain will fill that small pit of despair and you will, like a rat in that analogy, drowning, churn your guilt into something substantial until you climb out. But the saline you sweat and cry doesn’t solidify the same. You just drown. Now, I know there’s a better way, to acknowledge the shame without using it like a terrorist or a torturer. We try our best to beat someone with the shame, for a misdiagnosis, for a mistake, for a misstep, for a lack of knowledge. I sat through the self-flaggelating conference where we ritualistically punish ourselves and made a point out of a personal failure, or it seems, make a personal failure out of a point. I thought about the fact that the only voice I wished to hear was that of the dead and their family. I’ll never forget that. But it’s not the shame. It’s the empowerment that comes from knowing you could, you really could make it better. And there’s no shame in that. I don’t know why we use pain so commonly and primarily as a means of inflicting improvement. The sins of our fathers I suppose, that’s the shame.