The animated film Madagascar features animals from the New York Central Zoo who unexpectedly travel to the wilds of Madagascar. When Melman, a hypochondriac giraffe, ends up with a tree branch and some leaves on his head and neck, he screams, “Nature—it’s all over me! Get it off!”

I empathize with Melman and have quoted his line many times (although I thought he said “the nature,” and that’s how I refer to it).

As an SF Bay area resident, I risk social isolation by admitting that I am a child of the great indoors and a dedicated city-dweller. My ideal of immersing myself in the nature is lounging on a restaurant patio with a Diet Coke and a cheese plate on a sunny day. I live in downtown San Jose. I do not hike, and I ride my adaptive bike outdoors only when the weather is dry, warm, and not excessively windy. I lived in California for 14 years before I finally made it to Yosemite, and once was sufficient.

My nature avoidance has a long history. Before I married Glenn, we made mutual vows that—among other prohibitions—there would be no camping in our marriage.

Despite my unwillingness to voluntarily hang out in the wilderness, I have no wish to hurt the nature that surrounds my beloved cities. I believe absolutely in the science behind climate change (and in taking steps to stop or at least slow down pollution that contributes to it), I want to protect our national and state parks, I dutifully recycle (although I draw the line at composting—eeeww!), and I bring reusable bags to the grocery store.

Yet I just do not find the nature particularly restorative as others do. The only exception is my fondness for ocean views and breezes, preferably accessed from hotel balconies or beach house porches.

When my friend jokingly asked me if I didn’t want to go camping with her daughter’s Girl Scout troop, I explained with mock regret that I had to be able to plug my leg in overnight to charge the air pump and the computer processor, so I really couldn’t sleep outdoors on the ground. This is true, but it is only part of the truth.

More truth is that I didn’t want to sleep on the ground or in a tent or whatever, long before my leg was amputated. Some people go “glamping” in lovely RVs and such, which offer electricity, invalidating my standard excuse and exposing the rest of the truth, which is that I just don’t want to be up close and personal with all that flora and fauna.

Years ago, black feminist writer (and nature lover) Alice Walker helped me through one of her beautiful essays to understand my alienation from nature as rooted in the patriarchy and its false dualisms between women and men, nature and culture. My former therapist provided another piece of the puzzle when she pointed to the link between my chronic perfectionism and my inability to control the wind, rain, or temperature.

Avoiding contact with bugs, mud, snakes, and rain (which I refer to as “unauthorized water from the sky”) also bears some similarities to my desire not to raise children. That is, it reflects both my fears and my desire to raise something other than kids and gardens. Kids and gardens (and camping) are great for some people, but they are not what my heart wants to raise.

I want to raise words into books and articles.

I want to raise my voice to help create a more equitable and peaceful world.

I want to raise students into critical analysts of culture and fierce advocates for social justice.

I want to raise relationships into loving communities.

May you raise up what your heart yearns for, while I do the same—only I’ll do my raising up primarily indoors.

 

 

 

 

During one of many hospitalizations, I lay in my bed, running a fever and too distracted to concentrate on my school work or anything else. In the doorway to my room, one woman and several men milled about in their white coats. An older man nodded his distinguished gray-haired head to signal to a particular student.

Clearing his throat, the young man began. “The osteosarcoma in 12B was diagnosed via surgical biopsy in February 1989,” he said, and I realized he was speaking of me. “Right distal femur, stage 2b, limb-salvaging surgery May ‘89. Patient has undergone 12 rounds of chemo—uh, methotrexate, Adriamycin, and cisplatin. Readmitted with neutropenic fever. Current treatment is hydration, wide spectrum antibiotics, and acetaminophen.”

I was too weary to object to the reduction of myself to a diagnosis and occupancy of bed 12B, but it rankled. The attending continued to question the student reporting on my case, allowing anyone who was in a nearby room or wandering down the hallway to hear intimate details of my medical history. When the attending was satisfied, he led the way into my room, where he asked me a couple of perfunctory questions before continuing down the hall to his next patient.

Back in the old days, before the passage of HIPAA legislation in 1996 and the implementation of the “protected health information” privacy requirements in 2003, I used to lie in my hospital bed and listen to medical students summarize my case (and those of my roommate and other patients) to members of what my nurses referred to as the “herd”—the cluster of medical students, interns, and residents who roamed the hallways of teaching hospitals on the heels of attending physicians.

This time-tested case study approach to teaching medicine has much to recommend it, having helped generations of medical students grasp the complexities of differential diagnosis and treatment. The gross violation of patients’ privacy was strictly incidental, of course, an unintended consequence of a proven teaching method. At the time, it upset me far more that I regularly learned things about myself from eavesdropping on my case report than it did that everyone in the vicinity also overheard the herd. Why wasn’t all of that information shared with me directly?

Its teaching effectiveness notwithstanding, the hallway case study method had a dehumanizing effect; it sent a clear signal that patient privacy would be sacrificed to the convenience (and power and privilege) of the herd. That is, the education of doctors became the most valued goal of the ward, rather than the care of patients. We were cases for them to learn from, stripped of names but with many of our most intimate bodily details shared openly—not primarily for our needs but for the student doctors’ benefit.

Many years later, I have more language and concepts available to me to explain why hallway reporting was inappropriate. Of course, this was also back in the day when patients were not allowed to touch the paper medical records that hung on the end of our beds, and it never occurred to me (preacher’s kid and good girl at the time) to peek. Now I wish I had been a wild, outlaw, peeking patient! I’m incensed that I was explicitly forbidden to touch the sacred record of my own illness experiences.

Ironically, I have shared far more intimate details of my life, body, illnesses, and relationships in this blog and in some of the journal articles and academic books I have published than were ever included in the hallway case reports. But that is my choice, not theirs.

I am not angry at the herds who did their best to care for me in the pre-HIPAA landscape. Society’s understanding of privacy has evolved over time, along with our expectations for the practice of medicine. I’m pleased that the case study process now continues with the HIPAA requirement that reporting happens in a conference room or other (mostly) private space prior to the herds rambling down the hospital hallways. I am thrilled that healthcare organizations cannot give out my medical information without my written consent and that, conversely, they must provide me with copies of my records at my request.

HIPAA isn’t perfect, but it did promise patients that the power to decide when and how to share our stories in public venues (including hospital hallways) would now rest with patients rather than with wandering herds. Yeehaw!

 

 

I write this in a cramped airplane seat, smooshed between an amicable teenage stranger and Glenn, the love of my life. We are on a return trip to our honeymoon destination to celebrate a milestone, our 25^th wedding anniversary. I’m feeling thoughtful.

My inner feminist contemplates the heterosexual privilege that enabled us to marry so many years ago when others were forbidden by law to marry their sweethearts. Love is love! At the same time, my mushy heart reflects on what has enabled us to sustain our relationship for so long, with the good times far outweighing the bad.

For me, romance is what keeps love alive, but not the Hallmark variety. Instead, I understand romance in a way that I think will resonate with long-term cancer survivors and people who live with other chronic illnesses (and presumably some non-sick people as well).

Here’s how I explain romance to my undergraduate students. I teach a course called “Gender, Health, and Sexuality,” a more grown-up version of high school sex ed that features research on interpersonal communication about sex and sexual health. One of the exercises I use to help students think about their (possibly unrealistic) expectations of romantic or sexual relationships is having them write responses to this prompt: “Three things Disney movies never taught me about romance…”

Students’ answers are inevitably wonderful, running the gamut from “condoms are messy” to “how not to get pregnant” to “what to do when the prince cheats on you” and “sometimes two princesses fall in love.” I never horrify students by talking about my own sexual choices, even those made 30 years ago, but I deliberately gross them out with a particular story about romance.

A couple of years after the amputation of my right leg, I woke in the middle of the night, sweat beading along my forehead, nausea roiling in my stomach. I panted, trying to catch my breath as I grew increasingly certain that dinner would not remain in my stomach much longer. I reached for my crutches but fell back onto the bed, dizzy and unable to stand up. “Glenn,” I moaned. “Glenn! I need your help.”

“What? Huh?” asked Glenn, groggily.

“I’m going to throw up and I can’t get up. I can’t get my crutches,” I groaned.

My stomach started to convulse, and I slapped a hand over my mouth. Glenn sprang into action, grabbing the waste basket from his side of the bed and thrusting it in front of my face just as I threw up.

Turns out that above-knee amputees, weak with stomach flu, cannot maneuver our radically off-balance bodies (when we aren’t wearing a prosthesis) to the toilet (and even if we could, we certainly cannot kneel or otherwise get close enough for precision targeting of vomit).

After I lay back weakly, Glenn emptied the plastic basket of its vile contents, then lined it with a fresh trash bag, actions he repeated every few hours throughout the night and following day as I waited miserably for the flu to run its course. “Thank you,” I whimpered again and again.

“Of course, my love,” he answered each time.

“Now THAT is romance,” I declare to my students. “That is a love worth celebrating.” I see a variety of responses among the 20-21 year olds. Some nod, getting it. Others look thoughtful. A few look queasy or bewildered.

I ask them what romance means, scrawling key words of their responses on the board—whirlwind emotions, desire and love (or at least like) converging into passion, being swept off your feet, soul mates, being wooed with sweet words and flowers and special nights out.

“And how do you feel when you know that special person is being really romantic, going all out to let you know how they feel?” I ask.

“You feel special,” says one woman softly.

“You feel like they really get you, like they care about you,” says another.

“Exactly.” I respond.

If all goes well, we will celebrate our anniversary tomorrow night by dressing up and enjoying a romantic dinner in an upscale restaurant. I doubt it can compete with the flu for making me feel loved, but I’m willing to give it a try.