On our first full day in North Carolina, I am sitting with a group of sophomore and junior high school students around a conference room table on the Duke campus. The windows looking out are gothic with heavy leaded panes, new made to look old, like other features of the grounds and academic buildings such as chimneys without fireplaces and stone steps sloped to intimate hundreds of years of scholars’ feet smoothing the stones on their heady walks to and from chapel. We are sitting with the leftovers of lunch in front of our places, picking at kettle fried chips while we listen to one other share expectations for the trip ahead. Tomorrow we will go to a small town in West Virginia to learn about a region grappling with what comes after coal. All school year our students have learned about the most pressing health issues of a people without access to affordable, regular medical care, and how lifestyle and diet can balloon routine concerns to life threatening conditions like COPD and diabetes. Now we have traveled nearly twenty hours to work alongside community health workers at a clinic or on home visits, for our students to observe what public health looks like, and to practice talking with clients about their choices and needs, but first we are in a conference room on the Duke campus. Dr. Robert Malkin, founder of the program we are part of, Global Public Service Academies (GPSA), asks each of us to share what we will contribute to the people of Williamson, and what challenges we anticipate.
Our students are each part of the program because they are interested in pursuing medical careers, but they don’t know what that might look like yet, or the range of studies and positions that support medical practice. Just that morning we listened to a biomedical engineer share about her work in Uganda, helping to problem solve how to ensure neurosurgery can be safe and accessible to head trauma patients. I am proud of our students as they speak. They are self-aware and thoughtful as Dr. Malkin presses to understand more. I believe they are learning their own vulnerability as they answer. They expect to contribute by talking with clients about healthy choices and taking blood pressure and pulse measurements, by learning what they might do in their own careers one day. One student wonders how he can apply the tenets of GPSA to his home in Seoul. They are nervous about making eye contact or taking an inaccurate blood pressure reading. They will be challenged by the unfamiliarity of the culture, how to bridge their experiences with the clients’ lives. One student shares why she is afraid her shyness will get in the way of her service. By the end of our week together, I will know each student better but the hour at the conference room table first cracks an opening for me to see these kids as they are.
And then it is my turn. I will contribute by listening and observing, to tell the stories. At the end of our experience, each student will remember a moment from our week in West Virginia and craft a narrative to share with a middle school audience. I will help workshop the stories. But also I will write my own stories, because I do. And I will contribute encouragement because it is really hard to be uncomfortable in an unfamiliar place and press on – but we won’t know that until we’re in the middle of an overheated house that smells of cigarette smoke, talking with a man whose poor physical health draws the small circle he can travel. My challenge will be to remain present with people, even in a dim house that smells of cigarette smoke, because the man in front of me once had a dream to see Alaska in the summer. Most days he goes as far as the porch door but I won’t know any of that if I drop our conversation for the worry my hair holds smoke. After I learn this man once hoped to see Alaska in the summer, that detail will matter to me for months, though I won’t understand why, and I will be glad I asked if he ever traveled away from West Virginia, and glad he answered, and glad he will be more in my mind after.
Karl, one of our GPSA team leaders, shares next. He echoes my challenge of remaining present in a situation or conversation. The way his mind works is to sift interactions and observations for abstract conclusions: how does this woman’s health compare with other women’s health and what can that say about the state of women’s healthcare in West Virginia? This kind of thinking is a gift for the public health PhD program he is set to begin. But because his mind snags a detail to mull abstracts, Karl pulls away from the conversation in front of him, rushing to discover or conclude a thesis instead of simply talking with a person who wants to tell something about her day or breathing difficulty or what she wishes. I think in abstracts, he says. As Karl talks, I look around and see a few students nod in recognition. When Karl finishes speaking, someone else says, I think in equations. And as we’re preparing to leave the conference room I say to Karl, I think in stories.
Just that morning we attended a talk with a woman named Brittany, a biomedical engineer who spent two months in Uganda answering the question of what it takes to allow a neurosurgeon to operate in a hospital there. As she talked about overcrowded wards, understaffed ICUs, hospital systems and infrastructure I imagined her standing in a tall ceilinged ward making notes about how many nurses were attending how many patients, and what that could mean to patient recovery statistics. I imagined her interviewing surgeons in an underfunded hospital, learning how they improvise by using a power drill instead of a bone drill, sterilizing the bits between patients. I imagined her respect at the improvisation, and her frustration because these men and women should not have to improvise medical treatments like that and if – if – if. She talked about service contracts that medical equipment companies like Siemens and Phillips sell to hospitals, to guarantee the upkeep of CT scanners or X-ray machines, contracts as expensive as the millions of dollars the equipment itself costs, contracts that underfunded hospitals cannot afford so that when the very necessary CT scanner breaks it sits useless and throws doctors and surgeons to waiting for clinical symptoms to indicate what is happening in the body.
So as Brittany talked, I thought of two ways I might tell this story. I could ask for an interview and write a creative nonfiction piece, supplementing with additional interviews and research about the lucrative business of service contracts (already studied and, presumably, reported elsewhere). And I could learn all the language of biomedical engineering, the names of Ugandan cities, towns, roads. The cultural challenges she encountered traveling alone, the shifts in her mindset as she spoke with medical professionals working around the poor infrastructure of their hospitals. I could ask about the food she ate, the ailments she endured, what she wants for the places she visited, who she hopes to see again. So I could write all of this as a creative nonfiction piece. Or I could shape what I learn into fiction. Lift and modify elements of Brittany’s two months to tell a similar story. I would keep the service contracts, a detail so sinister I’d want people to wonder why we allow medical equipment companies to abandon their machines to inevitable disrepair in countries struggling to care for patients when the electricity might blink off after a rain.
I like that I think in stories. Sometimes I wonder why I want to tell stories, fiction or nonfiction. Always I’ve worked my imagination. Such a gift. But for two decades I’ve also practiced craft in the middle of my present. A line from a conversation or detail of the room or a question about an interaction comes to me highlighted and underlined: this is a story. And then I am thinking how to pull disparate elements of a scene into narrative: what to cut, how to order. Much of my story thinking lands in my notebook to stay in cursive because most momentary sparks don’t light a story for want of time or tension. (The man who wishes he’d seen Alaska years ago will land in my notebook, and so will Brittany, but one may be anecdote and the other a story). But still I draft in the middle. I think in stories so when I write stories I know a little more how to show you what I see.
Fourteen of thirty-nine. 1477 words.
Piecemeal 