Arriving to Yerevan sets off dozens of soothing little clicks in my brain. Like suddenly remembering that Marshrutka #29 goes to Nora Gyugh, that my feet can trace out the steps of the Papuri dance in unison with a score of strangers, that my colleague’s office is up on Mamikoniants Street, half way down the hall on the right. There is comfort, a sense of mind and body aligning, in suddenly remembering the arrangements of streets, of the people on them, of their beautiful faces. Like a dream, or finding that some old clothes I’d nearly forgotten suit me as well as ever; it’s a perception that works like the mind’s own hospitality ethic, the one that lives in a dozen ancient cultures–make yourself at home.
Travel also re-arranges geography in a pleasant way: when I’m here, Yerevan moves closer to Vermont than it was, or seemed to be, when I was in Vermont. So it may be with other kinds of fields–the intellectual kind. A trainee in child psychiatry joins me weekly, in clinic at UVM, and I strive to extend hospitality, make her feel at home by focusing our discussions on the psychological dimensions of the cases. Opportunities for this kind of intellectual hospitality arise when we see cases like one I saw last week in Arabkir Clinic, Yerevan:
Clinic. He is 10, and sits with the emotionless stillness, the poise I remember from Armenian children at this age, even though their brains have just cranked through a programmed developmental revolution, the kind that changes the furniture arrangements. I hear that he was referred here by a logotherapist–a speech therapist.
My colleague turns to me and asks whether in my work as a pediatric neurologist I see referrals for stuttering. “Not since the last time I was here.” She laughs, that happy-side-of-despairing laugh, for this referral signals a mis-understanding in her medical ecosystem, and she explains as much to the mother. But then there’s more–he can’t feel his palms. Just like that, the chief complaint around which the encounter should orbit has just re-positioned by 1000 light years. We don’t de-brief, historicize the numbness–but get right to brass tacks. Well nothing that sharp really. We check his nervous system.
The neurologist breaks a wooden swab and tests him–sharp vs. dull–through his face, shoulders, neck, arms, and finally his palms. He pauses longer, but identifies the sensation correctly throughout. Dismissed.
This is a scene I recognize: one care is addressed, and another swims to the surface, and none of the concerns speak of any serious pathology, just bewildering phantasms emerging in a Sisyphean interview. Why this tsav–hurt–that our tools can’t heal? We merely predict that it will pass, and then it does. But not before the parent leaves our office wondering, “an artifice of my child’s mind? Why?”
Back in Vermont, discussing such cases with my child psychiatry trainee, I venture that, perhaps for both the child and his parent, this un-satisfactory transaction exemplifies what the psychiatrist Chefetz has identified as the mind’s imposition of a “phony coherence that is better than confusion”: for the child, if they are at the doctor’s office, there should be a reason; for the parent, being a medical puzzle may make more sense than their child’s confusing somatizations.
At the end of the day, my child psychiatry trainee confides that she feels more comfortable here in Neurology Clinic than she had expected. Success! But then, I want her to be more daring, to venture further with her curiosity into Neurology’s dark forests. Curiosity, like music, signals a sense of safety, of security, and sometimes inviting curiosity, nudging it a little, can catalyze that safe feeling. Especially if the music is from the heart, if the questions come from wonder at the strange territories around us.