Vicarious traumas

Madeleine Cole

Below smears of low cloud in an arctic sky slipping slowly from black to blue, my children lean hard into the wind, chins tucked deep in fur-trimmed parkas, and hurry up the lane. Through tall windows we watch them climb up into the relative warmth of the school bus and roll onward, red tail-lights fading as they move away from us. After the mundane morning madness of toast and cereal, making of lunches, and the chaos of dressing for the cold, there follows a calm moment to look to sea and sky. From the scoured land, snow swirls and sweeps across the sea ice even as there is so little left to blow, most of it already wedged tightly into any available tundra nook. On a calmer day, an arctic hare might be seen nibbling at the frozen grasses that now do a high-frequency dance, holding tightly and bowing low to the power of the wind.

There is time for another quick blast of stovetop espresso. While standing in the kitchen awaiting the gurgle, my mind is shifting gears: mostly, there is happy anticipation of the pregnant women that I’ll see in clinic today. Being a family doctor here requires comfort with uncertainty and there will surely be birthing stories spun before the sun rises again tomorrow. Coffee consumed, I find my pager, brush my teeth, and hug my lover, and then, with an orange glow still just a hint below the wide horizon, I drive to work.

I am a child of the city, a white gal from away with distant settler roots, but I was drawn to this landscape and culture, to the challenging medicine and the meaningful work. Three kids later and I love Nunavut more with every passing year. There is room to breathe and so much joy, except when there isn’t.

In the middle of the road there is a woman waving me down, hair lashing about her small frame and unsteady in the mean mid-January wind. No boots, no coat. Without hesitation I open my door and with that small human gesture the arc of my day is altered.

In her hand she clutches a great mess of money— kiinaujaat, the stuff with faces on it. Tearful and tremulous, she wails: “Get me away from here! I will give you $300! I don’t even have my shoes. I just got raped.”

I tell her: “I don’t want your money!” My visceral reaction and rising panic amplify the distress in this small space. We are both sobbing. I drive on telling her she is safe now, and that we really need to go to the hospital or the police station. “No way,” says she. It is her choice and I take her where she wants to go. She races out of the car, and seconds later without any active decision on my part, I follow her further down the rabbit hole.

I wait outside a closed apartment door, for a minute, then 2, before her mother lets me in. She appears to listen with poise and calm and a heart that is breaking. The young woman definitely does not want me in their home. How is it that I have come to live this life and be right here, right now? I tell them that I see women raped, cut, strangled, and near dead in our emergency department, and they must, must, must do something about what happened. Standing in the doorway with another child in an amauti on her back, her mother makes a quiet promise to follow up. And with her daughter in the shadows cowering beneath a coat rack saying, “Get out, get out, get out,” I leave their home.

Back in the car I switch on the engine to fend off the cold. Here I am. Heart racing, chest heaving, snot soaked and alone. What the fuck to do now? Can I sleep with this and not speak to the police? Primum non nocere. First do no harm. These are good guiding words for medicine and for life, but inaction should also be a conscious choice. What can I do to be helpful and not harmful? None of my business some might say and they would be wrong.

This is and is not my story.

In health care we call it vicarious trauma. A good doctor is open to empathy but not crushed by it. In an office, emergency department, or birthing room this is the choice: how much to swim with the suffering or be lifted by the joy of which we have become a part. We can usually maintain the delicate balance of caring a lot and not being broken by the heft of that caring. But beyond the hospital walls? When trauma happens unexpectedly on the land or in the community, the walls are absent and the experience can be even harder to bear. And the cumulative effect of all this sadness on every one of us in Nunavut can be overwhelming.

Right brain, intuition, and heart lead, I find myself at Tukisigiarvik, a rickety underfunded resource centre where I might find advice and solace. I had learned to make kamiik in this place of shelter, friendship, and learning some years ago: an intergenerational experience where stories of health and hardship surfaced while sharing sewing skills and lots of laughter. What began one dark season finished months later in the blinding brilliance of late spring. An amazing opportunity it was, cultural continuation for Inuit and cultural sharing extended to the fortunate few, like me, who are not of the north. I left sometimes with a sore jaw from chewing sealskin to soften it, and months later with a beautiful pair of boots on my feet.

On this winter day, I am again made to feel welcome. In the front hall, past all the snowy footwear lined up on flattened cardboard boxes, an Elder advisor eyes my tears and then leads me to a quiet room. Jeannie listens while I find the words and then she holds me against her abundant chest where I can hear her heart beating in my ear. Lub dub lub dub lub dub lub dub. A vice around my soul loosens, and my own pulse slows in this gentle garden of nonverbal communication. And then, after what feels like a very long time, in Inuktitut, that beautiful throaty language of love, she prays for this young woman and for me. I take my leave with no advice proffered but a gift of comfort and shared grief.

I am the well-meaning witness whose aim is truth telling, illumination, and justice. But my intentions exist in tension, and responding to terrible realities is an uneasy affair. Witnessing goes only so far, and who is to gain when sharing all of this second-hand pain? Real pain. Sadness and badness can breed more of the same, so why write about it? Could there be fewer words and more action, better choices made, and deeds done? Is it even possible for me to make the world a fairer and more compassionate place?

In the here and now, duty still calls. The wind has died down and I know that a few minutes outside to walk the short stretch to work will do me good. Turning up into the hospital drive, my eye catches something jutting out from a jagged mountain of snow and ice left by the plows. It seems so unlikely way up there glowing a golden brown in the low indifferent sun: a tall, brown, lace-up women’s boot. Beside this boot, that is yet another reminder of so much gender-based violence, is a sprawling much-loved mural painted on the retaining wall. Full of positive energy, it tells a complicated colourful story seeded by the memory of Sula: a woman, a beautiful woman, whose life was stolen along with that of her 2 children. But here there is life and movement: a whale lashed to a long and well-packed qamutiik, Elders and young people, a bear, and a woman with flowing black hair, and something in the palm of her hand—a pearl perhaps? Happiness, hope.