The events that follow happened many years ago. However it was only during a conversation with the former Reverend Jim Kowalski, Dean of the Cathedral of St. John the Divine in New York City that I clearly realized with everything in me that I had been visited by an angel.
I don’t mean that figuratively or even religiously. I was truly visited by an angel, but didn’t know it at the time. It is from that realization that I am compelled to share the following with you.
“M-a-h-k, look at me and listen to me, you deserve to be on this planet! Do you understand me?”
It was nearly 50 years ago and I was literally at my wit’s end and Dean William McNary, or Mac as we medical students at Boston University School of Medicine affectionately and gratefully called him, may have been prescient in guessing that it might coincide with my being at the end of my rope.
I was about to request a second non-consecutive medical leave of absence. And it wasn’t to see the world on some exciting adventure.
A year and a half earlier, my mind stopped working. More specifically, I had completed one and a half years of medical school, was miraculously passing courses in our med school’s then pass fail system, but I was not understanding, retaining or able to recall nearly anything from my courses and books. All my books were highlighted yellow as if I hoped that highlighting the words would magically transport their meaning into my brain and mind.
I took a year off and did some honest blue collar work that to this day I miss for its simplicity and even its purity. My brain and mind came back enough to be able to handle the labor in that work and I felt some renewed confidence and competence. At the end of that year I came back to medical school, where everything was okay for a couple of months and then my mind left me again. I was actually able to pass courses and finish my second year and had just got started on my third year, but then I had hit a wall. Strike two. It actually felt like a third strike and the thought that I might hurt patients because of my mind being gone, horrified and terrified me. I actually still have occasional nightmares about doing just that.
I requested another medical leave of absence. What you may not know is that every time a medical student takes a leave of absence and their place in the class goes empty, the school loses matching government funds. So I had already cost them a chunk and was about to do the same.
At that point I was asked to meet with the Dean of the School, who was a very decent man, but whose role was among other things to keep the school fiscally sound. I met with him and had very little recall of what we spoke about.
Shortly after that, Mac called me and in his thick Irish Catholic Boston accent said, “M-a-h-k, I got a letter here from the Dean of the School and I think you need to come in for us to talk about it.”
Now for a little tangent, although my mind was non compos mentis and although I had always been a B- C student in English, the birth of my writing took place. The first thing I wrote was a little poem that was actually published in the Journal of Geriatric Psychiatry in 1972. It was entitled: “Lament for the Old” (the fact that I wasn’t just speaking about the old, should be patently obvious to you). I remember I had sent a copy to Mac months earlier when my mind was still working.
Lament for the Old
When I was a doctor
it was common practice
to avoid the geriatrics floor.
The most widely used rationalization
was the reminder
of our own ultimate demise.
But since my colleagues
knew not how to celebrate life,
I doubted that they truly feared death.
I then thought
it was because we had been taught
to salvage life quantitatively
and not qualitatively.
And it was obvious that
this group was a poor bet.
I then took the time
to get to know some of these marvelous people,
three times my age,
who offered a wealth of experience
that spanned hundreds of years.
What was so obviously missing
was someone to share the fullness of the past
and to help relieve the loneliness of the future.
And maybe someone
to give a damn
when they died…
– Mr. Goulston is a third-year student at Boston University School of Medicine, Boston, Massachusetts.
And so I found myself seated seven feet away from Mac in his office when he told me to read the letter he had received from the Dean of the school. I can’t remember exactly what it said, but the essence of it was, “I have met with Mr. Goulston, we discussed his current situation and also alternative careers, to which he agreed and I am therefore advising the promotions committee to ask him to withdraw from medical school.”
In retrospect, I realize Dean Friedman was instrumental in saving my life. Although he was the one initiating the idea that I should be asked to withdraw (kicked out of) from medical school, he probably knew I was depressed and didn’t want me to do something like kill myself. Also knowing that Mac was better at handling such situations, he wisely handed me off to him.
After I read it, I became even more confused than the very confused state I was already in. “I don’t remember agreeing to another career. What does this letter mean?” I asked Mac.
Again in that thick Bostonian accent, Mac laughed and said, “I knew you didn’t agree to another career. You’re too confused to agree to anything. M-a-h-k, it means you’ve been kicked out and you agreed to it.”
“I don’t remember agreeing to anything, and I don’t even know what the alternate career thing is about,” I replied dumbfounded.
“I knew that M-a-h-k, I know that you’re not clear enough to agree to anything,” Mac said with a mixture of kindness, humor and a huge dollop of understanding.
I couldn’t look at Mac. Instead I felt the air go out of me as if I had been shot in the stomach (and I know that feeling having suffered a perforated colon 35 years later that required life-saving surgery), paused for about thirty seconds and then I felt my cheeks become wet. At first I thought I was bleeding from my eyes (which is why since then I have often thought that I died and was about to be reborn into the loving kindness of Mac). I kept touching my cheeks and looked at my fingers and of course, it wasn’t blood, it was tears.
It was perhaps the greatest fortune in my life that I didn’t react with sarcasm (something I was fully capable of that in my pre-mindless days) or with “woe is me” self-pity. I probably did neither, because as I mentioned above, I felt as if I had been shot. I think if I had acted either way, it would have made me less than someone anyone would want to help. Instead I was 100 % pure grade broken, raw and vulnerable and communicated that with all of my being.
I had to pause before I wrote the following, because even now nearly 50 years later it still emotionally overtakes me.
I came from somewhat of a stern background and one in which I would be very reticent to show vulnerability especially in a completely exposed form. So I was completely unprepared for what Mac said next:
“M-a-h-k. You didn’t screw up. I mean you are miraculously passing (which was why they couldn’t flunk me out), but you are very screwed up. But I have a suspicion that if you got unscrewed up, that one day this school would be glad it gave you a second chance” (His kindness was so palpable, even now I can feel it, that I couldn’t look at him. All I could do was look down and feel this IV drip of safety and cry even more. It must be similar to the way someone feels who is in unbearable pain at the end of their life and what they feel when placed on a morphine drip).
“In fact M-a-h-k, even if you don’t finish medical school or become a doctor or even do another thing, I would be proud to know someone like you, because you have goodness and kindness that we don’t grade in medical school and you have no idea how important and how much the world needs that (I couldn’t fathom anyone thinking I was worth anything if I couldn’t do anything and only because of some quality they saw inside me). And you won’t know it until you’re 35, but first you have to make it until you are 35 (the tears were then pouring out like an ocean… just as they are now as I retell this to you). And one last thing, M-a-h-k and please look at me!”
Tear filled to their limits, my eyes were a blur as I looked at Mac.
“One last thing, you deserve to be on this planet M-a-h-k, do you understand me?” (tear city again).
Then Mac did something that would change my life forever, be my leitmotif that I was not as vividly clear about as I am now and that has compelled me to go on a journey as a “boots on the ground” suicide prevention specialist, essentially doing unto my suicidal patients what Mac had done for me.
He said in no uncertain terms, “M-a-h-k you are going to let me help you!” I think he also sensed that if he had not been so forceful and had merely said, “If I can help you call me,” that I would have instead withdrawn into my apartment and never called.
In retrospect, I realize that if Mac hadn’t insisted on helping me and instead invited me to call him if I needed help, I probably wouldn’t have called him and just withdrawn back into my apartment where I’m guessing I most likely would have descended further to suicidal feelings and ideation.
That didn’t happen because help me he did. Mac was a PhD and needed to set up an appeal with the Promotions Committee that was composed of powerful MD heads of departments and leaders of Boston area hospitals and that was all set to “rubber stamp” the Dean of the School’s advising them to ask me to withdraw.
I had my appeal. Mac had told them about me before I came in and then I sat in the middle of a circle composed of members of the Promotions Committee. At first several of the medical doctors questioned me in a kind way as I think my vulnerability touched some of them as it had touched Mac. But then the chairman of the committee began to question me. He was the head of the Department of Surgery at the largest public hospital in Boston and was universally viewed as smart, but just as universally disliked for his condescending attitude. He was nearly always one of the least liked professors at the medical school.
He started laying into me with one pointed question after another, making the point that essentially I didn’t have what it took to be a medical doctor since they have to be strong, tough and decisive and he didn’t think I had any of that. After making his case he pointedly said, “So tell me, why should we give you a second chance?” I remember the room growing quiet. Images of David facing Goliath must have gone through some of their minds… and an openly raw and crying David at that.
I didn’t know at the time what got into me, but I became very calm and focused and looked at the Committee chairman and said, “Dean _________, it has not been the best year for me. I came back from my leave of absence, developed Grave’s disease (of hyperthyroidism), then had to be shot up with thyroxin when the medicine made me too hypothyroid and lethargic, I then developed abnormal liver function tests from the hyperthyroid medication not to mention swelling in my breasts from the hyperthyroidism. My father also went through a bout of colon cancer and my wife (of a few years) has decided to divorce me. I don’t know that I want to be a doctor or even can be, but I don’t know that I don’t want to be a medical doctor either. And I’m so screwed up, as I have been told, that I don’t even know if any of those count.”
The room grew quieter still, but not to be derailed by my pleading my case, the fat cigar chomping Committee chairman said in a derisive manner, “And so what?”
“And so,” I looked him back directly in the eye, my tears beginning to give way to something I didn’t recognize in me, “I’d like to plead ‘insanity’ and throw myself on the mercy of a group of medical doctors.”
I kept looking at him, whereupon he squashed out his cigar in an ashtray, folded his arms and spun his chair around and refused to look or speak to me.
Several minutes of silence followed and then Mac said, “M-a-h-k I believe you can go and we will discuss this matter regarding you.”
I left the room and sat in a stairwell clutching the cold metal staircase, exhausted with all my “bravado” and energy gone.
Fifteen minutes later, Mac came out, sat down next to me, put his arm around me and said, “M-a-h-k, take a year, take five years. You will always be welcome back at Boston University School of Medicine.
Score David 2, Goliath 0. And I think what got into David, may have gotten into me as in a little help from Above.
I have been paying Mac’s love and kindness forward ever since, doing my best to stand up for, by and when needed to people, because like him I can’t allow good people to fall through the cracks.
I didn’t realize how much the world did in fact need goodness and kindness at 35. I just tried to practice a little of it, one patient, one client and one conversation at a time. It took nearly thirty years longer to also realize that without heartfelt people and heartfelt leaders, the world can’t and won’t survive.
And I didn’t realize until just recently, that I had in fact been visited by an “honest to God” real angel and what Mac meant when he said, “the world needs goodness and kindness and you deserve to be on this planet.”
It feels to me that my life is coming full circle and the pain and increased suicide rate has beckoned to me as a calling which I can’t get out of my head or my heart. I cannot think the words and hear the clarion cry from the world, “I don’t want to kill myself, but I can’t take the pain anymore” without feeling it in both my stomach and cheekbones… the same place I felt it when I was sharing my story with you.
Recently someone told me a story about Abraham Lincoln where he was traveling between towns and passed a horse stuck in a ditch. He traveled a half mile past with his group and then turned around and returned to the horse. When asked by a member of this entourage why he did that he replied, “I couldn’t get the pain of the horse out of my head.”
I can’t get the pain of the world out of my head.
Following my 30+ years as a clinical psychiatrist seeing suicidal patients, and when none of them died by suicide, I have since retired and expanded my work to see if I can help even more.
To that end I co-created and moderated the multi-honored documentary, Stay Alive: An Intimate Conversation About Suicide Prevention.
And recently I have been partnering with Jason Reid, whose 14 year old son, Ryan, died by suicide two years ago on his Moonshot mission to end teen depression by 2030.
Epilogue: If you want to get a taste of what the power of reaching out and touching people with compassion who are in the dark night of the soul, check out this gold standard of love and kindness that I presented in Moscow and see if you can catch the “OMG!” jaw dropping moment near the end.