Iatrogenesis

Johanna Shapiro, PhD.

Last night I found out P died. I couldn’t believe it – I literally couldn’t believe it. I tried to reinterpret the email our dean had sent. But there was no getting around it. “I don’t believe it,” I said to my laptop because it was 11:00 pm and my husband was asleep. My laptop remained neutral.

I start to think back to all the times I’d talked with P. This was a while ago, when he’d first entered medical school before he’d wandered off to PhD land where my small brain couldn’t follow. He was so bright, so eager, and no matter what, even in the middle of anatomy, had such a sweet smile. He was always so… hopeful.

The dean’s email said P had died under ambiguous circumstances. In med school, that is often code for the worst possible eventuality – a student suicide. “I don’t believe that either,” I told me laptop, which still didn’t seem to care. But wait, I argued, I’d heard he’d just gotten married. He’d invited me to his doctoral defense. That must mean things were going well, right?

My laptop stubbornly refused to help me out.

Then I started to cry, maybe about P, maybe about my laptop’s indifference. Could I have done more? Should I have been there for him when I wasn’t Did I remain silent in the face of his cries for help, however muted?
My laptop had no answers for me. Its smooth screen stared back. P, I cried, did I let you down? He didn’t say anything either.


I thought I belonged until I was 7 years old. Then my family spent 3 years as nomads in Europe and the Caribbean. I was mostly happy during that time, but when I came back I didn’t fit. I looked odd, thanks to my mom’s ideas about creative hairstyles and clothes, I didn’t know the slang of my peers or their cultural reference points (aren’t Beatles bugs>” and I even talked differently in a kind of stilted lingo based on the 19th century novels my parents had toted along for me to read. I belonged in my family but I didn’t belong outside.

This pattern pretty much persisted throughout the rest of my growing up and as a kid it made me miserable. I just wanted to be normal. I spent a lot of time being angry at my parents for inflicting this difference on me.

As an adult, however, I gradually started to feel comfortable feeling uncomfortable as an outsider. I was always on the periphery, but that vantage point helped me see things in new and useful ways. I learned how to fit in with institutions and organizations by not fitting. I came to see my outsider status as an essential part of who I am, and embraced it. Now when I look around, I’m aware that I do belong – in my family, in my work, in my community – in ways that are a little off the beaten path, it is true, but that also allow me to express my uniqueness. I like both the roles of insider and the outsider, but I’m happiest filling my piece of the puzzle from the fringe.