Composing a Life

the transition to an unknown future. At its best, care creates freedom. But even as almost any activity can be informed by care, the caretaking professions themselves can be distorted into forms of exploitation rather than caring, with one asymmetrical relationship easily transmuted into another. Caring fathers and mothers can become tyrannical patriarchs and matriarchs, devouring their children instead of nurturing them. Healing and helping can become forms of domination, medical qualifications an excuse for bullying. When Ellen first talked to me about shelters, I was amused at the euphemistic optimism of calling those driven to depend on them “guests.” After I began to get a sense of the pain and vulnerability of the homeless, I began to see this terminology as a steady, careful reminder, against all evidence, of the value of respect and of the freedom to move on.
    It’s a curious alchemy, the way caring enters into and transmutes other activities. An interesting example is the Iditarod, the 1,157-mile dogsled race across Alaska that has been won repeatedly by a woman, Susan Butcher. This grueling course was first run to save lives at a time when serum was desperately needed in Nome to combat an epidemic. Now, as a race, the mode of caring and service has been converted into competition, but it is clear that even within the competitive framework, Butcher achieves excellence by conceptualizing the struggle in terms of caring for her dogs. At every rest stop in the 1987 race, her rival Rick Swenson left early, while Butcher gave her dogs the full four-hour rest time; she was so busy caring for them that she had only fifteen minutes of rest for herself. By the end of each lap, her dogs were forging ahead of his. “My dogs just kept getting stronger and stronger,” she told the
Boston Globe
(March 20, 1987). “They gained in power the further along we got.” At the last rest stop, the rules of the race required Swenson to give his animals the full rest time. Butcher’s lead became unbeatable. Where he was willing to overtax his dogs, she was willing to overtax herself, organizing her efforts around caring for her dogs. After the race, care for herself: a glass of wine, a hot bath, and sleep. It has been observed that in women’s athletics, the women will stop playing when a teammate is injured, until she has been attended to, while male athletes will more quickly resume their competitive combat. Slowing down for caretaking is obviously a losing strategy in the short run, but a winning strategy in the long run, whether in a two-week race across Alaska or the life and survival of the human species on a planet that must be cherished, for it can never be replaced.
    It is easy to think of caring in terms of embrace and nurture, in the image of a mother holding a child, but Ellen spoke of caring in terms of a quality of attention, a total commitment to looking and listening, that also reminded me of Vanni’s infancy. “To do therapy,” Ellen said, “you have to be unencumbered, so you can really listen reflectively and allow your free associations to be very present in your head and not be all cluttered with other things.” This quality of attention has the same paradoxical quality as the need to be on duty twenty-four hours a day: it cannot be perfectly achieved, but it proposes the ideal that underlies real caring. No one is more attentive than a mother trying to learn to recognize and respond to the needs of a newborn. She sleeps, of course, but she is sensitive to cries even when she is busy or sleeping. There is a sense in which we need to turn that same kind of attention toward the fields we cultivate and the organizations we manage if these charges are to thrive.
    Growing up with the capacity to care for people or communities or ideas depends on the early experience of receiving loving and effective care. It is the lack of this experience that turns homelessness into a cross-generational disease. Caring can be learned, especially through the kind of total responsibility given to young doctors, but it requires a base of empathy built before internship or residency. Ellen sometimes found this base simply lacking. “It was my contention that you don’t need to know a lot to work in the ER but you had to have some intuitive sense of how to take care of someone—that was always one of my hobby horses. In the ER you’re at risk because they discharge people. Sometimes someone is discharged who is