I Am Not OK

On Small Talk, Sartre, and the Power of Other People

One casualty of the weeks since October 7th – as barbarism provoked war and hostility spread like a stain – was small talk.

What’s up? How’s it going? How you doing? These are rhetorical, not real questions – they have a different purpose: a greeting; a verbal wave; a social lubricant. Things you say before moving on.

The answers are equally automatic.

Nothing. Same old. Good (or Great!). But what happens when the choreography trips into cognitive dissonance, as in the past three weeks since the massacre of October 7th? It’s one thing to mechanically say things are fine whether or not they really are; it’s quite another to say so when they most definitely are not.

How you doing?

We – me, Rachel, our children, our family, our friends, our people – are not OK.

How’s it going?

Images of sadistic savagery committed by marauding terrorists against thousands of innocents haunt our dreams. The faces of children held hostage in Gaza insert themselves – infiltrate themselves – between us and our own.

Israel is at war, and the world’s tolerance for its imperative to eliminate Hamas, a proven genocidal enemy at its doorstep, guilty of crimes against Israeli (not to mention Gazan) civilians that no other sovereign nation would ever countenance, is wearing increasingly thin.

Meanwhile, our kids at college – we have three – are blindsided by coordinated attacks of antisemitic hatred, misinformation, demonization, delegitimization and false moral equivalencies.

Never mind being triggered by microaggressions. If only. Jewish college students are being assaulted by macroaggressions designed to make them fear for their physical safety in the yard.

Kind of a buzzkill, I know. So I mostly keep my feelings to myself. But I have noticed something interesting. If small talk is harder than it used to be, the work of doctoring – seeing patients – has been relatively easy.

Why is that?

You’d think all the stress would get in the way. Be the distraction that somehow it’s not. I noticed the same thing when Georgia, our daughter, was sick with heart failure as an infant. It was hard to focus on anything else – except patients.

I think there are two reasons.

For one thing, there is a natural compartmentalization that goes along with professionalism in general, and medicine in particular. Even the word, “clinical”, evokes detachment – the ability to block everything out except for the task at hand.

And my task at hand – Family Medicine – tends to require the full engagement of multiple cognitive domains – right brain and left brain, objective knowledge and subjective judgement, analytic rigor and human empathy – in a way that leaves little extra room. Everything else gets squeezed out.

But it’s more than that.

There’s something about being the exam room with a patient. In an private space. Listening to their story. Focusing on their problem. A problem that you have the training and expertise to figure out and treat. There’s something about other people that can neutralize even the biggest stressors.

Dr. Danny Grom is founding director of Metiv: The Israel Psychotrauma Center at Herzog Medical Center, in Jerusalem. He is an internationally renowned expert on trauma and resilience and the author of dozens of books and articles. While he certainly has no shortage of work in Israel, Grom has also trained responders to disasters in New York after 9/11, Haiti, Turkey, New Orleans, Mexico, and Ukraine.

According to Grom, trauma causes the nervous system to go into “survival mode,” causing normal emotional and physical homeostatic mechanisms to become acutely dysregulated.

Over the longer term, traumatic memories trigger recurrent episodes of heightened arousal, resulting in symptoms such as rapid heart rate, shortness of breath, stomachache, headache, resulting in an inability to process normal stimuli and causing often profound functional disability.

The goal of treatment, according to Grom, is to enable trauma patients to re-regulate in body, mind, and spirit.

I listened to an interview with Grom the other day. He said that while there are lots of different approaches and techniques to help patients regulate, “nowadays, there is way too much emphasis on techniques. What regulates people is another person.”

What people need more than anything, Grom said, is to be with another person that they trust. Who understands them and is genuinely interested in them. “Whatever you went through, I’m able to hear it and I’m with you.” That is the basis, Grom maintains, of all effective therapy.

Every action causes an equal and opposite reaction.

Newton stated this as a law of physics, and I remember learning it and thinking how science provides the best metaphors. I thought of it again when I saw how the wave of violence in Israel on October 7th, caused a tidal wave of selflessness and volunteerism.

Israel is a small but diverse country. And while it may appear to be fractured – witness the massive anti-government street protests that have riven the country over the past year – it would be a mistake to think that Israelis are fundamentally divided, like a river split into streams. Instead, the dynamic is more analogous to an ocean, where the surface roils in proportion to the depth of the water underneath.

The grass-roots organizations that had formed to fight governmental judicial reform transformed instantly into aid groups. Brothers in Arms, a group of veterans and reservists, many of whom had refused to show up for military duty in protest of the right-wing government, mutated into the largest NGO agency in Israel to help those affected by war.

As for refusing to serve? For every 100 reservists called to duty, 150 showed up – an unheard of statistic – with Israelis dropping everything, upending in their lives and flying home from all corners of the globe.

Tragically, you would be hard-pressed to find any Israeli who is more than one degree of separation away from a victim of the atrocities of October 7th.

Equally, you would be hard-pressed to find anyone who is not now volunteering in one of the thousands of initiatives that have sprung up across the country – packing food, helping internal refugees from the north and the south, providing for the children and families of soldiers called up for duty, going to funerals, visiting and caring for the countless mourners….

There is a new motto in Israel that you see on signs, T-shirts, posters, and banners all around the country: Yachad Ne’natzeiach. Together We Will Prevail.

If there is a secret to Israeli resilience in the face of universal, multilayered, multigenerational trauma, it is this. They have each other – “other people” – in exactly the way that Grom meant.

We are not OK.

After a few days of people acting as though everything was fine, Rachel went online and designed lapel pins announcing: I Am Not OK. We have extras if you want.

As much as I like the idea, I don’t wear them at work. One reason is not to make patients feel uncomfortable. Another is not to make the visit about me when it should be about them. But also because that is when the message is almost not true.

On October 7th, Hamas gave new meaning to the famous line from Sartre’s play, Huis Clos, “Hell is other people.” But it also inadvertently flipped a switch, causing a country that was embroiled in civil conflict to coalesce in a spasm of civil unity.

So thanks, Hamas, for the Sartrean lesson. For being living proof that hell is other people. And for the reminder that even despite the likes of you, so too is heaven.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!