Nitya Rajeshuni //
I don’t understand why wrinkles are blasphemous. I examined her face framed by wisps of smoky hair, captivated by the zigzagging marks traversing her forehead and chin, parables of her youth tucked neatly in their crevices. I imagined these lines etched into place by a magnificent painter, some with delicacy and precision, others more gross, fashioned with the edge of adversity. Although she lay covered, her frailty was evident in the outlines of wiry limbs veiled thinly by hospital sheets. As a medical student attempting to recruit patient participants for the doctoring course I was a teaching assistant for, I was completely unprepared for the question, “Will you sing for me?” I had just mentioned I was a singer when she asked about my hobbies, but the last thing I expected was the request for a performance. Will you sing for me? My mind searched frantically for a song whose lyrics I could fully remember, and all I could muster was “Remedy” by Adele:
When the world seems so cruel
And your heart makes you feel like a fool
I promise you will see
That I will be, I will be, I will be…
I finished quietly, trying not to wake the neighboring resident, although I already suspected this was a task far too gargantuan for the wispy curtain between them. “Why did you choose this song?” she whispered faintly, her eyes misting, flanked by the daintiest of the painter’s strokes. “It’s what I remembered,” was my first thought, but that felt insufficient. Forced to contemplate more deeply, I gradually and carefully detailed my conclusions…that this piece reminded me why I liked living. That it reassured me that even when no objective solution exists, a remedy can. That when I sing such lyrics, I feel time ever so slowly adjourning—palpable but not stagnant—coalescing into one pregnant, ubiquitous moment. The mist had lifted, water falling, the corners of her lips upturned, the peaks and valleys engraved by time now more salient…time that seemed to be dwindling. Despite her pain, “will you sing for me?” she had chosen to ask.
The first day of medical school is typically marked by a White Coat Ceremony, where in exchange for our new garb, we take the Hippocratic Oath, a long list of promises including doing no harm, protecting the sick, and respecting their privacy. While these are duties we frequently discuss in modern medicine, there are others equally important warranting attention—more poignant, and perhaps therefore more overlooked. The pledge to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug…that [we] do not treat a fever chart, a cancerous growth, but a sick human being.”2 This concept of what it means “to heal” in medicine is elusive. There is healing in the objective terms: to remove a tumor, to rid an infection; but there is also healing in the subjective, which naturally varies by person and context. However, subjectivity is not mutually exclusive from a framework; in fact it may depend on such scaffolding to cede any modicum of sense.
David Foster Wallace offers just such a framework in his 2005 Kenyon College commencement speech and subsequent essay “This is Water.” He opens with a “parable-ish story” about fish: “There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says ‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes ‘What the hell is water?’”3 He goes on to artfully craft his response, and while his reasoning is filled with layers and nuance, it can be distilled into three major themes: the power of (1) presence and attention (2) conscious choice and (3) empathy and connection.
One of the most memorable points in Wallace’s speech is his comical, nihilistic depiction of the act of grocery shopping in a store, “hideously lit and infused with soul-killing muzak or corporate pop,” the check-out line full of “cow-like, dead-eyed and nonhuman” people—one of the many mundane, soul-crushing regularities of adulthood.3 He decries a long list of relatable grievances faced by a specific but unfortunately large, subset of grocery shoppers: those on default. “If you’re automatically sure that you know what reality is, and you are operating on your default setting, then you, like me, probably won’t consider possibilities that aren’t annoying and miserable. But if you really learn how to pay attention, then you will know there are other options,” he writes.3 When humans operate on default, ensnared in their endless web of thoughts, all of life can pass in one, decrepit blur. Wallace calls instead for presence and attention, awareness of the moment. His description of the grocery store is not meant to be comical, the audience gradually learns as his story unfolds. Without awareness, life can quickly devolve into a series of meaningless such instances; but with intentionality and conscious choice, these moments can be transformed.
Wallace masterfully denominates the armsmen of conscious choice: discipline and agency. He reflects:
Twenty years after my own graduation, I have come gradually to understand that the liberal arts cliché about teaching you how to think is actually shorthand for a much deeper, more serious idea: learning how to think really means learning how to exercise some control over how and what you think. It means being conscious and aware enough to choose what you pay attention to and to choose how you construct meaning from experience.3
Awareness of the moment is incomplete without the choice to give it meaning. This agency takes discipline, but ultimately conceives an attitude and perspective of optimism. Wallace goes one step further, advocating for orienting such choice towards empathy and connection:
You get to consciously decide what has meaning and what doesn’t. You get to decide what to worship. The freedom all to be lords of our tiny skull-sized kingdoms…but of course there are all different kinds of freedom…The really important kind…involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.3
His grocery-shopping protagonist has the choice to consider the possibility that the other cow-like, dead-eyed humans in the store may be facing battles far more debilitating or tedious than his or her own. Wallace states, “It will actually be within your power to experience a crowded, hot, slow, consumer-hell type situation as not only meaningful, but sacred, on fire with the same force that made the stars: love, fellowship, the mystical oneness of all things deep down.”3
The majority of Wallace’s address is spent masterfully articulating his credo on the successful life, one predicated on presence and attention, conscious choice, and empathy and connection. He does not however forget the fish, at the end poignantly beseeching the audience to remember “This is water.” 3 And so, Wallace provides for us a framework within which to understand and facilitate healing, whether that be recovering from adversity or simply awakening from a life of drudgery. It is a framework that is essential to medicine, a field fraught with hardship, suffering, and outcomes that are often unideal. It is a reminder, put simply, to the clinician that the same scar can heal differently depending on its approximation—unruly, unkempt, and keloidal or controlled, clean, and intact.
For a speech with such lofty intention, Wallace’s main point is exceedingly clear. There is one nuance worth commenting on, however, not explicitly stated but rather woven intricately into the fibers of Wallace’s manifesto. In other versions of the opening parable, the young fish ask the old fish “Where is the ocean?” to which he says “You’re in it.” The young fish disappointedly respond, “Oh, but this is water.” Inherent to Wallace’s argument is one additional step between awareness and choice: acceptance. This, however, is not synonymous with floating or surrender, but rather the foundation on which productive action can be taken. In this version of the parable, the young fish are not necessarily wrong to ask “Where is the ocean?” because the quest is what encourages them to swim. Where their delusion lies is in their separation between water and the ocean. To them, the ocean represents the ideal outcome; anything less is merely water. They fail to recognize that water and the ocean are one and the same—that meaning does not depend on a specific outcome, but rather is derived from dedicated actions towards a noble goal. Attachment and expectation of an explicit outcome are imprisoning. It is this concept of detached engagement that inspires people to strive towards a better world and choose meaning in their own lives even when the end is uncertain or already unnervingly determined.
David Foster Wallace’s “This is Water” offers a beautiful reinvention on life, a framework for healing not only for those in the throes of illness but for a world and society reeling from a pandemic, political and social injustice, and the everyday challenges of simply living. It reminds me that time is sacred, its moments meant to be cherished and elevated by the choice to create meaning through love, empathy, and productive action unshackled by attachment; that the wrinkles Time anoints us with are to be honored, the battle scars of our efforts. In this reimagining, a remedy is always within reach. And so, Wallace concludes his deliverance:
The capital-T Truth is about life BEFORE death.
It is about the real value of a real education, which has almost nothing to do with knowledge, and everything to do with simple awareness; awareness of what is so real and essential, so hidden in plain sight all around us, all the time, that we have to keep reminding ourselves over and over:
“This is water.”
“This is water.”3
Cover Image: Wikimedia Commons. Creative Commons license. Soltan Salt Lake Iran. Amir Pashaei. CC-BY-SA-4.0
1. Adele. Lyrics to “Remedy.” Genius, 2015, https://genius.com/Adele-remedy-lyrics.
2. Lasagna, Louis. Hippocratic Oath: Modern Version. Pbs.org. 26 March, 2001. Web. 26 March 2021.
3. Foster Wallace, David. “Commencement Address.” Kenyon College. Gambier. 21 May 2005.