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On Automation

Jonathon Sturgeon asks in his review of Sarah Manguso’s book “whether poetry — more than autobiographical fiction, or diary, or memoir — might best help us to negotiate the self in these automated years.”


Manguso is reflecting on her compulsion to keep a diary. The compulsion is briefly paused when her son is born: “the baby became a little boy who needed me more than I needed to write the diary,” she writes. “He needed me more than I needed to write about him.”


Mothering small children is automated years. Daily, over and over— one attends, nurtures, observes. One wakes in the morning and provides the bottle, pull them gently from sleep, dress them, feed them (eggs and toast, yogurt and fruit, on the occasional Saturday, pancakes), clean them, take them to another caregiver, bring them home, dinner, bath, the same bedtime books, clean the bottles, run the laundry, prepare for tomorrow.


Medical training is also automated years. Wake up at 5, dress, commute, round on sleeping patients, pull the labs, round with the team, deploy the plan, run the list again. With time the patterns emerge and also become automated: Anemia. Pneumonia. Stroke. Liver Failure. Chest Pain. Do this again in fellowship. Infected diabetic foot. Newly diagnosed HIV. UTI in a transplanted kidney. COVID. COVID. COVID.


It is not to say there are not struggles to achieve the automation. It is not to say that there isn’t change or surprises. There is no lack of delights…nor horrors.


These years are finite. If nothing else, they limited by mortality. Children grow up. Careers end, if you are lucky, with a Costco cake and everyone politely patting you on the back. Like Manguso, my compulsive diary keeping stopped in medical school. It would sputter forth intermittently. But my patients and children needed me more than I needed to write about them.


Did they?


What is it to be automatic?


It can be tender, like mothering. Like gardening.


It can be relentless, like the extraction of labor in late capitalism.


But without recording…giving voice to these patterns and how the fit with each other, the I is lost. The One is lost. The particularities are lost. The newly diagnosed HIV is a rugged married sawmill operator from the hills with a wife and grown children, closeted for his whole life. The woman with the stroke arrived with perfectly manicured shiny red nails. On day 13 she is swollen, trached, pegged, hemiplegic, and the polish is chipped


The family patriarch with COVID, weaning from the ventilator for 43 days, is also a new widower, whose wife died of COVID in the first 3 days he was on the ventilator.


And the particularities of the I have also changed - the young student is not remembered by the mother, by the attending physician.


Automation…is it bad? Sturgeon suggest poetry is the better antidote. He may be right. Joan Didion, who writes about keeping a notebook suggests not only is there a price for losing track, but that the diary serves as a record. The revolution of the school of Hippocrates, was after all, observation and recording what is observed.


Didion: “I think we are well advised to keep on nodding terms with the people we used to be, whether we find them attractive company or not. Otherwise they turn up unannounced and surprise us, come hammering on the mind’s door at 4 a.m. of a bad night and demand to know who deserted them, who betrayed them, who is going to make amends. We forget all too soon the things we thought we could never forget. We forget the loves and the betrayals alike, forget what we whispered and what we screamed, forget who we were….


“It is a good idea, then, to keep in touch, and I suppose that keeping in touch is what notebooks are all about.”


But also: “Keepers of private notebooks are a different breed altogether, lonely and resistant rearrangers of things, anxious malcontents, children afflicted apparently at birth with some presentiment of loss.”

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