Friday, November 29, 2019


Figure 1: Ligature Marks

It's a Sunday morning, and my friend and I are sitting in a conference room learning about the physical exam findings suggestive of torture.  The lights in the auditorium dim, and an attorney walks to the podium.  She explains the steps of the asylum process, who might be eligible, how long it takes, and how few applications are accepted. How they need doctors like us to provide an objective, scientific voice to contrast those of the bleeding-heart immigration lawyers.  Then a physician takes her place, ostensibly to teach us how to perform the medical screening exam that will be used as evidence in an asylum case. Emotionless, he clicks through slides of the various methods used as torture -- waterboarding, finger crushing, electrocution, rape, etc -- and the markings they leave on the body. All the ways in which to crush a human spirit. The more evidence we find, the stronger the case. The attorney smiles encouragingly. I avert my gaze.

Figure 2: Metacarpal fractures consistent with trauma, my daughter's bow

When I see these photos, all I can think of is my daughter. So helpless at 9 months of age. What I wouldn't do to protect her. 

Figure 3: My family on Halloween, dressed up like giraffes 

While an applicant waits for their case to be evaluated, they are able to stay in the US. Given a permit to work. Granted a small space to breathe. During the slide about how to document scars, my friend leans over to ask me, "but how can I be sure that these skin markings are from torture? What if they are from childhood injuries? If I judge incorrectly, and that person is granted asylum, does that mean it is denied to someone else?" The weight of that decision feels too heavy. I decide I will pretend it doesn't exist. 

Figure 4: The Dermal Markings of Cigarette Burns Over Time

At lunch, we sit at a table with four young strangers, eagerly saying how they want to help. I learn that they are all medical students. Fitting. They haven't yet lost their eager optimism, forgotten the reasons they went into medicine. My friend and I may be the only attendings in the audience. Where are the rest? The ones who arguably have more authority, more experience, more to offer? Where are they? 

I can imagine, as my friend and I are about to sneak out of the conference early in order to join them. They are probably playing baseball with their kids, or out to brunch with friends, the tension from the hospital workplace dramas slowly dissipating from their taut shoulders. It's 75 degrees and sunny out. Now that we have finished the slog of medical school and residency, we no longer have to work eighty hours a week. Finally, we don't have to sacrifice quite so much. Now is the time to make up for all the years lost. The balance the only way to survive the years of practice that stretch ahead. The enjoyment of health the only way to live in the face of never-ending suffering and illness.

Figure 5: Chapter 3, Section 4: Medical Evidence [of torture]

104. In formulating a clinical impression for the purposes of reporting physical and psychological evidence of torture, there are six important questions to ask:

(a): Are the physical and psychological findings consistent with the alleged report of torture?

(b): What physical conditions contribute to the clinical picture?

(c): Are the psychological findings expected or typical reactions to extreme stress within the culture and social context of the individual?

(d): Given the fluctuating course of trauma-related mental disorders over time, what is the time-frame in relation to the torture events? Where in the course of recovery is the individual?

(e): What other stressful factors are affecting the individual (e.g. ongoing persecution, forced migration, exile, loss of family and social role, etc.)? What impact do these issues have on the victim?

(f): Does the clinical picture suggest a false allegation of torture?


Figure 6: The Eloy Detention Center is a private prison located in Eloy, Pinal County, Arizona, owned and operated by CoreCivic, formerly the Corrections Corporation of America, under contract with the U.S. Immigration and Customs Enforcement 

A few weeks later, I am fidgeting outside the 1st locked door at the large ICE detention center in Eloy. Fencing laced with barbed wire stretches out in all directions around me. The air is dry and smells like cow shit. The horizon is the hazy tan color of pollution. Although I can't see the guards, they can see us. We hear a buzz, followed by the mechanical clank of the metal door unlocking. We walk through a corridor to another door. We again wait. The first door locks behind us as the one in front opens. 

The guards are in the khaki green uniforms, and are annoyed that my friend has forgotten our official documents granting us clearance. They check a binder sitting on the counter, but our verification is nowhere to be found. Phones are not allowed past the security checkpoint, so she has to go back out to the car, retrieve her phone, bring it back inside, pull up the email, show it to the guard, and then return it to the car. There is some confusion as to whether or not we are at the right facility, it is possible that our client has been moved to another detention center in the area. There are several out here. After a few calls via her radio, the guard determines that our client is, in fact, here, but nobody knew he was supposed to have been brought from his cell in time for his 9 am appointment. We are filed through the metal detector, our legs are patted down, and then wait some more, this time in an internal waiting room between the security checkpoint and another locked door. 

I scan the waiting room. There are several benches, much like church pews, stacked in horizontal rows. Most of the other visitors are families, everyone wearing nice dresses, polished shoes, and pressed slacks. A young mother feeds a bottle to a baby swaddled in blankets. A small TV is hanging in the corner. It's playing a silly kids' movie featuring colorful, animated snails with exaggerated facial expressions. 

Figure 7:My stethoscope over sample medical documentation of trauma

The door under the TV swings open, and a guard calls our names. We follow him into another room with tables where detainees can meet their guests, and then into a small cell where our client, who we've never met before, is standing. He has a small frame and his eyes remain focused on the floor. He is biting the inside of his lip. Usually we perform these exams in the clinic, my friend tells the guard. Can we be moved there? We have to examine him and this isn't the best location. Also, we brought this gown for him to change into. The guard sighs. 

Well that will take more time. We may not be able to fulfill that request.

We understand, but if you can, we'd appreciate it.

The guard leaves. The three of us remain standing it the small room. It is freezing, I wish I had brought a jacket. Our client is wearing a worn uniform, it's cotton thinning. It looks the same as what the prisoners wear when they are brought to my hospital. I have to remind myself that our client is not a prisoner, that we are not in a prison -- our client is seeking asylum under international law. 

128. Interviews with people who are still in custody, and possibly even in the hands of the perpetrators of torture obviously will be very different from interviews in the privacy and security of an outside and safe medical facility. The importance of obtaining the person's trust in such situations cannot be stressed enough. However, it is even more important not to, even unwittingly, betray that trust. All precautions should be taken so that detainees do not place themselves in danger. 

Five minutes later, and the guard returns. We follow him down locked hallways until we are brought to the clinic. Immediately, the air feels a little lighter. The nurses and doctor wave at us as we walk past their counter. We are brought to a room that feels just like any other clinic room, with chairs and a medical examining table. No guards are within sight. But still, the chill remains. I cross my legs and wrap my arms around my elbows, trying to conserve warmth.  For the next two hours, we struggle to piece together a cohesive narrative about the man sitting in front of us. He rarely makes eye contact, talks in a hushed voice, and slurs his words. He was tortured when he was a child, and dropped out of school immediately thereafter. His memories about the incident and his life during that time are extremely vague. They also don't move in a linear, chronologic fashion. This is diagnostic of childhood trauma, but how can I convey that to a judge if I don't have the facts to back it up? Will the judge assume that a lack of details is instead diagnostic of a fabricated narrative?

He also shies away from our attempts to label him with diagnoses of illness, such as PTSD, anxiety, and alcohol use disorder. When I rattle off a list of symptoms whose presence are considered diagnostic, he denies all of them. I imagine that he wants to show us that he isa a survivor, not a victim. That he has overcome. That his scars have been erased. Invisible to the probing eye.

Figure 8: Child Dissociative Checklist juxtaposed against a fisher-price cross

Below is a list of behaviors that describe children. For each item that describes your child now or within the past 12 months, please circle 2 if the item is very true of your child. Circle 1 if the item is somewhat or sometimes true of your child. If the item is not true of your child, circle 0.

0 1 2   1. Child does not remember or denies traumatic or painful experiences that are known to have occurred

0 1 2   2. Child goes into a a daze or trance like-state at times or often appears "spaced-out." Teachers may report that he or she "daydreams" frequently in school

0 1 2   3. Child shows rapid changes in personality. He or she may go from being shy to being outgoing, from feminine to masculine, from timid to aggressive.

0 1 2   4. Child is unusually forgetful or confused about things that he or she should know, e.g. may forget the names of friends, teachers, or other important people, loses possessions or gets easily lost.

0 1 2   5. Child has a very poor sense of time. He or she loses track of time, may think that it is morning when it is actually afternoon, gets confused about what day it is, or becomes confused about when something has happened.

0 1 2   6. Child shows marked day-to-day or even hour-to-hour variations in his or her skills, knowledge, food preferences, athletic abilities, e.g. changes in handwriting, memory for previously learned information such as multiplication tables, spelling, use of tools or artistic ability. 

0 1 2   7. Child shows rapid regressions in age-level behavior, e.g. a twelve-year-old starts to use baby-talk, sucks thumb or draws like a four-year old

0 1 2   8. Child has a difficult time learning from experience, e.g. explanations, normal discipline or punishment do not change his or her behavior.

0 1 2   9. Child continues to lie or deny misbehavior even when the evidence is obvious. 

Figure 9: Review of Torture Methods

143. After eliciting a detailed narrative account of events, it is advisable to review other possible torture methods....Questioning about specific forms of torture is helpful with:

(a) Psychological symptoms cloud recollections

(c) in the case of possible organic brain damage

144. The distinction between physical and psychological methods is artificial.... the entire clinical picture produced by torture is much more than the simple sum of lesions produced by methods on a list.

H. Risk of re-traumatization of the interviewee [is very likely]

Figure 10: Vials of influenza vaccine upon my daughter's block

I arrive at Casa Alitas just in time for the arrival of twenty asylees just released from ICE custody.  It's my first time volunteering with this NGO, so I wander over to a man sitting behind a desk with a sign-in sheet. There is another young man also checking in, a medical student here for the first time. The front-desk-man seems unphased by new volunteers just showing up, and gestures towards the opposite end of the large building, "Find Barb, she'll orient you."

She shows us a form that we are to use when conducting our medical interviews."Usually we also offer flu vaccines, but we don't have anyone available to give them today." 

I spend the next hour administering about twenty vaccines to families from Ecuador, Guatemala, and El Salvador.  The atmosphere in the room is jovial, a sharp contrast to the mood when I give injections to kids in my hospital. What have they endured to make this seem like a pleasant experience? One at a time, kids march up to my table, boldly rolling up their sleeve and offering the flesh of their arms. They squeeze their eyes shut as I pierce their skin, and then laugh when it is over, bragging to their siblings how it didn't even hurt. Their parents laugh. Everyone gets candy. We hand them a packet, Bienvenidos a America. 

Although most everyone I meet that day is their with their family members, there are two women who are alone. They appear to be in their second trimester of pregnancy. I remember how vulnerable I felt while pregnant, every day a new opportunity to cause harm to my unborn child or my bloated, unsteady body. 


Things I hear from other volunteers and healthcare providers:

Usually, when they arrive here, they complain that their stomachs hurt because all they are given to eat in custody are tortillas and ritz crackers. They are usually in detention for several days.

Even though they aren't supposed to be separating families anymore, a woman was separated from her 14-year-old brother because she was not his parent. He was classified as an unaccompanied minor.

We responded to a 911 call for a kid with abdominal pain at a detention facility. There were multiple cells full of just children of various ages. Each cell seemed to have an older kid covered with little ones clambering over them. 

When we transfer pediatric patients in an ambulance from our rural hospital to the regional center with pediatric specialists, we often send them without their parents, as CBP will physically remove undocumented parents from ambulances as they pass through the immigration checkpoint. So we have these little kids, scared, undergoing surgeries in a strange place and without the comfort of their families. Can you imagine sending your child alone? [I imagine my baby naked in a cold operating room, hands in blue gloves holding down her flailing arms and legs, a mask pumping anesthetic gases held firm over her face, muffling her cries]

Figure 11: Health Risks of Customs and Border Protection Detention

Recent deaths of children in custody:
  • Jaelin Caal Maquin, age 7
  • Felipe Alonzo-Gomez, age 8
  • Juan de León Gutiérrez, age 16
  • Wilmer Josué Ramírez Vásquez, age 2
  • Carlos Gregorio Hernández Vásquez, age 16

From the Istanbul Protocol:
54. Health professionals also have a duty to support colleagues who speak out against human rights violations. Failure to do so risks not only an infringement of patient rights and a contravention of the declarations listed above but also brings the health professions into disrepute. Tarnishing the honour of the profession is considered to be serious professional misconduct. The World Medical Association's resolution on human rights calls on all national medical associations to review the human rights situations in their own countries and ensure that doctors do not conceal evidence of abuse even where they fear reprisal...It calls upon individual doctors to speak out against maltreatment and urges national and international medical organizations to support doctors who resist such pressure. 


It has been documented that while in immigration detention facilities, pregnant women and adolescents experience poor access to medical care, and are highly vulnerable to sexual assault. Although standards were published by ICE to improve women’s access to reproductive health care, including prenatal care, facility adherence to these standards is unknown. In 2016, the Department of Homeland Security’s (DHS) Advisory Committee on Family Residential Centers recommended that barring extraordinary circumstances, no pregnant woman or her children should be detained in a family residential center.

All pregnant women and adolescents held in federal custody, regardless of immigration status, should have access to adequate, timely, evidence-based, and comprehensive health care. Pregnant immigrant women and adolescents should have access to high levels of care, care that is not available in these facilities. The conditions in DHS facilities are not appropriate for pregnant women or children. A growing body of evidence suggests that maternal psychological state can negatively affect fetal and child development, and practices like shackling during pregnancy, which have been reportedly used at ICE facilities, have serious negative physical and mental health impacts on pregnant women.

Figure 12: Alternatives to U.S. Immigration Detention, trauma shears, and my daughter's fisher-price triangle

Medical Decision Making:

Innocent people are tortured. They seek asylum in the US. We treat them like prisoners and harm them further, inflicting trauma whose effects will persist for generations. It doesn't have to be this way.

Figure 13: The Sum of its Parts

Thursday, November 21, 2019

Real Winter

I don’t remember when I learned that no two snowflakes were ever the same, or the point at which we all knew it, but I remember how we traded that fact like currency; how we started looking a little bit closer, on those days where the snow fell slowly, and we were out there to catch it.
I suppose no solitude is ever the same, either, though, I used to use the word as indiscriminately as snow.  

There are some things that we repeat without much thought and there are some things accompanied by an enduring need for approximate knowledge even as we repeat them. Winter was always of those things. When it was especially hard, we would stumble into Spring, delirious, and repeat: yep, that was a real winter.
            What is real solitude?

Winter showed up right on schedule this year, though I started wearing the turtlenecks a little too early again. I am very eager about turtlenecks. But, besides that, everything else checked: the downtempo, somewhat depressing music that I love, the stocking of cheap candles, a decrease in my social output by a minimum of thirty percent, the stacking of Russian lit next to my bed alongside the bottle of whiskey, cigarettes and whole milk. The temptation not to leave.
I did leave the house the other morning, though, to buy just-add-water pancake mix and real maple syrup. Because, it is the middle of November and Michigan just got over a foot of snow. So yeah, everything checked. Except, I live in southern Arizona now, and it was almost 80 degrees by the time I opened my door. I walked out wearing two sweatshirts and wool socks and realized I would probably die if I did not change.
Winter is sometimes propped up as a desire for solitude.  

I used to tell people all the times I had been lost in the wilderness because I thought the solitude might be implied. I told them about the alpine snowstorms that covered trails and the dark white blizzards all landmarks. I told them about the deafening wind, the faint tracks in those steep and rocky ravines, the ones that seemed to lead anywhere but out. I told them about all the times I had been confronted with an unknown—an unrecognizable landscape—and found my way. I think I was trying to make a point about finding myself, but somewhere along the way I got lost in the topography of my own superlatives.
Wilderness is sometimes propped up as a synonym for solitude. 

So is a well-lit cabin in the woods.

I lived in well-lit cabin in the woods, once, too. It was situated on the side of a mountain called Big Mountain and nestled in a grove of cedars.
Well, let me rephrase. I lived in a cheaply constructed 70s era duplex in crusty condo complex called Ptarmigan Village, above the town of Whitefish, and below a ski hill that never really took off. I shared a too-thin wall with a retired couple from Texas who got pickled every night and yelled at each other from their respective televisions situated at opposite ends of their living space.
My room had wood paneling, though. And a fireplace. Fireplaces are extremely inefficient in heating a house, but I did get really good at chopping wood.

Gaston Bachelard, a French philosopher, had a theory about the well-lit cabin the woods. It was part of the “hut dream,” he suggested, “well-known to anyone who cherishes legendary images of primitive houses.”
Well, I imagine it takes a type to cherish, and everybody has their own archetypes, but think Lincoln Logs, Russian lit, Log Cabin syrup, Thomas Kinkaid puzzles, Sierra Nevada beer, books sold to hipsters under the label of Cabin Porn, the proliferation of reality TV shows about people fleeing to the woods or showcasing the kinds of people who actually come from them.
Bachelard believed the hut was the essence of what it meant to inhabit a “centralized solitude.” But also, that it was also completely unrealistic.
Well, so, winter, wilderness, cabin in the woods—these were my simplified cosmos of centralized solitude, things I reached for and never reached.  

There are other kinds of winters besides the ones I find myself romancing now that I live in the desert. The short stories of Anton Chekhov are like winters. As in: the focus is not really on development but on envelopment. Winter is a fact, but it is also a desire. There is little plot. Few words. There are no moments of truth. All is impression—light and sound and shadows, the most ordinary gestures.

There are other kinds of solitudes: the most ordinary gestures. 

Solitude is sometimes propped up as the desire for intimacy. The confusion for me has always been being that the desire for the vulnerability of circumstance has usually come with being a little more alone. So yes, a winter day, a wilderness, a well-lit window seen from afar as inevitable solitude of inner life, but also as inevitable encounter. None of which, I have learned, are ever quite the same.

Wednesday, November 13, 2019


By Julie Lunde

It was not a place I left behind but a movement, and the movement ended long before the song did. It is impossible for me to say when I stopped dancing, or stopped being a dancer, simply because it is still impossible to admit to myself that such things are true, that I have stopped dancing, that I am no longer a dancer. Of course these are undeniable facts, and, to me, monumental ones, yet they seem to have happened without my noticing. I have not really danced in eight years but am always telling people I do, or did, or will again, one day soon. I am not trying to explain to you, or to myself, why it is that I stopped dancing, but rather to convince myself of this basic truth. 
Ballet is a sport, an art, that is more about goodbyes than it is about greetings. Beyond a certain age you do not hear about people taking up ballet anymore. I started dancing when I was just four years old and my ballet slippers were no longer than the palm of my hand is now. It was at a school called Miss Caroline’s, and my sisters and I spent the majority of class time skipping in circles with hands on our hips. Imagination was a central facet of the technique we learned; we were always skipping towards made-up butterfly bushes or flower beds or, come Halloween, pretend bowls of candy. At skip breaks we would pretend to apply make-up in front of the long mirror, whisking invisible brushes in the hot air around our cheeks. And perhaps that was what I first loved about it, anyways; the magic games of the imagination, permission to picture any sophisticated dream we could think up.
When we are very young, ballet is all about this kind of romance; ballet itself is an infinitely romantic notion when we picture it in conversation with young bodies. In high school I worked for a summer at the local dance store, where I helped many new mothers pick out all sorts of pink, sparkly tulles for their daughters. Some of the mothers had even been dancers themselves. They always immediately gravitated towards the glittered leotards with sewn-on skirts, even when I cautioned them that these things were usually against dress code. But these outfits did not care about the rules; they were designed for the photos and memories of the first class, and sometimes I let myself get swept up in the excitement of them, too.
            For most people, both in and out of the dance world, the story goes that romance fades when reality sets in. As dancers age, I noticed, the focus always shifted towards the dark side of the dance world. People who hear about teen or adult ballerinas are always eager to ask after the horror stories, the eating disorders, the girls who ruined their feet or performed on pointe despite stress fractures and devastating injuries. I went to enough summer dance intensives to know that these stories were all true, not exaggerated, and perhaps even understatements. I didn’t just hear these stories, I saw them. But perhaps I was lucky; for me ballet held no trauma, only joy. It really was that beautiful, and I really was that happy while I did it. The worst thing ballet ever did to me was abandon my body; it left me before I was ready to tell it goodbye.

These days, I can get a whiff of any strong, antiseptic pine tree smell and immediately feel that I am thirteen again. This was the scent of the extra-strength aerosol hairspray I used to shellac my hair immobile, and sprayed on every fifteen minutes during performance days. I soaked my blonde hair almost brunette this way, and it was a nervous tic more than anything. The ritual of getting ready for a show was long and precise, and this was a nervous tic too. I could easily spend an hour or two on hair and makeup. Everything I had learned about applying makeup by then was in service of these shows. The first time I ever wore lipstick was for a dance recital. As the dances grew more complex, I eventually learned how to layer concealer, foundation, blush, and bronzer, apply fake eyelashes, curl hair, and even glue on eye jewels using the semi-permanent eyelash adhesive. In my regular life, I did not wear makeup at all.
By high school I had been dancing quite intensely at a different studio for many years. It was far from the end of youth, and farther still from the beginning of adulthood, but it was true that, when I did begin to transition away from girlhood, it all took place within those studios. One morning my partner had me lifted over his head, promenading me around the room in arabesque, when I spotted, in the mirror, a small red dot peeking out from the leg of my leotard. I was sixteen. I excused myself and ran to the front office, where one of the teachers made a big fuss over me. “I only have a tampon, have you used one before?” She asked. I said yes even though the answer was no, then hustled to the bathroom and pretended this was not a big deal. I borrowed a pair of warm-up shorts from a younger girl hanging out in the dressing room and raced back to the studio five minutes later, where we rehearsed without another issue. 
When I was even younger, just starting middle school, my favorite dance teacher instructed us once to treat the barre as if it were a boy we had a crush on, and we all giggled. In keeping with this directive, we were not supposed to turn our backs on the barre, instead turning in to face it when we switched sides, and we were meant to touch it delicately, even during difficult balances, as though we were only holding hands with it. Outside of the dance studio I did not hold hands with boys, or even talk to them. This made it especially exciting when the barre was switched out for real, live men, when I first started partnering. 
At home, during Nutcracker season, I was usually paired with Jamal, a dancer from Julliard who commuted to Connecticut for our rehearsals. In our first roles together we danced as Clara and The Prince, and my mom, when she met him, shook his hand and said, “My daughter’s first prince!” 
At dance camp partnering went a little different. Because we were all young enough, on the cusp of puberty, I was larger than almost all the male dancers my age, though still smaller than many of the women, which meant that I was paired with one of the smallest men in the room when we learned a contemporary pas de deux one day. My partner was supposed to stand bent over, torso parallel to the ground, while I balanced atop his back like a starfish, legs and arms outstretched in opposite directions. We were supposed to hold the pose for sixteen counts, but only four counts in, I began to feel a vibration. His legs were shaking, and it became clear that his body could not support my weight. I was about to remove myself when the instructor noticed us, and anticipated my deliberation. “Hold the pose,” he ordered. I tried to think myself lighter, and, with a rash desperation, did not breathe. There were four counts left when his legs gave way. I pancaked him, two ballet bodies splayed out on the marley, mine atop his. And then rose, and stood, heavy, counting every pound of my weight. 
It was only a moment, and when it was done I went down to lunch with everyone and bought a small cup of vanilla soft-serve, which, yes, they allowed us to purchase at the café. I ate a cup nearly every day, which perhaps suggests I was not serious enough or committed enough to be a dancer anyways, but still, I look at photos of my body then and think a few more cups of ice cream probably wouldn’t have hurt.

In the years after college, when I lived in New York City, I took up classes at the Joffrey Ballet School downtown. By then I hadn’t been dancing seriously for at least four years. I usually took Beginner Ballet II or Intermediate, though often I preferred the first. In this class, first of all, I could be almost assured that I would be the best dancer in the room. But the main reason that I liked it was that I could know nothing would be beyond my reach; I had found I could no longer command my body to move as it used to. Some nights I woke up elated from dreams where I did eight, nine, ten pirouettes, totally effortless, but found in class that my body could not get the balance right anymore. On my first day at Joffrey, I had forced myself into splits when I felt the instructor’s eyes on me, and now my hip flexors seemed permanently injured from the effort.
The intermediate class, because it was more advanced, was a more mixed bag. There were dancers there who took these classes recreationally, who had started from scratch with Beginner I, and then there were dancers who had grown up with ballet, as I had. It was easy to tell the difference, both by technique and by attitude. The recreational dancers were more motivated, more eager to improve, but also seemed to have more fun. The ex-dancers, on the other hand, were all very serious, not looking to make friends, and sour, as though we’d all been forced to come here. We got to class early to stake out our favorite spots at the barre and then scowled if another dancer tried to stand too close.
            For a few good months I successfully made it to the intermediate class at least once a week, but it didn’t last. One day a recreational dancer came up to me in the dressing room and told me she looked forward to coming every week because she loved to watch me dance. She asked, “How long have you been taking the classes here?” It was a very generous compliment, but of course I took it the wrong way, and so I skipped class the next week. Even this was a gradual stop; I went back to Joffrey a few more times, but much less frequently, and then I eventually moved away and it didn’t matter anyways.
For a long time, after I stopped dancing, my interactions with ballet were pervaded with this kind of rank bitterness. My parents brought me to see Misty Copeland in Don Quixote and as we walked out of the theater I remarked that she seemed to be “having an off day.” I was bitter that ballet had not chosen me, that it had picked seemingly everyone else. I was always seeing Facebook photos of home friends and camp friends who were dancing in companies, who were corps members or soloists, who had made a career out of the thing that I loved the most. Meanwhile I was working at a publishing company, which I did like, but I was crushed when my boss told me that she had actually deferred college for a year so she could go dance in a company. My boss worked at the same company as me now, even, coincidentally, had the same name as me, and it was easy to see her as a doppelganger, the owner of a life I had failed at. She had managed to do both, company and college; I had not known this was an option. 
Of course, the truth is that I made several small decisions over time that, step-by-step, led me away from the studio and stage, and I had done this for a few reasons, and many good ones. These decisions were sometimes things I did, but more often, things I didn’t do. For instance, I did not commute into the city every day for preprofessional lessons at one of the serious schools, as the head of my studio had suggested when I was twelve years old. I did not choose to be homeschooled so I would have more time to dance, nor did I even insist on dancing every day. I did audition for a chance to attend the summer dance school year-round, but declined when they offered me a partial scholarship. After high school I did not go to a conservatory or audition for companies; I picked my undergraduate school on the basis of academics alone. I didn’t even take dance classes at college, though I puttered around on a Bollywood dance troupe for a semester before I quit that too. And, somewhere along that path, the doors began to close to me, and I found myself unambiguously locked outside, not only from the elite ballet world, but also from the dance world in general. There was a time, during the winters, when I would put on Nutcracker music and perform my old routines in the kitchen, but I stopped doing this, fearing that I would not remember the steps anymore. 

As I saw it, there were two possible narratives for any ballerina. One, less favorable, was an early retirement. As my dance class aged, we got smaller, a general whittling away that occurred as the pressure ramped up and people got injured or lost interest. This narrative belonged to those who danced, but were not defined by it. The other narrative followed the young heroine (or hero) who, despite the odds, made a real go of it, persevered, succeeded and was a dancer. For a long time, I saw only these two options, and no in-between. Either you were serious or you were not.
I did not think that I would be whittled away, did not imagine that there would be a last time I wore my pointe shoes, or at least did not think it would come before my thirties. I did not notice as the time between dance classes stretched from one week to two, then to months, and then to years. When I finally did notice, when it was impossible for me to continue hiding in my denial, I saw that I was in fact a part of the first narrative, and I felt like I had given up. 
When you are at the ballet, certain decisions are irrevocable, but that does not mean everything is forever out of reach. If there is a moral to this story it is something about what really happens after the curtain falls, the final curtsy, the hairspray bottle finally emptied. After I quit ballet, and then, after I quit my job at the publishing house, I landed at a graduate program in creative writing, where the games of imagination are equally inviting, and I am just as happy. Thus the same cracked hubris that had me criticizing Copeland has now led me to repurpose the iconic Didion essay as a vessel for my own goodbye. 
It is a little different to say goodbye to an activity than it is to say goodbye to a city, though I do not see this difference as fundamentally altering the storyline. Eula Biss, who wrote her own masterful response essay to Didion’s, a Goodbye cataloging her own experience leaving New York, wrote in a craft essay that Goodbye To All That is “a narrative about narrative.” She wrote: “I tell you this just in case you are still tempted to believe that Goodbye to All That is about New York.” It was not a place I left behind, but it was the same story regardless; not a place, exactly, but the first of many possible narratives I had to bid goodbye to.
When my parents came out recently to visit me at the grad program in Tucson, I asked them to bring the dead pointe shoes I’d left behind in my closet, the ones I’d saved—six or seven pairs. Then I sat on the bed and pulled out a shoe, turning it over in my hands as if it were a foreign object. I did not put it on at first because I was worried that I would not remember how to tie the ribbons, worried because, if I did not remember, I would not be able to look it up; it would be too painful to have to read instructions on the thing I loved best. Then I did it anyways. I put a shoe on my left foot and my hands automatically began wrapping the laces, tying the knots. I could not tell you how I did this, but my body remembered for me, effortless. The shoes are on now and I have overcome the first hurdle. Perhaps I will take another ballet class soon; yet I have to imagine that, one day, this knowledge will leave me too.