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"Doctor, the patient in 629 is yours, right?" What words can inspire more dread in the heart of a third year medical student?
"629? Yeah, she's ours. What's up?"
629 was an old woman brought in by her daughter for a prolapsed rectum. The operation to repair this had gone well, but her hospital course afterwards was somewhat rocky. She refused to eat, got a bladder infection, and most recently a possible partial bowel obstruction. She had been with us almost one week now, and almost every day something was wrong when I came in for pre-rounds. Either she had pulled out her foley, or an IV came out or clotted off, or she had fevers, or she wouldn't take her medications.
"She pulled her NG tube out."
"Again??"
This was the third time her NG tube was out when I came in. We had put the tube in to help relieve stomach pressure since her bowels still weren't working right. However, her abdomen was somewhat distended again after she pulled it out. She was also somewhat demented, and usually fought like a wildcat every time we tried to put another tube in. And lucky for me, yesterday morning when I reported it was out on my rounds, my residents asked why I hadn't put a new tube in yet. I figured I had to at least try to put one in this morning.
"OK, I'll take care of it."
I walked into room 629 with a new NG tube and a tube of surgilube. "Good morning Mrs. W. Had some problems with that tube again last night, huh? We have to keep that in to help you get better, you know."
Mrs. W. stared hard at me, but didn't say a word. I was used to this, however, as she rarely said a word except to scream when we tried to touch her. Her history had been gotten from her daughter when she was brought in. I pulled my gloves on and lubed the end of the tube.
"Can I put this tube in to help you get better?"
A slight nod—this might not be too bad after all. As the tube approaches her nose, she begins to thrash around.
"This will be a lot easier for both of us if you hold still, you know."
This does seem to calm her down some, and I get the tube in first try. Placing my stethoscope over her stomach, I carefully blow some air down the tube, and I hear a distinct bubbling. It's even positioned right! The tube is taped in place, and I start cleaning up. This is gonna be a great day.
I look up and notice Mrs. W's hand on the new tube. I quickly grab her hand to keep her from pulling out the tube I was so proud of. Now she really starts thrashing.
"Mrs W, we have to keep that tube in, OK?"
She's still thrashing around, and has a hold of the tube again. How can she do this since she's already in restraints to keep this from happening? I manage to hit the nurse call button, then yell "I need some help in here."
Her nurse is soon in the room, and we get her hands away from the tube.
"It'll be OK, Mrs. W. We really need that tube in, though. Are you gonna leave it alone?"
Slowly she calms down again. We tighten the restraints some, and decide she can't get at the NG now.
Minutes later I'm in her room again, with the rest of the team. I list her vitals, and "She pulled out her NG last night, but I got a new one in."
The residents pull out their stethoscopes and blow some air in.
"Sounds good, Dave, good job. Let's do something to keep this one in now." He takes the extra tube loops it up, and tapes it to her forehead. "There ya go, Mrs. W. Let's try to keep this one in now, OK?"
Later that day, Mrs. W's attending doctor shows up. She tends to be somewhat short tempered, but does a good job for her patients. Since I'm the only team member currently on this floor, she asks me to come with her and let her know what's happening with her patients.
Mrs. W. is our last stop, and as we walk in she says, "What's this? These patients aren't animals, you know." Then she undoes the tape on the NG tube, and says "You will never tape these to my patients like this again. I'll show you how to do it." As she tapes the tube in place again, much like it was yesterday, she keeps talking quietly to Mrs. W.
"And do we really need her tied up like this?"
I tried to explain the difficulty with keeping tubes in, but for once Mrs. W. does not seem to mind at all. Maybe what Dr. A said had an effect on her, and she'll leave the tube alone.
As I'm getting ready to leave, I check on Mrs. W one last time. The tube is still in place, maybe this really will work!
"Good night, Mrs. W. See you tomorrow, OK?" Is that a slight nod from her? I walk to my car feeling
something good happened today.
Early the next morning, I'm back on the floor. "Doctor, the patient in 629 is yours, right?"
I tried to pin down the moment
That she must have forgiven
Forty-some years,
Including the day
He had spotted her walking to the grade-school kitchen,
The only time in his life he'd come home
Before noon on a workday,
And he beat up his wife,
Whose kitchen-whites shamed him.
When they married, she said,
He was uncommon-handsome,
A tall Irishman
With some Cherokee blood.
Until the day he died she called him "Red,"
But I remember him only as all-over white,
Pore-clogging, hospital-white.
At sixty-seven she finally left,
Stayed with her sister in Kentucky,
Wouldn't call,
Wouldn't tell him when she planned to come back.
When she did, he lay awake in the hallway,
Dehydrated and stinking from four days of urine.
At his funeral
I gave her a book about faith,
But I don't even know if she reads
More than street signs, or cereal boxes,
This woman who was seven when she saw Ellis Island,
Made it to fourth grade in night school,
And lived half a country away
Through all of my childhood.
Sometimes I take down the obituary she sent me—
Laminated, with the Lord's Prayer on the back.
I read over and over the part that explains,
"Albert Noah is survived
By a wife, two children,
Three grandchildren,"
As if repetition could make clear our connection.
"John, you're finally here. I was worried about you. What took you so long?" said Lydia.
"How are you feeling dear? Are you feeling any better?" said John.
"Oh, I'm feeling so much better today. Once in a while I get a twinge of pain in my stomach or back, but I don't like to take too much pain medication."
Allie, her nurse, entered the room and quickly scanned the overhead cardiac monitor. She walked over to the bedside, straightened the covers out-of-habit and smiled down kindly.
"How are you doing Mrs. Croft?"
"Fine, dear, you girls take such good care of me."
"Well, if you don't need anything right now I'm going on my lunchbreak. Just push your call light if you need the nurse and Sue will come in. She's covering for me."
"Thank you sweetie. You go on ahead and enjoy your lunch."
"They take such good care of me, don't they John?" said Lydia as Allie moved to leave through the door.
"Did you say something Mrs. Croft?" Allie paused momentarily and turned. "No dear. Bon appetit."
"They do my love," replied John.
Lydia took his hand and held on to it. She caresses it slowly and a whimsical look entered her blue eyes.
"Do you remember how we met John?"
"How could I forget."
"The Trianon ballroom on 62nd and Cottage Grove. You asked me to dance, and told me I was the prettiest girl there. What a beautiful place. Do you remember the music? La da da da, die da dun," Lydia hummed. "You were so handsome," She smiled and patted his hand, "And still are."
"I remember your light blue dress. The one with the sequins that shimmered underneath the ballroom light. I twirled you around and around on the dance floor. You were perfect from your head down to your white shoes. I knew then that you were the only one for me. I adored you and always have."
Lydia's eyes filled up with tears and she pulled at her sheets.
"I wish I was well enough....I wish I didn't have this cancer. I wish we could have one last dance."
"Don't fret now Lydia," tenderly pushing back the white curls on her forehead. "You'll come home soon."
"Do you really think so, John?"
"I know so. I have to leave now, Lydia."
"When are you coming back? Tomorrow?"
"You take a nap and I'll be back later." He kissed her lips softly.
Allie came back to check on Mrs. Croft after her lunch hour.
"I'm back, time to check your blood pressure. Do you need a pain shot?" said Allie.
"I think I'll take that pain shot now, my stomach hurts," as Lydia rubbed her swollen belly. She watched as Allie checked her pulse. "I had such a nice visit with my husband, John, while you were at lunch. We were reminiscing about how we used to dance at the ballroom. Those were the good old days just after WW I."
Allie looked at the emaciated, frail woman with the twinkling blue eyes.
"I bet you had all the men asking you to dance."
"Not all, but quite a few," she laughed.
"I'll get that pain shot now." Allie left the room. When she returned she found Mrs. Croft asleep and laid the injection on the bedside table for when she reawakened.
Mrs. Croft awoke with a start about two hours later and saw her son sitting at the bedside. Quietly he flipped through a magazine.
"Oh. I didn't hear you come in, Peter."
"Hi, Mom, didn't want to wake you."
"Did you have a rough day at work?"
"No, Mom."
"I always knew you were going to be an engineer. Even when you were a small boy you liked to tinker with things, taking all your toys apart and then putting them together. And look at you now, the best building engineer the City of Chicago ever had," her voice filled with pride.
"That's because of you. You always told me I could be anything I wanted to be as long as I put my mind to it and worked hard. You were right, Ma, you always seemed to know."
Lydia tried to surpress a yawn. "Sorry, honey, I'm just so tired these days. Come over here and sit down on the bed so I can see my handsome son better."
"Remember when you used to sing to me as a child when I couldn't fall asleep?" said Peter.
"Of course I do." She began to sing, "Let me call you sweetheart, with your eyes so blue, let me call you sweetheart I'm in love with you...." Lydia began to doze off. Peter gave her a kiss on the forehead.
"I'll see you later, Mom, miss you."
Jess entered the room and set a fresh pitcher of water on the bedside table.
"Hi, Mrs. Croft. Did you have a nice nap? Allie went home and I'm the night nurse, Jess."
"I sure did. But I had such a nice visit with my son, too. He's an engineer. Married himself an Irish girl. She's more like a daughter than a daughter-in-law. I have two grandson, both of them are big and strong boys. I'm so very lucky. You're a pretty girl, Jess. Are you married?"
"No, I'm not married. Do you happen to have an extra son who's single and has your pretty blue eyes?"
"'Fraid not," she chuckled, and then coughed.
"Are you all right Mrs. Croft? Would you like some juice or water? Would you like you pain shot?"
"Yes, give me the pain shot and I'll try a few sips of juice." Her voice was weak.
Jess gave her the pain shot and helped her onto her right side. She turned the pillow over and rubbed her back. "Is there anything else I can do for you?"
"No I feel much better now. Thank you. You're an angel."
Mrs. Croft slept well, arousing only slightly when the nurse came in and checked her blood pressure during the night.
Allie came in and opened the curtains in the morning. She noticed that Mrs. Croft's heart rate was a little bit slower than usual and her breathing a little more shallow than ordinary. She shook Mrs. Croft's shoulder.
"Mrs. Croft. It's me, Allie. Did you sleep well?"
"Oh yes," she said groggily.
"I hear your son came and visited you last night after I had left. I don't remember meeting him. Did you have a nice visit?"
"It was a wonderful visit. I had so much company yesterday—first my husband, then my son. Wore me out, though. I slept so soundly I don't even remember dreaming."
"Are you ready for your bath?"
"I don't really want one, but I guess I should get cleaned up in case I have more company today."
Allie was filling the wash basin with water when the cardiac monitors started alarming. She went to the nurse's station to check and saw that Mrs. Croft's monitor showed a flat line. She ran into the room. Mrs. Croft was dead. No attempts were made to resuscitate the patient as per the patient's and family's wishes. Allie returned to the desk and called Mrs. Croft's daughter, Alma Winters.
"Mrs. Winters, you should come to the hospital...."
Alma Winters and her husband made it to the hospital thirty minutes later; Allie was waiting for the family.
"I'm so sorry, Mrs. Winters."
Mrs. Winters cried softly and Allie put her arms around her. Mrs. Winters slowly regained her composure as Allie rocked her back and forth.
"Is my other sister here yet? Are any of my other family members here?" Mrs. Winters asked as she blew her nose. "She has a sister, you know, my Aunt Lil."
"No, no one else is here. Your father and brother were here yesterday but I couldn't find their phone numbers on the chart."
"I'm sorry. That's not possible. You must have made a mistake. My father died 20 years ago of a heart attack and my brother was killed eight years ago in an automobile accident. She missed them both terribly."
Walking down that familiar hallway, today it appears to be even longer than the days preceding. Exhaustion begins to sweep over me like a heavy wet blanket, and this makes me frustrated. It is now 1:45 PM, my 33rd hour without sleep, and only God knows when I last ate anything. But my clinic has been full all morning. Some patients had arrived for their appointments at 7:00 AM, an hour early, in the futile effort to be seen that much earlier. In my frustration, I ask myself, why can't some of them go somewhere else, or better yet, come on another day when I am not so exhausted and ill tempered.
Today of all days, I don't have the patience to hear Mrs. Barnwell tell me for what could be the hundreth time about her problems at home, or her children. It's not that I don't care, but I am just simply tired and can't muster the empathy to give a lonely frustrated patient what they want right now: a concerned friend to lend a listening ear. Doesn't she see the waiting room anyway?! She must know she isn't the only one waiting to see me today. My anger begins to rise as her story continues to drag on, and again I tell myself it isn't that I don't care about her problems. It's simply that I have so much more work to accomplish. If I can just hurry and finish with Mrs. Barnwell, I can possibly see the remaining three patients scheduled for the morning clinic. Never mind that the the afternoon clinic started at 1:00 PM and I haven't even finished the morning one. She is still damn talking and I can't get a word in edgewise, and my brain is screaming: who the hell put so many people on my list today?
She takes a deep breath and I see my chance to exit and finally end this visit. "I just don't have the time today, Mrs. Barnwell, to stay with you any longer, but you are progressing well. Your diabetes is well controlled. Continue with the same diet management and write down you sugar levels as you have done this week and I will see you again next month."
From the expression on her face, I know I missed my goal to end on a good note. I wanted to show concern but still end the conversation in order to move on to the next patient.
After I left the room I felt terrible. I had failed her when she needed me most. But I had done what I had to, hadn't I? I mean I had other people waiting to see me and they all had stories to tell. I was tired. Doesn't anyone care about me at all? It wasn't like I didn't care or anything; I just needed to get some rest and things would be much better.
As I walk down the hallway, I realize that I need a quick attitude adjustment before I see my next patient, a pregnant substance abuser. I ask God for the patience necessary to educate and give this woman good health care. I must remain in control and not become impatient with this one as I had the others before her.
Before I open the door I take a deep breath, and wipe the tear out of the corner of my eye. I am a caring person, not like I appeared with Mrs. Barnwell, but everyone has their limit. I need a break but I can't take one now. Then I realize why the tears. I don't care like I used to. A part of my compassion has died and I can't even remember when I lost it. I cry because I have become what I swore I wouldn't and I don't even remember when the metamorphisis took place. My fire for becoming the perfect physician has been replaced with the temporary desire to empty my clinic and get home to my own family and some much needed sleep.
I square my shoulders, and make a resolution to improve, to be better. With a new day things will be much better. Won't they?
I can't get the impression out of my mind. He looked like a nice guy. He was very attractive with lips that curved up and a relaxed, almost boyish smile. His hair was cut in the modern fashion and he had a great body with stong calf and thigh muscles. He was taller than me with a couple small stylish tatoos on his arm. One said "Natasha." His eyes were half open as he lay there in all his manhood, spent, like an ice cream cone dropped on the sidewalk on a hot summer day. There were about 30 people crowding around trying to get a glimpse of what happened. Someone was walking around in good shoes in the blood that was all over the floor and dripping off the table. They were sopping it up with rags. My heart was beating fast with tense anxiety, ready to look like I belonged there but wary of being in the way. Someone said there was a 1 in 100 chance of surviving this type of thing. I heard that twice. This wide-eyed young fireman jostled his way into the front of the group to watch as the chest was cut open and the left lung fell out. A big burly guy was standing off to one side of the body forcefully pumping bags of blood into it.
They needed O negative blood. I'm O negative. Should I mention it? A nurse wanted one of the doctors to sign a requisition form for the blood. Come on, I'm thinking, are you kidding—this is a 6-7 code. The mood seemed a little light, as if someone knew something I didn't—as if it was all a joke or a game. A tall, commanding-looking resident with a booming voice said it was all just an academic exercise. This person's dead. I guess I didn't know the gravity of the situation when the paramedics wheeled him in. He looked alive. Four teens in a car, a gun, and this guy walking on Sheridan Road 20 minutes ago. Now he's on the table being eviscerated by overeager young doctors not sure whether or not to try with all their might to revive him and risk looking foolish for not knowing he was a goner before he came in. Another 6-7 was called in. An auto accident. The nurse asked if someone had "called" it. Did they note the time? 14:48.
A couple of people hung around as if to survey what was left of a burning building. They had dazed looks in their eyes as if you could stand between them and the body and they would see right through you. A couple of residents were laughing as they assigned one of the juniors to stick around and sew him up. Like a baseball they said. They asked if I wanted to stick around to stich him up any maybe learn some anatomy. They rushed to get me a gown and a plastic full-face shield and told me to double glove. I put shoe covers on and nervously got into the rest of the garb. I asked the resident to fasten the gown in the back. That seemed kind of inappropriate—like he was buttoning up my wedding gown.
The bullet was this tiny thing. The central supply guy said that it was a 1 mm and I looked at him (accusatorily) wondering how he knew. The cop said it was a 38—they found 3 of the teens but no gun. A nurse and doctor who happened to be on the scene did CPR—did they have a mask with them? I asked if you could get hep by inhalation: The resident with one more mask than me said no. The bullet had gone in his left arm. The hole looked like it was from a BB gun. How could this bullet do so much damage? The cop looked over the bullet in the urine cup admiringly and deemed it a "spreader" and said that they're made to kill. The resident shoved his hand into the thorax and showed me the hole in the aorta and pulmonary artery. The heart looked great and strong. As I reflect back on it now, I wonder why it wasn't saved for a transplant. I kept looking at the guy wondering what his mom would think. I asked how old they thought he was. Too young to be lying here. About my age. In my medical student eagerness I wanted to learn to suture but this resident seemed to have a monopoly on that so I got ready to degown for my lecture.
I came to lecture late. The lights were off and slides on. Everyone looked up when I walked in. They looked twice once they saw my scrubs. I told my clinical tag team that they had missed out on something great; they should listen for all 6-7 codes because that's when you get the chance to do something. I was their heroine.
I came back through the ER on my way home and asked if the gun-shot victim was still in the room. I heard sobs from behind the curtain as a guard told me his family was in there. I hope that they didn't hear me—how insensitive—part of the "wow, what an interesting and exciting case" that happens when we lose ourselves in the medicine, oblivious to the fact that this is a feeling, thinking, sick human (not in this case though). Some friends of this guys were waiting outside—plotting revenge? I was in scrubs. They didn't want to meet my glance and said something about how this world is fucked. I didn't know it at the time, but I had blood on the sole of my right shoe.
I run out pleading with my wife to
Secure the front door from our toddler son's imprudence.
Who is Josephine? I wondered...
There—
An amorphous pile. Motionless—I ran and others ran too
Nearly to the intersection.
How did my wife ever see this from her vantage point?
Perhaps this is where all forces equaled zero.
A voice forcibly yells to the few bystanders "Don't touch her!"
My advance halts abruptly while the others continue theirs.
I know that wooden cane and that
Earth-sensitive plastic shopping bag. Oh, Lord!
My neighbor, Josephine. That fiercely
Independent ninety year old loner...
Face down in the fresh January snow.
Sprawled violently on frozen asphalt so close to home.
"Josephine"—"Josephine!—I cried
Kneeling at her side; No response—
Instant overwhelming desolation. Anger—
At the confrontation with my inadequacies...
What do I know? I'm just midway in my third year!
Engaging the internal debate against the voices of the past
Disclosures, my silent pleads for divine intervention
Answered: In trauma, evaluate ABC and stabilize the neck.
Is she breathing?
Without a touch, I seeregular puffs of expired steam... Thank, God.
Yes!
Is there a pulse?
Fighting my inclination for the carotid, I pull down the
Cuff of her right-hand glove and feel a fast, regular
Pulse. Her's or mine?
Recheck—Her's!
By chance or grace, we are offered a cervical-collar
Brace and excuses of liability from a passing
Private ambulance service.
We'll wait for our ride while I struggle against
Contact to secure this harness.
We wait and I recheck the vitals...we're fine!
Where is the EMS ambulance?
"Did anyone call 911?"
I glimpse up towards the street corner to
See neighborhood "gangbangers" chase and
Restrain the offending vehicle. Guilty!
Perhaps we all need to seek absolution—there may be
Hope for us yet!
In low-pitched groans and screams for help that
Straighten my spine—`my neighbor,
My patient; Josephine awoke.
"It's me your neighbor, the medical student."
"You're going to be alright, Josephine!"
I shouted over and over...Holding her hand and
Attempting to explain the reason her neck was immobilized and
Why she should refrain from moving.
She fought hard—that was a good sign!
At last; help arrived—we turned her over revealing
Multiple facial injuries and located her quickly to safety.
I was not permitted to accompany her—told not family or
Medically-qualified.
Relieved of my obligation, I stood there awhile in silence...
Hoping that I had done the right things,
Made the right decisions, said the right words...
Much to my surprise and for the
First time in my life, I am aware of the noise I reproduce while breathing—
How loud my heart pounds against my chest...
Of the tingling sensation in my hands...
How cold a winter's day this was...
I stood at the clerk's desk listening to the annoying rasp of the printer spew out a patient's medical history. The smell of the V.A. cleaning fluid momentarily took me back a year to my first clerkship here. I glanced down at a blue card on the desk and there was a name I recognized. Ambrose! Mr. Smith was one of the characters I had encountered the previous year.
I remember introducing myself inbetween translating what the resident was trying to say. At one point we all laughed as our dialects collided, and there it was, a unique crooked smile. It raised the whole right side of his face, finishing somewhere up in that dense mat of white hair. He was a lean, wiry gentleman with sparkling brown eyes, but that lopsided smile intrigued me. It was as if it spoke to me, saying "yep I've seen it all before."
Every morning when I came to see the patients I could usually find them in the showers, smoking. The first time I interrupted a gathering, one cigarette was out the window, another flushed down the toilet. They quickly shuffled out of the mist, dragging their wheeled walking sticks behind them. Mr. Smith just smiled, leaned back in a wheelchair and inhaled deeply on what remained of his smoke.
We met the same way most mornings, I would ask him how he was doing, let him know what the plans were and make excuses as to why things were moving so slow. More often than not he smiled his wonderful crooked smile and thanked me for the "salve" I would get for his cracking hands.
One morning he was gone, signed out Against Medical Advice. A note on the remains of his chart said he had refused a procedure and wanted to leave. His only request, "salve."
I tore the paper from the printer and gathered my things. A summary sheets told me that during the past year Mr. Smith had his stomach removed. As I approached his room the sound of the television grew louder until it was unbearable, then it seemed to fade into the background as I saw the tufts of white hair scattered on a brown scalp. He was collapsed over to the right side of the bed. He seemed weightless as I sat him upright and I watched the pulsating vessels of his hollowed out temples. His eyes looked dull and milky, they seemed to focus straight through the wall. So I picked up his floppy hand and squeezed, he returned the compliment, I think. He shook his head in recognition, or did he? I don't know. His smile was gone and I left.
If I close my eyes tight I can see his crooked smile.Ambrose: from the Greek ambrotos—immortal.
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Go to Illustration |
Mr. Moore came early for his appointment as had been requested. "Please arrive 15 minutes before time of appointment," the card said. And so here he was. Mr. Moore prided himself on being a law abiding citizen.
"Hi. I'm Albert Moore. I'm here for my 2:00"
"Yes, hello, Mr. Moore. Please have a seat."
Mr. Moore was always anxious when coming to the office. He liked to get in and out as quickly as possible. That's why he really liked Dr. Patterson. Albert was never in that office for more than a couple of minutes. Dr. Patterson did what he had to do, then let him know what the problem was and what was going to be done. "You might have a broken rib. You'll need an x-ray," or "your foot looks a lot better. Keep checking it nightly. We'll get some bloods to check your sugar level." And Mr. Moore knew that the doctor was well qualified: he could see the medical degree from the University of Illinois hanging squarely on the wall right over the examining table.
"Mr. Moore, this way please." Albert was led into the examining room. "The doctor will be with you shortly."
A few minutes later there was a knock on the door. "How ya doin' Albert? Listen, this is Jim. He's a medical student. He'll talk to you first, OK? I'll be back in a few minutes."
Albert stared across the room at the young, fresh face. His heart rate began to rise. Mr. Moore wanted to escape. His thoughts had a recurrent theme: "Please come back Dr. Patterson. I want to go!"
"Hi, Mr. Moore. I'm Jim. What brings you in to the office today?"
"I've had some stomach pain lately."
"How long? Dull or sharp? Scale of 1 to 10? Constant or off and on? Any particular area? Anything make it better or worse? Diarrhea? Any blood? Appetite? Nausea or vomiting?"
Mr. Moore wanted the questions to stop. He wanted to go more than ever now.
"I need to ask you some very general questions now Mr. Moore. Other medical conditions? Family history? Smoke or drink?"
Mr. Moore began to zone out. The student's voice was audible but was not being comprehended. A buzzing began in his ear. Now the pain in his stomach was worse than ever. He prayed for the doctor to return. The student's voice interrupted these implorations.
"Mr. Moore, excuse me, Mr. Moore, I asked if you ever rode a bicycle?"
"What?" Mr. Moore responded completely flabbergasted.
"Do you ever ride a bicycle?"
"Yes. I rode one here today," stammered Mr. Moore.
"Do you wear a helmet?" asked the medical student.
"No." Albert was dumbfounded. His stomach was hurting. He wondered just what his ailing stomach had to do with riding a bicycle.
"It's important for you to wear a helmet for your safety, Mr. Moore."
Just then there was a knock at the door.
"Thank god," said Mr. Moore out loud to his own surprise as
Dr. Patterson entered the room.
"What's the problem?" the doctor asked the student.
"He's had an intermittent, dull pain, not very severe throughout his abdomen for the last several days. He's taken Maalox which has helped at times. No diarrhea, no constipation. Some nausea, no vomiting. He's had episodes like this in the past which cleared up only with Maalox. He had some barium studies a couple of years ago which were all negative. He is taking one asprin per day as was recommended."
"Anything else, Albert?"
"No, that's it."
"Very good, then. Good job, Jim. Let's just do a quick exam."
Within a minute Dr. Patterson had listened here, felt there, and had put on and taken off his glove.
"OK, Albert, everything appears fine. I'd say it's just a little upset stomach, nothing more. Stop taking asprin. I'll give you some stronger medication to take when your stomach bothers you. If the pain isn't gone by next week, let's run some tests, OK?"
"Yeah, thanks doc."
"So what do you think, Albert. Is Jim going to make a good doctor?" The young man looked to Mr. Moore.
"Yes, I think so," Albert answered unconvincingly.
Mr. Moore left the clinic with the medications. He rode quickly away from the office. It had been an upsetting and lengthy appointment. He hoped that next time there wouldn't be a student with Dr. Patterson. Anyways, it was time to plan his trip home. First stop would be the grocery store for some milk and bananas. Then he'd run across the street to the sporting goods store and buy a bicycle helmet.
On December 1, 1994, at 10 a.m. I had an unusual experience: I lost my mind going to a lecture.
I was to lecture one familiar in the medical school arena, and with students familiar to me. I experienced my usual enthusiasm for the student class and then suddenly—I lost my place.
There was no special noise, there made no palpable impact on the body nor on my psyche. In fact with a muted query to those in my surround sometime between half-past 9:00 a.m. to 10 a.m., I said: Where do I go? This place, is it the same? I was then not yet aware that alterations had undergone my mental processes; I confidently assumed that the mind disarray will soon be righted itself. Surely an attempt to break through this brief interruption in the flow of my thoughts would begin with the usual associations and help me quickly find my place.
I continued the lecture as more mysterious experiences occurred, as the speaking tasks could not continue the lecture. More bizarre experiences continued and I could not elaborate the characteristic patterns which I have used for more than thirty-five years; I could not elaborate on the headlines written on my notes. Even the simple headings were not recognized:
Had I gone to the wrong lecture hall? Did I lose the right notes?
The lecture ended, when I suddenly allowed myself to be taken to the emergency section of the University Hospital, since I would not recognize any further clues to make a dent in my thoughts. I had suddenly become aware of others—helpful colleagues who served me well in my need—and I experienced a feeling akin to an episode of deafness, an emotional deafness and an intellectual deafness and I was paralyzed and helpless to break through this barrier. Certainly I would soon break through this barrier, certainly I would soon break through this wall against my thoughts.
Then I experienced that I was at great distance to all in others to my family, my colleagues, my patients. The experience was slow and quiet—I was not sad or anxious.
It was a loss of love. I could not experience the unison with those who could not share with us in their nurturance. Also I could not engage with our emotions and our thoughts with our caretakers and not to assist to offering their help. Obviously I wished to ease their distresses, and clearly I wished to show them for pity, and certainly I wished others to empathize with the self-of-the-moment I was undergoing but of what use to empathize with the others? This resultant experience was clearly a solo phenomenon. The aloneness was the centerpiece of the experience. Since no one could share the subject's experience of the other in these events in what the other's enters the other's feelings—the diagnosis: a loss of love.
What next? Can anyone be any service to to others in this dilemma? Can one only be a sympathetic spectator?
Shakespeare, perhaps writting in 1593, was able to understand the human experiences of deterioration when he was in his thirtieth year (his birth date was 1564). These comments of an astute observer by Shakespeare once again was helpful to allow us to teach us as we often taught us the great psychoanalyst of tragedy:What are the empathetic requirements for those who need to be of service to our patients in a world of silence, a world of un-knowing. As noted before, the need to join with our patients—or an attempt with our patients—our patients often feel incomprehensible, they feel the pervasive loneliness. The urge to immediately join the separated one, the wall experienced with the altered one cannot with good intentions by simple intrusion, and to urge on the subject by encouragements or give offered understandings to the separated one. Beethoven like others in many had the dilemma of the immortal aloneness knew the aloneness which kept him away from his own created music as well as keeping him away from his loved ones until death.All the world's a stage,
And all the man and woman merely players;
They have their exits and their entrances,
And one man in his time plays many parts,
His acts being seven ages....
Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
sans teeth, sans eyes, sans taste, sans everything.
("As You Like It," Act II, Sc. VII, lines 139-166)
The aloneness phenomena invites one through the state of illness or in blindness or in death. Also in death, it is of course not the simplest manifest outcome of the cessation of organic life. It is the meager with the dying who can experience the calming, the experience of worth. Ah! That's the curative ingredient to those of us who need to overcome the lonliness in an illness, and overcome the lonliness in states of psychic disarray. Shakespeare can be an agent of the cure and be our guide to those in need to be our source of worth and to be our calming and our soothing caretakers. There are three principles which will be the purveyors of worth and calmness and direction in those in need who suffer the organic aloneness in those who will alleviate to all:
The initial needs are to understand the extent of the organic or psychological illness or the extent of physical and psychic disarray. The caretakers must know the variety of dysfunction in our patients to begin our empathetic functions.
The second important principle to perform as competent caretakers are to overcome the inner experience of the initial uneasiness in our patients with the modal reactions to patients with a variety of illness, including the reactions to the dying state, i.e., the ubiquitous reactions to the unrational fears—the phobic phenomena—of the deformed, the ugly, and the weak which cannot overcome the caretaking activity before their activities can be detumesced.
The final caretaker principle is the resultant after those who study the physical and psychological dis-eases and who will overcome the phobia of those with differences, finally is the outcome of the empathetic achievement and be able to immerse one to one's self to join against the legions of the aloned.
One final outcome of Shakespeare will again attempt to understand and to combat against the irrational fears (phobia) and finally attempt to join in empathic contact with others. Here to us to instruct Shakespeare's is again to know and help us overcome the alone:You see me here you gods, a poor old man,
As full of grief as age, wretched in both.
If it be you that stirs these daughter's hearts
Against their father, fool me not so much
To bear it tamely; touch me with noble anger,
And not let women's weapons, water-drops,
stain my man's cheeks.
("The Tragedy of King Lear," Act II, Sc. II, lines 272-278)
Lost
he looks at the crowd
Bewildered
"I can't believe this happened -
I'm a safety worker, for Chrissake -
I was trying to prevent this!
I've been married for thirteen years
got four kids
What am I going to tell them?"
Winces as they remove his clothing
peel it away
from weeping blackened flesh
Whimpers
"My God, can't you make the pain go away?"
Swiftly
Paralyzed, intubated
Deep rents in the flesh
we make
to save plumping limbs.
Gray muscles
Eyes staring
Challenging
"Help me - I'm dying
from the inside out."
Helpless
we watch him slip away
Exiting the burn unit
with only the whir of the ventilator
It's become too difficult for me to prepare
meals so I don't eat and I don't care.
Because I'm exhausted, just exhausted.
It's all I can do to get to the fridge for
an Ensure. And this past weekend
was so bad I just wanted to die in my
sleep rather than go on feeling so bad.
And I wondered about God and said I
hate God if there is one.
And I think I'm a big wimp because
I want to quit chemo with only two
cycles to go. I believe the cancer is
gone now. The chemo is killing me.
And when people say "Look on the
bright side—you only have two more
cycles to go with excellent prognosis"
or "Just think—next year at this
time it will all be over" or
"At least you have insurance" or
"It must be nice to be a lady of
leisure" well I just want to grab
them by their throats and squeeze
until their eyes pop out.
And right now I think the hospital
is a nice place to be because I
can rest knowing I'm being cared
for and fed, and not worry about
getting groceries, cooking, cleaning,
and laundry.
And I'm probably the healthiest
one in the oncology unit.
And when I leave here my life
is reduced to basic necessities.
I've had to lower my expectations
of my physical abilities time and
time again.
And my psyche keeps getting beat up.
I'm nowhere near the person I used
to be.
When my cancer drama began I was
near death. Everyone sent flowers,
gifts and offers to help. They called
and visited me when I was in
the hospital. But the months are
lonely and difficult and drag by so
slowly. People are very busy
with running their lives.
When I am of my right mind I am
a strong and positive person.
For now, I pull myself onward,
kicking and screaming.
And that is a big part of who I am
right now.
Boys and girls
ran hand and hand
drawn to the twinkling whirl of bright lights
and sat high on their perches
as kings and queens
blowing kisses to their servants below
There was a time
when each carousel ride
ended with the soft brush
of my mother's lips
and I opened my eyes to angels
singing of the horses' laughter
with halos of blond hair
catching the dawn's first light
But now the ponies have fled my sleep
leaving an endless row of poles
stripped from their backs
moving closer together
and in the mornings
I tuck bloodstained panties
under yesterday's newspaper
so that only the garbage collector
knows of the goodnight kisses
which linger moist
on a fevered brow
and of the merry-go-round
illuminating the dark
where there are no horses
—oh, but in the shadows
the monsters are dancing nearer
Alfred watched the moon through the window
and thought about faceless men
and the honey they spread
when he was 15.
His mind swam above a lurking gloom.
Shiny body of his first lover: hairy, broad and golden;
thick music, beer and men's muscular arms everywhere;
licking stamps and roaring from one dream to another;
losing track of money, underwear, names;
wearing tight jeans that hugged your ass and explained everything.
He was stuck in that decade
because he could not think beyond
his 25th birthday two days away.
He ached from the new plastic worm in his chest
piping in medicine.
Warm rain flicked against his face,
and he turned away from tomorrow into sleep.
They refused to go quietly.
No one knew them before.
Hours later some were uncovered,
anonymous save for their method of dying.
Sounds of alarm ceased to be alarming,
simply buzzing, circling, flashing,
hypnotizing, then finally unheard to them.
Flames were the only marker
of deaths that had already begun in time,
set up with the certainty of multiplication tables.
Twenty-five point Helvetica
or five lines on page 27
or nothing at all that day because she had no address
or CNN Headline News
or 19 killed in massacre.
Sometimes the math does not work.
Five thousand seems the same as fifty
seems the same as two
seems the same as Alfred
dying in a pale green room
in the corner of a cancer ward
in the middle of a city
in the middle of a country
on the surface of Earth,
floating out to meet his dreams
and catch his beer
and run in the field
and find the men he loved,
his crying father, his sanity
but locked in a body
filling with fungus,
turning against him like a brother.
When he dies, he hopes not to scream.
Second Grade. I am standing by the swimming pool, holding a pile of leaves in my hands. It is summer. It is dark. And the sign says "POOL CLOSED." A little dark-brown boy climbs over the gate to the pool. Doesn't he know he is breaking the rules? He goes to the diving board and starts to jump up and down, up and down. He is giggling. I walk away, leaving a trail of leaves behind me.I return to the pool. The gate is no longer closed. The little boy is on the ground, wet. He is sleeping now. Men in uniforms, some carrying bags and machines that I don't recognize, surround him. A lady sits in the midst of uniforms. She is screaming over and over, "Willie, wake up!" The little boy sleeps soundly. I look back at my scattered trail of leaves. Is nothing immortal?
Nineteenth grade. Code Blue. I am standing in the back, holding a syringe and gauze pads in my hand. Men and women in white coats surround him. Willie T. is a 49 year old black male with a twenty pack a year history of smoking. He has difficuly swallowing. He has esophageal cancer. And one day he is dead, lying on the floor with a trail of blood streaming from his mouth, tears from my eyes. Little dark-brown boy, Willie T.- you marred me with your trails.
In a prenatal sleep, fever and methadone
From his mother's own body rendered him harm.
She stopped the breath of the child she had known.
He was Heaven's dilemma, this baby, this gnome.
His belly was full, his cheeks were quite warm.
His flesh was her flesh, and his bone was her bone.
She took back a life that would wrongly have grown.
In the quiet of sleep that was eye to the storm,
She stopped the breath of the child she had known.
She sweetened the pillow with talc and cologne,
Pressed gently the face in the crook of her arm.
His flesh was her flesh, and his bone was her bone.
She covered his body with one sheet alone,
Waited for tears that she wanted to form.
She stopped the breath of the child she had known;
His flesh was her flesh, and his bone was her bone.
I always wonder why more questions weren't asked. It's a good thing to question, to somehow reach out for justification. The Ministry wouldn't have liked the answers, and what they don't like doesn't happen. It was years before I could admit the answers to myself and I was there. When the smoke cleared all anyone really knew for certain is that one patient was missing and three were dead. Then again, She didn't officially exist so how could she be missing, but I jump ahead of myself. Like when taking a history it is usually best to begin from the start: Now Physician, when did you first notice something was wrong?
"PHYSICIAN PAGE, PHYSICIAN PAGE," came the familiar computer generated voice from my Identification Badge. I touched the sides of my badge in the appropriate sequence.
"Physician page report," I answered.
"PATIENT ADMIT, EMERGENCY ROOM CONFIRM CODE 427," the badge replied.
"Oh no, not another one," I said aloud.
I checked the time, two in the morning, and it was my turn to go down to ER and admit the patient. My thoughts were of the last two patients as I dialed the ER extension. They were both ruled out for leukemia, an epidemic which has only recently come under control, and their scans had just come back negative. Being able to tell one patient, let alone two, that they are going to be fine puts me in a good mood for days.
"Emergency Room, say code now please," said the ER computer voice.
"Physician code 427."
The call was transferred to the Nurse's Station. "Hello, Doctor, we may have a patient for you."
"You're not sure?" I asked.
"Evaluation is not my job," came the much practiced answer. Then after a pause, "between you and me, it doesn't look very good though. An elderly woman the paramedics brought in, definitely Post Concession, we weren't exactly sure she was alive at first....Look, you really should come down here anyway."
I replied that I would just as quickly as my feet could carry me and hung up the phone.
As I walked through the sliding glass doors to the ER an impressive, burly gendarme blocked my way.
"Your identification," he demanded with an outstretched hand.
I looked down at the hospital identification badge carefully pinned to the lapel of my white coat to indicate that he could see the badge as plainly as I.
"Come now, I've got no time for this," accompanied by an impatient gesture followed by the removal of said ID. The gendarme looked from the picture on my badge to me as if he had never seen either one before.
"Constable," I began courteously, for one must always be courteous, "I was just down there half an hour ago, you must remember me."
"That was the previous gendarme whose work unit ended ten minutes ago."
He was correct, the number on his red hat read 44725. The previous had been 44724. It was a silly mistake but they all looked alike. I made a mental note to pay more attention to unit numbers.
"My apologies, may I pass?"
With an impatient gesture he held out his Identification Palm Scanner (or IPS) which scans the fingerprints and fissures on one's right hand and compares the reading with the information both on the identification badge and the government data base. I complied, holding my hand over the small screen while the badge was scanned. A flashing green light indicated my legitimacy after which my identification was returned and I was allowed to proceed.
I found my patient in bay 27 with a technician hovering over her randomly searching her thorax with a stethoscope and a look of confusion. The patient was perhaps the oldest woman I had ever seen with skin darkened, blotchy, and peeling around her nose and forehead, with wrinkles that looked more like cracks on the surface of a ravaged, dry sea bed covering her from head to toe. As to her actual age, I wouldn't want to say for sure, but if I had to hazard a guess, I would put it at well over a hundred years. This was almost a once in a career opportunity, as physicians rarely saw patients this aged. In the old days it wasn't uncommon for people to live into their nineties and even hundreds, but ever since socialization and Medical Management Laws which demanded the discontinuance of interventional treatments to all those over seventy, people rarely live past seventy-five. The law also stated that all those under the age of seventy were to be given every medical intervention and advantage appropriate for their condition. This last was to be waved, if and only if, the patients themselves requested, in writing, on three separate occasions over a period of three months to the Ministry that care be withheld. If a patient was then evaluated as being psychologically sound by the CJA test, treatment could then be discontinued.
On closer examination I noticed that the patient wasn't moving. Her hands were raised a few centimeters above her abdomen and chest as if they had been frozen there. Her face was turned slightly to the side, eyes closed, wearing an expression of tranquility. "I'm not sure she's alive," said the technician, "I thought there was a heartbeat. Now, wait." The technician moved her head closer to the patient's chest as if that would amplify the stethescope. "Yes, there is a heartbeat. Slow, weak, but there." The technician straightened up and staggered as if she had risen too quickly, fortunately catching herself on a nearby sink. Just then the patient drew in a breath that sounded like rustling paper.
"If you weren't sure, why was I called, and if I was called, why is nothing being done?" The question came partly from anger and partly from frustration. I had seen this happen before, too many times.
"Look at her," the technician gestured toward the patient with a nod. "How old do you think she is? Granted someone of her age is of great interest. Even so, you know the law as well as I. No treatment over seventy. No exception." She said this with the same automaticity of one reciting a prayer, saying the words without acknowledging their meaning. It was true. I knew the law as well as any citizen. I also knew you could be disenfranchised for breaking it. It still made me feel like a murderer every time I witnessed a denial to someone because they were past the age of Concession. Self-flagellation is a private matter, however.
Most of us go into medicine because we want to heal, to make a difference. It goes against the nature of the physician to deny treatment. It was found soon after implementation of the Medical Management Laws that when physicians made the decision to deny tratment most would either burn out after ten years or break the law. It was for this reason, among others, that technicians were created. Those sections of the population who show the appropriate aptitude as children are sent to a Re-education School, run by the Ministry, from the age of thirteen until their twentieth birthday. After the age of twenty, the Neophyte is sent wherever needed. In this case, to Technician Associated Medical Education. Relations between technician and physician can become strained at times. It is the technician's duty to first examine the patient and make a judgment on whether or not they can receive treatment, at times under physician protest. If the patient is rejected, the physician will never see him. If he is accepted physicians are more or less in control of patient care.
"How old is she anyway?" I asked out of curiousity.
The technician's eyes grew cold and angry looking as if I had dared to question her. Not many question technician authority. Physicians, however, are one of the few sects of the population that are legally allowed to.
Her eyes softened as she slowly formed the words, "I'm not exactly sure."
"You're not? So that's why I was called."
"She has no papers, no identification," she said, lowering her voice. She paused as if considering our next option, for knowledge of exact chronological age was essential for Care Denial. If exact age cannot be verified, the patient should be treated.
Coming to a decision, the technician took out her Identification Palm Scanner and pressed the screen against the patient's unmoving right hand. The technician shook her hand and repeated the scan.
I was becoming agitated. If we didn't begin soon, by the looks of things, the patient surely would die. It looks very bad if one dies because of Care Denial without age being ascertained and often leading to fines.
"What's wrong?" I asked impatiently.
"I don't know. Look."
She held up an Identification Palm Scanner whose readout displayed the unthinkable. "SCAN UNTRACEABLE IN GOVERNMENT DATABASE BOTH ACTIVE AND ARCHIVAL."
The technician and I looked at one another. According to her scan, my patient did not exist. It also meant no exact chronological age could be fixed.
"Damn it, you have to treat the patient. Do everything possible until I can investigate why she's not coming up on the scanner." The technician stiffly walked away without waiting for me to respond and then stopped and turned. "And don't mention this to anyone. Please."
I nodded and wondered if she would really initiate an investigation. News of this nature was not received well, and more often than not the messenger came under undue scrutiny if not outright sanction. It was breaking the rules, but the technicians could get away with it.
I now had license to treat my patient.
The examination began: her general appearance was very stiff and emaciated, in a way reminding me of the mummified Egyptian pharaoh's. The skin was dry and hard like that seen with scleroderma, only more wrinkled. What hair she had was brittle yet long and very black—not one gray. Heart sounds were barely detectable at twenty beats per minute, peripheral pulses were absent and blood pressure nonexistent, respiratory rate was low without audible breathing sounds. There were no abdominal sounds and her vertebrae could be easily palpated anteriorly. Deep tendon reflexes were absent. I forced open her eyes to gage pupil reflex for a funduscopic exam.
As the lids came apart, I quickly drew away my hands though the eyes remained open. They were the most indescribable, piercing green augmented by miotic pupils. Where her body gave every impression of being on the verge of death, her eyes were very much alive, and though they didn't even so much as move, they seemed to convey unfathomable emotion. Remorse, fear, and even hate seemed to be trying to reach out and communicate to me though it was a language I did not understand. Finally, not able to look on them any longer, I reached out an closed the eyelids. The patient remained still.
I began intravenous therapy to rehydrate the woman in one vein and placed a monitor catheter in another. The blood chemistry unfolded on the monitor. Her hemoglobin was reading 3 with 10 percent hematocrit. I ordered four units of blood and began to wonder why she was still alive.
After giving appropriate medications and beginning the transfusion, my patient began to move slowly at first, then shaking her head as if recovering from a swoon. She opened her eyes and looked at me with the same unsettling, fierce emotion as before. From me she turned her gaze to the IV which was now rapidly infusing the fourth unit of blood. The hematocrit was now up to 20 percent and I began to order four more units.
Just then a wail of agony emanated from the patient very low at first like a distant wind then gaining intensity to a crescendo.
"NO, NO, NO!," she cried almost musically and reached for the catheter in her arm.
I hastily moved to restrain the groping extremity.
"Get away, get away," she hissed looking at me with a combination of anger and hate pushing my hand away with surprising strength.
I called out to a group of nurses standing close by, "Some assistance, please." Three of them came to restrain the patient who was much more tenacious than she at first appeared. "You fools, you don't know what you're doing," the patient pleaded, "I want to die, I need to die. You don't understand." Her protestations continued as she was strapped to the bed.
I accompanied the patient to the medical floor with two Gendarmes. When we reached the floor, administration assigned her to a room with my two other patients, the wisdom of which could be debated. However, she had calmed down by the time we reached the room and had begun to stare at me with those piercing eyes in an expression I could not recognize at first. It was not the same expression of anger she had given me before, it was more an expression of pity.
I left the room to fill out the appropriate paper work, trying to figure out how all this could be: a patient who by all accounts did not exist, on the brink of death not an hour ago, with lab values so screwed up that I began to seriously doubt the reliability of our equipment, was sitting up completely alert and even combative.
When I came back in the room, she was lying in bed quietly watching my every move. Sitting at the bedside, I began to adjust the computer to take another set of readings which I hoped would be more believable.
"What are you going to do with me?"
The voice was soft, clear, lucid, and completely without inflection. At first I didn't know where it was coming from. I turned my attention from the screen to the source of the voice.
"What are you going to do with me?" she repeated.
"I'm going to examine you again and take another set of readings. Hopefully we can find out what is the matter with you. You should be dead if I'm to believe..." I paused, realizing the insensitivity of what I was saying, yet I was almost unable to stop. "How do you feel?" I asked hoping not to make an ass of myself.
"I don't." She paused not saying anything.
I held her gaze unable to speak and not understanding why for what seemed like hours. A slight smile crossed her face making the wrinkles etch themselves even deeper.
"You should have let me die you know," she said almost playfully, "I've lived a long time, very long, and it was enough."
I noticed that she had an unfamiliar accent, very subtle perhaps French or German.
"How old are you?" I asked in an attempt to establish rapport.
"Now that is not a very polite question," her smile braodened to reveal a full set of teeth which like her eyes were bright and perfect. She continued, "I'm old, so old that I don't remember the exact number, so old that nothing really matters."
"You want to die?" I asked, placing my hand on her arm.
She looked from my face to my hand on her arm. "No, not anymore. The desire passes as my strength returns, as it always does."
I didn't understand.
"It isn't necessary that you understand," She read my mind. "When you have lived as long as I you become part of many things. There are potentials realized and potentials failed. Cultures, government, even people come full circle. They are born and rise and then they fall and die. The only constant is the inevitability of change. Everything in its season. It occurred to me that perhaps it was my time to go. I had done all I could. The passion was gone." She paused for a moment, then smiled again. "Now, thankfully, your treatment has prevented me from an unfortunate end. That was the choice you made and the sin you must bear." I shrugged my shoulders, still not understanding.
"It's all right," she said, "but look at you, you look so tired. Go to your room and get some sleep. You'd like that, yes?"
Sleep. She was right. It was all I could think of. I needed it. I should really be in bed. I got up and made my apologies.
"I'm sorry, I have to go now. I'll be in to see you later, perhaps then we can remove the restraints," I smiled and turned out the light.
"Good night, and sleep well. I'm not worried about the restraints."
I left the room and passed the nurses station. "Where are you going?' a nurse asked.
"Don't worry, everything's fine," and everything was.
I must not have slept for more than five minutes because the next thing I knew a nurse was waking me up telling me how I can't fall asleep now.
For a moment I was not sure where I was. My mind began to clear. What the hell was I doing? Why was I sleeping? I had a floor full of patients. The woman, the last thing I remembered was talking to that unbelievably old woman. She may be dead now and it will all be my fault. I jumped out of bed in a panic and raced down the hall to her room.
When I got there all was dark and quiet. I went across the room to the patient in the bed. It was empty and the restraints had been torn off the side rails. I was standing there wondering when a feeling of uneasiness came over me. The other two patients? The room was too quiet and the window was open. I was moving toward the other patients' beds when a voice stopped me.
"They're dead, it's too late."
I wanted to turn around and leave, I wanted to try to save my two patients, but I couldn't move. Instead, my eyes searched the darkness for the source, eventually falling on a shape in the window.
"It's too late," the voice repeated as the shape stepped into the light, "I needed their strength to leave here."
It was my patient, my unbelievably old patient, completely transformed. Her eyes left no room for doubt. She was young, her skin completely smooth with black hair falling over her shoulders. I tried to break away, to run, but those eyes held me. "Come," she said holding her arm out. I tried to shake my head to tell her no.
"You are coming with me. This is your reward or punishment for my salvation, I don't care which. I don't like to travel alone, Death needs a companion."
I felt myself moving slowly towards her.
The world is in turmoil
churning, grinding and surging
Yet he changeth not
Shaped slowly by the winds and waves -
he has been ground to a
hard and stoic jaggedness
On a sunny day,
he offers a peaceful perch
Yet, in the heart of the storm,
as the waves crash about
him
He is the rock upon which
the dreams, hopes and lives
of those who thrust
themselves against him
are shattered
He is neither moral nor amoral -
He is merely there
-fixed, immovable, constant
always throughout time
Strong against all
- Black, glistening and
jaded
- Offering a place of rest
for those who will rest there
- Offering a place of destruction
for those tides that will
thrust themselves against him
He is the rock.
We are absolutely amazed at the number of talented and creative people amidst us. Medicine is a field that demands many different skills. This journal is shining proof of a sincere dedication by many to not only cultivate but also to maintain the extraordinary skills of writing, rhyming, creating, photographing, and drawing. Congratulations to all for finding that extra time to contibute to a great tradition.Editors: NIPA R. SHAH
Our warmest and deepest gratitude goes to Suzanne Poirier, Eve Fine, Meg Valance, and of course our judges Raymond Hart, Robert Molokie, and Hyman Muslin.
We sincerely hope you enjoy reading the 11th issue of Body Electric.
RAJ SHAH
College of Medicine '97
Advisor: SUZANNE
POIRIER, PhD
Department of Medical Education