

THIRD PRIZE Accident Hania
Qutub
Metastases Cinnamon D. Bradley
In the ER Hania Qutub
To Be Stoned Tanya Reeves
Hands of Stone Patrick McInerney
Panic Steve Ciric
SECOND PRIZE Fall in the
Corn Belt Jeff Zagst
Dweller of the Deep Blue
Brendon Cullinan
Before Nipa Shah
Generation Gap of
Medical Remedies Tais Crawford
Speculation Vanessa Foster
Another Angel Miriam Manglano-Tierney
A Stranger in Their Shoes
Chris Schenewerk
Growing Chris Schenewerk
Eleventh-Hour Savior
Tanya Reeves
To Heal Tamarah Duperval
I cry... Marisela Dominguez,
M.D
Drawing P.K. Jamison
FIRST PRIZE Grandfather Keith
Weiler
Shadows Raj Shah
Isolation Patient # 681
Mary S. Ahn
Stairway to Heaven Craig
Allen Kornick
The Rhyme Raj Shah
Nadie Te Entiende Miriam
Manglano-Tierney
Iron Man Brendon Cullinan
Clinical Reflections
Vanessa Foster
SECOND PRIZE Somebody Loved
Her Patrick McInerney
The 'El'Ride to New York City
Nipa Shah
Two Weeks 'til Christmas:
Reflections of a Pre-Medical Student Kristine L. Bell
Jeremy Steve Ciric
Fireworks Keith Luther
Acknowledgements
Accident
There lies my mother on the sidewalk blood pouring everywhere. The
blood is everywhere dripping across one side of her face drenching her
neck glaring red. There lies my mother with strangers bending over her.
Here. Put this on it. Don't move. Hold your head down. Some people are
part of a staring background.
I am running into a tall building with two or three names I don't see
as I read through the glass windows I run past the front desk I've already
called an ambulance says a nice lady with red lipstick as she is hanging
up a receiver but I keep running my tears are flowing like the blood on
mothers face I am running into elevators and up stairs and on to another
floor 'til I realize I am in the wrong place and don't know where I am
going or why I'm standing here at the head of a long narrow hall with office
doors on both sides of a never ending grey carpet.
So I find another elevator and go back outside where a nice lady hands
me her card and says you can call me I saw the accident the ambulance is
carrying mother and grandfather on two stretchers inside I ask a young
man in short sleeves can I ride too. He says OK so I am about to climb
a stair but a man with a belly says wait give me the keys to your car so
I can tow it out of the intersection. So I say OK holding up the keys.
It's this one and he gives me his card as arms pull me into the ambulance
and slam the doors.
I am standing in a hospital room and a young man with shiny black hair
is asking too many questions. I am using my hands to tell him what he wants
to hear. He keeps wanting to know about the windshield. I sometimes answer
yes, sometimes no looking at the name of the hospital stamped all over
his green pants like K-mart. He is getting impatient with my shyness and
awkward smiles. Maybe he knows I'm lying and one's really sick. Did she
pass out or not? His mouth is flooding like a spring river.
Hania Qutub
University of Illinois
College of Medicine, Chicago
Class of 1996
Third Prize
Metastases
I.
Dirt stains, clutter, and chaos
in every corner, and you said
"This is where I'd like to die."
Surrounded by a riot of things.
But, when the hallucinations come
they will all begin peering at you
moving closer and closer...
It may not matter though since
it's said that every death is suffocation.
II.
Cancer creeps up your spine
and you say, "I don't feel no pain nowhere."
Six little bottles open on the card table—
is that all? Six little bottles and no pain.
"Even though I'm dying, even though I miss my children
already, even though I wanted there to be a lady that I loved
holding my hand."
III.
"Yeah, I was the meanest man in Carpenter, Mississippi."
Tell me something else, something fit for history.
"I'll tell you some good jokes, if you promise
to write them down." Tell me and I'll laugh—'til I cry,
'til your hands spread over your gray eyes and I wonder
if I should leave and if I have ever been this close.
IV.
"I'm going up on the rough side..."
I will even sing a little if you want, if it helps.
He says, "Just let the record lead you."
Sing even though you feel like shouting, like praying.
What's the difference now. There is a God—and I believe—
with a powerful hand—and you believe,
So hold on tight.
V.
Bananas, grapes, and butter pecan ice cream.
Brother will get whatever you want.
What you can still have. The throat went first.
Throat to lung to stomach to bone to spine to brain
as if it had a right to colonize your body.
VI.
You said, "Take three dollars in food stamps from the Bible."
So that's what is left. But you shouldn't have to die with
just that. Something is wrong. Which thing?
Which thing?
Tell me what this next goodbye means.
Let me know if this is an acceptable way to die.
Cinnamon D. Bradley
University of Illinois
College of Medicine, Chicago
Class of 1998
In the ER
I tried to concentrate despite the din outside the room.
A heart pumping. A heart pumping. A heart pumping.
A heart pumping. I look at the screen with the image of Helen's heart upside
down. I couldn't understand anything the tall, dark-haired tech was doing.
His face was fixed on the screen in stern concentration. I leaned over
the railing of Helen's bed in the dark room and touched her withered brown
hand.
"Looks like an anterior wall MI," he announced matter-of-factly.
I strained my eyes to see the hypokinetic tissue in Helen's heart that
made her sleepy, uncomfortable, and close to death. I imagined where it
could be on the black and white outline of her heart.
"What makes you sure she has mitral and aortic regurgitation?"
I asked haltingly.
"Well, basically, when you look at the Doppler scan...."
My eyes trailed off from the babbling tell tech
and his ECHO monitor to Helen's old hand and stared at the wedding band
on her ring finger. I asked her earlier who she lived with, and she had
remarked that she was alone at home, always had been.
"...and if you look at the directional flow of blood
in and out of the ventricles..." The tech was doing color graphics on his
portable ultrasound machine for me. From his calm posture one might have
thought that he was standing in line at the bank his lips moving in an
unfaltering tone that was droned by this woman's heart beats. My ears traveled
from his monologue to a gallant, booming alto outside our glass door, "I'm
dreeeaaming of a whiiiite Christmas!!" The bellowing voice rose and
fell like Helen's heart with the beginning and end of each word, rolling
like waves off a senile, old tongue.
Inferior wall MI. Anterior wall MI.
The room echoed the words. The nurses. The tech. The
resident. The cardiologist.
"Do you want us to call anyone?" I asked.
"No, I don't have anyone." She smiled at me warmly.
She raised her head from her pillow and nodded at me, shrugging her eyebrows
in affirmation.
She saw my eyes drift sadly to her ring finger.
"It's my parents'...."
"Left ventricular wall motion...."
"I'm dreaaming of a whiiite Christmas!"
"...what the hell is this, the Opera?!! We have
an inferior wall MI in here." For once the tech seemed to attempt an exhibition
of life with his wry humor.
Helen must have noticed my open month. "You see,
I never married. Just never met the right guy I guess." She paused, her
eyes fixed thoughtfully before her. "You know as a young girl, I always
thought of love as something best kept away from marriage."
I felt like sitting with Helen till she died at
that moment. This friendly parched old woman who had annoyed me with her
loquacious pointless parley less than one hour ago.
Throughout my questioning I had shifted uneasily,
as she told me about her second cousin's husband's friend's daughter's
pet poodle. The nurses who entered her room had rolled their eyes as she
spoke.
She lay between me and the man with a hundred electrodes.
The lines in her wrinkled forehead echoed my shame.
Hania Qutub
University of Illinois
College of Medicine, Chicago
Class of 1996
To Be Stoned
I used to walk uprighteously
Then tripped over pebbles, rocks, & boulders
with more passion than a first love.
So inseparable, as if til death do us part—the highs—
But the lows hated me.
Calculated sins afforded brief moments of that wedded bliss
But still, the lows hated me more.
My love stoned me—sacrificial crack in my worn
body & soul.
Would I succumb to "'til death"?
No, yet there was no divorce.
I belabored twelve steps to walk away.
Unfortunately, those deserted pebbles, rocks, & boulders
forever stalk me.
Tanya Reeves
University of Illinois
College of Medicine, Chicago
Class of 1997
Hands of Stone
—to my father's surgeon
You couldn't even catch a ball—
The last one picked and the first one pecked.
You were a pigeon-toed featherweight
who disappeared from the playground;
Returning new, in front of me.
With your hands of stone.
My father would never have approved of you.
Brow-beaten and throttled, you'd have
Brought your hands to your own chest.
You like the attention from the women a bit too much.
I'd tell you to put your game face on, but you never had one.
Tell me he will live or tell me he will die,
you would run if you were able to.
Your smile is not warm—it grins.
your laugh is not reassuring—it giggles.
There are no furrows in your forehead for a foothold, but
Just one small gray strand to cling to
Patrick McInerney
University of Illinois
College of Medicine, Chicago
Class of 1996
Panic
I'm feeling the pressure that's around me:
Stuporous gases that swell inside my mind
leave me faint and unable to fight
Dead-weight tears at the pit of my abdomen
and I wonder if the bowels will bleed.
...how can I love if unable to know it?
I see the yearning in her eyes and I want
to give myself to her and absorb the tears
But I fear she takes me for who I am not,
if only my body would allow me to feel...
I taste the salty wetness on my lips now
to tell me that my numb brow heralds fear
And a heavy electricity sends surges of shakiness
through my body in orbit around its center.
...where did I lose the control over this!?
An adult with education and all of that
I should not be falling for traps
for a brief moment I exit my person
to contemplate the dawn of these shackles...
In the final moment energy grows from chaos
to find all hurt love, burnt hope, dashed
dreams, and fear of premature extinction,
To focus on an organ beating though my chest
So that at these times I know my very death.
Steve Ciric
University of Illinois
College of Medicine, Chicago
Class of 1997
Fall in the
Corn Belt
You awaken
to an even darker morning
in a house on a small farm,
where your father once reaped
corn from the fields,
then abandoned
to weld GM chassis
and now, laid off, drinks beer
in his broken chair again,
gripping his leather belt,
ready to let it snap
and reopen the gashes
on your still stinging thighs.
Instead you slip out your window,
across the porch roof,
and jump to the safety
of the overgrown fields below,
whose weeds caress your body
like your mother's hands used to,
for one more day as you walk away
mile after lonely mile,
your misery is a map
followed anywhere but home.
But light fades all too soon.
Your thoughts return to your father,
beginning to hear his footsteps,
louder than the rustling leaves,
closer with each whisper
of your name in the wind
like his chilling breath on your neck,
summoning you to the flashing heat
of what home means.
Turning your head and running faster,
on to a country road,
his burning eyes are everywhere
even inside the pick-up truck
that ploughs you over
and shatters your leg and ribs. And fearing his punishment
for running out so carelessly,
so much now like the sissy he said you were,
gasping for breath
you peel away your body from the pavement,
and like a wounded animal
grinding bone against bone,
tearing muscles and skin from a trap,
dragging your useless leg behind,
you limp back into the safety of those fields
where the weeds reach out familiar arms
and softly cradle you to hidden sleep at last,
until they find you basking
in the morning sunlight
that thaws the frost
from your bloodless lips.
Jeff Zagst
Loyola University
Stritch School of Medicine
Class of 1999
Second Prize
Dweller
of the Deep Blue
He was a sea creature, an inhabitant of deep currents,
the depth of his passion like swift hidden ocean currents under calm seas.
His love spoke not with words but in gestures, in a lifetime of small actions
and habits of the heart. This sea creature, this blue whale, is now caught
under white sheets of ice, unable to burst forth but with lungs near bursting,
unable to breathe.
Home from the hospital for the last time, he gasps
for air as his wife of fifty years wonders how to help his pain. Feet at
the end of long legs untuck white sheets from a tiny bed set crammed into
the family study. He remembers this room where one son studied for the
bar, where priests and finances have slept, where his mother spent her
last year. In fact, she died in this very bed, relieving him as much as
his wife after that long year of progressive infirmity and confusion. He
had been the only one she knew in those last days twenty years ago, and
it had taken a real effort for him to connect her desperate face then with
that of the mother whom he remembered and loved.
Now his task is to breathe. He feels he is suffocating,
just can't get air into his lungs. And his thoughts are getting cloudly
from lack of air; like a baby trapped in the birth canal, his whole being
is hungry for air.
The wife tucks in the sheets around his blue feet
again, props him up somewhat in bed, doesn't know how else to help his
pain and breathing. She wonders what he wants and needs; perhaps it's time
for more pills. His writhing pauses, and he looks up at her with desperate
eyes, too busy breathing to talk and too focused on inhaling and expiring
to hold a pen. Does he know her, she wonders. Yes, there's that look of
affection and recognition when she calls his name and tells him that everything
will be okay. How soon, she asks, will the end come?
He looks into this woman's face. Who is she? I need
to breathe, he thinks. His mother stands over him. He is in her bed, having
sought refuge from the night and the closet mondsters. She tells him that
everything will be okay. He swims in her shadow; she will protect him;
she will love him.
They climb together to the sunlight above....
Brendon Cullinan
University of Illinois
College of Medicine, Chicago
Class of 1996
Before
Before
you ask me to unravel
my silk peels off
the form of my nakedness is revealed...
Say please.
Before
Your cold hands dice my body
I succumb to your demands
there is no privacy, only shame...
Ask please.
Before
you penetrate my walls
breathe into my loins
my sexual violation...
Beg please.
Nipa Shah
University of Illinois
College of Medicine, Chicago
Class of 1996
Generation
Gap of Medical Remedies
Mom, I have a cold and sore throat.
Take some goose grease out of the frig, warm it and put some
around your neck. Then, take some cod liver oil and a teaspoon of
honey and lemon.
No thanks. I'd rather take some Robitussin and Vicks vapor rub.
Mom, what's that smell?
Oh, that's my garlic water. I've been taking it almost everyday for
as
long as I can remember. It helps my blood pressure and diabetes.
No thanks. I'd rather take a multivitamin.
How was your dentist visit?
He pulled the tooth out. He gave me some pain pills and penicillin.
How many days do you have to take the antibiotics?
I am not going to take them.
Why?
Well, one of my aunts has diabetes. She had to take penicillin. She
got sick and was rushed to the hospital. So I am not taking the
penicillin because I have diabetes also.
Have you taken penicillin before?... Well, you can't become allergic
to it just because you have diabetes. You need to take it to prevent
infection.
OK. I'll take them.
Tais Crawford
University of Illinois
College of Medicine, Chicago
Class of 1996
Speculation
Hell naw! I ain't never seen no black docs up in
here before. But when she opened her mouth and started talkin' I knew she
was a wanna-be. Here she go askin' me "do you smoke, drink, or use any
recreational illicit street drugs." She really pissed me off with that
one, but I shoulda known better. I guess there's a whole lot more "white"
about her than that jacket she got on. "No, I ran out two months ago and
I ain't git no mo.," What's up with her grillin' me bout those iron pills?
"Huh? OK uh huh I am anemic that's what they told me after I had my first
baby in May and in July when I got pregnant again they told me I was still
anemic." Then she started telling me about how anemia means low blood levels
and by being pregnant I have to have enough blood for myself plus make
some for my baby. Since blood is made up of a lotta iron I have to take
these iron pills to help me out keeping my blood turnover rate where it's,
sposed to be. She told me that it's not unusual for a woman to get a little
anemic after having a baby because you lose some blood to the baby and
you lose some more blood when you go through delivery. She told me that
it's best to wait about four months after having one baby and getting pregnant
again because you have to give yourself enough time for your blood levels
to level off. There she started telling me that if I breast feed my baby,
I'll be smarter and I'll lose weight faster. Before I knew it we was talkin'
and she ended up hookin' me up on all kinds of things.
So now I'm standing in line waiting to make my next
appointment. I feel refreshed after today's visit and I'm actually looking
forward to my next.
Vanessa Foster
University of Illinois
College of Medicine, Chicago
Class of 1996
Another Angel
They traveled from far away.
Looking for a priest.
Father, please baptize our baby.
He does not have long.
Please, hurry. Please, hurry.
The infant's eyes were sunken,
Almost lifeless.
His shriveled tiny body was hidden in a blanket.
The priest ran from the church.
With holy water he blessed the child.
Just then as the Amens were said
The infant passed away.
His grandmother began to chant
—an old song to release his spirit to the heavens.
Everyone was crying.
His mother finally said
Do not be sad
For now we have another angel
And he will always guard us.
Miriam Manglano-Tierney
University of Illinois
College of Medicine, Chicago
Class of 1997
A Stranger
in Their Shoes
"No, I'm sorry."
"But he's a good student. He's done this many times." "I'm sorry, I
just don't feel comfortable having a
student in the room."
"I understand. Thank you," I say.
But do I?
How can I learn the delivery process and procedures
without being there!
I feel frustrated.
What's the problem? I've seen plenty of female patients
and deliveries.
I don't understand—or do I.
Now I'm in their shoes: the patient (well somewhat).
And even as a student, I question if we will
allow a "stranger" watch/help with one of the most
important times of our lives.
Seeing the two of us exposed.
The possibility of the stranger doing something wrong.
Am I a hypocrite?
I'm confused...
but now I am a stranger in their shoes.
Chris Schenewerk
University of Illinois
College of Medicine, Chicago
Class of 1996
Growing
Three months into medical school and his first patient is dying. A
man he hardly knew, yet so important to his life. "What is my role," the
student asks himself. Give moral support, but come on, anyone can do that.
"I should do more!" But what? He can't even answer their questions.
Why is he yellow? "Well...uh..."
Why won't he eat or pee? "You see...uh..."
But I heard morphine can be bad? "Well it's addictive..."
They try to extract information from his brain
like a mosquito sucks out blood on a hot August day. Angrily, he
wonders why don't they ask what innerrates the trapezius or the
insertion of the iliopsoas. The frustration is overwhelming.
The self-doubting begins.
"I'm going to be a doctor, for God's sake. Do something."
He lies there helpless.
Soon the patient's spirit leaves its organic counterpart.
Time passes....
It's three years later; the student is almost no longer a student. Looking
back, he realizes that he did practice good medicine. Giving moral support
is part of being a doctor. He realizes that these past four years were
not only helping him grow to be a physician, but more importantly he is
growing as a person.
Chris Schenewerk
University of Illinois
College of Medicine, Chicago
Class of 1996
Eleventh-Hour
Savior
Tanya Reeves
University of Illinois
College of Medicine, Chicago
Class of 1997
To Heal
Tamarah Duperval
University of Illinois
College of Medicine, Chicago
Class of 1996
I cry....
I cry but nobody hears me,
Why are they sticking me so much?
They are taking all my blood.
They filled up millions and zillions
of tubes and they want more....
Aw wo, Awo, that hurts
let me go! Let me go!
and then I kick and scream
and then I cry no more...
Sometimes I can't breathe,
then I get really hot,
I'm too tired, I can't play anymore.
They say I have phlemonia.
They think it is bad...
I don't wanna eat either,
and I won't talk anymore.
Because they keep sticking me
with needles. They are mean people
they say things I don't understand.
Granma looks sad. I never see
my mommy. Aichaibee?
Grandma what's that?
Marisela Dominguez, M.D.
University of Illinois
College of Medicine, Chicago
Department of Family Practice
Grandfather
I sat there watching him, this man, my grandfather.
Sitting on the couch, cigarette in hand.
Not really knowing what was on TV, not really caring.
Eyes closed, sleeping. He told us he was resting them.
Holding onto his cigarette. Smoke coming out of his nose.
He smiled.
I stood there watching him, this man, my grandfather.
Lying on the hospital bed, no cigarette in his hand.
IVS in his arm, oxygen so he could breathe.
Eyes half closed, mind half awake, body half alive.
Machines beeped, ventilators pumped.
Sitting up, trying to breathe, not liking his food, missing home.
I knelt there watching him, this man, my grandfather.
Lying in his coffin, arms folded, so peaceful.
Fingers curled as if holding a cigarette.
Wearing suit, old tie, old shirt.
No struggles, no worries
Once again with his wife, separated for eight long months.
Eyes closed, lips together, hair combed, skin cold.
No longer saying anything.
Keith Weiler
University of Illinois
College of Medicine, Chicago
Class of 1998
First Prize
Shadows
Raj Shah
University of Illinois
College of Medicine, Chicago
Class of 1997
Isolation Patient
# 681
No more silence,
Screaching violins.
Disco lights fire.
I scream of its betrayal.
White clothed girl exposes twin pink pills.
"Just say no."
White clothed girl summons
The Man
Shoots me up higher.
He carries me to The White Room
Nestles me into bed
Mmm.
But
Straps tie me down,
Bondage violates my soul.
Perspires,
Slips off His brow
Onto my naked forearm.
Videocamera consumes the act.
Exists The Man.
The White Room is bolted.
Siren expire.
Violence ends.
Silence returns.
Mary S. Ahn
University of Illinois
College of Medicine, Chicago
Class of 1998
Stairway to Heaven
The apartment you were rebuilding for you and your wife
Located right behind your parents home, it was really quite nice
Halfway completed just one year ago
Renovations since then have been put on hold
One might wonder why, for things appeared to be going so well
And basically they were, except for your health
It all began six years ago, as you turned twenty-one
When that tiny lump located above your knee proved to be malignant
Having found the sarcoma so early, after surgery everyone expected the
best
A beautiful new wife then a new baby boy, followed by a routine radiograph
of the chest
That same little tumor which had been removed from your leg year's ago
Had now spread throughout your body, barely twenty-seven years old
You retaliated bravely, armed with chemotherapy, radiation,and prayers
But after many months, you ceased your fire, resorting only to palliative
care
As a hospice volunteer, I visited at least once a week
Were you comfortable, was your pain well controlled, were you eating,
how did you sleep?
Always so cheerful, you had good days and bad
At times, strong enough to leave your parents' house and visit the
one you had worked so hard to rehab
Unfortunately, most of the remodeling you had completed was on the second
floor, out of your sight
As you describe the finished work upstairs. I knew the best medicine
I could provide was "one single flight"
I worked for weeks trying to find a way to transport you safely up those
steps
For a terminal illness had selfishly robbed you of your breath
Your desire to lie down and die inside the bedroom you had planned for
decades to live in
Transformed that one flight of stairs into a stairway to heaven
Sadly, your condition deteriorated rapidly over the Thanksgiving weekend
Surrounded by loved ones, you passed away peacefully on the first floor
of your parent's home
Although your life ended before ever making 'it upstairs' you are no
doubt in heaven
I thank you for teaching me more about life and medicine than my textbook
ever could have
Craig Allen Kornick
University of Illinois
College of Medicine, Chicago
Class of 1996
The Rhyme
"You never talk about literature,"
Was all that she said
Five minutes and thirty seconds
After we went to bed.
"Before, you would discuss Chekhov
In lieu of being fed.
While on reciting Keats,
Tears would you shed.
"And reading William Carlos Williams
Would make you see red.
For literature brimmed in your soul
Before you were pre-med.
"Recall that it was only for literature
That I thee wed;
Otherwise, I would've run off
With that law student, Jed.
"Now, talk is about how much
So-and-so bled,
And about bullets with which
Bones are shred. "Hours are wasted on germs
Or other things I dread
Now that only medicine
Has a hold on your head.
"And every night at dinner
I choke down my bread
For I've enjoyed more simulating talks
With our dog, Fred."
I turned to face her
And seeing that her eyes were red
All thoughts of sleep
From my mind quickly fled.
Visions of how to appease her
Came to me instead
However, I had to bite my tongue
Before I hastily said,
"In my heart, dear,
Literature is not dead.
Why, there was a wonderful article
In JAMA I just read!"
Raj Shah
University of Illinois
College of Medicine, Chicago
Class of 1997
Nadie Te Entiende
José is in the hospital
Nurses, doctors, residents came for information
Nadie te entiende
You sit quietly
Unsure of yourselves
And very shy
No one understands you
Why did they bring José?
Why can't they answer our questions?
Why don't they speak english?
Nadie te entiende
They "only" visit once a week
Do they know they can't bring their other children?
Why don't they get a babysitter?
No one understands you
Their children are so dirty
And where are their socks?
Nadie te entiende Dr. Reyes says you speak a different dialect.
Dr. Vincente says she can't speak to "those kind of people."
No one understands you
José is not gaining weight.
What did they feed him?
Did they feed him?
Nadie te entiende
Send DCFS
Have a nurse monitor the mother
You ask politely,
Why did those people come to my house?
No one understands you
You ask, why is José not getting better?
You want to take him home
He will be three months old the 10th
Nadie te entiende
Miriam Manglano-Tierney
University of Illinois
College of Medicine, Chicago
Class of 1997
Iron Man
I lost my way only once on the unmarked and haphazard
streets and highways of New
England on my way to Boston from my interview in a town just north
of there. I was going to stay with an old friend from college whom I hadn't
seen since his wedding in Philadelphia eighteen months before. After navigating
obscure and random Boston streets, I arrived at a pretty house with leaves
covering the lawn and masking tape around the borders of the garage-door
windows.
When she came to the door, I didn't recognize her
at all. Only later when I picked up their
wedding album was I able to connect my memory of the petite and joyous
bride I'd met once eighteen months earlier with the tired and very pregnant
woman who greeted me at the door. While we waited for Seth to return from
the hospital, Lauren brought me up to date on her and Seth's life together.
They had just moved into the house in West Roxbury, and would be furnishing
it as they went. Saying that a decent lamp would be their next purchase,
she uncovered a garnish and shadeless yellow lamp for me to view the album
picture. In the past month the pregnancy kept her from working, and she
spent her days occasionally talking to neighbors or waiting for Seth to
come home. She had been looking forward to this weekend, the first in months
during which Seth would not be working.
I'd met Seth early in college; as physics majors
we'd spent countless late nights together
finishing problem sets and preparing for exams. As our study group
became more comfortable we spent more time talking about ourselves and
occasionally about our futures. Seth had always wanted to become a doctor;
I was sure that from grammar school onward he'd always held himself to
an enormously high standard, and I never knew him to fail that standard.
I remember how easy it would be to trust his competence as a physician;
he shared with us his dream of being a country doctor, known and trusted
in some small town in middle America. In our last semester we'd had a very
memorable heart-to-heart conversation; saying that I would make a good
doctor, Seth urged me to consider medicine. And in fact that's what I'd
done.
When Seth returned home later that evening he looked
fresh despite having been on call the night before. It was clear that he
loved his job. While he showered, Lauren told me of the vision of their
living the romantic dream of being a doctor family in a small town, a dream
that had faded considerably when Seth's surgical residency began. Over
dinner he told me a little about his schedule. He'd have the weekend off
because the three residents on his team divided weekend responsibilities
such that every third weekend would be an "Iron Man" weekend: the Iron-Man
resident was on call from Saturday morning through Monday evening, but
had the following weekend entirely off. But, he added, an attending physician
had asked him to come in this Saturday anyway, "just for the morning."
Lauren did not look pleased.
Seth was in love with his job as a surgery resident.
Recently he'd been allowed to insert the catheters into the great vessels
of a patient in order to begin cardiac bypass. Once, while on call alone,
Seth had decided to and then performed surgery on a cardiac patient in
intensive care whose recent surgery had caused him to lose blood in this
chest cavity. "He walked out of the hospital later that month," Seth told
me.
He wanted to stay in academic medicine "to be with
people smarter than me who know more or less than I do." He was planning
to take three years off to explore the way cells organize themselves into
organs by applying concepts from physics and chaos theory. This would mean
that he'd be a resident for about ten years. I imagined the chaos that
this devotion to science and medicine and his patients might cause in his
married life.
Brendon Cullinan
University of Illinois
College of Medicine, Chicago
Class of 1996
Clinical Reflections
I'm searching for a piece of myself.
Checking charts—birthdates, addresses,
or an aspect of her history.
Just looking for me—in her.
It helps me stay grounded.
I don't feel so different
When I find a similarity.
We are more alike than not?
Sisters, sisters, I do know, I have ailed and
I have rejoiced.
Realize that first I am your sister and let that bond
fuel the rest.
I'll help you heal your body.
You'll help me heal my mind.
Fuel! Body and mind.
Vanessa Foster
University of Illinois
College of Medicine, Chicago
Class of 1996
Somebody Loved
Her
The ring is still on her hand, the gold shines as bright as ever.
His love has outlasted her, just as she had always hoped.
Her face, rouged with a brush, reddened by laughter, and blushed by
his touch, is kept moist grey under plastic over gauze on top of oil.
Her breasts, full of lust and full of ache,
were removed on the way to deeper, flatter, testable structures.
Her back, which bore the strain of five children and their burdens,
was halved by our hacksaw.
And her heart, broken a thousand times, was dissected perfectly,
and shows no want of blood, no mark of disease.
Her soul will remain alive in the eyes of her children,
and her heart will be burnt.
Somebody who loved her is left somewhere to grieve,
but none of us will mourn the death of our first patient.
Patrick McInerney
University of Illinois
College of Medicine, Chicago
Class of 1996
Second Prize
The 'El'
Ride to New York City
Just a few more steps. Come on. Wait! Stop! Pleeeease?
Damn! Too late. Missed the 'el' again, and this time I have to catch a
plane. I am in my fourth year of medical school about to embark on a two-day
journey to New York City for residency interviews. It's Chicago, it's December,
so it's freezing. And I just may have missed my plane.
I look around, and see others slowly filling up
the cement-roofed platform. The usual type—city walkers with Nikes and
pantyhose, white-bearded, leather-briefcased professor-looking types, and
the few young, over-consumed-with-appearance college students. I venture
a look down the hollow tracks, and am suddenly slapped by a brutal wind.
Punishment for my impatience. Punishment for being a Chicagoan. I retreat
in humble surrender.
Five long minutes later, the tracks shake, the people
on the platform rush about, and the train arrives. I quickly choose my
seat, naturally in an empty row. Everyone and their cousin in this country
respects space. It's an unwritten and widely-practiced law. One simply
does not sit next to another passenger when there's an empty row nearby.
Alas, seated and on my escape trail.
The train dwindles along, stopping as needed. I
stare at the lights everywhere, most of them clouded by the winter intensity.
I occasionally focus on a fellow passenger, when he/she is not looking
of course. Unwritten social law number two. My thoughts run without a pause
and without an order. I imagine an oil massage on a Maui beach, a sunset
that's happening about a mile above me at this very moment. Wonder if New
York City will be sunny? Will I survive its chaos, its numbing overstimulation,
its charm? Oh, oh, where's my ticket? My portfolio? Extra underwear? Alas,
a sigh of fatigue and impotence.
"Washington mumble static static mumble." Can't
beat the technology of communication on an antiquated Chicago train. The
train comes to a halt at the busiest station. Yes, it's Monday rush hour.
Yes, it's forty below with windchill, too cold for cars. And yes, it's
a downtown stop. But, why did the most rotund of the commuters have to
occupy the seat next to me? This triple-coated, double-gloved, wool-hatted
man glues the right side of my body to the metallic 'el,' and declares
in a husky, baritone voice, "Dang, it's cold out there." His big brown
eyes look at mine for a brief second, eager for a response. "Yup," I respond.
Short and succinct, I adhere perfectly to the protocol of a response by
a young woman traveling alone on a city train to an unacquainted member
of the male species.
Then, a few moments of perfunctory silence. Even
the most decent well-intentioned gentleman avoids the overzealousness at
the start of a conversation. I re-withdraw into the view from my window,
now that I am even closer to it. We are heading west, and within minutes
the glimmering Chicago skyscrapers are replaced by colorful, neon sign
of chain stores in strip malls. The stops are fewer and farther apart now.
I expect to have the seat to myself pretty soon. After all, he doesn't
have any suitcases, and the airport is the last stop on this line.
I turn away from the window and observe my cold-weather-loathing
seatmate rubbing his knees vigorously with his mighty hands. Somehow he
catches my stare. Caught in the act. My crime is my curiosity. "Zero and
below, and the blood don't reach my knees," he tells me. "Zero and below,"
he echoes sing-songedly.
Is he clotted? Is he status-post fem-pop by pass?
Degenerative joint disease? And what is this `zero and below' correlation?
Could it be studied double-blinded and controlled? Should I tell him about
anti-inflammatories, steroids, knee surgery? Is it may place? Do I have
a right?
The train arrived at O'Hare, its final respite,
and I excused myself. The 'knee-rubber' stopped his self-massage, and with
the aid of the handrail, lifted himself off the seat. I freed my left arm
in a gesture to re-acknowledge my space. "Take care," I said, looking at
the stranger directly. I hurriedly disembarked. I passed my old familiar
window, and took a quick look at my old seat. I saw him sit down slowly,
this time, next to the window. A few more steps, and I lose sight of him.
I head towards my gate.
Nipa Shah
University of Illinois
College of Medicine, Chicago
Class of 1996
Two Weeks
'til Christmas:
Reflections of a Pre-Medical Student
The woman in the hospital bed looked older than
the forty-some years documented on her chart. Her fleshless shoulders poked
landmarks in the otherwise formless hospital gown. Her face was gaunt and
pallid. Thin, mouse-colored hair, efficiently short, hung flat against
her scalp. Intravenous lines dripped medicine into her veins, and a nasal
tube provided her with oxygen. Her colorless lips were parted, revealing
discolored teeth.
This patient had systemic lupus erythematosus. If
I were to sum up my first impression of this woman with a single word,
that word would be "grey." Not grey as in dapple-grey, or silver grey,
but rather the grey of pavement or a November sky. If black represents
death, perhaps grey is the color for the terminally ill.
In the dim light, the woman merged with her surroundings.
She did not create a sense of presence in the room. It would have felt
the same had she not been there. She was seemingly only one small part
of the bed and the room. Certainly the room was a part of her, with its
tubes running into her arms and nose. Standing at the foot of the bed,
I felt my own physical boundaries were sharp and overly defined.
The woman's breathing difficulty, so efficiently
described by "s.o.b" in her chart, took on a different meaning as I watched.
Her entire concentration was on filling her lungs with oxygen. The television
was still and black, and no reading material was in sight. Breathing was
a demanding, conscious process.
The doctor asked if I wanted to listen to the patient's
chest sounds. She had a "pleural rub," a sign of fluid accumulation in
the lung cavity. The distinct noise is produced by the resulting friction
between membranes.
I took the proffered stethoscope, placed my hand
on the woman's shoulder bone, and listened for the lung sounds that the
doctor had described to me.
Hopefully I hadn't gotten the earpieces of the stethoscope
in backwards again. I'd been handed the stethoscope countless time in the
past few days, but there was still a fleeting panic that I would fumble
this extension of the doctor, or that I would be unable to hear anything.
I, however, had the requisite tool and the doctor's guidance to aid me
in this exploration of the patient's inner condition. It was exciting stuff
for a pre-medical student.
The doctor said that she had to step out of the
room for some reason. She suggested that I remain and discuss the patient's
disease with her. She then left, leaving me alone with the woman in the
hospital bed.
I did not ask her about lupus. Instead, I commented
on her untouched tray initiating a discussion on the unappealing aspect
of hospital food. When we'd reached that universal conclusion, I glanced
around the room for another topic. I admired her poinsettias. Christmas
was two weeks away. We talked about food, flowers, and the weather. I like
to think the woman enjoyed the non-medically oriented conversation.
The doctor returned. She turned to me and asked,
"So, what did you find out?" Offhanded I replied, "Oh, we were just talking
about her poinsettias." The doctor did not pursue the subject further;
she had enough on her mind.
I felt an aura of mild disapproval, whether real
or imagined. I felt, however, and still feel, satisfied with my actions.
Even more, I foresee that such conflict is only a small taste of what is
to come. I hope that I will be able remember this day. Medicine, and the
education that is so much a part of it, exists because of the patient,
and the patient's willingness to place trust in the health care provider.
Kristine L. Bell
Brookfield, Illinois
Jeremy
"He's pretty bizarre. I think you'll enjoy it."
My psych resident asked me to take on the case of
a University of Illinois college junior who had been admitted through the
emergency department the previous night.
"What do I do? A physical?"
It was my second clinical experience in medical
school and the first exposure to hospitalized psychiatric patients. I was
aware that I might be interested in psych but had no clear idea of what
to expect, much less what to do.
"They did all that stuff last night. Just talk to
him."
Great, I thought with sarcasm, real precise directions.
I'll just slide right in next to the patient and start some serious analysis.
Jeremy was sitting in the day room of the inpatient
ward, a locked unit that requires a key to get in, or out. The patients
shared rooms, two apiece, but spent most of the day in this common area
or simply floated around the two hallways that extended from a central
nursing station. The day room had a few couches, T.V., card table, and
refrigerator, but the white, tiled floors and sparsely decorated, yellowing
walls lent an institutional feel. I was nervous about entering the room
and being an obvious outsider, not only a non-patient but a new staff member.
Another staff member pointed Jeremy out to me.
"Hi," I introduced myself by name and as a medical
student assigned to help take care of him. "Can you tell me about why you're
in the hospital?"
He was sitting yoga-style, alone, on one of the
couches, a blondish kid with short hair and the blondish stubble of a beard
beginning to form on his face. He had a tall, slender build and the hospital
jams fit loosely over him, adding to the picture of a Tai-chi student in
uniform, mediating. His eyes, gently closed, the face, expressionless but
serene. "The images are in technicolor and move as if a kaleidoscope, but
it's the back of my eyelids and I'm really afraid my friends are right,
did I kill her, I'm really not sure, or are they playing a trick on me?"
He had taken "magic mushrooms" with a few other
people over twenty-four hours ago and apparently experienced a bad trip.
His friends had brought him to the ER because almost a full day had elapsed
and he was acting very weird. He was worried he had attacked a girl during
this time, or at least that's what his friends told him at one point. His
parents, who lived around Peoria, were going to kill him—or worse, make
him move back home.
"Can you interpret for me the following proverb:
People who live in glass houses should not throw stones." The 'normal'
person, falling into certain ranges for I.Q., education, and literacy,
and being of an appropriate cultural context should answer by generalizing
the proverb's interpretation to humanity. For example—people should not
hurl insults at one another because they themselves are sensitive and can
be personalizing the saying, making it self-referential, with a sometimes
extremely abstract interpretation or even a very concrete one, like, 'the
glass window will shatter.' "If my emotion is expressed to the world,"
he said, "the deception is uncovered, and I'll be punished for being a
bad person, too hateful, selfish, sexist, and racist. Pure evil."
The initial picture of Jeremy, sitting serenly and
speaking loosely, tangentially, describes a profoundly psychotic person.
A kid on a bad trip or someone with mania or depression with psychotic
features probably would not present so calmly under those circumstances.
Defining psychosis, Jeremy's ability to test, to even understand his reality,
or more exactly ours, was absent. His diagnosis was Brief Reactive Psychosis,
although the team consensus was that the hallucinogens precipitated the
reaction, despite their chemical effect having worn off. The idea that
many of us may go day to day with a predisposition to some kind of mental
'break' or to extrapolate, somatic one, and require some environmental,
social, chemical, or traumatic precipitator is well known in medicine but
its expression is so varied and unclear. That's one thing I love about
psychiatry: it teaches us that we are all in for some surprises in life,
some devastating, but all intimately linked to how we perceive, process
thoughts, and feel the world.
Steve Ciric
University of Illinois
College of Medicine, Chicago
Class of 1997
Fireworks
I began working for Mr. Johnson when I was thirteen
years old. My friend Rob was his
neighbor and had worked for him before, leaving for a more lucrative
position mowing riding trails for the Kensington Saddle club. Rob and I
worked together the first few weekends, and he showed me where the pruning
shears were kept and how Mr. Johnson liked the enormous garden hose coiled
in long loops rather than in a tight circle. When Rob left, I got that
first-day-on-the-job neverousness again, but Mr. Johnson was a kind man
and easy to work for. He was about sixty, balding on top with grayish-blonde
hair, and an old-time thick moustache. He was an executive of some sort,
but I could tell he had had a country upbringing. His wife was also friendly,
though quiet, and prepared wonderful lunches for us.
Mr. Johnson took an active interest in the care
of his place. It was a large piece of land, even in our area, hidden far
from Donlea Road by thick woods. The house itself was of the midwestern
farm style, and sat behind an old hedge. There were many birch and maple
trees scattered among small, well-tended gardens. Across the drive was
a small corral adjacent to the huge wooden barn, and a long shed containing
the vast supply of tools and equipment. Behind the house was a giant, sloping
lawn that curved gently against the thick oaks and weeping willows, like
a soft green pond. Further off was an old pasture and the dark, silent
lake where Rob and I fished for bass and big northern pike. All this was
Mr. Johnson's, cared for first by him and his son, then by him and Rob,
now by him and me. It was really very beautiful.
I settled into a routine pretty quickly. I would
ride my bike over in the cool early morning, and get right to work trimming
the hedge. Mr. Johnson would leave the trimmer out on the porch for me
so I could start with this quiet chore while the house was still sleeping.
I would glide the trimmer over the protruding, upstart leaves, with dew
still stuck to them, cleaving them neatly. Afterward, Mr. Johnson would
come out with a list and tell me where to begin. He might say, "Some branches
fell down in the back pasture. What I want you to do is haul them way back
in the woods, so they can't be seen when the leaves turn brown."
He always explained why he wanted things done a
certain way. He would make sure I understood, then leave to tend to a chore
of his own. Sometime mid-morning, when the grass had dried, I would begin
cutting. Halfway through that first summer, he taught me how to operate
the tractor. It was an enormous machine, an ancient International Harvester,
with only a little of its faded red paint remaining. It had a large and
intimidating mower deck underneath. Mr. Johnson had been using this to
cut the big area of lawn beyond where I had cut with the hand mower. He
showed me the levers for raising and lowering the deck, and how to adjust
the choke to start the thing under various conditions.
"When she's cold, you'll have to choke 'er all the
way," he yelled over the din, "And watch those belts there. You get a hand
caught there and she'll rip your arm out the socket."
I climbed 'way up onto the little seat, which gave
way with steel-spring tension, startling me a little. Mr. Johnson laughed,
"She don't have any shocks. That's the only shock she got."
My muscles tensed, and with nervous hands I put
the tractor in gear and took my foot off the clutch. It lurched, then stalled,
and I stomped back down on the clutch. "Easy, now," said Mr. Johnson, and
I eased out the clutch, slower this time. It lurched forward again, but
caught, and I rolled ahead. "You got 'er," he yelled.
I rolled along toward the lawn with a proud smile.
There was a strong gasoline smell, and the machine coughed out black smoke
now and again. After I had finished mowing, I stopped to examine my work.
I smelled the fresh-cut clippings, and walking along, stained my tennis
shoes green.
Arriving one Saturday in October, I found sitting
in the drive a big, gasoline-powered roto-tiller. Mr. Johnson had rented
it to mulch the dead plants in the vegetable garden. The air was cool by
now, and the leaves had turned. I could taste the rich scent of autumn,
the brooding power of this fleeting season. I first gathered the bulk of
the plants for the compost heap. They had already begun to rot, and were
wet with a pungeant, organic smell. I also collected the dead, half-grown
squash and eggplant that had already begun to decompose and mingle their
soft flesh with the black earth. The tiller was a powerful machine, with
menacing blades protruding from the front, and wheels covered with dried
mud in the back.
"This beast'll pull itself," instructed Mr. Johnson.
I stood behind the tiller and held the handles tightly,
without fear. "Let her chew on that dirt awhile, then lean on her a bit.
She'll move ahead. Greener pastures."
With awesome power, the blades tore through the
soil, churning the mulch in its revolving course. I made my way slowly
back and forth under the raw, gray sky.
Around noon, Mrs. Johnson rang the bell by the back
door. Her father, who lived nearby, would sometimes join us for lunch.
He was old and somewhat feeble, but still pretty sharp. Though not appearing
overweight, he was bulky, and I remember thinking he must have been very
strong at one time. He had bushy eyebrows and was very friendly. When Mr.
Johnson and I came in that day, he was sitting at the kitchen table, talking
with his daughter. The kitchen was warm, and thick with the smell of beef
stew.
"It's nippy out there today, huh fellas," said the
old man. "I don't believe it's getting any warmer."
"That's right, Pop," said Mr. Johnson. He looked
at me with a smile. "We'll be pruning back the rose bushes this afternoon
and covering them for the winter." He had warned me a few weeks before
about this particularly tedious chore. "You'd better dig out the iodine,
Sally. The kid may need it before this day is over."
The stew was hot and delicious. We ate it with warm
bread and big cups of cold milk. Suddenly, Mrs. Johnson's father began
coughing violently, struggling to inhale. I was sitting closest, just on
his left, and watched not knowing what to do. He wasn't completely choking,
but obviously suffering. He coughed out chunks of food and spit. Swaying
forward, he inhaled deeply, easier now, his face bent over his plate. Something
clear, tears or saliva, fell from his face. Mr. Johnson helped walk him
to the bathroom to clean up. I was sweating.
"Growing old," muttered Mr. Johnson. "Growing old
is hell."
After a couple of years, I left Mr. Johnson's to
work as a busboy in town. Now, years later, I am struck with the clarity
of these reflections. At the time, these things just happened. They seem
to mean more now, to give some twist to logic, some sort of insight. Now
just four weeks away from graduating from medical school, I am still trying
to understand these things.
During the first two years of medical school, the
students never even touched a patient. In June of our third year,
we took the National Boards exam, and started in the hospital soon after.
We had had an introductory course in clinical medicine where we practiced
the physical exam on patients who had varying degrees of tolerance for
fumbling students. My first real assignment was internal medicine at the
nearby Veteran's Administration Hospital.
The medicine rotation at the VA was notorious for
breaking the spirit of many a medical student. We all knew beforehand what
we were getting into?- to 100-hour work weeks, on call overnight every
fourth night, and a team of only one resident, one intern, and one student
to take care of up to thirty patients. Menial labor-intensive tasks, known
as scut, performed at other hospitals by paid employees, was done here
by the team. These things trickle down, of course, and the intern and the
student typically started all the IVs and drew blood in the middle of the
night. Patients came to the VA because they had served their country and
had no insurance. The VA was considered a step above the county hospital,
or maybe half a step. Our patients, coming from the west side of Chicago,
were mostly poor as hell. Regular health maintenance was not a priority
in their tough lives, and the bloated, poorly-funded federal system did
not particularly encourage a change. Admitting a patient with a tumor like
a softball sticking out of the side of his neck was never a surprise.
We met that first morning, the eight students, outside
the designated conference room. Our short coats were clean and white,
and the men wore their favorite ties. We showed each other our stethoscopes
and made nervous jokes about bringing in a toothbrush for whoever was scheduled
to be on call that night. One of the high-ranking attendings gave us a
brief pep talk, then the chief resident took us to meet our teams. One
by one we were swallowed up into the tiny residents' rooms where the teams
were meeting for teaching rounds. My attending was Dr. Patel, an older
man from India. He had a rough, expansive face and shiny eyes. He alternated
between being very serious and very jolly. He would sit with his palms
on his thighs, then lean 'way back in his chair with an enormous laugh
when something amused him. The senior resident was a Czech called Theo.
He was stern at first, but relaxed some after a few weeks. The intern was
short, with a young-looking face and a loud mouth. His name was Mike, and
he had just graduated from my school. "You live around here?" He boomed,
"We're on call tonight." He turned out to be a really great guy.
After rounds, Mike showed me around the ward. He
showed me the bandages and syringes kept in the locked supply room, and
how to use the computer. Patients walked up and down the hallway pushing
IV poles and talking loudly. Others crowded around the nurses' station,
laughing or complaining about something. There were stuperous patients
sitting in wheelchairs along the walls with bags of urine strapped to their
armrests. There were a few small patient rooms along the hallway, but most
stayed in the big room at the end of the hall. This room had sixteen beds
and four televisions. The odor was terrific. It varied in character, but
was always there. Sometimes the strong feculent odor of waste or the acrid
smell of urine dominated. Other times it was just the unwashed, diseased
flesh or the sharp chemical smell of disinfectant. The antibacterial soap
was also distinctive, and lingered, so that even if I smelled my hands
at home the whole ward would come rushing into my mind.
Later that afternoon, we got very busy with admissions.
I watched Mike start an IV on a new patient. "You'll do the next one,"
he said. "See one, do one, teach one."
The next one needed to be done pretty soon. Mike
took me into the supply room and began putting stuff into my hands. "You'll
need this, and this. And this." My arms were full with tubing, catheters,
guaze pads.
"You'll also need this," he said, stuffing a tourniquette
into my pocket. "Don't lose it. This is the VA and I doubt you'll be able
to find another one. Go ahead and get set up. I'll be in in a minute."
I introduced myself to the patient, and set all
the things down on the bedside tray. I connected the tubing and laid out
a chux pad to protect the bedding from blood. I opened the catheter and
guaze as I had seen Mike do. He came in and rearranged a few things.
"The key to this and all procedures is to have everything
positioned right before you begin. OK, go ahead. Wait, don't forget
gloves."
I wrapped the tourniquette around his arm. I was
nervous and dropped the catheter, contaminating it. As if expecting this,
Mike pulled another from his pocket and handed it to me without a word.
"He's got great veins," said Mike. He pointed to
a big blue-green bulge. "Try that one."
I wiped it down with alcohol, making it shine and
stick out even more. "Little pinch," I said.
I plunged the catherter in, pushing firmly and looking
for a return of blood. I pushed
further, but still nothing. "Pull back and try again," said Mike patiently.
This time a drop of blood appeared in the plastic
window. "In a little more," he said. "You got it."
We finally went to sleep that night around three.
It was still dark, though very late when
the PA went off.
"May I have your attention please. Code blue, six
north. Code blue, six north."
Mike was already reaching for the door while I tried
to shake off my sleepy confusion from on the top bunk. "That's us," he
said as light flooded the room. I jumped down; everything was rushing.
My mouth was sticky, my hands suddenly cool and damp. I fumbled for my
glasses and darted after Mike, the hallway like some weird fluorescent
tunnel. As we approached the dark ward, I could see at the end of the hall
light pouring out of the room on the left, and nurses hurrying about. There
was a crowd around the bed in the corner, and the other patients lay with
wide eyes under their covers. The dying man lay naked, jerking rhythmically
with each thrust made upon his chest. At his head, a resident was holding
a mask over his face, squeezing a bag with a hissing sound. Another resident,
a tall man, stood with his arms crossed, calling out orders.
"Epinephrine, please. Someone get a gas—try that
left arm." He laughed. "No. The other left arm."
Everyone seemed busy, precise. A nurse was placing
EKG leads on the man's chest while
another was carefully writing on a clipboard. There was a strange,
earthy smell in the room.
"Let's shock him," said the resident. "200 joules
please."
A nurse made an adjustment on the machine on the
crash cart. The resident took the paddles and untangled the wires. "Hold
CPR," he said. He placed the paddles on the man's chest. "Clear." Everyone
backed away. He pushed a button on one of the paddles and the naked man
jerked violently and was still. Someone placed his fingers deeply into
the man's neck. "Nothing," he said. "Resume CPR."
I stood outside the circle, watching. Someone had
to get by me, and I backed away from the scene. An older man, I never knew
what his position there was, leaned close and said passionately, "You got
to get in there. You got to grab all you can."
He walked over and whispered something to the tall
resident, who looked over at me. The
older man motioned to me, and I squeezed my way up to the beside. The
resident who had been doing compressions was sweaty.
"Ready to switch?"
I moved as though through water. Stepping up, I
bent over the man and placed my hands on his chest. I began rocking down
and up firmly. His ribs gave way like a spring, and I could feel cracking
somewhere inside.
"A little faster," someone said gently. "Watch the
monitor and get a nice, even rhythm."
All my muscles were taut and I was soaked with sweat.
It dropped on the inside of my glasses. After awhile, I heard, "I'm gonna
call it." I felt a hand on my arm and I stopped. The man lay still on the
bed, and someone moved to cover him. As we silently left the room. I could
see out the window the pale light of morning moving over the city.
A few days later, Mike and I were going over a list
of things to do. We had our feet up on the desk when Theo came in. "What
are you doing?" he asked. "Stomping out disease and saving lives," replied
Mike.
He looked at us. "I hope I don't get sick."
"We are pacing ourselves," I said.
"Well Mr. Stewart is asking about you. He says he
needs a CBC checked and you're the only one who can do it."
I reached for my tourniquette.
"Oh, we are getting an admission, you may want to
pick him up. He's got a head and neck CA. Dehydration, calcium of
17."
"Otherwise healthy," added Mike sarcastically.
Cancers of the head and neck are killers, and Mr.
Stevenson's was the size of a grapefruit. I learned about him mostly from
his chart, as he wasn't able to speak when he came to us. He had been diagnosed
about a year and a half ago and treated with chemotherapy, but had stayed
away from the follow-up clinic after that. We later learned from his family
that his right check had slowly swollen up, and he had become thin and
weak. But he refused to come back. "I ain't gonna take that," he'd said.
"Bringin' everything back up and runnin' off from behind. Just leave me
be."
The oncology consult service regarded a calcium
of 17 as a therapeutic challenge. They tried a variety of drugs, but if
it went down any, it soon came right back up. We put a tube down his nose
to feed him. His sister wanted that, but consented when we asked to make
him DNR. We saw him every morning on rounds, looked at his chart. What
were we going to do? Sometimes his eyes were open and tears rolled down
his face. I wondered if his tears were a physiologic response to his being
unable to close his eyes, or if he was crying. Was he thinking? Was he
feeling?
We were on call July Fourth. Late that evening,
after helping take care of our new admissions, I was sitting in the residents'
room. I knew the routine, and had earned a few minutes' rest. Maria, one
of the nurses, came in and told me that Mr. Stevenson's IV was out. It
had taken me an hour to start his last one, as the chemotherapy had fibrosed
all of his veins. Walking into his room, I saw the IV catheter with a piece
of wet tape stuck to it hanging from the pole beside his bed. His roommate
was reading the newspaper by a beside lamp, casting a shadow into the corner.
I looked down at Mr. Stevenson. His eyes were open, blank, and his skin
was very pale. I felt his wrist for a pulse. It was faint, distant and
very slow. There was a thick and pungant smell. I moved the IV pole out
of the way and adjusted his pillow. There wasn't any point in restarting
his IV now.
Mr. Stevenson's roommate looked over at me. He was
old, with sallow rough skin. I had seen him before, but he was on another
service. His checks were drawn, and his IV bag was wrapped in brown cellophane.
Another cancer patient. I wondered where it was.
"You can see the fireworks," he said, looking out
the window.
"Yeah," I replied. "Happy Independence Day." He
knew what was going on, I could tell. I sat down. He put down his
paper.
"We used to get the big ones, when we'd go on leave
to Hong Kong. We'd send 'em right off down the street." He paused and looked
at me. His face was impassive, and he held still the newspaper in his lap.
"We used to get them in Wisconsin," I said. "Me
and my friends would have wars with the roman candles. Nobody ever got
hit, of course, you never knew where those things were going when they
fired. Actually, I did get hit once, on the sleeve. My mom was pretty mad.
It was one of those Izod shirts—remember those?"
"With the alligator?"
"Yeah. She'd got it as Marshall Fields and all.
She was pretty bent outta shape."
There was a sudden gasping sound from the next bed.
I got up and stood over Mr.
Stevenson. His eyes were open, not looking at anything. There was spit
running from the corner of his mouth. His chest did not move. I placed
my stethoscope over his heart. Slowly, yes, and softly, but it was still
beating. I stepped back. He inhaled violently, and began slowly breathing
again. I sat back down.
"We used to take the streetcar down to Marshall
Fields," said the old man. "That was the easiest way to get around in those
days."
The dark smell seemed to fill the room.
"When did that stop running?" I asked.
"1940. Of course the buses were running extensively
by then."
I looked over at Mr. Stevenson. He was still. I
got up, listened again. There was a faint, distant beat, a long pause,
then another. I kept listening. Dumt. Dumt. Then, nothing. I put my stethoscope
in my pocket. The old man was looking out the window.
"I'm gonna do that when I get outta here," he said.
"Go shopping for some new clothes."
"What's wrong with what you have on?" I asked, indicating
his VA issue maroon polyester pyjamas.
He looked at me and smiled weakly. His face still
held a stoic expression. He looked out the window again.
"It's finished," he said. "The fireworks are over."
"Yeah," I said. "They're over."
Keith Luther
University of Illinois
College of Medicine, Chicago
Class of 1994
ACKNOWLEDGEMENTS
The monstrous task of maintaining and perpetuating this literary journal
required the time and energy of many extraordinary people. Our sincere
gratitude goes to Suzanne Poirier, our advisor and mentor, as well as Rafia
S. Farook for her abundant efforts at typing, re-typing, corresponding
and re-corresponding.
Our judges Raymond Hart, Robert Molokie and Hyman Muslin also get our
warmest thanks.
This 12th issue of Body Electric couldn't have been born without all
of you.
Thank you once more.
Sincerely,
Editors
Editors:
NIPA R. SHAH
College of Medicine '96
RAJ SHAH
College of Medicine '97
KIM BROWN
College of Medicine '99
Advisor:
SUZANNE POIRIER, PhD
Department of Medical Education