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Poetry and medicine intersect in the domain of body and speech.
The iambic lub-dub of the heartbeat, repeated five times, once for each finger of the hand, gives us the prototypic stanza of english verse, iambic pentameter:
Shall I compare thee to a summer's day ?
My mistress' eyes are nothing like the sun
I have been half in love with easeful death
Against the heartbeat play the more subtle meters of the breath, of sleep and waking, of sex, hunger, childbirth, hope and hopelessness. The body is a fugue of interwoven rhythms.
If we translate the beautiful Latin of our clinical vocabulary, we discover cisterns in our head, boats in our wrists, vinegar cups in our hip joints. We hear through wings and shells. A rainbow surrounds our pupils.
Even the Alphabet seems derived from the body. With the Os of Ocular, Olfactory, Oral, and Otic, our senses open on the world.
In medicine, hearts gallop, murmur, burn, rub, skip, attack, fail, arrest. In poetry, hearts ache, break, ease, rend, harden, throb. A living metaphor sings inside our ribcage.
Poems move along our synapses, associatively. Thyroid gland, bowtie, butterfly. Freud, one of Medicine's great poets, knew this.
There is an ancient impulse to tell stories, to create rituals for the moments of birth, coming of age, marriage, and death, to find what is binding and universal in the isolating particulars of our experience. In medicine, we are privileged attendants at these moments. Moments that come to us as well.
Before the writer must come the reader, the listener, the observer. We are immersed in the strange poetry of our patients' histories, in the rhythms of their speech; we must fathom the significance of a hesitation, a repetition, an unexpected cadence. We must hear the unspoken, decipher their secret code, their metaphors. The double meaning of semiotics: relating to semantics, relating to symptomatology. And at times we are witnesses as Language itself unravels, fails, and reveals the raw machinery of brain — aphasias, slips of the tongue, schizophrenic neologisms — unmasking hidden connections, utter disconnections, the weird contingencies of meaning, the perils of communication. Our avant garde.
Newton, Massachusetts
Laying I wait
Curled. A fetus
Skin so white, so thin
Waiting. Waiting.
August, I was born
People gathered
So many people
Eyes upon me
So many eyes.
They came to see me!
Everyone stands.
I am lifted. Up. Up.
Into my parent's arms.
Oh, so gently taken
Embraced with pride
My journey begins
To see the unforgettable
To learn without limits
Cradled in my parent's lap
I wait.
Gentle caresses I feel
Catching sweet smiles and glimpses
It's time!
Lifted, my arms unfold. Extend.
Embracing. Wrapping.
Close to my parent.
Piggyback ride, I go.
Into my journey
The next 4 years.
I am christened
"White Lab Coat"
College of Medicine
I no longer feel human.
The center of my brain has fallen out—
phone numbers of friends,
my mother's lullaby when I was three,
yellow daffodils in the rain—
I no longer linger on these.
My parents are now
white-coated lecturers bringing
simultaneous information
five forms of data:
chalk, overhead pen,
you must, you must, you must,
photos of people who you want to cry about so you laugh,
sounds and the power of the multiple choice test.
Sometimes people move to a new town
and they forget why they came.
They mow their lawns,
they make friends,
they get used to living next to the cemetery,
above radioactive ash, and without telephones.
In the smallest ways,
I've moved into medicine's
latest storefront on the mall.
I've learned to live on promises
of a better day next week,
next year.
When Thursday comes,
I may forget why I came.
Class of 1996
Volume XI (1995)
She cannot walk
from
parking garage to whirling world.
She freezes on cement incline,
sliver of a hill.
"Cheryl, can you get me home?"
No pain
but fear of it
collapsing her heart
clogged by a calcified rock.
This is the solution:
that is the requirement:
that all pain has a name,
that all people have a first and a last,
that all misery has an end.
Memory cannot be destroyed,
is not a shtick,
is not forbidden fruit.
Paradise is tomorrow.
Class of 1996
Who is it that calls with dusty voices from out of these
Pages ancient and new; alive with mystery?
You who ask me to stand vigil at the bedside
To eat the fruit of my fear and my longing.
The gift is not yet won.
Reading the myriad stories of women and men;
Watching over their lives and their deaths.
You have provoked me with my own deepest desires
But how can I heal the broken and lifeless,
The tired eyes, the slow tongues,
The drunk, the lonely, the weary ones?
Your touch, your work, your love in my hands
Your love in my eyes and on my lips
Your presence shining from the haunting eyes
Of the sick and dying.
I will drink in these precious lives. I will turn the page.
I will lift up my eyes and struggle on.
For the God of my hope and my joy and my
Secret thrilling at the mysteries I have
Chosen to watch over will summon my
Spirit to flow out of me like light from an overfilled cup.
A shining wave that washes over the weary world
And unearths the truth and the courage and the
Hope and the glory and the unfailing love that
Bursts forth with a shout like a
Child from the womb.
College of Medicine
It's getting kinked somewhere, I can hear him muttering. It's amazing he even found the vein, the kid's so edematous. So wrapped up in his big procedure Seth is that he hasn't even noticed that I've come back, much less that I had gone. Gone to talk with Mrs. Lu. Gone to shield her from the butchery Seth was intent on performing.
I groped for words in Mandarin, heck, even in my sorry ass Taiwanese, I was so distraught. And she...she was hysterical.
Maybe he feels the heat of my scrutiny. Looking up he sees that I'm still fuming.
What's up with you? I've gotta learn, he snorts.
My stare is scathing, burning holes through him.
You bastard. You are such a bastard.
He snorts back—goes back to forcing in the guidewire.
I'm repelled, but come to think of it, I did exactly the same thing two weeks ago on the multiple gun shot wound. But this is different. Or is it?
I wonder if I'm overreacting. Making a sin out of a little insensitivity on his part.
What would Rosalyn say?
Actually, I know what she would say.
You think too much.
I perk up from my trance and there he is. Still going at it. A fucking central line. All for a little fucking practice.
I try to concentrate on the face in order to burn it into my memory. To immortalize Ben as I would want to be immortalized.
The mouth is cavernous. It beckons—rounded to an "O." The eyes are so proptosed. Bulging as if to say, Why don't you just let me die?
Ben was last here a month before. Brought in after tumbling head first off his bike. Probably speeding away in some passion of anger or heartbreak when he hit a bump. Brain CT'ed, we were just observing him for a while. He, twitching there in pain, waiting for his mom...grandma...dad...whomever, to come. To show that they cared.
A call home for informed consent and it was found out that Ben was not living there. A truant, he was. The girlfriend cried over him when the nurse told them that they weren't coming.
God, to be worshipped like that. It makes me think of the day before I got my med school acceptance letter...late. Sarah told me that Wren had tears in her eyes when she heard me screaming at my mom over the phone next door. Screaming, having been screamed at by her for not getting into med school—so she thought at the time.
Is that all you ever care about?
Who said I ever wanted to go to med school?
I can take care of myself. I don't need your money.
Wren hardly even knew me. And yet her heart pored over me.
I miss that feeling. To be cried over. Actually, it was the same thing with Sarah when we first started out. She had fallen in love with my suffering. My martyrdom.
Maybe I do think too much. See myself in other people. See associations that don't exist. Sure, we are complicated creatures. And individuals, at the very least. I know that. Sure, I hardly even knew him. But Ben and I—we are kindred spirits. I'm almost certain of it. To think Audrey Hepburn is a babe. (Well, maybe it was Ingrid Bergman for him.) To dream of previously unimagined worlds and existences, to the forlorn strains of bossa nova. Maybe, it ached. His whole body ached to memorialize the poetry of his life on paper. Maligned by the masses. Laughed at. Scorned. We would always be misunderstood. Like the daydreamers and revolutionaries that perished before us.
Well, this time...today, Ben Lu would be carried out of the ER and I would be standing there...alive...a sell-out.
Somehow he had lept off the pier without being seen. Swam out as far as he could go, not sparing any energy for the return. Don't they have lifeguards or something?
It must have been something though. At the mouth of the river, bridgeheads overlooking the lake in grandeur. Morning light from cracks in the sky. The spires of Navy Pier. A swan dive against the background of a downtown skyline.
Meanwhile, battleships—the clouds edge above.
My shift is done. The body lays in a bag on its way to the morgue. I step out and there is Rosalyn waving me from triage.
For blocks we walk without a word.
Train wreck today? she pipes up as we're crossing Paulina.
A few more steps we trudge. The feet are heavy, the mind is numb.
Why are you with me?
She semi-circles around, eyes quizzical, sparks raining down on her from the tracks above.
You know? I squint as my head is throbbing. Today, I came across someone who did what I could never finish.
I wipe my eyes as she's getting blurry. Hard, I am trying to hold them back, but the tears are just streaming, obscuring everything. Stoplights, taillights. They're all running onto slick pavement like watercolors.
Yeah, sure I'm happy now. Or so I think I am. But I'm a failure.
Cars are beginning to pileup over on Harrison. An occasional pedestrian glances at us curiously.
I mean, look at me.
Look at me, through sniffles.
Steam is enshrouding her from a grate behind. Toxic is the smell.
I once thought I knew what I was living for. Or at least living against.
Now I don't even know what I am.
Rosalyn obviously doesn't know what I'm talking about. She's looking sweet and embarassed.
There he goes again. Beating himself up. Silly, sentimental...melodramatic fool, she is thinking. My Jim.
Come over here, her arms call out to me.
She enfolds me and I'm bathed in this warm space between her heart and a tight leather jacket.
No words pass between us as she is rocking me in her arms, cooing at me and I'm even more convinced that she doesn't understand. And that bothers me a bit. But, it's over anyhow, I realize.
Tomorrow, next week, next month. She will tire of me and my melancholy. As residual as it may be. As much of a shell, my deep sadness is of its former glory, it will sicken her. And yet it's this habit that I haven't been able to shake since high school.
Love.
Life.
Cherish.
These are the words I am mumbling as her head rests on mine, my face buried in her armpit. She's probably thinking how queer it is, but she doesn't dare call me on it in my throes of grief. For brooding is beautiful for so long. And then there is this instinct to breathe, this struggle to live that takes over. This I am thinking as a couple passes arm in arm and the cars inch along. As the El train rattles by once more and as the downtown lights share the sky with the stars, burning brightly as they've done since the beginning of time.
College of Medicine
Two a.m., again.
It's quiet now, but
voices slip out
from the 2D,
the TV,
my friend.
I woke just now
sad, from a dream
I can't recall ...
Aching desire
wanting love;
repair.
Gone is the pain
from failed loves
my past life brought...
I work hard now
for children,
for me.
Doing homework
with little ones—
and then my own.
Forget to cry
when I'm sad,
"What for?"
Only in sleep
do old dreams come
that I've denied
of letting go.
Not so strong,
"the rock"
But, now I find
I know one thing:
Duty drives me.
I open my book
learning more
Micro.
I want to heal.
I tell myself:
"never give up!"
Back to the books,
now its Path,
Endless.
And fear the sleep
When bad dreams come
To say "there's more
than stoically
working hard,
Doctor."
College of Medicine
Always something to stress over,
always something to weigh on the mind,
the mind, a fragile piece of equipment
responsible for what holds all the knowledge
needed to give adequate care.
I need to do well in this rotation,
What can I do that will make me stand out as the
pillar of knowledge I so desperately try to be.
Oh no, why did I say that. That was dumb.
Oh well, better luck next time with trying to make a good impression.
But I do read, I say to myself. As I think about what the upcoming evaluation will say.
Be more aggressive, talk more during rounds, ask more questions, read more.
If only they could read my mind and know how long I have worked, prayed and dreamed
about this opportunity.
Tossing and turning with these thoughts, I realize
it's 7 a.m., time to go do rounds. Leaving the call room I remember the words of my
resident the night before. "This attending is tough. Make sure you know everything about
your patient, you want to impress him."
Always something to stress over,
Peace be still.
College of Medicine
I'm only a third-year medical student.
The other day, as I was approaching my apartment complex, I noticed a long line of people waiting to enter the front door. Apparently, a new tenant was moving in, and the movers were blocking the entranceway as they precariously tried to fit a 3 1/2 foot wide couch through the 4 foot wide portal. As I got closer, the man at the front of the line peered up and saw me. I was dressed in my spotless white coat, and had my sparkling stethoscope dangling around my neck. "Make way, make way. Let the Doctor through", he exclaimed, "He's a very busy man, and he's got a lot of important things to do." The people stepped back, the portal opened, and I shyly stepped through.
I'm only a third-year medical student.
The other day, I was at the ATM, waiting to withdraw my weekly allowance. The woman in front of me was having problems with the machine as it failed to give her the money she requested. Upset and frustrated, the woman approached a nearby teller to complain. "Excuse me", she stated, "this machine is broken. Is there anything you can do to fix it?" The teller abruptly responded, "Listen lady, I just work here. You're going to have to call the telephone number on the machine if you want some help." The woman ejected her card and briskly walked away. As I turned to leave, I caught the teller's eye. I was dressed in my spotless white coat, and had my sparkling stethoscope dangling around my neck. The teller quickly jumped out from behind his desk and stated, "Don't worry Doc, this will only take a second." He proceeded to press a few keys on the ATM, and after three beeps, he stepped aside. "All ready to go," he said. I inserted my card, withdrew my cash, and shyly walked away.
I'm only a third-year medical student.
The other day, on the way home from work, I stopped by a corner pantry to buy some milk and eggs. An elderly man stepped around the corner, and I immediately recognized him. He was one of the patients I had seen earlier that week at Urology clinic. He had recently been cured of prostate cancer. His face brightened up as he approached me. I was dressed in spotless white coat, and had my sparkling stethoscope dangling around my neck. "Hey everyone, " he shouted, "This is my Doctor. He's the best in all of Chicago." He then whispered in my ear, "Listen, I own this place. If you ever need anything. Money, food, anything. Just stop by and let me know." I thanked him, paid for my purchases, and shyly left the store.
I'm only a third year medical student.
The other day, I was driving home after a night on call. I was anxious to get to bed, and paid no heed to the speed limit signs that were posted. A police officer caught me and pulled me over. "Where are you in such a hurry to get to?" he asked. I replied, "I'm sorry, officer. I was just on call at the hospital, and I wanted to get home before I fell asleep at the wheel." The police officer peered in the window to see if my story checked out. I was dressed in my spotless white coat, and had my sparkling stethoscope dangling around my neck. He said, "All right, go on. But next time slow it down a bit." I said thank you, rolled up my window, and shyly drove away.
I'm only a third-year medical student.
The other day, I was in my car with some of my friends. We were on our way to watch a movie. As we were driving on the expressway, we witnessed a horrible accident take place. My friends excitedly asked, "Hey, shouldn't we stop and help them? You're a doctor, aren't you?" I was dressed in a T-shirt and jeans. I veered away, kept on driving, and shyly responded, "I'm only a third-year medical student."
College of Medicine
The melodious smell of old potpourri
The warm glow of a summer's sun
illuminating pictures of her children
and her children's children
Laughter of loved ones, scampering of feet
The lingering taste of melons and berries
The comforting caress of familiar sheets
A passionate embrace
The sharp, stinging smell of antisepsis
The unforgiving rays of artificial light
exposing barren walls bleached white
Cackling of a delirious roommate, beeping machines
The bitter taste of medicine on the back of her throat
The paralyzing feel of cold starched sheets
A doctor's unfriendly touch
College of Medicine
Second Prize
in the ward
behind a curtain
with a sleeping cap
akimbo on her wig,
Alabama whispers
like a locomotive,
Let me go.
In some brown place
above her bed,
my stern professor stands
and frowns
at my attempts
to stoke the boiler
in her chest.
Wrinkled and abused,
this Alabama lies
in some deep structure
of my mind
where still I kneel
beside her freckled arms
pumping morphine, merc
and oxygen.
The distant locomotive chugs.
I slap her, Dammit,
Live!
Stony Brook, New York
My first medical mistake that I remember is when I killed an old woman by giving her too much morphine. This occurred during the winter of 1970 in a bed about halfway down the left side of the Women's Medical Ward at the University of Pennsylvania Hospital. In those days a ward was a ward. Thirty-two beds, sixteen on each side. High altitude ceiling. Institutionally pale walls. Suspended fluorescent lights. And a network of tubes for pulling curtains around beds when privacy was called for.
Alabama's curtain was drawn. She had appeared gasping for breath in the Emergency Room the night before, a tiny gnarled black woman wearing a knit cap and a heavy red sweater. Hers was a clear-cut case of pulmonary edema. Of course, there were no medical records available and the patient herself was too sick to talk, except to say that she hailed from Huntsville, Alabama, and wanted to go home. Thirty years ago she had a name, but in my memory, where she continues to live through that same night, that same morning, over and over, she has always been "Alabama." The ER doc must have dubbed her "hypertensive heart disease," so that's what I wrote at the top of the differential, although her pressure was nothing to write home about for a woman about to drown in her own fluids. Accurate diagnosis wasn't the issue, effective treatment was.
To treat pulmonary edema in those days, we had oxygen, Merc (Mercuhydrin, a diuretic), morphine, and rotating tourniquets. Merc was still widely used, even though the new loop of Henle diuretics were rapidly taking over the field. We also had a spanking new Intensive Care Unit at Penn, but in those days admission to the Unit was far from routine. Alabama's condition had stabilized and improved in the ER, so she appeared in my general medicine ward rather than in critical care. I remember how disheveled Alabama looked when I was first called to see her during morning rounds. Her wig was cocky-wampus, the red sweater mashed and twisted around her neck. But she was quiet and breathing comfortably. She even gave me a lopsided smile until I reached over to straighten out the wig. Swatting my hand away, she whispered, "Lawdy, Lawdy, Lawdy."
I pushed a bit more Merc, adjusted the oxygen, and went back to finish rounds. An hour later I was called back. Alabama was thrashing around, breathing a mile a minute, once again in florid pulmonary edema. I can't remember exactly what happened at that point—surely it must have included tourniquets, morphine, and a stat call to the ICU team. Those 15 minutes are an impenetrable black box as far as I'm concerned, but I remember standing by Alabama's bed a few minutes after she died and reading the label of the morphine vial. I had given her too much intravenous morphine. Not a multiple of 10, mind you, not egregiously too much, but sufficient (I thought) to make the difference between life and death.
What should I do? I couldn't focus on the shadows during x-ray rounds later that morning, nor eat the sticky, dry spaghetti they used to serve for lunch. I told my resident about killing Alabama. He pooh-poohed the whole affair. "Makes no difference," he said. "That lady was dead when she got here. Her heart just wore out." Later, I screwed up my courage and told my attending physician, a famous cardiologist who lived for supraventricular arrhythmias. He was a small man, shorter even than I was, who sported a crewcut and horn-rimmed glasses. "Not to worry," he told me. "You'll learn."
About twenty years later I wrote the poem called "Alabama." I sat down one morning and for no apparent reason the poem just appeared—poof!—out of nowhere. Several things about the poem surprised me. For example, who was the stern professor "in some brown place / above her bed"? I can recall the main corridor of the hospital late at night. In my memory the corridor is poorly lit and lined with paintings of famous 19th and early 20th century physicians, but surely there were no paintings on the walls of the Women's Medical Ward. And where did the freckled arms come from? Alabama was darker than mahogany. The biggest surprise, though, was that in the poem Alabama whispered, "Let me go." Let me go. Let me go. I'm pretty sure she never really said those words, at least not in the world of 1970, but who knows? Maybe that's what she has been trying to tell me all these years.
Stony Brook, New York
I heard a couple stories about "Code Brown". That's when a patient defecates on himself. It is kind of a joke between doctors. When someone calls a "Code" you think some kind of emergency to rescue some dying human being and paddles and epinephrine and clear! don't touch the bed so you don't get shocked. (Most of the time you get shocked anyway-not electrocuted shocked but shock shocked). The "Brown" is self-explanatory. It's funny that doctors get time to joke or have a sense of humor anyway. Medicine is serious business. That's what Docs go to school for. Imagine being a history major and spending two years studying Biology, Pathology and other "ologies." My nonmedical friends were at the club and dating. I was dating NMS and Appleton & Lange. That's hard. Then the wards—imagine being quiet and shy and trying to impress long white coat attendings with your assertiveness. I should've just baked them some cookies and gave it to them with my evaluation. Eat up gentlemen and remember that both Alexandre and Advanced start with an "A." With that I graduated to taking care of that patient on Public Aid with the cellular phone—you know the one I need but can't afford. (That reminds me that I have to call my fiancée, the one I have seen in a while, what's her name?) I shouldn't have been an OB/GYN. Baby isn't perfect...lawsuit... but your honor that's my house! Besides, when you are a male OB, you have to be a pervert, right? Wrong, maybe you just don't like seeing sick people. OB patients aren't sick, they just have to have a baby. Unfortunately, that value meal includes a side of Gyne. At least this MD degree gets me out of speeding tickets, and gets me respect. I've had one hour of sleep and we have a crash C-section to do. I think her baby is dead. But isn't that what being a doc is about—an emergency (Code) and a shitty situation (Brown) so I can be "da SHIT" (Brown).
College of Medicine
Mr. Black! Mr. Black! Mr. Black! This phrase often haunts me when I remember the first patient I encountered as a third-year medical student. I began my clinical experience in Psychiatry at the U of I and was assigned to a consult team. The attending physician on the team asked me to see the first patient in the morning and gave me the patient's room number. With a pad of paper and pen in hand, a newly pressed and washed white coat and shirt neatly starched and shoes polished, I approached the patient's room with ambivalence as this was my first real patient. The patient's name was Mike Black and we were consulted to evaluate him for Depression. That's all I knew about him. The patient's room was dark and as I entered all I could see was the outline of a body underneath the covers. The patient was sleeping with his head at the foot of the bed. I felt a queasy feeling in my stomach as there was an unusual smell of stagnant foul air that I later found out was a smell that the physician became used to. It was the rancid smell of pus.
I cautiously pulled up a plastic chair that was sitting in the corner with a dirty shirt hanging on the edge. Although I did not bother removing the shirt, I was cautious not to let myself make contact with any part of it. As I slowly began writing the patient's name on the new pad of paper, I gently announced my presence to the patient. I enthusiastically said, "Hello! My name is Sunil Lal and I am the third-year medical student." I got no reply from the patient. He did not move and simply had the covers pulled over his head. I tried again, this time a bit more forcefully. I said, "Mr. Black. Mr. Black. Please get up. I need to take a history from you." Before I could look up from the pad of paper I was writing on, before me stood a man that was charged and bursting with energy. He screamed "Mr. Black. Mr. Black. Mr. Black!" I nearly had a bowel movement in my pants. Mike approached me with a single eye. The other eye had been removed during his hospital stay secondary to mucormycosis, a type of rare fungal infection. As he was screaming, I did not know if I could not understand the patient's words because I was so scared or if he had a speech impediment. Most of the sound he attempted to make came from the empty eye socket. My heart was racing and I stood out of my chair ready to run. The patient stopped and motioned me best he could with his hands not to be afraid as he caught a wad of drool that was hanging from his chin. The roof of his mouth had been removed during the hospital stay along with the eye.
I mentally slapped myself and attempted to regain my sense of professionalism as I slowly sat down. The patient was agitated and could barely stay seated in one place. As I caught my breath I said "Let's begin...OK?" I started off by asking for the reason for admission. He began talking and I could not make out a single word of it. He tried speaking slower but both of us became only more frustrated. Finally, I gave him a pen and my tablet of paper and we communicated through writing. While he chicken scratched the answers to my questions I could not help but stare at the hollow hole in his head. The eye socket was completely devoid of any viable tissue. What remained was simply a dark hole that seemed to be endless. I wondered if I could see his brain if I looked hard enough. As he wrote, I attempted not to stare at the drool that was running down his hands and all over the pen I had given to him. I had hoped that a nurse would come by during the ordeal to break the monotony in the room while giving me a sense of security at the same time. No such luck. Finally, Mr. Black finished answering my questions and motioned me to take back my pen after he had wiped the saliva from it on a nearby towel. At first, I was going to ask him to keep the pen but instead took it back and clicked it and put it back neatly in my coat pocket. I said, "Thank you, Mr. Black." Angrily, he said, "Mr. Black. Mr. Black. Don't call me Mr. Black. Call me Mike." I took my pad of paper and turned only to wave bye. But before I could leave, Mr. Black did something that one would see in a low budget horror film. He took his finger and poked it through the hole in the roof of his mouth and waved bye with his finger through that black hole in his head. Although I was shocked, I said nothing and turned my back and walked out slowly. As I made it past his room and out of his sight I hastily made my way to the nearest bathroom to wash my hands and the pen in my pocket.
College of Medicine
I could not believe it. I had just come to the hospital because I simply did not feel well. Now I just lay here newly diagnosed with leukemia, my eye removed, and my palate gone. All in just one week. I could not believe it. I would never be able to sing again like I used to with my friends. Anyone that looked at me saw just one thing. They saw an awful looking monster that they were scared of, but I didn't mind. It was so much easier to be something that people were afraid of. That way, I did not have to explain anything to anyone.
I liked to lie under the cool covers not bothered by anyone. All of a sudden I heard the noise of footsteps in my room. Great! Who was it? Was it another annoying doctor, nurse or social worker? I did not sleep all night. Mr. Black! Mr. Black! Please wake up! We need to draw blood. We need you to sign this consent form. Who were they trying to kid with that phony politeness. Mr. Black. They did not have the slightest idea who I was. Yet they pretended to be so professional and treated me like their best friend. Right! I knew better. They were all afraid of me. I could hear the nurses whisper in the hallway. They would say things like, "Did you see him? How terrible! I really feel sorry for him. I mean look at how he looks! I wondered if he is married. I feel sorry for the wife. Could you imagine having to kiss something that looked like that?" I could not believe it.
"Hello! My name is Sunil Lal and I am a third-year medical student." I just laid there under my cool covers not wanting to move. Maybe he would just go away. I didn't want to speak with anyone! Especially not a third-year medical student. What was he gonna do for me? He was probably just here to see the freak! "Mr. Black! Mr. Black! Please get up. I need to take a history from you!" I got really angry. If I heard my last name once more I was gonna start swinging! Did this medical student want to see a freak show? All right then. I was going to give him a freak show.
I jumped out of the bed and sitting before me was this stupid little boy who thought he was so cool. He was wearing a spotless white coat, a pressed shirt, and polished dress shoes. I could not believe it. I screamed "Mr. Black! Mr. Black! Mr. Black!" I forgot that they had taken the upper roof of my mouth. I could barely talk. All that came out of my mouth was drool and muffled sounds. I really sounded like a monster. The student jumped up out of his seat! I was pretty sure I had his attention now. I could see a few beads of sweat on his forehead and thought I could see his jacket move as his heart was beating in his mouth. I tried to get a good look at him though my single eye. What was I doing? Had I really become a monster? I motioned the poor guy to have a seat. Trembling the student said, "I need to take a history. OK?"
My head was hurting. My Demerol was wearing off. I really did not want to talk to this little bastard! I just wanted to be left alone under the cool sheets. But he was probably like the rest. If I turned him away now he would be back later to bother me. I nodded that it was OK. He asked me "So what is the reason for admission?" How many times had I answered this? Must have been the 18th time. I tried telling him but he could not understand a word I said. Both of us were frustrated. The student gave me his pen and pad of paper. Slowly I scribbled the answers to all the questions. Maybe then he would leave me alone.
As I wrote on the pad the student stared at me. Whenever I looked up he would turn his head away and pretend he was looking at the wall or the IV drip. He was looking at the monster! He could not stop staring at the hole in my head. I was so angry. I used to be like him just a week ago. I felt like crying but would not give the little bastard the satisfaction. Finally I was done being cross examined. I gave him back the pen that was covered in drool. As I sent him on his way through the door, I wanted to make sure he wouldn't be back tomorrow. I took my finger and poked it up into my eye. I waved bye to him through my eye just as I did to the nurses and sometimes to myself practicing in front of the mirror. If they wanted a monster then a monster they would get. I thought I scared him away for good. But to my surprise he showed up bright and early the following morning to ask me more questions.
College of Medicine
BEEP. BEEP. BEEP. BEEP. It was 4:30 a.m., time to get up already. I couldn't wait for surgery to be over.
I got up, showered, dressed and got ready for my 45 minute drive to the hospital. Just as I was walking out the door it hit me, morning sickness. Great, now I'll be late. Finally I arrived at the hospital only ten minutes late, changed into scrubs, checked the OR schedule, rounded on my patients and wrote my notes, all in twenty minutes. I couldn't wait for surgery to be over.
There was another LAR, an APR, a hemorrhoidectomy and a lap chole. I checked the census, no new patients. I saw the rectal prolapse. No fever, + BK normoactive bowel sounds, no distention. Nothing new. Next was the partial bowel obstruction. Low grade fever, no BK hyperactive bowel sounds, mildly distended. Finally the LAR from yesterday. No fever, colostomy intact, hypoactive bowel sounds, no distention. I couldn't wait for surgery to be over.
I wrote my notes and waited on my residents to round on the patients. They arrived and we rounded in our usual pattern. The residents quickly went from one patient's room to the next as we medical students ran behind them yelling out vital signs and NG output. Not much was ever said to the patients by the residents. To tell the truth, not much was ever done for the patients by the residents. The last patient for morning rounds was the LAR from yesterday. He had a low lying colon cancer and had to have a colostomy. He begged the surgeon to do everything in her power to save his anus but the cancer was just too low. In addition to being unable to save his anus, they also had to pack him with gauze because of a bleed. Three times a day his packing had to be changed and we had the pleasure of changing it on morning rounds. The resident pulled the packing out without regard to the patients pain. I wet the curlex with saline and he starting repacking the wound. The patient yelled in agony as the resident continued shoving the curlex as if he heard nothing. The patient pleaded for the resident to stop but all he said was "If I don't do this right, you'll hurt more later." The resident shoved the entire curlex into the patient's wound, degloved and walked out of the room. I couldn't wait for surgery to be over.
The next six hours of my day were spent retracting, just what I wanted to do while I was six months pregnant. I managed to run to McDonald's to grab some fries and a pop before afternoon rounds. While I was waiting on my residents, a friend of the LAR approached me and asked about packing his wound. She said that he didn't want the resident to do it again because he wasn't compassionate. I went to speak with him, explaining why the wound had to be packed and what would happen if it wasn't packed properly. He stated that he understood but didn't want that resident to do it any more. He requested that I pack his wound but I explained that I was just a student and the resident or nurse had to pack it. He sighed, looked to the side and quietly said "thank you anyway." I exited his room and met my residents in the hallway. I expressed the patient's concerns to the team but no one seemed to care. I couldn't wait for surgery to be over.
Our afternoon rounds were pretty much like morning rounds. The residents quickly went from one patient's room to the next, we medical students running behind trying to keep up. We finally got to my LAR. He didn't utter one word about what happened on morning rounds or our discussion. The resident began to pack his wound and I quickly asked, "Is it okay if I pack it and you supervise?" The patient gave me a small smile as the resident moved to the side. I tried to be as gentle as possible, while at the same time trying to pack it properly. It took me a while but I finally finished. The resident told me I did a good job and that I would be the person to pack the patient's wound for the remainder of his hospital stay. As we exited the room I heard a soft, "Thank you Traci." I couldn't wait for tomorrow, to see Mr. Hughes, my LAR from yesterday.
College of Medicine
Among my acquaintances, none has been more conspicuous than Max. For the thirty-three years of my involvement in General Surgery, he had been, first, my professor, then my colleague, on the Faculty of Surgery at Yale. For some dozen years, since our retirement from Medicine, he and I have trod the same polite ground at the Sterling Library, I to read and write, Max to study. We had become members of that strange subculture of elderly, estranged, or apparently insane men and women who frequent such havens the way trolls congregate under a bridge.
Whether Max was born with the bone marrow to become a surgeon, I can't say, only that he had done so, and, once having been ordained, did it exceedingly well. Still, of all the thousand kinds of work with which the Earth teems, it seemed absurd that Max had located himself in surgery, a specialty that thrives on teamwork and esprit de corps, for neither of which was he was temperamentally suited. He was the quintessential outsider, the solitary Jew among the goyim, as it were, trusting no one, relying only upon himself. Perhaps he had not chosen surgery at all, but it had fallen at his feet at a moment when he was thinking of something else. If Max had backed into the wrong room, he had made it his own by sheer force of will, self-denial, and hard work.
Let me draw him for you, though, in doing so, let my pen turn back into a scalpel that, drawn across the page, leaves a wake of red. There was something Asiatic about his features, which were of a sallow hue, just this side of jaundice. His hair was Judas-colored above the large, dark, beautiful eyes of a camel: a brown gloom pooled there. From the bridge of his nose a deep furrow rose straight up to bisect his forehead. Might one see it from the back, cleaving the occiput, as well? It seemed a stigmata of the thousands of incisions he had made in the bodies of his patients, now transposed to his own brow. One might have seen this face beneath a turban, chanting from a minaret in Samarkand, or in a marketplace in Odessa, or draped in talith and phylacteries in shul in Brooklyn. Here was the surgeon as Talmudist, as elderly yeshiva bucher. There was nothing hoary about his head. Max at eighty looked no older than at sixty, as though he had been born gaunt, sallow, stooped, and with the same full head of reddish-brown hair. Ravenous Time had not deigned to feast upon him. As for his hands, they were the antithesis of the big red mitts of an orthopedist, say, that could set bones and reduce dislocations, hammer nails and set screws with proper tightness. Max's hands were tiny and narrow with long gracile fingers, the hands of a raccoon. Day and night, for decades, they could be seen plunged to the wrist in an open belly, rummaging. Surgery, yes, but Suffering was his true profession and no one enjoyed its practice more. Prometheus, having stolen fire from the Gods, now had to put up with the vulture at his liver. That sort of thing.
Sharp-minded he was, and with his vanity well-tamped. While toward the nurses he was courtesy itself—he called each one "Ma'am"—he was not a "gentleman" in that he was devoid of the aristocratic detachment and reticence that are the mark of that breed. His aloofness took the form of a dolorous aggrieved miasma in which he sidled along the corridors of the hospital with small waltzing steps as though he was dandled on marionette strings. His pride lay elsewhere—in being seen as the most learned among the tribe of surgeons. Scholarship aside, he was not a gifted surgeon, a deficiency he more than made up for by a methodical plodding performance, each suture placed and tied by his own hand (he would have held retractors if he could). Max succeeded in doing what the interns and residents in our youth and ardor thought impossible: he made surgery boring. "A dull knife," we used to say.
Despite his immense scholarship (he was by far the most learned of the surgeons), there was nothing of the skald about to strike his harp. Max always had the air of a man who had no right to be in the room, or who had been brought there in custody. Even when preaching in the well of the Amphitheater at Grand Rounds, Max would stand before the assemblage of surgeons, students, and nurses, half-bent at the waist as if expecting a blow to the mid-section, doing a little shuffle—two steps to the left, then back—all the while delivering his lore in a kind of Wailing Wall chant, or dovening, that ended with a tiny self-deprecating smile. Grand Rounds was held every Saturday morning at eight o'clock. It was widely noised about by skeptics that every Friday night, having apprised himself of the subject to be discussed, Max betook himself to the medical library, read the latest pertinent journal articles, and held forth in the amphitheater ex pulpito. This to the dark dismay of the other surgeons, who had gone home to dine with their families. To my credit, I was not one of those naysayers.
Max had the perpetual predatory look of a man with a gripping story to tell. Its subject was himself, and particularly his surgical exploits in the South Pacific during World War II, some twenty-five years before. It was a theme of such a size upon which a man might talk eternally, and so he did. Self-love equipped him with seven-league boots that enabled him to leap from atoll to atoll in the telling of his Epic. He alone had brought battlefield surgery to the Islands. He, and only he, knelt on a beach under fire, drilling burr holes in the skull of a soldier to evacuate a subdural hematoma, or completing the amputation of a smashed leg. Unassisted, and in fact hampered by the other doctors in the Yale Unit. All this he would relive, and at the thought, a smile of almost lyrical pleasure would settle upon his small injured face.
"Someone had to do it," he'd say, accepting in retrospect the great burden that had been thrust upon him. And never once was there the refreshment of an admission of failure or guilt: "He died at my hands" or "My best was not enough". If he had secrets, they didn't show. But secrets, conflict, uncertainty—these are the source of invention. Without them, any storytelling lacks art, just as it lacks truth. Nor was there any mention of the scenery, the beaches and jungles, the flora and fauna, or of his colleagues. For all we knew, Max alone had invaded and conquered that vast blue space on the map of the world that was the South Pacific. It was a superbly nuanced performance. While exhibiting no sign of vanity, neither did he err on the side of modesty, but had perfected the art of self presentation so as to retain the ear of his listener for as long as possible. Pursuing martyrdom, he came nowhere near it. At best he was a Titan, a heaver of rocks, rather than an Olympian. Clearly, his tour of duty in the South Pacific had been his Dent Blanche, the Alp he had once climbed and whose height he had kissed. Forever afterwards, he was to wear, day after day, his Government Issue khaki shirt and pants and his regulation army boots—his costume du soldat. Wore it to the hospital, he did, on rounds; removed it only to put on a scrubsuit, cap and mask. A harmless eccentricity, you say?
Oft and again, as his surgical assistant and unable to escape, I suffered the penance of the Listener. Even in the operating room, he had a way of raising his chin to the upper air when talking about himself. One was aware, hypnotically, of the opening and closing of his jaws beneath his mask. Time and again, I tried offering it up, but apparently my suffering was not received there. "Come, come!", I told myself. I should always like to hear a man talking about himself. In what other subject would he be so conversant? It is to be expected and forgiven that an old soldier would relive the ancient battle. He was, after all, just a boy playing "soldier", uncomplicated, transparent. All this I told myself while pinned to the other side of the operating table, and wriggling. More than once I was jealous of Eve in Paradise Lost. Whenever Adam grew expansive and began to deliver a sermon, she'd step softly away and take a nap. Perhaps I could have stood it better with a kitten on my lap, or a small green frog in my pocket, the way a child puts up with the lectures of his elders. I invented dialogue.
Max: Have I told you this story before?
Me: Yes, many times.
Max: Why, that is one of the forgivable faults of growing old.
Me: Since you have already forgiven yourself, Sir, there is no need for me to do it.
Max: Am I boring you? (This asked incredulously, and with just a hint of menace.)
Me: Not at all, Sir. I love monotony.
But even in my fantasy he had already mounted his tongue and was riding hard with only the occasional hesitant cough or sigh as if the story were being sucked from him under duress. He had not really heard my tiny rebellion. From each of these ordeals, I would go to my room and read that part of the Bible where Saint Paul preached all night long and Eutychus fell out of the window. From this it is clear that, while I revered his knowledge, I loved him not. Surely, he was not my friend. Friends animate each other. Friends consider each other's needs. We were not fit to be friends. The Gods had decreed a deep, wide canyon between us.
Boredom ought to have been included by Solomon in his catalogue of miseries. The garrulous have no bowels for their victims and are insensitive to the fatigue of others. It is one thing to stand pain: all that takes is courage. It is another to tolerate boredom: that takes upbringing and character. And, I suppose, a certain inbred docility, in which one has learned to subordinate one's own desires and impulses.
The greatest cause of traumatic injury and death is boredom. We are bored, and therefore we drive vehicles at excessive speed and do not wear helmets. We are bored, and therefore we grow careless on assembly lines or construction sites. We are bored, and therefore we drink too much, take drugs and then seek out incidents of assault and battery. Why, then, would anyone lay himself open to the ravages of boredom? Here's what happened.
For three days, Max had failed to show up at the library. A phone call informed me that Max was breathing his last. And with that phone call, a rush of guilt. Hadn't I wrenched my training in Surgery from the stony soil of his personality? Ought not one pay final homage to his teacher? All at once his self-absorption seemed as innocent as that of an infant at the breast. Considering the universal self-flattery of doctors, Max's amour-propre seemed not so extreme. Beshrew me, if ever I thought him villainous. He is not a villain, but a bore to whom odium quite naturally clings. But that was long ago, and now the news of his imminent death awoke in me a sense of obligation. Besides, of all the race of interns and residents who had been bloodied at his knee, I alone was left to pay him the respects that he deserved. The others had long since moved away or preceded him in the Hereafter. All my life I have been an easy mark for anyone with a long story to tell. No matter the repetitions, contradictions, digressions, the tiresome blending of nostalgia and elaboration, I have never so much as drummed my fingers on a tabletop. Even now, faced with a bore, I am apt to sink into a state of catechismal obedience until the last syllable of recorded time. Only then, when released at last, do I flee home to drain a dipper of gin and bitters.
"I have too kind a heart," sighed my mother. "It is a flaw." So do I. And so it is.
Thus it happened that, awash with sudden virtue, I found myself in a spare cell of a room whose furnishings consisted of an iron bedstead, a wooden chair, and a plain deal writing table. The sheets of the bed were barely disturbed by what lay motionless between them. From the doorway I could hear the rubbing together of dry twigs inside his chest. There was a cadaverous Hippocratic facies—yellowish complexion, down-turned, pointed nose, open mouth, sightless eyeballs roving loose, their lids at half-conscience for having thought ill of him, I saw, resting on top of the sheet, those tiny raccoon hands, their rummaging stilled forever. And, emerging from the sheet, the same khaki Army shirt shouldering the same insignia of the Medical Corps and his rank of Lieutenant Colonel. I had no doubt that under the sheets he was also wearing his Army boots. I was touched. To wear one's regimentals to bed! To be buried in them! It seemed no longer an eccentricity, but an expression of fealty to an ideal.
"Poor Max", I thought. Then caught myself. Poor Max? But Max is old and rich and dying in comfort. That is the way it is with the near or newly dead. Their faults seem forgivable, and even endearing. The Army surplus uniform for one, and that ancient battered car, the oldest one in the hospital parking lot, ostentatious of righteousness and self-deprivation—these seemed to me deserving not of derision but of sympathy. Even as my heart softened toward the man, I confess to the less admirable hope that my name would precede Abou Ben Adhem's in the Book of Gold. From now on, I would treat bores gently. They are after all, Ancient Mariners who grasp you by the lapel to disembosom themselves. Perhaps, they, too, suffer? Is it their miserable fate to talk on and on without respite?
"Max," I murmured, but he gave no sign I'd been heard. "Max!" I called directly into his face with no response. I prepared, if not to weep, at least to sigh. At the third "Max!" the half-shuttered eyes opened slowly, the eyeballs that had roved listlessly from side to side, centering themselves, and fixing on me. "I missed you at the library," I said. When the man in the bed spoke, it was as if from the next world.
"Ah, is it you?" he managed in a dry, dusty voice that had surely preceded him to the grave and moldered there, then lapsed into what at first was an incoherent babble, but which within minutes translated itself into the names Tinian, Saipan, and New Guinea. Garbled at first, but soon enough he had captured the pace. The way his brows drew together as, in defiance of the gravity of his terminal state, he fluttered up from his deathbed to tell of his "dawn-golden time," his mind traveling the sea-lanes of the convoy that carried him toward Guadalcanal. You have to admire the tenacity, no, the ferocity, of life. Now I was in for it. Within minutes, his eyes had taken on the glitter of the Ancient Mariner's. He who had lain immobile and inert grew animated. He stirred, raised first one, then the other of his raccoon paws as if to fend off a blow. His nostrils seemed to take on a life of their own, dilating and compressing to punctuate sentences. Now the saffron of his cheeks was suffused with a geranium red that had nothing to do with fever but was a revivification taking place before my eyes. It was as though he had just received a blood transfusion. Within minutes, he had captured the pace of his tale and for the next two hours it would fall from his lips with the inevitability of a leaky faucet. On and on he talked, retelling the old saga. If past were prologue, he would stop only at my departure, or the return of his semi-coma, for which I had already begun to pray. Now, to a doctor who has spent his life hoping for just such revitalizations in his patients, such a miraculous return of faculties would be reason for rejoicing. By my very presence and my acquiescent ear, I was effecting a cure, wasn't I?
His very life, it seemed, lay in my hands. Who could trifle with such a deposit? It is a lie that Virtue's ways are ways of pleasantness, and that all her paths are peace. But all at once the decades-old, endless drone of self-praise bore down upon me. Ah, the sharp and aching tooth of memory!
"Unpack not thy heart with words!" I longed to cry out. "Bray no more! I'd sooner see thee pale and still once more, than to be caught and fluttering in thy web." On and on I sat, until at last the voice trailed off and ceased. I waited a minute or two to be sure that he slept, then tiptoed from the room. The next day, I read in the newspaper that Max had died.
Epilogue
What I knew was only the constricted outward Max, nothing of the inner. For that, one would need context. What of the parents of whom he never spoke? Had he brothers or sisters? Nor ever did he mention wife or children. Only their number was known—seven. He seemed to owe nothing to his forebears or descendants, but to exist in the surgical present, and in the certainty that he alone had been chosen to heal the sick of New Haven. How had this charge been laid upon him? He had no God to hand down tablets, no Gabriel to Announce.
But let me be fair. Might he not, in the dead of the night, recall a tender moment with a sister? A father's conciliatory hug? I try but cannot imagine Max as a little boy in short pants. At what point did he renounce Judaism, and elect surgery instead? Might there have been an incident in his youth when he rescued a wounded animal and felt the surge of gratification of the healer? Had a beloved mother been cured by another surgeon's scalpel? Or lost in spite of it? Or because of it? Perhaps long ago, a child had died. And so a surgeon rose up in its place? Was there ever a moment in the life of this man when everything was thrown into question? The real Max eludes me. I cannot be his biographer, only a witness.
New Haven, Connecticut
October 1973
Today, this one free day with which
To recreate my life from tiredness,
Despite my vowed indifference
A patient's life beats round me like
A butterfly in dying autumn, chilled,
Flutters now against my lashes, frantic,
Calling me to still the birth of winter.
December 1973
Being a doctor yourself,
Not one doll of many
Toyed with daily in my hands,
You could see each horny joint,
You could feel each sideways step
As the crab crawled into your spine.
Feeling, knowing, as you did,
Your death became more, too much more
Than the stopoff at nothingness,
Ending of care, of work,
That all rubberdoll deaths become.
I wonder at that, that you were
And are not; that you stopped.
That only in me and in others,
Unknown to you, unknown to you,
Do you and will you exist.
I ask where you are,
As a child's doll might.
The pulse of silence answers,
In terrifying beats
Each more somber than the last,
Drumming in the slime-shrouded shape
Of my own primeval end:
There on a winterdusk shore,
Skittering among the lifeless debris,
A search with timeless confidence
In our ultimate ebb, for food.
Boston, Massachusetts
I stare out across the frozen lake
the water blends into the sky
the ice stretches out
the cars go by on Lake Shore Drive
the belly of the pregnant woman
stretches up toward the sky
the mustache of the resident
hides his upper lip
as he watches T.V. while the ultrasound
slides over the belly of the pregnant woman
the dimensions of new life flash on the screen
as he reads them aloud
I memorize
But I don't care
I see the lake and the sky
there is no difference to me
I see a truck pulling a house on the road
and the lake and the sky and the ice
stretch on around
until I feel sad and imprisoned
because my life is not my own
because I am not sure what is left of me
as I think this
I boil with hate
at the forces shackling me
at myself
at the mustachioed resident
a personal hate for the mustachioed resident
who blew his top
when I didn't know on my first call
who threw the book at me
I look at the clock, 4:30 AM
"Then read the chapter on it," he says
I look at the clock, 4:40 AM
"You must really be dazed out,
you're still on the first page," he says
I personally hate the mustachioed resident
particularly his mustache
it hides his upper lip
and I boil with hate
and I'm just tired, man
and I feel deflated with pain
for everything that binds every being
for the constrictions and dissatisfactions of life
I look out across the sleeping city
I am mostly awake
I can more than imagine the pain of life
the woman with the belly breathes and cries
new life born with a pungent mess
the baby breathes and cries
I breathe and remain silent
Class of 1993
Volume IX (1993)
(dedicated to Samuel Shem)
