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Her prayer is simple. "Lord, please let them find something curable or let them find nothing at all." Any other possibility is unacceptable.
She sits on the edge of the bed thinking of all the ways her body has betrayed her in the last six months. She hops out of bed on feet she has lost confidence in and fickle legs. She steadies herself. Today is a big day.
"Doctor, There's an ache in the crease of my back"
"...And a fullness in my neck"
"And sometimes it seems like there is fire shut up in my bones."
She walks to the bathroom and smiles at herself in the mirror because that is the least she can do. But this comes and goes like everything else. She examines her lips carefully like an experienced lover might about to kiss, devour. She sticks her tongue out making sure to look at the underside. She blows her nose and examines what ends up on the tissue, "pale yellow" she thinks. "Inconclusive," she says out loud.
She steps into the too hot shower, but it's okay because this is one of the few things that still feels good. A baptism of sorts. For a few moments there is peace. She steps out of the shower and before she can grab her towel she is weakened by the sight of the perfectly formed vesicles dotting her shoulders. "It's water, just water," she realizes. She steadies herself and rushes to get dressed.
She has become so keenly aware of her body—every ache, every tingle, every bump. Every itch is pruritis. Everything is something until proven otherwise. She sometimes jokes to herself that she is the newest superhero, "Body Woman," able to recognize even the smallest difference in her homeostasis in a single, panicked moment. "Sometimes it's not so funny," she thinks almost embarrassed for herself. She'll see the doctor today. Finally.
This past week has been the worst. Waiting. Sitting in her apartment holding a vigil for herself. Her Bible sits on her floor next to her Harrison's Textbook of Medicine. Sometimes she feels guilty if she picks up the latter first, but it's a struggle not to know what it means when her body starts telling its secrets. She believes.
The last two and a half years mean less than nothing now. If anything they put her at a disadvantage because they make the differential diagnosis more deadly. A nose bleed used to just be a nose bleed not a bone marrow issue—not life or death. Two nights ago she had a dream about her platelet count. She couldn't get back to sleep.
When she sits and thinks for too long she remembers a catalog of unprotected things. The teenage mother's water breaking like that and soaking her scrubs through. The delayed shower. The needle stick that didn't seem too bad and anyway this was the first time she was getting to close and how would that look to leave the O.R. for such a thing...this was Surgery.
And too there were boys. Not many boys and this was a long time ago. They were nice boys from good families. They were sweet. Some were beautiful. But they weren't faithful. They were just boys. When she got to thinking like this, decisions were easier. She picked up her Bible. She liked reading the 38th Psalm.
She wants to eat breakfast, but her body won't allow that. "Nerves," she thinks. Her mother wants to know if she's losing weight. Everyone wants to know why she looks so tired. She wants to know if she's going to make it through her medicine rotation today and finally get to see a doctor. "This damn student health crap is a disaster," she thinks. But then she repents on the spot as outbursts like that can't possibly help her case.
Slowly she walks to her car. "Is this how twenty-five feels?" she thinks. There's something much too slow about this. There is something wrong. She'll smile today on rounds, like she always does. If they ask how she is doing she will say "Fine." They won't ask that Her attending will shout his mantra, "Tell me, what can kill the patient?" As she drives, she thinks "Either I am the most alarmist, hypochondriacal woman-child in this world or I am one heck of a diagnostician." Though the latter is high praise on the wards, this time she prays she is wrong.
She had never been as keenly aware of her body
Exquisitely paranoid and angry, or mad.
His skin was first coffee with cream and then touched
by the sun.
He hates his mother because the man she married
is not his father. He hates me because I dare
to sit and watch. Over and over he repeats "I am white'
He has the strongest most defiant jaw I have ever seen—
his birthright.
College of Medicine
Exquisitely paranoid and angry, or mad.
His skin was first coffee with cream and then touched
by the sun.
He hates his mother because the man she married
is not his father. He hates me because I dare
to sit and watch. Over and over he repeats "I am white'
He has the strongest most defiant jaw I have ever seen—
his birthright.
His mother sits there without mothering hands.
Worried, yet almost amused. She says
"I think he does this for spite."
Then adds "You know he was on drugs, maybe"
The lady psychiatrist takes over "Maybe he's on them now."
"Are you on drugs?" she shrieks in her Filipino accent.
His voice is deep, his island accent lovely
He should have been saying 'It's a pleasure to make your acquaintance"
Instead he spits
" I said no...don't listen to her. She's a whore"
"Why are you so angry?" I chime in.
He looks at me. He wants to hurt me.
"I don't know you" he warns.
He is nineteen.
He wears a black baseball cap that cups his head perfectly.
Ms shirt is white. His khaki uniform pants are crisp
like springs they don't know here.
He should be somewhere falling in love, but fear is
the only thing in the air as he leaps up from his seat.
His mother asks, pretending to be smarter than she is
"Well doctor is this going to go away?"
"I don't know" she lies and hands his mother a prescription.
"Please come back next week."
When they leave she says "well maybe he's on the drugs."
"He's schizophrenic" I say. The first definitive thing I've said in three
weeks. "He's a paranoid schizophrenic."
"He's beautiful."
Later I am frustrated because I had to put something down on paper before I could get back to the business of enjoying my island home. This was the best idea ever—to do a rotation in St. Croix, but be that as it may something won't let me dangle my toes in the Caribbean sea just yet. Not tonight. I tell my roommate about him and about the lady psychiatrist who was afraid to make the diagnosis. I write an almost-poem because poetry is my language of closure, but he won't go. Perhaps the poem isn't good enough I think. "What can I do?" I remember that tonight is bowling night. I wonder what he does on bowling night.
The next day is better. It is Saturday so the island is ours again. We volunteer to lose ourselves in the greens and blues of this paradise. "Nineteen is too old for high school" I think to myself as I walk along the beach searching for shells. When he leaped from his seat that way I was afraid for us. But I imagine he didn't scare me nearly as much as I scared him.
The weeks pass. I learn what it means to lose myself in sunlight. I eat spicy concoctions at street fairs. I drink real fruit punch during hour and a half midday breaks. And I go to clinic. But beyond the asthmatics, through the hypertensives and around the rotund diabetics glares this boy. And I don't know why.
I thought I might lose him somewhere over the ocean or when we switched planes in Puerto Rico. Perhaps he'd break loose as we rode backward through time zones. Honestly, I didn't think he could survive the cold. But somehow he is here. A beauty. A memory. A haunting? Sometimes he is here in and out, in and out like a dream.
College of Medicine
Elena doesn't fit in the air.
When moving, she moves in three dimensions (at once),
Her arms and legs creating new angles
As she bounds, flailing, down the dusty field,
Madly chasing a small ball
Which bounces in expected trajectories.
Elena shall not be a trope,
no symbol of rejection, she;
Her contorting elbow is synechdochal for what—
Athatoid? Her life? The stars?
She cannot be an approximation
of a person,
or of what cannot be released from sounds;
A moment without oxygen
Is not a moment without inspiration;
She can't be crushed by metonymy,
a life in the domain of poems;
Elena finally grabs the small ball and,
Laughing, hurls it on to chase it again.
College of Medicine
The roaches scurried along the wall above his bed as if beckoned by some all-knowing life-form which was leading them not into temptation but into the salvation of another meal. These were not roaches of which horror movies are made; in fact, to the contrary, in every abode in the world these small creatures exist as peaceably as can be expected, for amongst them humans go about their daily routines with only disdain for them. So, when the Roach Motel awaited them at the end of their journey up the wall, into a small crevice at the upper molding of the dining room wall, through the cracked ducts that in a bygone era spouted air conditioning, into the kitchen by way of the cabinets that now held nothing but stale Fruit Loops and two-year old packets of Canel's gum, and under the refrigerator past remnants of what three weeks ago may have constituted a nourishing meal, it was to no surprise. No worries among the survivors. We breed faster than these mortals can ever imagine. We'll be back.
"Uuuuuuggggggghhh...," groaned Mahoney. The exquisite detail of his pain was embodied in this one utterance. His speech was becoming more unintelligible every day, but no one seemed to care. He was becoming a burden to them all. Hour after hour problems would arise. "It's not my turn to change his diaper." "Come on mom, I ain't going near that bed, that's some serious stank." "Goddamn Julius, what the fuck did you put on that man, some shit or something. I told you the Silvadine, goddammit."
"Uuuuuggggghhh...Mooooorrrr paa," he repeated. From the front yard of their coachhouse a grimy, yet glowingly pretty thirty-two year old Charlotte Luther came running to see what troubled her father. Because she had been trained as a nurses' assistant, the duties of caring for him in these last days of his life fell firmly on her shoulders. Not that she had any time to use that training to actually make any money to help support her family. Between being pregnant and caring for the six children, well, seven if you counted Mahoney, she had forgotten what hospital life was like. "Oh, I see, its time for your next dose of morphine." Charlotte was used to the routine by now; after all, he had been lying in this bed for the past four months. Lying there, in a hospital bed, in the middle of the dining room, waiting to die. Actually, she too was quite repulsed by the physical presence of his body merely existing in the center of her house. It reminded her of when he returned from Vietnam in 1972. He had lost his left leg to a vicious infection and appeared to her to be a scared man. Always a glazed look on his face, somehow distant, never affectionate. She was six when he returned and never remembered him otherwise. This incomplete man was supposed to be her father?
Charlotte learned, years later via correspondence, from her mother who had left the children with Mahoney and his new "squeeze" in the late seventies that what he returned from Vietnam with was a newfound devotion to heroin—a religious addiction which would only serve to worsen his health problems. A smoker from age eleven, Mahoney never needed much encouragement to try something new: reefers, moonshine, cigarettes, heroin. When he up and moved Charlotte, her four sisters and one brother, and their new "momma" north to Chicago in the early eighties she never thought things would be different but she had hope. That hope was squashed when the diabetes and the lung cancer were diagnosed at the VA. Mahoney delved deeper into depression and drugs, hookers and smack. Now look at him.
"Mommy, mommy, the white mens is coming." The doorbell rang and Charlotte hurdled the children watching TV in the living room to answer the door. "Good morning doctors, please come in." The "white mens" were actually Mahoney's hospice doctor and two medical students. All of them seemed to care deeply every time they came to care for him. Charlotte knew better though, as she felt their disdain for her way of life. The four of them entered the dining room and she felt each remaining drop of pride ooze from her being as she too watched the roaches, both small and large, scurry from the packages of gauze and hide in the nether regions of the carpet. "Do the roaches know something about these men? They don't scurry from us, Charlotte thought. A perverse sense of revenge came over her as the doctors seemed to feel uncomfortable and cringed.
All of their speaking was directed towards Charlotte. She never referred to them by name but continuously they addressed her as "Charlotte" while all the while looking and speaking at Mahoney. "Do they know that I'm a nurse? Well, nurses aide, at least," Charlotte wondered. They asked about "Mahoney's pain" and "symptom control." She showed them the log of escalating morphine doses, insulin injections, and meals. As she opened the log, a small roach, maybe one and a half centimeters of very light, almost translucent, brown jumped onto the floor, landing firmly on the carpet at the foot of one of the medical students, and fleetingly basked in the sliver of light entering the room from the southern window. "Oh shit," the medical student exclaimed and promptly squashed it under his jet black Dr. Martens. "Well, you guys have one less now," he said with a smirk on his face. The doctors checked the patient up and down—inspecting the bed sores which appear much improved, listening to his everfailing heart, palpating the abdomen filled with cirrhotic liver and almost certainly mets to somewhere, and finally asked Mahoney to breathe deeply while all three placed their shiny stethoscopes on his sweaty, smelly back. "I hear breath sounds on the left," one said as they played a game of Twister trying to switch stethoscope positions before Mahoney ceases to follow their instructions to breath deeply. Charlotte looked on in amazement. "They really care about him, don't they," she thought.
"It seems to us that his pain is under good control and he is not having much difficulty breathing, at least when he is not excited," explained one of them. Charlotte had heard this speech hundreds of times before, two, perhaps three times a week ever since they decided to enter Mahoney into hospice care. After all, this is what he had said that he wanted. After the seventh hospital admission last year the VA doctors presented Mahoney and her with all of the options but stressed "there is nothing left for us to do." What had they ever done? The years since his diagnosis had been a living hell. In and out of the hospital, surgeries, chemotherapy, radiation. Her father had become a human guinea pig. She thought that after years of this continuous medical investigation they should have some sort of answer, some sort of plan. But they did not. Repeated tests, more drugs, another tube into his body. She had heard their snide comments: "They all get what they deserve." "Look at what all those drugs can do to your body." "How many times has this poor sunabitch come in here, what a gomer." "Just put him out of his misery already, lady." She always tried to ask questions and allowed Mahoney to call all the shots, but it was not so easy. The doctors' biased commentary always led to only one logical conclusion. But Mahoney was happy, they always gave him a choice. He felt empowered through his medical adventures, the only time in his life that this was so.
Hospice was the logical culmination of this adventure. In and out of Rehab, hanging on to his remaining Lower Extremity, Insulin twice a day in the ass, other Meds too numerous to mention. Charlotte was a nurse, well, nurses aide, and even she didn't know what they all were for. Biopsy, Lobectomy, Radiation. When the kind Doctors presented Mahoney and Charlotte with the option of pain control and symptom management, they both were intrigued by the concept and signed on with nary a worry, even though it meant, according to Mahoney's oncologist, "Giving Up." The hospice workers were all kindly white folks who seemed far removed from previous experiences in hospitals. Always a smile on their faces, albeit they were always muted smiles. Caring, soft tones of voice. A hug here and there, always touching them. But now, after months of their visits, Charlotte was tiring of them, tiring of their caring. Was the decision she and Mahoney made a decision at all? The way it had been presented to them, hospice was a liberating experience. "The patient has power over his own Death." "Comfortable and at home." Well, the "home" had deteriorated to the point that it now resembled a shanty and comfortable was the antithesis of living under one roof with six children and a smelly, incontinent, rotting corpse of a man Charlotte called Father. Was this really their decision?
Escorting the Doctors to the front door meant crawling over the children lying on the floor in the living room watching transvestite brothers attack their prostitute sisters on The Jerry Springer Show. Charlotte opened the door at the exact moment that a pink and purple low-rider Ford F-150 truck rode by with its Chicano passengers glaring at her while they bounced to the sounds of a bass-heavy technodance remix of "Bella Maria de Mi Alma." "My how this neighborhood has changed," Charlotte apologized to the Doctors. They nodded in condescending agreement, left with her a plastic bag filled with saline, gauze, and two bottles of MS Contin tablets, said they would stop in at the end of the week, and wished her well. As they walked away, she swore she heard one of the medical students say, "He's going to die by then, isn't he?"
The walk through the living room into the dining room was saddening as always. The roaches did not scurry, they merely watched as if in agreement of all that had transpired in the room thus far this day. By now it was 12:35 in the afternoon, time to give Mahoney some food, the little of it he could swallow. First, however, she realized that the White Sox were playing that afternoon. Charlotte remembered how her Father loved sitting on the porch with his brothers, listening to the south-siders, and smoking a reefer. Quickly she sent her youngest son, Marque, 6, out to find Julius, her eldest. Then she put the small transistor radio on the window sill where the small sliver of light entered the room and fidgeted with it to ensure proper reception. While doing this, however, the window shade released and winded up instantaneously so that streaming sunlight blanketed the bed and its occupant. Mahoney opened his eyes with enthusiasm and looked right at Charlotte. "Let me Live...Die..." The first intelligible words he had spoken in nearly two months. Julius, 18, entered in a fine black and gold Karl Kani overall ensemble asking his mother what she wanted. "You got any chronic Julius?" "Yo, moms, you surely can't be serious," as he reached into a seemingly bottomless pocket to pull out a dime bag of marijuana and some rolling paper. Charlotte rolled the small faded green buds and crumbled leaves into a joint and lit it as her children looked on in amazement. After a deep toke, she placed her lips on Mahoney's and puffed gently...
For the first time in months, Mahoney was breathing calmly, peaceably, without his patented groans of anguish. His eyes were closed and he seemed to be happy. Around him were gathered in a half-circle of family, Charlotte, her six children (together for the first time in weeks), and three or four nameless "Aunts" that came by only in times of celebration. They were all silent while Charlotte recited a poem that she had been working on for years, something she had written on scraps of paper ever since they lived in Alabama:
"You brought us over on ships
You tricked us into building your railroads
You took our land and put us in camps
You killed our women and children
and yet you don't want us to breathe
free
You lynched my fathers
You raped my mothers
You try to kill my spirit
and douse my Hope
and yet, still, you don't want me to breathe
free
But through it all we survive...
all the pain...
the degradation ...
the persecution ...
We've given all the blood,
there is to give,
we're not asking anymore
we're telling you
Let Me Live
Free"
Julius of all people, the hardened gangster of the family, was the one who first noticed that Mahoney had stopped breathing. There he lay, eyes closed, a small smile on his face, and for the first time in months, there seemed to be no odor in the room. Also missing were the roaches that traditionally dotted the walls and littered the bookshelf and cabinet in the room. One of the Aunts suggested that Charlotte cover the body and say a prayer for him before calling the hospice operators who were always ready to forward the message of another successful Death to the necessary people. Charlotte repeated the poem as the Family came together, hand in hand, in a closed circle immediately surrounding the body. By the third stanza, the call-and-response traditions of their ancestors took over and "Let Me Live / Free" was repeated gloriously, louder and louder until the shades once again flew up, all but blinding the family members. One of the Aunts then went to get the hospice number and phone, quickly returned to the dining room, and handed them to Charlotte. "No, I don't think so. From now on, We can make the Decisions. And there's lots of Decisions to be made."
College of Medicine
First Prize
A world apart from the rest,
Sterile white washed walls,
Sleepy eyes, tired faces.
Uncomfortable souls in pain,
Sunlight barely creeping in
Pharmaceutics and disease
Little laughter, more tears
Smell of illness consumes
Smell of sadness and death
Knocked out by chemicals
Prescribed and over prescribed
The incessant buzz of the TV
Triple transvestites on Rickie Lake
White coats of all types
More people than really needed,
More notes than necessary
More hope than actual cure.
Time spent with incessant garbage
No time for the actual patient
Same questions asked over and over
Fighting nature and nurture
A world apart from the rest,
Sterile white washed walls,
Sleepy eyes, tired faces...
College of Medicine
The room was brightly lit,
Cold faces peered down from masks.
My mind wandered,
Pain in my head,
Numbness in my feet.
Dull faces moving in the light,
I dreamt the everlasting dream.
The hair is shaved off my head,
Slowly falling onto the floor.
Brains attempting to heal,
One another, one and the other.
Sounds of power tools drilling,
Little pieces of bone fragments flying.
The needle penetrating, probing,
Guided by the unswerving hand,
Of the unwavering sane maniac.
The decayed, cheesy material,
Sucked out to be dissected,
Analyzed, abhored and amused.
Beady eyes peering through,
Unfeeling microscopic glasses.
People in pink moving around.
This is my life, my only one.
All was done, routine of the day.
The wound is sutured, skin clasped,
The pink people gone away.
Battles raging, ravaging my head,
In the unconscious instability,
Of life and death coalescing,
As I dreamt the everlasting dream.
College of Medicine
He came into the waiting room slowly,
looking around with his cataract blue eyes:
the pale windows to his soul smudged
with the handprints and noseprints
of children and grandchildren peering in;
He sat down, and his jowls shook,
his skin wrinkled as his family hung on to him
like ornaments on a Christmas tree
getting scragglier—but no less wonderful—
towards the end of the season;
He sat back in his chair, his hands on his cane,
and then, aching, stood up as we called out his name.
So, Mr. Johnson, do you have any children?
"No," he said, "I guess I never had the time."
College of Medicine
The patient is an eighty-year-old
Male brought in by his wife of countless years,
Who said Doctors he just isn't the same.
She seemed so alone and full of worry.
I felt a sense of urgency, CVA?
The old man just lie there staring.
Quick Exam: Unresponsive man, VSS,
Crying wife who watched him roll away.
CT of head, chest X-ray, Labs, etc...
Each revealed pathology not in the other.
Multi-infarct dementia vs. endstage
Alzheimer's, diabetes, liver mass.
Nothing recent was on his problem list,
But we did not question that, admit him
Now, work up his problems in the morning,
Tell his wife to come back another day. But,
She was at his side all day every day
Eyes hopeful as white coats entered her room,
Distraught as we mention scans and biopsies
Briefly, knowing she did not know what to do.
No more pain for him she said after the
Third liver biopsy attempt came back
Inconclusive. She had waited by him
Three weeks ever asking when he'd be better.
My seniors told me we must send him home,
There is nothing we can do for him here.
I was sent to go tell her this awful
News, her tears flowed like rain down her sad face.
Although, touched by her pain, I was confused.
I asked her again why she brought him in.
After three weeks of tests and biopsies
Listen to her story, I finally did.
She talked and talked of a long loving marriage
Kids and grandkids all grown and far away
Leaving her to care for her husband without
Help. It took three weeks until I heard the call.
He had not spoken in over a year.
Every day she fed him and bathed him
Always hoping he'd recover one day
On the night she lost hope she came to us
The patient is an eighty-year-old
Male brought in by his wife who quit fighting
Today, She said Doctors he just isn't the same,
Leaving out how long he had been this way.
College of Medicine
Patient is a fifty-six year-old woman with a history of lung cancer with metastases to the brain and spine, presenting with fever, chills, shortness of breath, and a productive cough for two days.
Patient is alert and oriented x3.
But not for long.
When Madelyne was admitted she knew who and where she was, and though she could not remember who the president was, she knew it was 1998.
"The year? Oh that one is easy! I know that one! It's 1998."
Madelyne was a sweet woman, addressing everyone as "dear" and always happy to see you. She was very friendly and very talkative. She was from Scotland, and had four children and two grandchildren. Her children took turns visiting her every afternoon, and they wanted her at home as soon as possible. They wanted her to die at home and were afraid she would die at the hospital.
As the days passed, Madelyne's pneumonia got better, but her mental status got worse. Eventually, she grew silent and stared at the wall.
One day, I walked into her room and found her lunch untouched. I asked her if she was hungry and she said, "Oh yes dear". I asked her if she needed help but she said "No dear". I asked her again if she was hungry and since she responded again that she was, I decided to help her eat. I sat down next to her and began feeding her. She ate all of her lunch and smiled at me in between bites. I was glad I could help.
In the next couple of days, Madelyne got worse. She would not eat, even with "one on one assistance", and she would not talk. She only stared at the wall and seemed to be somewhere else. It was very frustrating to visit her now because no matter how much you talked to her, she would not respond. She wouldn't even look at me.
One morning, I walked in the room and Madelyne was again staring at the wall. I fixed her pillow and tucked the covers around her and as I did, she grabbed my hand. I looked up at her and she was staring at me now.
"What do you need Madelyne?", I asked.
"Help me."
"How Madelyne?"
"Help me."
"What can I do for you? What is it? What do you need?"
"Help me."
I didn't know how. I didn't know what to do for her, how to help her. I didn't know what she needed.
She didn't let go of my hand and so I sat down and held her hand until she fell asleep. She seemed so peaceful as she slept. The urgency I saw and felt when she was asking for my help was gone.
I guess I helped her after all.
Madelyne died that afternoon.
College of Medicine
He was iron
wrought from tough love and Dickens' porridge.
A face to inspire and lead armies
but he had no army, so he created one.
I remember his hands
they were huge, from hard work, with bratwursts for fingers.
I wanted my hands to look like his.
I feared him
but loved him because of tractor rides
and huge piles of sweet wild hay.
Only one held power over him.
She was dead now
and without her he started to die.
Cancer ate his brain
with lightning speed
and freed a young child with a goofy, stubbled, marked head.
The privates fed him with pewter spoons and
He said words that iron men do not say and left me speechless.
College of Medicine
Third Prize
There have been times
when I wondered ...
What was your life like?
What were the things that
made you happiest,
what were the things that
made you cry.
I have learned so much from you
though I must admit I was afraid,
I had never experienced
the coldness of death.
And never saw your face either
I couldn't imagine myself
looking into your lifeless eyes
but, kept my eagerness for anatomy
as we tore your limbs apart
So drifting away in thought
reflecting upon your days
I found myself quivering,
You too had blood once running
through your veins.
But, nothing was more startling
than the nail polish on your hand.
Class of 1992
Volume VI (1990)
Breaking of the silence
by the weeping of my own,
that blame one another
for leaving me alone.
Now, the hospital bed
where my body lies,
witnesses their wailing,
witnesses their cries ...
Who could they blame?
the doctor? the nurse?
I had been sick before,
I was a mortal
Didn't they know?
Now, that I've departed
to never come back,
No one was there to say good-bye.
I see them wailing,
I see them cry,
I see them leaving,
No one was there...
to hold my hand...
Class of 1992
We begin as pages
Hearing of the legends
Of the wards
Technique studied
Of the rapier and the shield
Eager young
Joans of Arc and Lancelots
To the battle
Against Morbidity and Mortality
Onward in the years
Our armor becomes kinked,
Rusted
By attending and resident lords
And the hordes that need healing
We rise each morning
To our castles
Riding the warhorses of Technology
To defend the dying
And destroy disease
Onward, promoted
After acceptance
From kings and queens
Allowed to hunt on their grounds
Be wary of thy crown
Learn well young pages
While on the battlefield
Do not fall down
For jousting is for glory
And battle is for life...
College of Medicine
Creating a medical context that is loving, joyous, and healing for patients and staff
One of the most puzzling aspects of the discussion around the health care crisis is the paucity of descriptions by health care professionals about their fantasy care facility. Has anyone, or any study, asked doctors and nurses to fully describe their ideal clinic or hospital? With the vast majority of patients and staff not liking hospitals, why is this context so tenaciously held onto? What role does powerlessness have in quieting a dreamer's voice?
Let this article be a stimulant to all people interested in health care delivery. Dare to think up and create a healing context (home, hospital, clinic) that the staff would crave to work hard in; where the joy that comes with being of service in meaningful ways would be routine. This would be a setting where patients and family would be delighted to be in when sick or well.
The health care context has been the horror of so much of today's medicine. One can still occasionally find the one-to-one intimacy so treasured in medicine, but these are special cases. Even as the doctor or the nurse has these great moments, they still feel choked by the context of their practice. The administrative (billing, paperwork, regulations, etc.,) and the hospital (serious, solemn, unfriendly, etc.,) contexts are not conducive to a thrilling, joyful practice of medicine.
The modern medical context must change. Many new experiments are needed to explore this very complicated field. The Gesundheit Institute has been one such experiment.
The institute's first 12 years were devoted to a pilot experiment. For most of those years, twenty adults lived in a large home and used it as a crude hospital. Open 24 hours a day, seven days a week, three physicians and others did what they could for whoever came.
We never charged money, accepted third party reimbursement, or carried malpractice insurance, believing that these practices are all at the core of the horror of modern medical practice. The work was supported by the part-time jobs of the live-in staff. We found that the joy of practicing medicine unencumbered by the trappings of modern practice is so great that it is even worth paying for ourselves!
To humanize medicine, we formed friendships with our patients. We gave three to four hour initial interviews, invited patients into our homes as guests, and went to their homes for both social and medical visits. Whatever the reason for the patient's visit, we stressed the importance of living a wellness lifestyle and provided many ways to make that happen.
To stimulate a path towards a joyous life for both staff and patients, we integrated medicine with the performing arts, arts and crafts, agriculture, nature, recreation and social service. To celebrate diversity and act as peacemakers in the healing arts, we accepted all complimentary healing arts as long as they charged nothing and could work interdependently.
To disseminate what we were learning, we invited medical students, nurses, and interested learners into our home to work with us and participate in the experiment. In these twelve years, fifteen thousand people came through our home/facility for everything from profound illness to simple curiosity and play. Since the heart of the practice of medicine is in the depth of the relationship, all these visits were seen as part of primary care.
After twelve years of this experiment, we realized that it was important to build our own ideal model hospital because there seemed to be no vision in the United States of real solutions in delivery of care. We decided to give up the practice to devote ourselves full-time to fundraising and building. The last ten years have been devoted to this task, and we have raised $1.1 million dollars. We bought 310 acres in Pocahontas County, West Virginia (the least medically-served state in the United States) and built one building and finished plans for a second. With the completion of this building, we can reinitiate patient-care.
I have spent this time networking with people and projects around the world and speaking at medical schools, chiropractic schools, and naturopathic colleges. Other members have lived on the West Virginia property, giving birth to our master plan with the assistance of a legion of volunteers from around the world. Though slow, the process feels organic, the progress ever palpable and the quest ever thrilling. We will not settle for less than our dream. Our forty-bed rural community hospital will offer Surgery, Ob-Gyn, Pediatrics, Psychiatry, Ophthalmology, Acupuncture, Chiropractic, Homeopathy, Naturopathy, Herbal Medicine, Body Work, Faith Healing, etc., in an interdisciplinary atmosphere. We will also have an outpatient clinic.
Forty staff members and their children will live in the hospital along with part-time help, medical and healing arts students, and entertainers. We will be an education center, providing opportunities for people who want to learn about what we do and want to serve humanity. We will have a school for our children, sick children and the children of patients. We will have a fully-operating farm, ornamental and herb gardens managed by staff, guests and patients. Indoor facilities devoted to the arts will include a modern stage, and workshops for ceramics, metal work, photography, fine arts, and woodworking. There will be a large library. Since aesthetic beauty is medicinal, we plan to make the hospital itself a work of art. We will set aside 30-40 acres for a village for long-term staff and for chronic care homes, to explore fun ways to care for elderly, disabled and chronically-ill people.
We are confident that we will be able to operate this facility on between $1 million and $1.5 million dollars per year of donations. We have agreed not to borrow money to create the facility so we will not have the burden of an expensive loan. We plan to rely (as we have for 24 years) on the cornucopia of generosity of services and materials from our network of supporters.
Our care facility is one approach to solving the health-care crisis. The point is not to suggest that we are the answer. In a complex, diverse world, we cannot afford single solutions. Instead, we need to nurture health professionals to band together and dream big. Be vocal and demonstrative about how you would like your health practice to be so that others can co-create it! If we can make our dream a reality, then you can boldly go after your own. You can lean on us for help. Please see us as a stimulant.
We are also here as an irritant. We must refuse to accept things the way they are because they are hurting everyone. We have a breakdown of community, a loss of a sense of belonging. As a family doctor, I see this in my practice as choking loneliness and insecurity. Everyone needs a health care system—why not use that as an impetus to bring people together as a community that creates a healing environment.
Our world is too troubled to think up puny solutions for gigantic problems. Do not settle for Band-Aids® where radical surgery is needed. Help co-create with the medical profession and all of the healing arts a context they love working in and you love being in. It is possible!
Arlington, Virginia
Medicine had an almost idealistic quality to it which was quickly erased from my mind. Returning to my home state, I was filled with ambition to do exactly what it is that every aspiring physician says they want to do (whether they truly believe it of not): to help people. Awaiting me, however, was a strange melange of lectures, an unforgiving and frequently incompetent bureaucracy, multiple choice exams, and, most regrettably, unfriendly and cut-throat students and instructors. I quickly lost any interest I possessed in the core sciences and began to drift from all that had to do with medical school. Paralleling this drift was a lack of interest in that which is central to medicine, the human experience. I envisioned an unfulfilling future medical practice which somehow resembled the tedious routine that was called medical school.
Unfortunately, I was not alone in this predicament; others were relating similar experiences. Why are we here? Life was beginning to resemble the world view which many instructors seemed to profess, that the world consists of two types of people, doctors and patients, physicians and non- physicians, healers and lay-people, deities and trash. These instructors (and, slowly, my colleagues) inevitably drift, on their sturdy boat of medicine, farther and farther away from the shore of common human experience. Even the superb body of experience to which they are exposed in their daily work is somehow largely lost to them as a source of existential growth. Their (and, now, our) knowledge becomes transformed into arrogance and in the process obscures all that is central to the "healing art."
Taken from a mid-'80s New York Times op-ed piece, the following tenets are central to medicine: trust (between the patient and practitioner), communication (likewise, between doctor and patient), the fact that systems of healing arise out of the shared worldviews of a culture (medical practice is therefore empirically-derived), the fact that medicine is inseparable from the rituals with which it is practiced, the fact that the practice of medicine is a privilege, and that acts of caring and compassion are seen as inseparable from acts of curing. These are fairly cryptic, but nonetheless quite powerful statements. From them, my view of medicine has but four basic concepts: passion (passion seems to allow one to grow larger than the problem), creativity (to defeat illness, this is essential), intentionality (on the part of the physician to heal and the patient to be healed), and, finally, self-discovery (how every day of medical practice enriches the next). These are the concepts which I want to incorporate into my future practice.
Out of self-discovery comes open-mindedness, something which is difficult to come by in the halls of academic medicine. Allopathic medicine has traditionally been quite unaccepting of "alternative" therapies, forcing practitioners of such therapies into the role of quack for nearly all of the twentieth century. What many in the traditional medical establishment fail to recognize is that randomized, double-blinded studies cannot account for every successful medical accomplishment; as mentioned earlier, at the core of medical practice is human experience. In the past few years, advances have been seen in the medical community in terms of accepting non-allopathic medical treatments; but, I have seen very few practitioners well-versed in the art of mixing allopathy with other forms of healing. I too am sometimes quite skeptical of this mix and match form of medicine; but, as I become more comfortable with both sides of the equation, I become convinced of the efficacy of such a practice. Granted, a bacterial pneumonia is not an indication for the use of massage therapy; but an unending bout with stress headaches that have been non-responsive to other forms of stress management and medication surely is.
Medicine is both an art and a science, while at the same time being neither. In the latter half of the twentieth century has the science of medicine so completely engulfed physicians that they are no longer interested in the patient as a person? "The patient knows how he feels but does not know what he has, while the doctor knows what the patient has but does not know how he feels" (Blumgart 106). This fascination with the molecular basis of disease has all but excluded the compassionate regard for the patient who is suffering; a robot generation of interchangeable doctors is being produced. However, the science of medicine and the art of medicine do not have to be mutually exclusive; on the contrary, they should be complementary, together constituting a continuum in the service of mankind. Without scientific knowledge, a compassionate wish to serve mankind's health is meaningless. My experience, however, is that scientific knowledge is more readily taught, more easily taught. The application of knowledge at the bedside, however, is largely a function of sagacity inherent in or personally developed by the individual physician. The scientifically-grounded medical practice which remains at its heart humanistic is one for which many physicians strive but few attain.
"One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is caring for the patient." This commitment to constant caring for large numbers of ill people is difficult to attain for most constantly overworked and sleep-deprived medical students and residents; however, it also seemed lacking from even the loftiest attendings with three "off" days per week. I wish more physicians were listening ver one hundred years ago, when William Osler said "do the kind thing and do it first."
"Life is short and the art long, the occasion instant, experiment perilous, decision difficult;" and, yet, healing is possible, indeed, it is ubiquitous—it occurs in every living creature every single day, with or without the help of healers. And, among our privileges as the most sentient, most clever creatures on this planet is the ability, occasionally, to perform acts in aid of humanity—both in a spiritual sense as well as a technical sense. We give aid not just for the sake of healing but for the sake of giving our lives and giving meaning to those with whom we have contact. I wish more of my colleagues, not to mention the countless doctors, before me, would take this privilege seriously.
College of Medicine
It was the first day of an eight-week core rotation and the fifth core rotation for us as M3 students. This professional PGY3 has to orient us to the first two weeks in this sub-specialty. She introduced herself as being one of the more friendly residents in this specialty and admitted that she really was not prepared for the orientation. She assured us that the next eight weeks would be only for the fittest because this particular specialty is as competitive as surgery. She then confided that the last group of our classmates that came through this rotation were generally too outspoken, rude and difficult so the professional residents gave a lot of the students bad evaluations. She went so far as to mention a couple of names. Anyway, if we would anticipate orders, carry them out without question, answer all questions correctly, show initiative, be awake and alert all night while on call, and be excellent caregivers and servants, then we had a good chance of hitting the jackpot—a grade of Honors. At this point it seemed the conversation had ended but this professional R3 continued.
"I did not go to the U of I College of Medicine."
She graduated from some extremely high priced med school in the east. Wonder why she ended up at UIH for residency?
"We have figured out that the reason UIC med students are so weird and unprofessional is because most of them never went through a formal preadmission interview process. So the school ends up with all kinds of weird, undisciplined students."
At this point, all I could think was "be still my tongue." My two classmates looked like they had tuned her out a while back and they were just waiting for permission to leave for the day.
This professional R3 picked at her red acrylic nails and unwieldly bleached hair all through the humiliating welcome. She promised us an intro to floor procedures for the following morning, then dismissed us for the day.
I could not help wondering whether UIH also admits residents without preadmission interviews. I felt like snarling (in my most professional voice), "Madam, if interviews could reveal all, then you would not be here today to humiliate and intimidate three frightened strangers who are your surbordinates. Your behavior today, Madam, is proof that interviews are overrated."
Of course I did not utter any of these words. I thanked her for her attempt to make our eight weeks run smoothly by telling us what to expect. I felt like a liar but quickly realized that most of this was a game—a game where you work with some people you don't want to be with and you cooperate with those who persecute you for the sake of the patients.
My two classmates left without a word. Interviewed or not, they are truly professional.
College of Medicine
Sugar Daddy Uncle Sam belches out another two hundred thousand dollar a year "hospital donation" as our savvy medical school delivers another freshly pureed "doc in a box" from their state funded primary care assembly line. While three bills a month as a fresh intern may briefly quell any loan-struck post-med school "premee", the hedonistic rhythm of the remaining one hundred and sixty grand government dowry is what really makes the interviewee succumb to the hospital's CEO corridor.
With the flick of a switch, our student wakes up from their fiduciary nightmare, a voice is heard and it says, "So what brought you here to our family medicine program ?" Traditionally, the student must surround the truth (about just wanting to become a good doctor) with a spectrum of bogus pleasantries and bludgeon the interviewer with unnecessary clichés. Humorously, the interviewee would enjoy an alternative response, "What I really love about your program are the brick inlay and the sumptuous cafeteria food. That, as a family practice intern, we have third year surgical residents doing our laundry and parking our cars is a big plus. The vending machines are superb." (i.e. CUT THE CRAP, please !!!)
To sum up the interview process, our jaded medical student has now developed a universal "Applicant Algorithm":
PAINFUL COMMUTE—CONCILIATORY GREETING AT EARLY HOUR—STUPID COMMENTS ABOUT WEATHER—MEETING WITH PHILOSOPHICALLY INAPPROPRIATE PROGRAM DIRECTOR—INGRATIATING ONESELF WITH PROGRAM DIRECTOR AND SUBSEQUENT RESIDENT INTERVIEWERS—EXPENSIVE, SALTY, GARGANTUAN, IMMENSELY CALORIC LUNCH AT FANCY RESTAURANT WITH CASH STRAPPED RESIDENTS WHO BOAST OF THE COPIOUS SPARE TIME DURING THEIR RESIDENCY YEARS—TOUR OF HOSPITAL PREMISES WITH THE FIRM UNDERSTANDING THAT YOU HAVE NEVER SEEN HOSPITAL ROOMS SO LAVISH AS THESE—FINAL MEETING WITH NOW VERBALLY REDUNDANT PROGRAM DIRECTOR AND CONVEYANCE OF FALSE SENSE OF MUTUAL INTEREST BETWEEN APPLICANT AND PROGRAM—HURRIED YET CHEERFUL GOODBYE (REPLETE WITH UNDERHANDED INNUENDOS, RAMPANT MISUNDERSTANDINGS, AND A CAMEO SMILE)—PAINFUL COMMUTE
Rinse and Repeat
College of Medicine
i. Forensics
Note her knees, flecked at the patellae
with scraps of blue—from the patina,
I would guess a cheap ecclesiastic
plastic, perhaps of Midwest origin,
circa 1965, or, less likely,
Eisenhower-era truckstop. The lab
will run the routine checks for traces
of holy aspersions, grape juice, catsup—
denomination can furnish motivation—
but, meanwhile, gentlemen, please take note
of the external auditory canal:
fluffy hyphae, characteristic
of the mold aspergillus furnigatus,
bloom at the os, each a tiny replicum
of God's holy sprinkler, the aspergillum.
We call this phenomenon "the signature,"
the one queer coincidence among the clues
that dogs us long after the chair has cooled.
ii. Excerpt From The Confession
...if I tell you how even her knees
flecked a rosy gold in the summertime,
then would you understand? If only you
had seen them brushed by her light, her light hem
(as I recall, organdy or gingham)
as she dipped in a smug genuflection,
the holy curtsey denied to Lutherans.
Lord, how she kept on lording it over me!
I swore on the fifty-six fingers
of St. Peter the Dominican
that stigmata, not pimentos had stained
my palms, and thus her new dress,
and she swore back that Satan himself
would swell on my tongue, reconstituted
from heathen spit and holy wafer,
leavened by mauvais foi and methane,
and moreover she hoped that my tongue
would freeze fast to the frigid altar rail
before the onrush of Christ's freight train and
that the devil's sizzling third rail
would spitfire me express to hell. (The gal
had a knack, there's no denying it,
for theological raillery.)
I can still see her knees—in slow motion
and in sagittal section—how they folded
at her lovely cruciates as she fell.
Newton, Massachusetts
for Isadore Rosenberg
Purpura fulminans. She scrapes a bit
of flesh from one dark lesion's leading edge,
and spreads it on a thin oblong of glass.
The lab, at 3 am, is empty, still,
except for the dull throb, the metered hiss,
the intermittent click of instruments.
The redolence of agar, warmed microbes
spreading over plates and clouding flasks,
milkens the basement air, reminding her
and her breasts of the infant sleeping, home.
Gram stain (c. 1860, Christian Gram)
is a task that any intern knows by heart.
Which really means, she thinks, by hand and brain.
She leans to stainless steel, adjusts the stream
of water (gentle, cold). Uncaps the lamp
whose woven wick leads spirits into flame
atop a thick glass bulb, a zungensprach
whose bluish heat will fix the stolen flesh
to glass, Pompei without its coat of soot.
First comes crystal violet. She decants.
The livid fluid drowns, obliterates.
She counts—one onethousand, two onethousand—
recalling lightning, and how she'd time the gap
between it and thunder, terror-struck, to tell
how close the storm was. Mother? Fast asleep.
Fulminans, it split the purple sky,
photographic negative of how
the purple lesions split her patient's flesh
white from white, so swiftly she could see
the fingers gloving purple, the slender flank,
barely sixteen, now wise beyond its years,
putting on the horrid, tattered lace
of a certain betrothal. Time to rinse.
Next, is Gram's iodine, brown but kin
to violet. It blackens starch and stings,
astringent, medicinal. She counts again.
Recalls Paré's humeur fuligineux,
the sooty, brackish humour that meant death,
modernizes it to DIC,
disseminated intravascular
coagulation, when the whole works
clots and bleeds at once, the clotting cascade
become Niagara, and then recalls
how every cliff and cataract reminds
a mother of her infant's perilous
sojourn upon the earth. She shivers, yawns.
Thinks of the silent woman by the bed
behind the weft of tubing in which her child
sleeps, and in which both seem caught. Now rinse.
This is the tricky step. Decolorize.
Too long and the caught flesh will wane to ghost,
too short and it's an inkblot, both everything
and nothing. It takes intuition, eye.
The rods and cocci come out pink or blue
according to their kind, gram-negative
or positive. Like us, they're named for stain.
Rinse. A name's a stain, a drain. The brain's
so easily misled by likeness, rhyme.
A bruise is not a flower, and breath's not time.
Last comes the counterstain, the safranin.
She counts again. The embalmed cells enrouge.
I undertake, she thinks. It undertows.
Her fingers, carelessly ungloved, are red
on splattered purple, on raw pinkish beige.
She counts. Her shoulders bend beneath the weight
of hospital. She likes it underground,
amidst the caged, proliferating germs,
things with no business but their own to mind
busily, mindlessly, endlessly, thousand.
She counts and breathes regret. The final rinse.
Then blots between the leaves of bibulous
paper, red and wrinkled as if by fall,
and looks, holding the slide up to the light—
a pinkish whorl caught on transparency,
the fingerprint that solves the heinous crime
but cannot ever resurrect the corpse.
She knows what's there, what fateful, slashing sword
undoes the body's weave so thoroughly,
terribly, swiftly, fulminans, more
fulminans than a Papal fulminare,
not war or condemnation or a flower
blooming on a girl, but just a Gram-
negative diplococcus, bean-shaped,
able to undo the body utterly,
within hours, within a breath. The mother sits,
she thinks, and listens to the bloody falls
just a bit downstream from where her child
hangs caught midchannel in frail branch and vine.
Penicillin, pencil, little brush
seem useless against this inexorable
flow and gravity. And microscope.
Three fifteen, she thinks, is the worst time.
Immersion oil bathes eye and lens and slide
in highest power. She twists the focus, fine,
and is ashamed to find them beautiful—
hard, fuschia, twinned, stippling a field
of pink and blue nucleated honeycomb:
Neisseria meningitidis, akin
to N. gonorrhea, named for Neisser
(1855-1916)
who was a German syphilologist,
as syphilis was named for the hero
of "Syphilis Sive Morbus Gallicus,"
the sorely afflicted shepherd, Syphilus.
Named by Girolamo Fracastoro,
a doctor-poet of Verona,
circa 1530, who was in turn
named by his mother, for something round
or spinning, for mud or olives, a fracas-
maker, bull, brother of beavers, Pollux,
swordsman, Hieronymous, holy name—
who knows? How did his name stain him? A name,
a dusty cabinet, piled bibelots.
Her baby, she thinks, she hopes, must be asleep.
After names there comes the bedside watch.
She tries to count the hours left till home,
loses count, and tosses out the slide.
Glass clinks on glass. She'll take the stairs. L'chaim.
Newton, Massachusetts
Do you know the muffin man
who lives in Drury Lane?
—child's song
There may be a few angles here
in Family Liaison, but we
are mostly sunk in womby curves
while our loved ones are off elsewhere.
Mercifully, there's no TV,
but just discrete high end Muzak,
the minor masters of Baroque—
G. Sammartini, Telemann—
and a few Christmas Carols, yes,
but of the not-too-jolly kind,
sprinkled in for seasoning.
says Tom, our host in Liaison.
The hospital white noise and med-
lies from the sweet Nutcracker Suite
sursurrate so soothingly
I could forget the wedding band
deep in my backpack's black abyss,
a guest beneath the loosened clasp
of my old change purse, and ignore
bone saws poised above their swift
descent, all whirring too, and in
fact, I slip into a cat
nap dream of spinal fluid, cold
and lucid on the petrous ridge
of temporal bone, bubbling and spry
as water sprung from rock, holy,
numinous, cascading through—
then jolt awake, kinked and adrool
on plump earthtones, between a pair
of Danish Modern arms that, blond,
curve around me, barely touch.
as the 4th Brandenburg comes on,
the dark andante, surely a
programmatic accident,
tactless as a surgeon's Oops!,
two flauti dolci falling side
by side through a vast space where just
three red beacons cast the light—
pointsettia, EXIT, fire alarm—
toward three closed doors marked CONSULT that
are clustered in one inlet. That's
where they keep it, the bad news.
and swipes a red scrap from his lip.
Below this room the dreary lanes
of Boston's Mission Hill darken
in the tenth straight day of rain
as sirens sluice down them toward
the sodden hospital, but our
window's just a snaking slit.
It's cut below the curved rooffine,
onto a view of scaffolding,
and airshaft sheets of concrete, glass.
We ask: has the sun risen yet?
Will it?
Newton, Massachusetts
for Dr. Williams*
Come round with me, Dr. Williams, in the modern
miracle hospital. Halls gleaming white:
tile, steel, porcelain.
Come round and see where we are now.
Accountants perform surgery.
Corporations deliver babies.
Billing as important as aspirin.
Come, watch the technical prowess,
artificial knees, hips.
Enter frail and leave metallic.
Brave world to replace Time's toll.
Visit the ER,
the portal for all troubles.
Dope addicts next to chest pain,
sore throats angry at the wait.
While nursing home patients lie
in gray stillness.
Feeding tubes supply mortgages.
The monetary supreme.
We are so lost, Dr. Williams.
The soulful touch, the faithful nod,
the peace of reassurance-
lost, hidden by fiscal reports,
tales of mergers, acquisitions,
sequestered by revenue reviews.
How to heal the wounded trust?
Examine and prescribe, Dr. Williams.
Make us whole again. Your ghost roams
these hectic halls, searching
for a quiet moment, finding poetry
where machines whir into the night.
*William Carlos Williams, M.D., American poet-physician
Class of 1987
Annals of Internal Medicine
Vol 128, No. 4, p. 312, 1998
The cops bring us doughnuts, fresh
from the bakery. They sit with us in the lounge
and tell war stories from the streets.
Sal, the grinning Italian, puts his arm
around the nurses, like all cops,
he is heavy, a paunch overriding his belt.
We bite, doctors, cops, nurses,
munching doughnuts with coffee,
hiding from the humanity we serve.
Feeling their presence out in the street,
the hospital beds, the bars, the jails...
They're out there—
Drunks who will fall
and need stitches.
The runaway will run before a car
and need x-rays, will be difficult, leave
against medical advice.
The out-of-towners will be robbed,
struck with a hammer to the head.
Welcome to Chicago.
The neighborhood gypsy's foot will not "feel right."
At 5 a.m., she'll come in.
The wino the cops will find left out on the street
a gash over his eye, blood everywhere,
soaking his clothes, dripping bright red
on our white tile.
They're out there, miseries waiting to happen.
A broken world, angry, and wanting repair.
The unreal city is all too real,
lost in its darkness, no dawn in sight.
Leave us for now
so we can sit and chew our doughnuts.
Because we hurt, too.
Class of 1987
Volume III (1987)
They say in France and Belgium
landmines still explode.
World War I remnants
buried under layers of soil.
Some poor goat or cow
unassuming, dull-eyed
will traipse a step too far
blasted to bits.
A farmer in the morning fog
surveys his pasture to find
a splattered carcass.
The past never disappears.
One step this way or that,
and it explodes.
I. Mr. Morgan, smoker of 40 years,
one day coughs up red jelly.
Empty packs litter the house.
His voice turned to gravel;
His chest round and hollow.
A tumor, silent and growing,
nibbles into an artery
II. Ms. Crawford, sober for the past year
finds her skin turning yellow.
I am becoming a carrot,
she laughs.
Soon her urine resembles Coca-Cola,
her eyes take on an amber hue.
I knew the bottle was bad,
she sighs,
missing her daylong cocktail.
III. Her uncle raped her
on her twelfth birthday
She dropped out of school,
met the wrong crowd,
stated out late, cried all day.
Ms. Warner slit her wrists
with a rusted razor.
The wound just deep enough
to cut tendon, nerve, vein.
Old landmines blast to the surface
leaving traces of blood
on dried grass and twigs.
Empty farm fields,
pastures lush and green
turn battleground once more.
Exploding shells rise to tell
the war never stops.
Class of 1987
The Journal of Emergency Medicine
Vol 16, No. 2, p. 237, 1998
We may meet at 3 or 4 a.m.
or on a weekend or holiday.
It doesn't matter.
I'm always there.
You wake in your bed
and I have coffee at home.
You work, play, live, love.
Then, you come here.
The moment of crisis or trauma:
The body against desire.
Or maybe it isn't you at all.
Maybe it's your mother, husband, child.
You bring them in frantic cars,
house keys dangling from your hands.
Always the open eyes and mouth.
How—how could this happen
Why—why did she get sick on Easter
or Christmas or Thanksgiving.
It doesn't matter.
I'm always here.
get in my car, calmly, no rush
to meet you, all of you.
Strangers: a handshake between us,
the quick smile, the knowing nod.
My drugs enter your veins,
commune with your flesh.
Your blood sprinkles my hands or face;
gloves a thin membrane between us.
Do something, you plead
The pain is unbearable, you scream.
I know.
Could you dream last night
You would stare at a stranger's eyes,
Your life's core given over on faith?
Our parallel lives merge now.
This intersection of fates:
the great family catastrophe
or even your deathday.
We meet at last,
and the lines diverge.
Class of 1987