You would have liked her.
She held the clouds in her hands,
And dreamt with sunlight in her eyes,
Her hair a tangled falcon's nest,
Of wild ideas and wondrous lies.
You would have liked her.
She danced to music
No one else could hear,
And when her feet would bleed
She'd feast upon her tears.
You would have liked her.
She ran along the precipice,
Where the cliff top meets the sky,
With the careless confidence
That if she fell, she'd only fly.
You would have liked her,
Though she may have sang off key.
You would have liked her,
Though she laughed far too loudly.
Oh yes, oh yes,
Of this I'm sure,
You would have liked me,
When I was her.
"A Journey into double matter"
A journey home
A journey to a familiar place.
Molecules of the now are mixing
With molecules of the past.
A critical mass is achieved beyond which
There is recognition of home.
Home is where there are molecules of the familiar
It is home because enough elements
Have been seen before, felt before, heard before.
If there are only few familiar molecules,
Then there is déjà vu and only a strange encounter.
I say: “I know but I don’t recognize”
More molecules of the familiar:
I say: it’s home, it is that feeling of 1968,
A belief that the world will renew itself forever…
Even more, then there is a nostalgic memory.
Nostalgia is when enough memories of the familiar coexist
To create coordinated feelings, thoughts, desires and hopes
For renewed coexistence.
I watched the swallows
Leave these lands.
Lining up, counting one more day.
Swarms orienting toward south.
Young and older,
Joining the dream of escape.
Ready to sail the skies of promise.
How many will arrive?
Is the real drive to success aimless?
Is success just a state of mind?
An illusion that can be handed down
Like a token from one generation to another?
"ACCIDENT on PCH"
We are sitting
drinking coffee, laughing
talking about our kids
The day is bright and happy
The air is crisp, the sky blue
the clouds white, the trees green
The people around us
are laughing too
glad to be
drinking coffee on such a day.
Then a thud
We all look up, laughter interrupted
First we see the car
at an unnatural angle
the driver already halfway out, lamenting
Other cars are stopping too
brakes squealing with annoyance
Only later do we see the kid
scattered in the crosswalk
the skateboard upside down
wheels still spinning
"Twinkle, Twinkle, Little Star"
Two men passed through a sliding door, going in opposite directions, both silently humming ‘Twinkle, Twinkle, Little Star.’
One older man coming in; one younger man going out, but for very different reasons.
They were at Good Samaritan Hospital in the small town of Puyallup, Washington, which has a tradition of playing ‘Twinkle, Twinkle, Little Star’ over the PA system in the maternity ward every time a baby is born.
It is a nice tradition, meant to celebrate the miracle of life.
The older man had been at the hospital for weeks with his wife in the cancer ward as she succumbed to an aggressive cancer in its unforgiving late stages.
He had been there faithfully every day and during those long hours, he would pass through the maternity ward halls on his way to the hospital cafeteria.
The first time he heard the faint tinkling of that familiar lullaby, he thought it was coming from a single room.
It was very soft, not meant to disturb anyone, as if it were background music almost meant to be ignored.
He passed through the same hallway many times and sometimes it played, but other times it did not.
But any time the song did play, the man would notice because it was special to him.
One day, he heard the song start from the beginning and as he continued down the hall the song did not fade away, but stayed at the same soft volume.
He knew it couldn’t be coming from a single room.
He saw a nurse and asked why the song was playing and she told him about the hospital’s tradition.
As he sat in the cafeteria he wondered if he should change his route back to his wife’s room.
He was having trouble dealing with his wife’s deteriorating condition and the memories he had of the song made it even more painful to think of losing his wife.
He had sung this song to each of his three daughters as a bedtime lullaby.
In his mind he remembered the many fussy nights that he sleepily hummed the tune to his girls.
However, on his return trip the man did not change his way back.
Instead, he was curious if he would hear the song again.
Would he be walking by when another baby was born?
He thought of all the times he had heard the song, and how many babies were beginning their lives every single day.
He smiled and couldn’t help but think about the days that each of his daughters was born.
He began looking forward to his trips through the maternity ward hallway.
One day, when he returned to his wife’s room, he told her about the tradition in the maternity ward.
She thought it was such a sweet tradition.
He asked if she remembered how he would sing the song to their daughters when they were young and she smiled as she remembered it well.
For the rest of the day the man and his wife talked about their children—about their births, their funny personalities, their awkward teenage years, their accomplishments, their memories of vacations, holidays and family traditions.
He did most of the talking, since his wife tired easily.
But he knew she was listening because even though her eyes were closed, she would smile or start coughing lightly if she began to laugh at a funny part of a story.
Sometimes he even saw tears slide down the sides of her cheeks when he talked about their daughter’s weddings, graduations, and children— but he knew they were tears of joy.
That day was the best day he had ever experienced with his wife in the hospital since she had been admitted.
Every day from then on, whenever they were alone, the man would talk with his wife about the memories of their lives together.
They went through the years, talking about places they had lived, things they had done, or friends they had made.
The man felt differently now—he felt grateful and blessed for the life that he had experienced with his beloved wife.
He no longer dreaded her passing, but cherished the memories of life that they shared.
When she passed, he missed her—but the final week of her life had been happy as they relived memories of their beautiful life together.
As he left the hospital for the last time he heard the familiar lullaby melody tinkling softly once again through the overhead speakers of the maternity ward.
He continued humming it to himself as he went through the main hospital door, passing a younger man who was on his way in.
The younger man was eager to see his newborn baby, a little girl born just the day before.
He had been at the hospital for two days with his wife in the maternity ward awaiting this new chapter in their life.
He had heard the song ‘Twinkle, Twinkle, Little Star’ many, many times gently announcing another child had been born.
He always wondered when it would finally be playing for them and frequently found the tune playing subconsciously in his mind.
As he entered the hospital to hold his new baby girl he had an epiphany.
“This will be the song I sing for my daughter when I put her down to sleep at night, a new father-daughter tradition.”
He smiled at the thought, as he passed an older man on his way out of the hospital, still silently humming ‘Twinkle, Twinkle, Little Star.’
"Everything Changed the Day I Heard Those Words"
David R. Lee
"비행기 표 사서 집에 빨리 와. 아빠 heart attack 받으셨어.” This roughly translates to: “Book a flight back to Sacramento immediately. Your dad had a heart attack.” The morning I got this chilling call from my mom was the day everything changed.
I am the type of person who likes monotony, who keeps a schedule and follows it. I wake up at 7am, drink my cup of coffee, get ready for school, and jog at night prior to falling asleep. But this particular morning, I froze. My schedule was broken. I felt numb in my fingers and toes. I had this cold, sinking feeling inside that I couldn’t explain. My mind went blank.
When I eventually got to the airport, I regained some warmth in my fingers. “I’m going to organize a vacation for mom and dad. They need to get away and relax for a bit. It’s just a heart attack; I’ve seen so many heart attack patients in the hospital who recover quite well. I’m going to send them on vacation.” With this in mind, I remember pulling out my laptop and looking at vacation packages to Hawaii. I wanted my dad to quit his high stressful job and let loose!
In Sacramento, I realized the situation was more complicated than I imagined. “He had a subarachnoid hemorrhage. It doesn’t look good; gather family. Know that it’s unethical to keep him in this state. We suggest you take him off life support.” Unethical? This word resonated in my mind. I developed a fiery hatred towards this neurologist. Who are you to say what is ethical or not? Who are you to pass judgment on others? Of course we are gathering family; give us some time!
With my hands and legs shivering and tears rolling down my face, I started to pray. I’m not a very religious person; the last time I went to church was 4 years ago. But out of desperation and fear, I turned to praying. “Please God, save my dad. I need a miracle. I need to see my dad awake. I need him to go to Hawaii. I’ll go to church, just save him God, Please.”
My dad passed away on January 5th, 2013.
My body was frozen with my fingers and toes numb again. I could feel a dark cloud around me with feelings of guilt and sadness. I had no voice. My body was in auto drive, going through the motions, but not processing what happened. I was on a collapsing bridge and my body had just hit the icy ocean. It was hard to breathe, hard to understand anything.
I remember waking up in the morning and looking outside as the frozen grass began to thaw. Winter was coming to an end and spring was approaching. “I can’t believe it’s already March.” I began taking steps to reconnect with the world, to rewire my understanding of the future. I stood together with my mom and brother looking at the ocean where we spread my father’s ashes, realizing all I still have in this world. The warmth of the sun was against my skin.
Everything changed the day I heard those words.
I now walk the halls of the hospital not as a patient, but a provider. I recall one of my attendings telling a patient’s mother, “I’m sorry, there are no signs of any neurological activity.” There was clear terror and grief on her face. Her face was full of tears. I reached out and warmed her cold hands. “You are not alone, we are here for you.
Stroke. With a stroke of a pen I can scratch out these words. Yet a stroke can scratch out so much more. Facial expressions, bowel control, personality, memories. It's a lottery of what will be erased. And what will fill the spaces left behind.
Most of my memories of my grandmother involve flowers. Going to garden centers with her to see what buds the new season had brought. Arranging bouquets for the beautiful Catholic church where she had worked and prayed for longer than I had been alive. Planting pansies in her front yard, letting the tide of colors and the warm smell of newly broken soil speak for us and bring us closer. Wrapping her long, elegant fingers around my short and stubby ones, she shared her passion for the earth with me. And of course, I remember her violets. My grandma had the best African violets in the state. She tended to them as fastidiously and tenderly as a mother tends to her newborn child. She kept them properly pruned, perfectly lit, and devoted an entire room of her home just for her precious violet buds. I always slept in the violets' room because I hated the dark and cold as much as these tender flowers, and so I fell asleep enveloped by my grandmother's passionate work.
The first stroke erased the flowers. Other things went too, I'm sure, but when I think back, the flowers seem like the crucial first stone of the inevitable rock-slide. She awoke from surgery, and the doctor said the bleed had stopped, but we would still have to see what had been affected. Indeed we found her body was almost perfectly sound, but she no longer cared at all for flowers. She found them ugly, especially those nasty purple ones, and just could not see their point. So her once bountiful yard became bare. Her former life's blood, those delicate violets, were thrown in the garbage with all the other useless trash, and their old room became cold and dark. They were scraps of a different time, of a different person.
The second stroke erased her memories. My mother called me to tell me that grandma had another bleed. Again, her body seemed unaffected, but now she could not recognize anyone or anything, not even her rosary. Thinking back, perhaps it is surprising that in that moment I was more shocked that she did not know what her rosary was than the fact she did not know her own family. Maybe because the idea that her memory of her children, grandchildren, and great-grandchildren, her 50-year marriage, and everything that had made up her life could disappear in a moment was too abstract, too enormous to comprehend. But hearing that she did not know her rosary, that integral, tangible part of her soul that she had carried with her to mass twice a week her whole life and prayed with every evening, was like being told she did not recognize her own hands.
My hope was with time she would start to remember me again, but each time I see her, it is the first time she has seen me. She doesn't know who I am, who anyone is, but she likes to sit and listen to us talk. My mother once lamented that it must be a miserable existence, to lose hold of your past and to forget everyone you knew. I agree, it is a terrible, horrible life...to me. The idea of waking up lost and utterly confused about the world around me, is terrifying, and to see that happen to someone I love is devastating. Yet, my grandma mostly seems content. The woman who she was, who lived a full and independent life, has long been forgotten, so how can she be missed?
I look at her in trepidation that someday I too may lose my memories, my passions, my very self. She just sits quietly, listening to people talk. I go and sit with her. I hold her thin hands, the same beautiful hands that used to hold mine. Her body is exactly the same, and yet everything that I could ever pinpoint as a defining characteristic of my grandmother is gone, utterly erased, and what little that is left has formed someone completely new. No longer a caregiver, she is someone to be cared for. In these moments, when I remember all the things she has lost, I miss my grandma most of all.
She doesn't miss anything.
When I opened my eyes
The sun tried to reach out.
To penetrate a deep screen
Of foggy turmoil.
Fragments of fog, low clouds
Dancing to the sound of celestial rituals.
Rituals of broken hearts,
Of pieces of broken lives,
From early days to these days.
Fragments are here
To both haunt and resurrect.
Departing for now
Until it is dark again.
Until night sleeps off
This day’s haze,
Until crisp stars
Will dance to a new tune again.
Time plays the cruelest tricks of all
For it is a prankster with no sense of humor.
It laughs and grins as it runs past us while we smile,
As if it couldn’t disappear sooner.
We play along as life flows by
Because we truly don’t have a say.
But when smiles fade and skies turn black
The days begin to stay.
“Three weeks” she said
In a hollow voice,
Reluctant to share words.
Three weeks until the results are in
And my final verdict is heard.
In the time it takes to fall in love,
Or perhaps simply grow a beard,
I’ll waste away on the inside,
A victim of timeless fear.
"The Good Night"
He leans back and smiles, adjusting himself on the stiff examining table as if it were his
favorite armchair. “You know, I read an article a few years back called ‘Why doctors die
differently’. Very interesting. Very well-written,” he starts. The younger physician raises his
eyebrows, attentive to his patient’s every word, trying to soak in the wisdom of his mentor. “I’ll
never forget the last line of that article. ‘There will be no heroics, and I will go gentle into that
good night.’” A pause, as both doctors come to a silent understanding. A handshake and a pat on
the shoulder, a nurse asking the doctor to sign a form. And now Dr. Thomas is left in the room
with only his wife. She has been watching, listening, thinking, but now that the brief visit is over,
she is left with more questions than answers. Mostly, she wonders how someone as brilliant as
her husband could be so utterly insane.
When he first got the diagnosis, metastatic pancreatic cancer, he had come home like it
was any other day. He was a little late, as he had scheduled his appointment after a full day of
seeing patients, but he was often a little late. After 35 years of marriage, the Thomases found
comfort in being a little late, as they both knew it meant that a patient had needed extra help, or a
few extra charts needed their t’s crossed. Life had settled into a comfortable routine after their
two kids had grown and moved out of the house. It felt like the good old days, when he was a
resident and they were newlyweds, only back then they didn’t have the luxury of being a little
late to anything. Yes, life was good. Until the day it wasn’t.
Mrs. Thomas reached for her husband’s hand when she heard those words, and he
wrapped his arms around her. She thought, in a flash, to all those times when women had looked
up enviously at her. “Your husband’s a doctor, how lucky! Just in case anything ever happens!”
they would say. When their children were all in grade school parents would call their house,
asking about their son’s cough or their little girl’s scraped knee. Never mind that Dr. Thomas
was an ophthalmologist, and never mind that the instructions on how many Tylenol to take were
written on the label. He always answered their questions, always reassured them. This was what
made Mrs. Thomas feel lucky, not that her husband knew how to be a good doctor, but that he
never had to learn how to be a good person.
It was the same thing that made his patients feel lucky to see him, that sense they got that
he knew how special they were and knew exactly what to do to help them. Over the course of his
career, he had performed over 15,000 cataract operations; it was undoubtedly his favorite thing,
the thing he felt he had put on this Earth to do. Sure, he treated macular degeneration, dry eye,
glaucoma, infections, even the occasional lid inversion. But every Monday when he went into
the operating room and started prepping his first patient, he still felt the rush of excitement he
had felt the very first time he removed a cataract. Patients knew this about Dr. Thomas, how
passionate and dedicated he was to achieving the best outcomes. That’s why they traveled hours
to see him, and why they called him a miracle worker when they saw better at age 85 than they
had at age 15. It was indeed a beautiful operation, and if patients were struggling with whether to
go forward with the surgery, Dr. Thomas would always advise them the same way. He would
look them in the eye, put one hand on their shoulder, and say “well, if you were my mother, this
is what I would do.”
Mrs. Thomas knew, the way nobody else could know, that this was the way Dr. Thomas
was with everything in life. The relief patients felt, knowing how confident and decisive their
doctor was – it was the same relief his wife felt whenever any decision was looming. Even when
it came to choosing what to order for dinner, they would sit down at a restaurant and look over
the menu. Predictably, she would be stuck between the chicken and the fish. Both sounded so
good and, oh she hadn’t even heard the special yet and that might be fresher. But then if they
ordered red wine, maybe she had better get the steak. She would peer across the table, past the
oversized menu, and her husband would have already set it down, gazing around and taking in
the scene. Their eyes would meet and he would say, “I’m getting the pork tenderloin. Side of
potatoes. Need some help?” And they would chuckle to themselves, knowing the answer and
also knowing that some things never changed.
She thinks about that now, as she sits in the corner of the exam room and hands her
husband his coat as he hops off the table and begins to dress. It made sense that he would be so
decisive, speaking with such thoughtful conviction when it came to his end-of-life discussion. It
made sense that he would approach this decision the way he had approached everything over the
years. But no matter how much sense all of this hypothetically made, Mrs. Thomas still couldn’t
make sense of any of it. The feeling in her heart couldn’t translate the knowledge in her head.
At dinner, all she can manage to get out is, “so that’s it? A quote from that Wall Street
Journal article about heroics and going into the night, and you’re done?” She thinks about all the
times that he loved being the hero for his patients and restoring their vision. Why couldn’t he
have that attitude now? He sighs. “Just as I know how I want to live, and have always lived how
I want to live…I know how I want to die. And I want to die, in many ways, how I lived. At
peace, with you by my side, knowing that I did things my way.” The tears come before she can
stop them, not because she disagrees, but because this is what she will miss the most about him.
How does he make everything seem so simple? How does he comfort her without even trying?
She has always been the one to overcomplicate things, to see a hundred shades of grey
when to Dr. Thomas there was pure black and white. An author of historical fiction novels, she
would research her material for months on end before finally settling on a narrative. It seemed
every time she decided she understood the motivation behind a political strategy or government
policy, she would find a document that subtly suggested otherwise, and she would be back at
square one. Her work was messy, complicated, just like her thought process. She always secondguessed
herself, and she desperately feared that without her husband to see things so clearly, she
would ultimately get stuck in the mess.
“Do you remember that drive on our honeymoon?” he asks her, holding her hand at the
dinner table while she wipes her eyes. They had been traveling to Stinson Beach, along the
curves of Highway 1, when she had looked around, disappointed at the charred stumps of trees
everywhere. She had expected lush forest scenery, and was afraid to say how sad she felt looking
at the burned hillside, thinking maybe it was a bad omen to the start of their marriage. Dr.
Thomas, then just Mr. Thomas, had told her calmly, “the forest has to burn and the trees have to
die to make room for a healthier, better forest. We’ll come back here. You’ll see.” And they had
come back, every year since, and he had been right.
The tears stopped and they were quiet for some time, enjoying the way it felt to be with
someone and not have to fill the silence. To just be there. They knew what would grow from this
fire, what would be born from his death. It was her turn to have his confidence. In that moment,
she knew, in every bone of her body, that he would go. And when he does, she thought, he will
go gentle into that good night.
"Nothing Left to Say"
She grabbed my hand when I sat down by her bed
The two of us alone in the pre-op area
Tears glistening in her eyes, deep with wisdom
Of having lived eighty years, now with cancer
She told me it was hard to say goodbye to her family
Before she left them for surgery
Which we both knew was risky in her condition
She said it was more difficult for her family waiting outside
I brought her husband to her bedside to wait with her
Each of us holding one of her hands
And her husband telling me how they met
On a blind date, since married 60 years
He told me he was a pianist
And she retorted he barely played
Rolling her eyes, like sarcasm at a party
Playfully bashing her lover
When the nurse said it was time
He gave her a quick kiss, while I waited
For a profound declaration of love
In the chance this was their last encounter
But there was no such profession
For it had all been said
During the life they shared, purposely
And wholeheartedly lived up to this moment
Eyes locked with a final glance, and then
He disappeared to the waiting room
Though he had not waited to tell her anything
He loved like there was nothing left to say
"Bones of Time"
Larisa M. Lehmer
Destruction amidst construction
Stress leads to strength, fractures to healing
Beginning delicate, flexible
Skyrocketing to unwieldy heights
Sustaining bumps and blows
Callouses contain the memories
Turnover. Both new and the same
The substance completely changed
Rigidly still, moving life forward
Built up, and slowly worn away
Backs sag, necks bow to behold
Young roots emerge from a calcific dust
would you like a cup of water, I asked her
so sorry to wake you, it's time for your father's CT
one more signature before he goes upstairs.
exhausted, I think about them while nursing a coffee mug.
forms and perfunctory midnight kindness.
two weeks later, I'm happy they're back -
that cruelest of hopes, to see a patient again.
more water for her, coffee for me,
her father's bum hip paying for our friendship.
we talk about the weather, our dreams, his schizophrenia.
as she speaks, I fall through a trapdoor in his mind
feel the fear greasing the white tile walls.
they come again within a week.
water. coffee. hip.
we three know each other better now.
the ice breaks easily as I help him into bed.
maybe today he sees my true face:
an agent of the government, a tormentor, a fellow acolyte.
she stares at the ceiling's fluorescent crucifixes.
later, eyes covered, she asks,
how much can God ask a family to bear?
soon after, another night of acrid chemical prayers.
he comes in alone, she's off at a wedding.
no water, I guess. the coffee and hip stay the same.
as the night quiets down, I sit on the end of his bed
we talk about the winter cold, our dreams, his fears.
he looks softly at me.
I was a cop, right out of high school, he says
won some awards. saved some lives.
couldn't work once I saw baalzebub sitting on the ceiling fan.
rain falls outside in the ambulance bay.
jesus, I say.
he smiles sadly.
shifts are hard when you can't tell what's real.
I rest my hand on his.
apologies. smiles. frozen time.
my heart breaks.
we are numb ships drifting on a windless sea.
then I'm off in my cyan armor
other ships in other beds to drift by
The First of Many Patient Progress Notes"
Identification: 56 year old male presenting with stage 4 adenocarcinoma of the left lung.
Fifty-six years old. When I was ten years old, that seemed ancient. Now that I'm in my early
twenties, that's disconcertingly young. Even younger is the age of fifty-four, when my uncle was
diagnosed with cancer and a newfound appreciation of time was imposed on my family.
Chief Complaint: Difficulty breathing, eating, performing daily functions.
That's to be expected, right? Lung cancer? Edema? Dysphagia? Words that I'd heard before, yet
to fully understand their true meaning and cause. The daily functions included things that I took
for granted, such as showering and going to the bathroom. It’s difficult to forget the look of
hopelessness on his sunken and sallow face while my aunt, mom and I assisted with increasingly
frequent diaper changes.
History of Present Illness: Diagnosed 2 years ago, currently undergoing chemotherapy.
If we're going to do this justice, we'd have to go all the way back to Vietnam, where he was born
and raised. A math teacher from Saigon, with a distinguished reputation in his town, he was
uprooted violently and unwillingly from his home as a result of the Vietnam war. After a few
torturous days on the ocean in a cramped boat, he found himself at a refugee camp in the
Philippines before being sponsored to the United States. Remember to ask him about his
experience in the refugee camp.
Past Medical History: None reported.
Nothing outstanding. Nothing that was caught anyway. His is the story of missed opportunities
for diagnosis, squandered chances to treat. The pain that he had for 2 years was dismissed as
being musculoskeletal in origin, but as a former smoker with an impressive pack-year history, it
warranted caution and proactivity.
It wasn't until he was laid off from his job and about to lose his insurance that he urged his
primary care physician to investigate further. The diagnosis of stage 4 adenocarcinoma was
devastating. However, for 2 years, an amazing drug called Tarceva kept the spread and growth
Family History: A father with dementia, mother alive and in good health.
I've heard it said before that the worst sadness is when a parent loses their child. There's
something unnatural about that -- to have the child that you bore and raised leave the world
before you. After witnessing the heartbreak of his mother at the cremation service, I understand
Social History: Married, no children.
It's not like they didn't have children out of choice. My aunt, who is my mother's blood sibling,
is my godmother. To deal with the sadness of not being able to have her own children, she pours
that love into my cousins and me. And so when it came toward the end, I became their surrogate
daughter. I was faced with navigating an onslaught of paperwork regarding Medi-Cal, setting up
hospice care, and interpreting for my family and the healthcare providers. These were all things
that I had experienced with patients in a clinical setting, but never for my own family.
Assessment: End stage cancer with metastases to the brain.
In his last two weeks, there was a very apparent decline in his physical and mental health. He
stopped talking, stopped eating, and stopped interacting with us. His body was motionless from
exhaustion and his eyes glassy, only responding to pain when we moved him from sitting to
Plan: Palliative radiation of the brain to reduce neurological symptoms.
Seeing those words printed in cold, unfaltering text on his chart was probably the first time I
really knew that he was nearing the end. Palliative -- the buzzword for end-of-life care, hospice,
and treatment of symptoms, but no hope for a cure. It was almost as unsettling as the initial
diagnosis for us, most likely due to our denial and hopes that he could eventually beat his
Subjective assessment and plan for the patient’s family:
On a personal level, his death is bittersweet, especially its timing. For my medical school
admissions personal statement, I described my uncle’s diagnosis and treatment as some of my
motivating factors for a career in medicine. Here, a few days before starting medical school, I
faced a poignant and personal example of what drew me to medicine in the first place- namely,
the dichotomy of exciting frontiers in science and the sobering limitations of our clinical
treatments and healthcare delivery system. Each lecture, anatomy dissection, and talk that I’ve
attended so far in medical school is a testament to this. There’s so much that we can currently
do, but an infinite amount more to be discovered and applied.
My family is still adjusting to his death. Each holiday this year has been a ‘first one without
Uncle Son around.’ We set aside a bowl of whatever meal we are eating as a placeholder and
decorate his burial site with holiday trinkets. There’s a fair amount of healing to go, but we’re
getting there together.
Jeffrey Suchard, MD
“Vicodin refill” was the chief complaint listed by the triage nurse on the electronic patient tracking system. One unfortunate consequence is that it is easy to make premature judgments regarding the validity of a patient’s complaint. The triage nurse usually does not elicit the entire story behind the decision to come to the ED, which may be very logical and justified. Instead, we get a brief and often cynical interpretation. But I can’t blame the triage nurses for this, because doctors do it too. One of my goals in guiding students and residents is to help them avoid becoming too cynical and uncaring about complaints that, at first glance, appear to be ridiculous reasons for coming to the ED. Nevertheless, the history offered by the patient who is the star of this ironic tale was a classic, obvious, and pathetic lie.
My resident had just gone to see “Room 32”, as I will call him. Instead of starting his presentation in the traditional way (e.g., “Room 32 is a 29-year-old man complaining of pain of one week’s duration after a dental procedure…”), my resident baldly asked, “Is it OK if I physically assault this patient?” I hadn’t thought this resident had any anger management issues, so I was obviously curious as to what had set this off.
Room 32 said that he had a tooth extracted the week before. The dentist had given him a prescription for only 10 Vicodin pills which were now all gone. The dentist was currently on vacation and so Room 32 couldn’t get a refill by calling the dental office. So far, this story was pretty typical, and nothing to set off my resident’s ire. It was the additional supporting facts of the case that caused the ridiculousness to expand exponentially.
Room 32 was drunk. Not falling-down drunk; just word-slurring drunk. It’s no crime and not that rare to be drunk in the ED, so that wasn’t the problem. When the resident asked the patient for the name of the dentist, he got two different names, although the two names were admittedly quite similar. Chalk that one up to the alcohol, maybe. The kicker was that Room 32 had bummed a cigarette off of the patient in Room 34 (who, incidentally was there requesting a refill of his Valium) and then smoked it inside the hospital. That’s just plain rude. It’s like walking into someone’s living room and relieving yourself on their carpet; well, maybe not that bad, but it’s still rather rude.
As you might expect, we were not eager to refill the Vicodin prescription. Yet, I wanted to give Room 32 the benefit of the doubt. I could imagine the following scenario: Assume that the patient actually had a dental procedure done the previous week; that he had received a prescription for only 10 Vicodin (now long gone); and that his dentist was now on vacation. If Room 32 then called the dental office for a refill, I could easily imagine that the other dentists might decline to give him a refill over the phone; I know that I wouldn’t do it if I were in that position.
I asked my resident to contact the dental office. If we could at least confirm that Room 32 had had a tooth pulled recently, I still might be inclined to refill his Vicodin. I was not optimistic that either name he gave us was real, so I was astounded when my resident came back to me to say that he spoke with the dentist. She was not away on vacation, as the patient had claimed, and she remembered our patient very well. She confirmed that she wrote him a prescription for 20 Vicodin (not 10), and even gave him one refill after that. When he kept calling her office for more, she decided to cut him off. I thought this was perfect. We felt that this guy did not have a valid indication for a Vicodin refill, and now we had incontrovertible proof that our first impression was correct.
The only thing that remained now was to finish the paperwork and tell the patient he was getting no prescription. When my resident went to discharge the patient, Room 32 had already eloped from the ED. Either he got bored, or he understood that we were on to his story, so he left without waiting for his discharge instructions. But he had left his “calling card” in the examination room in the form of an empty vodka bottle. I felt totally vindicated and thought that it had been a great teaching case for my resident.
Unbeknownst to us in the ED at the time, the patient’s exploits that day continued. He then went to rob a liquor store. It wasn’t a flashy robbery where he pulled a gun and demanded all the money from the register. That wasn’t Room 32’s style. Instead, he grabbed some beers and tried to run away. The operative word here is “tried”, since the proprietor saw what was going on and chased him out of the store and down the street.
Apparently, Room 32 was paying more attention to the guy chasing him, and not enough to where he was going. He ran into the street and then right into an 18-wheeler flatbed truck. The truck didn’t hit him; he hit the truck. Nevertheless, the truck still won, splitting open Room 32’s forehead, but luckily not his skull. Room 32 fell down, and then had his legs run over by the same truck. Someone called 911, police and paramedics arrived, and the patient was transported back to our ED as a critical trauma victim (CTV). We were alerted that a CTV was on the way, although of course there was no way of knowing who it was, and no one at the accident scene knew that he had just been in our ED.When the patient arrived, it was evident pretty quickly that he would need to be intubated. He was awake, but his only verbal response to all of our questions was “Help me!” My resident now got a better look at the patient and told me, “Hey, this is the guy from Room 32 we were talking about.” We intubated the patient and he was further evaluated and resuscitated by the Trauma team. His legs were seriously injured from being crushed by the truck’s wheels, and we knew he’d need to go to the operating room for this at the very least.
As the patient was whisked away to the CT scanner, I couldn’t help but feel really good about the whole encounter. I don’t know whether the patient initially had a significant amount of dental pain that required prescription drugs, or if he was just trying to fool us. Either way, the patient exhibited behavior that would not be tolerated anywhere else but the Emergency Department. I tried to give him the benefit of every doubt, yet he still couldn’t generate a story that got him to his goal. I thought this was a great learning opportunity for my resident. It felt very gratifying when we were able to confirm our initial negative suspicions, since this can rarely be done in the course of a typical ED visit. After he left the ED, the patient continued to exhibit anti-social behavior, but then he got struck by instant karmic retribution.
But the most striking and ironic thing to me was the certainty that, when the patient would ultimately get discharged, he would surely get his prescription for Vicodin: just like he asked for in the first place.
BREAKING BAD NEWS
Johanna Shapiro, PhD
Something breaks for sure.
What is it?
The words shatter
sharp shards spilling out
all around us
It looks like something
is breaking inside her
Her face is cracking
I am already wrecked
That is no news at all
He was a little boy with a name like honey, and a disposition to match. He was sticky and gooey and had oddly bright eyes that you could see in the darkened room from hallway rounds. He craved and sought attention, sweetly adhesive hands wrapping around the nurse, the respiratory tech, the attending, the green medical student with heavy pockets. Hold me, his eyes would say, please let me love you.
The hospital note reported that he would have been in agony for weeks after the incident. Each time someone moved him to change a soiled diaper or sat him up to feed, a million miniscule shards of sunburst bone dug further into the muscle, igniting pain receptors and sending his 18 month old brain into the kind of pain that forces professional athletes off the field in a stretcher. A force perpendicular to the femur, the note said, much like snapping a chopstick, can only be an intentional desire to cause harm to the child.
It was becoming an afternoon ritual. He sits easily on my hip, my arm curved around his small back, his spongy hair grazing my chin. After six laps around the unit, an attempt at a vocabulary lesson at the Christmas tree, and a high five to everyone we walked by, his eyes had begun to droop but his grip tightened as if he knew what was to come.
She was leaning against the doorframe as we waltzed back to his room, a giant stack of papers in one arm sitting on her hip just as my little boy was sitting on mine. Another shorter lady stood by her with a toothy smile that seemed filled with relief rather than joy. Good news, short lady beamed, we found a home for him and he can go to a home today. The lady with the papers beamed along with her and instantly that pesky beating organ in my thoracic cavity filled with some sort of bile acid and heavy metal.
I squat down to place him on his feet, peeling his honey hands away from my neck and wriggling out of his grasp. His transverse femur fracture, though healing well according to the orthopedic surgeons, has shortened one leg by half an inch and makes him walk with a limp. Strange, to see a child so young walking like an old man. Stranger still, to see him teeter over to the new foster mother, look up with his bright eyes, and raise his arms to be held by this stranger without anxiety.
My pager buzzes and beeps. I have other patients to see. I flash a smile at the two ladies and give him a high five. The baby is babbling happily, enthralled with the new toy that foster mom has bribed him with. Quickly, I slide away from his crib, intending to disappear unnoticed, but I stop suddenly in the hallway to glance back at my sweet little boy.
His eyes catch mine, says, Please don’t leave me again. My heart stops a beat. Then as if nothing had happened, he looks back to the adoring ladies and continues to bang the plastic truck against his crib.
Teary eyed, I marched out of the unit with a heavy heart and heavy white coat. Looking towards the future, there was no guarantee for a happy childhood and normal home for this child. As a student studying to be a physician, I like guarantees. I love to be certain that a treatment is going to work, the patient will be cured, and foster children will end up with loving forever families. But really there is never a guarantee in the art of medicine. For every patient encounter, we try our best to heal, optimize, and improve, and then we leave the rest up to the magic of the universe. I only hope that this little boy with a name like honey, after being taken from a situation of abuse, fear, and detachment, can learn that he deserves to be loved just as much as he love others with little handprints of affection on everyone he meets.
A Morning Jog
Wilfred Manzano, MS1 UC Irvine
Exhaling despair in exchange for new hope, He ran for the horizon
Through mist, fire pulsed the rising sun—
A glinting orb of energy:
Invigorating and golden
Like the marathon medal he strove for A dream, shattered by shattered bones, Now reconstructed
By the titanium forged into his knees
His stride hinged on new hinges:
Speckling the future with rays of dawn
Breaking through grim nights of somber immobility His bounds, now long and steady,
Each step a kindling added to a growing fire; Melting away the iciness of debilitation,
As hope warms his lungs with each inhalation
Raindrops hang on spring’s first crocus Scintillating buttercups
A solo daisy on the hillock
Dances in the late spring breeze
Some by instinct
Sink their finger
Nails into the fertile land and
For a moment are a unit
With their mother they are joined
Maidens round a maypole
What compels their well trod circles Blithe
Indifferent to the sun
That now has crept across the sky
Some are carried by the warm breeze Til it drops them come what may
Not this one she learned well
Learned to tend and Keep the garden well
Lawns and paths are weekly trimmed The crafty vole’s fenced out
And when the days start growing short Old vines are cut brown stems are pulled A plot of earth must rest
Among the last thoughts issued from the Deepest patches of my mind:
Her arms then tiny
Grab my waist
Illusion of Control
Soe Thein, MS1
I once walked under a clear early morning sky,
still dotted with sparkles of stars,
holding a mug of hot mocha flavored with dark chocolate,
on a path level yet rugged enough to demand my mindfulness
My mind wandered among the stars,
marveling at the complexity of the universe
My tongue danced to the hot sweet notes of the Belgian chocolate
With each step, I enjoyed a light massage from gravels beneath
After a while though I grew tired of the sparkling stars
My tongue craved plain water instead of chocolate
And with each step, my feet began to ache
Suddenly, I long for a refuge from the things I once cherished
When my perception of bliss is beyond my control,
I wonder what can be permanent?
Samuel Sampson, MS1
I felt the world narrow
as I looked at her, a frail woman tonight thin and grey,
lent animus by memory and desperation and loneliness.
She gestured weakly as I came to her and said something, muffled,
under the thick, coiled tubing
which snaked to the mask
bound about her face.
I took the straps off,
and at this early morning hour
she straightened her hair feebly, gazing in the darkness
as the machine sputtered and blew.
I rapidly ministered to it, pleading for silence.
Freed now, she spoke;
Dimly, there arose an elegance, rapidity and lucidity,
an English accent and gentle words spilling out in her deprecating way.
She beckoned; I sat, and held her hand.
She told me of her time -
she was a young woman,
on a boat, falling away, journeying overseas, Australia, to a new home far removed.
Of a man she had met there, and loved and buried. Of her work -
she had thought it very important;
Of the children she had borne -
how she missed them.
For me, for herself,
she sketched the arc of her star.
Sitting on a precipice, she spoke: What really mattered now, here mostly alone, in the dark,
a small hospital room
and drawn curtains, fold-out fabric walls.
At times I held that blowing mask against her face, to give her the breath, at times I asked a question -
but mostly I listened
and held her hand.
The machine huffed, disconnected, waiting, in the dark.
She smiled as she spoke, sometimes mocking herself, sometimes wry, sometimes happy, on some things she couldn't speak - we both understood.
She held a strength, I knew,
found in those who dare reject hubris.
My pager interrupted,
it was the world interrupting, really, I silenced it -
and sat with her and listened
until I could no more.
Her last words,
said with a smile:
"I know you're busy.
Thank you for listening
to an old windbag like me."
I told her it was my pleasure -
I have always honored teachers.
I strapped the mask back on
and smiled at her, constrained, buried now, under mask and tubing with life and machine
connected again, far from equal.
She gazed up at me, still and silent. I gave her hand a squeeze,
and left into the world of light,
and things to be done.
My world had expanded,
but it was her last conversation.
I just want to dance
This pain! I wish it would go away……I just want to dance.
It started with those fevers. And those sweats. How could I forget those? And that yucky cough; I couldn’t even breathe. It was the night of my recital, around Christmas time. I performed the Nutcracker. My boyfriend was in the audience… what a good show.
I remember waking up in a drench. And that cough! The thermometer said 103. That’s when we went to the hospital. I was tired, I really just wanted to sleep. I danced a lot that day.
The doctors let me go home after a few days. I didn’t feel too well, but I got better. I wasn’t really sure what they were waiting for; something to do with being “afebrile”. They kept saying that I had an infection in the lung? A pneumonia? I wasn’t sure. I just remember missing all my friends. We had our first high school dance that weekend. I missed it all. So unfair.
What was even more unfair was that it kept on happening.
I ended up in the hospital again 3 months later. But this time it was worse. The fevers, the sweats, the cough. I came to expect those feelings. I stayed there for close to a week. After 2 months – again, I was back. This time it was really bad. I needed “intensive care” I guess so I was taken to the ICU, as they called it. The doctors didn’t know what was going on. I kept getting different answers. They took lots of blood.
Finally during the last time in the hospital I remember this one doctor who came in. He talked to me about my lung: “After reviewing your CT scan…” I remember him explaining. “We found some abnormalities. In the left lower lobe…” I tuned him out at this point. I tried to pay attention but he was looking at the papers in his hands. Who was he talking to? Certainly not me. Was someone else is in the room? I watched him speak but didn’t connect with the sound waves… kind of like how he didn’t connect with me. I tried to care, but it didn’t seem that simple. I just wanted to feel better. I just wanted to dance.
I was shuttled from doctor to doctor. I remember waiting in a bunch of offices. Finally, I met with this one old man. I remembered he sat down with me. He told me I needed surgery. Surgery? Me? Why?
They told me I had a “variant of CCAM: Cystic medial adenomatoid malformation”- I had to look that one up. It just sounded too unreal to be real. Supposedly some people, like me, are born with holes in their lungs… and that little bacteria can live in them and cause fevers. It was hard to believe it was happening to me. According to them, the good news was there was there was hope for my condition. “When we remove this part of the lung with the holes with surgery,” the old guy explained, “we shouldn’t be seeing any more fevers, it should be all better”. I had no choice but to believe in him. I was ready for this nightmare to be over. I just wanted to dance.
The surgery was when it all changed. They took out part of my lung. I don’t remember much about the days after. It was such a blur. I remember feeling really good though when the IV was in. I could have stayed like that forever.
But it didn’t. I cooled down at least. The fevers were gone, yes thank goodness. But pain came… and soon it became unbearable. Nerve pain they said? Whatever it was, it was sharp, knifelike. Electric. In my chest and back. Horrible, horrible pain. I couldn’t sleep, I couldn’t eat, I couldn’t even really move. I needed that IV, and whatever went through it. Without it, it wouldn’t go away.
I thought I had known pain. Hours and hours of rehearsal. Countless nights with muscle spasms and blistered feet. That pain was worth it. I needed to dance.
I had good days and bad. I thought all hope was lost but I didn’t give up. The doctors and therapists worked a lot with me. We tried different medicines; we worked on my breathing. I wasn’t sure why at first, but it helped more than I ever imagined.
Thankfully now my pain is under control and I am in a better place. I knew I could do it… My life won’t be defined by diagnoses and pain, but by my love for the stage. I handle each day like I handled each play: endure the pain for the thrill of performance. By putting one foot forward, by just wanting to dance.
Much of my strength is lost, but my mom reminds me of how tough I am. I feel tough. As my recovery continues, I remain committed to be being better than I was. As if preparing for the final adagio, each day I take a moment to close my eyes and take in a deep breath, looking forward to all the times I get to smile and dance.
My Geriatric Patient
Under weathered, wrinkled hands
A soft handshake.
Behind thick glasses, gray eyes
A lilting smile
An inside joke told once upon a time
A trove of stories
Of lessons learned
Of friends, sorrows, triumphs
Of bridges burned
A bittersweet lightness of being
That only he can describe
Carrying something precious
And on he strides,
Steeped in time
Old in history, young in life.
Under weathered, wrinkled hands
A soft handshake
He smiles with his eyes.
My geriatric patient carries a burden I would not wish upon anyone – living a healthy and fulfilling life while the love of his life continues to destroy herself, and their future together, through smoking. She is a part of his daily life.
In Quiet Stillness
Giancarlo A. García, MS3
If I could only see once more
That smile of yours that I adore
The rosy blush upon your face
That graces mine as we embrace
I’d gladly give my life for yours –
For you the rose, for me the thorns
If you could only know my sorrow
That there will be no more tomorrow
They tell me now that you will fly
With choirs of angels in the sky
My dear, I did not give consent
For you to leave, while I lament
If I could have just one more chance
To hear your footsteps as you dance
Upon your glow, my gaze affixed
Your radiance is not eclipsed
By any other living soul
You gave me warmth, you made me whole
If you could hear my voice proclaim
The joyful sweetness of your name
Warm mem’ries of those summer days
When your light set the world ablaze
And how I loved those nights in June
The violet sky, and crescent moon
Your gentle hand enclosed in mine
Our lives forever intertwined
If I could travel at your side
You’d be my hope, and I, your guide
Your clement soul, I’ll always miss
As you now cross the great abyss
And if through darkness you must stray
Your emerald eyes will light the way
And when you reach your golden pasture
I pray your heart be filled with laughter
A world that knows no hurt or gloom
A garden of hope, always in bloom
Now all is calm, your body still
Your dreams, I ask, that God fulfill
As you depart, I, too, must leave
I will not mourn, I will not grieve
I’ll know that you are always near
When wind is whisp’ring in my ear
In quiet stillness, I’ll rejoice
When hearing echoes of your voice
Dear reader, I now say to you
I hope you do not misconstrue;
This has not been a tale of lovers
This is a tale unlike the others
A mother’s love cannot be known
The bond we share cannot be shown
She was my dearest little friend
And bravely fought until the end
And now that I must say goodbye
I look upon the halcyon sky
I grasp her palm, and softly weep
My darling daughter –
Rest in eternal sleep