Vol. 14 No. 1 Volume 14 Issue 1 Canada: HIV Rules by Mona Hedayati

Vol. 14 No. 1 Volume 14 Issue 1 Canada: HIV rules by Mona Hedayati

In this work, the HIV capsid protein, a structure that protects the rNA of the virus and delivers it to the cells when it infects the host, is 3D printed in red to convey the alarming situation of those living with the virus and those living with the virus who have yet to show signs of infection. It is then allegorically positioned on a throne to raise awareness of how the fear of contamination is ever-present in our daily lives. Since the discovery of HIV, the basic rights of those living with the virus have been breached on an ongoing basis; despite global education programs, the systematic discrimination has not been neutralized.

Mona Hedayati is an Iranian-Canadian interdisciplinary artist who ap - proaches her practice from a conceptual and critical perspective. She has presented essays in forums, conferences and symposiums in Berlin, rome, London, Manchester, and Tehran, as well as across Canada. In her recent body of work, she is interested in creating a multidisciplinary discourse around the role of superpowers in shaping the current world order.

We are grateful for the generous ﬁnancial assistance of the

Departments of Psychiatry at the University of Toronto, Mount Sinai Hospital, and Centre of Addiction and Mental Health, and to sup - port from the Canadian Association for Health Humanities / L’Association Canadienne des Sciences Humaines en Santé and Associated Medical Services (AMS). Published in partnership with CISP Journal Services, Simon Fraser University.

For subscription information or to submit a manuscript, contact [email protected] or visit: http://ars-medica.ca

ISSN 1910-2070

B S M P S L M J J A S S r S L A r A r P T A E r A F V A . o a t u t a o u i a r e i d T a f l l d o e o o a u e o s c r i l l r r a a a g z y u b x i . r v a i i a r n b b n a k d a t H e r r s s s r a l o l n

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Contents Volume 14, Number 1

eDITorIAL : W rITINg THe SoUL

Allison Crawford I – VIII

FeATUre PIeCeS over the rhone and Into the Night: Just Be graceful by Florence Gelo 57 – 60

The Last Patient by Diana J. Pi 48 – 56

To My Patients by Mays Tahseen Ali 61 – 63

ProSe

The Show by C. Alessandra Colaianni 5 – 12

I’d Love To, But Unfortunately I Have My genitourinary exam Tutorial Tonight by Michael Lubin 29 – 35

PoeTry

Phalaenopsis / April / The Way Art Lives / Doing good by Ingrid Andersson 1 – 4

Nearly Six years by Erica Danya Goldblatt Hyatt 13 – 16

7:45pm / Cry / Legion by Stanley Princewell McDaniels 17 – 23

I Kneel Down by Sage Schick 24 – 25 Volume 14 Issue 1

Bodies of Work by Rebecca Coles Lee 26 – 28

Commonplaces by Rebecca Ann Spears 40 – 47

Healthy by Trevor Morey 36 – 39

None of My Fellow CPr Instructors Have ever Done CPr by Ron Riekki 64 – 65

Lift by Dan Campion 66

Transplant / Doctoring / Cancer Season by Sarah Kristin Andersen 67 – 69

V o I l s u s u m I e e

“ i t s T a a p t s t i B g I g o n s n o h h o h t r r r f e h

h e r g

r t t r e

o o a c r “ , a A e i

n o e i

n p c i T t v r t o

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s e t h u r a u h o

i e i e l e h

a s s c d e e g b t e d v l e o f

h t e e h a

d e “ u v h M

e i T a g I t a , e k i

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h e d o n

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a t o e x n r ” c t w

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e e

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e e t I o

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E t h w

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e i h g

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a e e t o o N b s m

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e c i e i

o o c a t n

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s t h i

h e

n a t e c f t d h t o u ’

o w i l h i t c t

a N r t n i o t n

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a c B g i c t e r h i t t ﬁ

h v e

i a o n r

J e a h h

o e t ( o g w e

, a o t ’ u l

h 1 e i t

r t ’ e t t

. i n n s a

i h s

s n

s o a 9 s i

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g e t u s r a a o e h . e e r - - e The poem, as with the painting, allows Bernice to contemplate her life, and also to share it. Bernice is following ralph Waldo emerson’s injunction: “Make your own Bible. Select and collect all the words and sentences that in all your readings have been to you like the blast of a trumpet” (1983, p. 58). Doing so, emerson believed, makes us active souls. What does it mean as a care provider to en - counter the soul of the patient? We can consider this in secular as well as in religious terms. At its most basic, encountering a patient’s soul is to en - counter where meaning resides for that patient, and of course where it resides for us as healthcare providers. The challenge of contemplating the patient’s soul brings to mind what in philosophy is called the binding problem: the relation of the immate - rial soul to the physical body. The binding prob - lem also appears in the disjunction between the unity of our consciousness, so at odds with the dis - crete neurochemical processes that make it up. Learners in healthcare encounter this when they learn about “the kidney” or “the heart,” as if these organs are separable from the ecology of the body, and from lived human experience. This dichotomy continues for clinicians when it remains easier to recognize and diagnose disease than to understand how suffering, disease, and illness are experienced within a human life. In 1974, psychiatrist george L. engel proposed the biopsychosocial (BPS) model of medicine in re - sponse to what he perceived as a “medical crisis” that he believed “derives from adherence to a

II model of disease no longer adequate for the scien - tiﬁc tasks and social responsibilities of either medi - cine or psychiatry” (p. 129). Instead he advanced that medical practitioners and researchers “should take into account the patient, the social context, the physician’s role and the health care system” (p. 132). The BPS model was a call to a more holis - tic understanding of the patient’s experience, though it has been critiqued for oversimplifying how each of the levels (biological, psychological, and social) interact, for an overemphasis on the in - dividual, and for the failure of the model to ac - count for the spiritual dimensions of experience (see Borrell-Carrió, Suchman, & epstein, 2004; ghaemi, 2009; Hatala, 2013). recent research is exploring the implications of expanding the BPS model to the biopsychosocial-spiritual model (Hatala, 2013). In fact, many practitioners are learning from other cultures that adopt a more in - tegrative, holistic approach. 1 Many of the pieces in this volume of Ars Medica honour the existential encounters within medicine and healthcare. They represent patients’ and providers’ most liminal moments—whether crossing from life into death, as in gelo’s piece, or from medical training to practice, as described by Mays Tahseen Ali, or from practice to retirement, as portrayed by Diana J. Pi. These encounters are varied in their emotional impact. Ali expresses grat - itude and joy, while Pi, in her portrait of a long re - lationship with a man with an extensive history of self-harm, gives voice to the “burnout” that can ensue from providing deep care for patients.

III Both Ali and Pi take up the epistolary form to narrate these experiences, but other writers, poets, and artists in this volume use many forms to ac - tively explore and craft experience. on the cover, Iranian-Canadian artist Mona Hedayati uses 3D printing to replicate the HIV capsid protein “to convey the alarming situation of those living with the virus and those yet to be infected.” She alerts the viewer to the social dimensions of disease: fear of contamination, stigma, human rights. In “The Show ,” C. Alessandra Colaianni em - braces the absurd, inserting lines from eugène Ionesco’s Rhinosceros: A Play in Three Acts to capture the unbearable unreality of transitioning from medical school to residency, and the surreal feeling of role-playing as one tries to inhabit one’s new identity and have “real” interactions with pa - tients. Michael Lubin employs humour and text messaging in “I’d Love to, But Unfortunately I Have My genitourinary exam Tutorial Tonight,” to explore “[w]here should we draw the bound - aries around our experience,” in what to share of our conﬁdential and privileged encounters in healthcare. Many of the poets in this issue touch upon re - lated themes of the intersection of the body and spirit. Ingrid Andersson ﬁnds the resonance be - tween the natural world and the human drama of the body in “Phalaenopsis”: I sip and consider this common tropical genus, the profane, yet prayerful, nature of it

IV In “Nearly Six years,” erica Danya goldblatt Hyatt ﬁgures grief and loss, using the lyric form to enact the mourning of an unborn child: I have tried my best to really grieve this loss. Living and dying inside me, living and dying inside me. The lyrical incantation of the repeated line insists that the reader pause and repeat the ongoing na - ture of loss. Both Stanley Princewill McDaniels and Sage Schick probe the experience of mental illness and suffering. McDaniels writes of sound puncturing experience: & your body is always interrupted by the sound

of something breaking, falling, crashing, like a glass, like a building, like a plane crash-landing. Schick writes of the complex interplay between the

self and other, and self and society. In “I Kneel Down,” she describes a shifting veil between the

self and others clouding and darkening, making ex - perience impenetrable to the other. In “Presbycusis,“ from her series Bodies of Work , rebecca Coles Lee writes of “the bone conduction of time,” ﬁguring life and memory as a soundscape that recedes with age. In “Commonplaces,” rebecca Ann Spears ex - plicitly seeks to capture the interconnectivity of hu -

V mans with the environment and with the cosmos as recompense for our corporeal ﬁnitude: how we quicken when all is in balance, a pinch of this, more of that: cobalt and iron, copper and manganese, the world in us again and again as the stars, hot brilliant minerals, a promise that we are after all immortals who won’t be destroyed but rendered into other forms. The mortality/immortality of our physical bodies is considered in relation to the law of conservation of mass. Through their poetry, Trevor Morey, Sarah Kristin Andersen, and ron riekki make vivid the practices of healthcare. In all three works, the

bleakness and anonymity of care are transﬁgured into and through poetry. From Morey’s collection Healthy , for example, “From the Coffee-Stained Patient List,” creates poetry from a list of patients. Demographics, labs, discharge plans become

poignant points of life. The white space around

the poem’s lines suggests the vast expanse of the unitemized, unregistered life of the patient. In

“Doctoring,” which considers the borders between home and clinical practice, Anderson writes, “some lines are blurred of late,” as in the poem where the line between these experiences and iden - tities can be traversed and recast. Dan Campion represents the world of health - care from the outside. In “Lift,” the everyday expe - rience of the narrator is sliced through by the

VI blades of the helicopter overhead on the ﬂight path to the nearby trauma centre. Like the paint - ing Landscape with the Fall of Icarus by Bruegel, spectators can go on with their everyday lives, un - heeding the suffering and trauma around them. riekki’s poetry enacts the active soul of the practitioner-artist. Creating poems from the poetry of Nancy L. Meyer and Lisa Fay Coutley is like found poetry or the cento poetic form. Amid the detritus of clinical care, the traumatic experiences of loss and ineptitude, riekki ekes out poetry to create beauty and meaning. This active assemblage brings the reader simultaneously into contact with

the viscera of his work, and with the meaning- making practices of a community of artists. We hope that Ars Medica can do the same, and that these powerful pieces remind us of the work of the

soul and the spirit in medicine. Note 1. As an example, at the Centre for Addiction and Mental Health and eCHo ontario we are creating communities of practice with First Nations, Inuit, and Métis communities and employing a physical-mental-emotional-spiritual model to understand wellness.

Website Centre for Addiction and Mental Health and eCHo ontario, https:

//camh.echoontario.ca/first-nations-inuit-metis-wellness/ References Borrell-Carrió, F., Suchman, A.L., & epstein, r.M. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientiﬁc inquiry. The Annals of Family Medicine , 2(6), 576–582. emerson, r.W. (1984). Essays & lectures . New york, N.y.: Library of America, p. 58. (originally published in 1837) engel, g.L. (1977). The need for a new medical model: A challenge for biomedicine. Science , 196 (4286), 129–136.

VII ghaemi, S.N. (2009). The rise and fall of the biopsychosocial model. The British Journal of Psychiatry , 195 (1), 3–4. Hatala, A.r. (2013). Towards a biopsychosocial–spiritual approach in health psychology: exploring theoretical orientations and fu - ture directions. Journal of Spirituality in Mental Health , 15 (4), 256–276.

Allison Crawford, editor-in-Chief, Ars Medica

VIII

V o I l 2 s u s 0 1 u m 1 e e 9

p t b h l a o o j a y c t t b a A P i u e e o o m n e b k r e o f n i h

n n s l

t o s a m d o e a w

a c t a

d d i i a d m p

u t d

v n

l t b m r r

b e i a r e h r b s c g i i n i r e o a i l l v t

s o e o e l e a r e f e m

g y e i w e n

o t k d m n d d l n

h e

m y p r n r o m

g r r m i t c e c o

h e n f . c r p r s o e

e y T u o e b o h d a t o g n n s r

s e l m s l p i a

a n i n , h t t , a a d w

e e w t i , s i n

a e m c e

, t n r r ﬂ e o

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o i m n m i W o t o l I , n m k s

t w P p g s — I g s a e i r r

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s o t e d m

April

eliot was right. April is a cruel month, when tulips are too bright for winter eyes, and the lilac air steals the breath, suffusing danger with desire.

from my sunny kitchen window, I watch a male cardinal proclaim his desire from the budding crown of a sugar maple, until

like some heat-seeking missile, he drops and trails a female through air. suddenly, she veers left and ﬂies right at me

on the other side of the reﬂective glare— No! I wave my arms as her head hits the double pane and the bared complicities of April

kill her. penitent for my human part, I leave the house and bear her chilling warmth, heavy as a stillborn’s, to the muddy foot of the maple.

The cornell lab of ornithology says, every year there are a billion like her. I dig and feel the suck and pull

of innumerable buds, far above my head, like insatiable sapping mouths, and the sweet blood running up to ﬁll them.

I lift my eyes and watch their fat red bodies dance in the April air, as if they will dance forever, as if

they will never fall, until I see eliot was wrong: life makes no promises.

2 The Way Art Lives

she does not forget the small lives lost in the making of her new silk scarf, smooth and supple as newborn skin (its spun protein ﬁbers ﬁner than hair). Its yielding folds hold her the way the gentlest cocoon holds tender wet folds of metamorphosis, the way the pia mater holds supple memory, the way the amnion

in her womb held her buried son.

3 Doing Good

More often than not the most you can do, said lao-Tzu, some two-thousand years ago, is: imagine you are a midwife. do good without show or fuss. When the baby is born, the mother rightly will say: I did it, I am equal to life!

Ingrid Andersson is a full time nurse- midwife and poet in Madison Wisconsin. email: Ingrid@ communitymidewives .info

V o I l 2 s u s 0 5 u m 1 e e 9

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- Ionesco’s absurdist play Rhinoceros , in which or - dinary citizens sequentially turn into pachyderms. By the end, the entire town has transformed except for Berenger, the lone human holdout, whose ini - tial blasé response to the madness gives way to a hypochondriac’s nightmare that never manifests. My father, by contrast, viewed my acting as a terrifying hobby that would hopefully burn itself out before it precluded more legitimate career prospects. ever competitive, he loves to tell this story: in eleventh grade, I beat out a now-famous actress for the leading role in a high school pro - duction of Romeo and Juliet . I was a new student, and she was a popular and beautiful senior who would go on to hollywood, nabbing a role in the

hit show House MD. My father often ﬁnishes this story with the kicker, “Well, she got to be a doctor on TV, but my daughter gets to be a real doctor,” lest anyone be confused as to his personal taxon -

omy of acceptable professions. (he also loyally as -

serts that her ﬁrst season is when the show really started to go downhill.)

The rhinoceros continues its trumpet - ing. For a few moments, Mrs. Boeuf stares ﬁxedly, then suddenly she lets out a terrible cry. Mrs. Boeuf: My god! It can’t be true! Berenger: What’s the matter? Mrs. Boeuf: It’s my husband! oh Boeuf, my poor Boeuf, what’s happened to you?

6 daisy: Are you positive? Mrs. Boeuf: I recognize him, I recognize him. The rhinoceros responds with a violent but tender trumpeting. papillon: Well, that’s the last straw! This time he’s ﬁred for good.

eventually, and for many reasons, my burgeon - ing acting career gave way to medical school. I found ways to sneak in performances here and there, but the trajectory was clear; and though I devoted myself eagerly to the study of medicine, I mourned the loss of the stage. But the beginning of

my intern year felt oddly familiar, as though I’d been cast in another surrealist play. It started at orientation, with the debacle of my name: I’ve al - ways used a foreshortened version of my middle

name, and wanted it on my identiﬁcation badge.

“nope,” said the photo Id guy, sitting in front of a queue of bright-eyed new doctors. “This is a legal

document here. can’t have anything but your

name on it.” “But it is my name,” I insisted, “look, here it is on my driver’s license.” “sorry,” he said grufﬂy, waving the next person forward. And that was that; I literally wasn’t who I said I was. This deceit wasn’t so far from the truth. In a matter of weeks, I’d gone from the blithe existence of a fourth year medical student to the harsh, mili - taristic life of an intern in general surgery, covering the trauma neurosurgery service. My alarm chirped at four in the morning, nurses introduced me to pa -

7 tients as “the doctor,” and I stuck big needles into people without supervision. something about the rapidity of the change and the all-encompassing na - ture of the role I was newly assuming made me feel as though I was, once again, on stage. The costumes and scenery— hospital gowns (here called, baf - ﬂingly, “johnnys”), poorly lit labyrinthine corridors, spotless operating rooms—all of it felt like some set designer’s idea of what a hospital should look like. Jean: Today’s the same as any other day. Berenger: oh, not quite as much. I’ve heard of “impostor syndrome,” but my angst went well beyond theoretical worries of per - sonal inadequacy: I felt I was merely impersonating a doctor in this gigantic, storied hospital, going

through the motions. everyone had to be in on the joke: I’d had my degree for all of three weeks, and now experienced nurses were asking me to give

them orders for critically ill patients. “can you come administer this medication?” one nurse paged me, her eyes rolling heavenward, “It has to be pushed by an Md.” Another nurse saw me scur - rying down the unit hallway and came running. “hey,” she said, “You’re a doctor, right? I think the patient in room thirty-six just died. do you mind pronouncing him?” not knowing much about the patient, never having pronounced much of any - thing, and not feeling at all doctorly, I walked into the room where a dozen family members stood in various postures of grief, put my stethoscope on his chest, and closed his eyes. “I’m so sorry, he’s gone,” I said quietly, as the family started to wail. I’d

8 nearly gagged watching identical scenes in medical dramas, yet there I was, playing it out in real life. The trauma neurosurgery service was an ex - treme version of this alternate reality, where peo - ple who had been functional one day were comatose the next, with half their skulls sawed off and locked in a freezer in the basement. our pa - tients had suffered a smorgasbord of horriﬁc acci - dents requiring neurosurgical intervention in the form of the incongruously cute-sounding “hemi- crani,” otherwise known as a hemicraniectomy (or more crudely, to my etymologically oriented mind, “half-skull-gone”). Their charts read like a series of obvious public service advertisements. don’t clean your gutters on a rainy day. don’t use a segway on the stairs. deﬁnitely don’t drink a pint of whiskey before you trim the branches of the tallest tree in your yard. Their families sat dazed at their bedsides, trying to make sense of the unbear -

able new reality, asking impossible questions. I

worried that they could see right through me—or worse, that pretending to know the answers would

transform me into one of those burned-out, cyni -

cal residents I was so terriﬁed of becoming. After

all, I didn’t want to play a doctor—I wanted to be a doctor, a healer, someone who could legitimately treat patients and answer their questions, ideally without sweating through my scrubs. Berenger: Worried . Yes, it did make me cough. how did I cough? dudard: like everyone coughs when they drink something a bit strong.

9 Berenger: There wasn’t anything odd about it, was there? It was a real human cough? dudard: What are you getting at? It was an ordinary human cough. What other sort of cough could it have been? Berenger: I don’t know. perhaps an ani - mal’s cough. do rhinoceroses cough? I was thrust into scenarios that felt staged be - cause of how emotionally laden they were, and how absurd it was that they were tasked to some - one as novice as I. As my superiors were always operating, it often fell to me to represent the neu - rosurgery service at the family meetings held to

discuss patients’ dire prognoses. I hid behind “we,” as in, “we were able to reduce the pressure on his brain, but we’re not sure about the amount of damage that he sustained before the surgery,” and

awkwardly accepted gratitude from families

though I’d barely glimpsed the inside of an operat - ing room since graduation. After these meetings, I

would slink out, red-faced, ashamed to have spo -

ken up as though I had anything to add in a room full of experienced doctors. one of them, a physiatrist with a gentle de - meanor with whom I’d worked a few times, caught me lurking outside the conference room be - fore a particularly dreaded family meeting. “You’re doing ﬁne,” he said, unbidden. “I hate this,” I replied, the words tumbling out of my mouth. “I feel so unprepared. I feel like a fraud.”

10 “nothing really prepares you for this,” he said, opening the door and ushering me in, “you just have to do it.” The show must go on. of course. rehearsal was over; the lights were on, the stage was set, and it was time to perform. And of course, I realized, with a jolt at my own idiocy, I had been preparing for years in medical school, through slews of ex - aminations, rehearsed conversations, hours upon hours of study. Though the stage was new, that feeling of being underprepared, of abject terror, was something I had felt before every performance, every night, for every play I’d ever been cast in. part of the beauty of live performance—and of car - ing for patients—is that you don’t know exactly what will happen on stage. You trust that your hours of work and careful training will help you through. You keep yourself open to learning and discovering new things throughout the run of the

show. You stay true to yourself, and you recognize

your own limitations, and that keeps your per - formance honest. You stay honest even, as

Berenger does in the ﬁnal scene of Rhinoceros ,

when it feels like you’re the only one. And, eventu - ally, you recognize that terror as the thrill that drew you to your craft in the ﬁrst place. Berenger: Sobbing, he falls on his face, his shoulders heaving. I’m so ugly. people who try to hang on to their indi - viduality always come to a bad end. He pauses, then suddenly snaps out of it, rises, grabs the bottle of brandy and a

11 glass and sits on the chair. oh, well, too bad. I’ll take on all of them. I’ll put up a ﬁght against the lot of them, the whole lot of them. I’m the last man left, and I’m staying that way until the end. I’m not capitulating. A year or so later, I was rounding at the chil - dren’s hospital. Approaching one patient’s room, I heard voices singing: “Ten little monkeys, jumping on the bed. one fell off and bumped his head.” cautiously, I opened the door; the privacy curtain was drawn, hiding the singers. They continued: “Mama called the doctor and the doctor said…” I couldn’t hold back—it was too perfect. I threw open the curtain and gleefully all-but- shouted, “no more monkeys jumping on the bed!” The parents smiled, and the two older kids ﬂanking the bed giggled. But the three-year-old pa - tient sat back, a quizzical look on his upturned face. “Who are you?” he asked.

“I’m the doctor!” I laughed. Behind me, the cur - tain closed.

C. Alessandra Note Colaianni is a fourth- year resident in the 1. Embedded excerpts are from the play Rhinosceros: A harvard Medical Play in Three Acts (Ionesco, Eugene, 1960). school otolaryngology residency program. Reference she tweets @alessaco - Ionesco, Eugene. (1960). Rhinosceros: A play in three acts lamd and can be (Derek Prouse, Trans.). New York, NY: Samuel French Inc. reached at alessandra. [email protected]

V o I l 2 s u s 1 0 u m 3 1 e e 9

I S S C W S A A ( T S L A T A T T A t D i i i h o a

h h h n n n

n o n x n h t h i I t g t i r

o a a d d d d n i c

c n d d

h h a g e r n y f t t e e u

s y

i a o e s e r e

e I c s r y

y i g , h d g

r e t y I t a s

u a r b

c s o

h a a t l t e o t g r o ﬁ n e t I o

e o e o u i i m s n

h s

i r c u o l n e r d n I r n t n

a y g u a

s g ’ n n s

k e n c t a o i s g w v

t l i n r

m u m e e

b e e t

n w t , e n e i r

) r i i s d e o m l c l s a d d a e .

e d a , i r i E e

o e w

n a f e t g a

e e s a c

p a t

e y h f d y d d o i d r

r k w c n

, n o c

l o t h

i a

1 d y y u h c r t y e c c e u f u u

e h t

9 e

e o

a r

t o a e a r s s a d y m n

r a o e

w u

t i u e o n

w o t

a i

x a

t o e D w r n a b p r c u h t i s u N m

k m e

n r i

t l a y h 1 t e s i n

t e o e o

g t n t e e u o r e . f e o

k l h h

w 5 , s a d o g n s y o r

a f s ,

n o

a r

v u

w a

s y i ’ c r y l a s m l o n l n

a a d

m o o a g v l o m

h t d

r r y b d

e c e i g a e

u d u g n

o e G k s

a ) y

f c e i m S b t g a o r u e a l

a r e r

k k o i o t o r n

m s t e x v

x i i t

l p h a t e o b f

d o s r Y r o a n t n l ,

h o

i b

n r g a p n

e a e m t (

b l

l g t n a a i c a u h i r s

d l r r r

t t c l

o o d d h s o t

t k m o u w

e e w

g a t

a s d o e h d l j d y o o e e

? y e s

o l a

t s I p t o r o t

i u t f f c t

h r r

a o d i e n m m i

e k e d

h i

a n r e t e

a 2 d 0

In these nearly six years I have tried my best to grieve you I have advocated and I have marched I have therapized and I have narrated I have written and written and written And told your story justifying my choice (To whom? Admittedly, I am my own audience).

I have sobbed and screamed into your memory and I have used you as an excuse, tiny baby I have tried my best to really grieve this loss But you continue to be a step ahead Your ﬂaking pieces living in a box beside my bed.

A white box With your name and date of death printed out on paper that’s now creasing and yellowing And even the font is beginning to dilate with time and humidity Standard issued by the Delaware Valley Crematorium

That I dust every few months

And reposition the delicate angel statue above.

one time remy grabbed the statue and it fell

And it smacked against the radiator behind the table

And while I imagined some of the clay would snap off or that the muted face of the angel would pop off the body It was only the bent wire wings that dislodged So I frantically tried to stick them back in But the hole they sat in was too big And the wire was too thin So I’ve given up on replacing them.

These pieces of you They prove to me that you existed That you had enough bone to burn

14 That you grew human pieces, though incorrectly That stump of a trachea that blunted off The overblown lungs, stretched to capacity Maybe like fragile pink translucent bubble gum The diaphragm traveling the wrong way like an inverted balloon Those were the broken pieces we could see.

The distorted chromosomes I imagine like ill-fitting puzzle pieces jammed together by impatient toddler hands on a carpeted floor Creating a warped picture without much true fit A mottled and forced collage That lies flat on the ground, or a table, but cannot be picked up or moved Because the pieces will detach and cling half-heartedly to each other like a barrel of monkeys If you try to carry them.

There were also perfect, synchronous, seamless pieces:

Your sweet little ﬁngers on the 3-D ultrasound

That covered your sweet little face in the darkness of my body Living and dying inside me, living and dying inside me.

I wore hospital-issued, baby blue fuzzy socks With bubbly, sticky white V-shaped treads And a seam along the toe that never sat in the right place As I padded down the hall attached to an IV pole Like an overwhelmed child guided by her mother at the mall Amidst sensory overload holding the arm of the kind anesthesiologist Because I’d already received the ﬁrst dose That would allow me to lie down on the table Arms spread out and away from my body like a death-row inmate

15 But beneath gentle, sympathetic, masked ﬁgures with kind eyes Who quickly set to work.

And then I woke up and you didn’t exist anymore.

My therapist told me to let go. To spread your ashes, because I’m stuck. And the academic, the scholar of bereavement in me wanted to scream at her You Don’T KnoW ABouT grIef The WAY I Do There’S no SuCh ThIng AS pAThoLogICAL grIef IT’S heALThY To hAVe TheSe ASheS (but the truth of the matter is I’m afraid she’s right).

Erica Danya Goldblatt Hyatt is Assistant Director of the Doctorate of Social Work at rutgers university. email Address: erica.goldblatt.hyatt @rutgers.edu

V o I l 2 s u s 1 0 u m 7 1 e e 9

i & 7 o b f l l l l t h t h Y a Y i o & l y I s i i i i t i t a o h

o k k k k k f y e e f

: o o

l l w

g a

4 i a

a a o

u l e e e e e s h u u s y y t i e t l l l 5 o

t r n h a w

a o o

s i a a a a b t n

a a n m

h , s g o e p b u u

o P a r r

b g p d g

h , e f h p a o r

e e s r e

y M l

, a u l i r

c e w o

n e i T

a t d a s , s b w n r f s s r

i h n m s

u t n y r i o l e h c c o o a i e

s s d i

e o n n

a a e a r n s i n a s d

, a s s c i n p

m h r r t i d s n g

c m n d y y c o r e e e m , g u i a

S r p g o t e r a n u d d b s a e t a l r r , r l a u t n . e g

l s r e a

u s b o o a l n d

e . , d l h s n t i p a e f f n a

f h -

e e d t c k l l i e s n a k n 7 e i . d n g n k y : i d g 4 n

, i P 5 e n , r g

/ i .

C c e r w y

i / l

l L

M e g c i D o n a n i e l s & when it begins to function again — fueled by a fresh ﬁre, new engine oil, new pistines — it becomes liable to break down again like you each time you hope for something as new as a morning. But it’s okay. They won’t mind. They can’t see you. You’re a ghost.

You know every pain by name. You know the extent of their reach, so much so that it feels good, that you enjoy it, that you love it, & now, you have taken it like your baby. You tend it. You cherish it.

It is your lamb.

At night, you sing a lullaby & rock it as it fades into the alcohol stiring

your cerebellum.

This is what you do every night to sleep. & you don’t want to lose it

because it is all you have, & what would that make you? They will say, “here lies the man who couldn’t even keep his broken pieces.” so here you are, afraid to give yourself

18 a second chance, afraid to take one more step, to take one last shot at happiness because something in your body is always breaking, falling, crashing

like a glass, like a building, like a plane crash-landing. It is no wonder your body is ﬁlled with voices talking, whispering, screaming: die, die, die.

2 0 & C t v t w & w r w i i T i & l b f I & w t & l i b & t o w h s h & f h s n s i a n

h h o h h r u o o k e l f o o a

h o y i e h i o r

a o e e r e a

s s n m

g i l t m m e s p p m t I a e t h d i w y

m o o

d d c i u t h t w e s n ,

a t

h h b c s s

i i a e

k e e o

a a h

l a

y w

n n i o p o c u l j

e w l

e t & d d

k g w t a

l m b e

e t o m e r

d r h g g a h

t e m c

g p a u h b o i l

e s c d b s e t m h i i u l

r i s

o o m e i i

s t r

h d i h a t e o d m n g t t a n n g o w i m e a p e t l

u t h o n s

e e p i e r s h m o

d e e n I

r e n e n g d n s t o . e , y i n a

n , g i

d f y y s n f ﬁ

t l

w i r y l n o & t

I i l f u n t

t d , o t s c a n e h e

v c m a n i

d t

r o p a o o k o e a d e

ﬂ o m c m i i o h e g h o c y g

e f s d t

s s

e s o e p s e i v y r

h l k , e f o u w l u b

e n s e

a o t e y

l d e — i t

s e i e ? o o d i t t s a d r . r , n a g g

h n r f o e n n g . i

, e i o

n f

e . c f r & i b

e B

n e

m b

b t g e t

c i o e o w w n

g c h r o m e , n l

— e u t

e m r

a u

a o t a a ﬁ a h e

n h l a a o ﬁ m m , s p c i t r n n

n t

n p e u r

, i e , f l e h w i k

v u c d l s

, p g ﬁ f t s e t

o m t b h e o y l i o w o e s . , c h s f

l i

i r a r

w i u y e e r i y c h v c s l t t s d

l e e d

s i e a o i i v ;

t s s : a o n

r s o i

u c m — r r i e n n r t i

n s u e t ﬂ a . i d s r y z ; s d e

, a n s r , r o y u n d I search for magic formulas — cowries & incantations spread on the mat of the priest in search of the meaning of life since the prayers of the damned is an abomination; & I want to ask my grandmother where heaven keeps its unanswered prayers: whether they will fall back down in their envelopes when the sky is cracked open & jesus comes to collect his souls & damn the damned. Blackbird, oh blackbird! You ﬂy only in the shadows, never in the sun because sometimes you want to be water so you could slip out of the world, into the ground,

& scream like the voices in your head, & cry & die in droplets because the world is set in oblivion, & you live

in oblivion,

& you are hollow - something without begin nor end,

something deep & dry as thirst.

It’s so dark here: too many voices talking whispering screaming — die die die, blackbird — die!

21 Legion

In the hospital, the lights are sometimes red, sometimes blue, sometimes white. red, for madness in episodes; blue for remembrance; white for what people call...normal.

& there are pills: the pills look like emojis — someone’s ball-dropping animation of practical madness.

At night, I watch the stars twinkle, calling one another, whispering to one another: as one star glows,

the other glows too — the tricks of

secret lovers calling to one another, as if declaring “i love you,” & she

responding

from the other side, says “that is my vow.” It’s beautiful in the courtyard. The stars look like letters of

my name scattered in the sky & one mighty voice gathers them all into one body, & pronounces me.

22 I look to heaven & I can’t see the hospital anymore. The voices are all gone — the doctors, the needles, the pills, the courtyard, the nurses… They are all gone.

I look to heaven & beg god if he would allow me keep this night, just like this, with the voices outside, with the loneliness outside. he said Yes. now, I have a new handler.

Stanley Princewill

McDaniels is a nigerian poet and a 2016 ebedi International Writers’ residency fellow. his poetry chapbook, entrapment, was pub - lished (& available for free download) on Praxis Magazine . email: thepoetstanley @gmail.com

V o I l 2 s u s 2 0 u m 4 1 e e 9

k n t b t b h h e u u e e e t t

v d v t f k d d f t e e o r e h I h h ( a d o e l o o i i i

p r o l

e t l r a e o e ﬂ w c g

n r

i r v

n m b n v b v c e t o c w o s n a o o i t e a d a e h

a n z l o i a o t r t c p n o s n a t a w g w s r n h

, o i , c r

n b d I

t r d k e a e w ,

i m

u , r e s l

e n

ﬂ

g e o m u i i e i l n n n e n s s o a t u i l o n t

l o b

a s

u t t h u b m

f c e h h s t t a u e s i s u a h .

s u e e

p s r

w l

l I i t h e

l s m a l s e r

r o

. S a a p

b i n K n o c r c n n , s v o a o o l t

d u l

o l , z n i e o u c p

n y g

n n o c s o m l u e

n p v e ,

d o y l p m

o d e o o d i

z u m s u l e S f i l f y : a l s d d n s

t : b c p t n

D , e g e t b

a h r t l e d . n

l e e l o d I i o . t d x x

c a

w o s e a a p k e m r ) p h e n

r ﬁ o . o e n l e d

s l i

n b e e s f o r e

ﬁ r s t

m o w

d f a s a p t o c l a S i e s p n n a v i e f h h w e

a g i a d d w p e n i n r e

r n

i o g c g e o h r

e r o S e r o d

l n e w o l t o s c o

w r

. h i a n k a b t o n d h

i s n

a 2 r r c

- o l

e t d n k a l a i 5 k c

i n d n M , s a

i m t o i d e f u s o u a r o

M a o s

o r r s n s i

e e

n t u e a h w k g u d i t d t p o g o e

s r o a - h w y i n i e d t u f t n . , e

y e - a r t

t h t e h

e v

e d f m r t I g s f v f w s h i

r h r e i t u l e l o d a m i r i i

r o h e i e e m m b a w c o n l y r e n n e

t w e n s e b

m n p o t r d d t c

h ’ o e ﬂ

w i s r l t a s s d e n i t o e s

o t l w r k e c d

s l r h , I b r w ’ t

e a

s n o

e h u e u o l u y n d

l a o e

a n e c l e n m f o b t

r t n w r c

’ u

u l

u e t f n o h t .

e i a s

o r

h u d n

k ’ p

h c r l t r o i e s a

e n s

v i h s o e m

e t t ,

e h o s r

w t h

s d i m “ o t s o u y s a w , e

a -

f i t u

r s r t r t o t u h h r

n .

u o o

n w k d r a l e o e r s

l d e e r a n a

s h d n e

s n r p n l y

n e

e e : i k h i b i m s r t d m o n t e i h w e r a - p w g n i o

i i g l t t . s u e s

e . r t o o s r r m l e d . i l o

e . o d c . , o ,

a n

t t m l u ” h l ,

r , r g n o o e u ? d g

h s k

t e h l e e

t w o n i n d o w

V o I l 2 s u s 2 0 u m 6 1 e e 9

T T I S I C r t t

h h r o r w i a e e t l r

a a i o t g s g e h t s o p s h ’ e

s e t r b o d t

g p

t a i

u t l o e w l d o , e m s

. i n m t

h t t h t h h i y i c e

t h k

k f h r u o e . o a

n n r T o t

s g

t h t i . h e ,

s e R

T r

e i

, r t k

h B e o ’ t l s i a e h b t n

c t r e c d e i o t d

n o o m c

u t g i m s c h g e o . e a

a h s f

u o i t

n t

i C o r h g n t t f o e

, o

t t l c W h w s l e u e

e r i e r a s

n o l r d

n l

a r L s l u t e w k . .

n s e

. d e

a e n r d

h t h e

e p r i e n ’ s k

a n n g d e r

i n

2 7 T T f T T T P T T T T T T q A T T u i u r h h h h h h h h h h h h n r e i n s e e e e e e e e e e e e d e s t r n

r n

i p t

c k n b r s s n b e e t s

a h u r r n h

c i a o t g

y o i i e i d f d h r g o a g e

c s s n c r m a i o s i e g

n k m t g o l u e o t t k . l t

u e i

s h h e

m n i e . s s n t s c e n t ,

e e r h i e

t o

g . a

s s s t

i t h s

e t h m o u u

n o W h

n s h

i e o

w n s l g d

e d

e o u t t

o t g

u s u s u

ﬁ

s o h f s c t . r . e s c

n i r

h r d a r t s c e t s c l e o e e t l i s . . t d o m

y i w , e t n

n n

e w o o

x p d o

: . h

u i o

e o : g f s

r f t

n t W o r d a

h f i d e t e . n o

e i s k s c h m g

r . : t b n

y e

l I t e e y ’

s o c . t l

w t

o l a c o e i r i f h n r v n c e . a

’ e h

g t m t

e Y t Y p s e a o o r t r d r . e u u

a e s

. ? c b t

i e y n o d c

m , d u

i s p s i l t s a a .

i n n c t e s .

i k e

p i n Popliteal

how appropriate.

That it should start with a pop and end with teal. As if jumping into the sky was absolutely real.

But before the teal there is the pop. The shatter shock of old knees knocked.

I reach high, but I cannot move forward.

Rebecca Lee has pub - lished in a variety of magazines and jour - nals. her medical po - etry can be found in harvard’s Third Space journal, the British Medical Journal and dartmouth’s Life Lines journal. email: rebeccacoleslee @gmail.com

V o I l 2 s u s 2 0 u m 9 1 e e 9

I e s a t m w m c w b b t l l o a o i ’ i i a x o g r i l g u m c o a a e e g o o y d t o u e h s u n , s s r

s u k

e d I I I l

. l b t

s a s

y w

d n I t a s s e

y O i m s e l

l o ’ h

e t

y d d t

t u h x e b h u w o t s o r

, e

n e

s e

i o d c u o i d t p n m L

b n

t . l o

u u ﬁ r u e r r e

i e

m l o l g h e

n b y s e r y i s r

a l y w n v

t a d i n e s ﬁ e

r y c i e r h w h e t g n l d i r

e o r r

k s e i

g s e

a , y e d

t , T

m a

a a h

a m i t

v v c e

o t E m y a t o y w o t

t t h h

e e e

, l e t y o . y x t

a e

n h e a e o a

h x b i W s b

w a B

c t

t s

y e e n t e t e i

t e m t t o t M n i . r c u f l

a y h c u a e h e

e k f t e

i T

o r t

l i o n l o n r c e l l i i T w o

f k s d o e t

e m h c l I n

r e r

f e i g d s u o a

h h d o e d e l

H o

s a e i e t s t i t k r a

a t e m

g s h n

h o g h r t e h f t r e a e m d a

o h e i

e r e

m e d l i v n r t s

a t i r

e o e

s a e l u a

. L h e w d s p

y y o o

l r s b a l I i e e B i M u k r

e c e o e n ’ m d r c e T

a w o d u b i

i r c ﬁ b m

o i n n i d t o

v c y

e o n s i n e r t h y a n ’ n g e o o h a

n e e s t r n g . t G s a

, t n n l e o n e w i

w d

k I t .

p g b .

I r

t o t

l e e w

D i w l

e i h p W h o r n

c y t o m d t s o m o e t e o e r , k i i a u t n

l s t n i h m n u i o o i i , s t n o r e a . t n n

n k n n t t , s p g u a I t P g d

n i w d

a i

w b n , n p r l . r m m a .

d l

u , i e o s a e g

h n a

I h c s d c u o e n ;

t i

a a

n a e

e n h a n l v d w t a t r t i u d h t g a e o e

v a y

e h a s

o m

e l - e n

c t e n i k s

o a t e

o a e i e s - u t n - -

3 0 d a m r m w y d i s o w e h l h p t i e t w h I I n i m ’

h h e i v v l e o a v e k a o o m a g w e a o e i a t a i t e e r t e d g p m n e s w e n n e

n l “ r n n i

T I T r T B s s h u a

h . n n k r n o ’ g

a k l

t t

T i e t . t

o d d o y t e n y I h t h h t d

h ’ b

i s m g l u

v t e t

d , i

t r h s

a t w

b w e e i

a e l t

o o t t a w e h x t t o

s i y i a o d y h e h ,

a n o h r t r n f l n

i t n r a o ,

s r i , r y l e o h d o

I w b a n

e u

e g

i n

y a I k e n

I e i I

, l a m t o t p e e u d

w k

g i m

m i

l g

t a e t

s e d g s v a p e n , a g l u i e g

h e o

” i

w y d k s

y m a r h v e i s m m u b r r o a n

n e r h

t d

I . h

s o e e t e t

v h n e c s n

h s t “ p n

e e r n

d o w

e r r o c r h e

r e u s t e d n a b , u e a

r n t . e ’

r e

n n

u n u I r

t c h a o b r a

i i o w t u g a e

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e t n t . r t

h h l l p ﬁ l i b b o , t

e d h t d o

e l

e v e r s

h g w h t

c y h p

n b l a u c d

e u e o i s h o o

a h i f w t

n a t r a b a t u s a d t n n

n s t o u h n e f n u w i o

i e t s c l d , u s l t

, e a l o n

g r t e

u l

e r

r m t o l

u i y a y

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s f s

n t o

n p i i a o e m a w o p t a n

t t t e r o o

e a d e n w i

d i

n t , v

r r b s

e e n ﬂ d ﬁ

d i b x d p

t s i u

, i t I e m g s d

n g b l a

t a s l r a a a

i o t o e o w t e n m m y o h o h e e l

s s e , g

h y t t y i e n x f u ,

w t g

t l d

e l e e o a

a e r . o s b y n y e

. o

d l a l a

b e

d n

a . m d r v . i s d y s

t e

o B

u e n c t o i l

k l l

a n , c s i e I a

r t e w o i I

s t , m e t u d n a n s a e

c i . h f y

t e

a n s w i e t e s

y n . r e t c

w o r I e e g

v s u r t s

e , d o

e o r s t

I t u d

a h t e

n e u y w i r v i e e s p

b w ’

u o y o d t m g u l a i n o m t , o a i n s e h t d u s

a e e n o c h l i

t e p n a s y r u e f

n b i d e i

i e

d k e t

m r

s d n

o s d m t m b

n t

m t o . h g y . c

a r h e s

i h

, g s n e e o t y p e o o . h u

o h

I l d e i ” o h b o s a ,

i r .

s e t r n

m a . t

n u n e

i u p e n

e h

I s

e t I e p n

e n g

a a o g g t

r l . e d c o o e e d s a c o e

e o c s k

e c O n r t i t w y f

o . r l s k t o e

a . i d a i

I d h l

b o t

n o l I I

u a t z

i d y n f b h

, l s e e ’

f n h e g u g e o s l m e

e h e n r l e d g s u e

i , e r a l r e t v c

t , n r o e a e e , - s for a man approaching thirty, giddiness in any circumstance is unseemly. In a lecture on suicide, it’s more like alarming. I look around. no one is paying much attention, which is a relief. Though, come to think of it, it’s medical school. You could probably do anything in a lecture hall and no one would pay much attention. still, I try to remain discreet, even as she does me one better. she pro - poses we do something that very evening, which would be good news, if I didn’t have my genitouri - nary exam tutorial tonight. “I’d love to, but tragically I have…” I write be - fore stopping, mid-line. could I really send this to someone I met once, at a tiki bar, two weeks ago? It might as well have been an eternity. The explanation would surely lead to more questions, and I’m afraid the answers to these questions would surely lead her to never speak to me again. The stakes are high. I’m in recovery from ﬁve

years of relationships. I was with one person, whom I almost married, for four of those years.

When we split up, I moved in the ill-advised, time- honored footsteps of immediately seeing someone else. That lasted a year, about eleven months longer than it should have. When it was all over I decided to take some time off from dating, maybe forever. now, a few months later, I’m out of practice. But I have an excuse. It’s not that I’ve been doing nothing (I started medical school that year, late, at twenty-eight), just nothing that would be helpful to me in this situation.

31 Therein lies the problem—with me, with dat - ing, with life. I’m twenty-eight years old. I’m a first-year medical student. Basically, my life is al - ready over. The only consolation is that I have a killer bio for my Tinder profile. Maybe if I had been more like my accom - plished peers and started earlier, I would have had a chance. As it was, I wouldn’t graduate for an - other three years, at the earliest. I would be thirty- one, rapidly approaching thirty-two. Assuming my life didn’t get any further off track than it already was and I started residency, I’d have three to seven more years of training, depending on just how old I wanted to be before finally becoming an unquali - fied attending physician. A junior attending physi - cian. so still qualified, I guess. residency begins and ends in july. I have an August birthday. When I finish, I’ll be just under forty-years-old. half my life will be over. More than half, if physicians re - ally do die sooner than everybody else. This is a

statistic I believe. Besides, I’m only moderately attractive. On the

basis of half a semester of Psychiatric Medicine lec - tures like the one I’m sitting in, I’ve diagnosed my - self with social anxiety disorder (performance-only subtype) at the least, and possibly something much worse. I can count on three ﬁngers the number of times I’ve gone out with an absolute stranger in all my wasted years of life. I’m either exactly like everyone else, or I’m to - tally fucked. This is the ﬁrst real opportunity to go on a date to come along in months, and for all I know

32 it could be the last. Maybe, against the backdrop of the lecture on suicide, there is a certain urgency. Whatever the reason, I want to go on this date . My one saving grace is that due to the informa - tion asymmetry in our relationship, she doesn’t know any of this. she hasn’t done the math yet. so here I am. As matters of life and death are discussed, I’m thinking about how to say, “I’m sorry, I can’t go out with you tonight. I have to learn how to perform a genitourinary exam from a professor who will also play the patient while I try out my scrotal palpation technique and perform a digital rectal exam for the ﬁrst time. I will observe and be observed by two of my classmates, who, by the way, I’d really like for you to meet sometime.” I must say this in a way I hope won’t ruin possibly my only chance at future happiness. It’s a situation I know well. About a year ago, not long after I started medical school, I began to notice I couldn’t tell anyone what I was actually

doing. It was less an issue of professional conﬁ - dence (to the great relief of everyone involved, for

the most part we weren’t even in the same room as patients our ﬁrst semester of medical school), and more an uneasiness about whether I should. “What did you do at school today?” my mother would call and ask. I think it bears repeat - ing that at the time, I was twenty-eight years old. “We cut someone’s face off,” says the voice in my head, though it could easily also have said, “We resected her brain.” Or “We cut out her heart.” Or “We sawed her pelvis in half.”

33 “We did it in small groups,” the voice in my head drones on. “cutting someone’s face off only requires two people, so the others were free to qui - etly weep in the corner. After we had finished, we tossed her face in a red bucket, underneath the table. “Three hours later, around five o’clock, we tied off the orange, tripled-lined bags—stamped with BIOhAZArDOus WAsTe, filled with human re - mains—and tossed them in a dumpster in the hall - way outside the lab, waiting for a man I never saw to roll them away, to where I never learned.” I thought it would be better not to say this to my mother, or anyone else. she was kind enough to call me, in the mid-two-thousand tens, and ask about my day. she deserved to be spared from the superfluous daily horror of what I’d decided to do with my life. so I don’t tell her. I keep it to myself. By the time I have my genitourinary exam tutorial prob -

lem, I’ve been doing this for almost a year. Of course, an obvious alternative presents it -

self: I could simply not tell her and suggest an - other night. But I want to tell her, I realize, to my surprise. If she’s going to be in my life, however brieﬂy that may be, I want her to know about it. not the sanitized version—the truth. Then again, I don’t want to be alone forever. We date because we hope that somewhere out there is a person (or several people, if we’re feeling optimistic) who will understand us, and given the exact right set of circumstances, most of which are completely outside our control, will love us for it.

34 not in spite of ourselves, but because of ourselves. (At least I think that’s why we date. I have no idea, really. I’ve hardly been on any dates.) Dating is an admittedly imperfect method for finding this per - son, but so far we have yet to come up with a bet - ter alternative. In a profession where confidentiality is an im - perative and there’s so much we can’t disclose, it becomes that much more important to say what we can. But how much can you really tell someone else? Where should we draw the boundaries around our experience, especially the part where we threw away someone’s face after cutting it off? I decide to find out with the person I met at the tiki bar. It feels right. sure, it’s asking a lot of a stranger, but isn’t life about taking risks? What’s the worst that could possibly happen? shame? humiliation? failure? That happens every day in medical school! Though maybe not, admittedly, vis-à-vis dating.

I tell her the truth. Okay, I text her the truth. I don’t include all the details, but somehow I think

she’ll understand. While I wait for a reply, the lec - turer expresses a cautious optimism about the fu - ture of suicide prevention. he thanks us for our attention. Then it’s over. I look down. no reply yet. I pack my bag, and look again. still, nothing. so I Michael Lubin is a guess that’s that, and I get up to leave. fourth-year student at columbia’s Vagelos I’m walking out the door when I feel the buzz college of Physicians in my hand. “Well,” she says, “I’m free on friday.” and surgeons. email: mpl2146@columbia .edu

V o I l 2 s u s 3 0 u m 6 1 e e 9

“ F Y H a T b a N a T a A W N B T W Y R H

n s r r o o o h h l r e s f e o o

o e e i o d r m d u w g u u g e i o a

r m i s o

w g

u l a n h

e r m w

I ﬂ o e

s a d o t t y n

i l r t

e a a i n

u a n s

t ,

a a i

d m r a

e P k h l s y t m r

o g a l s l k . m o . e a r . w o , e r t e e r t

r r

e F b e r u t

j e t

N m a o y s h u

: s y h e

d r a

y s n o c t r s 6 o f e u , o u

a s e o o t g u d n

1 u r

r k n b m . u r d p

i s u e

? l e f e t a b i C g o l e

” r f

e 0

t b e e h a s t I . t h g a o h

e 1 a r d u

h c .

s e t , t e 3 f N

l a h a s n e t b

f / n

c n h e 5 e t

o p s l

t e

e 6 o t a h t e

o T e c - r . t s d a a u s h o S

d k d l a r m l

r m a

t e n i s f y a a s y i r . v c o p n , i t o i e n e o u a u n m

n . g t r f e e r

d m o . M . N m

y P o o

h a y t r a t o e e i n u s y e d

r n /

. s

t k F

L i r n o i , s m t

t h e

3 7 “ I A T t u O N R Y f I W I b r

h N u o e r t t o f n e o o r x e u h e m e t r s u u e t o

y r o b

p i s a a I

o r m p n l g p a u

r i

c s d o n n r e e y i e i e a g u

l a s d v r d o l n o 0 e , c h

y t ” a t e

u e 1 k o g t

m l t S h

u y

6 e r o d a I a b

y d n o y

r , o s t i t h u e

s u

g u e

d R b y e o

t r c e r r 2 r b s o a a a n o a r

e t 4 t y r c u

t t c

n s u r d i . t k e e r s e o e 3 d h b : .

s . ,

y n ° . h r e e 0 o C o o

l s e 4 7 f g , u u l .

d 4 n i y r g b n

i o h r y v z t e u o

o e o t . a r d

u h i a t

e h

y e t b i s o , o r i

a r

g u p s e g e e r e s . t

a r ; h f

m a m e c r s . e i . n . u t e . From the Coffee-Stained Patient List patient #1: Pancreatitis sick but stable. Nothing to do today. pain well controlled. recheck labs in the morning. patient #2: Sepsis palliative care to see. family Meeting, 1pm. sign off after family meeting. patient #3: Malignancy complex, multiple issues. Transfusion, 9am. follow-up with hematology. consult infectious disease. recheck Hb this afternoon. continue to monitor vitals.

patient #4:

patient #5: Bowel Obstruction post-operative day 6. still unsure what to do. cT this afternoon. patient #6: Diarrhea discontinue current antibiotics. stool culture and sensitivity, toxin screen. IV ﬂuids. continue to monitor.

38 patient #7: Delirium urine Negative. Bloodwork Negative. Imaging Negative. son coming in today at 2pm. discuss discharge plan. Alc.

Trevor Morey is a Queen’s Medicine graduate (class of 2017, pgY2) and a family Medicine resident at the university of Toronto.

V o I l 2 s u s 4 0 u m 0 1 e e 9

m b p r i t w T s a t T l w A o B C s n i h h o y t l k l r u o h h i n l e i o i

i a n e o o c

n n s e g r r

e e d k

t m k a w s o t

n c h d k

b h e

i e s i p p

a f w

n t

m i f d i e p o m i

i u n

t p r r r b t n

i i d h o l a t h n i g p r i c r s e t o o n e n i e m i c a

a o , d

u r e c

c a

n r e

n a l t a

e a d s l e p o e e

t e

t s p b

r s o a

s w

e h

s a d n a e s

t d

t l l

e f a l t i s h u t r e

n ﬁ a i e

i s r p t h f

n i n t g

e m ’ e

a e i c x r s h t

v a w e g d h

o r e c o e t e e b e e d t m n

t d m s d

p w

o a i

c t s g i b d o g v

e r o w c k v a

a o a e l l t r i n i a k o e e l d a e n h g l

e r i c

R r a

s n s r n , k h a n o e a o w u

t - , x e s b c C c i

o t w u

f e f l n i i s

i i

e o a

o n n r r c t u e n l b p o s o i s t i m h m r l n s l s

n g t t

e u u i e l i t , i m a r e

n e s c

h h

w d m n ’ n r c o b r t t s

, a g

t e

u e h

c u m s u i o n n u o t , o f

n n e

k t a r c a g o t r i e s o n u h

e d

n d l u g o r h

’ u s c o u

t s e i f - A

g e a e a l

n w a r r o

n f s u r l b r n e

m n r o

s , n g

. f t

s d p

a y r o a , o

f s o f m

t n k

a e S r s

e a b r

m h h l u

c t o u d

i t , a g l

p u o o a u n l g e l d t

l , a r e c t i

t l s n r c h

i o r i

s p f n t h e i e s k n p e , a a u , e u t

e s e t a s a t l a r n n

o o d h c l n s n n e d

o e d c o i

e . s n n m s e

l u . k c s t s

r e — . r

w r a . b — c e o k d , i e s ,

4 1 a a c a a h i w n o s g

p p h t o

a p t o r i o w h i p n o

o e e c w

t r a h s h

o n i t

a e s o e a n d

n e r q r f ’

d t

s t a u f t

, h

o b h g

i m h c a r e i a s k m o t

a i , d

n e t

n w s m

e n

b g . s e

a o r t w

r i a n r l o h e r l e i y e

e s a o

e e n n a f d ,

f t a t t

b h h m l e l u r a e

i i

t t n s a w :

r l e i c l e o n r

o n i a r

m b b l l d d s a a e m ,

l l r i t a n e o

n a d

r u c n t a e s d , l

s i r o n , Still Life, with Questions

When i approach from the tree-draped road, my small house appears huge. it’s a trick of the porch light, and a few lamps left on in the house, their glow pouring through the high windows.

here in the deep silence come questions, swarming like plump mosquitos—did i ask to be left alone? did i ask to lie fallow for a season or two? or did i feel especially fertile, wanting to make a life on my own? My second-guessing stings like insects hunting the dusk.

now you’ve sent word, you might be dying. Whether it is cancer or heart disease or something else you have yet to reveal, what must you want from me? Am i to travel across the open ﬁelds of my own heart back to you? can i ignore

the last grief of a man so practiced in love’s incantations?

42 Daddy-o

That man with the blinds pulled is like an eclipsed sun or moon that cannot ever emit or reﬂect light again. pale-blue eyes he must shield from light —the light hurts so much now— blue as a mountain pool on a hazy day, cloudy like the milk-glass plates on the shelf. There are fourteen types of noses according to the Daily Mail online—and his— not bulbous or ﬂeshy or hawk, but snub, a handsome one under a high forehead, a Mount rushmore forehead, a face smoothed by wind and war and warlike sports. Thin-lipped but not tight-lipped, always good for a joke or a brief quip.

A smile like the smile an old napping dog makes when it dreams or daydreams, content to be the aged one, housebound, world-shy.

43 Notes on Extremities

By three that afternoon, the backroads were leading me through miles of ruined crops, the ﬁeld corn stunted, blonde, and crisp. My cousin near Austin bedridden with Ms. her voice on the phone that morning faint as the birds’ in the summer drought. Breath lighter than the corn leaves on a hot breeze, lighter than a ﬁne mist that dries before it has a chance to settle on the skin, on the crops, on anything that wants to live. not as alive as dean Martin on the radio crooning about lilacs in full bloom on the street where you live. As desperate as that wayside sign on highway 77 proclaiming a service

to pray for rain. While i no longer bothered to carry my umbrella, i wasn’t immune to the prayers that year—even from those of us, who in a good year, professed little. i suspect, as in other tragedies, Whatever

held the World Together was suffering with us, but What should have Been enough simply wasn’t. And in telling this, here is where

i usually break down, having arrived ﬁnally to ﬁnd my cousin cocooned in the cool darkness of a room, in a hospital bed, her cropped hair recently dyed red, glowing like a night-lamp.

44 On Her Way

This will be the last time my mother will rise on her bird legs and take to the window. The chipping sparrow and inca dove will criss-cross the panes. her voice, thickened these last years, will thin to a silver wire.

My mother will rise and ask me to bathe her. And i will wipe away the mites, soap off the dander, the last bits of molt. i will sponge the yellow to soft pewter and stem, for a while, the odors that tell me

it’s time. Time to provision her. Time to perfume her with the lilac she loves. Time to settle my new griefs, feathers that attach one after another

daily, sometimes hourly, onto my skin.

Take heart, my heart. she begins to look like the mother i have been looking for— her brown eyes returned to green, her brood-

patches covered in eiderdown and oil so that she won’t be cold when she ﬂies.

i smooth her grey-feather coat. she coos, soothing her worries and mine for now. The suffering done, her caretakers begin to take their leave, their business with her done. i ﬁll her haversack with silly notes,

raise my downy arms to wave her on her way, and she is rising to ﬂy at last. The beaming grackles and cedar waxwings will lead her to earthen mounds where my father has already made a place for her.

45 Before, I Was Childless & Wanting

The child alone hasn’t settled in. other travelers on this northbound train half-drowse under the spell of passing farms and nearly vacant towns or they talk into the cloudless calm as daylight thins easily toward sunset. The moon-faced boy whispers as he tiptoes up several rows and back. he counts to ten, the mother tucked inside a dog-eared paperback on self-help while he paces, touching the seat backs. A few others look up. one makes a half-smile.

soon the horizon will shut out the sun.

The mother will doze, her low breath swirling in and out her open mouth. i’m familiar with this time of day when red-winged blackbirds empty the ﬁelds and pastures, and gather to roost.

They conceal themselves in sedge and rushes for the night. i know to expect this of the birds. And of people too—all along this route,

they’re collecting in their yards and houses. A pact with each other, to gather and settle at dark when we are exposed, easy prey, having gone away to dream of ourselves

and awakened only by daylight to hear a zwir of blackbirds. some nights i still dream of a boy cradled, hidden away in the rushes, watched over. it’s an old story. it stands in for all the children who’ve grown up and left. The child we lost before it was a child. The adult child

46 we could or couldn’t save. in a savage time, and i don’t know of a time that hasn’t been savage, to keep the child from harm is a lonely labor. i pat the moon-faced boy on his head. suddenly his mother is stomping the sleep out of her head. grabbing the child.

Rebecca A. Spears is the author of The Bright Obvious: Poems . she has re - ceived awards from the Taos Writers Workshop, Vermont studio center, and is a recent pushcart nomi - nee. email: spearsreb @gmail.com

V o I l 2 s u s 4 0 u m 8 1 e e 9

I t h L e a o o t m u a w i a p m h n

h h y n

n i f u p r i ﬁ o l e o e s c m a

e e a d i d s p r r a n

. l

“ “ t s s t c I T r l

s d u s

t e

t t y n t W H e t ﬁ

t s h t l w

r d W h i e

a l l o

t f n s c

m a c e e t m i

h a o e t e r

h f e n h l l a d a n h i h

t t r

i r r o e

l y d p g l

h e

s k n d e a o

i l i

t o m s e

s g i s

l c

i e

t ’ e u h e e ﬁ t e m

f s W t h

n r h G a f

s t

g i r c t w r a

s b c m o i h ’ d

a r s r r o h t i e o . P w n h e e t i

l e l u u

e a n

, ? c I l

m l t e e

h ﬁ

i e y

m n t s a ” e e I d e m

n e s m

r i v

e a

x w

d w t o

l s n

t e p w k I a e f y , p e d e t

h g

e o a l

j a

r e w

h r h p a i e e p a d e v w a l

y u n s s c h a y

a d f o s

w s o a e n

ﬁ

i o D r b o s

e o n u

n m y e

i r s a w

d i g t , f l n

u l

n s o v c d n

d w i L i

u p w

c o — n t a t r o h y n e d r c s e s e a u h r r n e d n

e o , u o w i v

a e d e e

ﬁ s s a n t r e w

n e a a u e s r r m k t d o s u i

v i t t l

i .

n o r b c c n n r a i . y

a w n o P J e m e

n i m r i i l u y . g g Y s -

n a t i u s y l

i j h y

s y y

P b t s t a g e

h s t . h E . e s . y g n t i ,

h e ; t i , g r

e T i f , h a i ”

, r a

e d s a r s e g h n

h h h

r i e h

r a b

h d e s f i w t e d i

c a i a t e m s a d o ﬁ d

d e d

, o i v

h h c

o s p r s

s i o w e e u i s g s n e c e i a u e n m i d n a d n c o r . h a — h n g d n

g , i a t e , g , n H

e a

. k

a r u l c w

l n n f t ﬁ r

i H e

e n i i o h h p s g k m e

r n s

a e n i a d l

a p v e e

i m

l c d

g s a n , ﬁ n d

e a

o i t c o

l t l r a r

W r d p

r k

s o h w l h o e v k s f

s i l

o ﬁ e o f o o e x e f t i y i t i g o e

n n n

k r r l h u . l s t h m e l k o r e e h e g g e i e r r i d d e , s d - m e t .

4 9 “ d I c d h w n n W t i w b a i s t m h t o t T h n n

e h a o e I o n r e e a r i t a d h ’ m e i i e t t g d s e h

e o o l t

v t s t d v i

e s s e

d l h i

“ “ “ , e h h u d h t e W e H p k l

t e

p d p c b

T y u k i n a s r e I W f s r d

o c , i

s p e c e

i u , ’ a

h m

s t

r d e n s e e h

h t o i m i u

h a o r v a e t b g i

l e

s u i v d h

g e e i l e p r l l l s d t o t s i r n r t b

i u s i a i

e p o

y t d r p y e h v i t g z o e l m

s c

a e i r l , t t i e u t

l l h

e e e a n

i l o l r t e

c w

h f e d h a d a h s e i e b i c n

s n b g a e n n

g r o

n z r h

a n d i e n o t

v , a k m a i i a

e z t e s d i , a

e a o m t

t r d t i

t e d d n h y x e r l . c d d

s h s c o

t c

l .

p u l r

t t

, d y ,

k T

e h

w e t y l h o , d ”

T d

d a t ﬁ b

e e

t o h h .

c v r

e o t

w h e s a

f r h

h r t e . n r l h u h o h I

a u i e h o e

a h m o h

u t u e e a n m

s s e e b g

e n l e s e

k i t t a

. o o e g d g t

i v e b h a

d e c v t i s , n n f o t a c - a w b d - t x e o

n o n r u o

a i e

o f e r o W a e

n a s n f t o a i

f t u r

m g r r w e c I

n b l y , o w r l

h l d e b t

l s h n

d s s t , s d t i y w i b ’ i

g u s

r e , e p

i v h e i s

u l - h i

e t m

s f d e l e , s r y r m

t p b d e u l o r h w a h r

i r i e t w h .

n s e l o o h e , e s s n u

a o p a

i f * i d ” a

e x A h e

e e f

o e e y m

p u o a a n s n t m p

s t * i e . s

a d

v - i c a h

f , v n t

t e r f t w t a e t w m a a

a * p f h r e e

o t s

d i i e h g l

n t a b n i i s m h

- n r d e e e i f a o

p h n n s - o

e . p

t n t - l w y d r l

i g i

u e a r h t o

p i e m , g f u r s u n i

s d e w

o b - i

l ?

n p o

a d , y o a e c e f t a r a f t h u

” u u i c

, r s e e d s

c s n a n a r d o - r i

t e

r a o

n t

c c e n a h h n l s s n

o I d d a

f t i a i i i p h a t n v

. c

d w n o t l g i a o

k d u

a g i ﬁ a c g

p r l i e W p a t o h - l e n t e b o

s g s a r

a r t w t f a r t i o g b

h c n

t k e d

e a h h i c t e l a s a m a o

m h e o n i e s o d s i d s e s

c d o o e

l n

c r n

o l n e

c l o .

d n

z t

e - w ” p l

f o

t l e o b t t n h e d k f y w c . h o i

n o d

e e

l n

n h v e r h l o

d e s m e

i o s s e i h c a H c ’ a e t c e i h c i a u

g d h

s h

r m a s c . a t

e i c a t v b v i y

l g a a l e o

e k s u i s a o l v d d t

e a o i i m .

l e n m

u o i e n l

s e u w . i r

i o m d t n n d b n e s k g u g e h l p n a e a d s e e , . g i y s d . s r s t - - . - - to cutting, and burning his arms and ﬁngers with matches. There was a two-year rap sheet from the Er in his early teens; his mother rushed him in whenever she was sober enough to notice. He had grown out of it, until the incident in which he had immolated himself. He played guitar in an experimental rock band called the roaming Inferno. I made a point of ask - ing about his music during each visit, if only to hear the excitement in his voice. during our sec - ond year together, I asked Willie for a sample of the songs he had composed. on the next visit, he proudly produced a cd with some twenty-odd songs, the titles scribbled in pencil, lines slanted, letters smudged. It was a whole three weeks before I got around to listening to it. After a few songs, I turned it off. Weeks later, I handed back his cd. “Interest - ing,” I said, remembering how a friend had once said “interesting” was a word you would use to de -

scribe an ugly baby. Willie took the cd back. His lips drooped slightly, but he said nothing, sparing

me. I asked about “dusty rain,” the song he was working on. “raining dust,” Willie said softly, showing his dimples now that he had more fat on his cheeks. “But “dusty rain” sounds better. It’s coming.” I cursed myself for not getting the name right. “can I see your hand?” He obediently placed his right hand on mine. “Are those ﬂexing exercises helping with your guitar playing?”

50 “Yes,” he said, though I doubted this was true. “How’s the band?” “I’m about to call the boys to crank out some new tunes.” “Promise me you let me know when you’ll be performing next.” I looked up at him, smiling, trying to distract him from what I was actually doing—prying, bend - ing, and testing the flexibility of his marble-white, skeletal fingers. He smiled back, eyes wide and mirthful, amused by my ill-concealed hopefulness. “I promise you’ll be the first to know.” He pulled his hand back and pressed his right fingers into the palm of his left hand. The joints snapped and cracked. “I’ll straighten out these fingers. don’t you worry,” he said. “I’m not worried.” The room fell silent. His slender fingers, I feared, had succumbed to the skin graft, and

would be ﬁxed in permanent ﬁsts.

*** Willie had no one except his divorced parents. His father was a seasonal truck driver who didn’t believe in mental illness or medications (“what my son needs is will power and keeping busy!”). His mother, an unemployed social worker and recover - ing alcoholic, took him in, albeit reluctantly. “I need to see your arms and chest, too.” Willie fumbled with his top buttons, which were difficult to undo as he had very little sensa - tion in his fingertips. He finally gave up on the last

51 few, and pulled his shirt over his head. He shook his head when I offered the gown. I looked at his pale arms and shoulders, haphaz - ardly decorated in white gauze. Then I noticed that only three of these dressings, all on his left upper arm, were taped. The ones on his belly and other shoulder were only stuck to his skin via dried blood. obviously, he had run out of medical sup - plies. The deepest ulcer glistened on his right shoul - der. The ulcers on his belly were oozy. I lifted the gauze gently, but bloody micro dots—like the thou - sand eyes of a dragonﬂy—coalesced into bigger drops, ﬂooding the shallow ulcer. Within seconds, they formed a bleeding rivulet. I quickly pressed the sore, hoping the pressure would stop the bleeding.

*** during the ﬁrst few months following Willie’s departure from the burn unit, his mother had called once or twice a week. she was worried

about his fast heart rate, his low-grade fever, and his lack of appetite, which was followed by a rav -

enous hunger once his anti-psychotics kicked in. she also worried about his non-healing wounds, his refusal to go outside, and their arguments. “You cannot argue with a miracle,” I said to her, making light of things when her tone got too angry or desperate. “He shouldn’t even be around.” I felt like a board-certiﬁed asshole for laying guilt on her like that. However, I was afraid he might end up on the street—or with his father, who would get him off all his pills. she went quiet. When she talked again, her voice was hoarse.

52 she told me she had caught Willie picking at his skin graft and eating the scabs. I brought him in right away. “I like the taste.” “You like the taste of what?” My sharp voice surprised myself. “I just like the taste.” He looked away like he was already bored with the conversation. “Are you depressed?” “no.” “Honestly?” He shrugged his shoulder. “Are you taking your medications? All of them?” “Yes,” he said. I glanced guiltily at his swollen belly—he was packing on weight furiously from the anti-psy - chotics. “Are you using drugs?” “no.”

He couldn’t look me in the eyes, and slumped low in his chair. for a minute, I contemplated call -

ing his young psychiatrist. Then I remembered how many psychotropic meds he had tried, only to have them fail. He gave me a blank look. finally I let him go and promised to call him later. The prospect of finding a substitute for his self- eating forced me to be creative. That weekend, I set off to a large chinese supermarket and con - fronted the junk food section. right off, I grabbed two bags of dried cuttlefish, five-spiced, with sea salt. Then I picked out bags of yam strips coated in powdery sugar, along with spiced beef and pork

53 jerkies in different ﬂavours: orange, pepper, and tangy barbecue. I bought sheets of congealed malt sugar, saturated with black or white sesame seeds, and rock candy, frosted like amethyst crystals. I was too excited to wait until Monday to call him. Willie answered on the second ring. He said he was happy that I had surprises for him that might help. “Anytime, any day is ﬁne,” he told me. I visited his mother’s house by the old city park. His mother welcomed me with a bright, lip - sticked smile. I had forgotten how young she was. Willie hid shyly behind her. I handed them two plastic bags full of groceries and promised more. In the end, it wasn’t the cure I’d hoped for. Willie reported that the food was “interesting” and didn’t need more. In subsequent visits, though, the old ulcers healed more and new ones popped up less. I said nothing, giving him room.

*** It was around this time that I decided to retire.

To improve efﬁciency, the hospital had imple - mented sweeping practice changes, and I couldn’t keep up anymore. The decision seemed abrupt, but deep down I knew I had been struggling with burnout for years. In my last month, all my pa - tients received a letter explaining my departure. It was a long month. I shook a lot of hands and held back tears. on my ﬁnal hour, I checked my emails one last time, and discovered that Willie had just visited the Er. The attending doctor described him as “appearing disheveled and intoxicated.” Her

54 suspicion was conﬁrmed by the urine toxicology. Marijuana, cocaine, and various tranquilizers were found. The one thing that was glaringly missing was any trace of anti-psychotics. “He is asking for you.” I wanted to scream. for all these years, I never thought I had done much to help Willie. I had al - ways been frustrated and scared by his impossible- to-treat mental illness and hopeless social circumstances. What I didn’t get until that moment is that my fumbling attempts at a “cure” had sus - tained his sobriety, along with my acceptance and genuine respect for him. I wanted to call him. The toxicology results glared at me. I typed calmly: Message to the nursing Phone Pool. Please call Willie in a.m. Make sure he shows up for his new patient appointment. Dr. Tufte is a great doctor. I’d go to him myself. Please tell him I’m sorry. I will probably never

see him again. Not at the rate he’s going, anyway. He is going to kill himself by doing something im -

pulsive, again. It’s unlikely he’ll fail the second time. Tell Willie I’m sorry. I’m very sorry to leave him and for neglecting to prepare him for the change. Tell Willie I thank him for sticking with me, and earning my respect all these years. Tell Willie not to hang his emotions and trust on people so much. Not girls, not his band mem - bers, not his father or mother, not me. He needs to rely on himself. No, no, that’s not true. We do care,

55 his mom and dad and friends and doctors and nurses. We all care. But we’re all too human—well- intentioned, but selﬁsh and limited. I kept writing and writing, as if I was penning a goodbye note to a wayward son. Tell Willie I want him to stay well .

*** I highlighted everything—and hit “delete.” Tell Willie best of luck.

*** I logged out of the hospital computer for the last time, staring until the screen went blank and there was nothing left except the grainy reﬂection of a tired face. I threw my stethoscope in the brief - case. Then, I gave one last look at my white coat hanging on its hook and decided to leave it there.

Diana Pi is a general internist from Westlake, ohio. she lives with her hus - band, two kids, a dog, and a rabbit. Email: diana.pi.md @gmail.com

V o I l 2 s u s 5 0 u m 7 1 e e 9

“ W g t m r n w e b c s s c p i b c t i l n e h e i p T l e h a r a a a l a c l l a e p n g n e e m e h y i l h r c s d k t s l e

s l n e t i t

k I e d a h c a

. l

e n . v i n ” s c e s d n y a

m s t r e

“ s o

o o o t d ’ t c

e s

I e r e . s r I l m a B i

f m

n r

y m i “

i c h p t

O h m t e , v a g e

m , e h e

o Y i e e a

t a o e p o m u r c s

a h v a y s r a r o t n t

w a . e n

e a e i h t t

e c a l

g i v d i d

I v

r b d

a m c n a

n a o t h t o

t e

l e e e n i o

k t t i d b

o t f

y m o c f a r i m ,

p h i a

c u n n

w y n y

h n a t d a t e e e n s i e t o h d

g h

a g e r . h

r a t

c d

” s

t w R

e n h s n , w i J s h s e t

s I s a

c o i s u u d h w

i F g e , I

h h g e l k ” k i t s h m

n s l n d e s e t l e i h e ô n ,

n e t o h n

s 8 t r g

i t

I n e i h

i h e o h r S f

g g B n

i 5 c v h e u m m e b n a I n a h w e h e e h

e - e

n e d l h r c y d d

s w y a e t

o y t r

o i c e

s a

e n

t o s

l h n w w a t e , h w u h r n c b a e t ” d o l r a

a t s

e e h d g f a r d

r G a a i c a h

v t s i d -

t a h i i t c l

o s c

r , d s o h h s n l e i m

, e

o i

t e . d v I , n

s t i

n l a e

t l

w a ’ s f m n h d h a e S r e o h b o d m

l ; u c p t e . s

d . o a

e a e u

o o o P s w l o n t T p t “

t u , r

s o t h g r i

v l r h

y I

o o I h d c h e

p e m i o d b e e

i ,

e m t s n b m

l e g

r u i i e i l b t m a o N e

n r a e n

l e u h c r a d d w a a u h

l d v g g s g a e e o a v g i o m n e t o u e n g

o u n e n e

d t l c i u

n s w h a i o p o n d u e s w s

c t n

u n

t a

e t

s f o h ,

l o g o

g i : r

i r b a t d d

t t

r I i t l r s i o y o

f d h

e e

o h n a a h

g o b e o m

r p

e g g

n e v r a a w n e

r n a i

a t d e r c d - s h e h . i i v r - t - i n t w e e y - - h t r -

5 8 “ a M p t p h N t r i f t V t h t e n ﬁ a i m s n e o t n n i h i h i h e o I v i u n o a e i i n o f e v o c a t g a i ﬂ t s v g i e t e e

e a s ’ e s i o e g r g w n n e n h e t s s y n

“ n e ? “ n e t d p . r K B T a s o h r p e t p

k i s

r ” t . b c A d

W t s

“ i h g i v i r v

r e e h r h t e s a a f n n

t c c

o O e y

i j r n a i e I r r e a I r i x i i r i r e o m o o o e g c e

m o ’ u e

o n r n p e n n l r g k a o a s d p w l w a . l s f

g f v w

n s y

d m i t

l o .

e s o n

l s e , u t e ”

l l c b h , e o t i S y

e a l h k .

r v i n f o

e o g o

r o w y

t e ’ f t n o v t

r i r i

e I s e t i

h g n

a h l r h n

f f t n I f e n k t t h q e g

l t r d a a

f w

. r e ’ p e h d o d h i i e

r a e l

s l g e

s ’ o u s n

r n g “ w

i s

i t

d a

e e u

e r

c g h y g s s i h

h h d a o t k l T o a

r e i

e e

v o t h e e e o h o

h e R n d a t n a

f d l

t N n n h e r

e a u h r i l o s o v t

t l t t . r a y c p h

a r n t e

h i i y r ! , e n

i p a e d t n f i t t

n t h

h y ” B n e

r i ô

o g

e I h d u s

d t w l n

g e i g S t

g e x

t g e

e h t n h t

s e

a a I

t h l

h g

a h

o h

e r . o t . e a

o h i t a e s t

a l s

b o u

e z n g o l h h a “

, e e l I o

n p k o a e

”

b y

e e y t b h

s k r i b u m u o e Y e o r e n g e

e t , c d f

e e o y

t l

e b r h n l ’ m o s d e t e e

n s o d B s l b

i h u

a o h

i a a i s d a

u n d

r t V

m i t o

e e e n w e e d l n h , h l e i v n t w t h

r e a ”

v f r d n a k

g o

m g e e f a o o r d t n

a y c a n t e n n e e g a s

a s o r f r a e h t a r s r

t t c ; i l

e o h

i c

t r a c

i c l o

e l l t e n i e n n w

h I a i y a d j e e

- i w e a f h n e p

o k d k e a g

n h

o l . p

m s y n

e ” e d t e f ﬁ

. c m t w n c e t f l n t

s u c h a

i d

r e h u T u

i a r h

c t e r

e v o a o h s l i

e t i s e a s a l

u n r l . l n . ﬁ o h s w a o e n ” m

r w l o t

e .

e l h o

T i c u i t t -

n s e n l e

k n r d “ v l

n l o h i o p S k e n

l r o k

i d

h n e . l B e o a w e

c h g

g i t e e

l e

f k d j

S w T e n s g

g e n h a n f u

r h

e i

e t a .

i a , t o d , t n o k e s n d o

h o e

r t

s s w t

o a h s o o h p B

g , i i t n t

i a

o r

I m n d I d s e e a t c m n , i a a h a e e

r t

’ f

o h s f

r e g a d t r e c m u r n ’ r t

y n . s e h s e h s

n a

t h t

n o o t “ s n y m

o d a s h i

e a t m a e e n i n a p n b t

I ,

f r i e

c r r r d - ’ u o r l a d t e r ’ e

e v s e e

r t e e . a s c u n - t e

, a l e m i o i h c a x r - x n - - - - cause I think that’s where I’ll be going. I dreamt I was in a tunnel and my husband was standing at the end of the tunnel. To me the lights are like the tunnel.” “If you made up a story about that painting, what would it be?” “I would write: don’t be fearful. Someone’s waiting for you up there. just try to be graceful. My husband was so stoic. he didn’t complain. he was amazing. But of course, I was with him, he’s not with me.” “And that’s the difference?” “That’s the difference.” “What do you think happens next? To the peo - ple in the painting?” “The older woman dies.” Bernice laughed. “There comes a time to go. We can’t ﬁght it. I have a nice poetry book, and one of the lines is, ‘do not go gently into that good night.’ I don’t agree with

that. I wanna go gently.”

“If god was standing behind you and listening to you, what would god put into this painting

that isn’t there?”

“he’d show me ﬂying up.” “just going up right into the sky?” “Into the stars,” she concluded. As our hour together ended, I asked Bernice whether viewing the painting was helpful in any way. She responded that looking at and talking about Starry Night over the Rhône gave her strength. “Yes,” she told me. “It conﬁrmed that I do believe in an afterlife, and that believing in the afterlife will help me to die.”

59 The Starry Night, Vincent van Gogh (1888)

Note: Vincent Van gogh: The Starry night, in 1888 (fr 1975 19) Paris, Musée d’orsay, usufruct donation of Mr and Mrs robert Kahn-Sriber, in memory of Mr and Mrs fernand Moch in 1975.

Acknowledgement The author is grateful to The foundation for Spirituality and

Medicine, Baldwin, Md, for their generous support.

Florence Gelo is Associate Professor and the director of the Medical humanities Scholar’s Program at drexel university, college of Medicine. email: [email protected]

V o I l 2 s u s 6 0 u m 1 1 e e 9

m f h ﬁ T t t w i ﬁ T i m l u m p t b n n e e h o e e r r t a o h h t l r e e y u t g e

e s s r l t t l e f e a r a

o t

s t . e i r i d u T T t

b d p e r

n .

e n n . “

w o

p d e

l n n h h e

a I g I k k n l S d

l a a t

d y

o s t l a a

r e a T ? e r m l y t y

y w s a w n n n e y r a

e a n

i o o o t k C a v k k

g o e d x

c , d a d h t

u u l o i

u e

n I e y p h M s

n l r y y i

t n .

y m u n i

a p

e r e d

c f h g o s p o t

I t s g e o ’ e c y a e t h

t e e e u r u

s g e

e k c h d r n

. a

e e y

n ? a

r a c r . T a i

s b f

b e

e s u a

d r o o r j n

m o e v S C a o o h , t e e a e t n i d

r r n t r M e i o i m r s i m

u b t a y a e z

n e n e

t o s c ! b

b d n l e

d t . a n y e ” . , i a e h g y e

g f

e n

k I t c u W

t t m y a a 1

r a t i

y i y i h s k g p ﬁ

n a o l s u o a n n r 8 r y : o o a b

a e

. r a n t g

t g

r n g d i T

o A u u s

i u k i t e n t I f

e e g n

t .

. h i m m u o r g

. m

n d w

e o

t g I A

T i o L e

n h Y o o n y

d n r y p f t

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e i n l u v y h t - n a . l h s d n t e l t e g s you felt depressed. hopeless. We sat and talked. And after several months of medications and long conversations, you felt better. Thank you for show - ing me what resilience and strength look like. Thank you for being respectful, compassionate, understanding. I wasn’t always on time in clinic, but I was always sorry. I know you were frus - trated. So was I. Thanks for not leaving. Thank you for allowing me to spend time with my new son. for saying that you didn’t mind see - ing another provider while I was on maternity leave. (I know you did, and I’m happy they didn’t restart the pantoprazole.) Thanks for asking me how I was doing when I walked in the room. And if I was sleeping (spoiler: I’m still not, and neither is he). We’re here to talk about you, but you gen - uinely want to know how I am. Thanks for caring. I wouldn’t trade our moments together for any - thing. even the challenging ones. even the ones where I questioned whether I was a good doctor.

Being a good doctor: it’s not about knowing the textbook inside and out, it’s not about never mak -

ing a mistake. It’s about listening. Being compas - sionate. not being afraid to say “I don’t know”, but then ﬁnding the answer. Thank you for shap - Mays T. Ali is ing me into the doctor I am today. If you were a Assistant Chief of starﬁsh washing up on the beach, I would pick you Service at the johns up, and toss you back in the ocean. Because if I hopkins Bayview Internal Medicine can make a difference to just one of you, that’s all residency Program. that matters. Correspondence may be sent to mays.ali @jhmi.edu Gratefully yours, dr. Mays T. Ali

V o I l 2 s u s 6 0 u m 4 1 e e 9

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S e a s o n Volume 14 Issue 1 2019 Doctoring

some lines are blurred of late—

in the liminal breakwater we trade stale air back and forth I look down I see your ﬂesh on my hands I must seem crazy to you, doc I hear voices, I do bad things to others

not at all—you see, some days we are the same person at night you crowd the clinic candle wax faces melting into mine multiplied on the murky horizon between illness

and migration

where we bottom-dwellers swim.

doctoring,

you must understand

is a lot like being a woman;

in the morning we put on our other faces we ride the subway quiet

hoping not to be seen.

68 Cancer Season

Inside now we are going gently to seed not this, the world we knew before; I see spores behind your eyes like dandelions in August.

still, the hot sun cakes our skin leaves fall as they do such are things.

Not a time we can cure but can we live on in the warm earth like nurse logs?

—perhaps

yes and slowly slowly the slowly burning forests will swallow us.

Sarah Andersen is a physician and poet currently completing her fellowship at the university of Alberta. Email: sarah.kandersen @gmail.com