Two elephants won't leave me alone.

Every morning, as I struggle into consciousness, my brain makes plans. I will get up out of bed, go pee, find my way to the kitchen, put water on to boil, fit the paper into the coffee filter, grind beans, slow-pour over the grinds….

In my mind's eye, I visualize that the coffee is hot, that the news I read is upsetting and that, caffeinated and dressed, I am up and into my day. My thoughts take me out the front door for a long walk with my dogs, and then to work.

The reality is that I haven't moved a muscle.

My first day on the wards,
the senior resident handed me a white coat
emblazoned with the twin serpents of Asclepius,
and a stethoscope I proudly draped around my neck.
I thought I knew everything
about the dying patient assigned to me.

I listened studiously to John Doe’s lungs
filling rhythmically from a little machine
with a red diaphragm that pumped up and down
and made a hissing sound that reminded me
of the snakes embroidered on my collar.
I grew to know him over weeks,
to speak in code through a system of lid blinks--
the only muscles intact after a brainstem stroke.

"I'm graduating and leaving our clinic in June."

Over and over again, in the months leading up to this transition, I break this news to my primary-care patients. I have developed many meaningful relationships with patients over my past three years of training as a family-medicine resident in a large, urban health center in Manhattan. But now it is time to leave and move on.

The fluorescent lights in an overly air-conditioned white clinic room illuminate face after face, all with the same look, staring back at me. Her face drops. His shoulders brace. His eyes shift. Her chronic low back pain tightens its grip. Her once improving mood slips back down. The eight-month-old bouncing and smiling on my lap quickly lunges back to Mom. She senses that her mother is hurting.