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Denial

Kendra Peterson

July first Fellow,
a pager blares announcing
my initiating consult, a 29-year-old
(just my age)
malignant melanoma
and a first-time seizure
while receiving an infusion
of experimental treatment.

When I arrive
she’s already gotten
two milligrams of ativan
dilantin load is hanging
and I examine
a somnolent young woman
now coming ’round,
could be my friend, my sister, me,

no fever or stiff neck
no lateralized weakness
reflexes are brisk throughout
and toes go up with plantar stimulation.
I recommend the usual labs, brain MRI
and scurry off to find
my famous mentor,
the one whose genius moved me
three thousand miles across,
a differential diagnosis forming
as I ascend the stairs.

After history and exam conveyed
I list for him the possible causes
for a seizure in this patient:
          -the experimental drug itself
          -electrolyte imbalance
          -immune suppression with CNS infection
          -maybe she’s a drinker or drug user
          -could be a subdural
          -a sinus thrombosis on birth-control pills,
and almost as an afterthought,
I suppose she could have

          -brain metastases.

As my words cascade
and pool between
I notice a kind question
forming in his eyes
as if he seeks to understand,
or perhaps I am familiar.
Gently he says, “You realize
she has brain mets,
don’t you?”
Well maybe,
but….
and with a hint of desperation
my list begins to flow again.
He holds my gaze, an eyebrow cocked.
Then soundlessly he walks away.

After visiting Radiology,
finishing my write-up with leaden
heart in the harsh yellow
of the nurses’ station,
a light hand finds my shoulder
and I turn to face the knowing
eyes, a moment that covalently
establishes our bond of understanding.
“You really didn’t want her to
have brain metastases, did you?
Neither did I,” somberly, “Neither did I.”
Then soundlessly he walks away.

About the poet:

Kendra Peterson is a neurologist who lives in Palo Alto, California. She is a member of Pegasus Physicians at Stanford University, a group of physicians who write creatively.

About the poem:

“This poem is derived from an experience that occurred many years ago on the first day of my neuro-oncology fellowship, but that has had a lasting impact. It reflects the challenge that healthcare providers often face, feeling empathy and compassion while simultaneously applying our knowledge, intellect and judgment. The mentor described in the poem has mastered this challenge, modeling it both in his approach to the patient and in his interaction with the fellow.”

Poetry editors:

Johanna Shapiro and Judy Schaefer