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Riding the Rails

William Toms

Our train starts to move slowly down well-traveled tracks. Sunny out,
clouds in the distance. We pick up speed.

We offer obligatory greetings,
courtesy How you feelings?
We both know why she’s here
we defer that talk
as if deferring for a few minutes will make it easier.

The trackside turns to trash, human detritus, rusting hulks without utility.

I edge closer, negotiating perfunctory reviews–
her history, her physical, her labs, her imaging–
she owns them, they’re hers alone.
Then it’s time to enter the forbidden room of abnormals:
machine-made “shadows,” the blood’s “too highs.”
Her cloak of woven fear lies quietly on her shoulders.

It stays immobile when I say the halfway word “tumor.”
It doesn’t wrinkle or slip upon finally hearing
that we have arrived at our destination,
the train stop with the “Cancer” sign swinging,
greeting us as we brake to disembark.

We enter the cavernous shell of an ancient building, pigeons circling great
columns as if this was normal. At the center of the main floor the newly electronic train
schedule flashes its options. It suggests we are free to choose whatever
route we wish.

I recite the complexity of the science of it all.
She is dismayed by the excessive information I offer,
couched in pretentious “We can do this… or this…”
She thinks, but politely defers saying
“We aren’t going to do anything. I will be doing it. Alone.”
When I eventually crawl out
from behind the evidence-based wall
I’ve taken for shelter, she says
“What should I do?”
I say something about shared decision-making.
She says “Fine, but I’m asking you
‘What would you do?’ “
I review again the pros and cons of option A
and the cons and pros of option B.

I mention the experts don’t agree,
the consensus statements have no permanence.
The latest study contradicted the previous one.

We sit on a long, well-lacquered bench, facing the ever-changing
train schedule, squirming on the hard wood and the too many
choices. Her fear moves over a bit to give confusion more room
to rest and then quickly fester.

A mild anger starts to swell, impregnated
by the word “cancer,” nourished by indecision.
The turmoil is discussed obliquely, hesitantly,
as a fully informed decision-making process.
She looks at me with the courage
of those facing this choice:
“I’m asking you again because I trust you–
what would you do?”
I realize my good intentions have been frail
and, so far, failing.

We get up to leave, confusion and fear walking close behind.
The train is waiting, refueled. We step on, sit down.
The train lurches, then slowly leaves the station, gaining deliberate
speed, heading out in a new direction.

I answer:
“What I would do, if it was me, is….”

About the poet:

“As a family physician, listening to my patients in New Hampshire and Maine over the last forty-two years has taught me so much more than books and courses–most importantly, perhaps, that I should listen better. Writing about my patients’ stories both serves to honor them and, hopefully, encourages me to listen a little better to each and every one of them.”

About the poem:

“This story is about two facets of the patient-physician dynamic that, unfortunately, seem to be fading: relating as two people who care about each other; and, derived from that, the trust that may be even more critical to the patient’s outcome than all the evidence-based protocols we have available to us.”

Poetry editors:

Johanna Shapiro and Judy Schaefer