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Hard Facts and Fiction

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Brian T. Maurer

At Daniel’s first visit, it had been like pulling teeth to get this fourteen-year-old slip of a boy to talk. Despite my thirty years experience as a physician assistant, I hadn’t made much headway. I’d pose a question, and his mother would jump in to answer it. He’d slouched on the exam table, staring at the floor. Occasionally he’d lift his eyes to meet mine, then quickly look away.

Daniel’s mother had said she was concerned about him. He didn’t sleep at night; he couldn’t get up for school. He’d missed so much that he was in danger of failing his grade, and the year wasn’t even half over.

Daniel’s mother was not much taller than her petite, quiet son. She was dark, slender and attractive, with a blunt, sometimes brusque, manner.

“If you want to know what I think, I think he’s depressed–just like his father,” she’d said.

I had to agree: Daniel showed many signs of clinical depression.

“We separated last year, and I’ve filed for divorce,” his mother had said. “His dad’s a drinker, and he won’t get help. It seems like he’s powerless to do anything about it.”

I couldn’t help but wonder » Continue Reading.

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Miscarriage

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Jessica Bloom-Foster

From the moment I walk into the room, she breaks my heart. She has just been sent to obstetrical triage from the ER, where an ultrasound has revealed a twenty-two-week pregnancy and a cervix dilated to four centimeters–halfway to delivery stage. She is moaning from her labor pains and moving restlessly on the narrow cot.

I am a second-year family medicine resident in a Midwestern hospital, and well past halfway through a busy call night. She is a thin, dusky-skinned woman, and she looks at me with wide, dark eyes full of sadness and pain. Her hair is pulled back with a nylon rag, and most of her front teeth are missing. Her face seems long and gaunt.

I take a rapid history before examining her, noting that she looks far older than her thirty-seven years. She tells me freely that she uses heroin and crack, is in a methadone program and smokes half a pack a day. She has not seen a doctor during this pregnancy. Her pains started at least twenty-four hours ago. This is her eighth child. She has only been using heroin for a few years. I ask her why she started using drugs,

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Listening

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Elizabeth Szewczyk

I couldn’t erase their words,
catch the breath atoms, stuff
them between lips,
couldn’t raise survival rates,
lottery odds dependent on cells suctioned
at the precise moment.

Your chest thumping, frantic,
valves siphoning warmth, drawing
cold through vessels, to your feet
crisping leaves beneath us while
you spoke her life.

Replaying slowly, baby girl, toothless
smile, creative toddler scissoring
Barbie hair (and styling hers to match).
Then, like a runner, sprinting
to that day the tumor revealed
itself, unveiled her future and yours.

You visioned her mane, now extinct,
loose, straight, gracing the crook
of her back, gracing the oval of her
face, strands like gold
embroidery framing emerald eyes.

We’d be mother-friends,
shooting Prom pictures,
scarlet satin shushing past her hips,
his fingers yanking the collar of his tux.
They’d glisten, her upswept hair
perfumed hibiscus.

About the poet: 

Elizabeth Szewczyk’s poems have appeared in Westward Quarterly, Crazylit, Chanterelle’s Notebook, Shapes andFreshwater, which she co-edits. She is also the author of the memoir My Bags Were Always Packed: A Mother’s Journey Through Her Son’s Cancer Treatment and Remission (Infinity Publishing, 2006)

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See One, Do One, Teach One

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Lisa DeTora

Back when I was in graduate school and working as a medical writer, a physician told me that the key to learning medical knowledge was simple: see one, do one, teach one. It was a clever (and effective) way of convincing me that I was qualified to teach something–like how to write a report–that I’d only attempted once myself.

Now, on days when nothing goes right, I find myself thinking back to that expression–and to the years when I used to see and do more, before I tried to teach anyone anything.

Soon after college, I worked at a private outpatient facility supervising the care and treatment planning for eighteen developmentally disabled adults. I was, in my own fashion, hoping to make a difference.

My program taught skills that would, we thought, enable our students to enter the workplace. But after years of observing and tracking their progress, I came to understand that most would never hold a job–and that some disabilities outweigh even decades of hard work and incremental improvements.

Some of my class, after taking doses of Haldol or Thorazine on a hot afternoon, would glaze over during group activities. I’d keep an eye on them

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Wounded Messenger

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I pulled back the plunger, sucking lidocaine from the bottle into the syringe as I prepared to lance Jimmy’s abscess. A voice in my head kept repeating, like a mean-spirited parrot, that I’d never done this procedure before–not even under supervision, and certainly not by myself…

I’d met Jimmy two months earlier. He’d come into our clinic with a fever, shortness of breath, a horrible cough, and a crumpled paper photocopy of a chest x-ray taken at another clinic. They’d diagnosed pneumonia and given him a course of antibiotics.

But now a month later, still coughing and drenched in sweat every night, he’d come to see us. He was pale, perspiring, exhausted and in pain.

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The Women of Victoria Ward

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Muriel Murch

I remember 
The women of Victoria Ward.

The laughter of Liz,
before there were good prostheses
before falsies
left, right or bilateral
were built into the cup size of your choice.
Pacing the corridors
and knitting.
Ready to go home.
Building her strength
with a strand of yarn 
Tumbled upwards from the empty cup
against that scarlet scar
beneath the bodice 
of her bright summer dress.

I remember 
Winnie’s eyes
watching feces pour
in a torrent
down her abdomen
searing her flesh
until I bathed her body
changed the bed
and wiped away
her tears.
We named that 
foolish pink protuberance 
her own John Thomas.
Her slow, shy smile 
heralded victory
for the moment.

About the poet:

Muriel Murch (//livinglit@earthlink.net/“>livinglit@earthlink.net) graduated as a nurse in England in 1964, adding a BSN from San Francisco State University in 1991. Her book Journey in the Middle of the Road: One Woman’s Journey through a Mid-Life Education was published by Sybil Press in 1995. Her prose and poetry have been included in several anthogies including Stories of Illness and Healing: Women Write Their Bodies (Kent State University Press, 2007). Muriel continues to write stories and poetry while tending her organic farm and

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Intern’s Journal–Surprises

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Jennifer Reckrey

Editor’s note: Jennifer Reckrey is a family medicine resident in New York City. Each week while she was an intern, Dr. Reckrey recorded some of her experiences as a brand-new doctor. Today’s stories are from weeks number nine and twenty-five.

Week Nine

I dreaded my rotation in the Intensive Care Unit. Though all the tools to keep a body alive are right there, their continuous bells and beeps jangle my nerves. I’m always afraid that in this place I will be called on to act decisively and invasively. And my mind will go blank. I will hesitate, and that hesitation will make an already awful situation worse. But even more than that, I dreaded this rotation because I think of the ICU as a dead end–a place you don’t leave alive, or if you do, it’s as a shadow of your former self.

So when I met my first ICU patient–a sixty-year-old woman with metastatic lung cancer, intubated for respiratory failure after a routine chest-tube placement–I imagined the worst. 

She was fully conscious and mentally sharp. For the first two days I cared for her, she was very stable. But she wasn’t improving–any time we turned down

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Chemo? No, Thanks

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Elaine Whitman

“If I were you,” said the radiologist, as I sat on the gurney discreetly wiping goo from my right breast, “I’d make an appointment with a breast surgeon as soon as possible.” His somber tone of voice, the white blotch radiating ugly spider tendrils on his ultrasound screen…neither of these made me nervous. If anything, I felt mild interest: “How very odd. He must think I have breast cancer. Or something.”

Ten days later, after a lumpectomy and sentinel lymph node biopsy, my husband and I sat in the breast surgeon’s office. “I’m so sorry,” he said. “You have Stage IIb breast cancer. There’s a 1.1 cm tumor in your right breast, and the cancer has spread to three of your lymph nodes.” 

I looked first at his solemn face, then around the room. Who was he talking to? I believe the psychological term is “dissociation”: a defense mechanism against painful emotions. Oddly, I didn’t feel particularly frightened–just very, very tired. Neal drove me home and I took a five-hour nap. 

When I woke up, I realized it was true. I had breast cancer. 

Three days later, barely recovered from the lumpectomy, I had a second surgery to

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Apologies

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Alex Okun

You were right.
That IV was no good.
Looking at his arm all swollen like that,
I thought, “That says it all.”

I’m sorry we kept bothering you.
“Please don’t wake him for vitals,”
You told us.

Sometimes we don’t see the signs.

I was hoping she would stay home longer,
That you would have had more time together.
She liked starting school every September.
She loved that backpack.

I’m sorry it always took so long
To get into the room.
I’m sorry I took so long to call you back.
I liked our long talks.

If I say “we,”
Then maybe I’m not to blame.
We don’t know why some children
Develop this complication.

We don’t know why
The brain is so fragile,
Yet so enduring.
That’s not very nice.

We don’t know why
It happened.
I know you had some ideas.
So did they.

Remember the time
We didn’t start the dopamine?
She pulled through that fine,
Amused at our discussions.

Or the time
We got the antibiotics started so fast,
And his blood culture grew out
Only a few hours later?

Those storms down South were nothing
Like what hits you every day.
The levees

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First Night Call

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Abby Caplin

During my first night on call as an intern, I felt scared. Not just scared–terrified. I was serving on the medical center’s pediatric oncology floor, and medical school hadn’t prepared me for children with cancer. What did I know about cutting-edge chemotherapy regimens? What if a child suddenly developed an overwhelming infection or a seizure triggered by a tumor? Someone would expect me to know what to do.

“It’s okay,” said Brad, the second-year resident. “The nurses do everything. You just treat the kids’ hypertension.”

“How?” I asked.

“Hydralazine,” he answered, glancing at his watch. He looked tired and ready to split. “Ten to twenty milligrams IV every four hours.” When I looked up from my hasty scribbling, he was gone. I was alone.

For reassurance, I touched the small but reliable pediatric handbook in my white coat pocket. My other pocket was stuffed with index cards, each labeled with a patient’s name, diagnosis and quantities of information written in my tiny print.

I looked down the hall towards the spill of light at the nursing station, the darkening corridors lined with rooms of sick children all trying to sleep–or at least not vomit from the chemotherapy.

I

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Snowscape

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Jeffrey R. Steinbauer

The snowstorm had started on Friday, before I’d gone on call for my group. At first I’d thought the weekend would remain quiet, that the small town where I practiced might just slumber under a fresh blanket of snow. But by early Saturday morning, things had gotten busy at the hospital. Several emergency-room visits, phone calls and admissions from the nursing home changed the stillness I’d felt amid the snowfall. In no time, there was the familiar stress of trying to bring order to a day that was rapidly becoming chaotic. 

Sometime that afternoon, I looked up from a chart to see the town sheriff standing at the nursing station. Although we were acquainted through weekly Rotary Club meetings, he now was barely recognizable–bundled in heavy winter clothing, his head covered by a parka hood. Flakes of snow lingered on his jacket and caked his boots. Beneath the hooded parka, his eyes were severe and his face ruddy; together they broadcast an unspoken weather report. He was not smiling.

“Doc, we need you to come with us,” he said.

This was an unusual request, coming at an inconvenient time. There was much to be done–phone calls to

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Tree Years

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Addeane Caelleigh

We used to trade off, 
she said.

He hated trees dying in our living room. 
I always loved the blue spruces
decorated on my December birthday

But his father fell near theirs
dying in their living room
one childhood night. 

So we’d have a year with tangled lights, a crooked stand
he sometimes helped me put together
Then a year with presents stacked on the corner table,
with no dry needles to sweep.

Turn and turn again
a solstice pendulum.
A ring for each alternating year

That was before the fog that eats my life,
some years feast, none famine, 
always a forecast of more

She says, I think now 
he’d welcome any tree, any year.

About the poet:

After many years as editor of the journal Academic Medicine, Addeane Caelleigh is now associate editor of Hospital Drive, an online journal of literature and art published by the University of Virigina School of Medicine, where she is also an administrator and a teacher of faculty development. Addeane is also curator of Reflections, an interdisciplinary humanities exhibit series at the University’s Claude Moore Health Sciences Library.

About the poem:

“Tree Years was prompted by thoughts of how chronic disease insinuates itself into

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