Hospital Tourism

Our ICU has over 100 beds.
You’ll take care of the sickest patients here.
At night, there is only one fellow so you get to run the floor.

We walk down the ward as if an ancient castle, admiring the fluorescence.

Our main floors are single rooms… mostly.
We have in-person interpreters for Spanish and Somali.
Resident assistants do all the scut work for you.

We peer past the curtains as an elderly man struggles to stand with a walker.

The ED is a level one trauma center.
You’ll get tons of procedures there.
I’ve done 5 LPs already.

We smile through body odors and GI bleeds.

We have tremendous patient volume.
We are a resident run hospital, no competition with fellows.
The fellows are actually really good about teaching us.

Patients try to maneuver around our group as we pile into an elevator.

Morning report has breakfast.
Noon conference has lunch except on Thursdays.
Sometimes attendings bring food when you are post-call.

Our elevator opens, full of suits. The family will catch the next one.

We have computers in our call rooms so you can put in orders without leaving.
We have cell phones instead of pagers.
We have really insanely good health-care.

We exit, falling over each other to hold the elevator doors open for our host.

This is the all-comers hospital.
This is the tertiary referral center.
This is the quaternary referral center.

We ponder retirement benefits.

We have a really nice resident lounge.
We have a really nice allergy-free garden.
We have a really nice donor wall.

If I ever get sick, I would choose this hospital.

Nirvana

I walked with them for miles

Listening to their stories

Till I realized that they were just lost souls

At that moment of clarity

I saw them disappear into the fog

The fog of illusions

Illusions of love and happiness and hope and God

I stopped and let them go ahead

I had reached my destination

I closed my eyes and reached out to grab Nirvana

But nothing

I open my eyes and realized

That the illusion of clarity was gone

And I was just as lost as everyone else

But even worse

Now I was all alone

 

Photograph by Awais Riaz, M.D., Ph.D. taken in Montana in 2013.

Of Patients and People

I didn’t know if I should wake him
or let him slumber on, further into the quiet, golden morning.
I hovered in the doorway, pausing for a long moment
I took a slow, meandering inventory of a life, manifest in objects around his room.

A well-worn watch resting on a floral arm chair,
untidy piles of books and receipts,
an armoire with a door cracked open
to reveal rows of folded sweaters and shirts,
and photos, obscured by dust, but proving
that a life, vibrant with people and places
had existed before Mark had been stricken with his illness.

It saddened me to think of the hospital room
where he spent so much of his precious, waning time.
Where rubbery beds and cold metal instruments
could be wheeled in and out, interchanged,
as easily as a person could be.
Where the ubiquity of thin gowns and all things disposable
threatened to bleach out the rich, complex dyes
that so uniquely colored the fabrics of his life.

The cold jargon that littered his chart
among hastily composed notes and litanies of numbers
seemed to be a betrayal, reducing
the man who had created homes from wood and nails,
who explored religions like museums, learning and leaving,
and whose life, garnished by the innumerable idiosyncrasies
that bestow our ineffable humanity upon us,
was inextricably woven among those who knew him,
into categories in an electronic form.

I wished that all of the white coats and blue scrubs
who whirled by “the CHF in 315”
could have stood there with me in his home
and known that Mark was more than pathology and a job to be done,
more than the next patient.

Magpie Wisdom

Up in the hills on a fine spring day
Blown amongst the tree tops
I met not a chickadee, not a wren
But a magpie
Lover of death
And Joyful Singer
All in one

We began a-talking
As I, lover of joy
Yet singeing of death,
Made the unlikely but matched foil
For this ying yang colored
Raiment of a bird

He hopped on one foot
Then jumped down to the grass
Shot his tail up towards the shadows
And began a-chatting fast
Bibbling babbling
Quicker than I could
Clap along

Finally a pause
A deep breath
And, I thought, a chance for me
To share my two cents of worthlessness

But no, began again the magpie
With that old wive’s diddy
Surely you’ve stumbled across it
While nestled in aproned lap of yore
It goes like this
Said the robin to the sparrow
I would really like to know
Why these anxious human beings
rush about and worry so
Said the sparrow to the robin
Friend, I think that it must be
They have no Heavenly Father
Such as cares for you and me¹

And yes! There lie a premise
I could pounce on
Fueled by a clever chill of the north wind
I dared reproach the magpie
And exclaimed…
But I have a secret garden!
So secret that even I
Barely know of its existence
For the garden dare not step forth
In the confines of these four dimensions

Ever the rationalist
The magpie glanced at the
Weather formed mountain majesties
And down towards the barren gravel
Beneath his feet

He sparred…
Growth in a garden
Often holds signs often symptoms
Leaves blossom, vines reach towards the light
And roots, though less visible, are massive
Even more massive when invisible to begin with
And how massive might roots grow
When torn out

I watched the trees sway in the wind
Jealous and an admiring spectator
Of worldly-unworldly feats
For never willI let roots down so far as to
Withstand the accidental sigh
Of a calm south breeze

For every chance for bloom
Means staying in one place
Means indebtedness to the earth and air
And sunshine bestowed upon that
Pocket of geography

Indebtedness
Pain in brutal storm
Reason enough to forego
The spring glory of petals
And cotyledons unfolding

Yet the best of growth occurs in spite of us
In spite of occurrences
What seems an empty hole
In fact a vast expanse
Filled with everything but emptiness
And spreading so far as to shame the big bang
For the laws of conservation of energy or matter
Matter not when it comes to my secret
garden

A brisk gust from the valley below
Ruffled the magpie’s feathers
From his dusky throat
Sang three clear notes of joy
And he was gone

You have wings, but I have roots, I cried after him
Roots, I cried
I cried
And it began to rain

¹Cheney, Elizabeth. “Overheard in An Orchard,” 1859

NPO

Bearded. Pungent. Sour smelling clothes stuck in places well beyond the expiration date.

“If you people don’t give me some god damn graham crackers right now I’m leaving!” His voice carries across the room, down the hall to the nurse’s station.

“You’re here for an amputation, sir. Your surgery is scheduled in less than two hours.” My delivery is flat and matter-of-fact.

“I don’t care about surgery! You’ve been starving me to death for two days and I want something to eat! NOW.” He is definite. “After I eat, then I’ll go to surgery,” he argues, as if to bargain.

Education regarding the risks of aspiration while intubated is delivered. Anesthesia is the bad cop, while I play the innocent messenger from internal medicine.

“God damn you people! I’m hungry!” The grey beard streaked with tobacco stain, an hombre look gone completely wrong, bobs up and down. Whiskers sprouting from an edentulous mouth. Profanities are slung around the room. The neatly groomed third-year medical student cringes as the patient pulls the sheets over his head. A clear signal he is done with us. Having obviously failed with my educational inservice on aspiration risks, I opt for a more practical approach.

“Sir, where exactly would you go if you don’t get the surgery?” I’m cautiously curious.

No response. I fill the space and remind him his foot is dead and the amputation with vascular surgery would be life saving. Crickets. I wait shifting my weight from one high heeled shoe to the other.

In one fell swoop, like a bird of prey about to pluck its dinner, he rips off the covers. I lean backwards away from the bed while still maintaining my balance. He looks up at me from the tiny island of a hospital bed. For all his big talk he’s a frail old man losing more than a limb, he’s losing his agency.

“Ma’am,” his voice is softer, almost quiet. I lean in towards the bed to hear better. Careful not to get too close. “I’ll go home and take care of it myself.”

“How?” my voice cracks.

“Well, I’ll just pretend like I’m an animal in a trap. I’ll take my buck knife and saw through the muscles and then the bone.” He makes gashes though the air with his hand wrapped around an imaginary knife.

Knowing what landed him an extended stay on 2-East, I believe him. Having recently been discharged from the hospital after being treated for a diabetic foot infection, he’s back not three weeks later. The wound vac carefully placed by the podiatrists to suck out drainage and encourage the crater in his foot to remember how to heal made it all of four days. Having fired the home health nurse at the front door, he removed the wound vac himself since “It really didn’t work anyway.” Then with fishing line he sutured “that son of a bitch shut.” His foot is now a black crater of oozing pus.

I stare at the man in front of me demanding to break his NPO status. Our gazes lock. Who will blink first in this no-guns-on-campus, gun slingers show down. I give the universal signal to the team we’re done here. In my most commanding of voices bark out the following orders.

“You aren’t eating anything until after your surgery. Those are your orders and I expect you to follow them.” In my most confident, respectable, “That’s doctor, lady doctor, to you” turn on your heels and exit stage right, I head for the door.

The sheets are now back covering his head.

“You know what you are?” says the taunting voice from behind sheets.

“What’s that?” I freeze.

“You’re just a bunch of Republicans!”

And with that the OR calls for my patient.

On my own rounds the following day I notice his name on a different floor. He’s now followed exclusively by the surgeons, medicine benched to the sideline. I pop my head into his room.

“Well, what the hell do you want?” he bellows from the bed. He is supposed to be working with physical therapy and I’m a distraction.

“I knew they were starving you to death so I just wanted to make sure you got something to eat.” I’m genuine, maybe he can tell.

“Yeah, I got dinner last night and breakfast this morning.” He’s less edgy, not exactly kind, just not hollering through sheets.

Another pause. We stare at each other. He’s lost a leg, but he’s already learning how to transfer, pivot and, most importantly, he’s regaining his independence. I smile as I turn to go.

“See you later, alligator,” I call.

“In awhile, crocodile,” he responds.

And just like that we patch it up.

Production Credits, 2019 Rubor Volume 7

EDITOR-IN-CHIEF

Kajsa Vlasic

CO-EDITORS

Lillian Boettcher
Serena Fang
Phoebe Draper

CONTENT EDITORS

Poetry
Amanda Walker
Hunter Wright

Prose
Anna Brandes
Leslie Denson
Allie Kroes
Sabina Imanbekova

Imagery
Michael Kennedy-Yoon
Allison Chang
Gina Allyn

REVIEW STAFF

Allison Chang
Sabina Imanbekova
Anna Brandes
Curtis Sudbury
Julia Moncur
Gina Allyn
Caitlin Indart
Nick Pappas
Allie Kroes

FACULTY ADVISOR

Susan Sample, PhD, MFA