Volume 9

I have never smoked a cigarette—
not even a puff—
which surprises people.
I promised my mother I would not
when I was younger,
and I never break my promises to my mother.
except when I do.

So it surprised me when I began to cough black smoke
which issued forth in my mouth
which hung low and wide and open like an O
in the depths of my surprise.
And blew forth in rings, slow and steady and constant

I think it comes from the tar
Which I can feel burning in my lungs
Which comes creeping back and coats my tongue with bile
I will find it one day
It will pour forth from me like so much black smoke

but until then I will swallow my bile
and breathe in my smoke
and hug and kiss my mother

and I will wait

Pronouncing a patient dead
in their own bed,
surrounded by the things they loved,
on the walls,
on the shelves.

The things you never really knew about them
the things they loved.
Never told in the fifteen minutes they spent with you
every few weeks
over how many years.
Not filled out on the “intake form,”
not asked by the receptionist,
not asked by the nurse
and not asked by you
A lot less important, I guess,
than the insurance number.

Were these the things he once lived for?
The things he woke up for in the morning?
The things he dreamt of as he fell asleep?
The things he shared with friends-
his close friends.

Were these really less important than his insurance number?
Though he entrusted to you his life,
you did not know his life.

But now you do.
Every interest,
every hobby.
Even a faded, small picture on the wall
tells more than you ever knew
about family
about friends.
Were these really less important
than his list of current drugs?

Dear Anne,

I can see you so clearly out of the corner of my eye,
sitting at the head of your bed,
in the room we shared.
You pause as you pull up the sheets to tell me
“It is best to make your bed as soon as you wake up.”
I listened to you, my big sister, my “I-want-to-be-like-you” sister,
and made my bed faithfully every morning.

We were so different,
you keeping everything so neat
me, untidy, sometimes just to make you angry.
We each had china dolls,
now I have them both and I can tell
which one is yours
carefully kept in its original packaging.

Dear Anne,

I can see you so clearly out of the corner of my eye,
but when I turn to look at you directly, you vanish
like smoke from a cigarette.
And I am reminded
that you are forever gone.

But Anne, I can see you
quirking your head as you order me
to move my shoes

out

of the family room.

or, standing in front of the Christmas tree

insisting

that I use one strand of tinsel at a time.
I laughed at you while I placed
clumps of tinsel on the tree
just to hear you be upset.

We whispered about you being so persnickety
in our pink bridesmaid gowns
with puffy sleeves and angular necklines.
Your two younger sisters
waiting to go down the aisle at your wedding
giggling about how

glad we were

that someone was willing to live with you.

How were we to know?

The man you married
would one day be the man

who would kill you.

Oh Annie,

I can see you so clearly out of the corner of my eye,
sometimes smiling in a lacy wedding gown
sometimes lying on a steel white stretcher
your hair matted with mud from the riverbank
where your body was found
bruises on your face
red hand prints in a constant strangle hold
around your neck.

We were so different you and I.
You so desperate to get married and have children
me so determined never to.
You pulling the family together
me trying to break away
“When will you be coming home next?” you asked.
“I already am home.” I replied
from my tiny apartment in Washington, D.C.

Dear Anne,

I can see you so clearly
dancing with your friends.
You invited us all to join you;
our brothers, our nerdy cousin.

Even me

who backed away from crowds.
You made me feel I belonged
even when I really didn’t.

So, we got to have you for 29 years.
But it wasn’t long enough
for sisters to become friends.
When I visit you at the cemetery,
I run my fingers over you name feeling guilty

and glad

That it was not me.

I thought when I reached 29 I might die too.
But here I am.
My hands still move.
My lungs still breathe.
And I do not know why I survived

and you did not.

And so, Anne, I continue on with my life
refusing to be immobilized
by the depth of the anguish I feel.

He will not kill me too!

As the anger rushes through me
urging me on, pushing me forward
your presence, Anne, seems very real.

And I am sure that I can see you
just out of reach
out of the corner of my eye.

I have struggled for so long to accept my body.
Today I realized there is no
thin person
inside of me
screaming to get out.

I am not made up of component parts
to be swapped and parceled.

I am not who I am
in spite of my body.
I am who I am precisely because
I inhabit this body.
My Body.

These thighs taught me perseverance,
told me I could climb mountains,
showed me I was strong and that I could endure
longer than I ever thought possible.

These calves (bless them) were too big for knee-high boots.
They showed me that I am not the standard,
disabused me of my egocentrism.
I will have to be creative
to find my place — my fit.

These arms taught me to cope with weakness,
how to be humble yet resourceful,
and that asking for help
is a strength of its own.

This belly
oh, this belly
my great source of shame,
the “ultimate proof” of my imperfection,
the evidence, I feared,
of my lazy, weak-willed nature
worn externally every moment of every day
for the whole world to see
an agony of constant self-consciousness.

This belly taught me
the best and most important lessons of all
it taught me to get comfortable being uncomfortable
it taught me how to absorb
bitterness, pain
(mine and others’)

and turn it into healing.

It taught me how to be soft
when the world would try to make me hard.

A constant physical reminder of my flawed nature,
it showed me that, visible or not,
everyone has flaws.
It continues to teach me how to accept
and forgive.

These teeth, with their years
of various metal implements late into my teens
taught me that even when you’re not totally feeling yourself,
confidence is sexy
and you definitely can make-out with braces.

This hair taught me that some things
are beyond my control,
and often, those things
are best left untamed.

This smile showed me
that I am capable of
Big, Bursting,
infectious joy.

It is not I
who made My Body;
it is My Body
who made Me.

I am not merely
a Soul and Hull
but
a Whole.

And while those arms may have encircled
my hips or my waist
without accepting my body
they never truly embraced
Me
(in my entirety),

and if acceptance is the birthplace of love
and My Body the birthplace of Me,

then accepting (and loving) my body
is not and cannot be
the afterthought
it is essential
it is the linchpin

to loving Me.

And I
am finally ready
to love me.

Shiny, silver locks
cold and clinical
clasp around thin ankles,
attached to callused feet
with yellow toenails
“Don’t look them up.
It will affect your care.”
the senior residents say
A patient rarely
is shackled to a bed
although always watched over
by guards, nurses, physicians
watching withering old men
struggling to make even an ounce
of yellow urine.
Who reserves the dignity
of a digital rectal exam
to a crowd of strangers?

These are the catechisms I have learned

In this seminary

And taken on faith

Those deeper doctrines

That you must obtain the date and dosage

That epinephrine is sympathetic

That the impulse indicates the position of the heart

Perhaps this will help me find mine

In a time when there is a crisis of faith in

Regards to those simpler tenets

Wash your hands

Wear a mask

Believe others when they say “please”

What use is mastery of the theology of human form

While remaining agnostic about human kindness?

I’ve got a white coat that feels like
The seams were sewn
with sutures thrown by shaky hands
It’s shoulders drape over the sides of
My shoulders

I’ve got a stethoscope
It works.
It amplifies my own second guessings
That pulsate through my head and
I hear the worried sighs of patients
Long after I’ve left their bedside.
In. Out. I sigh with my stethoscope,
worried too.

My pager is in my pocket
I keep forgetting to delete the page
So it beeps.
Beeps.
Beeps.

I’ve got a list.
Of patients.
Of mostly numbers.
Data that mostly doesn’t mean much
The list is sometimes a script and it’s sometimes
My job to print. And it’s always
Illegible scribbles in margins
reminding me
How much there is to remember

I have a badge that lets me in
To a rotating door of a schedule
And grants me access to the club of people
Who only know my name
Because of the badge around my neck

Coat. Stethoscope. Pager. List. Badge.
The morning mirror is
easy enough to trick.

School is
Interspersed
Between nightmares and dreams
Between novelty and habituity
Between flashes of inspiration and stretches of discouragement mixed
With
Regret, excitement
Joy, frustration
Moments
Friends, teachers, mentors, lovers, acquaintances, connections
You
Should maintain, must maintain, grudgingly maintain
Occasionally toss away because you
Want
Something better, everybody does
The reason most people come
To
Maintain status
Get ahead of the game
Find a spouse?
Land a job
Retire at some point because their parents, mentors, leaders
Swear
It’s all worth it
Worth the trouble
All the toil and strife
The sleepless nights
Grappling with problems that never seem to end
They never do

Diagnosis. A hated word.
Life changed overnight.
Young and healthy. Husband, children.
Time to fight, fight, fight.

Prognosis. A meaningless word.
Numbers can be wrong.
The Knife. Chemo. Radiation.
Bring it on, on, on.

Thrombosis. A frightening word.
Soul and body sore.
Doctors discuss time that remains.
Plead for more, more, more.

Neurosis. An unwelcome word.
Anxious. Full of fear.
Those you love never leave your side.
Hold them dear, dear, dear.

Metastasis. A somber word.
Love wells in your chest.
Surrender to mortality.
Time to rest, rest, rest.

Catharsis. A heavenly word.
Peace adorns your face.
As you lived life, so you leave it,
Filled with grace, grace, grace.

I think about my mom; I think about her when she was happy and healthy. I think about her being the happiest being a mom. I think about her on vacations, smiling and laughing.

I think about my mom; I think about her scheduled colonoscopy. I think about her fear to know the results. I think about the fear being so overwhelming that she cancelled the colonoscopy.

I think about my mom; I think about her regret three years later after being diagnosed with colon cancer. I think about how much she blamed herself. I think about the guilt she felt.

I think about my mom; days before her death, surrounded by her family. I think about my conversations with her; her favorite memories, what she loved about her kids and what she will miss about her kids.

I think about my mom; I think about the peace she felt towards the end. I think about her acceptance of the unacceptable. I think about her strength and her bravery.

I think about my mom, every time I see a patient, I think about my mom. I think about the things that make them happy, the fear they have about test results, about their favorite memories, about their kids, and I think about what gives them peace.

I think about my mom, every time I see a patient, I think about my mom. I think about how their needs, just like my mom’s, are beyond curing their illness. I think about their need for someone to just listen, to show empathy.

I think about my mom.

Shivering in anticipation
While dreading the reality
A daily battle between the
Skin
Stretched over quaking bones
And the
Bull’s eye
Placed over my dreams
Hope itches and burns, rouses and consumes
Resignation soothes and softens, numbing indiscriminately
How uncomfortable do I want to be?
The more I strive the more I fall
And as bruises coalesce and fester
I softly sink into resignation
And tell myself it’s self-care
Discomfort makes me strong
But feels unsustainable
Wake my soul?
Sleep my soul
March on toward new horizons knowing that
Drenching rain or blistering sun
I will feel fully and painfully
Or
Settle into a comfortable cove
Watch as moss covers my dreams and soothes the despair of hope
And abandon new horizons
Exhaustingly, each moment feels like a crossroads
And although I am surrounded
With strength and kindness and goodness
I start each path entirely alone

Beauty at a juncture
Seeps and saturates
Refusing to compartmentalize
Soaking life into dry sinews
My landscape is full of shadows
That cannot reach my aching hand
Futilely attempting to sway their course
I see the world in shades
Of sunrise and sunset
La vie en rose
Each hue carries a hello or goodbye
The two meanings disparate
Yet the colors indistinguishable
Goodbyes feel beautiful today
As I heal from eras where shadows
Itched and scratched
Raged and beated
With tangible ferocity
Hellos feel beautiful today
As I stare at the future
I have painstakingly gift-wrapped
Lately I have been lifting a corner
Of that tightly-bound gift
To glimpse inside
And it is as beautiful as I had hoped
Then I tuck the corner back down
And come home
Steeped in sunrise
Rejoicing in sunset
Anticipating my next glimpse at the gift
The shadows watch me
And I glance at them from time to time
We are weary and wary and worried
But it’s hard to always remember
The agony of the shadows
At sunrise and sunset

I held my grandmother’s arm
to steady her
as she wandered through the aisles of the outlet store
proudly picking out
clothes in smaller sizes.

But her weight loss was not a sign
of health, vitality, youth.
She was dying
of breast cancer.

I had seen the PET scan with its bright spots of metastatic disease everywhere —
bones, liver, lungs, brain.
I had seen the Kaplan-Meier survival curves
projected on big overhead screens
in large, dark lecture halls
– rational, numerical data, devoid of human suffering.
I had covered her nearly bald head with scarves
and emptied the chamber pot next to her bed
when she was too weak
to make it to the bathroom at night.

I knew this weight loss meant
the cancer was consuming
all the nutrients and energy
she needed to live
and chemo, with its accompanying nausea,
made it nearly impossible for her to replete this energy deficit.

I knew she was dying

As she scrutinized button-downs,
I steadied her, looking on
with a mixture of respect and embarrassment,
surprise and guilt and heartbreak.
I couldn’t blame her; I didn’t judge her
for the pride she felt at finally
shrinking her body.

I was well acquainted
with that aching,
longing-to-be-smaller-
body-too-big-never-good-enough-
feeling.

The first time someone told me I was fat,
I was eight.
The shame and humiliation I felt
drove me away from my beloved leggings
and into the dreaded stiff, thick fabric of jeans.

This was my first lesson in dressing my body not for myself, but for others.

The first time I counted calories I was 12.
I hid my sweaty middle school body in oversized hoodies
that I refused to take off no matter how hot I got.

By the time I reached medical school, I had engaged in a spectrum of disordered eating behaviors,
had internalized all the stereotypes (like a good little fat girl)
“lazy, weak-willed, uninformed, no-self-control”
and had learned to blame myself for others’ unkindness
people would treat me better when I was better (thinner), I told myself
(an irrational reclamation of control)

So, when the nutrition education came with a healthy side of fat-phobia
and dietary log assignments brought back destructive thought patterns
and fat jokes about “double deuces” and “Utah Units”
came over microphones from the mouths of professors

I knew how to endure. How to avoid scrutiny over my eating and my body
how to shrink myself
to package my personality for maximum tolerability
to make up for my physical intolerability
how to turn all the of hurt and frustration and feelings of injustice
inward – how to hate myself
so no one else could hurt me like I hurt me – how to protect myself

Now, in my third year, I’m continually meeting new residents, attendings, and patients
who have just moments to size me up
and decide if they find me worthy or wanting.
I have no way of knowing for sure how their unconscious biases impact these evaluations of me

I also see first-hand, how
the system of medicine (drenched in the cultural narratives
which hurt me so deeply)
harms patients every day
I’m feeling
inspired
to unlearn and relearn the stories
I know about health and size and weight.

I’m discovering small ways to let my personality shine
and finding, in the process,
that I am done
allowing others to dictate my worth
to shame me into shrinking, hiding

I alone define my worthiness
and I say, “I am worthy.”

worthy of leggings
and clothes that fit
worthy of mac-and-cheese
and dessert and love
worthy of taking up space
and of being heard
worthy of shedding the burden of others’ opinions
and feeling that weight lift off my shoulders
worthy of an MD behind my name.

My grandmother died last year, on hospice at home in her bed
She was feisty and funny,
and a little high maintenance – the way only the best people are
a teacher to the end
and absolutely worthy of taking up space,
worthy of acceptance and love.

I met a man with death in his throat.
He had to talk around it, raspy and soft.
Words twisted around half a tongue.

He had just come back from the mainland
where they had tried to kill it with radiation.
He had lain next to another veteran
and they had painfully whispered to each other
how much more frightening this was than war.

Yet still, his death was there
like an invisible fist.
Each word, each breath, squeezing past it
measuring out the remainder of his life
a mouthful at a time.

He knew, yet he was calm.
This wasn’t so bad, he said.
It was just waiting, looking at the horizon for the dawn.
It didn’t scare him now.

How mundane it was
Living your life
Letting in the dogs
Weeding the garden

How regular it became
Heading to appointments
Talking about treatments
Accessing your port

How precious it was
To go on that trip
To see that graduation
To have some time

How profound it became
To visit with your friends
To hug your child
To live your life