What happens to a dream burned out?

What happens to a dream burned out?

Does it flop helpless like a gasping trout?

Does it strike you like an open fist?

Or does it vanish like the morning mist?
–missed, you were missed at her party–
Part, part of me wishes I remembered why
–why don’t you call? We want to know how you’re doing–
Doing, what am I doing, playing at God
–God, you look terrible. Are you ok?–
Ok, one more day, come on, come on.

Paper Corpses

Tell us your life story.

Five short words smile brightly, innocently. What pieces of me do you want? I can hand them to you, bloody and dripping. You can fondle my pain, admire my jagged edges. No? Too personal? Take my mummified pieces, dried, analyzed, separated from everything that gave them purpose.

Ah, yes, you say. This represents her. This explains her. This we understand.

How can you claim to see me through the processed, pulped, revised remains you hold?

You aren’t asking for a living story. You’re asking for a paper corpse. Simple, unchanging, undead.

Oh, I’m sorry, 250 words or less?

I’ll remove another piece of me.

Politics

He fits in my palm.
It’s been about 20 minutes
Since he was coaxed from the
Baby house by the surgeon
But only 5 minutes of being alive.
(Those first 15 minutes, life was evasive.)

I blink at him
Still wishing I could swap
My heart rhythm for his
Both for his sake and mine.
In this moment I flail, I sputter,
Ache for a calm largo.
He doesn’t need a semblance of calm.
I blink at him
Take my allegro! Step it up!
Fight your battles like a man!
(But he has been. For so long.)

He blinks at me
Eyes opening for the first time
Assaulted by the light
Too blurred to see the
Face of the assailant who
Assaulted his chest.
Despite the deceit of the cardiac power grid
And his tiny form
It was the recoil, the bounce back
The integrity of the ribcage
True grit of neonatal cartilage
That first told me
He is old enough.

He sits in my palm.
So small
Yet he had already reached his time
to vacate the office
Probably cursing term limits
Like other local politicians
Holding on to the seats until forced
By customary convention
Or outside observers.
He was indeed
Braced against the actual seat
In all his smallness
Wedged in an even smaller place.

The place.
Cephalopelvic disproportion.
One way of saying
Too young, too stunted, too hungry
Suits declare such a place developing,
Conflate growing pains and labor pains.
If only structural adjustment programs
Could pause, take a breath,
Then loan a breath.

He blinks again.
Wrinkled and wise
To the politics of size.
So small.
Politics of place.
Even smaller.
Except now he’s in my open hand.
Perched over my heart line and life line.
Winking and wide-eyed.
Politics of age.
Somehow both too young
And old enough.
Politics of life.
15 minutes. 5 minutes.
Each heart beat – no flip of a coin,
A vote cast.

Terry

Students
Gathered around your bed we prod and we poke
Lying still – bare and exposed before strangers.
We listen to a worn heart and muffled lungs.
We comment on a swollen belly and two cold legs.

Somehow, we don’t consider your eyes.

We are here to see you, but we don’t stop and see you.

Self Awareness

The moment I first saw your heartbeat-
white lines progressing across the dark screen,
competing with echoes of the past:
Better not if you want a career!
You’ll loose your edge!
Don’t talk about family if you want the job!
now crashing across your amorphous shape
and drowning in the vast depths of human experience-
Is the moment I first saw myself.

A Touch of Healing

H&P

CC: “complaint”

HPI:
“Fifteen minutes is all that they could spare
Clinical touch, a sacred tradition
They did not touch me. Did they even care?

For years I have worked up the trust to share
To be in this vulnerable position
Fifteen minutes is all that they could spare

Sleepless nights, I have endured this nightmare
A ritual that deepens our connection
They did not touch me. Did they even care?

My pain runs deep, I can no longer bare
The stethoscope, they could use to listen
Fifteen minutes is all that they could spare

I have lost all hope that I will repair
No hope to overcome this condition
They did not touch me. Did they even care?

Every night this pain is in my prayers
The answer cannot be this physician
Fifteen minutes is all that they could spare
They did not touch me. Did they even care?”

Physical Exam:
Gen: CUT & PASTE
HEENT: CUT & PASTE
Neck: CUT & PASTE
Cardiac: CUT & PASTE
Lungs: CUT & PASTE
Abdomen: CUT & PASTE
MSK: CUT & PASTE
Neuro: CUT & PASTE

PMH: CUT & PASTE
PSH: CUT & PASTE
Allergies: CUT & PASTE
Medications: CUT & PASTE
Social History: CUT & PASTE
Family Hx: CUT & PASTE
Review of Symptoms: CUT & PASTE

Assessment/Plan: CUT & PASTE.
add ibuprofen.

 


Text arrangement viewable in PDF

Sherry’s Story

I’ve just returned from the memorial service with my son Otto; he had begun to scream during “Amazing Grace”, when thankfully the widow offered to quiet him. He buried himself happily on the widow’s oceanic chest, rocking slowly like a drunken sailor adrift on a sea of Jell-O.
This was the first post mortem ceremony I’ve gone to for any of my patients. I felt compelled to stand up and remember the deceased, but kept thinking about his wife, who would soon become my patient. I mumbled something about physicians learning from their patients, and how this family showed me the utility of humor at the most difficult times. (On arriving at the home to pronounce the husband dead, his wife kissed her husband goodbye with “You’re in heaven with the angels now, or in hell with the rest of our friends!” She gave up trying to close the stiffening mouth, remarking, “Oh well, he never kept it shut when he was alive”. ) As we gave him a clean diaper before the mortician came by, she lamented to her sons that “little Willie would never rise again.”
The things I learned from Sherry I couldn’t really say at the service. Her confidence in me, I like to think, came from taking this very funny woman seriously. She phoned me at home one day as I lay stuck to my couch, on bed rest in the 6th month of pregnancy. “Doctor Bell, don’t go out in your car for any reason today!” Denied my daily peccadillo, I asked her why she trusted her premonitions.
“My first premonition was when I was 5 years old,” she said. “My daddy was going out to hunt for the sheep herders food, and I begged him not to go! I couldn’t say why, and he couldn’t stay home. I went along with him, and before long, he tripped and shot himself in the head with his gun. I just sat there with his head bleeding in my lap and stroked his hair. It must have been hours later when my mom came up the path, furious! She hollered ‘Sherry! What have you done!’
Sherry went on describing the next year of her life, beginning with only silence in response to her mothers accusation, and continuing in mute acceptance as she missed first grade, unable to utter a word. Her father’s duty to hunt became the mother’s, and the cooking fell to Sherry. “The men would take the burnt biscuits and pocket them to spare my feelings. They were so sweet.” I wondered what it looked like, the 5 year old yanking a roast from the oven, sneaking hunks of meat and shoving them into the mouth out of which nothing came. Her weight began to swell to the gargantuan proportion of her sixth decade when I met her.
I felt sort of speechless myself. I lay there staring at my belly. Who could have imagined the import of someone else’s obesity? When Sherry became my patient, the job of helping her lose weight was out of the question. Her husband married her right out of a waitress job when she was near 250 pounds and 20 years old. (Her husband to be was 60.) He put her in the saddle and she rode the range beside him. Shortly after the honeymoon, a storm hit while they rode. Sherry’s husband saw her hit by lightning and thrown from the horse. He attempted mouth to mouth on her stilled bulk, but gave up and walked away. Turning around, thinking again to try, he hit his fist on her chest and she sat up! Sherry said that she found herself pregnant immediately after that, and deaf in one ear. (I have wondered what the trajectory of a celestial seed is…Must the tympanic membrane be pierced before alighting in the womb?) I became familiar with that problem ear and must have treated it twice a year for one disorder or another.
There was a day when I felt close to this mystery of the husband’s manhood. I went to visit him at home, my habit since the old man had become so stiff from his Parkinson’s that it was impossible to get him into a chair. I got to the house around 4pm; the sun beat into the westfacing window over his bed. Sherry had made her bed beside his on a twin bed. Her foam mattress hung over the box spring in dangerous fashion, and it looked like a melting chocolate bar. The adjacent bed reminded me of frozen white bread with a popsicle man perched on top.
He looked over at Otto, then just a newborn, and he spoke for the first time in many weeks. “What’ll you take for him?” he said. The real surprise of his nature came out when I leaned over the bed to put my stethoscope on his rasping chest. Unseen, he managed to ratchet his arm with cupped hand toward my bottom, and simply pat it. Sherry was hysterical with laughter at the patting, and described his habit of grabbing her breast as she changed his diaper. There were few words or actions ever again in Hayden’s life, which ended weeks later.
Sherry herself wasn’t around much longer, either. Within a year of her husband’s death, she had grown too large to support her own weight. She languished in bed, where even several nursing home assistants at once struggled to perform their orders to turn her every 2 hours.
The mystery of Sherry’s size was a complicated story that I have come back to whenever taking a history that could otherwise be quickly summed up as tale of simple overeating. During her life, Sherry had taken her job seriously: nourishing herself as well as others

It All Depends

I cannot for the life of me figure out or pretend to know what the clerk at Smith’s was thinking. I was cleanly, even nattily dressed at 8 a.m., a colored T-shirt underneath a pressed Façonable denim button-down, tan Banana Republic Gavin (“relaxed fit, lower waistline”) pants, National Geographic suede slip-ons and blue French socks with an upside down question mark. Sure I have gray, but not white, hair and even had been nursing a red apple on the right side of my nose as a remnant of youth. Maybe it was my focused, intent expression.

I had a simple task: to buy some newborn-sized diapers—which, as a pediatrician, are a necessity at my office. As Smith’s stores go, this one is massive, and I hate wasting time wandering while trying to shop.

“Excuse me. Could you please tell me where the diapers are?” I asked the first sales clerk I encountered.

“Disposable?” she asked. I thought this an unusual question.

“Yeah.”

“Right back there on the north wall past the health and beauty section,” she directed me. I headed off.

The north wall looked distant and wrong. The idea of going through the “health and beauty section” did not seem right. As I drew close, I noticed Tampax and sanitary pads and felt even more disquieted. Looking down the wall, I was unable to recognize anything that looked remotely like newborn diapers. As I moved along the display, I suddenly felt weak and mortified when my eyes settled upon the product she thought I had asked for: Depends. Shelves of them. I began hyperventilating and looking for the nearest store clerk.

There she was, around the corner, stocking the condom shelf.

“Where are the newborn diapers?” I asked, realizing that perhaps my initial question had not been specific enough.

Without hesitation she said, “Back on aisle 10 near the baby foods.”

“Thanks a lot,” I said with relief.

I found what I was looking for, and rather than confront the store clerk who sent me in search of Depends, I checked myself out at one of those new self-service registers so common now in large grocery stores. I felt at once mortified, angry, incredulous and the butt of someone’s cosmic joke. It was like the opposite of being carded at a bar. I had been profiled by an ageist.

For the next few days, I considered revisiting the site of the embarrassment. Even though I don’t consider myself that much of a scientist, sometimes you need reproducible results to believe something is true. So three days later, I ventured out to try my experiment. The first person I saw was at an information desk.

“Where are the diapers?” I asked.

Without looking at me, he said, “Aisle 10, where the baby diapers are.”

But it did not count; I needed someone to look me in the face and answer. I found a clerk stocking oranges.

“Where are the diapers?” I repeated.

She looked at me, furrowed her brow and said, “Aisle 10 I think.”

That was better but not good enough. I wanted to ask someone geographically closer to the Depends section. By the time I found the proper clerk, I had begun to feel like Larry David in a real-life episode of Curb Your Enthusiasm. She was standing five feet from the Wall of Depends.

“Where are your diapers?” I asked.

She looked me up and down and then straight in the eye without blinking and without a doubt in her voice and said, “Right over there in aisle 10.”

Age, like beauty, is in the eye of the beholder.

 

 

Years later, at age 76, and a victim of polyuria, buying Depends is not only a necessity; it is a purchase I can buy without embarrassment. It is something I can be proud of, a sign of both physical and spiritual maturation.