Infertility 

Ellis Island hospital

Graciously bestowing 
You spilled your precious seed
Upon my barren ground
Ignorant and unknowing
An unfulfilled wanton need
Your attempt at marking 
A territory unfound
Traversing the open sea

The ownership unclaimed
My body left untamed
Believing you were deceived
I’m naked beneath the gown
Empty loss echoes down 
Long abandoned corridors
Infertility finally decreed
By the sterile orators 

Devoid of progeny 
The solemn sodomy
Repeats itself again
Another painful bleed
An unwelcome visitor
Testifing silently
Before the Inquisitor
Sounding the final amen

A viscous self loathing
Clogs the rusted plumbing
Magnified through your eyes
Value is forever drowned
Held down by a flood of lies
I’m merely something to breed
A conduit for birthing
Your immortality 

With a Prayer

St. Patrick's Cathedral in New York City

I have prayed out loud with a few patients over the years at their request. I will admit, however, that I am personally very uncomfortable with public displays of my faith. I am not sure my prayers carry the weight and power that some people believe that they should. I feel somewhat hypocritical for that reason, as if I am selling a faulty product. 

That being said, I do pray privately for patients on a regular basis:

Please, God, protect my patients from my mistakes. Help your love for them to show through me…

When I pray for others, do I believe I am swaying God in any way? Not really. Prayer is not so much about others as it is about me, a sort of mindfulness. I need a reminder that I am a fallible human being and that I must demonstrate compassion to those who are vulnerable. I struggle with that from time to time, just like the next person. 

I could write a book on the various things people do to bargain with their God when they are desperate and in that respect I am just like them. I have my own rituals and my superstitions, my own pleading bargains that I have made. Some may mock me for that. 

Faith, though, keeps me sane. 

And that is good.

Ruined

Ruins of hospital on Ellis Island

He came with her to all of her doctor’s appointments, more than an observer he was involved, concerned, present. He came off as her protector. I thought we were on the same team.

The alcohol was getting worse, though. So was her liver failure.

“Who buys all of the beer she drinks?”

“I do,” she spoke up. “And he does.” 

I glanced over at him.

“Sometimes she makes me.”

“Makes you how exactly?”

“She can get really ugly.” He looked away sheepishly, unable to meet my eye.

“You mean to tell me that all of this time that she has been going to her liver specialist appointments, all of this time that we have been talking about how she needs a complete and immediate cessation of alcohol, all of this time that you have sat in that chair and nodded your head in agreement, you have actually been providing her with the substance that is killing her?”

I wanted to scream at him. What the hell are you doing? Sabotaging her? Murdering her? WTH?

But I don’t know what their life together has been like. Is he the equivalent to a battered woman in an abusive relationship? 

I just don’t know.

So I suggest counseling, giving them contact information for treatment centers, and usher them out the door wondering all the while if I have somehow failed them both.

Fatherless

Rose window example, San Antonio

“Can you tell me anything about your father’s medical history?”

“No. I don’t know him.” He shrugged as if it was no big deal but his voice said otherwise. 

Next patient…. 

“What about your father’s medical history?”

She scrunched up her face. “I think he’s still alive? I don’t know for sure. I never knew him.”

Next patient…

“So your mother is alive and has diabetes. Do you know anything about your father?”

“I’m not in contact with him.” The disdain came across loud and clear in her voice. “I hope he’s dead.”

If fathers ever think they don’t matter, they should sit in my seat and listen to the pain they can generate even when they are not there.

What Is Left

Submarine hatch
“What are you doing to me?” he asked sharply. 

I shoved a pair of new pajamas into the drawer and closed it, turning around to face him.

He sat on the edge of the bed. A once tall and proud man, he was now withered and shrunken. His eyes accused me. Of what, he was no longer certain, but he was absolutely sure I was guilty.

He was right.

“This isn’t a cruise ship is it?” I shook my head. “I lost my wallet and haven’t got any money.” The anger in his voice was replaced by fear.

I patted his hand reassuringly. “It’s rehab, hon. You’ll be back home before you know it.” The lie burned my throat as I said it but it mollified him for the moment.

The roommate sat across the room watching our exchange silently from his wheelchair, wrapped in a plaid robe with white socks pulled up to his knees. His grizzly, stubbled face showed no sign of recognition or understanding but his eyes followed me suspiciously about the room. 

“I’ll see you tomorrow.” I bent low, kissing the wrinkled forehead, and squeezing his hand. He smiled weakly. 

I’d loved him. Once. 

Now someone else was living in this body of his. There was distance between us that stretched much father than the few inches apparent to the casual observer. I felt nothing for this interloper, but still there were social expectations that had to be met, guilt that must be assuaged.

How often must I visit him to keep from being ostracized by friends and family?

Somehow I deserved this, I had no doubt, but he did not.

I understood now, I realized, as I walked down the corridor for the hundredth time. This must have been how Prometheus felt.

A Discourse on Intercourse

Philadelphia building

“Doc, I just want her to have sex with me. I come home after working hard and I want to make love to my wife but she’s not interested.”

I went into my usual discussion about wooing and foreplay and questions about their relationship but I was getting nowhere fast. It always feels incredibly silly for me to be giving anyone marriage advice, as if I have everything figured out, but here I was. Again. 

“Wait. Don’t you work out of town all week?”

He shrugged. “Yeah. So?”

“Look, you and she have four kids under the age of eight and five out of seven days out of any given week she is a single parent also working a full time job. You come home Friday night and want to get busy when she is exhausted and really just wants to finally get some good sleep? That is not math that is going to add up.”

“Can’t you just give her a pill?”

“Uh, no.”

“Then can you tell her she needs to lose some weight? Start exercising?”

I looked over at her, sitting silently in the corner. She was not obese. She sure did tired. She rolled her eyes.

“Tell you what, here is the name and contact info for a good marriage counselor…”

Take Me Higher

Entrance to St. Peter's Basilica at the Vatican.
The young woman glanced down at the distinguished, gray haired gentleman propped up on pillows as she hung the bag of potassium from the IV pole at the head of the bed. 

He was more handsome in person than he appeared on TV, she decided.

“This might burn going in,” she murmured. “The computer says your level was a smidge too low.” They were piloting a new AI program that made treatment decisions instead of doctors. It was said to be more effective and more reliable, better outcomes.

The patient looked up at her from his newspaper and nodded, winking. “Thanks for the heads up.” A great wracking cough rattled through his chest at that moment, leaving him gasping for breath. He sat down the paper. There was his face on the front page in an article talking about his admission to this very hospital for pneumonia.

“That sounds… better?” It was a statement and a question. She looked at him hopefully.

“Oh, believe me, I do feel better than I did yesterday.” He spit out the great glob of yellow phlegm that had caught in his throat, then wiped his mouth.

“On the mend, then!” She smiled down at her VIP patient. Her shift was approaching its end and she felt some degree of melancholia about that. Rubbing elbows with the rich and famous was quite fun.

Illness was the great leveler, after all.

She couldn’t wait to tell her fiancé! 

And her mom. 

And her best friend. 

Technically she was not supposed to tell anyone about this fellow, privacy laws and all that, but how could she be expected to keep a secret like this? She had really met him, spoken to him, touched him. The part she would not tell anyone about was the number in her pocket. He had slipped it to her after telling her she was beautiful and that he would like to hook up sometime. She patted her scrubs absently to make sure the paper was still there. Not that she would ever take him up on it, mind you.

Power was sexy…. but phlegm? Not so much.

She walked out of the room and back to the nurses station where she charted her activities of the past hour or so in the EHR. She caught sight of the man’s wife getting off an elevator and she found herself watching with envy. The woman was beautiful in a way she herself could never hope to be. His wife walked purposefully, a blue coat draped elegantly over her arm, a slight smile curled on her lips. No one at the hospital had ever seen her smile before. They were all warned to stay out of her way.

He must have called to tell her he was feeling better.

The nurse glanced back at the computer screen. There was a new order for another six bags of potassium for the fellow in room 432. 

How odd.

A quick check of the blood test results reassured her. His potassium level was indeed very low.

She checked her watch. It would be another 30 minutes before she could hang the next one. The next shift would be kept busy, that was for sure.

*********************************

The papers and news stations all shouted about his death. Across every front page. Leading every news program.

He was dead.

She couldn’t believe it. How? He was getting better.

Then fear. 

Did she do something wrong?

*********************************

The voice on the other line spoke a greeting in Russian. 

“It is done?” she asked.

“Da,” the voice said gruffly then hung up.

She smiled to herself as she dropped the burner phone into the crackling fire and poured herself a glass of champagne.

Yes. Of course it was done. A simple hacking right under their noses and no one would ever know. Cardiac arrest from a potassium overdose. In the hospital. They would do everything possible to keep it hidden if it were discovered. No one wants to be the hospital that killed someone like him…

It was a beautiful, elegant thing.

There would be no other women. 

Wavering

Boy making ripples in water of pond with a stick

Last week a physician shadowed me to see if there is anything I or my staff can do differently with my work flow with this new EHR. I was looking forward to having a forum to vent my complaints with the system and hopefully to have a way to fix it but nervous at the same time, not knowing what to expect, worried that they would have suggestions that would make me look a fool.

The physician who happened to come was one that had a hand in writing some of the new EHR templates. I was so disappointed in those templates that between you and me I actually cried in frustration in the first few weeks of our changeover. How could we be expected to do what we needed to do when these were the tools we were given to do it with? I told him that I did not like the templates, that I thought they S-U-C-K-E-D. 

Yes, I used the word sucked and I cringe even now at the recollection. With that one word I dismissed all of the considerable time and effort he had poured into those templates. 

Have you ever been so frustrated and nervous that unreasonable things just flow out of your mouth? 

Of course you have. 

Ever been on the receiving end of someone else’s frustration, as they vented like that? 

Sure you have…

At times, when I feel passionately about something, my filter just ups and disappears. After listening to him tell me that I should hire a staff member to approve or reject all of my refills instead of doing it myself, after having him say that my desire to take and enter my own past medical and surgical histories was a waste of time, after being lectured that writing a narrative history of present illness was silly that I should be clicking buttons instead… I was no longer really hearing his words to me or my own responses back to him. 

But I LIKE doing those things! Interacting with my patients is what makes medicine fun and rewarding for me.

It was not until days later that a realization hit me. He believes this stuff just as passionately as I believe that he is wrong. My response was not just unprofessional, it was mean. I try to have compassion and respect for all of my patients, even the difficult ones, but where was my compassion for him?

You need to be flexible. Medicine isn’t what it used to be. You have to adapt.

I don’t want him to be right. 

I hate that he might be right. 

And so I have spent this past week after reading his write up of our interaction licking my wounds, pondering the next step. What do I do from here?

The first thing, I believe, is to apologize. I don’t know that it will matter to him, but I need to apologize for me. I don’t want to be *that* person, the one who believes their rude behavior is justified.

And then? What then?

There is the question. 

Imitation

paor of dead flowers leaning on each other
His guilt always took the form of diamonds.

This was how she knew when he had been with another woman. The next morning there would be a sparkling apology waiting next to her coffee cup. 

I prefer words.

There was a vast collection now, a fortune in fact, lining the velvet boxes stacked in her custom designed closet next to the designer purses and dresses.

She never, ever wore the jewelry. To do so would be to acknowledge, to give permission to, his infidelity… something she swore she would never do.

So day after day, week after week, year after year, she waited while her hatred grew. She had no family, no children, no skills, no education… no independent finances. Thus, she endured his touch, biding her time. The trophy wife who was no longer a trophy.

Finally, the day came. 

Heart pounding, she loaded all of his guilt up into two large suitcases and took them downtown to a jeweler for appraisal.

It made her nervous carrying that much “money” in public. She glanced around furtively as she lifted the suitcases out of the trunk of her sports car and during the short trek across the parking lot, sighing in relief as she stepped through the door.

The young woman at the counter stared at her suspiciously when she explained what she needed. 

You are still pretty. Just wait. The 40’s will come for you, too, and then you will understand…

Anticipating a life of luxury from the proceeds, she fidgeted anxiously as she waited.

The gray haired man in the back had deep creases in his face. He sat hunched over a workbench, examining each piece carefully in turn while squinting through his jeweler’s loupe. Sometimes he would glance up at her before picking up another item. 

When he had examined each one, he bundled everything back into the suitcases almost carelessly and brought them back out to her.

She felt a horror and dread rise up from within, even before he spoke. He held pity in his eyes, as if he understood why she was really there but knew some other terrible secret.

He waited a moment, then spoke.

“Those are not real diamonds at all….”