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5.1

the Examined

Life

A Literary Journal of the Carver College of Medicine


EDITORIAL BOARD

Bruce P. Brown, MD, Editor-in-Chief Jason T. Lewis, MFA, Managing Editor Carol E.H. Scott-Conner, MD, PhD, Non-fiction Editor Hilary Mosher, MD, MFA, Poetry Editor Mary Helen Stefaniak, MFA, Fiction Editor Amy Margolis, MFA, Editorial Consultant Diane DeBok, MA, MFA, Reader Roberta Gates, MFA, Reader Ting Gou, Reader Rachel Ellis Hammer, Reader Loreen Herwaldt, MD, Reader Zachery Hickman, MFA, Reader Catherine Kasper, MA, PhD, Reader Brian Olshansky, MD, Reader Ann Rushton, BA, Reader Yolanda Rodriguez Villalvazo, MD, MPH, Reader Lindsay Vella, Reader Jennifer Stern, Reader Matthew Steele, Designer, Cover Artist Margaret LeMay, Copy Editor David Etler, Administrative Assistant The Examined Life Journal is published by The University of Iowa Carver College of Medicine in Iowa City, Iowa. Copyright © 2016 Roy J. and Lucille A. Carver College of Medicine Writing and Humanities Program; 1193 MERF, Iowa City, IA 52242-2600


Vol. 5, No. 1 | FALL 2016 university of iowa carver college of medicine iowa city, iowa THEEXAMINEDLIFEJOURNAL.COM


Foreword FALL 2016

To all those who have contributed, supported, and subscribed to The Journal, and to the many wonderful writers who offered work we could not make room for, we thank you. In this issue we find stories, essays, and poems to suit many tastes. A geneticist takes us back fifteen hundred years to the exact misstep in DNA sequencing on chromosome 15 that creates the characteristic funduscopic red spot and devastating neuronal injury in a Tay-Sachs patient. While a diabetic IT guy is saving an elderly patient from a long fall down a hospital stairwell, through slow-motion internal dialogue, we not only learn to sympathize with the universal plights of IT guys, but how to deal with hypoglycemic attacks. For those interested in lively funeral home conversation, we learn that dad is dead. However, his legacy of living like a toxic whirlwind lives on in his snarky adult children who try to agree on a coffin that suits him. Though the dead man’s wife is available only by phone, she adds to the chaos with a strange, last minute stipulation. Poetry takes us in various guises, to various bedsides, where care and love are revealed as unflinching and sharply observant forces: as a daughterin-law stays present at the end of life, as a nurse struggles with what is not possible, and what is. Many of these poems recount struggle, but are alight with humor and in their diverse ways elucidate, enact and honor speaking, even when a listener may be unable to hear.

The Examined Life Journal Editors

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the Examined Life Journal VOL. 5; ISSUE 1

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Foreword

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Margaret Nowaczyk, Almost Perfect ( N O N F I C T I O N ) Noah Rosenberg, Liquid Fear ( N O N F I C T I O N ) Lori Levy, Black Toes ( P O E T RY ) Christopher Duggan, The Snowman ( N O N F I C T I O N ) B. W. Beardsley, Her Constant Familiar ( P O E T RY ) Ashley K. Warren, Code Gray ( F I C T I O N ) Sean Higgins, Groundhogs and Moles ( N O N F I C T I O N ) Yuko Taniguchi, Working Together —Tohoku, 2011 ( P O E T RY ) Rebecca Myers, Guardians at the Gate ( N O N F I C T I O N ) Terry Minchow-Proffitt, Living Water ( P O E T RY ) Madeleine Beckman, Not the Blue Satin ( N O N F I C T I O N ) Jonna Higgins-Freese, Practice ( P O E T RY ) Jonna Higgins-Freese, No Better ( P O E T RY ) Rona Altrows, Vermilion Pee ( N O N F I C T I O N ) Maia Thomas, The Baby Tree ( N O N F I C T I O N ) Monique Kluczykowski, Surviving, Much Less Recovery (NO N F I C T I O N ) Imee Cuison, Nurse Imelda ( N O N F I C T I O N )

5 7 9 19 23 35 43 45 55 59 69 73 75 79 83 89

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H. K. Hummel, Scintigraphy ( P O E T RY ) Victoria Barycz, The Power of M ( N O N F I C T I O N ) Judith Q. Iacuzzi Spite and Malice ( F I C T I O N ) Erik Norbie, Life Drawing ( P O E T RY ) Claudia Reder, Writing Group, Assisted Living ( P O E T RY ) Iris Graville, Singed ( N O N F I C T I O N ) Justin List, Waking Up Thankful ( N O N F I C T I O N ) Joseph Livingston, Man-in-the-Pan ( N O N F I C T I O N ) Jenny Sturgill, Special Occasions ( N O N F I C T I O N ) Deborah Morris, Rectal Exam, Circa 1993 ( N O N F I C T I O N ) Claudia Reder, Eighteen Seconds ( P O E T RY ) Tony Gloeggler, All the Days of the World ( P O E T RY ) Editorial Board Editorial Readers Contributors

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NONF I C T IO N

Almost Perfect MARGARET NOWACZYK

“Tell me,” Meghan says looking up from Adèle’s eyes into mine. “Tell me what it means.” She brushes the yellow curls from Adèle’s forehead and hugs her tighter, nuzzling her face in Adèle’s neck. As the rag doll head flops back Meghan supports it with her hand. George, Adèle’s father, his arm around his wife, closes his eyes. I wonder what he is thinking. And so it begins. Again. The short, pert chromosome 15 unfurls itself, and shakes out its folds and kinks. It and its forty-five cohorts are getting ready for their big time: ensuring survival of their genes for another thirty years or so. Duplication for the next generation. The sequence in every one of them has to be copied perfectly to carry the genetic blueprint to build a healthy, robust body. No errors allowed: the DNA repair machinery will check and recheck the copies, running back and forth along the nascent strands, scanning for mistakes. In this case, however, about thirteen hundred years ago, amidst the ruins of the Roman Empire, one particular DNA polymerase trips, stutters, and spits out a four-nucleotide sequence twice. The ligase whooshes past and stitches the duplicated fragment into a short exon of a smallish gene tucked away two-thirds down the chromosome. The repair machinery misses the insertion, as tiny as it is and easy to overlook. The sperm with the faulty gene survives, its beating tail propelling it happily up the uterus and the fallopian tube and through the cell membrane of the egg rolling down to meet it; it beats out millions of others as it wiggles through and fertilizes the egg. The round zygote divides and divides forming a lovely thriving embryo, the error reproduced in all the cells of the healthy girl-fetus. Her own eggs begin their division well before she’s born, half of them tainted with the insertion. The affected gene codes for a crucial cellular clean-up protein which mops up and breaks down used fats and lipids. Without it, when there are two 1


THE EXAMINED LIFE JOURNAL | MARGARET NOWACZYK

copies of the affected gene and no healthy ones, cells choke up on their waste and die, full of abnormal metabolites. The neurons are affected the earliest: the brain­—swollen and fatty, fails in its attempts at normal development. This girl is born screaming; feisty, she wriggles in the grip of the midwife. Her cells have one copy of the altered gene; she’ll be fine because the other copy suffices to do all the work. She survives without any mishaps so common in those days: she encounters no mumps virus to render her sterile, no lethal plague bacteria; she doesn’t fall into a well, she is not kicked in the head by a horse. She grows up and marries a young man with soulful brown eyes, chosen for her by her parents. Half of her beautiful children­— curly-haired, pink-cheeked girls and tall, broad-shouldered boys – carry the altered gene. A quarter of her grandchildren do as well. By now she and her Jewish brethren have reached the Rhineland on their northward migration from the foothills of the Alps. She has many grandchildren, her grandchildren have many grandchildren, her grandchildren’s grandchildren have many more again. Some stay behind and become the Ashkenazim, “The Jews of Germany;” others move East, as far as Poland, where in the 14th century Casimir the Great grants them special privileges and protects them as “people of the king.” They prosper. They marry and multiply. But along their travels, in almost every generation, there are wailing mothers whose infants never smile, whose toddlers never toddle, and whose children die young­—deaf, blind and paralyzed, choking on their own saliva or starving to death because they cannot swallow; fathers who stop smiling as they lose son after son, and daughter after daughter. The couples who bury their children are the ones with a copy of the mutated gene each, the progeny of the Italian girl – the rouge gene’s mate needs to be mutated as well to wreck havoc in the developing brain. The couples’ other babies do well, but with time more and more of the girl’s descendants carry the killer gene and parents lose their children. And so it goes. The gene sneaks through seven centuries, hitching a quiet ride in the recesses of the genetic code, occasionally raising its ugly mutation in a conflation of sorrow and loss. Some of the girl’s descendants emigrate to the New World, but they cannot outrun the child-killer. For those who stay behind, the gene becomes the human smoke emanating from crematoria, killed instead of killing. And then it lies dormant for three more generations. Until one spring Tuesday morning in the beginning of the 21st century, in my office flooded by sunshine streaming through the windows, I look across my desk at seven-month-old Adèle with blue eyes with dark lashes 2


ALMOST PERFECT

curved back to the eyelids. She lies placidly in her mother’s arms, a Mona Lisa smile on her raspberry lips. She doesn’t wriggle, she doesn’t babble, she looks straight ahead without fixing on anything – a peaches-and-cream rag doll. Adèle has been referred for a genetic consultation because she does not reach for toys, does not hold her head up and has stopped cooing about a month ago. I can tell that Meghan knows that something is wrong: Adèle is her third child. George, Adèle’s tall and broad-chested father, his arm around Meghan’s shoulders, takes his eyes off Meghan only to look at me like a man without a future. When she was on the examining table, I asked Meghan to hold onto her as I reached for the ophthalmoscope to examine her eyes. “She might roll off the table,” I said. “If she rolled, I would jump up and cheer,” George said. The cherry-red spot with its milky halo at the back of her eye told me all there was to know: the past of Adèle’s people and her own short future. As my heart beat wildly I finished my examination, even though there really was no reason to – all I needed to know was in the back of her eye. Still, my impression needed to be confirmed by an ophthalmologist – I could chicken out and delay telling Meghan and George what I saw. That would be callow; you can’t cheat fate. I have seen it so many times and it never ceases to shock me. I know what I have to say and I want to delay saying it as long as I can. After we sit down, before I open my mouth, Meghan says: “It’s Tay-Sachs, isn’t is.” Her eyes wide open, pupils dilated, she doesn’t ask, she knows. George’s hand claws Meghan’s shoulder. I close my eyes and nod: “Yes.” Meghan gasps and incoherent vowels emanate from her open mouth. George tries to cover it with his hand, but Meghan shakes her head. He hugs her, instead, his arms around both his wife and daughter. Meghan squeezes Adèle to her chest and all three rock together. I want to turn away, to walk out of this office, run away. To not see this raw sorrow and pain. George looks at me, mute, his mouth a thin line, eyes glistening. “How?” he asks. “Meghan is not Jewish. How?” It never gets easier, it doesn’t stop hurting, and I have to do it again.

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