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EDITORIAL BOARD

Carol E.H. Scott-Conner, MD, PhD, Editor-in-Chief Jason T. Lewis, MFA, Managing Editor Bruce P. Brown, MD, 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 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 Matthew Steele, Designer Frances Cannon, Cover Artist Amy Mattson, Copy Editor David Etler, Administrative Assistant From the cover artist: All of my recent writing and art projects explore themes of illness and medicine. In a Japanese papermaking class, I was struck by the way that a drop of pigment or dye spread across the fibers of gompi, or mulberry paper. This spreading ink conjured a handful of images: drops of my grandmother’s blood on a napkin after her diabetic pinprick tests, and blood drops collected on filter paper. In researching this I came across dried blood spot sampling—tests where the blood spot’s edge is fuzzy and each spot has a unique shape. I concocted a pigment to imitate the color of blood from sumi ink (crimson), logwood dye, burnt umber, and cochineal dye, and carved anatomical imagery of capillaries or muscles into wood and printed them with ink.

The Examined Life Journal is published by The University of Iowa Carver College of Medicine in Iowa City, Iowa.

Copyright © 2015 Roy J. and Lucille A. Carver College of Medicine Writing and Humanities Program; 1193 MERF, Iowa City, IA 52242-2600

Vol. 4, No. 2 | FALL 2015 university of iowa carver college of medicine iowa city, iowa THEEXAMINEDLIFEJOURNAL.COM

Foreword FALL 2015

For this issue, we are honored to have Mary Helen Stefaniak as our guest fiction editor. Mary Helen is a graduate of the Iowa Writers’ Workshop. Her collection of short fiction, Self Storage and Other Stories, won the 1998 Wisconsin Library Association’s Banta Award. Her first novel, The Turk and My Mother, won the 2005 John Gardner Book Award, and her second novel, The Cailiffs of Baghdad, Georgia won the 2011 Anisfield-Wolf Book Award.

She currently teaches creative writing at Creighton University. We would also like to welcome our new readers to The Examined Life Journal staff.

In this issue, there are stories of patients who use humor to smooth the ragged edges that sometimes occur with medical care: A struggling writer forgives his bumbling family physician who repeatedly calls him by the wrong name. An aging gentleman likens his prostate workup to having his “potato poked.” In wry dialogue, we sit with a slightly paranoid psychiatrist as he is progressively trapped between his passivity and empathy for his patients’ problems and his wife’s admonitions to make more money; only freeing himself by making, perhaps, a fateful move. There is poetry that looks to the death of bees for clues to the origin of dementia. Here too are stories of struggle between the need to know and the need to step away, when a pediatric ICU nurse must allow a biopsy on an infant who is in the late stages of dying.

Thanks again to all our wonderful submitters, supporters and subscribers and welcome to our new staff.

Bruce P. Brown, MD Non-fiction Editor

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Foreword

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John O’Connor, Commodore Hairy ( N O N F I C T I O N ) Julie Goodale, Visiting Death ( N O N F I C T I O N ) Hannah Baggott, MS Relapse Treatment At Good Samaritan Clinic ( P O E T RY ) Hannah Baggott, Let’s Be Realistic ( P O E T RY ) Diane Kraynak, Science Project ( N O N F I C T I O N ) Jessica Barksdale, Not Once ( F I C T I O N ) Jonas Lee, Lost in Translation ( N O N F I C T I O N ) Carol Barrett, The Origins of Dementia ( P O E T RY ) Sandra Scofield, Life Cooking ( F I C T I O N ) Sadaf Qureshi, The Lionhearted ( N O N F I C T I O N ) Priscilla Mainardi, Going Home ( F I C T I O N ) David Allen Sullivan, Appetites ( P O E T RY ) David Allen Sullivan, Flight ( P O E T RY ) Angela M. Shupe, Remembering Lily ( F I C T I O N ) Arthur Plotnik, My Potato Poked ( N O N F I C T I O N ) Milton J. Bates, Facing Up ( P O E T RY ) Zach Jacobs, An Imprecise Science ( N O N F I C T I O N ) Anna Krem, not, October ( P O E T RY )

11 17 19 21 29 37 45 47 51 55 61 63 65 71 81 83 93

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95 107 117 125 133 135 149

Marlene Olin, The Summer of Magical Thinking ( F I C T I O N ) Raven Tolliver, Reality Check: On Working With a Guide Dog ( N O N F I C T I O N ) Thea Goodrich, Now as Ever, Seven Months On ( P O E T RY ) Eileen McGorry, The Novice ( N O N F I C T I O N ) Katy Giebenhain, Re-calibrating the CGM on a Bench in Kensington Gardens ( P O E T RY ) Katie Kress, Asylum ( N O N F I C T I O N ) Catharine Klatzker, Deathwatch ( N O N F I C T I O N )

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2015 Carol A. Bowman Writing Contest Winners

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First Place: Kaci Mccleary, Dandelions ( P O E T RY ) Second Place: Rachel Press-Goossen, On Following Instructions ( F I C T I O N ) Third Place: Alyse Marie Carlson, Brown Winter ( P O E T RY )

159 165 167 169 171

Editorial Board Editorial Readers Contributors

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NONF I C T IO N

Commodore Hairy JOHN O’CONNOR

It happened, as so much did back then, at the doctor’s office. I was quitting my job, again taking my chances among the uninsured, and needed a tuneup. Dormant illnesses tended to materialize during the uninsured stretches, I’d found, usually at a dinner party under the remorseless, Stockade lighting of some stranger’s bathroom. So the checkup was mostly preemptive, though I also had a specific issue I wanted addressed: a tender, garbanzo-sized lump that had appeared on the southerly edge of my anus. It bore distinctive hemorrhoidal qualities, namely a jalapeño-like burn when I toileted. But a gallery of other horrors had sprung to mind: anal fissure, folliculitis, perianal abscess, flesh-eating bacteria, cancerous polyp. If I’d learned anything in New York City, it was that there was no end to the Job-like misery I could expect to pop up at any moment.

In those years, my doctor, who I’ll call Dr. Albert, shepherded me through a lot of adversity. Every month or so presented a new opportunity to embarrass myself: leaky pipes, subcutaneous cysts, kaleidoscopic groinal rashes, STD scares, gravity-defying testicular retraction (as well as a corresponding, hobbling distension), something called a “varicocele”—like varicose veins in your balls—and once, out of the blue, yielding grand mal emotional collapse, that cruelest of masculine failures notable for an absence of physical pain while pitching the ego into a brush fire. And yet Dr. Albert never judged, at least not noticeably. He seemed to think it perfectly reasonable that I came to him every six weeks with vanishing testicles or chronic, explosive diarrhea. I knew that in his line of work he had staked a curatorial claim to unpleasantness. Still, I liked to think he was especially kind to me.

Which isn’t to say he was perfect. Although I’d been his patient for a decade, Dr. Albert had a strange habit of referring to me as Dave or Stan, and rarely by my actual name. Until this checkup, it hadn’t bothered me much. My memory is shaky too. I forget names, faces, addresses, whether 1

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I have a Y membership or have ever eaten foie gras. I even mark my own birthday on my calendar, just in case. So who was I to judge? Dr. Albert was a busy guy with hundreds of patients. Never mind that my first name— John—is a pretty easy one, or that it’s miles from Stan. After everything we’d been through, I let it slide. Dr. Albert had never let me down, not in a major way, and I knew he’d get a handle on this anal growth.

The day was terrifically cold, with a sky like a frozen puddle. New York was an open wound to me back then, so raw and obscene, a roaring and livid maw of space. I had grown up in the flat, dusty former celery capital of America—Kalamazoo, Michigan—and had never lived outside of my home state before I moved to Brooklyn at the end of the Clinton years. Inhabiting a squalid apartment at the edge of Park Slope—a kind of no man’s land whose sidewalks had not yet been colonized by pugs in turtlenecks and active wear—I worked as a gopher for a law firm, a job that required endless filing of documents at city courthouses. Each day, I’d take the subway to lower Manhattan or to the Grand Concourse in the Bronx; to Sutphin Boulevard in Jamaica, Queens; to Cadman Plaza in Brooklyn; and once even to the uncharted wilds of Richmond County Supreme Court on Staten Island, navigating a Kafkian legal bureaucracy and getting ruthlessly cut down to size by jaded court clerks. I loved to roam, to vanish and resurface through a hole in the ground, rumbling through the dark tunnels that coiled away and down like a flight of the soul into lighter, more hollow zones. They were my escape routes, in a way, from the known world to an obscure one, so intricately stitched together that they disclosed half-hidden patterns. I had little ambition beyond this orbit of sunup-to-sundown errand running. All I wanted was to indulge my new freedom and anonymity with a minimum of distraction. For years, I drifted under the teeming city, wrangling with court clerks and battling GI upheaval with a cocktail of Mylanta and Nestlé Raisinets.

Girlfriends came and went. There were a few brief collaborators in domestic bliss, but none that stuck. Directionless and alone, I embarked on a renewal plan. It was high time I got serious about writing. I’d written squat since graduate school. Now I’d really bear down, do the trench work, quit my job, uncork the torrent of shining prose bottled up inside of me, collect the lucrative book contracts and speaking engagements, and cruise the gulf stream of public praise and adulation owed a towering literary figure. I couldn’t afford to worry about health insurance. The future of my art hung in the balance.

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I arrived early at Dr. Albert’s on my lunch break, with designs on squeezing through my appointment with time to spare. I’d forgotten that’s not how things worked. The waiting room was a theater of chaos. Files were lost, appointments muddled, insurance cards mislaid, names mysteriously expunged from the sign-in sheet. The staff, guarded and unsmiling, used the front desk as a staging-ground for nightlife pursuits, gossiping and jabbing at cell phones, and poisoning the office with a spirit of mulish failure. I’d seen patients weep and curse and beat the walls with their fists, including one poor old lady whose hands reached up to cover her heart like a shield as she raked a file of nurses with savage eyes.

I signed in and took a seat. I read Time. I read People. I read Golf. Two and a half hours later, my lunch in shambles, I heard my name and was led to a windowless room, a kind of antechamber, at the end of a dark corridor.

Sliding onto the examination table, I took in the familiar surroundings. The shabby cabinetry, the scuffed laminate countertop, the jar of tongue depressors, the reflex hammer, the ophthalmoscope, the moth-eaten broom, the cracked plastic cushion of the exam table with the butcher paper stretched across it. On the walls were black-and-white photographs of dead and dying celebrities: Leonard Cohen, John Belushi, Keith Richards, William Burroughs, Hunter S. Thompson. Some were autographed. I’d often wondered whether any of these guys had been Dr. Albert’s patients, but I was always too distracted by the nature of my visits to remember to ask.

My last time here for instance, Dr. Albert had pinched my scrotum between his thumb and forefinger and rolled the curtains of skin like a cigarette, braiding my vein-work into a grisly skin-Twizzler. “Wormy balls” was how I’d described the problem to him, a spooling of the scrotal entrails, like angel hair pasta in the upper sacs—painless but alarming. I explained that my grandfather had died of prostate cancer. That he’d done chemo, gotten better, then sick again, and finally nixed an operation that might have saved him, but would have imperiled his love-making tackle. My father went nuts over that. But I was fourteen and Frederick’s of Hollywood had gained a powerful foothold in my life, so I thought I saw why that was something you’d decide. My grandfather, an Irishman who didn’t drink and an aspiring playwright who adored Seán O’Casey but considered the masterworks of Tony Scott sophomoric, died at Christmas. I remember in those last days his slackened cheeks and the folds of green-gray skin on his scalp, the stiff white hair like quills poking through.

“This worminess?” Dr. Albert had said in an accent that lay somewhere between the Volga and the Thames (he rolled his r’s in the Russian way and 3

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hammered his second-syllables like a member of Oasis), “is called a varicocele.” He’d pronounced it far-huh-cuh-zeal. “Enlarged veins. Quite normal.

Nothing to worry about.” Dr. Albert was an uncanny bearer of good news, rarely disappointing.

Another time, I’d had what looked like a wart on one of my testicles.

Domed and luminous with a milky, nauseating crest, it sparkled like a cathedral through a dense pubic forest. After a hasty inspection, Dr. Albert assured me it was only a large hair follicle. “It is nothing,” he’d said. “A peapod for the pubic hair stem.”

Part of what I liked about Dr. Albert was that he put things in layman’s terms. But his accent could lead to vernacular shortcomings. Once, when my cholesterol had inexplicably soared, Dr. Albert had suggested I eat “one less bacon per year,” without clarifying whether he meant one less slice of bacon or package of bacon per year. I had to figure it out on my own.

Dr. Albert finally appeared, smelling vaguely of almonds and mouthwash and shouldering a badly pilled cardigan. The sweater had been in rotation for years. A dampness had crept through at the pits. His slacks were in better shape, his loafers the burnished reptilian jade of city doctors. The man himself was short and heavy, with a nose like a tenderloin, a muscular five o’clock shadow, and a Radovan Karadžić-like bend to his brow that spoke hauntingly of gin and midnight firing squads. But Dr. Albert had his charms. He was a prolific chortler, for one, and an accomplished shoulder clapper. And in the face of dispiriting genital crises he displayed a stubborn optimism, rare in a general practitioner.

But for some reason, Dr. Albert had never shaken my hand, whether on account of germs or an occult sense of professionalism, I didn’t know. I did know, however, that his hands were freakishly soft and supple, because they’d probed every nook and cranny of my personal plumbing. I’d yearned to clasp one, to experience the full-bore, palm-to-palm magic, but the pleasure had eluded me.

Taking a seat, he leaned forward and hoisted his rheumy eyes to mine—his signal to proceed. As I explained the nature of my visit, Dr. Albert scribbled in a manila file folder, his hand cutting north and south in wild, Pollock-like slashes, choking a pink sheet with a livid animal scrawl.

The file was engorged with these sheets. A metal clasp winced against them.

Several pages spilled onto the countertop like biographical viscera. Again I felt grateful to Dr. Albert for his years of monkish empathy.

Unsurprisingly, he suspected the lump on my anus was nothing, but he wanted to check under the hood to be sure. Snapping on a pair of rub4

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ber gloves, he told me to drop my pants and assume the fetal position. I obliged, feeling the usual twinge of shame at my apishly hairy ass. Without a mulcher or heavy-duty brush clearing equipment, it’s a near-impenetrable thicket down there. But Dr. Albert sallied forth without complaint, parting the snarled, nettled copse and gripping his way from one patch of jungle to the next as expertly as that other physician-explorer, Dr. Livingstone.

He surfaced moments later to inform me in his phlegmatic, Lugosian drawl that the lump was not a cancerous polyp or flesh-eating bacteria, but rather a comedo, which to my ears sounded distinctly like commodore. As it happened, I’d just been dragged to the Stephen Sondheim musical, Pacific Overtures, about the nineteenth century American naval officer, Commodore Matthew C. Perry. Like all musicals, it was an abomination, but I’d found Perry to be an intriguing guy and read up on him. It turned out he was famous for opening feudal Japan to the West and suppressing the slave trade off of West Africa, and had once lived a few blocks from my apartment in Brooklyn. It dawned on me that Dr. Albert looked a lot like Perry: sunken, saddlebag eyes; sharp, upturned mouth; and prominent, eggplant nose. So it was only natural that, with Dr. Albert’s rubbered hands wedged in my shaggy buttocks, I should exclaim, “Commodore Hairy!”

Dr. Albert paused, an eyebrow audibly arched. Hooking my head over my shoulder, I explained how Perry, assisted by four warships anchored in Tokyo Bay, had forced the Tokugawa shogunate to sign a trade pact with the Fillmore administration, therein securing an endless supply of edamame to Manhattan delicatessens.

“I see,” said Dr. Albert, un-wedging himself. He took a solemn step back. There may have even been a throat clearing. “A comedo,” he soberly explained, “is a clogged hair follicle.” A blackhead, in other words.

“It is nothing,” he said.

“Oh,” I said, “That’s a relief.”

My relief was fleeting, as Dr. Albert announced he was going to pop the comedo—I was still hearing it as commodore—which would require some prying. Without ceremony, he stuck a fingertip inside of me and leveraged a thumb against the comedo on the outside (at least that’s what it felt like—it was hard to see from my vantage). It was unpleasant, to be sure, but far preferable to a prostate exam, when he plunges in to the third knuckle and scrambles around in there like a woodchuck. As strange as it sounds, having one of Dr. Albert’s chubby, latexed index fingers three-centimeters-deep in my anus, I almost felt lucky. He wormed and shimmied until he gained purchase on the comedo, then applied the gentlest squeeze. I didn’t even feel it pop.

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Dr. Albert exited stage left, presumably to freshen up, while I retrousered and swung my legs over the exam table, shifting the weight off my sore anus. Resting on the counter was the disemboweled file folder. I wanted to sneak a look, but I hesitated. Was it allowed? In a way it belonged to me, but it still felt like snooping. The door was ajar. Nurses breezed past.

I reached for the file. In that instant, the door swung open and a nurse hovered at the entrance, her eyes darting between the file and me. I snatched my hand back.

“Hello,” I said, casually.

She had a pale, delicate face. Blond hair coiled behind her ears and tumbled onto her chest, where her blouse was open a few buttons, revealing a patch of skin that shone like sand. Her nametag said “Anna.” Flashing a thin smile, she waltzed in, reaching over to flip the file shut, and without a word rolled up my sleeve and strapped a blood-pressure cuff onto my bicep, which suddenly looked very scrawny. She placed the diaphragm in the crook of my elbow and my veins swelled as her tiny fingers pumped the stiff, rubber bulb. While she silently counted off, I listened to her chest rise and fall.

Gazing at her neck, I noticed several moles clustered around her clavicle. I remember thinking she should have those checked out, because you never know with moles, when a blast of air shot from the sphygmomanometer.

“One-twenty over eighty,” she announced, un-cuffing me.

“Is that bad?”

“Not bad.”

“I’ve been cutting back on the bacon,” I offered.

She slipped the head of a stethoscope under my shirt, resting it coldly on my sternum. My heart burst out of my chest and ricocheted off a cabinet into the wastebasket, but Anna didn’t seem to notice. “Deep breath,” she said. The thinnest sliver of air escaped me. Then she jammed a tongue depressor into my mouth.

“Open wide,” she said, roughly tonsiling me. She drew and vialed my blood, probed my ear canals, and rinsed her hands before quietly vanishing. I sat there a moment collecting myself, ruffled and dazed. “I love you,” I whispered. Then I turned back to the file.

The very first item was a referral letter from a doctor’s office on Park Avenue. That’s odd, I thought. I didn’t recall having ever visited a Park Avenue doctor. Aside from the two years I’d been in graduate school, when I’d frequented the student health services, I’d only seen Dr. Albert. At least that was what I remembered. But confronted with my name on the imposing letterhead of an Upper East Side doctor, I suddenly wasn’t so 6

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sure. Skimming the letter, I came across some startling news: “Patient had scrotal lesions removed.”

Hmm. I didn’t remember ever having had scrotal lesions, whatever those were, let alone having had them removed. Granted, my memory is cheese, but you’d think I’d remember scrotal lesions. There had been a gruesome, splotchy rash once that had lingered for weeks, but its nexus had been the groinal rather than scrotal neighborhood, and it had cleared up after Dr. Albert suggested I switch laundry detergents. Scrotal lesions escaped me.

Like an amnesiac rediscovering his past, I read on, ignoring the feet sweeping past in the hall. Sweat boiled on my forehead. Blood thrummed in my ears. I felt like I was reading someone else’s diary, except that someone else was me.

“Patient had testicular sonogram.”

That sounded more familiar. One day in graduate school my balls had started aching and a nurse at health services sent me to New York-Presbyterian for a sonogram. I found myself thinking a lot about my grandfather during the exam. Cold waves of fear crashed over me as I reclined on the table, my feet in stirrups, a coarse, white towel covering my private and two corporals. Was this how it had started?

The procedure was performed by a large African-American woman with fleshy, callused elbows that I badly wanted to pumice. With a cunning intuition for testicular frailty, she massaged lubricant onto my balls and ran a metal ladle over them in figure eights. The ladle resembled an ice cream scooper and was connected to a machine with a screen on it like an ultrasound’s. I couldn’t see the screen, but I shuddered at the thought of my veiny, furry testicles crammed together on it like two monstrous sea anemones.

The ladle emitted heat that liquefied the gel. While the nurse spoke soothingly to me in her West Indian accent—never once lifting her eyes from the screen—the gel trickled between my buttocks. The procedure lasted about ten minutes. By the end, the gel had swamped my entire Speedo region. I had to sit through a lecture on Mrs. Dalloway with the stuff glued to me. When the results came back a week later, I was told that all was well, but to consider wearing tighter underwear when I jogged.

I quit the letter and started flipping through the file. Page after page of Dr. Albert’s inscrutable calligraphy sailed past. I found a form from New York-Presbyterian with my signature on it, and another form, sans signature, from St. Luke’s, a hospital I was certain I’d never visited. Other items were unmistakably mine: a photocopied health insurance card, documents with 7

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old addresses. I turned back to the letter: “Patient has swelling and discoloration around base of penis. Skin on shaft is mottled.”

This didn’t sound like me either. I must be losing my mind, I thought.

Could I have possibly forgotten scrotal lesions and a swollen and mottled penis? In the next paragraph I came to this whopper: “Patient is uncircumcised.”

Dr. Albert re-emerged from the shadows. I didn’t try to hide that I’d been poking through my file. “Doctor,” I said, “I couldn’t help but glance at my file here, and I think it might belong to someone else.”

He flinched. “Are you sure?”

“Well, I’ll admit that some of this sounds a lot like me, but it says I’m uncircumcised, and the last I checked I definitely was circumcised, unless I’m confused about what that means.”

To his credit, Dr. Albert didn’t insist on seeing for himself whether I was circumcised. He withdrew with the file. I soon heard bickering at the front desk, Anna’s voice rising, the clap of papers hitting the floor and scattering. Dr. Albert returned looking stricken. He explained that he had another patient with a name nearly identical to mine—the difference of a consonant and a vowel—and that the contents of our files had somehow gotten mixed together. We’d been patients for roughly the same amount of time and Dr. Albert didn’t know how long the mix-up had been going on, but perhaps for years.

This took a minute to sink in. If I understood him correctly, the man who had ministered to my reproductive machinery for a decade—attending to much controversy therein and assuring me that everything was in working order—had just revealed that he may or may not have been referring to somebody else’s medical records all along.

While I was relieved to learn I wasn’t the patient described in that letter, I thought of all the favorable diagnoses Dr. Albert had made on my behalf and wondered whether he’d been right about any of them. Something inside of me slipped. I knew I couldn’t trust myself to recall scrotal lesions or a swollen and mottled penis, and frankly I could live with that. But if I couldn’t rely on Dr. Albert to keep tabs on me, all was lost. My sexual health was an illusion, a mirage forever humming in the distance. Raising the file like a barbell, Dr. Albert revealed that he wasn’t entirely sure which documents were mine and which belonged to my doppelgänger.

“I’m sorry,” he said.

I gazed at him. There was both kindness and puzzlement in his face, and also, I thought, a fine skein of fatigue. His shirt was misbuttoned.

The veins in his eyelids stood out. For the first time, I wondered about Dr. 8

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Albert’s private life, whether he had anyone outside of the office or, like me, was alone. I wondered whether he too had ever swum the grim, soupy channels of masculine failure. It occurred to me that Dr. Albert wasn’t much older than I was, that in some ways we were a lot alike. I was even beginning to feel sorry for him when it struck me: Anna. Of course! How hadn’t I seen it before? She was half his age, the rascal, and light years out of his league.

For some reason that was enough. I decided the file snafu was a harmless oversight. The nurses were probably to blame anyway, perhaps even cruel, lovely Anna. Besides, so what if Dr. Albert kept shoddy records? It didn’t mean he was a bad doctor. I trusted him to keep the really important stuff straight. As far as I was concerned, he was guilty only of having a dicey memory. And one should never be held accountable for that.

“These things happen,” I said. “It’s nothing.”

Relief froze and unfroze his face. His lips detonated an atomic chortle.

Smoothing back his hair, he promised it would never happen again. Taking a stool, he tossed open the file and together we poured through it, sorting out which documents belonged to whom, lingering over words like “scaling” and “mucus,” and consigning dubious pages to the trash. We made two piles, and when we were finished I was glad to see that mine was the smaller. Dr. Albert rose and clapped me on the shoulder. We faced each other, smiling.

Then a strange thing happened. He stared at me a moment, then reached across and shook my hand.

Not long ago, I got to pet a chinchilla at the zoo. I’d recoiled at the softness of its fur, an unearthly, liquid phantasm of velvet that sent a shudder through my brainstem. Dr. Albert’s hand was softer. It was as if all of the chinchillas in the world had gathered in his palm. Straightening, he nodded and, taking care to enunciate, said, “Commodore.”

I snapped to attention, clicking my heels and firing off a crisp salute.

Grabbing my things, I strode into the waiting room, past the desk with its phalanx of nurses. Anna, a little flushed, looked away. As I heaved open the door, a gust of wind swept in, spinning cones of dust at my feet that turned and followed me out into the crisp, gray afternoon.

It was a while before I saw Dr. Albert again. My writing project had tanked. I was broke, months behind on rent, and surviving largely on Crystal Light and Little Debbie Zebra Cakes. Had I needed to, I could’ve clawed together one hundred dollars for a consultation, but I hung on for a year.

When I finally got a job and was freshly insured, I returned to Dr. Albert with business to attend to. The comedo had never gone away. In fact, several 9

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more had gathered around it, gouged to hard points like a mountain range.

WebMD hypothesized hemorrhoids, as did a doctor friend, who, when I’d mentioned the case of mistaken identity at Dr. Albert’s, suggested I find a new physician. But as crazy as it sounds, I felt more bound to Dr. Albert than ever.

Anna was missing, but other nurses nursed idly in her stead. Following the customary bedlam, I was led to the same windowless antechamber as before. When Dr. Albert arrived, minus cardigan and stubble, hair neatly trimmed, he had an altogether different smell, like a fresh-cut fairway. His head buried in a file, he failed to see my outstretched hand. Diving right in, he said, “How was the rectal exam?”

I didn’t see this coming.

“Dr. Albert, I didn’t have a rectal exam.”

He looked up, his eyes narrowed to slits.

“I’m Commodore Hairy . . . remember?”

Fixing me with a long stare, he said, “Of course.” As he burrowed back into the file, I cast around for something to reassure me and came to rest on the bank of photographs. They’d been switched. In William Burroughs’ place was David Byrne. Keith Richards was now Chrissie Hynde.

“Dr. Albert, what happened to Keith Richards?”

“What?”

“You changed the photos.”

“I don’t think so.”

He peered at Chrissie Hynde. The picture bore a swooping signature in black felt-tip. Dr. Albert slouched forward and mashed the frame with a finger. The picture rattled and nearly came loose. “Chrissie Hynde…,” he said, “from the Pretenders.”

“Yes, but…”

He returned to the file. “Last time you were here was for…” He wavered, “…lesions?”

My heart sank. “I’m afraid not.”

He burrowed again.

“Comedo?”

“Bingo.”

He snapped the file shut. “How could I forget?”

10

NONFICTION

Visiting Death JULIE GOODALE

Breakfast with Death, and the eggs are delicious. Actually, I’m having breakfast with a friend. Her companion is Death.

I stare across the table, she looks beautiful, my friend. Her face and skin are radiant—a head made of sunlight. Her body is strong. When she walks, her limp is barely noticeable. Most people would not see it.

I stare across the table, peering into her eyes. Like looking in a mirror.

Like looking at my darkest nightmare. No, not darkest. Darkest is something even scarier. Darkest is something she does not have. Although what she has is dark enough.

She is dying. My friend. Dying. Her death will not be immediate. She has time. But it will come.

Her cancer has returned. After ten years. After the rest of the world had moved on and put cancer in her past. Returned. It lights up her scans like city lights at night when landing at the airport after a long trip. So far though, her brain remains dark on scans—normal brain, no cancer.

And that is my darkest fear, not yet realized in my friend. Cancer in the brain. With my own cancer, an aggressive breast cancer anxious to stake out new territory, with so many cancerous lymph nodes, cancer invading my brain was always my greatest fear. Though I knew metastasis to some other body parts could be more painful or debilitating— knew this because I had seen it in friends—the spread to my brain, loss of my mental faculties, loss of my agency, was always my “Big Bad.” The Biggest. It still is. But this morning, I do not have to look that fear in its eyes while I eat my eggs.

Cancer is eating my friend’s bones and sucking on her lungs. Hungry breast cancer. It has already devoured part of her spine. Her femur has been replaced by titanium. But her limp is barely noticeable.

I think about the recurring pain in my hip, the pain that sometimes wakes me at night. I think about my own cancer. I think about the warnings 11

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that one of my drugs could cause necrosis in the hips. Necrosis. Death. I think instead about my rather unexpected perfect French omelette.

We met three years ago in a hotel room in Moshi, Tanzania, after several long flights, after landing in the dark, after driving through the dusty night with our noses stuck out the window to breathe in the foreign air. Two relative loners randomly assigned to room together. As we claimed our space and organized our gear, we ran each other through the bare basics of our cancers. When we moved out of our room and into a tent, slowly winding up the flanks of Kilimanjaro, we learned of each other’s fears and strengths. We struggled. We giggled. We ate scrambled-ish eggs with tiny, red hotdogs. We laughed out loud in the night at the sounds of men turned seven-year-old boys who joked about their farts. But we did it; together, and alone, with thirty-eight others from the world of cancer, we climbed the mountain. From start to finish, we had marched on, up and over the highest peak in Africa. Then we said our goodbyes, standing below a creepy 3D cat picture that convulsed us with laughter as it stared down at us from the hotel room wall.

Now, she is trying to slow cancer’s march through her body. That is all she can do, slow its progress. So here we sit, my friend and I, eating our breakfast and drinking our coffee. A lot of coffee. And we talk.

We talk about friends. She tells me that another of our climbing group has also had a recurrence. I add her to my list. She will sit next to another friend recently added to the list. I had gotten news just before breakfast that friend is now on a completely liquid diet. Trying to drink enough calories to keep her body from wasting away to nothing but skin and bones. And cancer.

I keep a list of dead people. I keep a second list of people whose cancer has progressed—they will eventually join the first list. Sometimes I forget the names on the lists. Some names I never knew—nameless faces from hospitals and treatment rooms. But I do not forget their eyes, their hands, the way their worries weighed on their faces. I do not forget their smiles.

One more from our climbing group. Just of the breast cancer survivors. That makes three. Three recurrences. Three metastases. One has already died. Our group has exceeded the statistics for breast cancer metastases. Approximately one third of people diagnosed with breast cancer will eventually develop metastatic disease—cancer that has spread beyond the breast tissue. In the three years since we were in Africa, 42 percent of our group has become metastatic. Has had breast cancer return and spread to distant parts of the body. Where it is incurable. Where it kills.

12

VISITING DEATH

Most people believe that breast cancer, especially when found in its early stages, can be cured. Most people believe that if it has not spread within five years, it will not come back. It’s pretty to think so, but the truth is that breast cancer can come back. No matter what the stage at diagnosis. No matter how many healthy years have passed. At any time. Five, twelve, twenty-seven years later. Which is why I never feel like cancer is in my past. Which is why I don’t know how to respond to people when they say, “But that’s all behind you, isn’t it?” Or, “Why do you still think about it so much? You’re healthy.” It is why I joked when friends asked why I was going to Africa with a cancer group: “Hello, it’s a trip to Africa! I’ll go with Mickey Mouse if he gets me to Africa.” Because it was just easier to laugh than to explain. Explain why the sword will never be taken from my neck. Explain why I sometimes feel veiled in shadow. Why I carry a list of the dead inside me. Why I still, always, fear that I will add my own name to my list.

While we were climbing together in Africa, my tent mate and I quickly gained confidence in each other’s strength and independence. We recognized a fierce self-reliance when we considered each other. We did not offer each other easy assistance, knowing we both would rather quietly push ourselves through our struggles. No, we would not offer to carry the other’s pack on a rough day. Instead, we would offer a hand to others whose fortitude was faltering.

Now, I wish I could. I wish I could help. Offer a hand. But I have nothing. I am helpless.

All I can do is drink coffee and talk. Although I know the darkness will come. Tomorrow, next week, it will come. It always does. It will descend and enshroud me, turning my eyes black. I will stand with fists clenched in impotent rage, mute except for the screams inside my head.

Because I was betrayed. I made a deal. And I was betrayed.

Thirteen years ago, in the midst of my own cancer treatment, when I doubted my strength, I had made a deal. I had called out. I had bargained with the Universe in my darkest moment, the moment when I asked to die. I had asked to die right then, rather than think I was safe, only to have cancer come back and have to go through it all again. Because I knew I would not have the strength for that. So I had asked to die.

And then I made an offer.

I did not ask to be saved. I did not ask that my cancer be taken away, that it stop having its way with my body. That would be ridiculous. Instead,

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I offered to complete all of my treatments. But I wanted something in return. If I finished all the treatments, every fucking one, then no one else would ever have to go through this. That seemed perfectly reasonable to me.

I would take on cancer treatment for the world. They would all be saved.

My very own Jesus complex.

I did—I do—understand that the universe does not actually work that way; deals cannot be made. But I had meant it. Most sincerely. And so I finished my radiation treatments. I went through more chemo. I took part in a drug trial. I took every drug that was offered to save my life. Because I wanted to live. And because I had meant it. Most sincerely.

In the years since, every time another friend is diagnosed with cancer, every time a cancer returns, a part of me silently rages. I was betrayed. I made a deal. I kept my end of the bargain. But I am always betrayed. Again.

Again. Again.

And so I will rage. Until my heart is black and shiny like rats’ eyes.

Until my fists turn to marble. Until the screams become shadowed wallpaper in my brain.

But here, now, we drink coffee and talk, my friend and I. We talk of cycling; she is a serious cyclist. We talk of running; I am a serious runner. She talks of riding across the country in the Race Across America. I talk of my latest attempt at running a one hundred-mile race. We talk about strength and focus. We talk about giving our thoughts space to roam freely. She talks about riding her motorcycle. “I took the motorcycle out; people asked where I rode. I said, Fast.” I cannot admit to her that the two times I’ve ridden on a motorcycle, I was afraid to go faster than 45 mph. We talk of planes to faraway places: Russia, India, the Middle East.

Minarets and castles. Head hunters and saints. High places and low, far from our shared heritage of russet and gold flatland contrasted against the azure sky in America’s heartland.

We talk about family. She has not told her parents. She has not told her parents the whole truth. They know that her cancer has come back, but like most people, they don’t realize that this cancer can never be cured, will never go away, will spread—fleetly, deliberately, or sluggishly—until she is dead. She is happy to let them believe in their ignorance until it becomes necessary to admit the truth.

She worries about her parents, about who will look after them when she dies. She worries about insurance. She wonders which will run out first, her life or her money.

14

VISITING DEATH

Drinking coffee and talking. And laughing.

“Friends tell me maybe I wouldn’t feel like death is my constant companion if I didn’t eat breakfast with a skeleton every morning.”

She has a skeleton—his name is Boner—which hangs in her front room. He has strong bones. At her house, before going out to breakfast, I had embraced Boner. We had danced. He was strangely comfortable and comforting. Until recently, his place had been in her dining room at the head of the table. She says she talks to him sometimes. It breaks the silence.

I tell her how, a few weeks earlier, before this trip, this breakfast, when R. finally had gotten on a plane to a month of concerts in Europe, I had relished my quiet. Perhaps too much. I sat upstairs in my loft, at tree canopy level, the highest point in the house, alone, quiet. I did not inhabit the rest of my house. I sat in my loft, writing. After a week, I forced myself to go out, to go to the grocery store, not just because I was running out of food, but because I knew I needed to hear my voice out loud, breaking the silence, speaking to another human being. Speaking to someone other than the characters in my head.

I remember that, actually, I had spoken to another person. While I was downstairs getting coffee one day, the FedEx guy had shown up. I went out in my reindeer jammies to meet him in the driveway and collect the package. I wonder sometimes how many other jammies he sees in a day. Or are mine the only ones?

My friend has been trying to school her friends to call or text before stopping by to check on her. With surgeries to stick a titanium rod in her leg, it’s just easier for her to not wear pants. More than once, she’s had friends walk in while she’s had on only a shirt—Porky Piggin’, as she calls it.

I tell her I don’t have a cartoon character. I don’t know of any who dress in reindeer jammies. Or my more frequent house outfit of a t-shirt and sarong wrapped loosely around my hips, woven by some woman’s hands in some far-off corner of the world. With fuzzy slippers on my feet. Or just a pair of underwear—a little like Mickey Mouse, I guess. Except that I am decidedly less symmetrical, with breast and non-breast comfortably hanging at different angles.

I ask a lot of questions. Probably too many. But I assume she will tell me if I ask too many. She answers with the truth. Details. Mechanics.

Options.

“Maybe I should try internet dating again….Nice man, loves the outdoors, not looking for long-term relationship.”

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While she is up getting more coffee, I check my phone. I have a new follower on Twitter. Brain Cancer is following me.

Breakfast with my friend. Drinking coffee and talking. Visiting death and laughing.

P O E T RY

MS Relapse Treatment At Good Samaritan Clinic HANNAH BAGGOTT

The woman next to me blows her nose rhythmically dropping tissues on the floor. Mumbles allergies.

Does not smile. I am trying not to breathe her in— her lungs, her sweaty rolls hanging over the chair, the gurgles of her oxygen machine.

When she is gone, the flustered nurse sighs, I shouldn’t be angry. Snaps on a new pair of latex gloves, tending to the tissues, face tense: she only has one arm.

I never did look at her—tried so hard to pretend I couldn’t feel the humidity of her body, her dew. I’d been staring at my hands, thinking how one day, they will sit dead in my lap.

But no one will notice unless they reach out to touch the cold retracting muscle—their bodies shifting, unsettled.

They’ll think: weak woman. Won’t think about ghosts.

Or nerves. I will not hold a thin-stemmed wine glass. My palms, shells: hold them up against your ears, and maybe you’ll hear the gusts of my desire to grip pens without needles. But even ghosts are whole.

I will look lovely, purple and pale, shrinking into my clothes, sipping

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carrot juice, and that woman still won’t have an arm—will still be pushed back to her hospital bed, leaving a trail of snotty tissues until infection sets in.

There is a space between guilt and shame that makes a mess of the conscience—the place where no one is behind the divider in the confession booth, the place where I’m sorry doesn’t exist.

Here, the woman’s rhythm will rot in my hands until every sneeze stops reminding me of her.

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P O E T RY

Let’s Be Realistic HANNAH BAGGOTT

Symptoms could arise that you may not become aware of

by yourself,

such as changes in mood or behavior, memory

lapses, difficulties with speech and communication.

Three months sober of those monoclonal antibodies— Believe me,

the brand names aren’t worth the struggle

of your mouth.

Next week, the neurologist will tell me

I must choose a replacement—

because. already. too much progression. to leave untreated.

And something implicit about excellent health coverage

because I am young and old enough.

Please, approve me

for avocado, currants, cashews,

spinach, ginger, turmeric, but listen, I get it—

this is one request I call hopeless.

Maybe this, too:

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most will never know how

other bodies work, but I’m tired

of being angry.

Take your glasses off. Let your eyes rest,

my father insists.

I name rest blindness, and if a symptom of these rejections is loss

of resentment, I will take note myself,

and leave it unreported.

20

NONFICTION

Science Project DIANE KRAYNAK

Aleeshya lies barricaded now in the south corner. White plastic screens surround her. Sick babies in the south corner of the newborn intensive care unit are common; sick six-month-olds among the newborns, though, those are rare. We pretend the screens provide privacy for the baby, but they shield us too.

I enter her protected space and take in the scene: IV poles, ventilators, monitors, tubes, machines. Blinking lights, steady lights. Various pings and beeps break the silence.

“Hey.” I smile at Willow, Aleeshya’s day-shift nurse. “I see we’re screened in now.”

“Yeah, since yesterday.” Willow looks up from her note. She smiles at me. “How ya doing?” she says.

“Good. How are you? How’s she?” I jut my chin toward Aleeshya.

“Well, she had surgery last week.”

“I heard.” I raise an eyebrow. “How long are they going to keep this up?”

Willow puts down the chart and rubs her forehead. She opens her mouth to speak, but stops.

“We talked to mom today,” another voice says. Ella, the neonatology fellow, a board certified physician now training to specialize in newborns, has stepped in behind me. “She’s DNR now,” Ella continues.

“We told mom it’s okay to stop?” I ask.

“Yes,” Ella says.

“Are we withdrawing care?”

“No. But mom agreed to no resuscitation if Aleeshya codes.”

We absorb this for a moment.

“Do you have her tonight, Diane?” Ella asks.

“Yep. Until eleven. Are you here all night?”

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“For a few more hours. I know she’s in good hands with you.” Ella gives me a wink and a smile. “I’ll check in later. Have a good night, Willow.”

“Night,” Willow answers.

Willow and I return our attention to Aleeshya. “When did you take care of her last?” she asks.

“Erm… about a month ago? She’s been here so long, I’ve lost track.”

“Didn’t you admit her? I think I remember her coming in.”

“Yeah. Either I admitted her or I was there for her delivery.” I call back a vague memory of a scrawny baby, arms and legs flailing, yanked from a toxic uterus. Aleeshya’s mother’s soaring blood pressure poisoned the oxygen supply. She was pulled out in June, eighteen weeks too early. She was the length of a fast-food paper napkin and weighed less than a pound.

For the newborn intensive care unit, she is not unique. Many of our babies arrive like this. Forceful hands free them from hot bellies and pull them into a cool antiseptic room. Their eyes fly open in disbelief, their mouths gape and gulp those first swallows of air. Relieved the ordeal is over, they mewl their thanks to masked blue figures.

Hands move everywhere; rubbing, pulling, touching, pressing urgently.

These babies are in trouble after the first few breaths. Hands grab and tilt up delicate chins. A sterile tongue depressor forces open the small mouths and in slips a long plastic tube down into lungs to help the newborns breathe.

Like so many before her, this was Aleeshya’s start in life.

Willow hands me the sheet of paper that holds Aleeshya’s information. “Anyway,” she says. “You ready for report?”

I flip over the paper and click my pen. “Yep. Go.” Over the next fifteen minutes, Willow summarizes Aleeshya’s brief existence. I know most of it already.

She was born at twenty-two weeks gestation—essentially unfinished.

For her entire life, we poked, prodded, infused, transfused, scanned, examined, stuck, and sliced her. She’s tenacious, persistently surviving each complication and intervention. Six months later, she has grown, but not improved. She is, in fact, worse. She requires mechanical ventilation to breathe. She has two large bleeds in her brain. She is blind. She is deaf. Recurrent infections and the antibiotics that cured them left her prone to fungal infections.

A fungus came and formed a ball in her heart. She had surgery for that last week, which left her chest open, but failed to remove the fungus.

Complications like these are common in the NICU. For one baby to get them all, well, that’s more unusual. We find the heart fungus particularly disturbing.

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SCIENCE PROJECT

We call her the Science Project now, our moniker to distance ourselves from her. She is a glaring failure of how we’ve tried to help but made it worse. We know how this will end. But we can keep her alive, so we do.

Willow gives me Aleeshya’s treatment plan, her medications and lab schedule, and the day’s details. “So,” Willow continues, “her urine output is all but gone.” Normal output for her would be 200 to 400 milliliters for the day. So far today Alyeesha’s failing kidneys made forty milliliters.

“Her heart rate’s down and so is her blood pressure,” Willow says.

We stare at her monitors, which confirm the situation. “We’re maxed out on pressors. We’ve cut her fluids as much as we can because of the low urine output.”

A commotion occurs beyond the screens. Faces peer around them— other night shift nurses. Everyone wants a glimpse of the Science Project.

“She’s still alive?” says Nessa. “Oh, my God. She’s huge.”

Tory sidles in beside Nessa. “You got the Science Project tonight? She looks pale,” she says, her words harsh and clipped. “What are they going to do?”

“Keep her alive,” I say.

Zoe, a respiratory therapist, is part of the crowd. “I can’t believe she’s still here,” she says. Zoe turns knobs and presses buttons on the ventilator.

“I’m all for hope and miracles but this just looks like torture,” Zoe says.

“We passed hope a long time ago. Like two or three months ago,” Nessa says.

We pause. That was about the time she ceased to be a baby and she became our science project.

My pen rolls between my fingers. “She can’t possibly survive this,” I say.

“Should she?” asks Zoe. We cock our heads questionably. We’ve had this unspoken conversation for weeks.

“I hope she’s not in pain,” Zoe says.

“Her morphine is due in an hour,” says Willow.

“Does it matter if it’s early?”

“Probably not,” Tory answers.

Zoe strokes Aleeshya’s cheek and gives us a sympathetic glance. “I can’t believe they left her chest open,” she says.

“I don’t know whether to be horrified or impressed that I’m looking at a living, beating heart,” I answer. “You don’t see that every day.”

“Doing compressions will be easy,” says Kandi, another night shift nurse who has joined us. We stand quietly by Aleeshya, mesmerized by her heart—a damaged, beating fungal ball open to the world.

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DIANE KRAYNAK

“I heard there was a phone conference with mom this morning,” says

Willow answers. “Yeah. She’s DNR now.”

“Good timing,” Kandi says. “Some nurses have been talking about going to the ethics committee.”

“For what?” I ask.

“Withdrawing care,” Kandi says.

“Aleeshya quit a long time ago; we refused to listen. We kept going.

Now we’re distressed, so now we say it’s okay to stop?” I take a deep breath and sigh.

We’re silent, sharing the same thought that none of us want to say aloud. She needs to die, but we don’t want to tell you that.

Someone else slips past the screen. This month’s latest medical resident stands tentatively on the outskirts of our group. Her stethoscope is slung around her neck, and she shifts from foot to foot. This is her first night on call in the NICU. The doctors have changed. We have not. We’ve remained at Aleeshya’s bedside. Second by minute by hour, day by week by month, we’ve witnessed her slow decline.

We haven’t learned this doctor’s name yet. We ignore her, weary of another interloper and suspicious of new perspectives. Every month, fresh energy propels this experiment and we dread the continuation. The resident takes a step towards Aleeshya and pulls back. She looks at Aleeshya’s monitor and scurries away.

“I’m going to check on the other kiddos,” Zoe says. “I’ll be back to suction her.”

“We’ll be right here,” I say.

Kandi leans over Aleeshya and caresses her head gently. “Go to the light, Sweetie,” she says softly. Everyone leans over to look at her once more.

They brush past the screens as they file out.

“Have a good night,” Willow says. Her mouth twists into a rueful smile.

“Thanks. You back tomorrow?”

“No.” “See you later, then.”

“See ya.”

She closes the gap in the screen as she leaves. Its flat, metal feet scrape the linoleum floor.

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SCIENCE PROJECT

It is the first week of December and the sun set four hours ago. Last week, the city’s Grand Illumination kicked off the holidays. White lights silhouette the downtown buildings. This will be Aleeshya’s first Christmas. If she makes it.

Alone with Aleeshya, I wash my hands and don a yellow barrier gown and gloves. I pause, lean up against her warming table, and watch her. She is not the baby I remember from a month ago, and bears no resemblance at all to the active, premature infant I helped into life six months ago—a tiny girl the color of café au lait, wide awake to her new world.

Tubes grow from her head, mouth, arms, legs, chest, and bladder.

She looks like a brown, bloated toad. She is sedated, but her face has a slight grimace to it. Her puffy eyes are squeezed shut, a dramatic contrast to the wide-eyed wonder of her birth. Her brown skin is pale and tinged yellow. Her tummy is hard, tight, and shiny. Droplets of fluid ooze from her skin. There is a one-by-two-inch hole in her chest. Her tiny heart pulses hypnotically through clear, flimsy plastic.

I begin my assessment of her, poising my stethoscope over the hole in her chest. Not there. I move it to the left of the plastic and listen. Her heartbeat is regular. Her lungs sound wet and coarse. I touch her leg and my finger dents her ankle.

I settle myself on the blue vinyl stool at her bedside and pick up her flow sheet. The flow sheet is heavy stock, printed on both sides. It folds out like an accordion. Patients get one flow sheet per day. Willow’s handwriting fills in the daytime. Mine will fill in the next four hours, adding to the rows and columns of numbers that document Aleeshya’s existence and decline.

I too participate in this experiment. I contribute with my care; I follow orders, enter data, and observe. I am not her primary nurse, but I am an accessory to the situation. My vigilance keeps her alive, and my silence condemns her to this kind of life. We are all participants. We haven’t advocated for her strongly enough; we haven’t said forcefully enough to the doctors that death, too, is an option.

The white screens surround us and the hum in our space is hushed.

Outside, I hear the rest of night shift working. They’re saving other babies— babies who will grow, get better, and go home. They’re trying to ease the passing of still other babies who will die. I scooch the stool to the window to look at the lights, and catch Aleeshya’s reflection in the glass.

What are you thinking Aleeshya? Do you know what a thought is? How 25

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could you? With those big head-bleeds on both sides of your brain, can you think?

You’ve never babbled a word in your six-month life. Are you babbling now or are you screaming into your breathing tube? Are you drowning in all that sugary salt water that we pumped into you when we cut your chest open to get at your heart full of fungus?

You’re blind. You’re deaf. You can’t breathe. You can’t eat. You can’t talk. Your heart doesn’t work. Your mother doesn’t visit. Why are you still here? Why are we bothering? What is the point of you?

Aleeshya’s ventilator shrills. I look at her and check her monitor. Her oxygen saturations are 70 percent and her heart rate is sixty. Both numbers are dropping. She is dying. Now. I jump up, my feet kicking the stool into the wall. “Hey, guys?” I say to the ceiling, loud enough for everyone to hear. “Aleeshya’s coding.”

Zoe, Nessa, Kandi, and Tory materialize immediately. Ella and the anonymous resident appear shortly after. We circle Aleeshya’s bed, gloving and gowning.

“Heart rate’s sixty, fifty-four, fifty-three,” someone counts.

“BP forty-two over twenty,” says Kandi.

“Nessa,” I say, “can you write all this down?”

Aleeshya’s monitors pierce, ping, and beep in time with her plummeting vital signs and warn us of her impending failure. Our fingers twitch to start chest compressions, open chest and all. She is DNR. All we can do is watch. We struggle, torn between the trained reflex to save her, and the human desire to let her go. Seconds later, she is gone.

Ella lays her stethoscope on Aleeshya’s chest, just to the left of the plastic-covered hole. She holds Aleeshya’s upper arm between her fingers.

The plastic ceases its throb. The red and white lines that squiggled her heart rate and blood pressure lie flat.

“9:02 p.m.,” says Ella, calling the time of death.

Zoe disconnects Aleeshya from the ventilator. Kandi and I unhook her IVs. Nessa clicks off the monitors. Tory turns off the warming table heater.

“You want some help, Diane?” Nessa asks. “Kandi can watch my baby.”

“No, thanks. I got her.”

Someone audibly exhales. The experiment has ended. We don’t have to do this anymore.

They leave her to me and our corner is quiet again. I begin her postmortem care with a bath and I plunge my gloved hands into the basin of warm water. Air in my gloves bubbles up, a cushion between my hands and 26

SCIENCE PROJECT

the latex. I run the washcloth down her arm. She feels firm, but spongy, like a rotting cucumber. She is rotten, actually, and has been rotting for weeks, further proof this experiment should have ended much earlier.

Despite her spongy skin though, Aleeshya is hard, solid, and surprisingly heavy. Her illness, not rigor mortis caused this; her body, unable to make urine, saved fluid and stored it in her cells. When I turn her to wash her back, she lies like a rock in my hands.

I leave in the breathing tube and chest tube for the medical examiner.

I replace the yellow ooze on her skin with lavender baby lotion and put a clean diaper on her. I take one last set of footprints, in case her mom wants them. I print her palms too. I swaddle her in a soft, clean blanket.

Aleeshya’s eyes remain tightly shut, and her skin is taught, but she looks less clenched than she did two hours ago. I can see her better without the machines and wires that connected her to life. If I tilt my head and squint, she is a sleeping six-month old. She looks almost peaceful. Almost.

I pick her up and rock her in my arms. I realize this may be one of the few times anyone has held her. She is still warm and smells of lavender. I carry her to the window. City lights twinkle in the distance.

Kandi pokes her head in. “You doing okay?”

“Yeah. I’m almost ready for transport.”

“Oh, my God. She’s so pretty.” I stop rocking Aleeshya. Kandi ruffles the little girl’s black curls.

“I know,” I answer. “We can really see her face now. I’ll be done in a few minutes. Then I’ll come help you guys,” I say.

“Take your time. We’re okay out here.”

I return Aleeshya to her table. I wrap her snugly in another blanket.

The white plastic body bag, made for a child, not an infant, is too big. I nestle her into it and fold up the bottom of the bag.

The wreckage of her area has my attention: stained sheet; strewn blankets; tape, scissors, and clamps; boxes of gloves and surgical masks; dangling IV tubing. I pack up Aleeshya’s footprints and palm prints, her ID band, her hat, and her nametags for her mother. I fold away the white divider screens and prop them against the windowsill for housekeeping to clean. Another family enters the unit to visit their baby, two beds down. I hastily replace the screens.

An elderly man comes with a wheelchair. He will carry her body to the morgue. His name badge says “Leroy.” I raise a hand to signal him I need a minute. He nods and waits at the unit door. I pick Aleeshya up and the body bag crackles. She is solid and heavy. The scent of plastic overcomes the 27

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lavender. I kiss the top of the plastic where her head should be and embrace her a moment longer. I brought her into the NICU. I am bringing her out.

Leroy drapes a clean hospital sheet over the wheelchair seat. I lay Aleeshya gently onto the sagging blue seat and cover her in white cotton. I squat to tuck her in and straighten the sheet. There is nothing left to do so I stand up.

Leroy closes his eyes, nods, and pushes past me. The unit door snaps shut behind them. 10:00 p.m. Nine more hours on shift.

28

FICTION

Not Once

JESSICA BARKSDALE

He is running on the beach, the waves a slow, false slap on the shoreline.

He wants to get home, and that’s why he’s running. Why he’s running and not driving is because he’s drunk. Why he’s drunk is because of what happened at the party—before he started drinking, and then afterward. But he’s a smart boy—he’s been told this by everyone—and doesn’t want to lose anything: his car and his college fund. He doesn’t want his mother’s gaze to shift. Even as he runs, he can see her face, the way she turns to look at him when he comes in the door. Her eyes wide, waiting, expecting him to provide what he always has. Things are good. Things are going to be fine, now and later and forever.

He’s held it together, so no, nothing will change. Not now. Not for this thing that no one can know about. So he runs, his shirt unbuttoned, his jeans wet, unbelted, stained on the knees in dark circles.

Even with only starlight, he can see the dock, and then knows to look right for the rowboat and the canoe and the path that will lead to the lane and then his street. He will be there in what? Seven minutes? He will sneak around the back of the house, up the wisteria vine—decades old, thick and knotty—and crawl in his window. His mother will never have to know.

Betty couldn’t help herself, actually. It was because the woman Jill—a girl, sort of, even though she must be in her late forties—was a stranger. But nice. A teacher. Kind and likely caring. She has large breasts and a rounded stomach, the kind of woman who breastfed her babies for too long and who took solid afternoon naps on a well-worn couch. The kind of woman who ate chocolate without worrying.

Jill would listen. She would be interested. Also, Betty would never see her again after this odd, forced tour week together, the eighteen of them on 29

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a bus wending through the Irish hills. A famous castle. A famous stone. A famous crystal factory. A famous church.

And then every night here, as with every night for fifty-five years, Betty would lie down to sleep with Art. She on her back, he snoring, her thoughts a darkness over them. He doesn’t wake to comfort her or tell her a story. He doesn’t talk of things other than golf or grandchildren or the damn economy. At least he hasn’t for years.

Betty’s feet hurt, both Achilles tendons stretched like taffy after too many power walks and tennis games, not to mention today’s hike around the castle’s grounds. Art was up in the room taking a nap. Jill’s overly chatty mother was off buying a hat or some Chapstick in the hotel store. “Chapped lips! I’m still so thirsty after all those hours in the airplane,” she’d said before toddling off. She was probably Betty’s age but acted older.

As they relax on the large bar couch, Jill looked at Betty and tried not to roll her eyes. Betty gave her a conspiratorial grin, an “Oh, how do you put up with her?” But the smile stilled and almost cracked. Her own daughter Lily was too busy with her three children and husband to come to dinner on Sunday, much less travel across the world with Betty to see things neither of them cared about.

“It’s a miracle we haven’t killed each other.” Jill sipped her gin-andtonic. But Betty has seen Jill reach out for her mother’s hand, hold it as the tour group walked like school children in rows up cobblestone streets. They sit together on the bus and talk about the passing landscapes and vistas. At dinner-time, they exclaim over the seafood chowder and light-as-air desserts.

“You travel together often?” Betty asked, wondering what it would be like to go anywhere with an adult child. When her children were little, they clung to her legs and hands. They reached up for her when she leaned over their cribs and then beds. When had the affection become a turnedcheek kiss?

Jill nodded, her chin comfortable on her neck, her neck on her chest, her chest slipping onto the mound of her stomach. “Her brother—my uncle—died. They used to go somewhere big every summer. Giving up her travel seemed like a last step she wasn’t ready for. So off we went.”

Betty felt her mouth open, but she could tell her response would turn into a sob. So she swallowed, thought about that night, and the verb to step. “That’s nice.” She looked out the window on to the parking circle, rain slicked and gleaming. “Lovely.”

“Do you have children?”

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everywhere. “Yes,” she said, turning back to Jill, her story changing. How her mouth felt, her jaws as tight as the old castle door. “Two. A boy and a girl.” Jill turned to look at her, and Betty felt the words slip past. “But my son died.”

Just before he reaches the dock, he yanks to a stop, as if pulled from behind. He breathes hard, but catches his breath after a shocked one, then two inhales. He runs every day, and it is only how far from the Abbotts’ house? Two miles? But his heart pounds in places it shouldn’t, the thrum in his fingertips and ankles and shoulders. He can feel his skin in all these unusual places. For the first time in his life, he feels the knobs of his spine.

A press, an ah, a press, an ah, all the way down to his sacrum. He wants to touch exactly there and there and there, but instead, he put his hands on his hips and turns to watch the lake, a pool of clear nothing.

He wants to go back. He wants to go home.

Looking down at his feet, only the moons of his toenails visible—he so tan already—he knows he could go back to the party. Everything could return to the second he’d jerked away, pushed back again, and ran—backward, and then forward—pulling on his clothes as he moved through the trees and shrubs.

An owl hoots. Across the water, someone slams a door, the echo skimming toward him.

He walks forward and then stops again, slamming down on his knees.

He cups his face in his hands and cries the way he must have as a child, the sobs dragged out hard and silent from the bottom of his lungs. The time he lost his toy train. The day he missed the bus and his mother wasn’t home to pick him up. When he didn’t make the junior high track team. When his father refused to get him a dog.

He’s so tired, so exhausted. He wants to stay here where it’s dark and quiet. Where he’s alone.

“Just stay the course,” his high school counselor said at their last meeting. “You’re a shoo-in at Harvard.”

“You could apply closer to home!” his mother said, when she saw all the college catalogues. “For heaven’s sake!”

“Don’t leave,” Matthew whispered moments ago in the woods. “Please, please, please don’t leave.”

He wants to leave. He wants to stay, but only for short pieces of time he can escape from. Here, gone. Here, gone.

Here, Matthew’s hands on his chest, smoothing up to his neck, pulling 31

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his face to his. A kiss, their first kiss last year. His first kiss. His second kiss, his fiftieth kiss, and with Matthew, the kid from first grade who grew up to be six-foot, one sixty-five, long blond hair to his shoulders. A swimmer.

A pool outside and inside, a calm, clear body of water in Matthew’s gaze.

An open expanse of yes. Matthew, who knew who he was. Matthew, who tonight did what they’d both wanted.

Hands, mouth, the tree holding him up, Matthew kissing and touching and moving down his body. His hands on Matthew’s soft hair, holding him tight against his body. But always, his focus couldn’t stay with lips and hands and tongues. He’d flinched at the crackle of branch, the flicker of white. Annie, looking for him, her thin arm on a tree limb. Annie’s pale face in the flashlight, wide open with the truth of their entire high school relationship.

“We should wait,” he’d told her every Friday night as they rolled around on her living room rug, the back of his mother’s station wagon, the deep mats in the high school gym. “I don’t want to ruin things. I want it to be special.”

Things were ruined in her muffled yelp, the rush of her quick steps in the woods, Matthew’s hands trying to hold him still.

“Please, don’t! Please.”

Then he ran.

“I’m so sorry,” Jill said. “Oh, my! That’s terrible.”

She was polite, this girl. Betty had heard it all, the questions before the “When did it happen?” and the “Oh, it was so long ago. That must give you some comfort.”

But everyone who said so was wrong. It was not long ago. It was just yesterday. It was now. It could be tomorrow, she still desperate to drive to the party and pick up Stephen, drag him to the car, press him into to the passenger’s seat, and zoom home. Or better, take him to another county, state, country. Planet. Take him away from whatever it was that made him run away from the party and head through the woods. That’s what dear, sweet Annie later told her.

“He was there, and then he wasn’t,” Annie had said. “I saw him run into the forest.”

It had been so dark that night. Betty hadn’t seen a thing when she glanced outside the window before bed, though she’d imagined she could see the party. Behind her, Art snored.

“Something you can never get over,” Jill said. “I’m so sorry.”

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Betty was ready to nod as she usually did. She felt her head move up, but then there were tears, hard and solid in her mouth and throat. Stephen beating in her chest. How she could see him running. How she could reach out and hold up her hand, yell, “Stop! Don’t move a muscle!”

But then and now, Jill’s hand on her shoulder, Betty couldn’t say a word. All she was able to do was sink into the truth.

He was there, and then he wasn’t.

A bat twirls overhead, a rustle in the dark sky. Stephen follows the swirl with his eyes, the bat skittering up and then rushing out over the water.

Behind him, he can still hear the whine of the party music. Matthew is back there somewhere. Outside still. Or maybe inside, trying to act natural, whatever that means. Matthew didn’t see Annie in the woods. He must think that Stephen ran off because of mouth and tongue.

Stephen turns to his right. There’s his house, the kitchen light on, as it always is when he’s out. His parents upstairs, his father dead asleep. Some nights, his mother leaves him a sandwich. Others, a plate of cookies. He reaches out his hand. He can pretend home is that close.

But he’s left home already. He knows that, even if no one else does. He left home the moment he had this secret. His longing for Matthew. Really, his not-longing for Annie. A girl. With Matthew’s first kiss, Stephen cracked off the family shelf like an iceberg.

Wind whisks his neck. Stephen walks toward the water, turning back toward the music, pausing in the sound. He knows that once floating free, ice has only to melt before it becomes the ocean.

He glances home one more time. For a second, he imagines he sees his mother’s flickering form in her dark window. Stephen lifts a hand and waves, and then he turns back to go find Matthew. He walks fast; he swings his arms. He runs.

Instrumental music filled the bar. A flute. A violin. Betty ordered another Jameson. Jill put down her drink on the shiny wooden table.

“When?” she began, and then changing course, “How?” Betty reached for her new drink. There they are again, those old lady hands, brown-spotted from years of tennis, golf, and sunbathing, though now—too late—she wears sunscreen. Her joints thickened with arthritis, her left index finger pulled in, that hand almost a triangle.

“He’d be fifty-two now,” Betty said. “Maybe a grandfather himself.”

Jill waited, her smooth fingers around her glass.

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“It was right after the summer of his junior year. Sixteen. Almost seventeen. He’d almost gotten through high school perfectly. All A’s. Track team. He could run like the wind. He was so lovely to watch. Like some kind of African animal. You know, all that golden grass and a sleek body of muscle zipping through like a blade.”

In the lobby, Jill’s mother talked to the concierge, the up and down of annoying questions. A loud laugh. More questions.

“That night, he went to a party with his girlfriend, Annie. They were so cute together. They wouldn’t have married, but I always hoped they might.”

Sometimes before falling asleep, Betty had imagined Stephen and Annie at twenty-eight, coming home to visit with their two waif-like children, both with Stephen’s dark eyes. Once she’d joked with Stephen about it, but only once. That look on his face. “But they’d had a fight. Right in the middle of the party. He ran off. Into the woods and toward the shore of the lake we lived on back then. If he’d kept going, nothing would have happened. But for some reason, he stopped.”

Betty looked at Jill, who stayed silent, nodding a little, eyes wide.

“They found the place. He’d walked around a bit. In a circle. Must have been staring at the water. Thinking about Annie. How to make up with her.

They’d been going out for three years.”

Betty looked up at Jill, who held her gaze. Betty continued. “So like I said, he stopped. And then instead of walking back up to the woods toward home, he started running along the water’s edge, headed back to the party.”

She felt the worst part of the story rise up and press against her breastbone. This was the part that people were listening for.

“You don’t—“ Jill said.

“He was running. He was running, and he didn’t know about the workers. The live electrical cable.”

“Live?” Jill asked. “How did that happen?”

“Everyone blamed someone else. The neighborhood hadn’t been notified. The gas and electric workers made a mistake, you see. Left the cable down right there on the beach. Didn’t cut off the power. It was dark, and he was running to get back to Annie, and he stepped right on it. His best friend found his body thirty feet from the wire.”

The pounding on the door. Betty’s hand at her throat. How long it seemed for Art to wake up. Flicking on the porch light, she’d opened the door to find Matthew, his body covered in dirt and sand, his hands dangling at his sides, his face stricken. The calls. The sirens. Matthew waiting 34

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in the kitchen for the police and firefighters. Annie showing up and sitting motionless at the table. All night, they both stayed in the kitchen with her and Art and listened to the men talk about what happened. Annie still sent Christmas cards. Where had Mathew gone to?

“Stephen would be fifty-two,” Betty said, even though she knew she’d already said that. “A grown man. A man heading into the last half of his life.”

Jill began to talk, almost humming the words, a comfort, a lullaby.

But no words would ever comfort her. Nothing helped. Not her daughter’s life: Lily’s successes and bright children. Not charity work. Not money. Not alcohol or time or her husband. Not travel. Not Ireland or Russia or Sicily.

Betty made some additional comments and then gently turned the talk to other, lesser losses. By the time the conversation was over, they were relating the differences between first and business-class seats. Finally, Jill’s mother wandered in with her tiny shopping bag. Jill stood, pressed Betty’s shoulder one more time, and then took her mother’s arm. The two of them excused themselves and clambered up the main staircase. Betty knew she should wake up Art for dinner. But instead, she ordered another drink.

Once, long before he’d retired, Art came home from the office, his eyes red. Betty watched him as he stood in front of the family room window, staring out at the water.

Finally, he said, “I can’t drive down the road without thinking about him. I drive all the way around the lake to not see where it happened.”

Alone, Betty sat on the couch, staring at the Irish amber clinging to her glass. In a few years or maybe even months, she’d be dead. But she would feel this loss even then. Her body might stop and then rot in her own box, but there would be no release.

All those years ago, Art had turned to her, his face wet. “I see him running, Betty. He’s running. He’s still running. I can never get to him. I hold out my arms, and I never make it. Not ever. Not once.”

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Lost in Translation JONAS LEE

I started driving the eight hours from Brodhead, Wisconsin to Overland Park, Kansas at 6:00 a.m., worried that I would fight to stay awake while crossing the vast, yellow-green plains of northwestern Missouri. I tucked a brand new, candy bar-sized dictaphone in my backpack for the trip. I spent my childhood here in the ’70s and ’80s, bicycling over dirt trails and hunting for crawdads and garter snakes through vacant farmland at the edge of our development. Since then, my parents had moved a few miles from my childhood home to a larger home that could accommodate all my nieces and nephews when visiting from New York City and Washington, D.C. I planned to interview my parents about growing up in Korea.

Sporadically, my father would offer snippets of his life surviving the Korean War. Since retiring from his daytime employment as an architect and evening work running myriad family businesses, he seemed restless.

For the first time in his life, he showed interest in landscaping and home repairs. After having his fill of cable TV piping in Korean soap operas, then failing miserably at day trading with his meager retirement savings, he had mentioned he might write his memoirs.

My father and grandfather escaped what is now North Korea during the Korean War, leaving my grandmother and seven uncles and aunts behind. He spoke endearingly of how my grandfather had scraped together tiny balls of rice to sustain them, how he had built a tent of rice sacks on the outskirts of town to survive the harsh Korean winters, how he had worked his way up to factory manager despite a gimpy leg from a logging accident. This allowed my father to abandon his odd jobs selling donuts and newspapers at dawn in order to return to school after years of absence.

Somehow, he told these stories without any sadness, only a profound awe that he and his father had somehow survived.

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My father had the same haircut, given to him by my mother, for his entire life. Every morning he wiped on flesh-colored makeup to cover the extensive, white patches of vitiligo covering his hands and face, wolfed down his American breakfast of cereal or oatmeal, and went on the way to the architectural firm in suit and tie by 7:00 a.m. He returned by 6:00 p.m.— never seeming to taste the elaborate, traditional Korean dinners my maternal grandmother took the entire day to prepare—before closing our family’s ice cream shop or clothing store or Asian grocery. After watching the nightly news at 10:00 p.m., he disappeared to the basement office he designed himself to do the day’s accounting, long after I went to bed. His exercise consisted of stretching and sitting in a sauna. Beyond the occasional bout with hay fever or a cold, I had never seen him ill. I don’t recall him ever missing a day of work.

My parents had been using me as an interpreter of medical information for years. At times, they would blur the lines, asking me to play doctor for them. “You are too far away. I can’t see you or examine you or keep an eye on you. I can’t do good medicine from so far away,” I would say.

Typically, they would call me immediately after a doctor visit to ask me what I made of the diagnoses, the new prescriptions, the upcoming tests. Sometimes, they were able to convince the doctors to phone me directly. I could hear the echoes of the doctor and my own voice on the speakerphone, but my parents always remained silent. My recommendation to have a formal Korean interpreter for their doctor visits went badly. My parent’s English was good enough to understand that the interpreter was interpreting poorly. Nor did the interpreter offer the additional service of asking questions they would never think or dare to ask. They decided they would never use a stranger to interpret again.

Four years ago, my father suffered a small stroke without any obvious residual deficits that I could tell from afar. He carried a diagnosis of high blood pressure for decades, but took his medications sporadically, only at my pleading. He could not see the benefit of taking medicine when he felt fine. I saw my parent’s phone number on my cellular screen on a Tuesday morning. I answered immediately and excused myself from an exam room in the midst of a patient interview to take the call. I call my father every Sunday morning before my parents leave for church, so I was alarmed. I expected to hear that my ninety-plus year old grandmother with Alzheimer’s had again misplaced her envelope containing her entire social security savings, and was again accusing my parents of pilfering her cash. Instead, my father casually mentioned that he was having difficulty 38

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speaking, and that his right arm felt clumsy and numb. When I told him to go immediately to the nearest ER, he seemed confused and simply handed the phone to my mom. My mother is the original Tiger Mom, actually born in the year of the tiger. She howls with laughter when telling us about her auspicious match to my father, who was born in the year of the mouse.

In their marriage, she always wins in wars of persuasion, and this morning was no exception. Per my advice, she made sure he made it to the ER. The hospitalist called me later that day to confirm my suspicions: my father had suffered a small stroke, most likely due to uncontrolled high blood pressure.

My beloved paternal grandfather had died from complications of a stroke when I was a teen. Only after the stroke did he and my mother look beyond Korean herbal and nutritional remedies for Western medical treatment.

Over the several weeks before my visit, my father told me of several doctor visits for an incidentally discovered elevated protein, noted on routine labs to follow up on his high blood pressure and high cholesterol. When we spoke again, he told me his doctor had recommended a bone marrow biopsy, then a meeting with a hematologist. My mother emphasized that this was not an oncologist. Finally, just before my visit, the hematologist prescribed several cycles of medications for the coming months. My parents couldn’t name the diagnosis, but I knew what he was describing must be some type of blood cancer.

Kansas still has plenty of open space for suburbs, which continue to devour grasslands further and further south of Kansas City. I drove through curling streets lined with McMansions until I finally reached my parent’s cul-de-sac with its weedless lawns, absent clotheslines, and closed garage doors, all by decree of the neighborhood association. I hustled to gather my bag and remnants of my lunch to reach the house before my father could wander out to inspect the peeling finish and duct-taped rear view mirror of my sedan. The front door of their home was left unlocked, and I knocked as I entered the two-story foyer. I greeted my father with an awkward hug and took off my running shoes, as I could hear my mother calling from the kitchen. For the first few minutes, I could again smell garlic and mothballs, the scent of my childhood that has followed them from home to home, before the odors faded into the background. As expected, my mother had prepared a feast for my arrival, even though I had warned her that my brother had invited me out to Qdoba for an early dinner shortly thereafter.

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to this day I am still unable to name; crispy, pan-seared tofu; and a mound of steaming, sticky, white rice to balance the intense red pepper, sesame oil, soy sauce, and vinegar that infuse most of the dishes. My parents had already eaten, so they seated themselves around me to encourage me to eat.

Later that weekend, to please my mother, I again stuffed myself to the point of discomfort with several plates of her Korean pancakes. While recovering from the strain, my father handed me the thick envelope he had received in the mail with his most recent test results. I leafed through the fifteen pages of what turned out to be my father’s bone marrow biopsy report while loosening my belt. The lines of text were tightly spaced, with three or four results buried within pages and pages of the pathologist’s automated interpretations. On page eight, I found “17p deletion,” followed by a paragraph describing this as the most aggressive gene mutation for multiple myeloma. The report stated standard therapy is ineffective and that guidelines recommend a referral for experimental therapy. Did my parents even know what was going on? They clearly could not name a diagnosis.

Who else would translate this for them? I could actually envision myself changing out of my jeans and t-shirt and donning a white coat, which I never wear in real life. I am no longer son. I am doctor.

This is the mental shift that I have practiced to try to protect myself and those close to me over the years. How many times have I been approached by a friend or a family member with a medical question? So often, it’s in the midst of a conversation, in a restaurant or family room or backyard. Sometimes, it’s in a hallway at work. After hearing horror stories of a complaint being brushed off only to find a devastating diagnosis later, I’m terrified of being too casual in my evaluation. So I create an “appointment” in my head. I take the person aside and do my best to pretend I’m back at work with my full presence, my doctor mindset, sitting before a new patient.

“Did anyone tell you that you have a kind of cancer?” I asked, emphasizing the word clearly. My mother and father stared with wide-open eyes at my question. They reported that nobody had used that word.

I spent the afternoon using the words “bone cancer” and “chemotherapy” and “very bad genes.” I translated the biopsy report for them: “This says that most patients die in two to three years.” My father stared blankly, at times glancing to my mother, searching for help. Over the past few years, he seemed slow to grasp what I thought to be simpler ideas when we talked about his health, or about his interest in investments. After I answered a medical question he had posed, my father would often begin 40

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speaking as if he hadn’t heard any of my answers. My oldest brother had literally chased a salesman from their home in the past, when it appeared my father was being swindled. I had always chalked this up to his mouse birth year personality and to his mediocre English, so I had never seriously questioned his judgment or understanding.

On a whim, I grabbed a piece of paper off the mail pile and turned it face down to show its blank backside. “Hey dad, I’m worried about your memory. Could you take a little test for me?” I asked.

“My memory is fine,” he said. He sat next to me.

I pulled a pen from my pocket and drew a large circle. “Let’s pretend this is a clock face. Can you draw in the numbers?” I handed him the pen.

He stared at the page for several seconds, then began drawing lines slicing the circle into several pie slices. Maybe this is his way of evenly spacing out the numbers, I thought. Then he wrote numbers around the edge of the circle: five, ten, fifteen, twenty… He stopped, and smiled sheepishly at the page. “Hey, wait a minute…” he said. He placed the tip of the pen on the page, as if to write, then lifted it off the page without writing at all. He repeated this several times, staring, chuckling uncomfortably.

Finally, my mom walked over and bent over his shoulder.

She scolded sharply, “What are you doing? You can’t do this? This is how you do this!” She snatched the pen from his hands; wrote in the numbers twelve, six, three, and nine at north, south, east, and west; and filled in the remaining numbers to show a perfect clock face.

“Oh, of course…” my father said. The man who prided himself on being the best draftsman in his elite college class. The man who could hand-draw the precise location of every pipe and beam in all the layers of a building long before computer drafting had been invented. The architect couldn’t draw the face of a clock.

Several months after my visit, I was on the speakerphone with a new oncologist. My father’s myeloma had advanced past the “smoldering” stage despite several months of a two-drug regimen, and the community oncologist had transferred my father to the care of the university cancer center. I said “hello” to my parents over the speaker, but I heard no response.

The oncologist summarized the history and findings, and offered his recommendation in a light Indian accent. He was going to double the dose of the previous agents, add a third agent, then consult for a bone marrow transplant. Receiving the skeptical doctor/son call from out of town cannot be comfortable, I thought.

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“Wait a minute. How does this treatment change the prognosis?” I asked in my most polite tone, while silently mouthing the words, What the hell?

“That’s an excellent question,” he replied. “It doesn’t really change the prognosis, but it might increase his symptom free survival.” He spoke medical-ese for our entire conversation. After adequately answering all of my questions, I thanked him and said goodbye to my parents.

On the following Sunday, during my weekly phone call home, I hesitated, and finally threw out, “Dad, we need to talk about what your doctor said.”

My father’s voice suddenly sounded exhausted. “Call me tomorrow night to talk about it. I have to go to church.” He had never put off a conversation before.

The following day, my father answered in one ring; he had been waiting for my call. This time, I jumped right in. I still felt the unreality of telling my father he had cancer several months ago. I returned to doctor mode. “What’s your understanding of what is going on?” I asked.

“We are going to do several cycles of chemotherapy, then do another bone marrow biopsy, then do a bone marrow transplant,” he rattled off.

“Yes, but did anyone tell you that there’s no cure for this cancer?” I asked.

Instead of the, “I’d like to hear it straight, doc. I don’t want you to beat around the bush,” that I usually hear from the metal grinders, the dairy farmers, roofers, and landscapers that I doctor every day, my father asked, “Why do I need to know that? If it’s one day or one month or one year, I’ll just live my life. Don’t make me worry about that.”

“Okay…” I hesitated. Is this denial, or is this his life philosophy after near starvation as a teen? I wondered. “Does Mom know?” I followed. She had been purchasing thousands of dollars of Asian herbal remedies in the hopes of a cure. Her father died suddenly and unexpectedly when she was six years old. She was very unlucky by Korean standards: an only child. Despite her mother’s profound dementia, my mother demanded that her mother remain a full code.

“Do not tell your mom! It will make her unhappy!” my father replied.

“Why are you doing the chemo? You said you didn’t want to do chemo,” I asked, already knowing the answer.

“Your mother wants me to,” he replied. The tiger mom had won again.

It was his lifelong habit to tell my mother what she wanted to hear and to shield her from bad news.

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“Don’t you think she’ll be more upset if this news was a surprise? Most people like to know ahead of time when they might die. They can prepare.

They can plan.” I echoed what I had heard from so many other families, appealing to his Korean sense of following societal norms. I’d never had to resort to that before with my parents.

Shifting the conversation, my father began recounting my offenses against him. My mother had thrust upon him the role of the voice of reason to complement her fiery emotion. Over the past twenty years, I had refused his fatherly advice on such topics as my choice for a wife, my choice for a medical specialty, my decision to forego formal schooling for my children, my decision to become a vegetarian family. On countless occasions, my father would begin with, “Why did you decide…” Never waiting for my reply, he would offer his reasons why each of these life choices was a bad idea. Typically, the argument revolved around living up to the expectations of an Ivy League graduate. My children would be poor, and hungry, and unemployable. Growing up in America, I would be judged by my yellow skin and black hair first; opportunities could vanish after a first glance.

“We’ve gone over this so many times. After all these years, you don’t understand me at all…” I winced at my own words as they spilled out of my mouth.

I am steeped in the primacy of the Western medical ethic of autonomy.

I don’t believe that fits completely with the Confucian ideals that were most prominent in my childhood home: strict adherence to rituals and the norms of society; non-questioning of authority; and always duty to family above the individual. I had always prided myself on developing a skill for breaking bad news to complete strangers. How many times, when on hospital call, did I have to discuss a new diagnosis, a grim prognosis? How many times had I squatted lower than my patient, or sat on a bedside to hold a patient’s hand, to ask about what brought meaning to their life, and therefore, what goals they might have with what few moments they had left? In some ways, I considered this news a gift. So often I had seen families reconcile and talk and hug and cry together. So often, patients and families appeared more peaceful, grounded in the moment. I discovered it was surprisingly more difficult to give this information to patients I had grown close to and knew well. Now, perhaps most difficult of all, to offer this to loved ones.

Suddenly, my father was screaming into the phone. “You don’t care about your children’s future at all! Do you want me to die? Okay, I’ll die!”

Then the phone was silent; he had hung up.

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experience helping so many patients face death. All the years of schooling and training. None of this mattered now. I am no longer the doctor. I am again the prodigal son, who has yet to return to the fold.

We didn’t speak for two weeks following the incident. But I felt the heavy weight of time passing. This is part of the gift of knowing that death is coming. On my long drive home from work, I finally dialed his number, hesitated, and pressed SEND. “Hi, Jonas. There is no cure for this cancer,” he stated slowly; he stated as fact.

Breaking years of our family habit of never acknowledging a previous argument in any way, I replied, “Hey dad, I’m sorry for what I said.”

“You know, I just want to enjoy my life. I’m old. I can’t live long anyways. I don’t care if it’s a few days or a few years. I don’t want to worry anymore.”

I conceded. If this was the voice of Korean culture or immaturity or denial or his particular life, it didn’t matter. “Okay… and you don’t want me to tell Mom. So, I won’t tell her. I’ll leave that up to you.” I wanted him to understand how torn I felt that nobody was better equipped and more ill equipped to act as his interpreter. “You want me to talk to your doctors, but they don’t tell you everything. Or maybe you don’t understand. What am I supposed to do when they don’t tell you this important stuff ? I don’t know what I’m supposed to do.”

“Just tell me what I need to know,” he said. He offered no solace, no clarity for my role. I didn’t try to dissect further what he thinks he needs to know, versus what I think he needs to know. I decided I would try to honor his wishes, as I understood them. I still haven’t determined where the line is between son and doctor, between Korean and American approaches to life and death, between my story and their story. I’m still searching for my way home.

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The Origins of Dementia CAROL BARRETT

Even in courtship he would forget things, her room number, ring size, but she couldn’t dream where this was going. As bees dance about the bougainvillea climbing their condo, she says he cannot remember his military tours, even when she pins the medals to his pocket. He wants to know what day it is, who is she. “Still your wife, Tuesday.” He repeats her name, then kisses the hand of every woman at the adult daycare center, saying, “Hi pretty lady.”

We are losing honeybees, whole hives frozen in a flash after aerial dusting of blooms.

In the back orchards of the Carolinas and West Virginia, organic apple blossoms stir in the breeze and still the bees are dying. Some say the genetic alteration of pollens poisons the divine nerves of apis mellifera. Confused, they forget how to get back to the hive, fly in dizzy circles instead of homing with their golden burden.

I wonder, was it something he ate, something we all eat, ticking inside, something he brushed against, 45

small and unannounced, airborne, years back, that yielded this fruitless union?

I grieve for the bees, circling in aimless quandary. But at least the journey is quick. Tired of looking for something familiar, they drop from the sky in a day or two. Grass swallows them up.

The buzzing questions stop.

FICTION

Life Cooking SANDRA SCOFIELD

They were five miles out of Spinning when Regina shrieked, “Mary Delight!

We got to go back!”

Alarmed, Delight slowed down and pulled onto the shoulder of the road. “Are you taking sick, Nanna? Maybe it’s better to go on to Odessa to the hospital.”

“Who said sick? You’re set to put me on my deathbed when I’m not ready yet.”

“What an awful thing to say, Nanna”—this from Delight’s daughter, Teresa, in the back seat—”when I’ve only made my way through twenty-six recipes in your Life Cooking book, and nobody can read your handwriting to get through the rest without you.”

Regina looked at Teresa over her shoulder. Her neck cracked.

“You should type them up in your computer, Missy, before you cook every single one. Though you might need a little consulting.”

“I’m very happy to see the two of you on the same wave-length here,” Delight said, “but I don’t see what Life Cooking has to do with driving, or stopping, or scaring me half to death. What is wrong with you, Nanna?”

“I wanted to take my dumb bars with me to Ceci’s.”

Teresa giggled. “Barbells, Nanna.”

“Oh my,” Delight said, and put her forehead against the top of the steering wheel. Fortunately, the shoulder of the road was as wide as half an alley; they could sit there until sundown if need be.

“So she can see I’m getting my strength back. She won’t take my word for it. She thinks a little-bitty stroke is the kiss of death. She’s counting out my days on her ten fingers.”

“That’s an awful thing to say. And if you say you’re better, well, you are.

Nobody’s ever known you to tell a lie, Christian woman like you. “ Delight started the car, looked both ways, and made a sharp U turn back toward 47

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Spinning. “We’ll go get your barbells. But I’d appreciate it if you wouldn’t startle me like that.”

At the house, Teresa ran in and got the weights—hot-pink, rubbery things Ceci had bought for Regina in the Odessa Walmart. She put them on the back seat beside her. As soon as they were on the road again, Regina asked her to hand one over.

“Be careful,” Delight said. She didn’t take her eyes off the road. In less than a year, Teresa would be driving, and Delight wanted to be a model driver.

Teresa leaned over and gently laid one of the bars on her greatgrandmother’s lap. “There you go.”

Regina put her hand around it and Teresa said, “Remember, thumb over, Nanna.”

Regina bent toward the weight. With her elbow solid on her thigh and her face tense with effort, she lifted the bar a few inches, slowly, then put it down again. “Is it that hard, Nanna?” Teresa asked.

Regina twitched her shoulders and raised her chin. “Certainly not. It isn’t very hard at all anymore. But you have to do it with the right form, and that takes concentration. That’s how they taught me in rehab.” She lifted the bar again and held it a little longer before letting it plop onto her lap. “I’m ready to go up to purple.”

“Purple what?” Delight asked. She knew her grandmother could not lift both two-pound bars at the same time, with the elbows down; and she could not lift one straight out from her body. They had worked on it together briefly a few times each week, but Regina tartly reminded Delight that she was not a physical therapist and really shouldn’t be offering so much advice.

“Five pounds,” the old lady said. “I’m going to send Ceci to Walmart for five pound weights.” She pushed the bar hard and it rolled with a thump onto the floor between her feet. “Won’t that please her, though.” She snorted.

Delight took one hand off the steering wheel briefly to pat her grandmother’s knee. “Nanna, Mother is always happy to see her mama. It doesn’t have anything to do with the color of your weights or how hard you’re working. She’ll be glad to see your progress, though, I’m sure of that.”

Regina laid her head back and shut her eyes. There was time for a short nap before Odessa. Softly she spoke, “I don’t want her to worry that I’m dying anytime soon, that’s all. I don’t want her to think she needs to put me in a home.”

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“Oh Nanna,” Teresa said. She leaned forward and rested her hands on each side of Regina’s neck. “Mommy and I are never going to let that happen, are we, Mommy? I don’t know where you got such an idea. You’ll stay with us, like forever!”

Regina, her eyes still shut, half-whispered her last words on the subject for now. “Your mother’s got her hands full, Teresa. She’s got her job, and church, and friends, and you to take care of. I hear her sighing at night like a tired cow, and I have to ask myself what’s going to ease her duties if it isn’t moving me on out.” She turned her face toward the window and put her cheek against the back of the seat.

Delight, stunned and stung, clasped the steering wheel so tight it made her elbows ache. There wasn’t a car in sight, so she turned quickly to catch a peek of her daughter’s face. Even as she did it, she knew she was violating her oldest rule: never look to a child for comfort.

What she saw made her feel much worse. Teresa, still perched on the edge of her seat—without her seatbelt—was looking at Regina. And it only took her cheater’s glance to see that Teresa was as worried as she could be that Nanna might be right.

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NONFICTION

The Lionhearted SADAF QURESHI

It was 6:15 a.m., and I could see the undergraduate football team running enthusiastic laps around the field from the window in Mrs. I’s hospital room.

Mrs. I had a private room in a corner, and you had to pass through two doors to enter. This was either because she was terribly sick, or because she was too ill tempered and unmannerly to be expected to share a room. I had known Mrs. I for only two days, but both seemed like strong possibilities.

According to her chart, Mrs. I had “MMP,” which I had looked up on the Internet and de-coded the previous night—multiple medical problems. She had multiple myeloma, amyloidosis, anemia, Bell’s Palsy, diabetes, delayed gastric emptying, and chronic kidney disease. So many labs were drawn on her each morning, that matching each lab value to its corresponding medical problem was a herculean task. She hated to be woken at six, and stubbornly refused to acknowledge my barrage of questions each morning with anything more than an occasional grunt, moan, or roll of the eyes. She had particular skill in conjuring a unique slew of curses for every person who walked through her door, and she had two adult children who scarcely came to see her, though she had warned for two days in a row that her son was going to be visiting very soon, and that he would have, “plenty of questions for all of us doctors.”

I had just finished doing a physical exam, and had stopped to marvel for a moment at the sight of that young, carefree burst of energy on the football field—a world away, and entirely oblivious to the stagnation, the frustration, the hopelessness that had seeped in and slowly overtaken that little corner room from which we both watched. An unknowingly inconsiderate display of vitality and vigor. Turning to leave, I patted Mrs. I on the shoulder, but it landed too lightly and too frivolously for it to garner the sincerity and intimacy that I had hoped to convey. Mrs. I looked up at me, skeptically, with one bulging eye, as if to inform me of exactly that.

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Clicking the second of two doors gently behind me, I looked up to find my intern, A, bouncing happily towards me. “Good morning,” she chirped. A was unfailingly upbeat and spritely, precisely the opposite of the strung out, disgruntled stereotype of a resident that older, wiser, fourth-year medical students had advised me to be wary of.

“New patient in room twenty-six. Just came up to the floor from the ER. She came in for right foot drop, but also had some shortness of breath.

She got a chest x-ray in the ER—huge lung mass on the x-ray, confirmed with CT scan. Also, a recent diagnosis of dermatomyositis. Can you see her this morning?” she said, handing me a big blue binder.

“Sure,” I said, always quick to respond in the affirmative, and trying hard to mirror her own enthusiasm with the pitch of my voice. After two days of Mrs. I (whose particular brand of the tough girl act I quickly grew to adore, by the way), I was ready to have a new patient on board. Mrs. I was my very first patient as a third-year medical student, and her multiple medical problems were a complete enigma to me, so I was thankful for what I assumed would be some uncomplicated, nerve-compression-induced foot drop. But as I reviewed Mrs. W’s ER admission forms, the “huge lung mass” that A had mentioned began to sink in. Mrs. W wasn’t admitted for a benign case of foot drop. She was admitted for the incidental finding of almost certain lung cancer.

Well, okay, I thought, catching a glimpse of my wrist watch—time to meet Mrs. W, however uncomplicated or complicated her case might be. So I repeated the three digits of her room number in my head, as if I might forget them (but mostly as a self-soothing, courage-gathering sort of exercise), and I made my way down the hall.

The door was open, with a curtain pulled halfway around her bed for privacy. Mrs. W’s sister was the first person that I saw as I approached. She was a pleasingly plump woman in a cheerful summer dress, and she sat in a chair in a corner near the door. Her face was broad and open, with a welcoming smile, and she had the air of an encouraging grade school teacher, or a kindly aunt. She stood up to shake my hand, putting aside a pen and piece of scratch paper she had been holding. Mrs. W was not yet in a hospital gown. She sat poised at the edge of her bed in a deep green V-neck dress, with a mollified rash dripping down around a prominent set of clavicles. She had sophisticated bangs that slid neatly along her forehead, dark-red lipstick against deep brown skin, and clear polish catching the dim fluorescent light on her fingernails. And still, her big bewildered eyes when she looked up at me made her look like a frightened child.

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Over the course of that first encounter, Mrs. W told me about everything from her cardiac ablation several months prior, to dress shopping for her sister’s upcoming wedding. We talked about her teenage son, her job, her recent divorce, and her unintended weight loss. She didn’t ask me about cancer, or about what came next, or about how her lungs sounded through my stethoscope. But before I left her room, she did tell me that she “was still processing everything,” that she was overwhelmed, that she had expected to be able to go to work after “stopping by the ER just to get everything checked out.” She had a calm, low voice, and there was a stillness about her, but even so, her fear was unmistakable. It burned right through her slightly timid, people-pleasing sort of smile.

While Mrs. I continued to live behind double-doors, Mrs. W quickly became everyone’s favorite patient on the floor. Even those who hadn’t been assigned to take care of her knew her. She was gentle and warm, and she remembered everyone’s names, and she never had a single complaint through all of our finger-pricking, and lung-listening, all of our repetitive questions, and our five in the morning please-wake-up-now nudges. Nurses stopped by her room when they didn’t need to, the resident checked up on her far too often, and so did I. Somewhere along the way, with all those people dropping in and out, and the oncologists coming by every so often, Mrs. W had come to understand that she had lung cancer.

The morning on which Mrs. W was scheduled for a bronchoscopy, she was noticeably quiet, so I asked her if she was nervous. She responded by asking me, “Have you ever seen anyone come back from this procedure?” I was wordless for a moment. Though I had yet to do any reading on the subject, I was certain that the risk of death by bronchoscopy was negligible. But since I had never taken care of any patient who had had a bronchoscopy before, the best I could do was explain the procedure, promise to print out some material for her to read about the procedure, and listen to her concerns. Before I left, I reminded her of how much courage and strength she had exhibited over the past few days, and told her how deeply I admired her optimism.

All of our patients, whether they present with terminal illnesses or trivial ailments, are afraid. Some of them are afraid of dying, and some are afraid of procedures, and some (like Mrs. I) are afraid of being afraid. All of them are entitled to their own particular kind of fear. Mrs. I and Mrs. W were both born within a decade of each other. Both had grown up and lived their entire lives in the same state. Both were divorced with teenage children. Both were suffering from life-altering illnesses. And yet, caring 53

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for each of them simultaneously was a study in contrasts. While Mrs. W embraced her fears and relied on the people around her for help, Mrs. I’s self-sustaining strategy was to convince herself and everyone else that she was unshakable. Fear is not a rational creature, and how each of us reacts to fear may not be a choice, but an instinct. Sometimes the lion-hearted tremble at the tip of a needle. Sometimes they roar. As physicians, we must learn to be receptive to both.

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FICTION

Going Home PRISCILLA MAINARDI

“Last night, I dreamed I was walking down the street,” the patient said when I went into the room. She was sitting up in bed, running a comb through her hair. She had arrived by ambulance early this morning, straight from the nursing home to our floor, admitted with gastritis.

I turned her statement over in my mind for a moment. Then I saw that the blankets lay flat where her legs should have been. It was a long time since she’d walked anywhere. “That must have been a nice dream,” I said, smiling. I held out my hand. “My name is Devon. I’ll be your nurse today.”

“Sybil Moran,” she said, taking my hand. Her fingers were warm. She wore round, black glasses and a gold ring on her left ring finger, thin as a wire. “I was back in Jersey City where I grew up. There were birds singing in the trees. I could hear the birds and I could see them singing, but I couldn’t match the songs to the birds singing them. Then I woke up and they sent me here.”

She must have seen something pitying in my face, because she said, “I’m fine now, dear, don’t worry about me. I used to be a great bird watcher. Not anymore.” She put the comb back in her purse, which sat open on the bed next to her. “I’m so damn thirsty. Are they letting me have anything to drink?”

“Let me check with your doctor.”

“She’s bleeding,” Dr. Spellman, her gastroenterologist, said to me on the phone. I was standing in the nurses’ station, the other nurses flowing around me. “I want to get her down for an endoscopy. Right after lunch. You can give her clear liquids. But better check with renal first.”

I called Dr. Ahmed, her renal doctor. “Dr. Spellman wants her to go to Endo.”

“She should have dialysis first,” he said. “I’ll have the nurse from the unit call you to set it up.”

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“Can she eat?”

“What did GI say?”

“Give her clear liquids.”

“Fine.”

I went to the pantry and heated a bowl of chicken broth in the microwave. I brought it to Sybil with a cup of apple juice. I checked her blood sugar, which was in normal range, then asked her the thousand questions required to admit her. A middle-aged man sat at the foot of the bed, watching me punch keys on the computer to enter her answers.

“This is my son, Scott,” Sybil said.

I said hello to Scott. Sybil said to Scott, “Doesn’t she look just like Miriam?”

Scott nodded. “Yes, she sure does.” There was a coziness to this exchange that reminded me that their lives were a whole world apart from me. I had a walk-on role only. I pulled the curtain and listened to Sybil’s heart and lungs, rolled her to check her backside for sores. Her skin was dry and sprinkled with moles, the flesh soft as an old crushed-velvet purse.

It looked like her permanent state, as if she had been born this way. I tried to picture her young and strong, hiking through the woods with binoculars around her neck. That old age overtook a person gradually seemed to be something I had to relearn every day.

“I have to start a line for when you go to Endo,” I said, rolling her back over and raising the head of her bed.

“They can’t use this?” She lifted the gauze-wrapped ends of the Shiley catheter in her neck.

“That’s only for dialysis.”

I examined her arm until I found a little vein on the side of her wrist.

A woman came into the room and stood by the bed and stroked Sybil’s head. “I’m glad they’re finally getting your stomach trouble straightened out, Mom,” she said. “You’ll be coming home soon.”

The woman’s face was broad and unlined, her teeth white and even.

She wore green eye shadow. I thought: this is what Sybil looked like when she was young. The woman turned to me. “Last time it was her heart, now it’s her stomach. We’re going to take her straight home to our house this time. She hates it at the nursing home.”

“Everyone does,” the son said.

The woman sat down next to him. He turned and kissed her on the lips. “Beth, honey,” he said. “Glad you made it.”

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Oh. She must be the daughter-in-law. Still, I thought I detected a resemblance to Sybil. I tore open an IV start kit, cleaned Sybil’s wrist with alcohol, and unwrapped a catheter. I tied on a tourniquet, pulled the skin on her wrist taut, and pushed the needle into the vein. I could feel the couple’s eyes on me, watching me closely. The needle flashed with blood and I let out a breath. I released the tourniquet, flushed the catheter with saline, and taped on a dressing. “Looks like it’s going to be dialysis first, then Endo,” I said. “Can I do anything else for you in the meantime?”

“Can I have some more broth?” she said. “It tasted so good.”

Most patients found the broth too salty. But maybe her mother had brought it to her when she was sick as a child and she found it comforting.

I went to the pantry and heated up another bowl and brought it back to her room.

Her family had left. I leaned down to set the broth on her table.

“Someone loves you,” Sybil said, pointing to the necklace I wear every day, a thin silver chain with three rings suspended from it.

“My father. He gave it to me when I turned eighteen.”

“Married, dear?” Sybil said, looking up at me. Her eyes, nearly lost in wrinkles, were bright blue.

I shook my head.

“Always been a nurse?”

“Yes.” “Ah,” she said, smiling and nodding as if I’d settled something she’d been wondering about for a long time.

I smiled too, and turned to leave. “I’ll let you know when dialysis is ready for you.”

Endo called for her at eleven. “I thought she was going to dialysis first,” I said.

“Guess not. Dr. Spellman wants her down here. Did she eat?”

“Clear liquids.”

“Okay. Send her on a stretcher. We’ll send her to dialysis from here.”

I got a stretcher from the end of the hall, covered it with a clean sheet, and wheeled it into Sybil’s room. She had something pink in her hand, a disposable razor. She was removing stray hairs from her chin with it. “Looks like there’s a change in plans,” I said. “You’re going to Endo first.”

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fingers, her grip firm.

“Sure. I’m here till three.”

“Code Blue. Endoscopy. Code Blue. Endoscopy,” I heard from the loudspeaker. I was standing in the hall charting at one o’clock. The floor seemed to come alive with a buzz of voices and a flurry of footsteps, as if a code was just what we’d been waiting for. But as soon as the word “Endoscopy” sank in, the commotion died away almost as soon as it had started.

But Sybil was in Endoscopy. I had sent her down there less than two hours ago. My heart made a little jump into my throat. Sweat dampened my uniform. I went into the nurses’ station, and just as I was picking up the phone, I heard the operator again. “Cancel Code Blue. Cancel Endoscopy Code Blue.”

I called Endo. “We were just calling you,” the nurse who answered said. “Mrs. Moran expired in room three. We’re sending her back up to you for post-mortem care.”

“No. Wait.” I had been standing, but I sat down quickly when I saw Sybil’s son and daughter-in-law coming up the hall. I didn’t want to face them until my heart stopped pounding. I took two deep breaths. “What happened?”

“Cardiac arrest. We had just finished. She was a DNR so we cancelled the code.”

“Well, yes.” I had put the yellow DNR bracelet on her when I admitted her.

“Dr. Spellman’s still here. Can you send the family down?”

I hung up and walked down the hall to Sybil’s room, awash in disbelief, the feeling I have whenever a patient dies, and that I had when my own father died. But he decided to fight the cancer, I wanted to say to someone, anyone. He’s not ready, he’s too young, there are still things I need to ask him— Sybil had left her glasses on the table. A folded scrap of paper still marked her place in her book. She expected to return, and we all expected her to. We always expect to return, and for our loved ones to return to us.

Beth stood at the window, gazing down into the parking lot. The toilet flushed and Scott came out of the bathroom.

“The doctor wants to talk to you down in Endo,” I said. “It’s on the first floor. I’ll take you down. It can be hard to find.”

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They exchanged glances and followed me out into the hall.

I couldn’t tell Scott his mother had died. We weren’t allowed to impart this news, or give much important news at all. Our communication was limited to helping patients and families understand their condition and verbalize their feelings about what they already knew. We did this by asking open-ended questions and calling on a series of stock nursing phrases. Has the doctor talked to you about your options? Is there anything you’d like me to explain? That must be difficult. We’re here to help you.

But none of these fit. Small talk didn’t feel right either. Finally I said, “She really enjoyed the chicken broth this morning.”

Quick smiles and nods. Scott said, “Maybe she can have some more when she comes back up.”

I nodded, fighting to keep my face neutral. By now we were in the elevator. The doors closed. “I wonder what the doctor wants,” Scott said in a worried voice as we descended. He turned to me, brow furrowed. “Do you know, Devon?”

The doors were opening. I took a chance, veering widely from the script; Scott would only have a few moments to ponder my words before learning the news. “Whatever it is, I’m sure your mother wants you to be strong and happy.”

Back upstairs I stood in the doorway of Sybil’s room. I intended to tidy up, but it was too soon. I was still trying to absorb her death. I had been so swayed by her family’s hopeful conversation this morning about bringing her home that I had had no idea she might die. It was too sudden a shift to take in. But now I saw, looking back even from this short distance, what I had failed to see before. She was very frail, ill enough to wear the yellow bracelet designating her as a DNR, a patient who has chosen not to be resuscitated.

I went away, leaving the room untouched. Best not to disturb the signs of her last moments here. Best to leave it for her family.

My manager called me into her office and asked me what happened. I recited the facts, the same way I would later write them in my nurses’ notes, repeating verbatim the conversations I had with her doctors and listing my actions: I admitted her, assessed her, called her doctors, checked her blood sugar, brought her two bowls of broth, sent her to Endoscopy. I left out the inescapable fact that maybe she should have gone to dialysis before the 59

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endoscopy, that maybe she was too frail to withstand the sedation, the sidelying position, the insertion of a tube down her throat that the procedure entails. Lorraine called Endoscopy and asked them to wrap the body down there.

None of this began to cover what transpired between Sybil and me, or to encompass the last hours of her life. She told me her dream, talked about birds, asked me about myself. She was going home.

I was glad I had brought her a second bowl of broth.

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Appetites

DAVID ALLEN SULLIVAN

We wheel our father out of the dementia ward through passcode-barred doors.

His head lolls forward, triples his chin, and his eyes are recessed, piggish.

He shouts, “giddiup” to speed my older brother who motors him on, waves fatted fingers towards where he wants to travel.

We give him choices only when we’re sure what he’ll choose. He takes us outside, sucks up air.

I pluck a birch leaf for him to feel. He sniffs once, turns it over, then pops it in his mouth.

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my hands and complains, gagging on stringy veins, “Mine!”

“Marc, please don’t tell Mom, she’ll go ballistic, say I poisoned him.” So chew in camaraderie.

It’s tart, astringent.

He points at another. We could feed him the whole tree.

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P O E T RY

Flight

DAVID ALLEN SULLIVAN

The day my dad’s felled by a stroke from which he won’t recover, I bike my daughter to school as always. Speckled hawk, back plumage roughed against the cold, perches high on a telephone wire. Redtail turns, looks through me as always. This time I drop my bike, raise my cell to take a photo.

The screen shows only arcs of the quivering wire.

No one’s called me yet.

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FICTION

Remembering Lily ANGELA M. SHUPE

“Annie, look who’s come to see you. It’s your daughter, Lily.” Hearing her name spoken out loud, Lily cringed. She watched the young aide place two beige pillows behind Annie. Holding the old woman’s hands, the aide coaxed her forward to prop her up. Lily set her briefcase down and sat on the ottoman facing her mother.

“Hi, mom.” Her mother didn’t move. It wasn’t like Lily expected her to, but some acknowledgement would be nice.

“I’ll leave you two to talk, Lily,” the aide said. She gently patted Annie on the back before turning to walk away. At the mention of her name again, Lily nodded her head, irritated. She’d always hated that name.

It was a weak name, not fitting for one arguing across courtroom tables. As soon as she’d passed the bar, she started going by L.K. Stein. Why her mother hadn’t just named her Katherine to begin with, she could never understand. Katherine was a good, strong name. She’d considered using it, but decided against it at the last minute, thinking that with L.K. there was the possibility of surprising an opposing attorney with her gender. Anything that might throw them off their game could come in handy, and L.K. exuded power. Lily did not.

Her mother took a moment before looking up to see the face that belonged to the voice seeping into her thoughts. It sounded familiar.

Maybe a cousin, a friend from long ago. Yes, definitely a cousin. But what was her name again? It was out there, beyond her reach. Try as she might, she just couldn’t grasp it with the clutches of her mind. She seemed friendly. Annie smiled.

Then, it was there. This was no cousin, this was Lily. Lily had come to visit. She’d not seen her for so long. Annie willed her body to jump forward to embrace her. But her arms didn’t follow the path directed by her mind.

She slumped forward instead.

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“I’ve brought you something,” Lily said. “Something Aunt Helen wanted me to give you. She sent it awhile ago, but you know, I’ve had meetings nearly everyday…” Lily let her voice trail off. What was she saying?

Her mother wouldn’t care about her job. Annie never had a career, just settled for raising her kids, volunteering around the community, and tending her garden. That blasted garden meant more than any of us. Lily pursed her lips at the thought.

“Anyways, Aunt Helen sent this book for you. I think it has some photos of your old house from when you were little.” She pulled the book from her briefcase and handed it to her mother, placing it on her lap. Annie just sat still, eyes focused down.

My gosh, can she even see it? Lily sighed, exhaling frustration at her mother’s apparent inability. This was futile, she was sure. She reached for the book, and opening it to the first picture, leaned it up so her mother could see.

“Well, this must be you and Aunt Helen. Is that your Dad?” Lily waited for an answer that never came. She pointed to another photo, this one of a frail woman with black hair loosely pulled back. In front of her stood three children: two young girls and a little boy. “That’s your mother, right?” The woman in the photo had a smile on her face, but it looked forced. Scrawled in the corner, the date read May 12, 1938. “Must’ve been taken just before the war.”

Still no response from her mother. The picture was loose, so Lily placed it in Annie’s lap before picking up the book and turning the page.

Deep down, dormant memories like bubbles began rising to the surface. Annie could feel them. They lay just on the periphery of her grasp until slowly, one centered in her thoughts. “Mama.” The word echoed in her mind in a child’s voice from so long ago. Wrinkled lips struggled to form the name she once called as a small child. Of course, it was her mother.

Lily had already gone through two more pictures, but Annie sat looking intently at the faces staring up at her from her lap. It was a winter scene. Annie felt it instantly—the frigid cold. It hit her as if she were standing in the snow in front of the house in the picture.

Lily had never seen the house her mother had grown up in. She knew little about her mother’s past. Annie had rarely talked about her childhood.

Lily and her brother, Noah, assumed her silence had something to do with the war. It never bothered Noah. But Lily resented that the silence was there at all.

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little time for Annie. As a teenager, she’d wondered if her mom even wanted her, given the chasm between them.

And there was always Annie’s garden. Her mother loved that garden.

Might as well have been another child, Lily thought. Annie was a good gardener and had spent countless hours tending it. The day Lily left for college she’d stood in that garden, wondering what her mother could possibly see of interest in those flowers that received so much of her attention.

Annie’s cough tore Lily from her thoughts. She looked at her mother, so small and weak sitting on the mossy green couch. She looked like a helpless child, like the shy girl in the picture. Annie had always seemed weak to her and weakness was something Lily abhorred in herself and others.

Lily felt like she’d burst if she had to stay any longer. She bolted off the ottoman, looking at the Cartier on her wrist. “Well, Mom. Wish I could stay longer. But, you know. I’ve got a meeting this afternoon. Got to get out of here or I’m going to be late.” It was a half-truth, but she didn’t care. She placed the open book back in her mother’s lap, then bent low with a kiss that never reached Annie’s cheek.

“See you, Mom.” Lily started down the hall. “Enjoy the book,” she said without turning back. She walked fast towards the main hall leading to the exit. If she could’ve run without looking the fool, she’d have sprinted to the door. She hurried to the parking lot and pulled out her phone, dialing her brother who she was sure wouldn’t pick up.

“Yeah…what’s up, Lil? What are you doing calling so early?”

Lily stumbled on her words, surprised to hear his voice. “I…I just wanted to say I just visited mom.”

“Mom? Really? What’s wrong?”

“Nothing. Nothing’s wrong. She’s fine. Barely spoke a word.” Lily almost added, “just like usual,” but refrained for her brother’s sake.

“Oh…well. Okay.”

“I brought her the book Aunt Helen gave her. You know the one with the pictures.”

“You mean the one she gave you a year ago?” She could almost see Noah shaking his head in disgust.

“All right. Enough. Yes, that book. I know…I know I should’ve brought it sooner. But, it’s been really busy. You know I’ve got meetings and…”

“Yeah, I know.” Noah cut her off. “Did she like it?”

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“If you call staring into space interest, then I suppose yes.”

“Geez, Lil. Give the woman a break. She’s got Alzheimer’s.”

“I know, Noah. I get it, all right? Anyways, I just wanted you to know I gave her the book…I’ve got to go. I’ll talk to you later, okay?”

“Yeah, fine.” Noah hung up quickly and Lily could hear the silence as she fumbled with the phone to shut it off. She turned and looked toward her mother’s room with a view out to the parking lot and the stamp-sized garden. She thought she could see her still staring down at the book. Lily shook her head and got into her car.

Inside, Annie had turned the page as Lily was leaving. She’d been staring at the same picture ever since. It was another one of the house. It was the house she grew up in, she knew. The one of so many memories. The picture was taken as spring turned to summer, full of sunlight. At one time it was a happy house, filled with laughter and the smells of Mama’s bienenstich, the cake with the name that made her laugh as a little girl—bee sting cake.

Looking at the picture now, Annie felt a heaviness. A sadness came over her.

She sat, intent on remembering.

The young aide who’d brought Lily to her walked up to the couch. She walked softly to not startle the old woman. “Annie, what are you looking at?

Can I see?” The aide gently took the book from Annie’s hands, making sure to turn it, so they both could view the picture.

“This is beautiful,” she said. “Is this where you grew up?” She looked to Annie for a response. Annie crinkled her brow.

The photo was glued into the ancient book over half a century before and was loose. As the aide touched the tip of the page to turn it, the picture came undone and fell to the floor. “Oh, Annie. I’m so sorry,” she said. She picked up the photo and turning it in her hand, she could see some script on the back. It was a handwritten letter dated February 13, 1949. She scanned the words and then began to read them to Annie.

“My darling girl, I came across this photo of our old house & wanted you to have it. So many years of laughter & good memories. And then, we both know, so many of hardship & darkness. You can barely see the door to the cellar where we hid those long, dark years.

But, look at the lilies, Annie! Oh, those lilies! So beautiful in June. I remember how much you loved them. The hours you’d sit & just stare at them through that tiny crack in the cellar door. They brought you such joy. Wild lilies… the most important thing to you that awful summer. You could see them reaching for the sun. Remember how the breeze would carry their scent down to the cellar?

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It made you smile.

I knew you must have the picture, sweet girl. Remember the good, Annie. It was always there, even in the worst of our times.

Lilies for my Annie. My gift to you.

Much love always, Mama” Annie’s eyes grew wet. “How beautiful, Annie. A letter from your mother…all these years later. What a gift…I’ll leave you to look at it.” The aide carefully placed the book and photo on Annie’s lap before walking away quietly to not disturb her from her memories.

Outside, Lily fidgeted in her car waiting for the light to change. The arrow flickered green and she sped out of the parking lot.

From the couch, Annie looked up from her mother’s letter to peer out the window, remembering. “Lily,” she said, her voice a whisper.

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NONFICTION

My Potato Poked: A Pesky Gland Sends a Message ARTHUR PLOTNIK

A curious thing happens to millions of men of a certain age: the sexual gland they least like to think about—the one invariably compared in size and shape to a walnut—aspires to become a big fat spud.

That image entered my consciousness in 1972 via the film Last Tango in Paris. In the most poignant scene, a randy, middle-aged wreck played by Marlon Brando confesses to his young lover, “I got a prostate like an Idaho potato.”

At the time, I barely knew the difference between prostate and prostrate; but fifteen years later an annual exam revealed my own enlarged (and somewhat wonky) pomme de terre, and I found myself mumbling the Brando line in front of the mirror.

I wasn’t particularly worried about the enlargement; symptoms were negligible, and the wonky bits proved non-malignant in subsequent biopsies.

But in fall of 2014 I got a taste of how this tuberous organ—a major player in sexual pleasure—becomes an agent of demonic torment. The laughter you hear is the devil’s, amused at the irony.

As bedeviled taters go, one could say I’ve gotten off easy, at least so far; but the experience awakened me to a special circle of suffering, to conditions endured discretely, with preternatural courage and dignity by afflicted millions—by someone you know and probably someone you love. Allow me take you into the landscape and my own enlightening ride through it.

Not so benign Doctors have a name for the vaguely understood enlargement of the gland between a man’s bladder and the rest of his male apparatus: they call it “benign prostatic hyperplasia” or BPH. It earns Woody Allen’s favorite term—“benign”—only because it is not prostate cancer, the bête noire of men’s ruminations. But BPH has its own twists, some of them as far from 71

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benign as fatal kidney malfunction, and others—as in my episode—merely days of personal-worst agony and weeks of bloody discomfort tinged with mortal terror.

That the prostate is located at the base of a man’s bladder, surrounding his urethra like a chubby fist, is something of a bad evolutionary joke, maybe the devil’s, come to think of it. Because of this design, the urethra—the delicate, critical pipeline for passing water and making babies—must take a perilous route through the middle of that muscular moat, that unstable fluid-processing plant, and (in later years) cantankerous constrictor. Don’t get me wrong; a healthy prostate is a gift that keeps giving. It provides most of the medium of male ejaculate and helps rocket it forth at blissful speeds of up to twenty-eight miles an hour. Why, when such a gland might have blended and delivered its reproductive cargo from a less intrusive set-up, did it have to be involved in the peeing process? But involved it is, and by virtue of its location, often becomes a troublemaker: An enlarged prostate tends to crowd the bladder, even choke its opening, and/or squeeze the urethra to cause a heap of urinary woes. Symptoms may include a pathetic rate of dribble, day-and-night urgency, incomplete bilge disposal, and an acute, terrifying blockage—the panicked cry of, “I can’t pee!” as heard in my house on a Tuesday evening in late October before dinner time.

A “routine” gone awry It is Tuesday morning, the day of the panic, and my troubles begin with a visit to the urologist for a diagnostic procedure, a common one for men with BPH symptoms grown annoying (such as rising five or six times a night to confront the porcelain throne). As I sit in the waiting room, I glance at the faces of other male patients—not an exalting thing to do in a urologist’s office. Men here may be dealing with cancer, infection, sexual dysfunction, incontinence, and the indignities and pain that such maladies and their treatments bring about. Some wear concealed medical paraphernalia that makes their skin crawl. There is a miasma of dread—How bad?

What’s in store?—and several of the patients are accompanied by partners or family members gripping their hands.

I am here merely for a “routine” cystoscopy, a visual probe through my pipeline. It gives the doc an illuminated glimpse of how the prostate is bellying up to the bladder or otherwise misbehaving. The sighting is by remotely lit, flexible cystoscope, a much-improved version of ramrod-stiff, nineteenthcentury probes with hot, incandescent lightbulbs. But the modern instrument, hovering over my littlest orifice, looks no less medieval to me.

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I have to trust the urologist, a skilled young practitioner with an alliterative name that sounds invented for soap TV. He is boyishly handsome, with rosy cheeks he tries to obscure with a patchy beard. In my vulnerable state I look for a touch of compassion in that face; but empathy might be too heavy a burden for urologists, most of whom treat one terrified patient after another. The doctor administers a local anesthetic, puts cold eye to cystoscope, and snakes it down. An equally dispassionate female assistant stands by. Though the wrong-way tunneling feels creepy, it is quick and largely painless. But my subsequent stream—required before leaving the offices—comes out deep strawberry.

“Don’t worry about the color,” the urologist tells me. “It’s normal to see a little bleeding for a few days.” He explains that my potato is indeed very large and “vascular,” meaning lots of blood vessels waiting to be disturbed, although everything else seems to be functioning okay for now. Then, with gravitas, he warns that advancing BPH might call for surgery down the line.

“Down the line” is always good enough for me, as I mentally shove that line from here to the back of beyond. In my case the surgery would entail a partial scooping out of the potato by knife or laser beam, a tricky procedure that ultimately helps some patients, while others suffer the misery of serious, sometimes gruesome complications. But the urologist puts the next appointment months ahead, and I go home and tell my wife, Mary, that it’s all good.

Not good for long, however. In the afternoon comes a little, strawberry piddle here, a little one there, with the occasional red tadpole of a clot.

By late afternoon, it’s more dribble than piddle, then more droplets than dribble, and by early evening—try as I might—nothing but the urge.

The longest night Mary now does the hand-holding as I lie in an emergency room awaiting relief. I am bursting, still blocked by God knows what, as nurses, aides, and a cheery female doctor hustle between their computer stations and storage cabinets. They are working other cases as well and rummaging for a proper catheter—apparently in short supply tonight—to drain the swollen reservoir. When they finally locate one they form a huddle over my groin, taking what seems forever to call the play. At last, a catheter is launched on its journey upstream, but there’s a problem. Confusion. Back to the huddle. More pain. When a trickle eventually finds its way out, it is only the red stuff, no relief. The catheter is removed.

The standard device for such procedures is called a Foley, after Frederic E. B. Foley (1891–1966), an inventive urologist who helped develop the so73

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called “self-retaining balloon catheter.” Failing to win the patent, he still got his name associated with the instrument—not a legacy I myself would cherish. A glance at the lengthy thing just ups my anxiety as the crew gathers for another try. I find out later that once such a catheter tube arrives at the bladder, what keeps it from slipping back out is a balloon-like element that can be remotely inflated (with sterile water) or deflated. For this I should be grateful, since early catheters were held tenuously in place with bandages and tape. Balloons have their own problems, but right now I don’t want to know the dynamics; I just need the damn thing to work.

The probe continues; no strike. If I’m now a basket case, poor Mary is a whole hamper of distress. On her urging, a nurse administers a small dose of morphine painkiller through an IV, but I am no less in agony, just more spacey. Down below, something else is going on: a large plastic syringe—a mini plunger—has been attached to the catheter to pump in a fluid and draw it out along with clots, stones, tree roots or whatever might be damming the flow. The pumping process is repeated for a while, bringing withering new discomforts each time. Something is said about clots now coming out. Longing for someone to cry, “gusher!” all I hear is the cheery doctor’s less-than-cheering observation, “I’ve never seen so much blood with this thing.”

This “thing,” the plunger, has one of those technical names with meanings outside medicine, conjuring images of mixed impact. It is called an “irrigation pump,” and as I hear the word in my druggy state, I feel the suck of a million agricultural ditches on the reservoir. Another such word in the air is “void,” which in urology-speak means urinate, and causes my troubled mind to go directly to the cold, dark, cosmic void from which we come and shall return. “Can you void?” “Have you voided?” Maybe when I’m dead, for chrissake! Even the synonym “micturate” is less stressful to me, with its Mickey-Mouse cartoonishness.

It is now about ten o’clock, four hours since arrival. The crew has been trying to reach my urologist and get him here, meanwhile giving me two more pain medications—another morphine cocktail and some lorazepam, both ineffective except for making me a groggy man in anguish waiting for my kidneys to shoot out of my sides. I’ve had blood tests and other trackings (with twenty-seven indicators) and a CT scan of abdomen and pelvis; no revelations except that I have a body crying under the pain and pressure. Mary is controlling herself as best she can, but laments to me as she massages my neck, “Where the bleep is someone who knows what the bleep they’re doing?”

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At last that someone arrives, a taciturn associate of my urologist, drawn out of bed from across town. I am becoming less aware of what’s happening, but I perceive that he undoes something that has been done and then—oh happy night!—does what has to be done. It is less a feeling of emptying than of diminished pain, but I void! I micturate! My kidneys stay where they belong; I fall asleep and am wheeled to a hospital room for rest and observation, the Foley and its daintily named “drainage bag” in place. Mary accompanies me to sit bedside, with little likelihood of sleeping through what are now the wee hours.

Later, I will get the gist of what apparently happened with at least one of the errant catheters: On its way to the bladder, the Foley took a wrong turn (toward another gland), backed out, and entered the prostate—only to pop out its balloon there instead of in the bladder. Given the prostate’s bloated vascularity, the balloon and all that poking released the multitudinous seas incarnadine, along with their jetsam, flotsam, and clotsam, thus blocking the channel. Only the urologist-yanked-out-of-bed managed to save the night, guiding the Foley home and dropping anchor so it could start its work.

As I lie in the hospital bed, a long night becomes longer. I’m awakened regularly by the floor nurses who read vital signs and adjust this tube, that wire. Observation is not just of bodily functions of course, but also of such traumatized body parts as my battered and forlorn willy. Other than in the coziest intimacies, I’m on the shy side when it comes to airing my genitalia—my “junk,” which better describes its status under the circumstances.

Bad enough Mary has to view it as is, but from the moment I entered the ER my junk has been in the public domain, uncovered at will by anyone at all, peered at, flipped, flopped, manhandled and womanhandled. As reasonable as such de-privatization might be, it is still embarrassing, especially given the state of my abused package—awash in crimson stemming from several points of trauma and staining everything in contact with it. I apologize to a perky young Filipino nurse when she pulls back the once-white blanket. I’m appalled at her having to handle my bag of tomato-red output, just as I am to have micturated the ghastly mix. But she waves off the attitude. “It’s fine, it’s okay. It’s normal,” she sings. But to one not used to the indignity and overall ickyness of a bloody catheter and a transparent, telltale bag the size of a wineskin, it is anything but fine.

The next morning, seeing that I’m still unblocked and that my vitals are okay, the attending doctor sets my release for midday. I can go home hooked to the catheter and in a few days have it removed by my urologist.

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Mary helps me—ouch, the pinching!—move around. Before we leave, a nurse coaches her in handling each of the two types of bags that go with a Foley: the larger one for use at rest, and a leg bag—looking roughly like a quart freezer bag—that can be worn against the thigh beneath trousers.

The receiving tube of either bag joins the end of the catheter at a “hanger” taped to the upper thigh, where clever clips allow for removal and reattachment. We collect all this paraphernalia, leave the room, and walk slowly to the parking garage. With a leg bag hidden under my pants, I join the secret fraternity of walking wee-makers, unnaturally bound to an external plumbing system the world has no wish to behold.

Void-less déjà vu Settling into my bedroom in relative comfort, I’m upbeat. A procedure went awry; okay. Soon I’ll be back to where I was—a writer, enjoying an active life with worries pushed “down the line.” But as the day’s October light fades, I grow uncomfortable. I notice that the levels by which I’ve been measuring my flow into the drainage bag seem to be stalling…stalling…stalled!

I advise Mary to put her coat on and get ready to roll. Damn everything, I am blocked again.

“What are you doing back here?” the same cheery ER doctor chirps to us as we arrive in her domain. Her cheeriness is less out of place this time. My catheter is already attached and tonight she has on hand “the best person” to perform the irrigation—an assistant experienced in the task. Before long, a woman with serious, curly black hair appears, and with reassuring certainty, goes to work. In less than an hour I am uncorked of my “bladder outflow obstruction.” But another tracking of my vitals, fifty-three-indicators this time, shows an unlucky thirteen in the abnormal range. Although most are attributable to stress, an admitting doctor decides that I should stay another night to forestall or treat infection—a grave concern when microbes have been piggybacked up internal fleshways for the last two days.

It takes hours for the room to be available. I encourage Mary to go home and sleep. Once I’m in bed and hooked up, the night is more or less a repeat of the first one: a parade of kindly staff having a gander. I know I am fortunate to be in a good hospital, but my mood has darkened over the prospect of going home only to enter a Groundhog Day cycle of bag, blood, blockage, and back here.

Mary arrives after breakfast, and as always, my heart leaps upon seeing my cherished soulmate. At the same time my noirish thoughts extend to the 76

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burden I’m putting on her and how much worse it could become as we age.

She herself is no stranger to this hospital. Though Mary keeps herself robustly fit day to day, she suffers from occasional bouts of asthma. One severe attack, triggered by bronchitis, occurred in the middle of a frigid night just eight months ago and landed her here for four days. She has counted on me to help her through the fears and crises; but now I think, what if, what if…

As if to cap such thoughts with black icing, my urologist himself—Mr. Empathy (not)—stops by for a few minutes, mainly to tell me that I’d better start considering a long-term treatment for the problem. “Meaning surgery?”

Oh, you mean just an exponential increase in the present gore and anguish plus a Mahabharata of unthinkable risks?

“Yes, probably,” he says.

The urologist leaves and soon the hospital’s attending doctor takes a look. A bit later I learn I’m to be discharged after lunch. I’m surprised, feeling as shaky as I do. The doctor must have been influenced by my steady flow, acceptable vitals, and maybe the HMO insurance denying me nonemergency care in this hospital.

Home care and cares I—who in the first weeks of this October was kicking leaves with Mary on a New England jaunt, bike riding, whacking golf balls, patching our house, writing, socializing, acting generally youthful in my cool, leather jacket—am closing out the month a decrepit old man, or so it feels. Physically run down, I spend a lot of time in bed the first two days home, obsessively watching the bag for signs of the next crisis. When I’m staggering around with Mary’s help, the bag and catheter are my ball and chain and make everything an ordeal: washing, dressing, changing positions, sitting down—worst of all on the throne, where the demons Strain, Pain, and Stain await.

It hits home how life is a series of dispiriting ordeals for so many of the world’s damaged bodies. While I try to see catheterization as only temporary for me, I think of its ceaseless toll on men like the war-wounded or prostate cancer sufferers. That territory now stokes my fears, especially the fear of dependence. I am now in decline, says a voice in my head. Could I bear even one more of the likely afflictions of aging? I proceed to imagine a superannuation of one disability after another. I brood. How quickly a life becomes flimsy and useless. Whatever vitality I’ve enjoyed seems irretrievable. Vanities evaporate.

I’m disgusted by the funky whiff of blood, like old steak. I see myself as a repugnant, rumpled simulacrum of the former me.

I try to remind myself that I’ve reached the prelude to old age with 77

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good fortune and in remarkable shape, that I’ve dodged a hundred bullets, that millions—hundreds of millions!—of the world’s people undergo vastly greater suffering than I will know even if catheterized the rest of my life. I try to present a brighter face to Mary, but inside the baby is mewling and hating itself for it.

She tries to help. “Hon, you’ve just been though the worst pain in your life, the stress, the bleeding, the drugs—of course you’re weak and feeling down. Your system is just telling you to rest. Stop worrying.”

Okay, I try not to think about getting another big clot. Clot, that ancient Old English word that sounds exactly like what it is. Instead, I round up all the ailments and procedures that could possibly be down the line—incontinence, shingles, cataracts, diabetes, tumors, stroke, Parkinson’s, Alzheimer’s—and bring them to “just around the corner.” I swim in these turbid waters until I fall asleep.

When I wake it’s Halloween eve, when normally we would give out candies to the few kids still allowed to roam the city streets. This time, empty-handed, we keep the porch and the front room forbiddingly dark.

Too bad. I should come to the door naked, the whole mess revealed for hard-to-scare tricksters.

Nights have been wicked. One has to sleep in rigid positions. Bags fill and need emptying. Morbid pre-dawn thoughts are the worst. And yet today—my third at home—trickles of strength and spirit somehow enter my corpus, driven by healing hormones or whatever recovery mechanisms still work. Though red continues to speckle garments and outflow, I begin to accept the possibility of no more blockages, no more night flights to the ER. I perform more routines unaided, move around, find an appetite.

Midday I get the first of two scheduled home-health visits, set up during the hospital stay. Having associated such things mainly with feeble old folks, I’ve been anticipating the visit as an official inauguration into that club. But the nurse, a woman of about fifty who attends me with sinewy arms and kind hands, exudes such robust health that I feel it spilling over my hurts, like balm. After an exam we chat, and Mary and I learn that she’s done courageous field work abroad, was even weighing a stint in Africa to help fight Ebola—much in the news these weeks—before her family held her back. Imagining the horrors she’s seen, I wonder how my case registers with her. A widdle boo-boo in a white male’s woo-woo? But she carries out this visit (and later the second one) as engaged as if world health were in the balance, taking great pains to keep things sterile and sanitary.

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to cause nightmarish ones, which is why I’ve been on a potent antibacterial drug called Levaquin (levofloxacin) since the hospital stay. I’m generally wary of such scorched-earth drugs, but the warnings and contraindications for this baby take up three pages of fine print. I read them with trepidation.

Each danger seems to be underscored for “the elderly”—a phrase I used to skip over blithely, but no more. Death, one of the possible side effects, would be a blessing next to some of the others listed, “rare” as they might be. It was my urologist himself who once told me, “’rare’ is rare until it happens to you.” So I pop one of the orange tablets each day waiting for my brain to hear voices, tendons to collapse, tongue to swell like a dirigible, and heart to throw a piston.

Happily, the drug does what it was meant to do, besides make money.

It helps me get through the week without the wrong kind of culture subsuming my body. Lesions are healing; my flask of vintage red turns rosé.

Tadpole clots shrink to mere roe. Energetic, if still existentially shaken, I get to my desk to poke at writing projects. Mary and I take short walks. And finally, on a morning seven days after being so rudely catheterized, I arrive at the urologist’s office with Mary to have everything detachable removed.

Out proves to be infinitely easier than in. The Foley balloon deflates; I feel the catheter tube slide from bladder through the potato down the pipeline and—adios! It’s almost a pleasant sensation. Choosing not to look at the thing, I lie peacefully until the urologist helps me rise and swing off the table, a free man.

I dress and the three of us convene in the examining room to discuss future strategy. But before the doctor can depress me anew with talk of surgery, I sneak in a question that’s been on my mind, accompanied by horrific images: “What on earth was done to men long ago when they couldn’t pee?”

I expect a shrug or a blunt answer, like, “They died screaming. See you next week.” But suddenly, it’s as if I’ve brought an automaton to life. The doctor relaxes in his chair, his face brightens, and with a flash of his white teeth he laughs and offers historic tidbits—how a type of green onion would be used as a catheter; how castration was and still would be an effective, if unpopular, treatment for BPH; how Benjamin Franklin was said to have concealed a silver catheter beneath the head of his hollow cane and how he and others would self-catheterize; how, if we’re ever in Baltimore, we should visit an outstanding museum of urology with its displays of past instruments and procedures.

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detachment I’ve taken for compassion-fatigue may instead be an intense devotion to the science and craft of treatment, perhaps the one thing more critical than a bedside manner for a surgeon of delicately intertwined organs of life and joy.

Mary, who doesn’t quite share my new perspective, is happy to learn that for now I’ll simply be going on a medication (finasteride) that can shrink the potato significantly. “It’ll take four to six months to start working if it’s going to work,” the doctor advises, “but let’s keep a check on how you’re doing and we’ll see.”

I had tried this very drug a few years earlier. It had mitigated some symptoms of moderate BPH, but side effects such as deflated libido and swollen breasts led me to go off it. I’d decided to gamble again on housing a big potato, resisting pressure to deal with it once and for all surgically while my body might still handle the trauma and heal again. But now, given my glimpse of potato-poking gone awry, just hand me those capsules and a bra.

Let ‘em laugh, those who would check out a man my age. As for navigating the dips in sex-drive—well, the thrilling, hands-on love driving our more than thirty-year marriage isn’t going to change, whatever the going libido.

The literature that comes with finasteride (and its cousin dutasteride) reveals that all isn’t shrinky-sweet. Rare side effects include an aggressive form of prostate cancer. But there’s a fair chance that with ongoing daily doses I can once again push the bad stuff down the line and allow myself to savor each normal day.

In one of my short stories, a troubled soul passes through airport security after “they’d checked everything but his prostate, the one ticking bomb they allowed a man to take on board.” As we age, a thousand such bombs— mostly unpredictable—start ticking in every nook of our bodies. We can try to have them defused one by one or let the damage come when it may, hoping for late or never and going on with the best, healthiest lives we know how to live. I believe we take our chances either way, acting neither courageously nor cowardly, but according to our faith in the defusers. Me and my potato? With luck, we’ll be holding off the bomb squad for a good while.

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Facing Up MILTON J. BATES

Prostrate is how my wife pronounces it, the name of the gland they carved from my father’s father in his nineties, hurrying a robust old man into his grave.

The gland my father’s doctor stuffed like a pomegranate with cancer-killing seeds so he could die of something else.

The gland that sends me on a nightly errand to the bathroom.

Back in bed tonight, I ponder the Hobson’s choice my doctor offered: take a yearly census of those telltale proteins in the blood, then wonder what to do if they run rampant; or skip the tests and live in willful if not blissful ignorance. Choose your poison, he said.

How did evolution bring us to this pass?

Prostrate my wife calls it. She may be on to something, how we’re brought low, by the bullet lodged in our loins.

It’s 2:00 a.m. and I’m still supine, studying the ceiling. But I’ve decided.

You and I, Great-Grandfather.

We’ll have blood and ignorance in common.

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An Imprecise Science ZACH JACOBS

It was a joke. I swear it was a joke.

I’m lying on the couch watching Conan the Barbarian on TV, my older brother, Kyle, slouched in the matted brown armchair a few feet to my left. My mother walks in from the kitchen with a concerned look on her face, approaching me. She doesn’t sit on the coffee table. She stands on the other side of it. “We need to talk about something.”

“Okay.” I sit up lazily. I’m in trouble.

And then it all breaks down into something simpler, something visceral. She’s telling me that she talked to our therapist about what I had done, the joke with the cord, and Mom agrees with her that I should go to the hospital for a few days. She’s asking me to go to the hospital not for a checkup, not for a therapy session, but for a stay. I’m ten years old, I think to myself, and it was just a joke. I say, “No.” So it comes to a point. I don’t realize how much this matters to her until she’s on her knees in front of me, all tears, with my hand in hers. They stand out, these words, making everything else stop and grow dim, everything else quiet.

“I don’t want to lose my baby.” I begin to cry too, the way a child does when he sees a parent weep. We sit there and cry and I say “ Yes.” I have to go. I know that she worries about us, her three boys, as much as I worry about her. She’s a single mother working full-time and raising us. Every day is too much to lose.

I say “ Yes” to going to the mental ward. I say “ Yes” for my mom.

People who heard voices in the pre-modern world may have been followed or worshipped as prophets or seers. But by the twentieth century they were locked up and bound, electrocuted, shot up with insulin, their brains played with and prodded by professionals, called insane, sick.

I’m a little envious. I know of no great and terrifying legacy for the Depressive, but he was probably the one in the back of the crowd muttering about how the prophet was full of shit.

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The problem with depression is that it is something that everyone thinks they’ve experienced. It’s easy to dismiss. It’s easy to say, “Get over it” or “Buck up” or “It’ll be better tomorrow.” But it won’t be. It’s a lot harder to think about Depression—Capital-D Depression—as a potentially life threatening condition or illness. And it’s invisible. Most professionals trace it to issues having to do with neurotransmitters in the brain. But physical tests are not administered to diagnose it. One does not examine blood samples or monitor the brain in order to diagnose Depression. Instead the patient is sat down with a psychiatrist and asked questions. You determine whether someone is Depressive by talking to them. So while this diseaseillness-condition-disorder-imbalance is supposed to have a physical source, it is defined by the telling of stories.

I’m good at telling stories.

I am unique. I am what some folks call “terminally unique.” Surely, there is no one on the planet like me. The world is at my feet; it’s there for the taking. I am a white, heterosexual male living in the middle of the United States and going to one of the most prestigious universities in the region. I have many scholarships and financial aid because I am smart and poor. I am majoring in Biology and will be admitted to medical school in four or five years. I graduated second in my high school class with a perfect GPA—the same high school where I was co-captain of the football and wrestling teams and Prom King my senior year. I will be wealthy and successful. The world is on its knees, begging me to stop kicking the shit out of it. But none of it matters because I am worthless. I will never be happy. Life is a meaningless waiting room. I hate myself, and I just want to die. I am unique.

Terminally.

Bipolar Disorder is diagnosed in the same way as Depression. At age nineteen, after telling my story to a psychiatrist and a panel of medical students in an adult inpatient unit, I was stamped with both severe Depression—Major Depressive Disorder—and Type 2 Bipolar Disorder. I was promptly prescribed Lexapro, an antidepressant, and Topamax, a mood stabilizer that made me nauseated. Soon after I had been released from the adult inpatient unit, the mental ward, I was in a group-therapy session around people with real problems feeling like I was going to pass out, my head light on my shoulders, my stomach unsure of itself because of the Topomax. When I told my stories to my new, more permanent outpatient psychiatrist, an advanced practice registered nurse, the Bipolar stamp was removed. I stopped taking the Topomax; I felt better.

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I want to be honest with these professionals. I may be nineteen, but I know exactly what they’re asking me, and why. They are the determiners of my fate in this hospital. Dr. Wu, a slight man with thinning black hair and a perpetual look of concern behind his big glasses, asks some simple questions from his post on the right side of the long conference table. He’s accompanied by five medical students.

Mom sits quietly to my left, Dad to my right. There is a box of tissues in front of us. I tell of my descent into madness. At least that’s how I think of it now. I tell of the night over two months ago in my first semester at college when, under pressure both academic and psychological, I snapped. I sink into the rhythm here.

I’ve danced this dance before, written it and told it to blurred, faceless people who listen to me in my head, and I’m sure I will do it many times after today. I tell these faces and white coats that I had a profound realization that night. I tell them I found that all my feelings of worthlessness and loneliness and pain were, in fact, justified. I realized that I was broken, that I wasn’t meant to be happy, to succeed, to live a normal life. I could wade through the slop for a long time, sure, but it wouldn’t really be a “life” so much as a benign, boring, heartless existence— animal, obligatory, hollow.

So, I explain, it was not worth it. For two months I had planned my suicide, hiding it like the Dickensian Madman, seemingly normal on the outside but burning for blood within. I bided patiently, deciding the best course of action and waiting for the right time, that time when you finally say “ Yes.” For two months, I tell them, I sat in darkness both literal and existential, having lost faith and purpose and certainty and happiness. I slept so much, so often, because I hoped, fantasized every time, that I wouldn’t wake up, that I would slip into the dark pool of the abyss. I’m being melodramatic, of course, but I’m nineteen and lost, fucked by my own mind.

Of the six professionals in the room, there is one woman. Young, fair, and pale with soft features, she fits as easily as the rest of her cohort into this ward— ordered and composed and stainless, easily washed of the detritus that accumulates here. And then she breaks the fourth wall. I’m so consumed in my tale that I barely notice her reach for the box of tissues, but as she pulls one and wipes tears and snot, I try not to pay too much attention and embarrass her despite the sick thrill of it.

At least she is listening.

I finish, and the man sitting opposite me at the far end of the conference table begins. He is clearly the leader of the troop of students. He alone asks the questions. I’m sure it was axis for axis straight out of the DSM IV: Major Depressive Episode. More than one in a short period, Major Depressive Disorder.

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enunciating perfectly through his perfect teeth with his perfect hair and suit and pristine white coat, he clearly moves on to another mood disorder. I know that he is, in so many words, asking me if I am Bipolar, hanging on to every word and every facial move and gesture like a cop in an interrogation. And I realize only now that I have to be careful; it’s not just your story, but how you tell it, that matters. I have to be careful, but I want to be honest. In this setting, being hopped up on caffeine can earn you a new disorder.

Invisible diseases are hard to deal with, like invisible monsters, voices from invisible people. Everything is imprecise, including the diagnoses and drugs. Lexapro is an SSRI, a selective serotonin reuptake inhibitor. Think of it this way: neurons in the brain are like spark plugs, and the synaptic clefts, the spaces between them, are the plug gaps. Neurotransmitters like serotonin, dopamine, and norepinephrine are the sparks that link them, making the whole mess in your head work. Reuptake is the absorption of those neurotransmitters, which is natural, but they need to be floating around in the gaps; they need to be accessible, so when too much is absorbed, the spark plugs don’t spark, and you become Depressed— Capital-D Depressed. A reuptake inhibiter ensures that you’re firing on all cylinders. Or so they say. The problem is that the Lexapro didn’t work.

The next time I was in the adult impatient unit, it was supplemented with Wellbutrin.

The science is so imprecise, in fact, that it’s hard to tell if the drugs are working or not. Is it the drugs, or did I just have a good day, a good week, a good month? Was it the drugs, or was I simply stronger than the diseaseillness-condition-disorder-imbalance this time? Wellbutrin, I was told by my inpatient psychiatrist, targets dopamine, the neurotransmitter associated with euphoria, and was to be a good compliment to the serotonin control. After I got out, I talked to my outpatient psychiatrist, who didn’t even know that I had been in and out of the ward again despite the fact that she’s at the same hospital. She said that some believe Wellbutrin targets dopamine, while others believe that it deals with multiple neurotransmitters. An imprecise science.

“I don’t think you’re really a cutter,” he says to me while everyone in the therapy group listens. I agree. I’ve dabbled and experimented, but this guy, he’s got badges, walks around with his story etched into his skin. It looks like he’s wearing a glossy, pink scar-tissue suit that’s been torn and re-sewn a few hundred times, or like he’s covered in the crude, straight-lined markings that young lovers carve into tree bark. He talks about how he always has to wear 86

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long-sleeve shirts to job interviews.

I should feel something, but I don’t. I should be learning something, but I’m not. I just watch him and listen. Somewhere upstairs I’m thinking about how I don’t belong here—that the cute, geeky girl next to me must have been molested by her stepfather; that the alabaster goddess with only a slight speech impediment across the circle of chairs must have been abducted when she was a child; that the guy so drugged up that he draws out his Ss must have watched his mom walk out the door and his dad work himself to death; that the burly, scarred flesh golem with a big heart talking next to me doesn’t need to say a thing.

But I’m not like these people. I don’t have a big hole in my memory where I was fondled by a priest. I didn’t watch my father murder my mother and then blow his brains out. I’m just broken. Straight-off-the-assembly-line broken. I’m not even a cutter. Mostly, I just did it for practice. Slitting my wrists with razor blades seemed like the simplest and easiest way. Lie in a dry bathtub and bleed out, fade to black. But I couldn’t cut deep enough even after practice, even after all the cheap Canadian whiskey. I faded out all right, and then I faded back in on the hospital bed with my parents and stepbrother standing around me. I don’t even have the glossy, pink scars to prove that I meant it.

When I was in that outpatient therapy group at age nineteen, nauseated, with people who had real problems, there was a guy who was medicated up to his eyeballs. One day he brought in his key synthesizer and performed a rap song he had written. Slow. It was a slow rap. He talked like he was shitfaced. I guess he was. Loaded on drugs. I could see the pills squeezing out of his eyes like blue and white and pink tears, fat tears with pharma-company initials stamped on them. Once, when he left the room, one of the two therapists thanked us for being patient with him. He was having a rough time, hence the drug-induced stupor. I don’t remember his stories. It was hard to wade through his slurred speech; but I remember the way that words had to climb out of him like labored little workers emerging from a mine shaft—how his eyes were distant, as if he were one degree removed from our collective reality in that room. Shitfaced.

His meds were working a little too well, and mine weren’t at all.

Eventually, my Lexapro was replaced by Fluoxetine, better known as Prozac, another SSRI. But ultimately, none of it worked. I felt the same whether I was on the drugs or not. After years of trying, I stopped taking them.

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where I’m going. A few minutes ago it was all black, then the bang of my younger brother, Taylor, slamming his hands on my car, opening the door, yelling, “What the fuck are you doing?!” with both worry and anger. Then it was mostly anger: “Get out of here!” I stumbled out of the garage into the house as he turned my car off. He came in and told me to go out front. I stumbled, still drunk on alcohol and carbon monoxide. I walked out and a cop was there, and another, and my uncle.

And that is where I started to freak out. It wasn’t because I was confused. I knew where I was by then. It wasn’t because I knew that the cuffs were coming, and the hospital. I had done this drill before. I freaked out and started yelling and cursing because I had failed again. Officer Waltman calmed me down; Uncle Jim calmed me down, both men offering soft words in upturned hands. I paced and paced and tears started running and I sat down on the wood retaining wall that runs along the driveway. Neighbors started to come out of their homes. Oh god, I thought, I failed again. I’m twenty-five and I still can’t get it right. I woke up again. And now I have to live again. What a sick fucking trap.

When I was ten, the first time I was in the mental ward, with kids who had real problems, I was prescribed low doses of Zoloft, an antidepressant. The pharma-giant Pfizer, which manufactures Zoloft, warns that antidepressants have been shown to increase suicidal thoughts and tendencies, and Zoloft is not approved for use in children unless they have Obsessive Compulsive Disorder. An imprecise science. It made me feel weird, like someone was breathing cool air on the back of my neck. I don’t remember when I stopped taking that drug, or why. I didn’t even know why I was taking it in the first place. I do remember cutting the small, baby-blue pills in half and taking them in the morning before school, the way they popped and powdered slightly under pressure of the butter knife against the cream-colored Formica countertop next to the kitchen sink. Sometimes mom would do it for me. Maybe I thought she owed me that. She was, after all, the one who checked me into the hospital because, as she said crying, begging me to go, she didn’t want to lose her baby. I guess I should be glad that she sought my consent. I doubt she needed it. I didn’t know why she said “baby,” either. My four-year-old brother was the baby. I didn’t know why she was so scared or what she was afraid of. I had done something that scared her, some innocent thing that might not seem so innocent to an adult. I was just playing around. When she told our therapist in an individual session, the therapist put more fear into her.

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it would be like. But I recall doing the homework that mom brought from my teacher—the bright primary colors on the pages like superheroes in contrast to the dull whites and beiges of the ward. I remember the older boy with scars on his wrists who taught me how to sketch the roses he used to draw for his girlfriend, the one who had broken up with him. I remember the boy with a limp and a gnarled, paralyzed arm from the car that had run him over. I remember how upbeat he was, and his thin puberty moustache.

I remember feeling truly alone for the first time except when my therapist came for our sessions in the afternoons, or when my family came to visit at night. I had never been as sad as I was when they left. The dark seemed deeper then, after “lights out,” and I welcomed it, a place you could cry without being seen.

I talk to Mom about it—when I was in the ward at age ten. It’s been years.

Sometimes it takes that long to be able to talk. Sometimes you have to revise your story. My older brother and I were cleaning our room and I said something like, “Hey Kyle, look, blaaaaaaah,” as I wrapped my bullwhip around my neck and feigned choking. She says it was an electrical cord. My mom was really frightened.

But actually she wasn’t. She knew that we screwed around and killed each other with sticks and plastic swords all the time. Why was this any different? It wasn’t until she told our therapist in passing that it got serious. She said we were joking around and the therapist said it was nothing to joke about. Then she got worried, and worried that she hadn’t been worried when she saw it. Mom knows now that it was all messed up. She knows that I really didn’t need to spend a few days in the hospital. I say it was Monday through Friday. She says it was Thursday or Friday until Monday. She knows all of this. I know she’s sorry. I know that even if I didn’t need to be there, even if it was a joke, it wasn’t something that she could risk. She couldn’t risk it being one of things that you don’t worry about until it’s too late.

The drugs never helped. They can curb the weird, vacuous diseaseillness-condition-disorder-imbalance that we call Depression—Captital-D Depression—but they don’t deal with your real problems and don’t teach you how to deal with them, or how to deal with new ones. The vagaries of life can be truly treacherous for the ill-prepared. I think that is why they have never worked for me. I wanted to believe that they would. I did for a long time. I thought that if I could just find the right pill, or the right combination, I would be okay. It was easier to have faith in the science than see the world for its uncertainty, its imprecision. I knew that the universe 89

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was infinite because the evidence suggested it. I knew that there was a Big Bang because the evidence suggested it. I knew that my brain was broken because the evidence suggested it. But now I have learned not to put too much faith in anything, because everything is imprecise, even science.

After my third suicide attempt at age twenty-five, it became apparent that something else had to happen besides taking the pills. Or more precisely, I needed to make something happen. The mental ward never worked, even after three stays. You can’t save people from themselves unless they want to be saved and they’re willing to crawl through miles of shit.

Still, I had faith in the science. In the idea of science. I had clung to it for so many years. A few months after my last stay in the mental ward, when I filled out the forms to begin sessions with my current therapist, Karen, I wrote that I wanted nothing short of a profound discovery of the self.

I wanted to find that one thing that would fix me—a metaphorical pill that would make the spark plugs spark. I was still searching for a Grand Unified Theory of the Self. Something to tie it all together. But even Stephen Hawking concedes uncertainty, even when he’s not talking about Heisenberg’s Uncertainty Principle. If there were a unified theory of the universe, it would determine our actions, and it might also determine that we come to wrong conclusions or no conclusion at all, he asserts. And my wish for a Grand Unified Theory of the Self is equally uncertain—uncertain because life is as well.

Even if I did find that one truth that bound me together in an inextricable whole, into an organism, that human organism that only the gods had envisioned, and for which I strive, there is no saying that it would be anything I had hoped for. Hawking has also explained that our scientific discoveries might spell the end of us, and that a unified theory wouldn’t necessarily do anything in the way of ensuring our survival. But I wasn’t looking for survival. I had managed that. Survival ensures life, but life is not just survival. Life is something more. I don’t know exactly what it is, this “more,” but I will continue to search for it. And if I get there, I will have to be okay with the fact that it may not hold all the answers. It may not fix the fissure in my soul.

“I see you wrote on your form that you want ‘nothing short of a profound discovery of the self,’” Karen says to me. “That’s a pretty heavy thing.”

“Well I’ve been in therapy off and on for about… fifteen years, and it’s never helped me. But I’ve got to find whatever it is that makes me the way I am—the flaw. I think that if I can find that, I can fix myself.”

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Karen had come out to the small waiting room, introduced herself, and shook my hand. She had led me into her office that contained a large, wooden, wrap-around desk; plaques on the walls; pictures of family; a table with a couple chairs; a sofa; an armchair; ample lighting; soft colors; and plenty of quiet. I chose to sit in the armchair, not directly facing the sofa, but about 45 degrees off. The sofa, though it looked comfortable with two fluffy, fuzzy pillows, was a bit too psychoanalytic; I might have felt the need to lie down. Conveniently, the angle of the furniture meant that if I stared straight ahead, I would be looking at a wall, or an end-table with toys on it, toys mostly blocking the small analog clock. “What makes you think that you need fixing?� she asks.

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not, October ANNA KREM

I have seen so many of you but not dead, not here, not like this, framed by the black of the cold of the bench rails outside the Harvard Square CVS where I duck in to pick up my meds at the other end of October whose predawn mornings simmer the freezing breeze like caught growls in the throat of a dog trained to bite. Your bold, puffy sneakers hangs off your foot which hangs off your leg off the side of the bench, pulled closer to the steadfast ground from which you had risen, wobbling after the last beer, to lie down between two black cold rails on the wood slat mattress.

Sleep not to wake. and I hope it was peaceful because I picture you young as Matt, maybe, or Cameron, walkin’ the walk with your easy smile when you raise your hand and wave and say “hey, doc!” and name me as yours in the generic genitive of healing, which I have loved. I could not picture you here if you were they and so I don’t. You are only the sneakers anyway. The rest of you (of all of you) is covered in a white hospital sheet, the contour of your never again nose softened into the shape of a commonplace laundered cloth.

An ambulance hovers by, and uniformed guardsmen of this new age crypt direct me elsewhere.

I don’t know why but my mind jumps to the young father with bladder cancer on Ellison who I took care of by not. The first time I touched him was when he died, and after I pronounced him the family thanked me, like I had done anything but bring to being with magic finality the fact of his death, like an exact time two thirty-three could close the gap between truth and sorrow.

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The Summer of Magical Thinking MARLENE OLIN

It was June. Half the town was emptied. The streets of New York City smelled like garbage and remorse. Broken glass glinted on the sidewalks.

Homeless men huddled over windswept grates. It never occurred to Anders to leave. He couldn’t afford a vacation even if he wanted one.

“Good to see you, Garrett.”

His first patient was early. The digital clock flashed: six forty-five, six forty-five, six forty-five. There’d be no time to put up the coffee or water the plants. Anders quickly closed the blinds. Some of his patients thrived in a sunlit office while others wilted. Garrett McCrane preferred psychotherapy in a cave.

“Sleeping any better?” Squinting in the darkness, Anders held his pen and clipboard inches from his nose. Each of Anders patients had two options. Sprawl on the black leather sofa or sit in the armchair. Garrett always chose the couch.

“Not really.” Garrett taught high school English. Soft and stocky, he wore his pants below his stomach and waddled as he walked. Like a basset hound, his jowls swayed as he spoke. “Ambien gives me a hangover.”

“I believe we discussed trying Halcion.”

“Makes me jumpy.”

“Didn’t I give you samples of Lunesta?”

“You mean la siesta?”

Anders forced a chuckle. Most of his patients had either low selfesteem or hubris bordering on delusional. Garrett believed he was Jerry Seinfeld.

“Nope, no effect at all.”

Garrett was terrified of pills. He simply researched them on the Internet and came to Ander’s office with a rehearsed retort. In his notes, Anders wrote: Patient refuses to be medicated again.

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“How’s work?”

“I’m encrypting my emails so the administration can’t read them. Not that I’m putting anything personal in them.” He got up, walked over to Anders’ desk lamp, and spoke into the fluorescent tube. “Because this is one teacher who never watches porn during his free period.”

Anders sighed. “I assure you, Garrett. My office is swept before you get here. No bugs, no hidden cameras.” He flipped through his papers. “I believe we’re approaching the end of your marking period.”

Garrett started pacing. “I’ve been working on a code that circumvents the computer main frame. These kids have access to their grades, I’m sure they have access to their grades. They hack into my laptop and change them before they’re even posted.”

Anders nodded. Every session was a variation on the same theme. The FDA doesn’t monitor the food supply. China’s putting poison in our drugs.

Someone’s listening to his phone conversations or accessing his computer.

As fucked up as Garrett appeared to be, six months down the line each of his paranoid fantasies came true. Anders clipped the articles from the New York Times and kept them in his file. Garrett was always one step ahead of the curve.

His one o’clock was Bina Schwartzman. Bina was a Holocaust survivor. For years she washed and rewashed cellophane. Each time she ate at a restaurant, she tossed the coffee sweeteners in her purse and delicately wrapped the rolls in a napkin. Like many elderly people, she felt compelled to keep anything that was free. But ever since 9/11, her endearing idiosyncrasies started taking over her life. She became a hoarder. The images of people jumping out of the twin towers were indelibly stamped into her brain. And every time she saw them, she bought another can of tuna.

Bina chose the armchair. She always came to therapy in her going-tosynagogue clothes: pearls, a suit, her one good pair of non-orthopedic shoes.

She fished a plastic container with cookies out of her huge purse and set it on Anders’s desk.

“Mandlebreit today, doctor!”

“Thank you, Bina. I’m starving.” Anders opened the box and took a bite. Nothing brought Bina more pleasure than watching others eat. Crumbs fell in his lap. Knowing he was on stage, he rolled his eyes like Al Jolson and licked his lips. Bina studied him, her mouth making the smallest movements while he chewed. “So, how was your week?”

“I made the map, Dr. Steinhoff, like you suggested.” She dug a paper out of her purse and handed it to Anders. “Four feet clearance on both sides.”

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Bina lived in a one-bedroom condo. When Anders first saw the apartment five years ago, his heart jumped in his chest. Piles of flea market clothes and toilet paper had taken over the living room. Towers of soup and peanut butter tottered in the kitchen. Anders had nightmares picturing the rescue squads shoveling Bina out. They’d need a map just to find her bed.

“Did you get rid of anything?”

“I brought some to the Salvation Army, some to the nursing home thrift shop.” Then Bina scratched her forearm. The one with the numbers.

Hoarding was the only thing that made the itching go away.

“Can I see?”

Anders steeled himself. He was a physician and during his training had seen worse. Car crash fatalities, shooting victims. Yet he dreaded this part of their weekly talks. When he looked at the grooves Bina carved into her skin, he felt like someone took a fork and raked his own.

His waiting room was set up to offer his clients privacy. While Bina exited a back door, he greeted his next patient. “Sienna.” Then he shouted, “Sienna?”

Plugged into her earphones and scrolling her iPod, Sienna hadn’t heard a word. Anders gently tapped her elbow. Then he grabbed her heavy backpack and ushered her into his office. “How was school today?”

Sienna shrugged her shoulders. This was part of the warm-up act.

Fifteen minutes of mindless banter with Anders chattering like an idiot.

Meanwhile Siena would pop her chewing gum and ignore him. She was seventeen-years-old and a recovering anorexic. He usually referred eating disorders to other colleagues. He was terrified of their twig thin arms, the crucifix collarbones. But Sienna refused to see any other psychiatrist. For some reason Anders couldn’t fathom, she would only talk to him.

“Okay! ” Anders clapped his hands. “I’ve told you about my week. Our new puppy still craps in the house. My youngest son refuses to be pottytrained. I lead a pretty shitty life.”

Sienna’s mouth cracked a small smile.

“Now it’s your turn.”

“The new nutritionist is okay.”

Anders arched his eyebrows. This was progress. He refused to weigh her at their meetings, but somebody had to. The food was a secondary issue.

It always is.

“And how’s the finger?”

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allowed to gnaw one nail to the bone. She was an Honors student, a cheerleader, the sort of girl everyone envied. If she had to be self-destructive, Anders figured this was an appropriate outlet. Or not. He always secondguessed himself.

“And your mom?”

Sienna stood up and gave a dead-on impersonation of her mother.

Pacing the small office, she raised her voice an octave and shrieked.

“You’re so beautiful, Sienna, How can you do this to yourself ? I can’t possibly take you to the manicurist.” She waved her hands in the air. “How long are people going to believe you have a paper cut?”

It was Anders turn to smile. Mrs. Gutierrez was a bitch and they both knew it.

He reserved the last hour of the day for new patients. Suzette Campbell had made an appointment three times and three times she had cancelled. Anders was shocked when she actually showed up. As he opened the waiting room door, an attractive woman stared back at him. Tall with silky, dark hair, country club slacks and sweater. Anders imagined she was in her early forties, about his age.

“Sit down. Make yourself comfortable.” He waved his hand towards the armchair and the couch, but the woman looked too terrified to move.

“Either option is fine,” Anders prodded.

She hesitated and glanced at the pictures on the wall, as if the answers to her questions were written there. Tentatively, slowly, she sat down in the armchair.

“How can I help you?”

“I’m Catholic, you see.”

“Me, too.” Anders nodded in commiseration.

“Twenty years ago, when I was a senior at St. Agnes, I went on a very wrong date. I drank too much and ended up in a Loyola frat house. It’s a blur, really, a terrible blur. Ten seconds of bad sex and I was pregnant.”

Listening and leaning forward, Anders touched the top of his wrist and furtively took his own pulse.

“The worse day of my life was when I had to tell my father.”

“Where was home?”

Anders swallowed a burp and tasted bile. A picture of his own father coursed through him. A neurologist from a family of neurologists. Their photos lined hospital walls. Anders’ was the empty frame.

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never went back to school. They just had someone ship all my stuff home, I guess. It’s just a blur, really a terrible blur. The church arranged for me to stay with a family in Pittsburgh until I had the baby. They told everyone, even my brothers and sisters, that I was studying abroad.”

She spoke in all black keys. These were patients you always had to look out for. The ones who buried everything.

“Were your parents there when you gave birth?”

“No one was there. Just the nuns. And all these years we never spoke of it. We never had to. Until a month ago.”

Anders repositioned himself in the chair.

“That’s when the social worker called me. Someone found out who I was…I don’t know how that happened…how do they let that happen? She told me that my daughter would be calling me, and was there a better time, or a number I would be preferred to be called at? I’m so ashamed. So very ashamed.”

When she started crying, Anders felt enormous relief. His shoulders loosened. The blood pulsing through his ears slowed to a turgid drumbeat.

“And did you speak with her?”

“We set up a date. Tomorrow. Is tomorrow Saturday? Saturday I meet my nineteen-year-old daughter for coffee at Starbucks.”

For the next five minutes she said nothing. Just quietly wept and wiped her tears. A white noise machine swooshed like the ocean. The airconditioner hummed. Anders hated pauses. He counted to himself—one Missisippi, two Mississippi— so he wouldn’t rush to fill the empty space. Like quicksand, he always felt the need to fill the empty space.

“Does your husband know?””

“Thank God I told him before we were married. But my children, they’ve just become teenagers themselves. I’m so ashamed. I’m just so ashamed.”

Growing up, shame was disbursed in the Steinhoff household like aspirin. Any time, any place, a dollop or two would satisfy any situation.

“I know many women who struggled with their consciences for years after having an abortion. I think what you did was very brave and very selfless.”

Suzette stared at Anders. Then she stood up and marched to his bookcase. His diplomas were sitting on the shelves sandwiched between journals, hidden behind the dust motes and cobwebs.

“Johns Hopkins. Harvard. Very impressive.”

“And your parents. Are your parents still alive?”

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“Mom’s dead. My father’s in bad health. He’s on oxygen twenty-four seven. If he knew about Debbie, that’s her name, Debbie, he would just die.”

“Do you see him often?”

“Every day. There’s no one else to care for him, bless his heart. And the aides never last long.”

“Didn’t you mention siblings?” Anders knew these families. They were often huge, the houses more like dormitories than homes.

“They’re all much too busy.” When she unpeeled a Blanche Dubois grin, Anders felt his stomach flip. “He likes when I bring him his lunch.

Tuna on rye with a glass of milk, served on a tray in front of the TV. He likes when I bring him lunch.”

Anders hated this feeling. The feeling he was being bushwhacked.

Sometimes his patients had truly horrible lives, horrible spouses, and horrible parents. It was a miracle they were walking and talking and functioning at all. Teachers who hated children, doctors who despised their patients, clergymen who despaired of God. He wished he had answers, a magic pill, something to ease their pain. But most of the time his pockets were empty.

“And what would happen if you missed a day?”

“Father wouldn’t hear of it. He just wouldn’t hear of it. He still finishes The Times crossword. He’s as sharp as a tack.”

Anders shuddered. The numbness in his fingertips was working its way upwards. The last phone conversation with his own father didn’t go well. He needed a down payment on a house, just wanted to borrow the money for Christ’s sake, but Anders father wouldn’t budge.

He glanced up from his notes and looked at Suzette. “Fathers can be difficult,” he said.

“My father’s an angel, an absolute angel.” She pulled at a loose thread on her sweater. “Weren’t we talking about my daughter?”

The rest of Ander’s day was spent recording his notes in the patients’ files. He took his time writing them longhand. Garrett was right. Anything typed on a computer could wind up on a billboard in Times Square. It was nearly eight o’clock when he headed for home.

His dinner was in the oven, the dog in its crate, the kids in the bath. His sons were three and five. His wife MaryAnn never let them out of her sight.

“Hi Daddy! Hi Daddy!” they screamed. Bubbles floated in the air.

MaryAnn wiped her hands on her apron and turned to peck his cheek.

“Long day?” she asked.

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grabbed a fistful of latex gloves. One, two, three tugs later they fit snugly over his wrists. Only then did he turn to his sons. Like a surgeon probing a wound, he tentatively dipped his hands into the soapy water. There was no telling what sort of bacteria germinated in a tub. It was a veritable cesspool of little boy detritus. Anders tried hard to erase the thought.

“Daddy! Daddy!” the children cried, laughing and splashing.

“Who wants to be a taco?” Anders bellowed. He wrapped them each in a towel, herded them to the bunk beds, and held up a pair of books. “You get two options,” he said. They all knew the routine.

“That one! That one!” they shouted.

“That silly book? Lasagna, you know, can’t fall from the sky.”

“Meatballs! Meatballs!” they screamed. “It rains meatballs.”

“Oh,” said Anders.

An hour later he sat at the kitchen table with MaryAnn. The chicken on his plate was halfway eaten. He picked at it with his fork.

MaryAnn sipped her tea. “Any news?”

His wife looked tattered around the edges. Despite the apron, her clothes were a daily casualty. Tomato sauce, crayon, even blood stains from the boys’ tussles, blotched them like a Rorschach’s test. Anders glanced at her. Somewhere in the mix of Norwegian, German and Scottish blood, a little Cherokee worked its way in. Her hair was as thick and wild as a horse’s mane and stood out in all directions. Anders remembered why he loved her.

“Did you speak with Moochie?” she asked. Moochie Teitelbaum was their accountant.

“We just can’t swing it now, MaryAnn. We’ll have to rent for another year. This place isn’t so bad, is it?’

“It’s a two-bedroom apartment, Anders. Maybe you should examine a different business model. You know. Like think about taking money from your patients instead of cookies.”

“She’s on Medicare, MaryAnn. You think they pay for an hour’s therapy?”

“What about that nursing home gig? I thought Moochie could get you into the nursing home?”

His accountant had made a series of shrewd investments. Geriatric care was a bottomless pit of revenue. If Anders jumped on board, his income would be assured for years. It was a scam, a perfectly legal scam. All he had to do was spend a half-day a week scanning patient records and writing scripts for anti-depressants. No face-to-face meetings. No physical exams.

He just had to fill in the codes.

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Anders felt his eye tic and rubbed it out. “I need to go to sleep, MaryAnn. I’ve got to get some sleep.”

He brushed and flossed his teeth, clipped his nails, trimmed his cuticles, and polished his shoes. Then he clipped his nails, trimmed his cuticles, and polished his shoes once more. When he could think of nothing else to do, he lay down in bed and watched the ceiling turn blue, then red, then yellow. Finally it was dawn.

The following week everything that could go wrong did. Monday morning at eight o’ clock he found Garrett pacing the sidewalk in front of his office building. It was first period. Garrett must have skipped work.

“Did you read about the ricin?” Garrett’s foot pawed the cement.

Instead of looking at Anders, he spoke to the street lamp. “They sent letters to Bloomberg, to the President.”

Anders looked up and down the street. People were hurrying. Men in suits, mothers with strollers, messengers with totes. They all seemed to have a destination and a purpose. How confidently they put one foot ahead of the other.

“Let’s talk in the office, Garrett.” Anders had never seen him so agitated. He refused to lie on the couch, to even sit.

“There’s no antidote for ricin, Anders. Did you know that?”

“Garrett, the chances of someone mailing you an envelope of ricin is about the same as getting hit with lightning. You just have to take your chances.” Garrett circled the floor frantically, flapping his hands like a wounded bird. Anders grasped at the first desperate idea that popped into his head. “There’s nothing I can do for ricin…But I can give you a prescription for Cipro.”

Garrett stopped in his tracks. “Cipro?”

“Good for anthrax, MRSA. A pretty good hedge on lots of bad stuff.”

The moment Anders put the white slip in his hand, Garrett relaxed.

The grooves on his forehead smoothed. His neck stopped twitching. Anders doubted he would actually go to the pharmacy and have the prescription filled. Just having that little piece of paper in his possession worked its charm.

Five minutes after Garrett trotted off to school, Anders wrote up three scripts for himself as well. In fact once he had his pad out, Anders couldn’t stop writing. Biperiden. Colloidal silver. Doxycycline. Sitting at his desk, he eyed his computer. Just to be on the safe side, he ordered a supply of stabilized oxygen and four gas masks. It was surprisingly easy. Like buying 102

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a vacuum cleaner filter or a cartridge for his printer. He punched a few buttons and plugged in the credit card numbers.

He was scrolling the Internet for bulk purchases of bottled water when his nine o’clock showed up. Suzette Campbell was as impeccably dressed as she was on her last visit. Over the weekend, he had googled her name and researched her background. Her father had been a founding partner of a prominent law firm. Her husband was following in his footsteps. This time he gazed at her more carefully and noticed the Louis Vuitton purse, the fivecarat engagement ring. She looked like she had walked off a page of Town and Country.

“How did the meeting go?” asked Anders.

“She’s the spitting image of Daddy,” said Suzette. “Red hair, tall.” Anders was surprised at how calmly she spoke. “It seems that her family was in the foster child business. Did you know that the government pays people money to take in children? At one point they had ten kids. She was the oldest, the only one they officially adopted. It was her job to take care of the others.”

Anders felt like his chest was shrink-wrapped. “Maybe they were good people?” he suggested. “Well-intentioned?”

“She said her father beat her when he drank.”

One Mississippi. Two Mississippi. “Does she want a relationship with you?”

“What she wants is for me to pay her college tuition.” Suzette dropped a large envelope onto the coffee table and slid out the contents. “She showed up like it was a job interview. Brought her high school transcript, recommendations from her teachers.”

Anders glanced at the credentials. The girl was a straight-A student.

“What are you going to do?”

She rose from her seat and straightened the pleats in her slacks.

“Father always says that people should stand on their own two feet. That a handout is a curse.” Walking backwards as she spoke, Suzette smoothed her hair, petting herself like a puppy. “Thank you for your help, Dr. Steinhoff. I really appreciate your help.”

She quickly shook his hand and headed for the exit door leaving the scattered papers. Anders knew he would never see her again. He gathered the documents, placed them on his desk, and shuffled them like Tarot cards.

Suddenly he realized that his message light was blinking.

Beep. “Anders, it’s Moochie. Call me.” Thrusting out his finger, Anders quickly erased the message. Another followed.

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Beep. “Is this Dr. Steinhoff? Is this Steinhoff the shrink?” The voice was all Brooklyn. Anders probably could have heard it just opening his window. “This is Carolyn Levy. L-E-V-Y. My mother Bina Schwartzman S- C- H- W- A- RT- Z- M- A -N broke her hip last night. She’ll probably be at Mount Sinai for at least a week. That crazy apartment will be the death…” Beep.

Anders wondered if there had been a full moon. The next message was just as troubling.

Beep. “Dr. Steinhoff. This is Meg. Gutierrez, Sienna’s mother. There’s been an accident. A terrible accident…” Beep.

Mrs. Gutierrez had left five contact numbers on Sienna’s info sheet.

Her home, her cell phone, her assistant’s cell phone, her husband’s office, and her husband’s cell phone. There was a high correlation between teenaged eating disorders and suicide attempts. Panicking, Anders tried each one three times before he reached an actual voice.

“Hello, this is Michele, Mrs. Gutierrez personal trainer!” Then not quite into the receiver she shouted, “Way to go, Mrs. G!” “Can I speak to Mrs. Gutierrez, please? It’s urgent.”

Five minutes later, Sienna’s mother picked up the phone. She was huffing and puffing like she just finished a set.

“I got your message. How’s Sienna?” The words flew out like a Tourette’s tic.

“She tried to slice off her finger, that’s what happened. At Kinkos, believe it or not. Only she missed and got the tip. Three hours with a hand surgeon saved most of it. Is this what I’m paying you for? So that Sienna finds more and more creative ways to mutilate herself ?”

A flurry of professional assurances followed. All memorized clichés. In truth, the woman deserved any anguish her daughter doled out. He opened his desk drawer, took out his scissors and placed the tip of his finger inside the blades. Slowly he pressed down and imagined the pain Sienna must have felt.

The injection to numb the site, the stitches, the throbbing for days afterward.

He only stopped when tiny drops of blood threatened to stain the rug.

Counting the cracks in the plastered ceiling, Anders waited for a strategy to unfold. He stared at the clock. Tied and retied his shoelaces. As the sun worked its way up the louvers, a plan materialized. He cancelled all his appointments and raced to the hospital.

Carolyn Levy was planted in front of her mother’s door. She blocked it like a linebacker. “It’s all going, you charlatan, you two-bit fraud. I’m packing up the crap and emptying my mother’s condo as we speak.”

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Anders placed himself inches from her face. He was six-foot-three and loomed over Bina’s daughter like a storm cloud. “I’ll take care of it. Please.

I’ll go there right now. Let me take care of it.” He pushed his way past her and walked up to Bina’s bed. She was heartbreakingly little, swaddled in blankets like a baby, the tubes tethered to her body like an umbilical cord.

She opened her eyes and blinked.

“Is that you Dr. Steinhoff ?”

“It’s me, Bina. I came as soon as I could.”

“It’s not a bad break, tanks to God. But Carolyn is meshuga like I’ve never seen her. All I did is slip in the shower.”

He placed his hand over hers. “It could have happened to anyone, Bina.”

Tears escaped her rheumy eyes. “I have a favor.”

“There’s no need to ask, Bina. Some things people should do without being asked.”

By midnight, a dozen years worth of food, emergency supplies, newspaper clippings, and magazines were stacked in Anders’ office. His patients would have to exit via the waiting room since the back hallway was now crammed floor-to-ceiling. Twenty cartons were hidden behind an Oriental screen. The rest were propped behind the couch. Anders’ muscles ached as if he’d run a marathon. He couldn’t remember a time when he had felt so good.

Finally, while his adrenaline was still pumping, he sat down at his computer and checked his bank balance and his stock portfolio. Then he typed a letter to Suzette’s daughter.

“Congratulations! You are the first annual recipient of the Anders’ Steinhoff scholarship fund. A $100,000 check will be held in your name and disbursed as needed for your college education.”

He cancelled the following day’s appointments and deleted five more emails from Moochie. Then he rushed home to his wife and children and woke them up from a sound sleep. “We’re going on a field trip!” he announced to his family. He tossed MaryAnn a pair of blue jeans and shoved the boys’ feet into their sneakers. Then he loaded his kids and his wife in the mini-van and headed to Pennsylvania. “It’s a surprise!” said Anders. His wife narrowed her eyes. His sons started wiggling in their car seats.

“A surprise! A surprise!” they shouted.

“We’re going to buy firecrackers for the Fourth of July. It’s in two weeks. Do you know what the Fourth of July is?”

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“Firecrackers!” The boys shouted. “We’re going to buy firecrackers!”

“Are you out of your mind, Anders? Have you lost your mind?”

But Anders didn’t hear her. He rolled down his window, stuck his head out and breathed in the summer air. With his free arm, he lassoed the wind.

“Why it’s Independence Day!”

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Reality Check: On Working With a Guide Dog RAVEN TOLLIVER

I made the decision to get a guide dog when I was nineteen. I was stuck out in the middle of a snowstorm at nine at night. And all I had done was walk away from my dorm. I just wanted to go get a burger! But I was lost. The snow was coming down heavily, and I couldn’t hear a damn thing. Sighted people don’t have to think about it, but snow absorbs sound. There was no chance in hell of using echo location to find the building, and a cane was useless in these conditions where the snow was so deep. I couldn’t tell the grass from the sidewalk from the path back to my dorm. This was a blind person’s version of fog.

At the time, I hated being blind. I was alone out there at night and I couldn’t hear anyone approaching. I stood there feeling like shit, hating being blind, and hating myself for hating being blind. I didn’t know what I would do, but I knew one thing: next winter this would not happen to me. I had to get a guide dog. The dog would take me to The Corner or back to my dorm, no problem. I needed a guide dog.

The Application Process Applying to guide dog school is like applying to college, except you don’t need to worry about costs for the education because most programs give you the dog for free upon graduation. Even those who charge only charge $150 —pocket change compared to the thousands that other assistance dog programs require their students to raise before they can even train the dog for them. There are over a dozen guide dog schools in the United States alone, and they all have different things to offer. I applied to one of three in New York state, called Guiding Eyes for the Blind (GEB), and to one in Southeast Michigan, Leader Dogs for the Blind. The one in Michigan was my safety school. I had been to Leader Dogs for various 107

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seminars, including one to learn about how to get a dog, and to get the chance to walk with one.

GEB accepted me, requiring me to stay at the school and train with a guide dog for twenty-eight days. It is one of the top three guide dog schools in the country, and is even known internationally. I wanted to attend this school for several reasons. I wanted an adult dog, not an adolescent dog.

GEB doesn’t put out dogs under two years old. Also, the school provides $200 to $300 annually in veterinary assistance, which is important for a broke college kid. Another thing I appreciated was that the school was in New York. I truly believed that if a dog could work in New York, he could work anywhere.

Shortly after receiving my acceptance letter, I had a home interview with a representative from GEB. This was a visit that would assess my lifestyle, my home environment, and my walking pace and stride. The representative asked me a series of questions about my schedule and lifestyle, checked out my dorm room, walked with me using a harness handle, and recorded video of me walking on campus. This interview helped the school match me with a dog that works well in the kind of environment I live in, that fits into my lifestyle, and that walks at my pace. It also ensures that I am an adequate cane user, which is necessary in order to receive a guide dog.

Dog Day Dog Day is an international holiday. It’s the day of class you receive your guide dog, and the day that marks the start of a new relationship that will hopefully be long-lasting. Everyone’s Dog Day is different according to what month and day they begin guide dog school. It is usually the second or third day of class, after instructors have observed and confirmed students’ handling skills, walking speed, pace, and lifestyle. My Dog Day was on the first Wednesday of June in 2012. I sat in my room at the school, put on a podcast, and lay down. In the lecture hall, the instructors had told us the breed, color, sex, and name of our dogs, and now it was time to play the waiting game. The class staff was comprised of one class supervisor, two class instructors, and two instructor assistants. Only the class instructors were bringing each dog to their handler, so there was a wait since there were twelve of us. I fell asleep so I wouldn’t explode from anticipation.

Eventually, there was a knock at my door and I leapt out of bed to greet my instructor. I opened the door and she walked in. She approached me and I reached out to greet the male golden retriever that was with her.

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He was incredibly silky, and didn’t seem to care much for me at first. He headed for the crate, and nosed at the latch.

“Where’s your leash?” She asked.

I grabbed it from a wall hook by the door, and showed it to her proudly. This was the most special moment—the moment when I clipped my leash to my dog’s collar, and the insructor unclipped hers. He was mine.

“Give ’em the treats,” she reminded me. I grabbed my treat pouch containing five, high-value salmon-flavored treats that we had been given in the lecture hall. I offered them to him, one by one. He took them from me gently and stepped closer to me, sniffing my hands.

“I’ll be back around four when it’s time to feed the dogs.”

She left, and I was alone with him. He attempted to go back to the crate. “Kipling,” I said gingerly. He looked at me. “It’s us now.”

He sat down in front of me, and sighed heavily.

The Transition Period Switching from cane to dog was not an easy transition for me. The cane provides information about the environment that a dog will not.

A cane’s purpose is to hit things first so that the user doesn’t, whereas a guide dog’s purpose is to keep its handler from hitting anything. The cane gives tactile feedback about the texture of the terrain—whether it’s brick, concrete, or asphalt, whereas the dog is trained to detect and stop at elevation changes. This is the biggest difference between cane travel and guide dog travel—the level of tactile information. With a cane, it is easy to find landmarks and physically feel paths and turns before you make them, whereas a dog guides you around everything, and will make turns suddenly, or pass them in an instant. Because of this, guide dog handlers typically walk faster than cane users; they probably walk faster than most people. Relying on landmarks and terrain texture are a bit tough with guide dogs, but guide dog travelers do it. We learn to feel the terrain with our feet, and use our arms or wonderful sighted people to find landmarks.

Then we can teach our dogs to find specific landmarks like plant pots, light poles, and bus stops. Of course, it took me time to develop different ways of exploring the world, and until then, it felt as if the world was rushing by me at a pace I couldn’t keep up with.

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directions, to signal him forward when I judged it safe for us to cross streets, to continuously praise him for his good work, and to refocus him if he was distracted. I moved with him as he guided me around obstacles, backed up with him as cars pulled out of driveways or parking lots in front of us. I slowed as he approached curbs, stopped with him as he indicated we were at the curb, and followed his direction as we crossed the street.

I also had to learn to move with a guide dog. They all move differently, and have their own signals for communicating. I had to learn what it felt like when Kipling was pushing me right, pulling me left, or rounding a corner. I had to learn how Kipling moved and behaved when he was distracted, because it was my job to refocus him and continue traveling in the correct direction. It was so much to learn and keep track of, and I was incredibly overwhelmed.

One day, Kipling was guiding me down the streets of White Plains, New York. Suddenly, he started pushing over to the right. “No,” I said, “forward.” He insisted, pushing me right. Thinking he was distracted, I pointed forward. “Forward,” I emphasized. He stopped trying, just stood there, and huffed. “What the hell is happening?” I asked my instructor.

“Let him guide you,” she said. It’s the most common, but dreaded phrase from a guide dog class instructor.

“Why won’t he go forward?”

“Reach out and find out.”

I reached out in front of me and found a railing. “What is this?”

“Remember that outdoor eatery we have to go around? Let him take you around it.”

I felt like such an idiot. I was also frustrated. Why couldn’t she just tell me what was in front of me? Or, at least tell me my dog was pushing me around something! Why couldn’t these people understand that I was having a damn hard time of letting go of my cane and relying on this dog?

The Adjustment Period When I left school and knew how to use a guide dog, I was still not used to it. There was no longer an instructor to walk with me or work out any problems. It was just me and Kipling, and sometimes my family or friends. There was no longer a Jiminy Cricket hovering over my shoulder to tell me what to do when Kipling wouldn’t listen, or when there was something in front of me and I didn’t know what it was. There was no one to wake me up at the ungodly hour of six in the morning to feed my dog—no longer anyone going around ensuring that I was playing with, 110

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relieving, or grooming my dog. It was up to me to set a schedule and fit Kipling into my life.

I also had to learn to work with Kipling in my environment. When I first returned to Aquinas College, I struggled to teach Kipling the campus. I knew it like the back of my hand. But how could I teach him without using my cane? How could I allow him to guide when it was a challenge to know where we were going at times? I could no longer trail the grass or edge of the sidewalk with my cane, but I somehow had to tell when my dog was going straight or turning. How could I trust him to not get us lost?

Trust? I didn’t have any. I didn’t have a reason not to trust him, other than the fact I wasn’t accustomed to working with a dog. Don’t get me wrong, we got lost. It happens, and it was my fault for not having a clue how to tell where we were going. Losing that constant tactile feedback from the environment that comes with cane travel was not easy to get used to. My remedy for this was to teach Kipling landmarks so I could check his work. And I still second-guessed him constantly. Sometimes, he would make turns while we were traveling outside, or push me in a certain direction as we moved through a room, and convinced he was going the wrong way, I would stop and check his work with my feet or hands, seeing what was around or in front of us. It was difficult to let him do his job.

And it was difficult to repeatedly be proven wrong by this dog, and admit I was way too damn controlling.

It was almost easier to learn an unfamiliar route with Kipling because I didn’t feel the need to take control of what he was doing. I knew where I needed to be and could provide adequate direction to that point. It was a relief to both of us that I didn’t know the ins and outs of the route—every turn, curve, and obstacle along the way. I had to follow his lead, and could not make him stop so I could check his work—like criticize him for pushing too far to the right, or hold him back and nudge him with the harness because he was about to pass a turn. When we neared our destination, we could slow down and figure out where we needed to be, or just ask for help.

Another aspect of adjusting to a guide dog is dealing with the public.

All of a sudden, I was a spectacle, and my dog was for everyone’s viewing pleasure. A fellow guide dog school graduate and close friend of mine put it best: “I hate it when people are staring at my guide dog and commenting on her as if she’s some exhibit at a zoo. It’s like we’re on fucking Animal Planet, and the public is audience to the way my dog acts: how she lays there, or how she looks tired, hungry, sad, antsy, or whatever. I don’t like it.”

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Every guide dog handler must get used to this—people wanting to pet your dog, making ridiculous noises to get your dog’s attention, asking stupid questions about your dog, wanting to know your dog’s name (as if it’s the most vital information in the world), and just commenting on them in general. It’s one of the most annoying things about having a guide dog, and each handler must find their coping mechanism. Mine is to ignore just about everyone unless they give a compliment—then I’ll smile and thank them, of course. And anyone who pets my dog in-harness will be sent to hell.

The Testing Period One thing to know about all guide dogs is that they can be incredibly stubborn. It is what makes them good guide dogs. A guide dog has more responsibility than any other assistance dog because they must act and make executive decisions without input from the handler. For instance, I don’t have to tell my dog to navigate around people, street signs, furniture in a room, or vehicles blocking the sidewalk. He is trained to do this, and he does it without any command other than “forward.” Guide dogs are also required to disobey the handler if the handler has given a command that is unsafe. For instance, if a car is coming or turning in front of the team, and the dog is given the command, “forward,” he must refuse to guide. Or, if the dog stops because there is construction on the sidewalk or in the street, and is commanded, “forward,” he must disobey, or guide around the construction.

A guide dog handler puts it perfectly in an article from The Bark: “Because we can’t see, we don’t know the particulars of what we’re commanding our dogs to do. The dog has to stand up to us to get it through to us that something is there that we don’t know about, then find a way to get us out of a dangerous situation. A dog that isn’t comfortable holding his ground isn’t suited to the job.”

In the beginning, the stubbornness always manifests itself in other ways, like when I couldn’t get Kipling to stay laying down for any length of time while I ate my first dinner with him beside me, or when I sat down in a chair in the lecture hall at the guide dog school and he refused to lay down. I think I dealt with this for about a week and a half before he decided that the person giving treats, food, water, and playtime was probably worth listening to. Fortunately, after the testing stage, the stubbornness is only displayed when necessary.

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During a visit to Woodland Mall in southeast Grand Rapids, I was done after hitting up TeaVana, Bath and Body Works, and the food court. When I first entered the mall, I had stopped a person to ask them which stores were by the doors so I knew what to look for when I left.

Not knowing if it was the right way, I headed down a random hallway to leave the mall. I neared a set of doors and stopped. Listening, I didn’t hear anyone nearby. Unsure, I turned around and headed back the way I came.

Paying attention to the music around me, I noticed one shop was playing heavy electronic music and another was playing punk rock. I didn’t recall hearing such music upon my entrance into the mall. I exited that hall and turned down another. Twangy, exotic music met my ears, letting me know I was most likely going the right way. I reached the doors out, but I wanted confirmation. I tried to turn around to ask some people exiting a store.

Kipling would not budge. “Let’s turn around,” I said gently. I tried to turn and make him turn with the harness, but he would not listen. I dropped the harness handle and turned around, thinking he would move with me. He continued standing there, looking out the doors. Deciding to listen to my dog, I exited the mall. He’s right when he’s right.

The Bonding Period Bonding takes place from the moment a handler receives their guide dog. Handler and dog learn one another’s strengths, weaknesses, quirks, habits, and comfort zones—and how to deal with all of it. I learned that my dog needs plenty of praise to stay motivated and assured he is doing the right thing. Kipling learned that I am directionally challenged, and that when I point right and say “left,” he must always go with the hand signal.

I learned Kipling has a moderate-to-strong dog distraction, and that we must walk faster to get by the dog and refocus. Kipling learned that I am overwhelmed in noisy environments, and that he must guide confidently despite my uneasiness.

Another aspect of bonding is teaching the dog that you, the handler, are the provider and leader. The dog must understand that all good things come from the handler, and that the handler’s instruction is above anyone else’s. The biggest struggle guide dog handler’s face with this part of bonding is opposition or uncooperativeness from family members or roommates. I snapped at almost everyone in my family about petting my dog in harness or playing with him without my permission. For the first two weeks after getting home with my new guide dog, I had control over every interaction 113

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he had with others. I kept Kipling on leash for those first two weeks, and everyone had to ask my permission to so much as touch him, even out of harness, and if I said no to anything, they had to accept it. It is important for housemates and guests to understand that the guide dog and handler are still establishing trust and who’s leader, and in an unfamiliar environment, the dog will seek out someone to provide discipline, guidance, and normalcy.

That person is supposed to be the handler.

Lastly, the bonding period is over when dog and handler have each other figured out. Communication is almost telepathic. The dog makes few mistakes, and the handler is able to effectively communicate what they expect and need from their dog, and understands their dog’s signals and indications. When movement with the dog is fluid, communication is easy, and mistakes are few; that is when a team is bonded—when there is complete trust. This period can be anywhere from six months to a year and a half.

The reality of working with a guide dog is this: It is one of the most exciting, challenging, uplifting, and frustrating things a person can ever do.

In order to reap the benefits of a good guide dog, a handler must be willing to put forth Herculean effort to maintain the dog’s training and learn to work with the dog effectively. During the first six months of working a guide dog, there is a lot of arguing, pleading, protesting, insisting, praising, and cheerleading. Sometimes, your guide dog will make you pleased and proud, and other times, your guide dog will do things that make you question your sanity. As long as the handler is consistent and doesn’t have a meltdown (and trust me, everyone reaches the brink), the hard work will pay off.

Having been together for almost two and a half years, Kipling and I have surpassed this period. Communicating with him through hand signals, movements with the harness or leash, and verbal praise, travel is far more fluid and communication is far easier than it was when we were first matched. And when the snow comes, I no longer face the snow with uncertainty, but with confidence.

In late November, Grand Rapids received an uncharacteristically tremendous amount of snow. The weather was miserable, but the world wouldn’t stop turning; I still had to go to work. Taking our normal route to the bus stop, one of the sidewalks in front of a park was not shoveled. We moved slowly through the deep snow, and as we neared the place where we usually turn left and cross, I realized Kipling would not be able to see where we needed to turn. It was a mid-block crossing—a T-intersection, and the place where we needed to turn was covered with snow. Having traveled this 114

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route countless times, I took a guess at where we needed to turn. Directing him left, we moved over the snow toward the street. He led me into the street and pushed me right as we crossed, lining me up perfectly to step up onto a sidewalk. We had turned too soon for the crossing, so we needed to cross the intersecting street to reach the proper sidewalk. But before we crossed, I stopped and praised Kipling profusely, wishing I had treats on me.

That had taken true teamwork.

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Now as Ever, Seven Months On THEA GOODRICH

Adapt or perish, now as ever, is Nature’s inexorable imperative.

—H.G. Wells March 24 Could anyone have predicted this?

No broken bones, no blood loss, no appendicitis, no chicken pox.

Just this, suddenly.

Just this, irrevocably.

They say you’ll remember what you were wearing.

Or maybe no one says that, but I do remember (the top half, anyway; I haven’t worn that scarf since), and when I put myself back in that plastic chair in that blue-painted room in that small and useless clinic in that minute when everything changed, I remember disbelief.

A week before twenty-one—that’s important.

Neither juvenile nor adult, I am medically atypical.

Denied a bacchanalia, the coincidence of timing is laughably raw.

A week after leaving home again—that’s important too.

I want to crawl back to a crib, fit in my mother’s arms,

be rocked to sleep, be unaware of permanence.

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In that small and useless clinic where I insist that I feel fine, I don’t feel any different (we are speaking physically, of course, and they are astonished, shocked at this refutation of diagnostic tip-offs, and they are, moreover, less than certain, speaking of latency and hypothesized halves).

They assure me it’s nothing I did: not the pounds of pasta I ate abroad, not the brownies I baked in midnight bouts, not the hours I napped when I could have leaped— it was shrouded in my genes, an inevitable incurable allergy.

They think an absence of scapegoats will calm me.

They do not fathom the implicit second stratum:

that my body, unbeknownst, has betrayed me.

Now, more than ever, I am indignant at my own insides. Not damaged goods, but defective—a glitch at the manufacturer’s, long-encoded, long in coming.

How could I never have known?

Still, I say. It could be worse.

You’ll have to become a body girl.

I have always been a brainy girl.

Bruises blossom like opaque, baleful ripples on the deepening lake of my stomach.

An empty balloon hangs small and useless somewhere beneath the surface.

All ingestion and every injection is a pound of flesh repaid.

These are, I assume, the usual metaphors.

I cannot think of better ones.

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Spring and Summer Twenty years, boxed up, behind me.

Can there really be sixty more still to come?

The only finish line is “complications from.�

I do not want to race toward it.

I want an end in sight.

Still, though, as always, I want what I cannot have, I have what I do not want.

These are my grievances, the fault lines I stand on.

I want bagels, muffins, ravioli, hard cider.

I want raw cookie dough and baked Alaska.

I want spontaneity, impulsivity, to be drunk, to be daring.

I want to bare pristine skin beneath a polka-dot bikini.

I want to scream from hills and collapse in canyons.

(I have never had baked Alaska.

I have never worn a bikini.

I have never been in a canyon.)

I want this to disappear, to be a medical blip, one for the diagnostic record books, a miracle cure self-wrought.

I want to break down in your arms (cinematic, sybaritic), I want a restitution from karma (irate, impatient), I want to stay the same always (impractical, unfeasible).

I want your pity, your sympathy, your clemency:

I cannot stomach my own.

You are stronger than you think you are.

I am not small and useless.

I am resilient, robust.

I am rising to the challenge.

I live sinusoidally: lows and highs, peaks and troughs.

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It could be worse.

I say this; I hide behind it, a suppression of catharsis.

At least it’s not—you know.

There is retreat in repetition, but beneath the surface I am shrieking, I am spitting, I am a Fury, a Harpy, I am incensed, resentful.

My fingerprints dotted with fingersticks, my interior factory never before supervised now failing with a whimper (not a soldier turned mutinous, but a slow and lingering sigh), old habits and new impulses kicked unkindly to the curb.

This will never go away.

I see advertisements everywhere.

First for food (universal), then treatment (personalized), such opposite ends—I am angry at them all.

I want to scream obscenities, to rip up magazines, to punch holes through posters, to throw dumbbells at the bright television screens I can’t avoid when I pretend that exercise will save a dying organ.

When I pretend that penitence improves prospects.

You always were a sweet girl.

Now I’ll be a bitter girl.

I am reminded of my changed existence— unbidden, unasked for—at every mention of sugar, genes, starch, and blood.

The joke about mosquitoes’ attraction is, in retrospect, uncomfortably portentous.

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a support team, new vocabulary (including fuck—long hoarded, the only good one in the bunch), and needles and vials, pills and notices, and I cannot handle any of this, overwhelming, all at once, I do not know my body, I cannot like my body, I was not built for challenges, ten hours from family, one minute from folding, a burden for a lifetime, I am falling apart.

Between my bones and my skin flows something untempered, something too sweet.

Whenever I begin to explain it (a need-to-know policy, this new identity, always couched with apparently, an acquittal of ignorance) I fear I seem self-indulgent.

So I shrug off anger, conceal frenzy, project a semblance of control.

At least I didn’t need the hospital.

Three cheers for modern medicine.

Nowadays it’s easy to manage.

Perhaps this is a psychological process with a polysyllabic name, one more step in the protracted progression of grief.

I do not care. I pretend to soldier on.

Better finding out sooner than later.

Everyone’s got something.

It could be worse.

I know these are facts, but underneath I am kicking, I am railing, beating fists against the sky, floundering in fatal unfairness.

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I prefer the adjective—that way you can’t mispronounce it, can’t make it sound like lard rolled in fried dough, drawling it out accusingly, repulsive.

I prefer not researching it, not thinking of it, staying ill-informed of intricacies, refusing to embrace what I did not request.

Really, it could be worse.

Though I am sick of these mantras, these manifestos, if I echo them often enough, I will start believing they’re right.

That’s the plan, anyway.

Everyone’s got something.

This, I find, is true— shame has no place in sickness.

August 18 No one will notice.

How could anyone not notice?

I’ve been self-conscious enough for a lifetime already.

The answer is simple: thank God for pockets, for waistbands, for ubiquitous rectangular cell phones.

But how do I wear it with dresses, with skirts?

A holster. Your cleavage. You’ll figure it out.

Uncomfortable, but better than a belt clip.

(Only middle-aged men wear things on their belt.)

At least it will do all the math for me.

At least the tubing is pliable, the adhesive almost invisible.

These are my concerns at first.

I know they are of little consequence.

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one simply more obvious than the other.

I may as well take the steadier one.

You’ll be a bionic girl!

I will be a bionic girl.

People tell me they don’t notice.

People tell me I am brave.

In that small and useless clinic, a nurse said better a bracelet on your wrist— a reservoir on your hip— than a tag around your toe.

I finally believe her now.

Everyone’s got something.

Seven months on, the tears exist but have subsided.

Something small and useless within swapped for something small and useful without.

Minutes of frustration are small prices to pay.

Of course there are days. It is what it is.

I still hate naming it, don’t know what to call it.

Disease, condition, syndrome, illness.

Inconvenience. It is an inconvenience.

It will get worse, but it could be worse.

Seven months on, I remember the dates, but do not realize their passing.

This does not have to define you.

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FICTION

The Novice EILEEN MCGORRY

I looked at her lying there, the clean sheets drawn to her chin, her white hair still large and full around her face, her eyes closed, tired from all my ministrations. I had been with her over an hour, washing her body, then removing and replacing soiled drainage bags, applying a heat lamp, then rubbing soothing lotion into her skin, and finally pulling the soiled sheets from beneath her and replacing them with freshly laundered bedding. It had been heavy work for me, heavier for her. Now with pain medication flowing through her body she rested, peaceful, if only for a few hours.

She was too old for what they had done to her. She had a belly full of cancer, and in trying to cut that out the surgeons had left her with a colostomy bag and a bag draining urine. They had also cut her uterus and ovaries free and removed them. Had she not been so brave, I would have thought of her as a poor old woman, aged to my twenty-one years. But instead, I thought of her as feisty, a woman ready to fight the death sentence she had been given. And in 1969, the war on cancer was being fought with a heavyhanded knife.

Ready to leave her, I stood still for just a moment. I had done a good job; I had been kind and competent and was flush with the satisfaction of completing her care all on my own. I was new to all this, new to these extensive surgeries, new to being on my own. Finally, I gathered the dirty linen and stuffed it in a bag and dragged it toward the door. Feeling good,I pulled on the door, and as it opened, all the weight in my body sank to my feet.

Looking into the room directly across from me, all I could see was white.

It was a thick crowd, most everyone in motion and circling the bed of the young man with the lung tumor. Just that morning, only a few hours past, he had joked with me right before he paused to cough bloody sputum into a cup. Smiling at his joke, I stared at that cup transfixed. Was there more blood than yesterday? Now everyone around him was moving fast and 125

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shouting. Through that mess, the only thing I could see was a corner of the bed where the sheets I had changed that morning were still pulled tightly to the mattress. While I had changed that bed I had marveled that, sick as he was, his body looked well, his face was full and his arms and legs sturdy.

Now, as I stood watching, one of the nurses inside the room turned to me, distress in her eyes. The look she was giving pierced through me until I turned it into accusations. I was thinking of that sputum cup and the blood, still asking myself the same question: Had it changed from yesterday?

Later, others helped me as I washed his body, a task not always done with the reverence it deserved. Often it was not even done quietly, but amid chattering and senseless talk. And when we were finished, when we had covered him and moved him to a stretcher, when the orderly had wheeled that stretcher onto the back elevator, we separated, each of us returning to all the work that was still left to do.

That morning, I had dragged myself from sleep long before the sun had risen. Five stories below, the traffic on Second Avenue roared down the east side of Manhattan. A half hour after pulling myself from bed, I was on the street. On the blocks around me, my white uniform, so new to me, was ubiquitous. I lived in the center of a bulging medical center, and the streets were filled with the men and women of medicine.

I had been engulfed in the rush: people and cars and buses, and the clanging, drilling sounds of construction workers who were already hanging from the girders of newly rising buildings. Hospital care was booming. I had graduated from nursing school into a recruiting frenzy. Having been fed coffee and donuts at many hospitals, I had chosen this one—not for the work, but for the generous housing subsidy. And I thought I would be safer here; everyone had cancer, and to me, that meant everyone was dying. I could not hurt them.

In my first weeks, I had been assigned to work with Margaret. Grey haired, stout and strong, and trained in the Army, she had rarely talked to me except to tell me what I had failed to do. As I followed her around, she pounded me with information, correcting me, explaining, directing until I thought I would be crushed from the sheer weight of all she tried to teach me. She never asked me who I was or where I came from; besides knowing my name, she knew little about me. But when I wasn’t angry with her pushy ways, her personal disinterest, and her constant prodding to do more and do it quickly, I knew I was lucky to have her.

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This was a place much different from where I had gone to school.

Here, every surgical procedure was preceded by the word radical: radical mastectomies, radical hysterectomies, radical head and neck surgeries, and radical intestinal or abdominal surgeries. Always on the edge of feeling overwhelmed, I stayed with Margaret as she burst out of morning report and buzzed into each room on our side of the hallway, checking everything quickly before any morning care was started. All day I did precisely what she told me to do, taking every direction—including shortening my lunch break to twenty minutes. On my second day, she began assigning me patients of my own, but she was still over my shoulder, constantly checking on me and leaving me with no hope of pleasing her. A few weeks later, unknown to me, she told the head nurse that I was doing well, learning faster than she expected. But she never told me that; what she told me was, “you forgot this,” “you did that wrong,” “hurry,” and “no, you can’t sit down yet.”

I was fearful of making any mistakes, and her litany of all that could go wrong never ended. She was exacting in how I was to check intravenous lines, add medications, check and empty drainage bags, and walk recovering patients down the hall while managing their many tubes. I had little time to talk to patients, no opportunity to know them beyond the cancer that had befallen them and the surgery done to drive it from their bodies. I knew their names and I told them mine, and beyond that, I was with them like Margaret was with me: focused only on the work.

In some ways, although I didn’t know it then, that made the work easier. And ultimately, there were times that it didn’t matter much; I wore white, I did what they needed. These patients were not poor in spirit. They were people who had come here after local practitioners had told them they had three months, six months, maybe a year. And to change that prognosis, they agreed to surgeries that eviscerated their bodies. Soon, better treatments and wide-scale preventive measures would slow these radical surgeries, but until then, these patients were not giving in.

And to that end, we pushed them to stay in front of every complication. We arrived every morning full of energy as we helped them to bathe, then pushed a needle full of pain medication into their arms before we made them get up and walk. Often it took three of us to walk them, one to stay behind and make the bed, one to watch all the tubes, and one to steady the patient, helping them take just a few more steps, one patient after another.

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patient developing a peripheral clot or a pulmonary embolism, only occasionally a post-operative pneumonia. It was not a place without surgical complications, but those caused by passive post-operative nursing care were rare. We ignored statistics and probabilities and preached a get-them-better, get-them-home, give-them-time mantra. Now I know that many of those patients probably died within two years, but they were not dying then; they were planning on getting better.

I knew that place was going to be the beginning of everything else that would happen to me in my life. I would succeed there or I would fail; and from that success or failure, my life would flow. Because of that, my heart would pound at even a hint of a misdeed. I found personal failure in any nuance: in the voice of the head nurse who found me sitting down to chart while one of my patients had a heart rate of 120, in the patient who was found slumped on the floor even after I had checked her side rails, in the patient not bleeding before, but bleeding now.

But I kept showing up, and like Margaret, I would burst out of report like a bullet and then just as she had taught me I would keep moving until my shift was done. On some days the work would go well, and I would walk out of that place to immediately sense the vibrancy of the city: a place where everything felt possible. But I knew that all that possibility was fragile; it was all dependent on me being able to do that job. Every day, walking out of that hospital, my white uniform no longer crisp, I simply wanted to believe that I could make it all work.

Sometimes the work was so hard I walked home seeing only the sidewalk beneath my feet, oblivious to anything around me. But there were other days when, stepping on that elevator, my energy would rebound. On those days I would rush home to pull off that uniform and exchange it for pretty clothes, clothes suitable for the places where the music was so loud we had to yell to be heard. Sometimes in these places I would meet energetic young men, men I would later discard, or at other times, men who would discard me. And, in the cold of the New York winter, I would fly off to the beaches of the Caribbean and return home brown and glowing. Using every minute off, I would take red-eye flights back into the city, arrive to the sun barely rising, and then rush home to pull on my work clothes. Turning the key in my door, I would immediately feel the burden of returning to work.

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done; or because of my efforts, all the tubes would stay in place and urine and feces would not drain onto the skin but into the carefully placed plastic bag. It would be a day when the patients felt as if they would recover and I felt like I had helped them do that, a day when the inevitable tiredness arrived but I felt the fullness of satisfaction. Then I would forget it had only been a week ago that I had left work tired and bedraggled, wanting nothing more than never to go back.

After the day I had stood in the hall, holding that laundry and worrying about how much blood there had been in that sputum cup, I got even harder on myself. I was more and more adamant about watching and seeing and reporting. No matter the reason for walking into a room, I was looking at everything. I was checking skin color, facial expression, and level of consciousness. I may have been speaking to one patient as I walked in, but I was seeing all of them: every intravenous line and every drainage bag. And when passing one patient to get to another, I was looking at IV sites and briefly touching each of them, checking skin temperature and texture.

I never again questioned reporting a change, even a subtle change, even changes I was not sure I had seen. I was checking everything, all day, every day, and doing it as I gave meds and baths, and made beds, and emptied drainage bags, and gave tube feedings, and suctioned tracheotomies, and cleared gastric drainage tubes, and walked people down the hall. I was doing all these things while I hoped to God that I was getting everything right.

Sometimes all that checking didn’t matter; inevitably there were some patients whose bodies gave out. And when this happened, it was about cleaning up the blood on the floor, about the needles lost in the crumpled bed sheets, about washing the body of the person we had failed to save.

But there was more. In all my efforts, I was ignoring the vast emotional landscape that lay heavy in the air as these patients fought so hard to live. I had to ignore it; it was too deep a well, and letting empathy rise in me was simply beyond my capabilities. And when it did, when a patient broke through, I suppressed it. But sometimes things happened in such a way that I was unable to dampen my emotions, unable to see only tubes and intravenous lines and vital signs.

Not long after the loss of the young man with the invasive lung tumor, we admitted another with a different kind of cancer, but a cancer no less deadly. He had already lost a leg to the disease and was fighting a metastasis to his lungs. His breathing was ragged at rest, and when he moved around 129

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he was gasping for air. When I was assigned to care for him, he often refused my help; his arms still strong, he would pull himself around on the bed, and when needed, up from the bed and onto his crutches.

The young people often came to us with virulent cancers, cancers likely to kill them, no matter the fight in them, no matter how extensive our care. Often their bodies still looked strong, as if capable of winning a battle we all knew they would eventually lose. They troubled me most, not only because of the unfairness of seeing them stricken so young, but because I could not separate myself from them. I could not easily change from peer to nurse. This young man looked the same to me as the men I met at parties: the men who chatted me up and made me laugh; the men I would sit and watch from a far-off corner, hoping they would notice me. Walking into his hospital room, I would have these thoughts and then feel embarrassed, and I would blush as I offered him pain medicine or help to walk. With the young male patients, I was almost happier when they refused my help, my own discomfort at least equal to theirs. Ill at ease, I stumbled around them, caught up in social mores, my clarity gone.

One afternoon, I looked up from my charts to see a young woman walk off the elevator. She was pretty in the way many young woman are pretty, patrician features and long, shiny hair. She walked between her parents, themselves still young, and behind them, her boyfriend. Every one of them looked weary as they dragged themselves forward. The parents held their heads up and were more watchful, aware of those around them. The young girl and her boyfriend, though, looked down, never lifting their eyes from the floor. I thought the girl looked like a cheerleader or a recent prom queen. I would not have been a friend of hers in high school; she would have walked in a social circle above mine, a place I had always longed to be.

For a brief second I was back in the hallways of my high school, feeling excluded and full of envy. I pushed the thought away and looked down at the papers handed to me by the clerk. Cancer of the vagina.

I clutched at the papers with all their blank spaces and the question, “why are you here?” How could I make her say the words of her diagnosis?

And if I did make her do that, what would I say back? I knew why we asked the question. I knew that I had to give her the opportunity to talk about all that was happening to her. But I was frozen by this young woman. I was frozen by her age, and by her diagnosis, and by all the feelings she raised in me.

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about all that was happening to her. I got caught up in all of it: the weariness she carried in her body, her downcast eyes, her silent boyfriend. And instead of offering a respite to all that, I joined in it, unable to push myself to offer her what she may have needed.

It was hard with all those young patients, harder than I like to think about, but it was not a lot easier with the older patients. I was just uneasy asking probing questions. I was inexperienced and just getting beyond my own natural timidity: a timidity that had interfered with all the intimate tasks of nursing. I had only recently become comfortable helping patients bathe and toilet themselves, and was only now mastering the skills to insert tubes into places thought private. I was pleased that I was gaining some confidence in performing procedures that would hurt patients, and that my skill was sufficient to minimize that pain, but I was still guarded. On many days I simply lacked the capacity to be open to the devastation around me.

Later, I would gradually learn how to do all this. I would learn that often patients want to talk, but sometimes they need our help to do that.

And they need a kindness that is born in humility. I would learn that all the tasks of nursing—probing patients’ bodies in intimate ways and cleaning up the mess of unruly body secretions—are only one part of the phenomenon we label nursing. When I finally learned this, I would come to know that asking probing questions or eliciting deeply held feelings is as much a part of nursing as starting a complicated intravenous or anticipating and preparing the medications in the midst of an emergency situation.

Responsibility, intrusiveness, and intimacy invade every interaction nurses have with patients. We have no choice. We can hide behind white uniforms, or the scrubs that came later, or the rigid rules about boundaries, but to do what patients need us to do, sometimes we must sneak past the normal boundaries. That is what I didn’t know then: that it is possible to do this, that we must do this.

But on that day with that young woman I was simply doing the best that I could. There were other days when I was better, when I could look into the patient’s eyes and not fear what I would find there. I wish I could say that in the days following, I made up for my self-preoccupation and helped that young woman get through what she had to get through. But I don’t remember. What I do remember is that it was these kinds of conversations that were the hardest part of the whole thing, harder even than watching someone die.

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short stay within the walls of that hospital. We were pushing toward two and five-year survival rates hoping that emerging drugs would ultimately save our patients from the metastasis that was sure to come. My initial belief that all these patients were dying was probably accurate, but I was not right in thinking that I could not hurt them. Margaret may have focused on details, but in focusing on those details she made sure that I learned these patients still had lives to live. They had not come to us to die.

I worked with acutely ill adults for only a few years before I wandered into community mental health and unexpectedly found my place in nursing.

But nothing that came later was the same as those early years. I can still feel the hyper-alertness that started as I walked off an elevator toward a nursing station, a place that was alternately teeming with energy or tensely vacant. I can remember rushing down the hall to find a patient blue and not breathing when I had just spoken to her fifteen minutes before, and when this happened, always wondering if when I had last looked at her, I had missed something: something crucial, something lifesaving. I can still feel myself slipping into rooms, especially at night, checking breathing, and softly laying my hand on a patient to feel the temperature of his skin, and always wondering—always—will I be good enough?

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Re-calibrating the CGM on a Bench in Kensington Gardens KATY GIEBENHAIN

Pigeons gossip and shrug.

The gadget beeps for blood.

Like London’s CCTVs the Continuous Glucose Monitor records, a good spy in the belly fat of a type 1 diabetic.

From a distance she could be setting a bomb, booking a table for dinner, tweeting, knitting, reading.

Past Weeping Beeches the slow tide of cell phones, runners, dogs, three-wheeled strollers flows.

What data, on any given day, will save us, will stop us, will give us away?

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Asylum KATIE KRESS

Summer has always seemed to me a time of waiting. Three months on pause, breath held and lungs expanded, an interstitial time spent in ways I hadn’t expected. It is a time spent recovering from the rains of spring, anxiously awaiting the rushing nip of autumn. In summer, I look inwards and I think of summers past.

During the summer of 2012 I was preparing to move to Chicago, and so I read of loss and thought of time. I read Joan Didion’s collected works, almost in entirety, during the week and visited my brother on the weekends.

Saturday mornings, my father and I would drive either his Honda Goldwing or his Ford Crown Victoria, depending on the rain, westward. From Dubuque, Iowa, he took Highway 20 west, then Highway 1 south until he hit Iowa City and picked me up. From there we drove past fledgling corn and soybean fields that were—even in June, even that early in the season, even as they were growing—suffocating from drought.The fields flanked Highway 80 west as we sailed by, my father almost always speeding to his son. And while he sped, I kept my arms and legs covered from the sun even if we took the Ford. That was the summer I peeled, that my skin turned red and burned and was spotted with freckles and sprouted fresh moles. That was the summer that, after exiting Highway 80 and merging onto Highway 141 west, my father and I visited my brother, John, at Woodward Academy. He was sent to that place near Des Moines after being found guilty of drunk driving, breaking and entering, and possessing paraphernalia.

He was sent to that place after spending time in both the Dubuque County Jail and Hillcrest, a juvenile detention center, and after a judge sentenced him to ninety days of detention and rehabilitation.

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photography, titled, Asylum: Inside the Closed World of State Mental Hospitals, the photo book was created by photographer of ruins and vanishings, Christopher Payne. From 2002­2008 Payne traveled the United States in search of abandoned state mental hospitals. He gained entry into seventy of these exquisitely grand dilapidations in thirty states and shot curiously beautiful and haunting photographs of walls and doors, chairs and beds, all empty and missing bodies, voices.

I was about halfway through perusing Asylums when it occurred to me that Woodward operates out of an old, repurposed state mental asylum. I began to understand that my brother was mandated into the same confined space where others once sought sanctuary. I began to think about all those who entered state mental asylums willingly, compared to those who were put away for the safety of others, and the irony of the word asylum came upon me. And since then, I’ve tried to imagine myself into Payne’s photographs, into the abandoned asylums, so that I might understand my brother and those long ago bodies and my place in it all. And since then, when I speak of Payne’s photographs, I speak of myself. I imagine myself into the photographs and into the past that my brother, my father, and I shared and I’m there again, surrounded by seemingly perpetual fields of bean and corn in Woodward, Iowa.

Norwich State Hospital Preston, Connecticut The shingles on the peaked roof are pocked, faded gray. Window panes dangle out of their frames, push out as the building slowly sinks down into the earth, compressing glass and brick and peeling wood until it cracks and shatters in the air, landing with a crinkle of tiny thuds in the weeds. Vines have reached out of trees to tangle with rain pipes and weak gutters. These vines climb and scale and clutch, wriggling past old metal window screens, eating the building slowly, coercing it back to dirt.

I imagine how it might feel to walk inside this abandoned asylum, footsteps echoing off bare and peeling and melting walls, toes pushing against chalky plaster. I imagine sticking my head and neck and shoulders out of a window whose glass has succumbed to the lure of gravity. Up there, with nothing around except the bugs and broken glass, the birds and dust and dirt, I hear the silence. That buzzing silence that sticks in your ears when you’re alone and have no chance of being discovered. You begin to discern the frisky hum of cicadas from that of gnats and flies.

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Here, you don’t smell sweat or freshly cut grass; instead, you smell the heat of sunshine on rotted bricks and wild white yarrow and maple tree saplings.

The land waited for decades to take back the building. It comes back slowly, careful not to threaten the memory of those who once lived within the brick and mortar, careful not to incite the kind of alarm that depression and anxiety cause outside the asylum, the alarm of a society who equates mental disorder with identity. I use the term asylum—originally meaning refuge, sanctuary—rather than hospital because it doesn’t seem that hospitals today save psychic sojourners the way asylums once sought to do.

I fear sounding romantic, fear that I may be looking at the past sideways instead of head-on. But I know of the brutality, the mismanagement, the maltreatment. And yet, hospitals aren’t built now as they were once. They lack an ornate spaciousness, an elaborate construction of doors hewn from real wood instead of the synthetic mishmash of cardboard and stray flour fibers. These asylums, the buildings, may now be abandoned but they are not dead. They live and evolve, they grow as vines stretch and grasses push up from the earth and mold proliferates and divides in those corners damp from last night’s rain. Lichen, too, slowly devours brick, tunneling inside, transforming it into motes of sand. One replaces another, the clouds break, the lips and knuckles and knees have gone, and the sun moves on.

I want to say that the architecture of this asylum reminds me of a museum, but it doesn’t. Maybe it might have before the moment of abandoning when the grass looked uniform and the bricks scrubbed. It doesn’t quite remind me of a mansion or chateau either. Nor, a hospital. It seems to be none of these things, fulfill none of those functions, and yet, it exists as all of them at once. The way contemporary American society often perceives the mental hospital—as an outpatient clinic or a place to recuperate and heal for a few days, weeks, or months—differs greatly from the original function and mission of asylums when they were popularized and proliferated in the mid­1800s. Then, and up until the 1950s, asylums acted as places those with actual and perceived mental health issues could live, could remain, for decades or until death.

Asylums, regardless of their bureaucratic mismanagement and maltreatment of patients, really acted as a home both rudimentary and elaborate. The land hovered around these monstrous campus­style hospitals, often built in the shape of a flying “V” so that sunlight might flood through all the windows indiscriminately. But the patients who acted their lives out in these asylums often became institutionalized and hence, museum­like, static, kept separated. There existed no training or programming in place for patients to 137

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learn how to re­enter and assimilate back into society after receiving treatment. After passing through the asylum doors, it was expected that patients stay—that they sit in a straight backed rocking chair by a bare window and take in the sun.

The first time I visited Woodward I felt struck by the empty windows.

Upon first entering, after driving past two stone pillars and through a small lane over which hung a stretch of aged trees, I felt the quiet. After exiting the highway, after my father slowed his motorcycle and I could lift up the shield of my helmet and breathe fresh air, I heard only the rushing of wind through early June corn and the Goldwing tires meeting pavement. As I unzipped the faded black leather jacket that my father had lent me for the drive from Iowa City, where I lived during the summer of 2012, Woodward came into view. High school aged boys dressed in khaki pants, combat boots, and navy T­shirts marched in a straight line, counting out their steps.

I peered at those boys trying to find my brother, searching for his shoulders, his eyes, straining to single his voice out from the others. I wish I could say that my eyes alighted upon his, that I recognized his particular march, the way he swung his arms stiff, just so. But two years have passed since then and I can no longer recall. I do remember, however, that during the summer of 2012 I was aware that Woodward was housed in a repurposed state mental hospital. But, preoccupied by immediate pressing matters, I failed then to interrogate the parallels and meanings of the intersections of Woodward’s past and present.

Woodward State Hospital opened in 1917 and existed until 1921 as a colony for epileptics. But, due to demand and overcrowding in other Iowa state hospitals, Woodward began accepting patients labeled as feebleminded in 1921. By 1952, the walls of Woodward enclosed more than 1,600 patients from all over Iowa. Today, Woodward Academy and Woodward Resource Center (the new and revised name that replaced Woodward State Hospital) share one campus. Upon passing the two stone pillars and driving under the stretch of aged trees, you first come upon the Resource Center. It seems abandoned and still, as if no one ever enters or leaves those buildings. I wondered then if in 1917 and 1921 and 1952, the whole campus lived encapsulated in this static way, if the only thing that ever grew or moved or changed was the amount of cells and hairs piled up in corners and on shelves, the density of dust.

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Typical Ward, Kankakee State Hospital Kankakee, Illinois I’m inside now, at the helm of a long and wide hallway. Thick, heavy bedroom doors of glossy cherry wood once flung open now stand hinged, still.

Each of these bedrooms must house a tall window because sunlight has pressed through the open doorway and lies stretched across the hallway floor. There’s a window at the dead end of the hallway, too, at least six bedroom doors away. I stand in the shadow and the light fixtures dangling from the arched ceiling are turned off, but I don’t mind—there is light enough.

Enough to make out strings of white paint drooping, substantial patches of paint flaking in an ever widening spread above my scalp. The hall rests empty now. It occurs to me to wonder, when state funding crumbled and everyone evacuated, who decided to leave each bedroom door open. Who understood that although the floor may crack and become slick with dust and the paint might melt and drop and the birds could very well build nests in the ceiling corners, that if the shades were left up and the doors open that the sun would remain, relentless and warm?

We used to ride bicycles, my brother and I. As children we rode in wide circle eights through the parking lot of our townhouse. Sometimes we rode out of our cul­de­sac, over gravel and grass where the city hadn’t laid cement, across the overpass arching above Highway 151, and down the road to Murphy Park. It was summer, and I wasn’t any older than twelve, so John wasn’t any older than eight. It was evening and I watched John pedal in circle eights while my father cooked dinner. John weaved between parked cars and I cannot remember now if I warned him not to get too close, not to clip a side view mirror. And I cannot remember if maybe I looked at my tennis shoes or the mulberry tree, its weighty branches hanging over the garage, but suddenly John’s front tire caught on a curb and he tumbled over the handlebars and his feet tangled and his face fell to the cement. He laid there and blinked up at me and I didn’t say a thing and neither did he. And for a moment we stared at each other just breathing. Then I turned and I ran across the parking lot, over the wood chips gathered under the tall fir tree, banged through the screen door, and I screamed. A clatter came from the kitchen and my father sped past me to his son. I might have followed with the first aid kit, but I cannot remember anything after the door shut behind my father except how my brother’s skin broke, that our shared silence seemed to echo, and the way we looked at each other real slow.

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Before Woodward, the skin of John’s face didn’t feel smooth. Colored a violet­gray, peach hue, his skin looked exhausted and felt parched. Bruised from lack of sleep, his eyelids seemed painted plum. And although I hadn’t touched his ribs since he was a baby, I could see them. I imagined that the skin stretched over his rib cage felt tight and thin, as if it’d been starched.

But that June, that first time I saw him at Woodward and hugged him, I felt meat. That first day he probably flexed his right bicep so I could see how the muscle had grown and thickened. And his skin looked clear and tanned from the marches, the runs, the outdoor military­style physical training. It was his hair, however, which surprised me most. Before Woodward, John’s dishwater blonde hair covered his ears, fell over his eyebrows, sleek but shaggy. At Woodward, though, they took a buzzer to it. I ran an outstretched palm over his new prickly hairs and thought that his new haircut suited his skin. It matched his laced combat boots and his new gait. When he stood up to ask a staff member for permission to use the bathroom I noticed he walked differently—with squared shoulders he stepped corners at a ninety-degree angle, sure footed.

Oregon State Hospital Salem, Oregon The tile in this bathroom is the very same as that in the bathroom of my apartment in Rogers Park, Chicago. The first time I saw that tile my breath caught. I inhaled quickly and my lungs pressed out, lobes against a rack of bones, and for a moment I thought that bathroom mine. For a moment I feared that I repressed memories of myself in an asylum, of my body submerged in a deep porcelain tub, my hair damp with water and shampoo tangled around my finger, split ends puddling in my palms. I sat quite still until I realized it was only the tile that seemed to share space between the asylum walls and those of my bathroom. The tile is a calm green. A sea green.

It is not a grass or tree or weed or cornstalk green. It’s a cross between mint and turquoise, between aloe and celery. The walls of the asylum bathroom are rimmed in this green, as are mine. The deep bathtubs that appear to be six feet in length sit squarely on a cement floor, wrapped in mint and aloe, too. My bathtub is not. When I used to think of asylums I did not think of bathrooms or a complicated shade of green; I thought instead of the people. I did not think of the architecture or the furniture, the width of the hallways or the color of paint splayed on walls.

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I thought of the people housed, living, healing, worsening, loving, screaming, and dying behind the bricks and windows and curtains. I thought, too, of doorknobs. Of plastic, opaque, iron, gold, and locked door knobs twisting, rattling in my palm, fingers stretched and flexed, biceps engaged, pulling.

Now when I think of asylums I see mint and aloe. I’m standing in my bathroom.

Each Saturday, after my father steered off Highway 80, we stopped at a gas station for snacks. We bought Gatorade, Gardettos, beef jerky, and Chex­Mix for John. Sometimes we bought him Cheez­Its or fresh fruit. After arriving at Woodward and rushing to secure a first­come, first­serve table, one of a very limited amount in comparison to the demand, we ate together. Some of the Woodward staff baked frozen pizzas made to order, too. We always bought one or two and ate them off napkins that after the second thin slice were soaked in orange grease. We crunched and slurped our way through the hellos and how­have­you­beens and only­X­number­of­days­until­you­get­outs. I visited my brother every week (except the very first week after he was admitted because I had been finishing final exams and graduating college) for ninety days. And I cannot remember any thing or sentence or subject we talked about besides the generic fillers. The specifics evade me.

I struggle to remember words, but I do remember the emotions I felt.

I remember how they jumped and spasmed without my control or consent. I remember spending a significant amount of time within the women’s bathroom stalls, crying. I cannot anymore remember the words said or unsaid that sent me into that bathroom, but I do remember that I cried instead of screaming in anger and that I leaned my forehead against the stall door, my left hand clutching the top and my right pressing my eyeballs into the back of my skull. I shook in those stalls, waiting silently with fists balled and eyes upturned toward bars of fluorescent light.

Lobby of Mead Building, Yankton State Hospital Yankton, South Dakota I’ve yet to show you the stairway. Carved from white granite with gray marbling, it separates into a “Y” stretching left and right. I imagine that grand parties with red wine, black, silk gowns, and starched cummerbunds were celebrated here. They would have danced the waltz, not the foxtrot.

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champagne or Brut Rosé, appearing precisely when the hostess began her toast. I think of all this extravagance even though dust and chunks of plaster lay in wait at the foot of the staircase, even though it seems as if someone has scrubbed the sea foam colored paint off parts of the walls, even though I cannot hear this great hall echo with the click of heels or one party guest calling out to another in delight.

I find myself slipping from the party, pulled away by the thump of non­stick shoes and the cacophony of shouts between one orderly to a nurse about a patient across the way who tongued her meds, who refuses to allow her body to be infiltrated. She used to believe she possessed control of the things she swallowed and said, the things she allowed entry into and exit from her body. As the orderly clasps her shoulders and wrenches her forehead back, her throat opens wide and her eyes blink at the ceiling. She imagines tumbling down that white granite staircase laced with gray marble, her body a sojourner, sliding, her mind reeling with what’s been lost.

I understand now that in a lot of ways riding on the back of my father’s Goldwing allowed me space and time to cope. After I yanked the helmet past my ears, nimbly secured the chin strap, and slapped down the face shield, I heard only my breathing and the buzzing fugue of wind shoving against my body. I didn’t need to recount and parse out everything that was said or avoided during our visit with John. I didn’t have to go through it all twice. There was no need to think about much of anything that had just happened or might happen soon, so I didn’t. Instead, that summer, I thought a lot about the wind and the land and dehydrated dirt and the feeling of worn leather between fingers. I thought of Iowa and her corn and the roads and repeated paths, pauses, and stops that I never thought I’d take.

It has only become clear to me recently that back then, during the time of face shields and bathroom stalls, I believed very much that my fate, my future, was tied closely to my brother’s. I couldn’t clearly see how to move on, to leave Iowa for Illinois, until he left Woodward. Those hours on the Goldwing represented hours of waiting in movement. Waiting to go, waiting to leave, waiting for some signal that time was ending and another time beginning.

John did leave after ninety days. In a sense, his release from Woodward acted as a signal of transitioning times. But Woodward seemed to linger in my bones long after I stopped visiting. And I expect that the air of confinement by corn and law, by both nature and man, has housed itself inside John, too. It proves difficult to extricate oneself from these defining moments in 142

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life regardless of how many details or conversations one does or does not recall. The feel of place and time—the dust of gravel in the parking lot staining the hem of jeans, the stick of grade school sized chairs on a damp lower back, the cheap feel of thin toilet paper crumbling between thumb and eye, the realization that you have no other choice but to wait in line to see your brother, and that after you leave he will be strip-searched—doesn’t simply vanish because your body no longer returns. The land that I stood upon and felt beneath my feet, the land that supported my weight and absorbed my stamps and sighs and screams, the land of Woodward, Iowa, followed me all these years, remaining within me still today.

Patient dresses made at Clarinda State Hospital Clarinda, Iowa Where are the bodies that fit into contours of fabric, whose knees stuck out past the hems, whose fingers stitched the delicate lace? Whose mind chose the soft rose and lemon and blueberry patterns? Whose palms grasped and whose arms stretched measuring tape against another’s body, around their belly, searching for girth, substance? I imagine the fingers, the minds, that pieced and sewed together disparate scraps into something whole and beautiful, delicately soft but sturdy. I imagine the rheumy blueberry dress suspended upon warm shoulders, the hem skimming her kneecaps, the delicate short sleeves encircling her biceps, a high elastic waist clutching dermal periphery.

Near the end of John’s ninety days at Woodward he graduated from high school. Seventeen years old and a senior at a public school in Dubuque when he was first jailed, he missed the last half of the school year. At Woodward he made up the classes and credits, and in that way earned his diploma. At that time, when I struggled to see a way forward for both myself and my brother, his graduation seemed a moment of control and catharsis. The hour of John’s graduation marked the single time I allowed myself to cry without the concealing bathroom stall walls. John stood on the stage shaking hands and my father’s gaze never strayed from his son. No one bore witness to my eyes.

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Mattress Springs: Taunton State Hospital Taunton, Massachusetts & Patient Toothbrushes, Hudson River State Hospital Poughkeepsie, New York There are coils in the closet and a rainbow of used toothbrushes, hanging bristles down, in the pantry. Sunlight pushes through window panes and dangles above the coils, tangled, heaped one upon another, caught and intertwined. They rest still, but not easy. Without a mattress, without body and blanket, they’ve lost their will, their willingness to tolerate compression, a squeezing, limiting, shadowy pressure. In the pantry the bristles have yellowed and grown hard, their red, yellow, and green plastic handles soft and slick with dust, tiny skin and hair cells gathered together, slowly sighing, voiceless. That closet and pantry, those coils and toothbrushes remind me of museum installations, of items that visitors and gawkers and voyeurs come to peer at after everything has settled and the bodies that brushed and slept have gone.

It does not escape my attention that which is lost when one turns to dust from sitting and waiting. That which is lost when one remains silent and still is the fight for a reckoning. When you drive and the wheels spin back and forth and you speak of time’s enchantments and disguises while sitting and waiting, you feel like a portrait of yourself, as if you were living inside a photograph.

The corn, stunted and dry, seems frozen and no one disturbs the curtains or strolls past the windows and you continue reading silently, saving the strength of your voice for a moment that you are not sure has yet come to pass. You were as burnt and dusty as your brother, walking in circles around the visiting room with nowhere else to go. You rose only to sit again, sat only to sit some more, unable to walk yourself out.

Patient­made game, Cherokee State Hospital Cherokee, Iowa These are the only bodies left in the asylum. They are puppet­like dolls strung up with narrow poles of balsa wood shoved into their shoulder sockets like beads on an abacus. One doll winks, one wears a bowtie, one sports red hair twisted into braids. Another is black, another brown, yet another sickly white. A face painted like a clown, a face mimicking an angry mother, and 144

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another face stares in wide-eyed, unblinking, shock. And yet, all are female, all are armless without fingers or palms.

What was the game? Who played with these armless, dolled puppets?

Did the players mock the women, scream in hysterics? Were they excessive, too emotional, their insides drawn out, laid bare, desiccated? Did excisions and electrocutions incite screams and cackles for all to hear?

Were puppets spun around and left upside down, blood dripping through vessels, draining to tips of ears, pooling in eyes shocked wide and unblinking?

Before Woodward and the drought and my burnt skin, before all that, there was the clock tower. There was a time when my brother marked his days and nights by the orotund movement of the hands on the face of the town clock tower.

In the Dubuque County Jail, clocks did not hang on walls or wrap around wrists or sit on bedside tables. But my brother said that during lockdown, when he sat in his cell, he could see the town clock tower through his small window.

Built of cream­colored concrete and topped with a cupola, the clock rests above a four­column pedestal situated in the middle of Main Street, Dubuque. The clock tower has stood 108 feet high over the city for 139 years, and back in 1873, it was believed to be one of the most accurate clocks in the United States. Still, he asked about the time when I visited.

But when the guards brought him food he could tell the time, too: 7:00 a.m. breakfast, 11:00 a.m. lunch, 4:00 p.m. dinner, 8:00 p.m. snack. His life was restricted by sequence—breakfast, lunch, dinner, snack, lockdown, breakfast, lunch, dinner, snack, lockdown. John said the guards brought his food like clockwork, like magnified cogs and wheels armed with batons and handguns.

Hallway, St. Lawrence Hospital Ogdensburg, New York The walls look like the sea—restless and cold chapped blue. Foam seems to slide over and peel back off rock, concrete. Chairs balancing atop wheels flank these seawalls, their empty seats peer up at the peaked cathedral­like ceiling. Two rows of chairs, at least twenty crammed in each row, sit parallel to each other. It looks as if people might meander in at any moment to fill these seats, stare across the aisle, and look into each others eyes. It almost 145

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seems as if these chairs haven’t been sitting empty for years, as if they haven’t gathered dust in dimpled cloth atop exposed foam, deep into the veins of leather worn and supple, cool to fingertip and palm, weary thigh.

At the far reaches of the seawalls, beneath the ceiling of ample air and empty prayers, and past chairs colored raspberry, lime, goldenrod, tangerine, and sage on stiff stuck wheels, there stands a door. Chairs lead right up to this wooden door, waiting for it to open, for one eye to acknowledge another, for an invitation, a whisper or scream. The invisible and empty, the dust laden and heavy lidded—they wait for a reckoning.

It was John’s voice; I knew that. I could see his lips moving. But before Woodward his voice didn’t travel through the same air as mine, through the same room that I sat in at the jail. John’s voice sounded like his voice, but seemed quieter and softer than normal. I strained to hear him. And I cannot say for certain, but I don’t think my voice sounded the same either. How could it, with a window of glass and a metal speaker separating us? We shared no common air. And too, there was a moment when I saw his lips move but couldn’t hear his voice—the sound delayed as it was processed by the speaker, as it pushed through the holes punched perfectly into the face of the metal speaker. That speaker filtered his voice before it reached my ears. And the quick, almost unnoticeable moments between when we spoke and when we heard each other filled with liminality—a silence, a waiting. A waiting to hear, to be heard, for the time to pass, to leave and come back again, to run out of things to say, for silence, for a time when this would all end and I wouldn’t have to pass through locked and guarded doors to see my brother; for a time when he wouldn’t need to peer out a small rectangular window at the clock tower, but instead, could walk up to its base, tilt his head, lift his eyes and look up up up and watch the hands of the giant clock tick.

Unclaimed copper cremation urns, Oregon State Hospital Salem, Oregon & State records and files, Spring Grove State Hospital Catonsville, Maryland There are 36 shelves brimming with 396 urns filled with ashes and bone fragment, unclaimed. These urns, under fluorescent light, shine illuminated and found, realized once again. Aloe, celery-colored mold grows slowly across the bottoms and up the side of dozens of urns. Most of the labels, covered with personal identification information, have long since peeled at the corners, 146

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detached, and fallen by the wayside. It seems these peels and their words are nowhere to be found. And so, I cannot give these ashes a face or name or voice that might accurately represent or recreate these long ago beings.

Instead, I imagine myself as one of them, as part of their delegation of the dead and scant remembered and long since forgotten. I imagine myself with them because even if they do not need company, even if their bones rest easy cushioned in a bed of burnt hair and skin and muscle, I could use a rest from this place where I live, where people burn without notice. I could use a rest from screaming and writing, whispering and wailing to ears chock-full of wax that if even one of us is abandoned, burnt, and unclaimed then the rest of us are too—living or dead. We are all, all of us, burnt and dusty, peeling and torched even as we walk around loving and looking and touching hands.

The last written records of asylum sojourners and seekers sleep in a square room, toppled and piled upon each other. The names of the faces and brains of the legions of burnt bodies and delicate mounds of ashes live in ink on these yellowed pages. But, you try to match a name to a blank urn, label peeled off by time and gravity. What are you to do but sink your hands into the ashes and pull out a bone? Tell me, does the heft of that femur shard feel like a Scarlett? A Sarah?

I imagine that if I were to sort through, organize, and stack these fragile papers, crisp with age, I might discover information such as name, date of birth, diagnosis and prognosis, medication list, psychologist notes, and date of death. But I want to know the person beyond the figures and statistics. I want to know why she wishes to wear only wool socks, no shoes, and why her skin reddens and peels. I want to know why her way is not mine, why her femur is not mine, why she is burnt and I am still burning.

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Deathwatch

CATHERINE KLATZKER

There is a pinpoint of light on the computer screen that grounds me as I transcribe numbers, chart vitals, and track the path of my six-month-old patient from scribbles on scraps of paper towel taken from his isolation room. Even without the computer screen, there is a bracing light on the bedside monitor, always present. Even without the monitor, there is a presence in my mind when I call it up, and I can buttress myself when the ICU alarms blare, and when parents freak, and when the residents forget what comes next.

I finish my RN emergency-check this winter morning, gowned and masked and gloved. The baby’s isolation door is shut against the Pediatric ICU clamor, and I quickly assess whether we can safely move this patient into his parents’ arms. When I say the word, four professionals will rush in to help me. It will take that many to lift and support him; change out the bed beneath him; turn his head to the foot of his larger bed; protect all his IV lines, his chest tubes, and his high-frequency oscillating ventilator; raise him on pillows on his mother’s lap at the foot of the bed; and make sure his blood pressure, heart rate and oxygen saturation stay as stable as possible during the transfer. No one will question my judgment, even as we spend the rest of the morning recovering his fragile oxygenation, even though we cannot increase the settings on his drips or his ventilator—they are already maxed out. There will be no escalation of care. His parents have agreed to no further heroic measures beyond what we’re already doing. They only want to hold their son.

When the geneticist shows up in the afternoon, I am still playing catch-up with all the labs that continue to be sent, with all the ongoing drips and blood gases, and of course, the documentation. I focus on the pinpoint of computer light when she tells me she needs to collect biopsies 149

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for genetic studies. My voice is calm, if disbelieving, and so am I, when I tell her, “You know he’s dying.” She nods her understanding and I remain unconvinced that she actually wants consents and biopsies right now.

“He’s actively dying,” I say. “I don’t know if there’s time for this. Is this really necessary?” I mean this in the kindest possible way and I hope my voice conveys that.

She assures me the parents are expecting her; she’s talked to them and they want her to do this. I’m still dubious, but Dad confirms this and asks through the door for a pen so he can sign. The middle-aged geneticist gowns up and I repeat to her, “You need to be prepared, he’s vigorously dying, I don’t know where you’re going to find any skin for punch biopsies, and I won’t let you hurt him.”

She gives me a look, says, “Just give him some pain medicine, this is the ICU, you can do that,” and I shake my head. I don’t know if he’ll survive a morphine bolus and I don’t know if he’ll survive the pain of her procedures.

The genetics doc approaches parents and baby, and I see her gasp behind her facemask as the color drains from her face. She wasn’t prepared at all. What did she think dying looks like? I’m annoyed, but I find my center. I connect to something steady, and I swiftly pull a chair up for her next to where Dad is holding baby securely on the pillows, the ventilator tubing strapped to the bedding from the high-frequency oscillating ventilator—that in 2009 sounds deceptively like an overactive lawn sprinkler on a carefree summer day.

I apologize to Mom and Dad. I’ll need to disturb them to reposition their little son so this doctor can find some skin for her punch biopsies, and I do so as gently as I can. He has so many dressings, so many tubes and lines and IVs and wounds, and the skin I find has almost no padding; this six-month-old baby weighs 3.6 kg, or less than eight pounds. The geneticist very carefully proceeds, and each time she collects a specimen I monitor for pain, for changes in heart rate and continuous blood pressure and oxygen, and the doctor’s eyes tear up until she’s fully weeping by the time she has her last sample. “I’m so sorry,” she tells the parents, dabbing at her eyes with a tissue. “I’m so sorry to disturb this time for you with your baby. I wish we could do more.”

The baby’s mother comforts the doctor and I almost lose my center again. Families in grief are comforting their caregivers…No, I protest inside, until I find the glimmer of light on the bedside monitor and I remember to breathe. “It’s so important to us,” this mother says, “that after these biopsies 150

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go to the Netherlands and become part of the research into this rare condition, that maybe other babies like ours will live,” and my heart opens.

Even to the genetics doc.

The day wears on. We watch. We watch his color deepen to something unhappily blue-tinged; his fingers and toes and mouth are dusky gray.

We watch his vitals dip and rise. His oxygen hovers as his nasal flaring increases and we cannot bleed any more nitric oxide into his ventilator, it will hurt more than help. His parents are too frightened to go anywhere for nourishment, but they finally leave in turns for ten minute intervals to gulp something down, probably junk food. I make sure they drink water, at least.

He continues to spike fevers and I am still running triple antibiotics, triple anti-fungals, pressors and milrinone. I begin to frazzle at the edges when a nurse pokes in her head to tell me I’ll be docked for not taking a timely break. Really, that’s your concern? You’re going around telling people they’re out of compliance when I could use some help here? If it’s help for five minutes, there are plenty of people. If it’s ongoing help, no one can be spared.

The first time the palliative care doc shows up at my computer and says, “How can I help?” after I update her on our patient, I say I want a cup of coffee, and she brings it back to me from the kiosk downstairs. The next time she comes by I don’t know what to ask for, I need so much. A point of light, maybe. “Do you want a hug?” she asks. The first thing I think is that I don’t have time, I’m too busy. Can’t you see how busy I am? And a hug is exactly the thing I need. It takes five seconds and I’m back to work.

Grounded.

By end of shift, it’s clear the parents need to stay close. They sing softly to their baby, they stroke him, they hold each other until his heart stops and their child is gone. His ventilator still huffs and puffs until the respiratory therapist turns it off. This child’s struggle was valiant. So was theirs. The room is filled with his light. My center is secure.

Traditionally, I will help to clean him now. I will remove his dressings and lines and wash the evidence of medical interventions from his beautiful body. Before I can do so, I step out of the room to get some clean linen and to give his parents a few moments. It is 7:00 p.m. The day shift is signing off to the night shift. On my way back from the supply room, the night charge nurse stops me. “You’re not staying over,” she announces. “Just give a fast report, someone else will wrap the body. We’re not paying any overtime for this.”

Just like that, my composure abandons me. I turn on my heel and leave the ICU. I head straight to the nursing lounge to collect myself. I am alone 151

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at a table, shaking with anger when a respiratory therapist sits next to me and begins to massage my hands with her Mary Kay massage cream. I don’t stop her. We finally speak, hesitantly. Yes, the baby died. Yes, I should be with the family. Her touch is firm and sure and strong and my mind clears. I find my own presence, my balance, and I know I don’t give a flying expletive if the night charge nurse has issues that are not mine. I know her, the night charge nurse, from when I used to work nights, and I know that at first look she appears hard, and that her flat exterior hides a well of compassion so deep that it frightens her. She won’t look too deeply at what was lost today, or at the fear that threatens every caregiver-witness who shares that deathwatch, who enters that space. I rise, I punch my timecard, and I reenter the ICU on my own time.

I go directly to my patient’s room. In death, the baby has been bathed and swaddled in his own soft blankets, and his parents are waiting for me.

“We looked for you, we wanted to thank you. Where did you go?”

We embrace and I tell them I’m so sorry for their suffering, their child was a blessing, we’ll always remember him. I don’t recall what else I say.

“Thank you,” they say. “Thank you so much.” Their baby son has died and they thank me.

This is irrational, it’s nuts, I think, before the pinpoint of sanity finds me…We hold it all, the sorrow, the anger—so much sorrow, so much anger—and the stillness.

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2015 Carol A. Bowman Writing Contest Winners

This is the third year featuring the top three entries from the Carol A. Bowman Writing Contest, held yearly and administered through the Carver College of Medicine’s Writing and Humanities Program. It is at times humbling to read the work of such talented students, and we look forward to providing you that opportunity this year and in the years to come.

Carol Bowman received a PhD from in the Medical Humanities at the University of Iowa in May 1992. Soon after, she was found to have a malignancy from which she died in July 1993 after a valiant, difficult struggle. She had been a successful writer, a substance abuse counselor, and an enthusiastic teacher of high school and medical students. This contest is a memorial to her concern for the humane treatment of patients and students.

Dr. Richard Caplan established the Bowman contest and administered it through its early years. We appreciate Dr. Caplan’s dedication to the humanities and honor his efforts through the publication of these works.

First Place: Kaci McCleary, Dandelions Second Place: Rachel Press-Goossen, On Following Instructions Third Place: Alyse Marie Carlson, Brown Winter

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Dandelions KACI MCCLEARY

Once in a green grassy school yard He gave his friend a dandelion And whispered, “You’re pretty like this flower.”

Because he wanted to see him smile.

And none of the other kids noticed And the teachers chatted about how cute That he was so sensitive And they were such good friends And when his parents heard Their eyebrows raised And they said nothing But were sure to take him to church that Sunday.

That was the year he learned about God And was told that God loved everyone the same And the songs they sang were about charity And he felt like Jesus was inside him When he played house with the girls on the playground and kickball with the boys And believed God would always keep him safe.

Once on a commercial holiday He gave a boy a daisy With the note, “I picked this special for you.”

Because that’s what people did And it made the boy blush hot pink While the other kids laughed and laughed And the teacher told him it wasn’t fair To give a Valentine to just one person 155

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And sent a note home Where his parents, Their eyebrows raised, Said nothing But sent him to a special camp that summer.

That was the year he was baptized into the church And told that some kinds of love are sinful And his pastor led prayer every evening And shouted praise at the heavens Because he wanted to be sure he had God’s attention And he tried to feel the Holy Ghost And to cry out in rapture with the group And willed himself to forget the pain in his father’s eyes When he asked why the other kids called him a sissy.

Once at a senior dance recital A girl gave him a bouquet and a long tongue-kiss And a card that said she loved him Because he had been inside her one time And it made him feel like a filthy liar While the crowd stood and cheered And the teacher told him how proud she was That he had come so far and worked so hard And sent home a performance tape For his parents to watch, Eyebrows raised, And say how nice it was that he finally had a girlfriend That was the year he learned about the boy in Wyoming who was beaten bloody And tied to a fence and set on fire And left to die And told his classmates he thought fags deserved AIDS Because he didn’t want to seem like one of them And prayed every night for God to take away the thoughts And told himself he enjoyed touching girls With shaky, sweaty hands And he went to a Bible study every week And pretended to understand what his pastor meant That the gays had some agenda other than to be left alone And spent hours reading the paragraphs over 156

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And over Because he wanted to believe God would not make him this way Without some sort of explanation or cure Once on a college campus He gave a man a rose And a promise to always be faithful Because that’s what people in love do And they wanted to put it on paper And tell all their friends And their families And be able to hold hands in public That was the year his parents told him to not come home for Christmas And said they could love the sinner Without welcoming the sin into their home And they sounded just like his pastor And his mother cried And asked how he could do this to them And he walked all the way back to the airport Because he couldn’t afford a taxi And his parents wouldn’t even look him in the eye And he realized he couldn’t remember the words anymore To the Sunday school songs about charity And wouldn’t believe them even if he could Once in a hospital waiting room He gave flowers to a nurse With a “Get Well Soon” Hallmark card And asked her to take it to her patient Because only family members are allowed visits in the ICU That was the year he learned “sexual orientation is not a protected class” And that “crimes motivated by hate are not necessarily hate crimes” (If you are a damned faggot) And that the police would only take an assault report Because technically they had to And they would fill out all the proper paperwork And nothing would ever be done about it And he tried to see his boyfriend through the tiny window And he prayed for the first time in years And tried to explain to God That he didn’t blame him for the ways people hurt each other 157

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And just wanted his lover to live That’s why when he put flowers on the grave He brought a Bible And read the parts about charity out loud Because he needed to believe there was still some good And he saw on the stone it said “Loving husband” And wished it had been true Because then he could at least have collected insurance And a few days off work to grieve And a final kiss goodbye.

And so he lay down in the grass by the dandelions And gave his body to them for just a moment Because he knew that soon he would have to get up And keep going on alone.

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FICTION

On Following Instructions RACHEL PRESS-GOOSSEN

“So, what brings you in today?”

She sets aside a battered, outdated issue of People magazine and adjusting the small gold cross hanging around her neck begins to speak in her low, slightly southern drawl. She interrupts each sentence to crack jokes at herself and sigh at how she really needs to start exercising again. Her short, curly hair has been box dyed an orangey red and combed through so that it hangs in cotton ball poofs at each side of her face. She flicks the ends of her chipped pink manicure against the corner of the magazine as she talks.

Amidst the small talk about her work as a secretary at a local middle school and her long drive to the hospital in the early fall rain, I take notes on Linda Humphrey’s story.

Yes, her symptoms have been improving. No, they have not gone away altogether. Yes, she uses the suppositories she was given at the last visit and has been using the cream we’d suggested religiously. No, she and her husband have not been sexually active in the past four months since we last saw her. She has been feeling better, but still a little “off, ya know, down there.”

“I just really want to exercise, ya know? It helps my depression and I just don’t feel up to it when I’m dealing with this—it’s just so messy.

And, well, I need to lose some weight.” She laughs nervously and gestures vaguely at her abdomen.

I can feel minutes passing to the cadence of her slow and garbled twang and I know that I’ve been in the room for too long. “I understand.

Well, let me talk to Dr. Cook and we’ll see what we can do to get you back to the gym. Do you have any other questions or concerns?”

I immediately regret my offer of assistance as she launches into yet another cycle of self-deprecation, wistfulness and finally weak humor. I am physically backing out of the room and Linda has twisted 180 degrees at the 159

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waist just to maintain eye contact as she rattles again through her story in her train track voice.

“Okay. Sounds good. I’ll be right back.” I close the door on Linda’s expectant gaze and hustle down the hallway toward the workroom. It’s been too long. I know that Dr. Cook will tell me it’s been too long.

Dr. Cook smiles at me mirthfully as I sit down to begin my report.

“I’m sorry that took so long,” I begin. “She was chatty.”

“Yes, she is,” says Dr. Cook, lifting her chin and peering down her nose at me. “She’s very depressed and she’s been dealing with this infection for a long time.”

We enter the room together. Linda is sitting with her back to us on the exam table, drape sheet wrapped tightly across her legs leaving a wide stripe of her bare, pale backside clearly visible from the doorway. Dr. Cook opens with her normal string of pleasantries and expertly dodges Linda’s attempts to re-launch additional accounts of her recent challenges and victories, and determination to resume physical activity. I stand with my back plastered against the cool wall, waiting to be told what to do. Linda’s floral print turtle neck and faded jeans sit folded neatly on top of her walking shoes on a chair in the corner.

“I’m not going to have you do a pelvic exam, Rachel,” Dr. Cook says to me as she positions herself between Linda’s legs and raises the sheet covering her. “Her vagina is already irritated. Would you want two pelvic exams if your vagina was irritated?”

I shake my head.

Dr. Cook inserts two fingers into Linda’s vagina and paws methodically around her abdomen, as I’ve seen her do with so many other patients before. But then, her face changes. Her chin drops, and her gaze turns from me to Linda. “What is in your vagina?” she asks.

“Um, nothing?” she rattles, with an uneasy laugh, her eyes darting back and forth between Dr. Cook and myself.

“Yes...yes, there’s something in there...” Dr. Cook slows and her eyes shift. She stands up from her stool and looks Linda directly in the face.

“What did you put in your vagina?”

“Nothing!” Linda is blushing and there is a note of panic in her voice, which is now faster and higher pitched. “I haven’t put anything up there!”

I try to stay stoic but can feel my heart beat quicken and my eyes get wider. I think that maybe if I stand very still, everyone will forget that I am in the room.

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Dr. Cook grabs a speculum and expertly maneuvers it into place. She grabs the adjustable light from the side of the exam table and focuses it between Linda’s legs. “Yes, there’s something in there. Are those—oh! Are those the suppositories I gave you?”

“Oh, hahaha, yeah, I guess I did put those up there.”

I feel the breath I didn’t know I was holding quickly rush out between my pursed lips and Dr. Cook turns to me, smiling.

“Rachel—Rachel come here. Sit down. Do you see that? Those are the suppositories we prescribed. They are still in the wrapper.”

I sit down at the stool between Linda’s legs and peer down the still open speculum. At the end of her vagina I can see very clearly a not-acervix.

“So you’ve inserted the suppositories with the wrappers on—you need to take the wrappers off before you insert them.” Dr. Cook’s chin raises again as she speaks to Linda, who is flushed with embarrassment. I can see tears gather in the corners of her eyes.

“Oh gosh. How stupid. I’m so stupid!” She laughs, and her voice cracks--a deep, sad sound.

“That’s okay!” Dr. Cook goes on. “It could happen to anyone. I’m just going to have Rachel take them out.” She hands me long-handled forceps and pulls out the drawer at the end of the exam table, placing a towel in the bottom of the built in metal bucket for me to dump the offending objects.

I inhale sharply and look up at Linda as I reposition myself on the stool, my smile grasping desperately for “reassuring.”

I grab for the first plastic edge. Success. I tug gently and it dislodges from the tangle of two months’ worth of weekly suppositories. I drop it in the metal bucket. The blister packs have sharp edges, ever so slightly scalloped where they had been torn from their boxmates at perforation. As I pull them out, one after another, a ribbon of blood begins to trickle from Linda into the bucket at the end of the table. I find myself wincing with each pull, but Linda doesn’t flinch—she just continues to mutter about how stupid she is in that slow, sad twang. Dr. Cook assures her kindly that it could have happened to anyone.

“Well, I think you’re going to feel like a new woman!” Dr. Cook exclaims, tilting her head to the side and smiling warmly. “Let’s just do a quick wet prep and see if that yeast is all gone.”

She hands me long handled cotton swab, which I try to touch to a place unscathed by sharp plastic edges and we are out the door to the lab.

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“Oh, yep—do you see what that is?” Dr. Cook steps back from the microscope and gestures for me to look. I see a fuzzy mess of nothing. “Hmmmm...” I say, trying to remain non-committal.

“That’s candida. Don’t you see the yeast cells?”

No. “Um, yes! There they are.”

“Well, we’re going to have to treat with gentian violet. Gosh—you’re having a good day! You’re probably having the best day of any of the students in clinic this week!”

I follow Dr. Cook back to the workroom where she sits down next to her nurse, Dana. “Dana, ask Rachel what she just pulled out of Ms. Humphrey’s vagina!” she exclaims. Dana turns to me with a smile and wide eyes. As I tell her, she bursts into peals of laughter.

When we reenter the exam room, Linda is exactly as we left her, legs still in stirrups and head back against the exam table. Her magazine lays forgotten on the floor below the chair with her folded-up turtleneck.

“Alright Linda,” says Dr. Cook. “We did see some yeast under the microscope, so I’m going to have Rachel paint on the gentian violet like Dana did for you last time, okay?” Linda nods. “I know this is kind of messy, but it does seem to be helping. Did you bring some underwear you don’t mind staining?” Linda nods again.

“Alright, Rachel. Sit down.” Dr. Cook gestures for me to sit down on the stool at the foot of the exam table.

I position myself between Linda’s legs and raise the sheet. I carefully insert the speculum and using the long handled cotton swabs Dr. Cook hands me, begin to paint the walls of Linda’s vagina a deep, vibrant hue of purple.

“Don’t get any of this on your clothes. It will never come out,” Dr. Cook warns me as she hands me a fresh, purple swab.

“Now,” Dr. Cook continues, “you’ve painted both sides of her vagina, but the speculum is covering up the top and bottom. How do you think you can get the gentian violet on the top and bottom?”

I pause, waiting for an answer.

“I want you to pull the speculum out just a little bit, then paint above and below,” she says.

“Above and below?” I am incredulous. If I paint this woman above and below the speculum, I am going to ruin a lot more than her underwear, I think.

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“Yes!” Dr. Cook says with a hint of exasperation. “Now pull the speculum out just a little bit...”

Not wanting to torture Linda any more than she already has been, I decide to feign confidence as best I know how and gingerly pull the speculum out about an inch. Sucking in my breath I reach around the handle of the speculum with my left hand to paint Linda’s vulva purple.

“NO.” Dr. Cook grabs my hand. “Above and below in the vagina.”

She takes my hand, places the cotton swab inside the vagina and paints the upper and lower walls in the inch exposed by the slowly regressing speculum. I can feel my cheeks burn. Of course she meant in the vagina. How could I be so dumb?

“Good. Keep going like that,” Dr. Cook coaches from over my shoulder as I continue pulling back an inch at a time and painting the newly exposed bits of pink skin.

And then we are done and it is over and Linda sits up and covers her lap with the sheet and we fold the stirrups up and put the speculum in bucket of tools to be cleaned and it is like it never happened.

“So I’m sorry the yeast isn’t gone all the way yet but it sounds as if it is getting a lot better,” Dr. Cook says to Linda. “Let’s have you come back in two months and see Dana for another wet prep and in the meantime you can keep using the same treatments. I’ll bet they work a lot better with the wrapper off!”

Linda drops her gaze and laughs. “Yeah, probably. Thank you, Dr. Cook.”

“No problem!” Dr. Cook answers cheerfully. We leave the room and hurry to the last patient of the day, who is a well-coiffed, elderly woman with a warm smile and a rhinestone-studded broach clipping her scarf across her shoulders. She has brought her husband to discuss the success of ongoing treatment for vaginal dryness.

“Have you been using the suppositories I prescribed to you?” Dr. Cook asks.

“Yes,” she answers.

“Do you take them out of the wrapper?”

The patient pauses and raises her eyebrows, “No! I just pop them in there, wrapper and all!” she scoffs, rolling her eyes with a goodnatured laugh.

“You’d be surprised!” Dr. Cook says, chin up. “Ask Rachel here about the patient she just saw!”

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The woman and her husband both turn to me, smiling. I pause, then quickly recount my tale. “Oh my goodness!” the patient exclaims through laughter, “of course you unwrap them!”

I think of Linda, who has likely begun her long drive home in purple stained underwear. I wonder when she will be able to exercise again.

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Brown Winter ALYSE MARIE CARLSON

This is the time when winter lets go but spring is slow to drag itself around again, when there’s just a thin glaze of ice left, enough to crack under my boot and sink into the slush beneath.

This time around I’m trying to remember the different kinds of brain tumors; I knew them yesterday but not today, not with the sky gray like this, not with the hour I just lost to daylight-saving time.

I learned once that most people commit suicide in the spring, if they’re going to do it, and I remember thinking that seemed about right though I couldn’t place why.

The Norwegians call this time ‘brown winter,’ I say to the people at a party, a grillout where someone with too much optimism left the sliding glass door open to let cold, wet air seep in.

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I think of the woods I ran through that morning, the brown leaves matted together with mud, I think of headaches and round, gray masses on an MRI and how people with craniectomies look like they’d taken a gun to the side of their head and survived, and I suppose when the leaves finally unfurl from their tight, green buds I’ll know I survived this brown winter, too.

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Editorial Board

Bruce P. Brown, MD is the founding editor-in-chief of The Examined Life Journal: A Literary Journal of the University of Iowa Carver College of Medicine. He currently serves as The Examined Life’s non-fiction editor. His literary work has appeared in The Annals of Internal Medicine, Kalends and Hospital Drive. He is an emeritus radiologist and internist at the University of Iowa in Iowa City, Iowa.

Jason T. Lewis, MFA is the director of the Writing and Humanities Program at the University of Iowa Carver College of Medicine and a graduate of the fiction program at the Iowa Writers’ Workshop. His first novel, The Fourteenth Colony: a novel with music, is available at amazon.com. He’s currently finsihing work on a second novel and writing a collection of songs to be recorded in 2016.

Amy Margolis, MFA is the director of the Iowa Summer Writing Festival at the University of Iowa and head of Writing Programs in the Division of Continuing Education. She is a graduate of the Iowa Writers’ Workshop.

Hilary Mosher, MFA, MD is an award-winning poet and a clinical assistant professor in the Department of Internal Medicine at the University of Iowa Carver College of Medicine, and a hospitalist at the Iowa City VA Medical Center. She received her MFA in poetry from the Program for Writers at Warren Wilson College.

Carol EH Scott-Conner, MD, PhD is professor emeritus and former head of surgery at the University of Iowa Carver College of Medicine. She has written or edited ten surgical textbooks and served as editor-in-chief of a major surgical journal. Her short fiction explores the interactions between patients and surgeons and the ways in which both are changed by the encounter. It 167

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has been published in multiple literary journals ranging from The Healing Muse through North Dakota Quarterly, and was nominated for a Pushcart Prize. Her most recent short story collection, Beachcombings: More Short Stories was published exclusively as a Kindle e-book by Rachel Lord Press.

She lives in a rural part of Iowa City with her husband.

Mary Helen Stefaniak is a graduate of the Iowa Writers’ Workshop. Her collection of short fiction, Self Storage and Other Stories, won the 1998 Wisconsin Library Association’s Banta Award. Her first novel, The Turk and My Mother, won the 2005 John Gardner Book Award, and her second novel, The Cailiffs of Baghdad, Georgia won the 2011 Anisfield-Wolf Book Award.

She currently teaches creative writing at Creighton University..

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Editorial Readers

Diane DeBok is an editor and content manager at the University of Iowa and is also a freelance writer. She has an MA in Journalism and completed her MFA in Nonfiction Writing at the University of Iowa in 2001.

Roberta Hartling Gates, MFA received her B.A. from the University of Iowa and her M.F.A. in fiction writing from the Vermont College of Fine Arts. Essays and short stories of hers have been published in numerous literary magazines, including Confrontation, Other Voices, and The Louisville Review, as well as in two anthologies. She also served four years as chair of the literary awards committee for Friends of American Writers, a Chicagobased group which awards yearly prizes to emerging writers from the Midwest. She lives in Riverside, Illinois.

Loreen Herwaldt, MD is a professor of medicine at the University of Iowa Carver College of Medicine and professor of epidemiology at the University of Iowa College of Public Health. Her book, Patient Listening: A Doctor’s Guide, which recounts writer-patients’ experiences of receiving healthcare, was published by University of Iowa Press, and her poem, “Imaging His Pain,” was published by the Annals of Internal Medicine. She edited the first edition of A Practical Handbook for Hospital Epidemiologists.

Zachery Hickman received an MFA from the University of Miami in 2003 where he was a James A. Michener Fellow, and editor-in-chief of Mangrove 2003. Zach spent 11 years as a Senior Lecturer at the University of Miami, where he taught all forms of writing and communication and designed, implemented, and evaluated a longitudinal, multidisciplinary faculty development program for UM’s College of Arts and Sciences. He is currently working within the University of Iowa’s Graduate Medical Education office 169

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as an Educational Consultant and continues to write and publish poetry and short story collection.

Catherine Kasper’s books include Field Stone (poetry) and Notes from the Committee (fiction). Recently, her editorial work includes “The Quiet Born From Talk: A Festschrift for Wendy Barker,”(2015) and a co-editorship for American Letters & Commentary, a literary and visual arts journal. She teaches at the University of Texas in San Antonio.

Brian Olshansky, MD, a cardiac electrophysiologist and tenured professor of medicine at the University of Iowa Hospitals and Clinics, graduated from Carleton College, and completed his MD at the University of Arizona and residency training in internal medicine at Bellevue/NYU Hospitals. He has directed electrophysiology programs at Loyola University Medical Center and University of Iowa Hospitals and Clinics. Brian is known for his diverse interests, ranging from technological and mechanistic aspects of cardiology to holistic issues regarding medical care and the doctor-patient relationship. A creative writer for many years, he has been affiliated with the Writers’ Workshop for the past ten.

Ann Rushton’s work has been published in such magazines as Amazon’s Day One, The Chariton Review, The Breakwater Review, wigleaf, Literary Mama, and many other publications. She is the editor and co-founder of Bound Off, a literary audio journal, and lives in Iowa City, Iowa with her husband and daughters.

Yolanda Rodriguez Villalvazo, MD, MPH is the Clinical Director for the Iowa City VA Hepatitis C Clinic and a Clinical Assistant Professor in the Department of Internal Medicine. She earned her undergraduate degree in Psychology at the University of California, Davis. Yolanda has many diverse interests, ranging from The Migrant Health Program in Iowa to medical missions in third world countries. As a creative writer, she journals her experiences and reflections on medical issues and the doctor-patient relationship, but has been too shy to submit.

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Hannah Baggott is a Nashville native. She recently received her MFA in poetry from Oregon State University. She is a regular contributor with PDXX Collective and winner of the 2015 Marcia and Jan Vilcek Prize for Poetry with Bellevue Literary Review and the Joyce Carol Oates Commencement Award for Poetry. She is working on a full-length manuscript about her experience with Multiple Sclerosis. Her work can be found or forthcoming in [PANK], Passages North, HOBART, Ninth Letter, and through her website (hannahbaggott.com).

Jessica Barksdale is the author of thirteen novels, including Her Daughter’s Eyes and When You Believe. Her latest, The Burning Hour, is forthcoming from Urban Farmhouse Press. A Pushcart Prize and Best of the Net nominee, her short stories, poems, and essays have appeared in or are forthcoming in Compose, Salt Hill Journal, The Coachella Review, Carve Magazine, Mason’s Road, and So to Speak. She is a Professor of English at Diablo Valley College in Pleasant Hill, California and teaches online novel writing for UCLA Extension. You can read more at: www.jessicabarksdaleinclan.com Carol Barrett holds doctorates in both clinical psychology and creative writing. She is the recipient of an NEA Fellowship in Poetry, and the Richard Snyder Prize for her book Calling in the Bones (Ashland Poetry Press, 2005.)

Carol teaches for Union Institute & University and Saybrook University.

Her poems have appeared in many magazines including JAMA, Poetry International, Poetry Northwest, Christian Century, and Nimrod. Her scholarly articles appear in journals in the fields of psychology, gerontology, women’s studies, art therapy and education.

Milton J. Bates has published several nonfiction books, most recently The Bark River Chronicles: Stories from a Wisconsin Watershed (2012). His 171

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poems have appeared in anthologies and in magazines such as the Bellevue Literary Review, the Broad River Review, the Great Lakes Review, Midwestern Gothic, and The Wallace Stevens Journal.

Alyse Marie Carlson is a fourth year medical student at the University of Iowa. She is originally from Centennial, Colorado and received her undergraduate degree from Luther College where she majored in biology and minored in Spanish and English.

Katy Giebenhain edits the Poetry + Theology rubric for Seminary Ridge Review and co-hosts a reading series at a coffeehouse in Gettysburg, Pennsylvania. Her creative writing MPhil is from University of South Wales (Glamorgan). Her MA is from University of Baltimore. Poems have appeared in The London Magazine, The Healing Muse, Spiritus, Better Living through Beowulf, Water-Stone Review, Glasgow Review of Books and elsewhere.

Julie Goodale is a professional violist living in the woods north of New York City. She is also a passionate advocate and fitness trainer in the cancer community; her work in this arena can be found at www.Life-Cise.com. Julie is often found outdoors running trails, climbing, hiking, or windsurfing. And although she is sometimes one of the slower skiers on a mountain, she likes to think that she’s just searching for the perfect turn.

Thea Goodrich is a 2012 graduate of Kenyon College, where she was awarded the John Crowe Ransom and Academy of American Poets prizes.

She now lives in New York as an assistant editor of literature textbooks.

Her poetry has appeared or is forthcoming in Hanging Loose, Ping•Pong, The Nervous Breakdown, Really System, North Dakota Quarterly, and The Kenyon Review Online. An essay about her struggles adapting to life with Type 1 diabetes can be found on The Toast.

Zach Jacobs earned his MA in English with a creative nonfiction emphasis from the University of Nebraska at Omaha.

Catherine Klatzker’s essays and stories may be seen in The Intima: A Journal of Narrative Medicine, Emrys Journal, Tiferet Journal, (2014 nonfiction winner,) Lime Hawk Journal, and in mental health anthologies from In Fact Books and Lime Hawk Literary Arts Collective. She was a 2013 Ragdale Foundation Fellow. “Deathwatch’s” perspective has been shaped by twenty172

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two years in Pediatric ICU nursing, where Catherine also coordinated mindfulness retreats for professional health caregivers coping with death.

Diane Kraynak is a pediatric nurse practitioner. She began her career as a neonatal intensive care nurse. Her speciality as a nurse practitioner is pediatric nephrology and dialysis. Her essays have been published in Zone 3, Lifelines, and anthologized in Creative Nonfiction’s “I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse”. Her essay “Lazarus” was recognized as Notable in Best American Essays 2013. “Science Project” won the Women’s National Book Association 2014-2015 contest for non-fiction. She is working on a collection of nursing essays.

Anna Krem is the pen name of a physician at the Massachusetts General Hospital. Her work has appeared in Phoebe.

Katie Kress is an alumna of Columbia College Chicago and The University of Iowa where she graduated with a Master of Fine Arts and a Bachelor of Arts, respectively. She recently moved back to her homeland of eastern Iowa with her dog Stella after living in the Chicago neighborhood of Rogers Park for three years while pursuing an MFA under the tutelage of David Lazar and Jenny Boully. She has been published in Glassworks Magazine, Stoneboat Literary Journal, pamphLIT, and Intima: A Journal of Narrative Medicine.

Jonas Lee grew up in the suburbs of Kansas City and stumbled through college. He decided to return to the much more friendly midwest for medical school. Traveling through Mexico, working with homeless populations, and reading John McPhee’s description of newly minted family docs in “The Heirs of General Practice” convinced him to become a family physician. He led a federally qualified health center for 11 years before joining faculty at the University of Wisconsin. Jonas enjoys homeschooling his five children, exploring cities on foot, helping out on the farm, and building his dream eco-home.

Priscilla Mainardi, a registered nurse, attended the University of Pennsylvania and Rutgers University, where she received an MFA in creative writing in 2012. Her work appears in Blue Moon Literary and Art Review, Nurse.com, and the narrative medicine journals Pulse, the Intima, and Blood and Thunder, among others. “Going Home” is part of a novel that explores the impact of a nurse’s patients on her life.

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Kaci McCleary is a second year medical student hoping to go into neurology, psychiatry or a combination program. She is invested in advocating for LGBTQ rights, mental health awareness, and more accessible health care. In her free time, Kaci enjoys swing dancing, running, writing, and playing nerdy games.

Eileen McGorry has been a registered nurse for over forty years. She recently retired in order to write full time. She lives in Olympia, Washington with her husband, Ron Jemelka.

John O’Connor is from Kalamazoo, Michigan. His writing has appeared in the journals Open City, Post Road, Quarterly West, and Gastronomica, and the anthologies The Best Creative Nonfiction Vol. 1 and They’re At It Again: An Open City Reader. He has also written for The Believer, Oxford American, The New York Times, GQ, Saveur, Men’s Journal, Hemispheres, and The Financial Times, and for two years was a foreign correspondent for Japan’s largest daily newspaper, The Yomiuri Shimbun. He currently teaches creative writing at Boston College.

Marlene Olin was born in Brooklyn, raised in Miami, and educated at the University of Michigan, She is a contributing editor at Arcadia magazine. Her short stories have been featured or are forthcoming in publications such as Emrys Journal, upstreet Magazine, Steam Ticket, Vine Leaves, Crack the Spine, Poetica , The Water Stone Review, The Santa Clara Review, The Broken Plate and The Saturday Evening Post online. She is currently working on a novel.

Arthur Plotnik is the author of eight books, including “Spunk & Bite: A Writer’s Guide to Bold, Contemporary Style” and two Book-of-the-Month Club selections: “The Elements of Expression” and “The Elements of Editing.” Among his many publications are award-winning fiction, essays, poetry, op-eds, and biography. He studied under Philip Roth at the Iowa Writers’ Workshop and worked as editorial director for the American Library Association. A former columnist for The Writer magazine, he lives in Chicago with his wife, the artist Mary H. Phelan.

Rachel Press Goossen is a fourth year medical student at University of Iowa Carver College of Medicine. She completed her BA in English at UC Santa Barbara, where she cultivated her love for the written word. She loves good characters in literature and in life and her favorite part of medicine is hearing her patients’ stories.

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Sadaf Qureshi is a fourth year medical student at Georgetown University.

She grew up in northern New Jersey, moved to Washington, D.C. to study English literature at Georgetown, and decided to stay put for medical school. Her writing has appeared in The Intima, The Doctor Weighs In, and The London Magazine.

Sandra Scofield is the author of seven novels, a memoir, and “The Scene Book,” on the craft of writing fiction. Her book of essays, “Mysteries of Love and Grief ” has recently been published. She lives in Portland, Oregon and Missoula, Montana, and is on the faculty of the Pine Manor Solstice MFA Program. She is an avid landscape painter.

Angela M. Shupe received her BA in English, cum laude, from the University of Detroit Mercy. Her writing has appeared in various publications including Wild Violet Literary Journal, Relevant Magazine and Women’s Adventure Magazine. She was awarded a Silver SOLAS award for travel writing from Travelers’ Tales and was selected as a finalist in Biographile’s Short Memoir Contest on Overcoming Loss. Ms. Shupe also has a short story forthcoming in Westview Journal.

David Allen Sullivan’s first book was Strong-Armed Angels and three of its poems were read by Garrison Keillor on The Writer’s Almanac. Every Seed of the Pomegranate, a multi-voiced manuscript about the war in Iraq, was next, then a book of translations from the Arabic, Bombs Have Not Breakfasted Yet. Black Ice, about his father’s dementia and death, was just published. He edits the Porter Gulch Review with his students. He was awarded a Fulbright, and taught in China for one year (yesdasullivan.tumblr.com). His poems and books can be found at http://davidallensullivan.weebly.com/index.html Raven Tolliver lost her sight at the age of three to retinal blastoma, a type of eye cancer. In December of 2014, she graduated college with a degree in philosophy and a writing minor. Currently, she resides in the midwest where she works for a local guide dog school, and does freelance writing on the side.

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