Tarnished gold

I was standing at the nurses' station today, looking for a patient's chart to find out which room was his. It was another resident's patient, and he had the day off. I was covering for him, just as he'll cover for me on my day off. An old woman approached me, paper in hand. "Here's the menu," she said, thrusting it at me, the sheet marked all over with meal choices.

I looked back at her. "Okay," I started hesitantly. She just looked at me. "I think they come around to the rooms and pick them up."

"Well, I brought it here yesterday, and they took it," she said.

"Okay," I said again. "I'm not sure where it goes," I added with a little shrug.

"Well, just give it to one of the nurses," she blustered at me.

I took the paper with an attempted smile, and gave it to the unit coordinator. She smiled, a genuine one this time, and took the menu, setting it on the counter.

Then I found the chart I was looking for, and turned towards that room. In the back, just visible behind a curtain, I saw the same old woman. I tucked my pen into my pocket and walked into the room.

A nurse was helping the patient take a few steps to stretch his legs. Both she and the patient gave me smiles. The old woman looked at me and snapped, "What do you want?"

"I'm one of the resident physicians," I said. "I'm covering for Dr. L who has the day off."

She sat there, shocked.

"I thought you were an aide," she finally said, after I'd inquired after the patient's health.

I just shrugged.

And from then on, she treated me with respect.

I find this tremendously sad.

Living Will

This is my wish,
when my voice becomes too soft to hear.
If you cannot do these things,
I understand.
I am not angry.
Only have no regrets,
for yourself or me.

Did I tell you often enough
that I love you?
Did I do enough
so that you can survive
on your own?
Did I think too much of myself,
or not enough?
Or of you, or anyone?
If I have wronged you,
please forgive me.
Regret is the stone
that pierces wings
and keeps us from flight.

This is my wish.
Keep me comfortable.
Play Beethoven's seventh,
and Monteverdi's Orfeo--
and don't run after Euridice.
She thought your harp too lovely
for you to hang it up.

Keep me comfortable.
Hold my hands,
stroke my face with callused gentle thumbs.
Tell me goofy jokes
and laugh for me.
Wrap me in blankets
and love.

This is my wish.
Let me go,
but if you can't,
I am a bodhisattva
and will pause on the threshold,
one golden-slippered foot hovering,
listening.
As soon as your cry reaches my heart,
I will turn and fling myself back.
I will not leave until you let me go.

Let me be so selfish
to leave you not with firm desires,
but to allow you all the time you need.

This is my wish:
let me take up residence
in your memory,
and always remember
I am love.

Mythology and Medicine

Since before I began medical school, I have been interested in the two symbols of the profession: the caduceus and the staff of Asclepius.

The caduceus is probably the more familiar symbol: two snakes entwined around a winged staff. Mythologically this is the symbol of Mercury/Hermes, messenger of the gods, and not really a healer. I've heard it is the usual medical symbol because of an on-a-whim decision of a bookbinder to stamp the spines of medical texts with it.

The staff of Asclepius, however, is a single serpent twined around an unwinged staff. It is argued that this is the correct symbol, because Asclepius was a healer, a son of Apollo (who was a healer in his own right), who was advised in healing by a snake, symbol of wisdom. The snake insisted on talking with Asclepius at eye level, so Asclepius held out his staff. The snake climbed it, and the two met face to face.

However, what fascinates me is that Hermes was the god of boundaries, helping travelers have safe journeys. One of his epithets is "Psychopompos," conveyer of souls, a word still used today to describe those who guide the souls of the dead safely to the underworld. Some use this point to argue that the caduceus is a devastatingly wrong symbol for medicine, but I have to disagree. Shouldn't part of all medicine involve guiding the dying to their rest?

For myself, I take them both as valid symbols of the profession.

(And in an interesting footnote, Asclepius was raised by Chiron, a renouned centaur healer, whose name bears an eerie resemblance to Charon.)

Sweet Heaven

"What do you want?" we asked.
"I want to walk into sweet heaven."
She smiled,
hugged her family,
and nodded.
We gave the sleeping medicine.
She closed her eyes,
leaving two orange flowers
to keep unblinking watch
while a tiny chipmunk
scurried across the patio,
carrying away her soul.

No story, no poem can do her justice.
A life fully lived
leaves no scraps for words.
I can only say how
her eyes were sparkling,
her hands warm,
her face bright,
as she stepped out into the sun.

All is well

My patient is dying. Perhaps she is already gone, but she is young and has a strong heart. It could be days... or it could have already happened.

I've seen her for a week and a half, following from hospital to residential hospice-- it just happened that my schedule coincided with hers. I was there when her family said their goodbyes. I got a hug too, and I wanted to hold her hand, to be there with her, to be as comforting as I could... but her family was there, and it was for me to step aside and let them be nearest their loved one, even if their loved one had also become my loved one.

There was one point, after she'd been given medications to make her sleepy and comfortable, where she cracked open an eye and seemed to look at me. "It's ok," I whispered, and she shut her eye again.

Her family shooed me out, but not out of malice. I had been suffering an allergy attack all day, and it was only worsening as time drew on. Ever nurturing, her family told me to go and pick up my new allergy prescription so I didn't suffer so much the next day.

They gave us both permission to go. I wonder if she has yet.

Untitled

She stretches out her arms for a hug.
"I wish I could give you a kiss," she said,
"but this mask..." she tugs at it,
the plastic Clotho on her face.
All the spinning has rubbed raw her nose,
and she is exhausted.
Her son and sister sit in unfailing vigil;
they say all the right things,
tell her not to worry,
it's her choice,
she's in good hands,
we're here for you,
relax and rest,
we love you.
But when she lets go,
to what will they cling?

Rest

"It's all going so fast."
The team congeals around her,
doctors, nurses, therapists,
social workers, chaplains,
and me.
I've been sent along,
the last gelatinous fragment
to see her safely to hospice.

Where once panic had marked her face,
now there is only peace.