Rachel Kowalsky is a pediatric emergency physician in New York City.
As a pediatric emergency physician, I read Brian Ascalon Roley’s “Caregiving” (Intima, Fall 2019) and marveled at its painful honesty. Roley invokes the sadness and joy he feels in caring for his severely disabled son. He speaks about his son’s weight, and his own corporal decay as he struggles to care for him. The poem is full of burning: inflamed tendons, arms that burn hot with the labor of care.
The poem recalled a child I cared for many times during residency. I’ll call her Nandi. Nandi had a rare dysautonomia that caused her heart rate, blood pressure, and temperature to fluctuate wildly, in ways seemingly incompatible with life, terrifying even the seasoned senior residents. When she came to the ER in crisis, my heart rate, too, would skyrocket.
I remember Nandi as a tiny being at the center of an immense collaboration of tubes and lines, the monitor fairly shrieking her numbers like an air traffic controller. She’d flush, burn, and stiffen; her blood pressure would soar, then plummet.
This was not okay, we all decided. This was no life, at the center of an awful web of medical equipment and intravenous drips, this unending physiologic storm. Why did we always rush to Nandi’s bedside? Why keep her moored to a life she constantly tried to lift away from?
One day she touched my sweater. Just that. But she lingered, she liked how it felt. I’m not sure how I knew; perhaps in the unconscious way we gather information about our environment daily, without full awareness. It was pink cashmere, a self-consciously pediatric choice, and I too—as a literature major living in a world of STEM—felt strangely pinned inside it. Where were my silent garret, my dark cafés? Why was I stuck at the center of this odd world of medicine? My work held joy and sorrow. My patient’s life held the harshness of tubes and lines, the soft touch of a sweater.
Ascalon ends his poem with “she says every word counts more in poetry / I say, every word burns.” Nandi never stopped coming, crashing through the doors of our ambulance bay like a shooting star. She never stopped burning. But now I knew her. And I knew myself a bit better, too. Sometimes we find ourselves alive in strange places. Sometimes we have to walk through the storm.
Rachel Kowalsky is a pediatric emergency physician in New York City. She is a Pushcart Prize nominee and winner of the New England Journal of Medicine’s fiction contest. Her work is in The Atticus Review, JMWW Orca, JAMA, and elsewhere.