After reading Again by Randy Hale, I felt that we have both gone through the same life-changing medical course: she, breast cancer; me, primary lateral sclerosis that for several years had the potential to morph into ALS.

Moral and ethical considerations can greatly increase the complexity of medical decisions. The dilemmas described in Ellen Kolton's essay (“Ethics Consult: To Tell or Not to Tell;” The Intima, Spring 2015) and those that I experienced as a military doctor (“The Moral Matrix of Wartime Medicine;" The Intima, Fall 2015} share a similar frustration – the inability to find “correct” answers for difficult questions. 

In the Intima Fall 2013 edition, Dan Luftig confesses a secret: he wants an anonymous person to have a stroke during his first hospital rotation. In his Field Notes piece: “Paradoxical Wishes,” Luftig describes this furtive hope. It seems a logical way of attaining every ounce of knowledge and skill through first-hand experience. He recognizes his inner quandary as he “hopes” to rid himself of the “hope” that his patients have a specific diagnosis that he, because of his education, suspects they have. He struggles with the disconnect between his wishes as a doctor and his patient’s wish for health. What a strange juxtaposition.

When I was twenty-one and not pregnant, a stranger on the subway congratulated me on my pregnancy.  It was so presumptuous.  Preposterous!  A decade later, in my own medical narrative, I again experienced unwanted public intrusion.  Marcia Butler’s “Cancer Diva” and Katherine Mcfarlane’s “Flying into Jerusalem” illustrate this particular public quality of women’s bodies, especially during illness.   

There are secrets in our blood we don’t want disturbed; when blood transmutes into information, some part of the magic of human life is lost.

I was moved by the beauty of the writing in Susan Ito’s “Rounds” as well as by its subject matter: the centrality to her life of the hospital where she worked for years which is also the place where she met her husband, lost her first child, and, most recently, brought her 92-year-old mother to the emergency room.  It’s a profoundly resonant place that deepens in meaning as Ito passes through the different stages of her life.  This piece has inspired me to attempt a similar essay, albeit about a less obviously freighted topic, and I’d like to use this short blog assignment to sketch it out.

In “The Quixotic Pursuit of Quality,” by Dean Schillinger, and in my story, “The Identification,” (both Fall 2015 Intima) we have a couple of “bad patients.” They are not doing what their doctors want them to do.

Two pieces in the Spring 2015 issue of the Intima illustrate how fiction and poetry enable a writer to range widely in search of an emotional truth.  In Stephanie Reiff’s affecting poem, “Emergency Department,” a woman’s mind fills with images of a miscarriage in the emergency room while she cleans her house.  In Kimberly LaForce’s short story, “Emerging into the Light,” the nurse recording and assisting with an autopsy imagines the life and death of the dead man.  These works show different ways caregivers cope with death.  

I was immediately drawn to Doug Hester’s poem "Speed Dating by Type." As a registered nurse, the jargon is one I can easily understand and upon a first read, the familiarity of language made me stop and look again.

My essay "Christmas Day" was written almost twenty years after the incident it describes. Besides the common excuse of being too busy, one of the many reasons for the delay in writing it was the sadness that permeates it. I would periodically visit my notes describing that day and tears would well up in my eyes every time. I knew this story had to be told—the question was when would I be able to.

 “'Wanna Play Doctor?'” Lauren Kascak’s article in Intima Spring 2014, describes the same country (Ghana) and same province (Central Region) as the one in “The Death of the Old Farmer” (Intima Fall 2014). My article chronicles the final day of a man who lived near a rural hospital where I completed observations in 2007. Hers describes a student trip to a different rural town, where she completed training in gynecological techniques.

From the opening of her essay, "Heart Failure," Rachel Conrad reveals the dark space of her psyche. Her generalization about patients’ “overload,” the symptoms of their various diseases, is her particular failure of heart. This inability to empathize with the other threatens her career.

It’s funny. I visited the Intima website to initiate a dialogue with an existing piece in the archives that, metaphorically, had been chatting (unbeknownst to me) somewhat telepathically with my poem "Dude, the Stage?”(Intima Fall 2014). Furthermore, the writer Keenan Whitesides ("The Choice," Field Notes, Spring 2014 Intima) had similar telepathy occurring concurrently. She too reacted to something in Aimee Burke Valeras’s “The Appearance of Choice” (Fiction,  Spring 2012 Intima) in writing her piece.

Clinical Flashback (Fall 2014 Intima) by Osman Bhatty, sharply and beautifully reveals how one woman’s rapid and bewildering decline into terminal illness became a seminal teaching moment for the young medical student. Beyond the person lying in a hospital bed was a life story that he could not possibly glean in the 10 minutes he expected to be there, just to draw blood from her gnarled hands. But Bhatty drew back, startled. He recognized what every doctor must: there is a history behind those old and wrinkled hands.

Caring for my grandmother was incredibly frustrating. There were many things I wanted—and felt as though I needed—to communicate with. I most often wanted to talk to morphine. I wanted to understand how, pulsing through her body, the morphine could send my grandmother back to places and times I did not know.

Most of us are not prepared for our role—medical or otherwise—with a person who is dying. We are not around death often, and we feel awkward and unsure of ourselves when confronted with it. In my poem, “What Do the Dying Want?” I give voice to this dilemma—do the dying want words or silence or music? Do they want to be touched or “to be left alone, to slip modestly/from their bodies when no one is looking, to leave without a fuss?”

Most illness narratives lack a definite beginning or end; instead, they are conglomerations of family stories, heuristics, and societal images from long before a disease presents. Despite knowing this, I always return to that first moment of disclosure as the once upon a time conception of an illness narrative.

When I first was asked to comment on the connection of my work to another one in this journal I didn’t know where to begin. How to choose? All of the pieces spoke to me in some way and I was so happy to have found a community of like-minded souls, searching for meaning and beauty in stories of illness. Then I came across “Translate” by Mario de la Cruz and realized how deeply the heart of my work connects to his spoken words, as I too am looking for “…the power to translate/from my lips to your ears/from my thoughts to your thoughts/my interior to your exterior…” using language to shed light in dark places.

When I read, I find there are moments where it seems the author has plucked an emotion or idea out of my own experience and brought it to life on the page. This happened as I read Katherine Guess's piece, “I Need to Tell This Story” (Fall 2014 Intima), which chronicles the author's discovery of the emotional and psychological importance of sharing one’s own story. Guess adeptly writes, "I realized that [my patient] needed to tell [her] narrative in order to sort through the events of the last few days." This discovery perfectly describes my own experience in writing my poem, "Emergency Department," I found myself continually revisiting my patient, her loss, and my own personal struggle with the emotional burden of informing a patient she had miscarried.

The questions begin as soon as the patient or family member hears a diagnosis. They come in no particular order. Sometimes, they come frantically. Sometimes, they come slowly, but nevertheless, they come. The physician can usually predict the questions. “What are the treatment options?” “What are the chances of success? Of cure?” “How long does he or she have?” And most physicians likely have memorized research results to regurgitate. But then the patient or family asks the question the answer to which cannot be found in medical literature, “What would you do, doctor?”