In Sarah Shirley’s poem ‘Wernicke-Korsakoff’ (Intima, Spring, 2017), she elucidates the dilemma of caring for a patient who is angry, non-compliant, inarticulate, hostile, confused, or otherwise “difficult”. How do we reach across the barriers that such patients present, to find an opening through which we can glean from them the information we need to take care of them, and to establish mutual trust? 

This truth became inescapable when I began my nursing career on a cancer and hospice floor. Oncology care is fraught with the observation of suffering. The desire to find meaning in pain converges with the harshness of reality. Why becomes a pervasive and agonizing question.

Life and death, as blatantly simple as they may seem from a purely physiological standpoint, are rather complex phenomena. Healthcare practitioners witness life and death a countless number of times. They are taught the intricacies of the human body: how to optimize its function and how to declare it deceased. Yet, nothing can prepare even the masters of this trade to face their own demise.

 Our verbal and written stories tie us together and promote understanding. They help us to work through traumatic experiences, to acknowledge our demons, and to heal.

Illnesses are contagious. 

We all know this, but while the frame on the bed grows ever smaller, sometimes the faces of the grieving grow gaunt as well. 

I first discovered I had Minimal Change Disease, the mildest form of nephrotic syndrome, when a routine insurance urine examination came back with higher than normal protein.  Up until then, I assumed that foamy urine was a by-product of what I’d eaten or had to drink. In Sarah Safford’s poem, “A Cute Kidney Failure” from The Intima Fall 2016 issue, she asks the same question, “Kidneys, shmidneys, who thinks about them.”  After my initial diagnosis, I did. A lot.

No one, not even someone you love, can fill the hollowness. Still you cannot walk this alone. You need a witness, an errand goer, a soft presence, a light in the hallway. Someone who brings you tea or clean clothes, whose eyes will look back into yours.

When I looked up from all the waiting rooms, I found a communion of once-strangers waiting to help me

What to do?

            In 1927, in his lecture to Harvard medical students, the terminally ill Francis Peabody M.D. provided the answer, “the secret in caring for the patient, is in caring for the patient.”

Togetherness is not artificial–it is not forced into the nooks and crannies between people. It is intrinsic to our existence as humans, no matter how fleeting the collision of our worlds. Moreover, togetherness need not be physical. We can feel connected to others even when there’s an ocean between us.

The hierarchy in medicine is impossible to ignore. Medical students shuffle, interns survive, senior residents manage, and staff attendings command. Fortunately, these relationships have evolved over the last few decades and past feelings of authoritarianism have turned into mentorship.

The sociological concept of the “sick role” may absolve patients of responsibility for causing their illness. But it does not protect them from the stigma often associated with illness. Nor does it protect them from their own feelings and thoughts.

The Room by Jodi Paik (Fall 2016) and my artwork The Last Stand both examine medicine through the eyes of a child— a perspective not yet laden with the what-if’s, should-have’s, and if-only’s that come with growing up.

When something dramatic, threatening, and life-altering happens, chaos frequently ensues among those affected. While individuals struggle to incorporate the trauma into their lives, the relationships among them are inevitably strained.

In her poem “Letter to a 93-year-old Cadaver Who Died from Multiple Causes,” published in the Spring 2014 Intima, I feel Jennifer Stella perfectly presents the learning curve of a medical student working with their first human patient – a body gifted to them to dismantle. 

We, as physicians should go beyond “Why do they do this?” to ask, “Where did trust break down?” and, “How may I make myself a worthy recipient of my patient’s deepest, darkest fears?”

Memory may seem even more mysterious when there’s less of it—why do we remember this and not that? Other times, it seems to make perfect sense, especially with Alzheimer’s patients, who often remember earlier memories and forget later ones.

Transitioning from a cross-cultural neophyte into a culturally competent warrior is a precarious and arduous process in medicine. It is typically a journey accomplished on one’s own with little guidance, training or support. It’s also a journey that requires deep self-reflection and the ability to objectively critique the culture of biomedicine.  

Openness vs secrecy. These subjects are familiar to anyone who has ever struggled with a serious health condition. 

Her first night on call she is assigned the care of a man with AIDS. He is rail thin, on the slow train to death. He was once a person just like her, but now he seems frightening, repulsive, and dangerous, although endlessly pitiful.