In my professional role as a medical illustrator, I'm often drawn to a good metaphor. As a patient, the allure of metaphor can be dangerous.

In both the literary world and in the clinical world, metaphors take hold of our relationship to illness and health.

“Giving Up the Fight,” by Rebeca Stanfel (Spring 2023 Intima) is a first-person account of her struggle with sarcoidosis and the metaphors that complicated her ability to deal with it. Well-meaning friends and family assailed her with encouragement that depicted chronic illness as a battle to be won or lost.

Jen Baker-Porazinski's story “Dying at Home” (Spring 2024 Intima) drew a vivid picture of a patient and her family, and the rhythm of her last few weeks. The love and dedication of her husband was especially moving.

I was also struck by the narration of Baker-Porazinski’s journey, as a doctor. Reflexively, at each visit, she listened to her patient's heart and took her blood pressure. Baker-Porazinski felt this showed that she hadn’t given up on her patient .

Big moments are surrounded by little moments. That’s what I was trying to pull out in my story “There’s a Special On Car Washes,” published in the latest issue of Intima. That bewildering sensation, common in life and especially in healthcare, that extraordinary things happen but that time marches on without sentimentality. You win the big game but when you get home you still have to take out the garbage. You receive a life-changing diagnosis and then you have to figure out the machine to get out of the hospital parking lot.

I have been practicing medicine since completing my residency in June 2000. It baffles me that to this day I still hear comments from patients, families and loved ones that we physicians often cannot relate to their concerns, their health struggles and their ailments because we are doctors, because we harbor medical knowledge, because “we are not human.”

Every now and then, at the end of a call shift, I leave the hospital with aching feet and heavy eyelids. And then I remember: I am the lucky one. I am the one who gets to go home. My patients – the grandfather whose kidneys are failing, the ten-year-old with meningitis – are not so lucky. They will not go home tonight. They may never go home again.

Carl Jung believed house imagery in dreams represent the human psyche. In both artworks, the houses are familiar structures of shelter that simultaneously represent ominous confinement and isolation. We may be capable of observing and moving past some psychological structures that have become an obstruction, while others feel intertwined with our very being, like a house that fits more like a skull.

Even with the astonishing knowledge of medicine, the anatomy of an illness cannot fully be known from the outside. It takes an act of tender and careful acquaintance. And the only one who can truly map the illness of a living being is the occupant of an ill body. The geography of sickness is mysterious: its borders begin vague, its peaks conceal its valleys, its oceans rove and deepen and rearrange patterns of flood and firm ground.