I’m diligently writing a detailed note in the patient’s chart as he speaks of his multiple concerns – severe depression, headaches, and dizziness. I’m not making good eye contact. Often this is effective because I can resist the allure of passively following his narrative to its own diagnostic suspicions. Instead, I can record his intuitive guesses without persuasion, formulating my own independent ideas even as I value his. Except that as I write in his chart I notice streaks of red blood appearing among the black script. Am I hallucinating? Am I capable of making paper bleed? Am I, the doctor, bleeding?

With closer inspection I notice three small cuts on my chapped knuckles and fingers, products of the incessant and obsessive hand washing compelled by modern medicine. We are obliged to wash our hands before and after each patient contact, which leads to about 60 hand washings per day. In the dry winter air this can become punishing to the integrity of the skin barrier.

I apologize to the patient for marring his chart, yet it almost seems symbolic – physician blood spilled upon a script of human affliction. I know I should tear the page out of his chart and write a clean new one, yet the scrawls of black ink and stripes of red blood look like art. It is a poem, punctuated with living iron and crimson flourish. Despite having made poor eye contact in an attempt to distance and strengthen my consideration of his symptoms, ironically I see the commonality of our bleeding.

When the Republicans took back the House of Representatives this past week, John Boehner, the presumptive new Speaker and current Senator from Ohio, unleashed a “sob heard round the world.” As The New York Times quotes:

“I’ve spent my whole life chasing the American dream,” (Boehner) said, beginning to cry. He swallowed and tried again. But describing all the bad jobs he had once led to near sobbing when he got to the line, “I poured my heart and soul into running a small business.”

Boehner has cried in public many other times, the recent election night being only the largest stage to date. The tears also flow at his annual golf tournament, or while watching a child pledge allegiance to the flag, listening to a Republican colleague speak about his Vietnam War experiences, the unveiling of a statue of Ronald Reagan, while accepting various awards, during a rendition of America the Beautiful… Could these tears be signs of major depression? Should melancholy be a disqualification for leadership? Were Clinton’s tears any better?
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I’m increasingly unable to watch the sport of football.  It has become a violent, malicious, hurtful abomination.

Here’s to October baseball instead.

Deadspin videos of concussions this year.

What is in a prenatal vitamin? Why do most doctors recommend them? Is there any evidence taking them is worthwhile? I decided recently that I would read through the ingredients of these vitamins, often touted as “essential vitamins and nutrients, crucial for the healthy development of your baby.” Hmmm. Does that mean eating traces of polyvinyl alcohol every day is beneficial?

The fine print ingredients of such brands as “One A Day”, “Centrum Materna”, “Rite Aid” and even the prescription only “Prenate Elite” are a confusing mess of milligrams, international units, RDA’s, and chemicals. As the makers of Centrum explain, “It is very challenging to formulate vitamins and minerals without the use of non-medicinal ingredients which serve to keep the product stable and to prevent the various ingredients from interacting.” They also find fault in the limited number of suppliers of the active ingredients in prenatal vitamins, and therefore claim substances like gelatin are difficult to avoid.

Let’s take a tour of the prenatal vitamin ingredient zoo.  Among the chemicals found in the most widely available prenatal vitamins are:
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A depressing, inspiring, sobering, and thoughtful essay written about the herculean task of meeting death and illness well.

(from The New Yorker)

Life can bring absolutely terrible circumstances to our peaceful lives. A sudden phone call bearing grave news. A nauseatingly bad diagnosis. Financial anxiety. Self-doubt. An irreparable mistake. Guilt.

Stressors compound upon one another, and the psychological toll builds. In my office I am visited daily by a torrent of fears, heartaches, and tears from the pained faces of men, women, and children. I think the general state of the world and our acute, extraordinary economic hardships have amplified the occasional woeful visits into the norm.

I do my best to help, emptying my shallow pockets of whatever empathy, counseling, and medication I can find. Sometimes I can help, but for some the burdens are too great. And when the stressors in my own life abound it becomes even more difficult to take on others’ despair, although a more genuine sympathy rises.

Yet in our supposedly mundane lives, going through times of great adversity, the Heroic emerges. People fight cancer. People fight misery. People persevere in the face of ruin. Bruised and tattered and self-aware they cope with incredible pain, or pass honorably having so endured.

I sometimes wonder if I should write one-word prescriptions instead of, or in addition to, medicines to stabilize a tempestuous mood. Should I dispense “citalopram 20 mg 1 tab po qd #30” with my right hand, and “Courage” with my left?

In tense moments of my own life I often resort to focusing on one-word manifestos. I meditate on the heroic qualities of literary characters, family members, patients I’ve seen walking the plank before me. I try to drown out the internal anxious dialogue with a mantra-like ohm.

Bravery. Resilience. Strength. Beauty. Courage. Hope. Faith. Endurance. Light.

Perhaps these most powerful assemblages of letters deserve a mystical place on prescriptions, helping to conjure walls of stone in the besieged minds of those who meditate upon them?

It is with great pleasure that I announce the winner of the poetry contest. Over 125 poems were received with a general theme of medicine or science. 7 judges were consulted, representing a diversity of training in medicine, science, and the humanities. A few of the judges were moved to tears at times, and all expressed their wonder at the quality of writing.

What makes art, poetry, or literature special? Perhaps it is a combination of graceful observation and hopeful creation which lends light, perspective, and meaning to our existence. We know it’s good when a certain hum of neuro-electricity splashes brilliant colors across our satisfied brains, soothing ills, making us want more.

So here are the top 5, as chosen by the esteemed judges! Congratulations, and may the awards given to the winner (money and a cherry tomato) bring a smile. Thank you to all who entered the contest.

Winner:
Fireflies, by a medical resident

Runner Up:
Song for my Father, II, by Pal MD

Honorable Mentions:
TO SYLVIA, by Maria A. Basile, M.D.
The Harvest, by C.L. Wilson
If I Were Frida Kahlo, by Amanda Hempel

And here are the poems:

Fireflies
~a medical resident

Hand clasps hand
on the window sill,
he in a paper-thin gown,
she in her Sunday dress.

Snow falls.
He craves the sting of crystals
on his tongue,
a shovel to carve a meandering path
to the front door.

And she –
a spark from dying embers
that once flushed his cheeks,
now sunken and pale.

Lilacs blossom.
He dug the earth for their resting place,
pruned them religiously,
watered their roots.

She filled glasses with branches
pouring over the rim –
a breath of lavender anticipation.

Heat rises.
He remembers capturing fireflies in jars
with punctured holes to breathe
and watching them through the night
as their lights flickered
then faded away.

She remembers
laughing at the red juice stains
from freshly picked raspberries
on their chins.

Leaves fall.
The crisp sun is distant
from the blurred shadows of the hospital bed.
The hurried migration of the birds
is silenced by the glass.

From the window,
they imagine the rush of delicate wings
headed south
and the imminent scent of autumn –

Burnt orange peels, smoky maple,
roasting pumpkin seeds.
Their lights flicker,
then fade away.

***

Song for my father, II
~Pal MD

“Say Ahh,” you said
as you pressed my tongue down
with the back of a spoon.

I can still taste the cold metal,
feel your warm hands, impossibly large
palpating my neck.

Doctor, father.

“No need to bother the doctor,” you said.
Your eyes showed no hint of bother.

So we went back to the bathroom
as I watched you set a new blade in your razor
hold a warm cloth to your face
lather yesterday’s whiskers.

I wondered where the old blade went.
A small slot in the back of the cabinet,
a mystery, like your newly shaved face,
betraying little of what was beneath.

Your copy of Cecil’s looks old,
like you.
The cover worn, the pages yellowed.
But you, a younger you on every page
Underlines, margin notes
expressions of wonder.

Maybe your face was stoic then
but you loved the mysteries
I can read it in every pen stroke.

It must have been a fountain pen.
I’ve always loved fountain pens
But I found them on my own.

You handed me your stethoscope
the rubber stiff with age
and said, “Go for it”
a smile breaking out,
cracking through an old psychiatrist’s
habitual stoicism.

“Daddy, my throat hurts.”

Sure, I think,
as I hold the spoon against her tongue
and palpate her impossibly small neck.

“I think a kiss will fix it,
no need to bother the doctor.”

She seems to agree.

***

TO SYLVIA
~Maria A. Basile, M.D.

I am the sun, in my white coat.
– Sylvia Plath

The surgeon at 2 a.m. is not where you think she is.
She is not waging war on cancer.
She is not resting her 9 month
belly near the belly of a sleeping patient. She
is not answering another
solace-seeking call
from you.

She is not visiting her
sickest of patients. She is not
loving the husband she tells everyone about, but
barely touches.

She is not paying the mortgage. She
is not taking care of herself.
She is not even feeding
her baby.

The surgeon at 2 a.m. is
stroking sunset blood on college-ruled
canvas, breathing blue
abandonment between lines,
drenching gauze decay in bleach
and lye.

She is writing
for her life.

***

The Harvest
~C.L.Wilson

She talks to them; knows that
although the remnant quiver
of a working nervous system at the knife’s point
is not awareness but only life’s
most rudimentary reaction, still she turns
this residual life into death by her hand,
and this one death into six lives or ten,
or sight, or new bone and ligament,
a new blood type, new scars, new hopes.
They cannot hear or see, but perhaps they know
that their last cut was made with love,
their last gift remembered. Such a cut
can never wound, could never sting.

***

If I Were Frida Kahlo
~Amanda Hempel

Perhaps a ten percent chance, he said.
My heart slid across his perfect white wall
and I shrank under my paper sheet.

If I were Frida Kahlo,
I would paint my cystic ovaries
in a pale green thunderstorm sky.

If I were Frida Kahlo, my uterus
would hang in churning clouds
raining blood above salted earth.

With no god to blaspheme,
I cursed traffic, potholes, the fact
that I already knew her name.

***

Thank you to each and every writer who entered the contest. I’ve learned a bit about running a contest, and hope to improve things for next year. It’s been a truly humbling, inspiring, and outstanding project for me to coordinate, and I very much hope that in reading and writing poetry you gain the same sense. Until next year, thank you.