In the hospital the unknowns twist
And characters enter stage ER
Faster than you can
Dictate the
Script

When you are a certain kind of
Black bones tired
Everything feels like a dream anyway
And so so emotional
People die with disturbing regularity until it is only
Disturbing the
Families and they seem to be hamming up the
Scene and you just want to
Check the fridge to make sure you didn’t leave
Anything smelly in it 48 hours ago
When you left home
But the fridge is near the bed so you
Don’t although you hope you got all the
Blood off
Your shoes

So that is when you start to see
Now-right and future-wrong
It’s about the time you stop….
Needing to change the plot
And stand back, a precise narrator
Sometimes intervening, but always on script
And you see that you are caught
Because the now-right could easily be future-wrong
And the people in front of you
Can’t see it

You can say all the [conveying uncertainty] and [autonomous decision-making]
You want but they will only remember
It right if the ending is
Happy
And you don’t write the endings
The story is convoluted and you can
Barely make breakfast, in fact you
Didn’t eat that day
Maybe longer

Time can be a bitch
When emotions happen out of
The true
Choice sequence
And sometimes all you can do is
Carve a space out of the air
And a silence to emphasize
That a decision is being made
And everyone
Including a trembling tremulous poorly fed and
Sleep-starved you
Will have to face
The consequences

Commentary

This piece was originally written for a publication that required commentary or interpretation. Personally, I think poetry should speak for itself, but since I wrote it, you get it.

I’ve begun to think of medicine as paths and nodes. Doctors and nurses, equal. Simply doctors make decisions, at a node. And a nurse walks your path with you. Different jobs, true. Intertwined.

Decision fatigue the AMA calls it, as if it could be so neatly summarized. What we wish patients knew about our work. It affects everything: mental and emotional exhaustion, surgeons’ choice to operate, cancer screening tests. It leads us to overly rely on the status quo, the heuristic, the absolution of choice. Yet there is more.

Part of becoming a doctor, in the endless hours of residency, is the strange sense that comes while haunting the hospital that you people a character in a poorly-scripted play. All the family’s arrayed in circles, and all the important decisions add up, blend together and a pattern emerges. The parody of time. The unpredictable nature of the outcomes. What you know that they don’t.

That you are not in control.

We like to think we can control everything, but we can’t. And clinicians know the deep trauma that comes from pretending that we can — only to find out we were wrong. One only needs to reassure a patient falsely once, to remember the unending shame of claiming a right to a future we do not own.

The body is a complex system. Not simple, not complicated, but complex. Chaos theory describes complex as “multiple component parts that interact in a nonlinear fashion, and the results of their interaction are often greater than the sum of their parts”.

Perhaps the most difficult part of medical practice, is learning not to be angry when patients do not remember their journey, their decisions properly. When the outcomes affect how they view you, even if you did everything right.

We say terms like “autonomy” and “conveying uncertainty” in training. But the reality is these actions are just compassion. When you know that a decision can only be right in the moment, and only sometimes in the past. When your patients don’t. When you tell them as well as you can.

When you forgive them for not understanding until it is too late.

People get addicted
To an illusion and the
Illusion
Kills them slowly
Because illusions are not real

Looking at her emaciation
Each vertebra clearly curled
She is a tiny fern
In a spiral on the bed
Bleached of nutrients

Heroin was her illusion
Each one has its signs

I see a tiny fragile child
Newborn kitten
Beginning and ending blurred

A good nurse teaching me today and a
Good hospital
She’s dying the nurse says
And gently guides my hands to tap the spine with a long grey needle and draw the fluid that will tell us
Uselessly
Of what else, because we all know
Why

All I remember, aside from the deft
Maneuver trapped in my hands

Is the love radiating from the nurse
Somehow this moment replaces all my judgements
Of this condition
Forever

Because I know how it ends now

Junky they call them
But at the end they are only our brothers
Beautiful forgiven children

And there is only love
For those who know they need it
But mistake
Its source

“Nobody thinks you’ll graduate intern year.”

“But this is just gossip…”

“But a consensus of the experts
is what medical education
Is.”

“There are no facts at all in these assessments.”

“Yes. You haven’t made a critical error that hurt a patient.
Yet...”

“But you’re below the level of a medical student.

Your two greatest weaknesses are,
medical knowledge and
clinical competency.”

“Oh, and patients report you lack
compassion.”

“I think…
There’s a chronic underlying level of
incompetence
and every once in a while it
rises to the surface.”

“Well is there anything I have done right?”

[A staring silence.]

If you’ve ever wondered what
carved your doctor
into unfeelingness,

It was this.
Planted in their subconscious,
day by day,
like a thousand tiny splinters
festering in the
soul.

But some of us,
have
Tweezers.