Each side a stretch of sunset lit

Across the glazing blue-green sea,

Upon the snow and back to me.

The cityscape between its jaws

Is slowly steaming as it thaws,

And raising eyes to what may be

A beauty born from tragedy.

Like shards of ice on rocky floors

Replacing smooth and sandy shores,

Or haggard limbs of crumbling brown

Replacing summer’s leafy down.

Or hearts grown cold from recent harm

Replacing those still young and warm,

Fragmented pieces of a soul

Replacing one still strong and whole.

Why are these raw and barren things,

So welcome in their wanderings,

How can such sharp and damp despair

Still lure us down and keep us there,

To slowly suffer life’s full force

Despite the writhing of remorse,

While we lie still in winter’s wake

And wait for gathered clouds to break,

To burst with warm and lustrous light

And dust the darkness from the night.

That stirred in our stomachs on our first day here.

Or the raw recognition of our own defeat

When we first held a heart that could no longer beat.

We may not remember the rods and the cones,

The ethmoid or sphenoid or palatine bones,

Each circumflex, neural crest, ramus or rectus,

Or each tiny branch off the cervical plexus.

We may not remember each page that we read

About trochlear nerves causing tilt of the head,

Or the pathways that every red blood cell must take,

Or which kind of fall leads to which kind of break.

We may not remember each sulcus or groove,

Each longus or brevis and how they all move,

Each pterygoid, coronoid, cristae or carpal,

Which tendons attach to the first metatarsal.

The dermatomes, myotomes, orbital veins,

Adductors, extensors or quadrants of pain.

Nights spent with books somewhere no one could find us

To learn just what ends at the pez ancerinus.

But no matter how long it has been since the days

Of Moore and Persaud or Netter’s and Grays,

We will not forget how we all got our start

And the honest investment of those who took part.

And we’ll surely remember the sacrifice made

for foundations of knowledge and truth that were laid,

How these generous strangers were brave to instill

A trust in our touch and a faith in our skill.

How their deepest respect for the field we adore

Will bind us, remind us to always do more,

And the way they inspired us all to pursue

Greater meaning and purpose in all that we do.

And the sadness that creeps into songs that it sings,

And the loss that it leaves in its wake every day,

How it rolls up and smooths out and goes on its way,

But the pains we remember seem somehow so near,

While those we forget are the ones we most fear.

Like what if one day I could no longer speak

And each word from my mouth just came out as a squeak.

Or how would I feel if I woke up one day

To find that my legs did not move the right way.

And I watched while the runners ran by on the street

Feeling only the weight of the world on my feet.

1) I gave my first real shot (yes, to a living person) and she survived and went on to lead a relatively normal life, though I believe her reaction may have included the phrase, “maybe just a little less forceful next time…” It seems to be a trend now that instructors underestimate my strength when they tell me to “use force”…perhaps the “gremlin in scrubs” metaphor is even more appropriate than I imagined.

2) I failed my first medical school exam. The practical portion of the thorax exam was a surreal and Kafka-esque experience, with scrub-clad clones walking in twisting lines between 30 cadavers, stepping in unison to the deep, thundering “TIME” that was called from some mysterious room somewhere over the loud speaker. It was all I could do to participate in such a bizarre activity, let alone identify the tiny little blip of a piece of tissue within 60 seconds amidst the mess of various biological materials from which we humans somehow spring. My professor assured me, however, that it “takes English majors at least a few anatomy exams to get the hang of it,” and my TA reminded me that “THIS, is not medicine…you are learning to talk about medicine.” Perhaps that will reassure any of you who may be my future patients.

3)I used an AED (Automated External Defibrillator) for the first time. I was certified in Basic Life Skills (yes, it is truly called this), which is CPR, rescue breathing, and dislodging airway obstructions in adults, children and infants. In my practical exam, I used an AED on my dummy, but I did not shout “CLEAR” before I shocked, since I am not dramatically inclined.

4) I saw true pathology for the first time, and it hit me with blunt force. Like a furious natural disaster, our own insides can attack us with undiscriminating violence. Even though my patient was already dead, the evidence of a painful and unexpected death that stared us in the face when we finally opened the abdominal cavity was something that I will likely never forget. I will explain more fully in my next post.

For now I am eager to get out of my scrubs and just be a gremlin.

I was introduced to a few of the social conflicts and emotional trials of my future profession in lab this past week. I will recount them here in a way that (I hope) is sensitive to the fact that many of you will not be dissecting humans any time soon.

1) For the first time, I truly experienced the internal conflict that will become a perpetual facet in my life as a doctor–the conflict between detachment and investment, seeing the patient as a scientific specimen and seeing the patient as a fellow human who is suffering. More than a place to learn bones and muscles, the anatomy lab is where this realization first hits home. At times I am enthusiastic, (I have already developed a reputation as the wild one with the scalpel), but at other instances I realize exactly what I am doing and lurch backward in disgust at myself and my own fascination with doing something so utterly abhorrent.

2) Among normal citizens, what we do in the anatomy lab would be criminal. We chop people up, take out their organs, and saw them in pieces. What a fitting introduction to an entire profession where such trust and exception is granted and accepted by the very same citizens who criminalize these actions in anyone else. We see people naked, physically abuse them, chop off their limbs, knock them unconscious and take out their organs, give them lethal substances, ask them personal and humiliating questions, touch them and poke them and prod them in places that many would consider obscene. And this is accepted by society at large. What a profound and overwhelming honor. What a horrifying responsibility.

3) I have never so bluntly faced my own mortality, or the mortality of everyone I know and care about. The dead body in front of me–terrifying in its lack of shame and self-consciousness, grotesque and misshapen, molded and swollen–was not a person at all, but a body that a person had left behind. Never has it been more clear to me how much of the beauty we see in the human body can be attributed to vitality. It radiates outward indeed.

We were given a challenge as physicians to always be working to see the humanity in our patients. I found this to be a sad challenge to assign–my biggest fear has always been being too empathetic, too involved. I was reassured that this was “never the problem,” and I would be acting in ways as a third-year that I would never believe if I saw them now. I would be disgusted with myself. Not surprisingly, this was not the “reassurance” I was looking for. Of course a certain amount of distance is required in order to do the job well, but there will always be a “gremlin” in the “gremlin in scrubs.” There will always be a common base that remains unaltered beneath the white coat, but acknowledging that commonality is an ever-increasing challenge for physicians, and thus will be a growing challenge for me. I look at the band-aid on my cadaver’s finger that he must have put on the day of his death and I am painfully reminded of this challenge. Thank goodness for Gremlin in Scrubs, for my family and friends, and for literature and art and writing and all other non-corporeal expressions of humanity. The impressions made upon one another will never be altered by sickness or lost in death.

I can truly consider myself the “gremlin in scrubs” for the next two months in the anatomy lab, and I hope I will have a few interesting and inspiring experiences there to share on this blog. I hope to be able to appreciate and respect the sacrifice my cadaver’s family made for my sake, though I may never be able to look him in the eye–as Montross describes, “…The horror is not what is present and cut apart but what has so completely and irreversibly gone.”

Of course he explains this more eloquently…

Though I earned an MFA at Boston University with some wonderful mentors, including Rosanna Warren, Robert Pinsky, and Derek Walcott, I think my apprenticeship was really at the physical body itself, which I encountered in all its complexity during my medical training… I was stunned by the kind of drama enacted by those stubborn iambs resonating within a heart’s broken vessels, between the astonishing dignity of my patients and their incomprehensible suffering. This harrowing, lovely music, I soon realized, was the same one I’d always found in poetry. What other medium could accommodate all the struggling physicality and cognitive determination of this drama, and offer at the same time the prospect for peace, for resolution, for healing? I believe the indigenous Americans and the ancient Greeks in their great wisdom, before the advent of so many distracting technologies, knew that in poetry, in performative language, in catharsis, body and soul could indeed briefly be joined, and that in this union was a chance to abet healing.

I will be just and generous to those who have taught me this art, holding them in the highest esteem, and will give guidance and instruction freely to all who wish to follow in this path.

I will strive to correct the knowledge that I have acquired and to extend its domain, while remembering that medicine is more than science, and that warmth, sympathy, and understanding may heal as well as the surgeon’s knife or the chemist’s drug.

I will practice my art solely for the benefit of my patients, knowing that at times I must put their interests before my own. May I never see in my patient anything but a fellow human in pain. My goal will be to help, or at least do no harm.

I will remain free of all intentional injustice, practicing with integrity and honor, and will not exploit my privileged role in the lives of my patients. What is revealed to me in confidence, I will keep inviolably secret. I will use my skills to serve all in need, with openness of spirit and without bias.

In the [virtual] presence of my teachers, my family, and my friends, I make this pledge freely and upon my honor. I am ready for my vocation and now I turn unto my calling.

Won’t come to your room,

‘cause they’ve not yet learned

To control where they zoom.

But when little gremlins

Become gremlin teens,

All the teachers from Gremland

Know just what this means.

They’re ready for mischief,

And must learn the rules,

For choosing and using

Their best mischief tools.

But this time is confusing,

For each gremlin teen,

When their paws can move faster,

Than they’ve ever seen.

They get wild and restless,

Boisterous and brave,

And their instinct kicks in,

‘Til it’s hard to behave.

But they’re still scared of humans,

And all human ways,

So they must keep their urges

For mischief at bay,

‘Til they learn about humans,

And what humans do,

To deserve wads of gum

On their slipper or shoe.

So if you’re quite scared

Of the things gremlins do,

Remember these creatures

Are more scared

of…

YOU!

* It occurs to me that the relationship between medical students and patients is somewhat similar to that between mischief-making gremlins and humans. In both cases, the mischief-maker (or med student) is more scared of the helpless human subject than the other way around– fresh medical students in the hospital tread lightly, caught in a constant push and pull between wanting to single-handedly take over the procedure and wanting to remain on the sidelines to avoid any potential part in a catastrophe. Being chastised by the more senior members of their profession is to be avoided at all times. That is the story of Gremaline’s struggle as a talented mischief maker–in sneak-skirts or in scrubs, the same conflicts ensue.

Underneath the sole

Each step is felt, but only just

Only that which God deems must.

But real life is a wound so large,

So tender and exposed,

That though I stitch it tight with strings,

With every touch or step it stings.