Category: Narrative

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General Narrative Opinion Reflection

Visit Your Ill Loved One Less, Please.

Mr. Gerald knew the exact day, three years ago that his wife moved into assisted living due to her early-onset dementia and primary progressive aphasia. After being admitted, she suffered a femur fracture, underwent surgery, and soon was no longer able to walk. Her dementia progressed rapidly. As I sat collecting interview data from Mr. Gerald in the hallway, his wife was being moved from her bed to her wheelchair; she was now unable to speak, only able to change her facial expressions and occasionally move her hands. I feared talking to Mrs. Gerald’s love, as I knew that he must be hurting tremendously. Making Mr. Gerald relay the struggles of the last few years simply for the sake of practicing my interview skills felt wrong. My sorrow began to mirror Mr. Gerald’s as the story of his wife’s incurable condition unraveled. He told me the intimate details of the Gerald family dynamic with great accuracy, stating that he was happy to be teaching medical students about their experiences.

“I am with my wife every morning and afternoon for six days of the week; our daughter comes on the seventh day. I am her companion and I keep her active constantly.” Honored to be speaking to such a dedicated husband, I asked, “…and what is that time like? Do you feel that your presence helps your wife with her condition?” Silence fell upon the room. Mr. Gerald tried to speak but was caught by tears. “Please,” I said, “you don’t have to talk about anything that you don’t want to – you are doing such incredible things for your wife. Thank you so much for sharing with us.” The other medical students added their humble thanks and Mr. Gerald continued,

“the aids here, the nurses, they tell me that my wife lights up when I am around – that it is simply not the same when I am not here.”

I asked Mr. Gerald about the strain that this illness has had on life and he relayed that tending to his wife was indeed difficult but it was his duty to do so for his loved one. Being by her side was crucial to him. He described his other daily activities, revealing the healthy social and family life that he maintains outside the assisted living facility.

The physical examination was next, so we moved into Mrs. Gerald’s room. Calling her by her nickname, Mr. Gerald walked in with great enthusiasm and began attending to his wife. Her eyes opened and she smiled, fixating all her attention on her love and ignoring the three white coats that brooded over her.

Once my time with Mr. and Mrs. Gerald was over, I consulted Mrs. Gerald’s medical file. As I read, I came across notes from the assisted living facility’s social worker:

“Mr. Gerald visits his wife frequently. With time, he should do so less.”

That is all that was written. Posing that family or friends aught to visit their ill loved ones less often is not such a cut and dry topic and surely does not merit such stringent of a statement. All families react to illness differently and this should not only be understood by healthcare providers but respected. This was a case of absolute dedication. The physician-patient relationship is secondary to the loving human relationships that enrich patients’ lives. Recognizing this essential fact is crucial to approaching patients and their loved ones humbly – without it, true healing is not attainable.

 

Featured image:

MTSO Fan

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Clinical General Lifestyle MSPress Announcements Narrative Opinion Reflection

“Preserving the Nobility of Medicine” Dr. Robert Alpern, 2014 Commencement Address of the Northwestern University Feinberg School of Medicine

Page 1 copyIn continuation of the Medical Commencement Archive, this Friday we are releasing a new commencement speech. Today’s commencement speech is titled Preserving the Nobility of Medicine. This commencement speech was given by Dr. Robert J. Alpern, a Northwestern University alumnus, to the students of the Northwestern University Feinberg School of Medicine. The esteemed Dr. Alpern is Ensign Professor of Medicine and Dean at Yale University School of Medicine. He also is President of the American Society of Nephrology, as well as a sitting Advisory Council Member of the National Institute of Diabetes and Digestive and Kidney Diseases.

Dr. Alpern took a moment for students to take a closer look at the value and weight of the two-lettered title: MD. He reflected upon the unique status given to physicians, and the reverence given to doctors from the community and from patients. Yet, at the same time the medical paradigm continues to evolve. Dr. Alpern astutely foresees a future where physicians must adapt to the growing roles in the medical team, changes in bureaucracy, and the changing expectations of patient’s for their treatment. Dr. Alpern also notes that these changes will influence the training and education of physicians. On top of our own desire to stifle the monsoon current of medical information during our education, there are legitimate concerns that the future medical student will receive but an abbreviated biochemistry course, or won’t need to take an MCAT, maybe even spend less time in medical school. Yet, Dr. Alpern urges one thing: to value the pursuit of scholarship. He reminds us that only with a strong foundation may a strong physician be built.

“We observe the patient and draw on our scientific understanding of how the body works and sometimes does not work, to develop a truth that we can implement as an action plan. We must know clinical guidelines and the most up-to-date treatment algorithms, but we must also be ready to identify clinical circumstances in which they do not apply.”

Dr. Alpern eloquently explains that, above all else, the pursuit of knowledge and scholarship is indeed the nobility of medicine. He reminds us to respect this pursuit in lieu of the changes we will see in our futures as physicians, such that “we do not return to the era of trade schools of medicine”. Dr. Alpern further mentions that, in addition to being a scholar, the physician must be compassionate, and that neither trait is mutually exclusive:

“I also want to make the point that an emphasis on science is not the antithesis of compassion, but it is rather the complement of compassion”.

At the end of his speech, Dr. Alpern concludes with this piece of wisdom:

“Do not be intimidated by the evolving healthcare system. Rather, as the next generation of physicians, you will define healthcare, and you must define it well.”

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Clinical General Innovation Lifestyle MSPress Announcements Narrative Reflection

“Timelessness in the Ever-Changing Medical Field” Dr. Abraham Verghese, 2014 Commencement Address at the Stanford University School of Medicine

Dr. Abraham Verghese, critically acclaimed author and widely respected clinician, is now featured in the Medical Commencement Archive. Dr. Verghese’s commitment to medical humanities, teaching, and the art of medicine is one that students have the pleasure and honor of learning from through various platforms.

In his speech, Timelessness in the Ever-Changing Medical Field, Dr. Verghese calls upon the Stanford University School of Medicine graduates to find the connection between their technology-laden careers and the careers of their predecessors.

“I hope that sense of history will make you conscious that when you are there with the patient, you are also participating in a timeless ritual. Rituals, like this one today, with all its ceremony and tradition are about transformation, about crossing a threshold — indeed the ritual of our graduation ceremony is self-evident. When you examine a patient, if you think about it, it is also a timeless ritual, a crossing of a threshold.”

In his speech, Dr. Verghese discusses the graduation speech boycotts of 2014, patients from his past, memories of medical school examinations, and opinions about medical licensing techniques. Dr. Verghese currently serves as Vice Chair for the Theory and Practice of Medicine at Stanford University, among many other appointments. Ending his speech, Dr. Verghese leaves the graduates with words that resemble a blessing:

 

“May you celebrate the rituals of medicine, recognizing their importance to both you and the patient. May you find courage to face your own personal trials by learning from your patients’ courage. May you minister to your patients even as they minister to you. When there is nothing more medically you can do for patients, remember it is just the beginning of everything you can do for your patients; you can still give them the best of you, which is your presence at their bedside. You can heal even when you cannot cure by that simple human act of being at the bedside — your presence. May you discover as generations before you have, the great happiness and satisfaction inherent in the practice of medicine, despite everything”

Page 1Interested in reading about Dr. Verghese’s work with infectious diseases? Check out My Own Country which features stories of the rise of AIDs in rural Tennessee. Interested in reading about mental health and creating balance within the medical field? Check out The Tennis Partner which explores the drug addiction and familial struggles of medical professionals. Fancy yourself a great fiction read in medical drama? Take a look through Cutting for Stone.

Further, Dr. Verghese writes on a variety of other interesting topics through New York Times, Newsweek, and Washington Post articles. Expounding upon the importance of the patient-physician relationship, Dr. Verghese has had a number of talks and interviews including TED talks.

Incredibly popular amongst medical students is, “Stanford 25: An Initiative to Revive the Culture of Bedside Manner” which features videos of Dr. Verghese’s physical examination methods.

Dr. Verghese is a champion of medical writing and a fantastic advocate of the importance of the healing arts. Enjoy this wonderful new addition to the Medical Commencement Archive.

Categories
Clinical Narrative Reflection

On ICU Rounds

Passing through the restricted entrance of the ICU is like stepping foot into another dimension.

A web of clear and blue plastic tubes makes it nearly impossible to determine which machine is wildly wailing as you enter this strange environment. Few patients are conscious. Some might argue that few are truly alive. Passing by rooms with no visitors is depressing but a crowd of family members in a doorway may just choke you up.

I knew I was in a fragile state, at the mercy of sharp memories of previous trips to the ICU, where my own family members shared the same lifeless gaze of each patient that was now before me.

Torn between my current emotional state and desire to learn all I could about the patient on whom our team was currently rounding, I stood between the IV stand and my preceptor as he discussed the course of action with the nurse and me. I was part of the team, part of the conversation, part of the solution. I was in the moment. It was exhilarating.

After discussing our treatment plan, my preceptor and the nurse left the room and I suddenly found myself alone with the patient. I was no longer part of a conversation. I was in a different moment. I was simply an observer that might as well have been family. This patient was no longer a forgettable name on a chart. He was a father, possibly a brother, certainly a son. The poor chances of survival that my preceptor had mentioned earlier echoed in my ears, as I watched the green peaks and troughs dance on his heart monitor. I wondered when he had last opened his eyes, and I wondered who he last saw with them. I no longer felt like the powerful problem-solving medical student that I was just minutes before.

As I stood silently next to the patient, I contemplated a recurrent source of anxiety: the desire to enter into a field of medicine with constant variety and endless excitement, and the potential for high levels of emotional stress. It was then that I realized the subtle yet poignant experience that had just occurred: in the moment, I thrived. I recognized the importance of logical discourse in the treatment of this man, and I was able to focus on the task of caring for our patient. As soon as the tethers of responsibility had been cut and I was free to feel, I felt. The ability to compartmentalize heavy emotions is a necessary skill in the practice of medicine and one that paves the way for balance between successfully caring for our fellow humans and remaining one ourselves.

I proceeded to meet my preceptor outside, bursting at the seams with questions regarding our patient’s condition. Back in the moment. Cool as a cucumber.

And I cried the whole way home.

Featured image:
to much food by wolfgangphoto

Categories
Narrative Reflection

An Ambulance’s Burden

I step off of Northeast Corridor 7871 and into New Jersey. Sunlight makes the tracks look so warm that I feel cheated when cold wind rushes my face. A man walks toward me. He comes close enough for me to smell the rancid recency of cigarettes before he says, “Excuse me.” I look at him and his eyes dart from my face to the door.

“Do you have a cellphone?” he asks.

“Do you need to make a call?” I ask, annoyed at a flash of thought I catch myself engaging, how do you know he won’t steal it?

“Yeah. The ambulance.” he says, casually.

“9-1-1?” I ask as I dial the numbers on my phone.

“Yeah.” he says, emitting a forceful exhale. I have yet to eat and his breath hurls vomit at my senses. I hand him the phone. I imagine my brother scolding me, “Really, Sara, you can’t just hand your phone to people. At least get insurance.”

He won’t take your phone in a train station where there are policemen. I reason with my fear, still guilty over my first-thoughts.

“Yes, hello. I need an ambulance at Trenton station… Suicidal thoughts. I wanna go to St. Francis. I’ll wait in the parking lot outside… OK… yeah… OK.”

He is silent. I imagine a weary dispatcher typing information into a form.

“Yeah, yeah.. suicidal thoughts… yeah, wanna kill myself. I’ll stand outside the station. Uh….” He looks at me.

“Which side we on?”

“The Newark/New York side.” I say.

“Newark/New York side” he repeats, “Jeans and a grey sweatshirt. My name is . . . “

I stop eavesdropping and start thinking about his call. He hands me my phone.

“Thank you.” He smiles, showing gaps between rusted teeth. “You have a nice day.”

“Take care.” I say, trying to reconcile myself to his smile.

If I could not understand English, I might have imagined his call was a take-out order. He was ready with the prompt they couldn’t refuse. “I wanna kill myself.” He expected the questions in the order the dispatcher asked them. He picked his hospital.

What does it mean that his best option is to call for a ride to the hospital that would cost up to $900 if he could pay?  Waiting for my train, I think about his smile. I wonder at the difference between a usual day for him and usual day for myself. What do I know?  Maybe he did want to kill himself. But what if he just needs a place to stay or needs help with the sweating agitation of withdrawal?

How will EMTs, nurses, and doctors think of him? As a system manipulator? Someone who suffers because of gaps in social insulation? Another case? A person who makes choices?  A recipient of charity?

I think of a patient I interviewed who said he came to the hospital to “Get halodol to chase the voices.” When I pressed for explanation, he replied, “You know, get clean. Get outta everybody’s way, get some… some free sleep, take care of my medicals . . . get outta everybody’s way.”

“What do you mean by get out of everybody’s way?” I had asked.

“You know… I don’t wanna bother nobody…be in their way while they trynna do jobs and work and studyin’ and workin’, you know… like get outta their way to not be sick you know… don’t wanna be a burden.”

After the ambulance leaves for St. Francis with the man who borrowed my phone in tow, I wonder whether an ER doc will tell his resident, “He came to get out of everybody’s way.”

Featured image:
Ready by Matt Carman

Categories
Narrative Reflection

On Anatomy Lab

Photo courtesy of UC Davis School of Medicine

For a medical student, anatomy lab is a rite of passage.

Everything about it is a test: Can you withstand the sharp sting of formaldehyde at 8 AM? Can you differentiate between the vagus and the phrenic nerves? Can you delicately dissect the muscles of the forearm?

Can you make that first cut?

Human emotion fascinates me and my psyche just so happens to be a complex, peculiar, and interesting specimen to study. The psychological effects of working in the anatomy lab had a profound impact on me, even with scalpel in hand two months after my first day. Day one of lab went just as I had anticipated: I kept my cool until someone broke my composure by casually asking how I was doing. I fought back tears after the harmless inquiry until I could isolate myself and let it all out in a corner between a large window and a countertop covered in plastic model brains. I had been trying to make a positive first impression on my lab group by keeping a composed demeanor despite being in an environment worthy of vast displays of emotion. Clearly, this was no simple task. Although mixed with a bit of embarrassment, I immediately felt relief upon the crumbling of the emotional dam that I had worked so hard to build. I would have stayed in the corner longer to release all of the fear, sadness, and confusion had I not felt so guilty about leaving my group within the first five minutes of lab. I typically use distraction techniques to rid myself of negative thoughts but the impending return to the lab table invalidated those tricks. Instead, I accepted that I had nothing to be embarrassed about, that I could sort through my feelings on my bike ride home, and that it is okay to let my classmates see me cry. One deep, cleansing breath later, I rejoined my group and together we embarked on our seventeen-week journey.

After that episode, I dreaded returning to the chilled tank that housed the body of a woman who could have been my mother: same age, same surgical scars, same body type. In the seven-day interim, I pondered her life. I wondered about her family, where she had worked, what made her choose to donate her body. I wondered if she died in peace or in pain. I thought about the people in my life who had passed away. Each of their deaths was sudden, painful, unanticipated, and unjustified, and left me with an incredibly significant sadness. I wondered if my perspective on death was natural, if it was normal for me to feel such heartache in the presence of a deceased stranger. I eventually concluded that there is no perfect answer because there is no norm by which to judge my perspective. With that understanding, I made peace with my emotions.

My sadness subsided over the subsequent weeks as I found myself head-over-heels in amazement and respect for the human body. I felt like a pilgrim finally reaching a sought-after shrine, seeing for the first time with my own eyes the conglomerate of vessels, nerves, organs, and muscles that until then I had only ever read about. Despite the body’s collective complexity, the individual parts seemed unbelievably simple and incapable of carrying out the multitude of physiological functions required for life.

As we uncovered one pathologic finding after another in our hunt to determine our cadaver’s cause of death, I began to involuntarily formulate a mental scenario of this woman’s final years, months, and even the day she died. Soon enough, each physical finding that suggested a potential cause of her death was accompanied by an imagined reproduction of her life. One half of me was determined and anxious to uncover new pathology that might lead to a stronger differential and the other half wished it could painlessly declare natural causes. In the histology lab, I encountered yet another emotional challenge. One minute I was eagerly anticipating visible signs of liver metastasis and the next I was welling up behind the eyepiece of my microscope, imagining our young patient receiving the news that she had five months to live.

No two medical students have the same anatomy lab experience. For me, the past nine weeks have altered my view of death and further sensitized me to human suffering. Death no longer seems personal, but rather a fundamental biologic process. It is the suffering that often precedes death that has consumed me as an anatomy student. Death undoubtedly brings about a suffering all its own—which was my initial source of heartache at the beginning of lab season. Who did this woman leave behind? Are they still grieving over her passing? But as we uncovered her countless medical problems, I wondered what was harder for her family and friends: to live with her absence, or to live with her suffering?

When it comes to anatomy lab, many medical students would express that there is nothing to it — it is simply another requirement. For others, it is unashamedly so much more. It is said that the cadaver is the medical student’s first patient. I only wish I had the opportunity to thank mine.

Featured photo courtesy of UC Davis School of Medicine

Categories
Lifestyle Narrative Reflection

Time | The Balancing Act of Medical School

Not too long ago, I was rushing from one informational meeting to the next, trying to gather the scoop on medicine, medical school, and what exactly it meant to be a pre-med (I found it strange that these three rungs on the medical ladder were not necessarily complementary with each other… Did acing a nit-picky orgo exam really hold any bearing on my future abilities as a physician?). During my data-gathering in college, I soon saw a common theme emerging from all of the advice I accumulated.

Regarding the medical school experience: Medical school is tough.

Courtesy of Dalya Munves: http://thehealthscout.blogspot.com/
Courtesy of Dalya Munves: http://thehealthscout.blogspot.com/

I was told that the material would be overwhelmingly vast, that I would spend most of my spare time with my nose in the books, memorizing, and that I should not even think about third year yet, because that was a whole ‘nother story. I was not deterred—I had found medicine (or rather, medicine had found me) and I could not imagine myself pursuing any other field.  I was a little afraid because I knew I was not much of a memorizer.  But, I would try my best.  This all happened after my sophomore year of college, when I finally decided to “go pre-med.” (My path to choosing medicine will have to wait for a future blog post… stay tuned!).

I couldn’t imagine being busier than I already was. I was already heavily involved with three extracurricular activities, was starting to go into a lab to do research, and had a full course load. Yes, medical school was probably going to be busy—everyone said it would be—but somehow, I couldn’t wrap my mind around a life busier than what I was experiencing in undergrad.  If I had been a more pro-active of a pre-med, I might have planned for the time-suck that I heard medical school was going to be. Maybe I would have started studying anatomy on my own, flipping through an atlas over the summer and starting to put down to memory muscles and nerves. Maybe I would have freshened up on my biochemistry or genetics.

Either way, I don’t think it would have prepared me at all for the balancing act that attending medical school has been. (In any case, I’m glad I didn’t fritter away my summer with a Grant’s Dissector.) It’s true that I’ve never been expected to memorize so much material in such a short period of time ever before. And that my attending lecture, small groups, and mandatory clinic sessions have resulted in much more class time (and hence, less free time) than in undergrad. Yet, these challenges are singular, and I have come to accept them as essential parts of the path I have chosen to take. The real challenge arches over other aspects of my life.  It is the challenge of prioritization.

Most, if not all, doctors would agree that in order to keep sane, they’ve had to prioritize activities other than studying during their medical career. Often, it’s working out, cooking, sleeping, watching TV, or spending time with friends and family. It’s ultimately all about balance.

Being a medical student is like this: a teetering balancing act that may lean or sway more towards one activity or another on a day-to-day basis, but ultimately, in the big scope of things, stays firmly upright. This dynamic, rocking state of being is what balance truly is.  I’m still awful at memorizing, and binder-loads of lecture material still catch me off guard. Yet, the biggest challenge of medical school has been learning how to best use the limited time I have in the most fulfilling way for me.  It’s about learning to promote balance in my life.

In C. Dale Young’s poem, “Gross Anatomy: The First Day,” he begins the poem with an anatomy dissection instructor telling his students to:

“Begin with bone and muscle to discern exactly what you need to memorize. Each region has so many things to learn.”

He ends the poem with a snapshot of a sentiment too often felt by medical students:

“…You have many things to learn:
procedures, facts, new words at every turn.”
His introductory words elicit sighs.
Begin with bone and muscle to discern?
There is no time—too many things to learn.”

If I were to give advice to my naïve, pre-med self, I would sit her down and look her in the eye. I would tell her with confidence that she will be able to handle the course load of medical school just fine, that she will one day wield a stethoscope and call herself student-doctor without a second thought. But I would add, after motioning her to listen carefully, that she should make sure to pay particular attention to what is important to her. I would urge her to not let those things wither and to make finding balance a priority during medical school.  Then I would share some sage advice I have gotten from fourth years past, “The extra hour you spend studying may not help you become that much of a better doctor in the long-run, but the extra hour you spend with your friends/your significant other/your family/your hobbies can make all the difference for your current and future happiness. Either way, you are going to get that MD. How you get there is yours to choose.”

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General Lifestyle Narrative Reflection

Stop, Look, Go | An Approach to the Medical Student Lifestyle

From David Steindl-Rast’s TED talk, “Want to be happy? Be grateful”

Medical school is not what I expected. I’m neither saving lives day in and day out, nor am I the most knowledgeable person in my class. I’m not performing medical miracles and I’m not revolutionizing medicine as I envisioned I would be (yes, with just my twenty odd years of “life experience”). Instead, I feel as though I am trying to drink from a full powered water hose that won’t shut off. I am continuously faced with my own idiocy, ineptitude, and more importantly, fear. I see these super-human, overly capable figures who bear the name of doctor and wonder if I’ll ever be able to stand beside them. And then I stop, look and go.

“Stop, Look and Go” is a theory discussed by a monk who goes by the name of David Steindl Rast. He believes that the key to happiness is to be grateful for every moment that one has in life. However, he stipulates that this can only come about once one realizes that in every moment there lie an infinite number of opportunities at ones disposal. Now, keep in mind that this is, of course, easier said than done. I am far more comfortable wallowing in my self-loathing guilt-infested thoughts about all the opportunities I’ve missed, than focusing on the promise of the moment at hand. Rast’s ideas challenge human beings to do more−all by employing a simple rule we learned to follow as children before crossing roads.

So, what do I gain from the application of said rule? Here is an example of my utilization of this theory, albeit on a rather small scale:

When I Stop, I allow myself to be in the here and now. I am not thinking about the amount of material I have to learn over the next few days, or what I neglected to go over the night before. I am simply absorbing what is provided to me in this moment in time.

Then I Look. Of course, this requires so much more than simply looking. It requires the utilization of every sense to, as Rast puts it, take in the enormous amount of richness provided to us. Looking is the process of making associations and enjoying the present. It requires full awareness. For example, I happen to encounter a patient with inguinal hernias in a clinical setting, after just learning about the condition in the classroom setting. This is a highly enriching experience−an invaluable experience.

Finally, I Go. Now that I have grounded myself in the present and made associations about the overlap of opportunities of that present, I move to motivate myself to do something with this newfound peace and knowledge. This ranges from sharing my thoughts with a colleague who might appreciate them; to renewing my interest in a subject matter I am studying thereby incentivizing myself to continue studying when weary.

For some, all of the above may very well prove to be an exercise in futility and I certainly do not know if everyone will take from this theory what I have−wise monk or not. What I will say is that this has very much widened my perspective on the power of purposeful action and, in my opinion, enhanced my ability to learn and absorb the waterfall that is medical knowledge. To me, medical school is a lot of things. Some days it’s a nightmare, other day the bees knees. Some days it’s taking over my life, other days it is my life. It is difficult but awe-inspiring; fun but tiring. If it were a drug, I’d be an addict and if it were a person we’d be in a torrid love affair.  Overall, medical school and being part of the medical profession is surely an invaluable opportunity and I strive to remind myself of my fortunate position as often as necessary, fueling my daily work and propelling me into the future. Thank you brother Rast.

Categories
Narrative Reflection

Ghost | Reflections on Anatomy Lab

Andreus Vesalius' De Corporis humani fabrica

The towel felt heavy the first time I lifted it,
Weighed down,
Soaked.

I held in my breath while we grabbed the ends of the white damp cloth and peeled it back,
In part from the acrid smell of formaldehyde,
And in part because of,
The fear.

Its chin was jutting upwards to the ceiling,
The black buds of a sloppy row of stitches closed the deep fissure running along the clavicle and towards the midline.
This was where the blood was drained.

I braced myself,
The cold iron table sucked the life through my hands and from my body as I braced myself on the dissection table.
And then I saw it.

I felt nothing.
Just a floating,
Lightheaded feeling,
As I begun the ascent,
Levitating into the ethereal space that fills the gap between the world of the living and the world of,
The dead.

Like purgatory,
I was completely still.
Motionless.
Dissected from reality.
Cutting away,
Just naming—
The structures.

Then later,
The day was done.
We coated it with formaldehyde through a spray-bottle.
Like gardeners tending a plot,
As though the skin we just eviscerated would sprout back.
And then we covered it with the white towel and hosed that down too.

My foot was poised on the step-lever to hoist down the dissection table,
But I was disturbed.
There was the white towel in front of me.
What was underneath it?
Her body outlined a humanoid shape along the matted towel.
She was someone that was loved, and had loved.
Where was the gash where she bled?
She was someone’s daughter.
I could not dissociate dead from alive anymore.
The idea of what was underneath,
The idea of life,
I had touched a ghost.

The thin white veneer that wrapped the outside of her body,
It was a canvas.
Upon which you paint an image of an offshore breezy fishing town.
She lived there for a while, I’d like to think.
In that little idyllic village off the coast.
With her husband,
A hardworking man with a stout jaw,
A stern and powerful jaw.
He was an Irishman by blood,
And made a living off the boats.
Often he was away from home but he always brought her back a handful of daffodils on his way from the marina.

There wasn’t much pollution there,
If any it was from the tugboats wrangling along unwelcome fishing seiners.
This was evidenced by the lack of carbon pigment deposition on the lung tissue,
Seen on gross dissection and histological analysis.

The years weighed on and on like lead,
The grief of the love that passed on and along the waves more days than not.
No longer did love linger lightly on her like the tiara of trillium I always imagined she wore on her wedding day.
So her back bent and broke under the load of grief.
Specifically,
Anterior T12-L1 compression fractures secondary to osteomalacia,
Evidenced by post-mortem CT imaging.

When her neighbors asked when her old man would be back,
And joked of a love affair with a mermaid.
Her back started hurting again.
Tears welled in her eyes.
And the lump in her throat made it so hard to—
Speak.
That one we excised out.
The lump.
It was a thyroglossal duct cyst.
Characterized by the presence of parafollicular cells seen on an H+E stained tissue sample.

Through the many years she was still a good woman to him.
Though he died one day,
The way that things usually die.
Naturally.
According the literature women live longer than men.
Approximately by an average of 5 years.
She lived.

I had to slip underneath her right arm to cut open her neck,
In her icy embrace I swore I heard her speak to me in that moment.
After,
We had cleared the cobwebs from her throat.