Our Internal Medicine Residency Program believes that nurturing creativity is as beneficial to the individual as it is to developing empathetic physicians. The resident-led Humanities and Wellness Committee launched a writing competition this year, inviting residents to submit works of creative nonfiction, poetry, and fiction. These were then anonymized and posted for their peers to read and judge. Of the eight pieces submitted, the following three were the ranked winners. We are grateful for their permission to publish here.
1st Place – Erin Briggie, MD
Untitled
I watched the mud seep into the seams of my black dress shoes and thought to myself, “Why did I wear my favorite work shoes to this?” Immediately, I chastised myself for such a superficial thought.
“It doesn’t matter! Why am I thinking about a pair of shoes?” I scolded.
The hillside gleamed in the afternoon light and the blue sky was clear—perfect in the way only early May could be after a rainstorm. The sun’s rays brushed my skin as we made our way down to her grave site. The cars had strewn themselves across the cemetery lanes like a beaded necklace across the hillside—so many strangers connected in this moment in time.
I don’t remember the final words of the pastor before her casket was laid to rest. We huddled together and I held my head down in prayer as my eyes traced over the fake grass covering placed by the funeral home—a shield between us and freshly torn earth. The stone looked cool, pristine—completely untouched by the wear of the elements. The visitation had been a closed casket after the accident, and it felt right in some ways. My memory was not scathed by the grayness of death or the distortion of her features, but full of vibrant laughter and smiles she had shared. Her son stood with his head turned out from the canopy toward the sun as he held the hand of his dad patiently. He was doing well for his age—his over-sized tux only slightly lopsided across his chest. His voice whispered into his dad’s ear, lying low beneath the silence that permeated the adults towering over him.
My sister asked, “Do you want a flower?” as she plucked one from the wreath draped across the vault. I declined, anger raging internally at the thought of holding such a delicate, beautiful creation to remember such tragedy. This wasn’t a memory I wanted.
Yet, my life went on. I returned to work the following Monday. Going about day-to-day tasks monotonously, the rhythm of work required steady focus and distracted me from grief for blocks of time. I looked at the schedule for clinic: acute back pain, return appointment, medication refill. The nurse brought me the next veteran’s check-in sheet.
“He scored rather high on his mental health screening questionnaire this time, just so you know. His wife died recently apparently,” she said as she handed me the medication list and turned to exit the workroom.
“How recently?” I asked.
“He said last week sometime, poor guy,” she offered, closing the door.
The veteran sat on the exam table like any other patient. My first impression was rather surprised at how put together he looked. He composed himself well—his legs crossed slightly, and hands held neatly over his lap. He was well-dressed, with a button-down shirt tucked beneath a leather belt and standard blue jeans. His glasses perched over the bridge of his nose with large metal frames that brushed beneath weathered, gray eyebrows. I avoided eye contact, whether to respect his privacy or protect myself, I wasn’t sure.
“The nurse told me your wife passed away recently. I am so sorry for your loss,” I sputtered. There was no “right way” to start the conversation so I just dove in, guarding myself at his response.
“She died last week. It just doesn’t feel like she is gone,” he stated in disbelief. “They said she had an infection, but it took her real quick. Earlier that day she told me she didn’t feel well, and just went to lie down. Then, before I knew it, she was in the ICU. They couldn’t save her,” he uttered quietly.
“I am sure you are just in shock,” I said. “Has anyone been there for you?”
“I’ve been scheduling activities with friends to keep my mind busy. Going to the local coffee shop and the grocery store to get out of the house,” he stated.
“It is normal to feel grief,” I told him. “But if you ever need someone, we are here for you. You can always call the clinic to be seen. This will just take time.”
“Who am I to be telling him about grief?” I thought. It felt out of place, like one wounded person passing their crutch to another.
“The worst part is the nights,” he said. “The days I can keep myself busy, but the nights….” His words trailed off. “The silence keeps me awake. The sound of her breathing gone.…It seems like an eternity ‘til the sun comes up.”
I stood from my computer seat and positioned myself to listen to his lungs so he could not see my expression.
“I have lost someone recently too,” I whispered. “I am just so sorry; it is just so hard.”
He nodded in understanding and returned his condolences with the standard “sorry to hear,” which I accepted quietly.
“Take some deep breaths through your mouth,” I requested.
I looked down and listened, breathing deeply with him to clear the pressure welling in my chest. The air flowed in, then out in long sighs.
My eyes cast down to the floor. I had scrubbed my work shoes clean but had missed a spot—a faint trace of clay lingered along the seams.
2nd Place – Roger Struble, MD
The Sun Always Rises
Today is a fog. It is my 12th day in a row on rotation. Tired, cranky, I stumble towards the doctor’s lounge to get my fix for caffeine, fearing my transformation into a bit of an addict. After consuming a large cup of strong black coffee with a shot of espresso I walk into the Intensive Care Unit for morning rounds. My favorite ICU nurse is working today, Jorge, who approaches me with a heavy look on his face, a countenance most disconcerting.
“Mrs. Reynolds is close to maxed out on her pressers. I just gave her another bolus of normal saline.”
Debbie is a seventy-year-old woman with a husband of 40 years. She has stage four breast cancer that has metastasized to her lungs and spine. She was admitted for a fungal pneumonia. They had chosen initially to forgo treatment, but the oncologist has convinced her and her husband to change their minds. She is currently on a ventilator with broad spectrum antibiotics, fentanyl intravenously, with tubes running through nearly every natural orifice.
Debbie is my champion. She has been dealing with the harsh realities of cancer, but stubbornly maintaining her optimism, keeping sunshine in her life. Each and every morning over the last year she woke up, despite the nausea, diarrhea, the alopecia, despite the pain, the rashes, the hot flashes, and the allergic reaction to paclitaxel that nearly killed her, to paint the Iowa sunrise. She has never missed one day, even during hospital stays. Her husband Alfred has been right there by her side each morning with water colors and brushes. They watch the sunrise together. She paints. He writes her a love note.
“You are the best thing that ever happened to me.”
“How did I ever get so lucky?”
Debbie is so proud, she always shows off her notes of affection to the staff. Al has told me before that he could not live one single day without his soul mate. That life is not worth living if she is not there. When Debbie is too weak to read, he reads them to her.
Since the tumor was graded by the pathologist, the realities of stage IV cancer has slowly picked away at their life. Normalcy has been redefined, a word so foreign from what it once was, it may as well be French, “et ne parle pas français.”
Words like “response” and “long-term” provide a superficial shine on the harsh reality of the situation. Debbie has a stage of lung cancer for which there is no cure. Even with recent advances in targeted chemotherapy and immunotherapy, the median survival time for her condition is only a year. Debbie and Alfred have thought long and hard about their decision for care, and wished to “aggressively manage” the cancer growth. Unfortunately things do not always go as planned.
Being in an immunosuppressed state has put Debbie in the hospital for an infection. The oncologist thinks she will recover, and be gifted an extra year of life with her family. The ventilator should only be temporary.
On this cold October morning I see Alfred in a chair holding the hand of the person he loves. Slowly I walk up to my old friend who looks up at me with tired eyes.
“Good morning, Doctor.”
His clothes look wrinkled, and his hair is a mess. I doubt he has left that chair all night. He is the type of person to whom the words visiting hours do not apply. He looks up at me and quivers his lip. Something big has been weighing on his mind. I look into his tired eyes wait for him to gather his composure.
“Do you believe in heaven?”
Startled, I gaze out the window and think for a hard moment. The long pause draws out and I realize that he is waiting for an answer. That he needs an answer. Suddenly the sunrise begins to peek through the hospital window. I notice the water colors, brushes, and paper untouched in the corner. I move slowly into the corner to grab a chair and sit down opposite from Alfred. I grab hold of Debbie’s other hand. It’s warm and moist, instantly my mind thinks of sepsis and cytokines storming through her body. Her blood pressure is getting dangerously low. Debbie’s condition is not getting better, it’s getting worse.
“I asked my father that same question one day when I was only 8 years old. He looked back at me and said: Junior, I wish I had a better answer. I wish that I could tell you yes. That all the good people in this world live on forever in total happiness. That when we die we are reunited with everyone we ever loved. The truth is that I don’t know. The truth is that no one knows. All that I know is that you were somewhere before you were born, and you will be going somewhere whenever you die. I like to think that heaven is real, because it makes me happy to do so. Because I miss my own father. I miss my grandfather. And some day I want to walk into heaven and tell them all about my wonderful daughter whom they never got the chance to meet.
So to answer your question Alfred. Yes, there is a heaven. And every morning there is a beautiful Iowa sunrise.”
3rd Place – Tyler Bullis, MD
Hour 19
A strong wind kicks up the dust of the surrounding plains and brings a rain of small particles which shed off my duster jacket like rain on a tin roof. My horse is not fazed and continues its slow pace through the knee high grass.
I gaze out on the feeble cattle of which I keep. No more than a dozen head now. After the bear came the rustlers, after the rustlers we set out, after we set out came the wolves. “Keep moving downstream” was the plan but everyday it seems like the streams don’t end.
Everything is a blur. I remember losing Sadie to consumption, seems like ages ago. And then my boy, he went down not long after. I cough, must have been the dust, but I continue coughing. I never check my handkerchief, not since Sadie. If I never check, there can’t be blood, if there is no blood, I’ll keep living. The urge to cough shortly returns, my chest seems to be vibrating.
My chest vibrates again. What is this strange sensation? An alarm bell beeps. Suddenly the earth around me is shattered. I’m no longer on my horse. I’m no longer in the plains. The fluorescent light in the room attacks my bloodshot eyes. My location comes apparent, my call room. Focus turns back to the sensation of sandpaper running over my eyes with every blink, could I be developing herpes keratitis?
I look down at my pager, which looks back at me with its aqua blue eye. My heart races, maybe I have sleep apnea? Risk factors for sleep apnea include obesity, male gender, and large neck circumference. No time for thoughts, the pager demands my attention.
“Patient in room 12’s potassium is 3.8, mag 1.9 would you like to replete?” My heart rate declines, “not an emergency” my amygdala screams to the rest of my brain. A dull headache sets in as my cortex recovers from the false alarm. Do I have a brain tumor? What’s my lifetime radiation dose?
My focus switches to the task at hand. What kind of a question has been presented to me? Any potassium less than 4.0 puts the patient at a serious risk of arrhythmia. I must act now in order to stave off the bad ethers that are certainly trying to claim this patient. Why have I not imaged the adrenals of this potassium wasting machine in bed 12? Is this my case report on Bartter syndrome?
I clumsily move to my computer, the sword with which I will slay the hypokalemic dragon. The alarm clock stares tauntingly at my face, it reads 03:43. Morning labs are cooking and soon my breakfast will be served. I muster all my strength and open my first Red Bull to greet the new day. The electric taste courses through my esophagus. Does Red Bull cause esophageal cancer? Squamous cell or adenocarcinoma? When was the last time I drank water? Unimportant questions in an important time.
I crack my knuckles, the equivalent keyboard warrior’s bow before opening the battle screen of Epic. My right pinky metacarpophalangeal joint hurts. Rheumatoid arthritis? I have never checked my anti-CCP. But there is no time for self pity in the trenches fighting the never-ending onslaught of Father Time.
My eyes pore over the results of the exclamation marks of the patient list. The map for the morning presents itself before me. I’m fully awake, ready to navigate the seas alone until the crew joins me on the bridge at daybreak.
The captain is now at the helm.