My eyes trace the outline of her face

Weathered features, soft

Brown eyes, wrinkled

Skin

Familiar.

She looks out across the

Yard, smoke curls from

Her nostrils

She stokes the cozy campfire

Of her cigarette

Nursing the flames back

To health

 

At her age, rules have faded

Into suggestions.

 

Things are so clear.

Aren’t they?

 

Her favorite painting

Hovers on the wall

Just beyond her smoky silhouette.

A Rembrandt

The men on a ship

Fight to stay upright

Caught in a storm

Light on one side, dark

On the other

These figures, stuck,

In the middle.

 

Simple, yet

Not.

—

When I was younger,

Which in my case, had less

To do with age, and more

To do with wisdom, or more

To do with its absence,

The world existed in lines.

This way

Or

That way.

 

Starkly, medicine is science.

The answers are found

In numbers. In

Algorithms. In

Steps, in

Black and white.

Aren’t they?

 

In this dichotomy,

People vanish,

Forgotten.

 

This patient,

One of my first.

He has been here for two months.

Decreased saturations,

Now receiving breath

Through a tracheostomy tube.

I monitor his oxygen saturation levels, adjusting

As needed. Ordering

As needed.

All

As needed.

Isn’t that why he’s here?

For medical treatment?

To fix his breathing, and leave?

 

A birthday overlooked.

A father lost this year.

A brother killed at eighteen.

New onset depression.

What does he need from

Me?

 

Rembrandt

Did not adhere

To a set of step

By

Step

Rules.

Another patient of mine

In my first weeks

In the hospital.

She knew the weight

Was falling off too

Quickly

Her energy levels

Had plummeted.

Skin, yellow,

Urine, dark,

Stool, pale.

The diagnosis revealed

A pain already

Known. Just not yet

Explicit.

She hears the news,

And cries.

 

Just 

 

Cries.

 

Am I, are we,

Reduced to proper condolences?

“At least we caught it now!”

“We are so sorry.”

“Let us know if

We can do anything.”

 

—

My role,

The path forward,

Her navigation —

All as obscured

As the smoke

That had taken up, in her,

Permanent residence.

Cloudy

Nuanced

Unsure.

 

At first, you start

Simply.

Objectively.

Yet at some point, a true artist,

In extraction of Spirit over Law

In understanding of the

Larger Painting

Reorients an individual brush stroke

 

But this time, against

The Grain.

Intuiting a deviation

Down and to the left, rather

Than up, to the right.

 

You will not find

The steps to a Rembrandt

In a textbook.

Don’t you see? 

 

In light of all this

Or rather,

In its darkness,

I reach

Carefully into the carton

Grasping for another 

Cancer stick

Extending it to her

Outstretched hand.

 

Looking at her.

Welcoming the ash.

Beckoning the smoke.

A brush stroke

Against the grain.

Looking at her.

 

Things are so clear

Aren’t they?

---

I hope to speak generally about some of the overarching ideas that shape this poem and its origin. It is multi-faceted. The idea for this poem began when a physician-teacher of mine told the story of the patient on whom he made house calls for a period of time. He mentioned once picking up a pack of cigarettes for her. This struck me. Such a thing goes entirely against the conception of what a physician should do, of what a physician should be. Right? As I have considered it more, I have instead been swayed in the opposite direction. Mentors of mine have said that physicians operate in a space of “gray.” And this is the central idea that I want to communicate in this poem — that the best physicians must learn to operate in this space of ambiguity, mostly because people are ambiguous. If we are to fulfill the role afforded to us, learning to sit in this space becomes a substantial and a necessary component of caring for souls. People are not black and white, and thus, neither can medicine be.

I use several images throughout the poem — art and smoke, in particular — to help portray some of these dynamics. The piece of art I mention is a real piece — The Storm on the Sea of Galilee — and has actually perpetuated some of my thoughts on this topic. The themes of art and smoke are then applied to several patient experiences that I have had thus far. And all this is framed in the context of a strange situation — a physician being in the position of providing cigarettes to a patient. A paradox. The second to last stanza states:

“Looking at her.

Welcoming the ash.

Beckoning the smoke.

A brush stroke

Against the grain.

Looking at her.”

In this, the poem finds its pinnacle. The opening and closing lines place attentiveness to the person behind the patient as the central focus of a good physician. I hope that this piece inspires you to consider and conclude what medicine means to you. Thank you for reading.

Image credit: Christ in the Storm on the Sea of Galilee by lluisribesmateu1969 is licensed under CC BY-NC 2.0.