Like a Surgeon

This is an excerpt of a working draft of a chapter from a book-in-progress titled “Swearing by Apollo.”

I presented this excerpt at Richard Selzer’s Masterclass at the 3rd Annual Yale Writers’ Conference.  Anyone interested in the entire chapter can read it here: Like a Surgeon edit 619


Like a Surgeon

It’s 5 AM on a hot September morning in 1984. I’m sitting in my pale blue VW Beetle. The car is twelve years old and has a stiff clutch, a loose stick-shift, a broken speedometer, and no air-conditioning. But it has everything I need in a car: an eight-track player with three tapes –– Linda Ronstadt’s Heart Like a Wheel, Jethro Tull’s Thick as a Brick, and Bruno Walter conducting Brahms First Symphony with the Columbia Symphony Orchestra. My mind is racing in anticipation of my first clinical rotation as a medical student. After two years of lectures and labs, it is time to enter the hospital and work with actual patients.

I’m parked in the Rice University stadium lot. Although the medical center has it’s own lot and shuttle, I prefer to park at Rice where I attended college and jaywalk across Main Street to the Houston Medical Center each morning. I find the ritual of parking in the familiar lot of my alma mater comforting and the walk to the school gives me time to collect my thoughts and prepare for the day. I prefer not to endure the fifteen-minute shuttle-ride at sunrise with a crowd of over-caffeinated students. Medical students are prone to nervous chatter fueled by fear and doubt. Even worse than the typical anxious students are the ‘gunners’ (derived from the military slang ‘tail-gunner,’ –– referring to the crewman who sits in the rear turret of a B-52 and guns down enemy planes that approach from behind.) With a head full of memorized facts, a gunner acts without doubt or fear –– he’s already mastered medicine and is out to prove it.

I check my watch and hurry out of the car. I’m wearing a waist-length white lab-coat –– several feet shorter than the lab-coats of residents and attendings –– it clearly marks me as a student. I wade through the Houston humidity and dodge traffic to arrive at the edge of the medical center. In the pre-dawn dark, the buildings look strange and unfamiliar, reminding me of the neurological symptom called jamais vu. The opposite of deja vu, jamais vu is French for never seen. In neurology, it refers to the uncanny feeling that a well known place is being seen for the first time. Jamais vu can signal the onset of a migraine or seizure. I brace myself for the day.

The Houston Medical Center is a huge complex of hospitals, institutes, libraries, and research centers, including two medical schools: Baylor College of Medicine, and the awkwardly named University of Texas Health Science Center at Houston. I interviewed at both schools –– Baylor turned me down, UTHSCH did not. UTHSCH is adjacent to Hermann Hospital and across the street from the Hermann Park Zoo. The white-washed facade and terra-cotta tiled roof of Hermann Hospital exudes an aura of nobility, reflecting the pride and purpose of a past era. In contrast, the medical school, built in the 1970s, has a utilitarian sensibility, composed of brownish-orange bricks, straight lines, and plenty of glass.

Only halfway through the eighties, the decade already feels stale. The excitement of the sixties has long ago evaporated into a psychedelic haze. Bob Dylan, The Beatles, Joni Mitchell, and Pink Floyd have been replaced by Wham!, Foreigner, Chaka Kahn, and Dire Straits. Our culture has become boring and disappointing. But the medical school feels fresh and utopian. One step through the plate-glass doors and the atmosphere changes: a palpable energy is in the air. It feels something like hope, optimism, and, dare I say it, joy. A large sunken lounge –– known as the leather lounge –– dominates the lobby of the medical school. The musky scent of the couches portends success and fulfillment, way out there, in the future, somewhere on the other side of the hellish labyrinth of medical education.

For the first time since starting medical school, I walk past the doors to the leather lounge and head across the Houston Medical Center for the first of three month-long surgery rotations. It’s a mile-long walk to the MD Anderson Cancer Center where I am assigned to work with Dr. McQuillen. Dr. McQuillen is notorious for aggressively interrogating his students. This practice is referred to as ‘pimping’ –– it involves asking a series of escalating questions until the ignorance of the student is revealed. Only a true gunner can withstand the assault.

[The next several pages are internal reflections on the events that lead to my decision to go to medical school leading up to this:]

… I knew it would be a prolonged and challenging ordeal: four years of medical school, four years of residency, a minimum of two years to become board-certified, then a lifetime of practice. My acceptance in medical school was like the closing of a door. There was no going back, and the passage ahead felt dark and confined. For solace, I dreamed of becoming a physician-writer and fantasized crafting the next Andromeda Strain, or becoming the next Richard Selzer.

I put my dreams of being a writer aside as I arrive at the hospital. I enter the automatic doors and am hit by a peculiar smell –– a mixture of bleach, soap, and surgical steel, tinged with a hint of blood. I pass through the lobby and search my way through the halls and stairwells to the third floor surgical ward. As I approach the nursing station, a stout middle-aged man with shoulder-length grey hair wearing scrubs and white lab-coat looks up is writing in a chart. He looks up and glares at me.

“You’re late.”

The other student assigned to this rotation, John LaPrade, arrives a few minutes later. He is one many students in my class of 160 that I have never met. As Dr. McQuillen admonishes him for being tardy, John glances my way. I can tell by his expression that he is not a gunner. I will have a sympathetic companion during the arduous month that looms ahead.

McQuillen introduces us to Dr. Martin, a thin woman with blonde hair, no make-up, and tense, thin lips. McQuillen tells us that she has just started a two-year post-residency fellowship specializing in cancer surgery
“You will be working with Dr. Martin. Whatever she says, you do. Now let’s run through the patients.”

[After morning rounds, I scrub in for my next surgery. After gowning and gloving, the nurse tells me to take my place at the operating table.]

… “Now you can go enter the sterile field. Keep your hands above the table at all times. And do not move away from the table until the surgery is over.”

She steps back and nods towards the operating table. A woman is on the table, covered in green sheets with an opening exposing her bare belly. The skin is tinged orange from iodine antiseptic that another nurse is applying with a swab of gauze held by a pair of forceps. The scrub nurse is standing to the patient’s left near the head of the table, arranging instruments on a cloth-draped table on wheels. The anesthesiologist jots some numbers onto a flowsheet, looks up at the heart monitor, and reaches over and turns a valve to start the flow of oxygen and halothane. He injects something into the intravenous live then picks up a mask that is attached to the valve by a tube. The mask hisses as he leans over the patient. He whispers that it is time to go to sleep and places the mask gingerly onto the her face. Her breathing slows and her body relaxes. The anesthesiologist holds the mask in place and squeezes on a bladder attached to the mask to oxygenate the patient. After a few squeezes, he takes the mask off with his left hand and picks up a laryngoscope with his right hand. He inserts the long curved metal prong of the scope into her mouth and deep into her throat. He puts the mask down, and while still holding the laryngoscope in place, picks up an endotracheal tube that is glistening with KY jelly. He bends down and peers down her gullet as he and deftly slides the lubricated tube down her throat. He quickly injects air from a syringe attached to the near end of the tube to inflate a bladder that surrounds the other end of the tube. I know from a class that I took last month that the syringe inflates a bladder that expands around the outside diameter of tube in order to secure a seal in the trachea so that all the airflow to and from the lungs goes through the tube. I left the class after the instructor suggested we pair up and practice on each other. I later heard that several gunners actually stayed and took turns intubating each other. The anesthesiologist then attaches a tube from a ventilator onto the end of the endotracheal tube, and flips a switch. The breathing machine clicks on. A rubber bellow cranks up and down within a glass cylinder. The patient’s belly rises and falls, ebbing and flowing with each sigh of the ventilator.

McQuillen enters the room. The float nurse is waiting for him, gloves and gown ready. McQuillen pirouettes into the gown. He waves each arm into the air with a flourish as the gloves are pulled into place. He takes his place at the other side of the table next to the scrub nurse. He hold his right hand out to the side and places the fingertips of his left hand onto the bare skin of the lower abdomen. The nurse hands a scalpel to McQuillen.

With a grand sweep of his hand, he places the scalpel onto the abdomen and pulls across the skin from left to right. A slight break in the skin opens up in the wake of the scalpel –– a six inch cut from pubis to umbilicus. McQuillen teases the scalpel across the cut until the membrane that lines the inside wall of the abdomen is exposed. He delicately pinches the lining with a pair of tweezers and raises a small tent which he then nicks with the scalpel. The nurse exchanges the scalpel for a pair of scissors which McQuillen inserts into the opening. He cuts along the length of the incision. The scrub nurse places a retractor into one side, holds it in place with his left hand, and hands McQuillen another retractor. McQuillen places the second retractor into the other side of the incision and looks up at me.

“Hold this.”

I grab the handle with my right hand and pull.

“Pull harder. And don’t move.”

My hand twitches.

“I said don’t move! I want you to hold that retractor like a catatonic monkey.

The incision stretches open into a gaping maw. McQuillen reaches in and feels around for several minutes. He looks up at me.

“Put your hand in here.”

I slowly move my left hand towards the wound. McQuillen grabs my wrist and shoves my hand deep into the pelvis.

“What’s your hand touching?”

“The uterus?”

“What’s above your hand?”

“The bladder?”

“And above that?”

“The pubic bone?”

“What else?”

“Skin?”

“What else?

What is he getting at? My mind races as I try to imagine diagrams from anatomy class. The sound of the ventilator fills the silence in the room. The scrub nurse is averting his gaze. The anesthesiologist is attending to the settings on the machines, adjusting dials, and glancing at the clock. The float nurse is standing behind McQuillen, fiddling her thumbs. I notice the movement of the second hand of the clock. I’m distracted by my overwhelming awareness that a woman is lying on the table, riddled with cancer, undergoing a major surgery, and that her surgery is being delayed due to my inability to answer McQuillen’s questions. I try to recall the nerves and arteries of this area but cannot remember anything. McQuillen has stepped back from the table and is staring at me with his arms folded across his chest. He’s not to continue this surgery until I answer. I remind myself of the question: What is above the pubic bone other than skin?

“The surgical drape?”

“OK. Let me rephrase. What else would be above your hand in a woman who’s not getting chemo?”

Pubic hair? Is he trying to get me to say pubic hair? The scrub nurse glances up me. The anesthesiologist is staring at me. The float nurse is looking at me. McQuillen begins to grin.

“Pubic hair!” he announces, as he pulls my hand out of the depths of the patient’s pelvis.

McQuillen reaches back into the abdomen. He probes around for a while, the nods towards a deep crevice that he’s holding open with his fingers.

“What’s this?”

“The ovary?”

“No no no. Not that. What’s this, down here, at the tip of my finger?”

I lean in closer to get a line of sight into the hole. McQuillen lets go and the crevice collapses into a sea of blubbery pink bowels.

“I can’t see it.”

McQuillen crosses his arms across his chest again.

“OK then. What could it be?

“The kidney?”

“No.”

“The ureter?”

“C’mon, think.”

My mind goes blank. My pulse is pounding in my neck. Sweat’s dripping down my back. This poor woman has no idea that her surgery is being delayed due to my lack of knowledge. I can’t recall anything. Jamais vu… Jamais vu… The textbook images that I am trying to visualize implode into a dark void.

“Jesus Christ, son! What the hell are they teaching in medical schools these days? Haven’t you learned anatomy?”

McQuillen shakes his head and returns to his work. I concentrate on holding the retractor and pray that McQuillen doesn’t ask any more questions. My hand is cramping from holding the retractor. I tense my arm to make sure that the retractor doesn’t move. I don’t want to do anything to attract McQuillen’s attention.

McQuillen holds out his right hand and waits for the scrub nurse to supply an instrument. The nurse glances back and forth between the surgical opening and the instrument table, his hand poised over the instruments. McQuillen rolls his eyes.

“Forceps.”

The nurse chooses a long pair of forceps and hands them to McQuillen.

“No. I want the Moynihans.”

The nurse looks over the rows of instruments. There are over a dozen forceps lined up on the side by side on the instrument table. He chooses another and places it into McQuillen’s hand. McQuillen tosses the instrument over his shoulder.

“Moynihans!”

The nurse scrutinizes the instruments.

“They all look the same to me.”

McQuillen throws his head back, spins away from the table, goes around behind the scrub nurse and without pausing to look at the forceps, scoops them all up using both hands. He holds the bundle of forceps in front of the nurses face.

“These are all wrong.”

McQuillen flings the instruments across the room. They fly by my head, hit the wall, and clatter onto the floor. He then returns to the table and stands with his eyes closed.

The float nurse runs out of the room. McQuillen slowly opens his eyes and stares blankly into space, holding his hands clasped as if in prayer. The cycle of the ventilator marks time as everyone waits motionless. The nurse returns with a new set of instruments which she places on the table. She carefully unfolds the edges of the sterile cloth wrapping to lay the instruments bare. The scrub nurse sorts through the instruments and hands what appears to be an identical pair of forceps to McQuillen. McQuillen takes the instrument and proceeds with the surgery as if nothing has happened.
McQuillen remains silent for the next two hours until he announces, ”You can let go now.” I try to release my grip on the retractor –– my hand has cramped up, I can’t let go. McQuillen pulls the retractor out of my hand and chuckles. He closes the wound with sutures. Then without saying a word, turns away from the table, pulls his gloves off, and tosses them into the corner as he leaves the room.

There is a noticeable shift in the atmosphere of the room –– a release of tension –– as the nurses tidy up the remains of the surgery and the anesthesiologist turns off the halothane and waits for the patient to begin to wake up. The float nurse is picking up the interments that are scatter on the floor. The scrub nurse turns to me.

“McQuillen’s next surgery will be in OR 5.”

As I exit the door, I see John standing at the sink, scrubbing his hands. It dawns on me that John never made it into the OR.

“Have you been here the whole time?”

“Of course not! Dr. Martin showed up just as you went in and dragged me into OR 6 for an exploratory lap followed by a lymph node biopsy.”

“How’d it go?”

“Delightful. How about you?”

“Marvelous.”

Dr. Martin arrives to assist McQuillen with the next surgery. Martin tells John scrubs in. There will not be enough room at the table for both of us, so I am to observe the surgery from behind. As soon as McQuillen finishes his incision and exposes the organs of the belly, McQuillen begins to interrogate John. I cannot see into the abdomen and have no idea what McQuillen is pointing to as he pimps John into oblivion. John responds to McQuillen’s questioning by becoming flip and sarcastic with answers such as I have no idea and How would I know that? It doesn’t go over well. McQuillen ramps up the intensity. John becomes a lightning rod, drawing McQuillen’s attention away from me. I am invisible to McQuillen for the duration of the surgery. I feel sympathy for John’s plight, but am relieved that it’s him and not me.

It’s after 5:00 by the time the last surgery is finished. Dr. Martin tells us to go write up the new admissions.

“You mean tonight?” asks John.

“Of course I mean tonight. We have patients. They need to be seen. That’s what doctors do.”

“How do we know which patients are on our service?”

“Look at the charts, and figure it out.”

My first patient is a twenty-six year old mother of three who has advanced breast cancer. She is scheduled for a radical mastectomy at 7:30 tomorrow morning. She is youthful, attractive, and buxom. Tomorrow she will wake up from surgery disfigured. Even with surgery, she is unlikely to live more than a few years. Her breasts, symbols of motherhood and feminine beauty, have become her mortal enemy.

I spend the next three hours seeing the rest of my patients in preparation for evening rounds. During rounds, Dr. Martin proves to be even more intimidating than McQuillen. Her demeanor is dour and stringent. I imagine that she has never smiled. I wonder if the severity of her personality is a reaction to being a woman in the male-dominated field of surgery –– a response to the macho bravado of her peers. But I suspect she was like this before she held her first scalpel.

With a tone of derision punctuated by signs of irritation, Dr. Martin critiques and corrects every detail of our case summaries. Late into the ordeal, John mentions that one of his patients is nauseous.

“Saying your patient is nauseous means he made you feel sick,” Dr. Martin interjects, “ the correct word is nauseated. Learn to speak English.”

The sun set hours ago. Backed by the dark of night, the windows of the hospital reflect the fluorescent-lit interior. Everything feels intimate and raw. Just as I begin to wonder if Dr. Martin will keep us here all night, she announces,

“You can leave, now. I suggest you get her by 4:00 tomorrow. See all your patients prior to rounds and be prepared to present. Rounds start at 5:30. Plan to be here late every night –– no one leaves until I leave. Any questions?”

“Is there a call room for us to sleep in?”

“No, the call room is only for residents and fellows. You get to sleep at home”

“Do we get weekends off?”

“No. If you’re lucky, I might let you have Sunday afternoons off.”

It’s nearly midnight when I leave the hospital to return to my car. I am hit by a wall of heat and humidity as I leave the lobby. It’s a comforting feeling, being enveloped by the sauna of August that persists into the night. I jog across the medical center and cross the sparse traffic on Main Street in a hurry to get home for a few hours of sleep before rounds. I realize that the circadian flow of the next two years will be disrupted. One day will bleed into the next without a break.

Back in my Beetle, I relax into the torn vinyl seat and breathe in the familiar scent of mold, oil, and gas. I start the car and look across the campus towards the science buildings. I wonder about being a graduate student at the university. What if I had stayed at Rice to get a Ph.D. –– perhaps in Biochemistry, or Literature. I imagine that life as serene and idyllic. I think of the camaraderie of the academic environment, the challenge of the research laboratory, and the satisfaction of teaching undergraduates. I find myself feeling nostalgia for the life I did not pursue.

As I pull the stick-shift into first and release the clutch, the Beetle grinds into gear and lurches forward. I push an 8-track tape into the car stereo. The music starts up in the middle of the second movement of Brahms First. It is recording that I have listened to since high school. The arching line of a solo violin soars in unison with the woodwinds: yearning, pleading, hopeful.

 

WHEN WE WERE THREE

 This is a vignette from age 3 that I have been working on. 

======================================================

 

When We Were Three

I am sitting on the pink porcelain tile floor of the bathroom in my childhood home. A bottle of St Joseph’s Baby Aspirin is on the floor in front of me, it’s contents carefully poured out two at a time into Dixie cups lined up in a row on the floor.  Several of the cups are filled with water. The cups are tiny, but barely fit in my hands. Using a fork, I crush the aspirin, add water and stir. The water turns pale orange as the tablets dissolve.

Just a few moments earlier, I woke from my nap and found the house empty.  I remember wandering the empty rooms, looking, seeking.  All the shades and curtains are drawn to keep out the heat of the late-summer sun. There is a buzz of cicadas off in the distance, rising and falling in continuous waves. The house is dead, the thrumming of the insects outside heightens the sense of stillness inside. Outside is nothing but the searing glare of the bright white light of the mid-day sun. I have no awareness of the other houses on the block, or of the families, all the people of the neighborhood, the city, the world. I have no awareness of anyone but myself.

As I search the house, I arrive at the half-open door to my parents bedroom. I peek around the door. Mommy is napping in bed with my newborn sister. I want to wake her, but I know not to bother her. She has been so tired lately, caring for three children plus a newborn in the Texas with only two window unit air conditioners, one in the living room and one in my parent’s bedroom.

My two older sisters are at school, one in Kindergarten, the other in second grade. My father has gone up school. That’s what he says when he leaves for work every day –– “I’m going up school.” It’s a different school than where my sisters go. It’s where he goes to teach chemistry and do experiments in the smelly lab.

Mom is an artist. She is always painting on the walls of the house — lemon trees in the dining room, a window with views of boats in the entry hall, a european city square with a fountain drawn free-hand with Marks-A-Lots on the living room wall. But with the heat and a fourth child, she has not been painting lately.

Along with teaching me how to draw, mommy teaches me about life. She tells stories of her childhood in an impoverished neighborhood in Pittsburgh –– her father built their house, her mother died when she was 15, she and her younger brother and sister games played outside with the neighborhood kids because they didn’t have toys. She teaches me how to fix things around the house, how to paint walls, and how to and clean brass door knobs. She saves butcher’s paper for drawing and talks about carving Ivory soap and painting pictures with left over house paint. She talks about how Jackson Pollack learned to paint by peeing on rocks. She often talks of the government housing project called Terrace Village in Pittsburgh where our family lived when I was born. She didn’t like it there –– it was dirty and scary. She had to stomp her feet before opening the back door to scare away the rats when she took out the trash. An old lady next door was killed in her apartment and robbed for the change in her purse. Mom was home with three children under the age of four while my father completed his Ph.D. at Pitt. We didn’t have much money. Mom did what she could to make life better. She says she painted the concrete floors of the living room and kitchen with black paint then drizzled white and gold paint onto the floor. She says Pollock painted the same way. She painted windows on the walls, looking out to beaches, oceans and trees. She creates beauty and wonder, no matter how bleak the circumstances appear to be.

Mom likes to tell me stories. One of her favorites is the story of stone soup –– how someone started with a pot of water, placed a stone in it, and invited everyone in the village to add a few scraps of food until they had a feast. This is the inspiration for the soup that she makes every week out of leftovers and bones. I don’t like the soup, but I like the story.

My mother had often warned me to never drink or eat anything kept under the kitchen sink: Clorox Bleach, Old English Wood Polish, Comet, Windex, Brasso, Brillo. These are easily accessible, but they do not interest me.

On the top shelf of the kitchen cabinet, as high as she can reach, is where Mom keeps the baby aspirin. She gave me some recently when I had a fever. “It’s orange flavored,” she said, “Like candy. It will make you feel better.” Although it was unlike anything I had ever tasted, I knew that candy was something special. I decided I liked it.

She told me that if I ever took too many pills, that I would have to go to the hospital and have my stomach pumped. I didn’t know what that meant, but the idea terrified me. I imagine a garden hose shoved in my mouth, down into my stomach, and attached to an elaborate Dr. Seuss-like machine with tangled tubes, jars of fluids, a bunch of belts and pulleys, cogs and pistons, driven by a large motor that sounds like a vacuum cleaner and smells of ozone and oil.

I push a chair to the kitchen counter and climb onto the grey and gold speckled formica. It is difficult to open the door of the cabinet. I nearly fall backwards as the door lurches open, I hold onto the handle of the swinging door to steady myself. Standing on my tippy-toes, I am able to reach the box. It is white and orange with dark brown lettering and colorful balloons — red, yellow, blue. I like the balloons. They look cheerful and hopeful.

I retreat to the bathroom where I open the box, slide out the bottle and pry off the white plastic cap. My heart is racing. I line up a row of small Dixie cups and drop two tablets into each one. After carefully crushing each aspirin with a fork, I pour water into the cups and stir. I imagine this is like what daddy does up school in the smelly lab, pouring fluids into flasks, adding chemicals, and stirring it all together.

I down one of the cups. It is bitter and sour and only vaguely orange-flavored — like Tang. Then another cup, and another. I know I shouldn’t be doing this. I hurry and finish off the rest by chewing the pills, one by one, chasing the acrid taste with tap water. I place the cups in the trash then put the empty bottle back into the box and hide it under my bed.

Later that evening, after dark, I am lying on the dining room floor, breathing heavily. My chest is heaving. I’m hungry for air, taking in deep gulps, unable to get enough, like an unquenchable thirst. My heart is beating in my throat. My ears are ringing and humming, louder than the cicadas outside. I feel funny. My lips and fingers are tingling — not in a good way. My eldest sister is sitting on the floor next to me, watching with a look of horror, ordered by my mother to sit with me and make sure I don’t stop breathing. Mom is on the phone in the kitchen, frantically dialing various people, describing my breathing, and asking what to do. After several more calls, she locates my father, who is still up school in the lab.

I do not remember much of what happened next. I remember being held down on a table, in a room with shiny green-tile walls and a bright light blinding me from above. My arms are taped to wooden boards and needles are being stuck into me by a crowd of concerned strangers wearing green pajamas. They keep sticking me, all at the same time, in my arms, in my legs, my feet, my hands. I twist and pull as I am restrained and held still. I wish they would stop. I count what I imagine to be hundreds of shots. One hundred is a big number, its more than ten. That’s all that I know.

I look around for the dreaded stomach pump. The room is full of strange things. It’s hard to see past the crowd of people. Is that the pump? But no hose is stuck down my throat, and the shots eventually subside. The people in pajamas are calm now. They step back from the table. I look at my arm. A thin clear tube runs from under a swaddling of tape around my arm up to a bag of water hanging on a hook atop a chromed pole. I am wheeled into a room and placed in a crib. My father is there. He tells me everything will be all right. I am exhausted and disoriented but feel secure with my father’s presence. I want to stay awake. I want this moment to last.

When I wake in the morning, my father is still there, sleeping in a chair next to the crib. This room and the events of the last twenty-four hours will remain in my thoughts for the rest of my life. Twenty-three years from now, I will return to this very same hospital as an Intern.

WHEN WE WERE ONE

Back in 1984, when I attended the Humanities in Medicine Conference sponsored by the William Carlos WIlliams Competition, I read this poem along with six others. After the reading, Richard Selzer walked up to me and in reference to the juxtaposition of  birth and death in this poem proclaimed, “From such callow youth!” while clasping both hands over his heart. I was so callow at the time that I had to look up the word “callow.”

=======================================

WHEN WE WERE ONE

It was a chance meeting

in the night that brought

me together, my two halves

became whole within you.

As I grew, suspended

in time, zygote to

blastomere, morula

to blastocyst, embryo

to fetus; I had no

awareness, no sense

of the journey

just begun. Floating

within your ontogenous

sea, your body

enveloped, your warmth

sustained; we were one.

.

But those waters have long since broken and we are oceans

apart, now. I search within

for those lost memories, a sense of

how it felt; for this is what death

must be like, a reversal

of the process, a sucking back

into the womb, quiet,

dark, effortless. A shrinking

back through time

as each cell of life decays

then recombines, dissolving

into fluid, flowing

into waves.

©1984 Kurt Biehl

RHAPSODY FOR SOLO VIOLIN

This is one of three poems that I submitted to the William Carlos Williams Poetry Competition back in 1983. Two of my poems were chosen for the final ten.  I ultimately placed third and was invited to attend a conference on The Humanities in Medicine where I was gave a 20 minute poetry reading. Poetry is meant to read aloud. To my eye and ear, a poem is a like a musical score that can only be fully realized by hearing it out loud – word choice is determined by the non-verbal sound of the syllables, with the progression of sound being crafted like a melody. The challenge is to try to achieve some sort of literal content and meaning. I also pay attention to rhythm, line breaks, and punctuation to help convey the musicality of language.

=================================================

 

RHAPSODY FOR SOLO VIOLIN

 

A wisp of smoke rises from the ashtray, arcing

in a glissando of pirouettes, fading upwards

into the brilliance of a single nude lightbulb, dangling

from a frayed cord. Record covers lay strewn among

discarded kleenex, empty reminders of the music

they once held. The records are stacked naked

next to the turntable, their mysterious grooves

exposed to dust as Subotnick mingles side

by side with Bach and Stravinsky.

 

Botticelli’s Venus is born over the crumpled sheets

of a stained mattress, a thumbtack

holding her against the wall. Bartok is spread open

across a music stand, his bare belly exposed

and scarred by the cut of a discerning pencil.

Nearby lies the violin, a 1738 Guadagnini

resting quietly in its rosin-scented case.

 

It is a scene that I view from within;

all boundaries are blurred between myself,

this room. Within this portamento of space,

the walls become my walls, my skin.

I can feel the night breeze brushing

across the shingles, I can sense

Venus and Saturn in conjunction

within the arc of a moon sliver

rising above the roof, way out there

where there are no walls, or windows

or doors. I often dream

of fading these walls, bending the flat planes into curves

that spread out, dissolving; until it is no longer

a matter of edges, until there is nothing

but space.

 

©1984 Kurt Biehl

 

To Die To Sleep No More

This is a poem written as a challenge to write a poem based on one of several “thesis sentences” provided during the Yale Writers Workshop. I chose the sentence, “Nightmares aren’t as bad as insomnia.”

=========================================

TO DIE  TO SLEEP NO MORE

A tropical depression moves in

and falls upon the shore.

No eye can stand still or evade

the demons and succubi that haunt

my nights. A tsunami of blood,

zombies chase me after dark,

Naked I arrive to the Calculus exam,

every time, I have forgotten to study.

Again I fail, my sleep is uneasy;

My car won’t start, I get lost walking home.

The alley is empty and long and ominous,

they follow me again, this time dragons and bears.

Tonight my eyes burn after lights are turned off,

heartbeats thrum in my throat. The moon glares

into my window, the neighbor’s dog is barking again.

I cannot escape the exhaustion of unrequited slumber,

The creeping regret of loss and boredom.

I would dream of nightmares, if only I could sleep.

©2013 KURT BIEHL

FIFTY SHADES OF WHITE

During Stephanie Hart’s Poetry Workshop at Yale on Friday, we wrote “circle poems” (that’s what she said.) I wrote the first two lines of this poem, then it was passed around the room for each person to add another line. After it was edited by the class, I took it and made some final edits in an attempt to  breath some life into this Frankenstein creature. I cannot take credit for the beast-with-two-backs reference, nor the phrase “sweet taut rump.” Those were the creation of a couple of attractive blonde women in class, one of whom went to Cambridge and the other Oxford.  It’s always heartening when intellectuals peruse the gutter.

=======================================

Fifty Shades of White

The bright light white of the next day’s sun,

glimmering pebbles along the river run.

Her skin trembles, our kneecaps bump;

My hand flows down her sweet taut rump.

She glances towards the meandering stream,

Her toe dips in, I begin to dream:

Our bodies are one, or so it seems —

A two-backed beast in four-legged jeans.

HAMLET REDUX

Back in the 1980′s, my medical school  adopted  a Pass-Fail system of grading. The administration boasted of how they had reduced the pressure and competition of medical training by eliminating grades. But they added an additional grade of Honors for the top 10% of each course, thus negating the original intent. For many students, the presence of the rare and lofty “Honors” actually heightened the intensity and ruthlessness of competition to which doctors in training are prone.

========================================

MD or not MD, that is the quandary.
Whether ’tis easier on the butt to suffer
The hours and minutes of outrageous lecture.
Or to take a stand against a sea of schedules
And by leaving end them: to sit, to study
No more; and by no study, to say we end
The head-ache, and the thousand unnatural exams
This flesh is heir to – ’tis a vacation
Much to be admired. To sit, to study,
To study, perchance to learn; Aye there’s the rub.
For in this study of life, what learning may come,
When we have bubbled in this meager sheet,
Must give us Pass. There’s the respect
That makes Doctors out of B.A.’s,  B.S.’s.

For who would bear the classes of so long a time
The lecturer’s wrong, the proud Profs disdain,
The pangs of borrowed money, the sleep’s delay,
The insolence of course directors, and the stench
Of formaldehyde and rotten flesh,

While he himself his dissection make
On a bare cadaver? Who would gladly bear

To bleed and sweat under a weary light,
But for the hope of something here after;
The Doctorate of Medicine, with whose bestowal
All good things come. Piques the will,
And makes us rather bear those ills we have
Than to cast off eighteen years of education.

But compulsion makes cowards of a few,
And thus the nature of these students
Is sicklied o’er with the pale cast of concern,
And enterprises of little consequence,
With this regard, their meanings twist awry,
And lose all moderation.
I want you now, the fair Honors!
Nymph, in thy transcriptions
Be all my virtues remembered.
KURT BIEHL @1986