UNLOCKED SECLUSION

GOODBYE PORKPIE HAT

Although Alan Ginsburg is commonly considered the best of the Beat-poets, my favorite has always been Lawrence Ferlinghetti – his writing is deft, clean, concise, and vivid: his poems are black-and-white snapshots of the 1950’s that invoke nostalgia for the decade prior to my birth.

Goodbye Porkpie Hat is dedicated to Lawrence Ferlinghetti and presented again today in honor of his 100th birthday.

LINK TO POEM: https://kurtbiehl.com/goodbye-porkpie-hat/

Oh, Pi in the sky
Why oh why oh why oh why?
Seriously. Why?

Lucy in the Pi
With or without diamonds
Is not a drug song

Pie is delicious
Whether Chicken Pot, or Moon
Pi? Tastes like digits

Moon Pie, num num num
Marshmallow and chocolate
Pi, you have been pwn’d!

My average Haiku
Takes a minute to write;
A lifetime for Pi

Ever heard of this:
Have your Pi and eat it too?
No, it makes no sense

Obsessive thinking:
It might help write Haiku
But it’s annoying

Pi does no thinking
Nor do I when I “Haiku”
Mindless, simple, duh

What’s worse than haiku?
Making an error in math
My cousin says so

Calculus? No thanks
It’s name means stone in Latin
Not fun in kidney

Haiku is not math
But Pi is pure poetry
Do you understand?

When your flying drones
Math accuracy is key
Watch out! Friendly fire!

3.141
5926535
89793

Haiku is not math
You just count the syllables
Maybe it is math

The beauty of Pi
Is not in the formulas
Snark snark snark snark snark

The beauty of Pi
Is beyond mathematics
Proof is in the… Pi

Two times Pi times r
Just wander in a circle
Back where you started

Around a circle
Pi times so on and so forth
You end up nowhere

Divide Pi by One
And you will have Pi again
Never too much Pi

Pi Haiku is fun
Circumference over radius
It just never ends

Radius times Pi
The result tells you how far
Around the circle

The number starts with
3.14159
It goes on and on

KURT BIEHL ©2013

Back in 1984, I gave a poetry reading at the Humanities in Medicine Conference sponsored by the Northeastern Ohio Universities College of Medicine (NEOUCOM) and the William Carlos Williams Poetry Competition. After the reading, the Yale surgeon physician-writer Richard Selzer walked up to me, placed both his hands over his heart, and  proclaimed, “From such callow youth!”

I was so callow at the time that I had to look up the word “callow.”

This is the poem he was referring to.

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

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. Then, a shrinking

back through time

as each cell of life decays

and recombines, dissolving

into fluid, flowing

into waves.

©1984 Kurt Biehl

Another excerpt from the draft I am working on. My dream has triggered a sense memory of my mother’s past which has become my past.

My mother was a child of the Great Depression. Her father built their house on Bellaire Avenue in the Brookline District of Pittsburgh, creating a home with his own hands which he finished in time for mom’s birth.  Her parents first four attempts to start a family ended in miscarriage. The fifth pregnancy was successful. In September 1929, my mother was born. One month later, the stock market crashed.

Her father of Scotch-Irish heritage had quit school in the 9th grade to work with his father as a plasterer. Her mother was a first generation American of Czechoslovakia immigrants. My mother never heard the story of how they met.

Her father struggled to find work during the Depression. In early 1935, they lost the house. They rented a new home a few blocks away on Birtley Avenue. The backyard had a large apple tree that became the heart of the neighborhood in the summer. All the neighborhood boys would come over to play and swing in its branches. My mother describes a normal childhood, with a loving mother and a younger sister and baby brother and many friends. She and her sister taught the neighborhood boys games such as Mother May I, Statue, and Simon Says, and they joined the boy’s games in the street, Kick the Can, King of the Hill, Red Rover, and Cowboys and Indians. Her family was poor, but my mother did not know it at the time. She would hear her parents whispering about the Depression over dinner, but she thought they were talking about the blue glass bowl that sat on the dining room table.

In the late 1930’s, her mother was diagnosed with breast cancer. Her illness progressed despite three surgeries — two radical mastectomies and a hysterectomy. Through the initial years, she continued to take care of the household. When she suffered post-mastectomy weakness of her right arm, she adapted by switching to her left to beat batter for cakes and fudge. She moved the furniture to clean the house. She taught my mother how to use a vial of Spirits of Ammonia to revive her when she fainted while she worked. This happened on many occasions.

I asked my mom, “Did you ever have to revive your mother?”

“Yes. She would get off the floor and go back to her housework. You have to think in terms of those days. She was a good housewife and Mother.”

In the winter of 1943, her mother became too weak to climb the stairs to the bedroom and took to sleeping in the dining room. She was hospitalized at the University of Pittsburgh Medical Center in January 1944 where she agreed to experimental Radium treatments in exchange for free hospital care. My mother and her sister went to free art classes at the Carnegie Museum on weekends, after which they would go to visit their mother in the hospital. It was against the rules for children to enter the hospital without an adult. The nurses would sneak them in by the back stairwell and let them see their mom.

“Mother got yellower and yellower but each week the nurses combed her hair and put in a blue ribbon to match her eyes and she was propped up I bed smiling and laughing. She would say that when she came home she would ‘Sit on a cushion like a fine queen and dine upon strawberries, sugar and cream.’ I loved that and pretended it were so. I recall the day in February when Dad told me she was not going to live and that I would have to be mother to the family from then on.”

She died on June 11th, 1944. My mother was 14.

“After the funeral, I was at our home with all the relatives. I remember the crowd walked out onto the back porch. I stood close to Aunt Stella, my mother’s sister closest in age who somewhat resembled her. We stood not talking when suddenly a rabbit darted across the backyard. I had never seen one there before. It was a sign to me that life went on or so it seemed. It gave me a kind of hope and courage. It may sound strange but that is actually what I  thought at the time.”

“Dad had hired a little old woman to take care of us but he must have stopped paying her for as soon as she had finished all the liquor he had in the cupboard, Mrs. Noble left. That is when my duties took over. I was fourteen. I never told my friends at school and only told my art teacher what was going on. She gave me some hand-me-down clothes which were too big on me but I cut them down. I learned to make things over for my sister Nancy and me.”

“I did the laundry and cleaned somewhat and cooked the meals. I had no preparation for this and ended up with my many varieties of meals with hamburger, chili, sandwiches, meatloaf, skillet meatloaf, etc. Dad seldom came home while we were still up in the evening. Many is the night that I saved the meal till 9:30 and then put it away and went to bed. Doing the laundry was scary for our basement had low, dark ceiling with broken glass jars embedded in them for some reason. Maybe to give them strength. Mother had made her own soap and boiled clothes in a copper kettle. I didn’t do that, but used bluing and starch and hung clothes on the line with big long poles that sometimes fell down and dirtied the clothes. Start over time. Because it was so dark in there I sang loudly as I washed. All the operettas I could remember, songs from Brigadoon and Desert Song, were belted out loudly. Good thing we had empty lots on each side.”

Her father retreated further from the family and disappeared into bars.

“Several times I walked back up to Brookline Boulevard to Joe’s Tavern where I knew Dad was and went in to bring him home. I realized later that he would hide in the back while the bartender told me he wasn’t there. One time the bartender even bought me an ice cream cone to distract me. I would think of the old song, ‘Father, O Father come home with me now, the clock in the steeple strikes one,’ but it really wasn’t funny.”

“One day I came home and dad said we were being evicted and we had to move. Then he left me in charge. All out belongings had to be out of the house within 72 hours, and we had nowhere to move them to. It was a horrific experience getting rid of all mother’s things as well as our own in that big house. The basement was full of storage junk. Everything was stacked on the side yard and we were evicted. Most of all I regretted leaving the piano and the dog whom Dad turned loose in the country.”

My mother was 16. They moved into her grandparents house for a while. All four of them slept in the attic, two to a bed. They had to move the beds to the dining room when winter came and the attic was too cold. Her grandparents had little income. She began to realize that her father was not contributing any money for food. Her grandmother began to talk about wanting her to quit school and get a job. Her grandmother, having come from a small village in rural Czechoslovakia, never understood my mother’s desire to finish school and go to college. Mom took a job after school in a bakery to earn money for the household. Her Aunt Blanch, the youngest of her mother’s sisters, also lived in the house. When Aunt Blanch got pregnant, they all had to move out.

Mom took her younger brother to The Milton Hershey School for orphan boys. She was 17 and had to lie about her age on the papers to sign him in. Her Aunt Mary helped her sister Nancy find a home with a neighborhood family. After Nancy left, my mother remembers standing in the cellar, crying hysterically. She went to live with Aunt Mary. She does not know where her father went.

“Don’t be afraid to tell this tale with a little schmaltz, and humor. The three of us siblings shared black humor or Galgenhumor for years without knowing what it was. That is the best way to survive an idiotic world.”

She finished high school and got a scholarship to Carnegie Melon where she studied art under Samuel Rosenberg in the same class as Andy Warhol.

“He was a strange fellow. He had acne and wore trench coats to class. He was very gifted but chose strange subject matter such as a drawing of a young boy picking his nose. He had much potential. Too bad he stopped painting and wasted his talent.”
I grew up hearing my mother’s stories. Her descriptions were so evocative that I created pictures in my mind of the scenes and her memories became mine. When I was in kindergarten, I remember standing at my bedroom window in Dallas and knowing, somehow, that I was facing north towards Pennsylvania. I knew that was my birthplace. And I felt a sense of longing, and relief that our difficulties had been left behind.

I think she told the story of her past in order to put it to rest in her own mind. But I also feel that she told her stories to teach me about life, about how hard work can overcome challenges, about the importance of finding beauty in life, about believing in yourself and ignoring what other people think. She told me and my three sisters that we were all smart and creative and could do anything we wanted in life, no matter what happened. She told me that she wanted all of her children to be independent and not feel we had rely on her so that we would be OK if anything ever happened to her. She raised us to not need her.

But mom’s favorite subject was art. Mom smiled when she talked about how her mother saved butcher paper for her to draw on. She told me about how Jackson Pollock splashed house paint on canvases to make art and she had dripped black, gold, and white paint on the barren concrete floors of the tenement apartment in Pittsburgh that we lived in when I was born. Her description and her joy at turning ugliness into beauty was so vivid that I developed a memory of that floor, I can still see it in my mind, even though we moved from that apartment when I was one-year-old. She put a four-by-eight piece of quarter-inch plywood on the wall upon which she painted a window looking out onto a bay with sailboats. She kept the wooden panels and put them up in our house after we moved to Dallas when I was three. In our new home, she painted another window with bay view on the entry hall wall and lemon trees on the wall in the dining room. She used artist oils to craft fairies on the walls of my sister’s room. She painted the walls of my room sky blue and then free-handed lines with white acrylic to turn it into a wall of bricks. She gave me a book — Harold and His Purple Crayon — a story of a boy who creates fantastical worlds by drawing along the wall as he walks — and told me I remind her of Harold.

When I was in grade school, Mom had a calendar with photos of European towns which stayed on the wall well into the following year, open to one particular month — a photo of a magnificent tree growing in the center of a town plaza. When she took the calendar down, I remember her looking at the picture one last time and talking about how beautiful it was. She found a Magic-Marker in the drawer and began to sketch on the living room wall. A piece of the image materialized on the wall. The marker ran dry. She found another one in the back of a drawer. The tree grew a bit more across the wall. After all the markers in the house were spent, she went to the store and bought a half-dozen more. By that evening, a three-foot wide reproduction of the photo was completed. I was in awe of her ability to create like that, without a single errant line, free-handing permanent marker into a beautiful scene.

Kurt Biehl ©2015

This is an excerpt of opening lines of a draft I am working on. It’s a memory piece that takes place in a few waking minutes between dreams.

An elderly woman is shuffling towards me shouting, “I want to see the face of God!” I recognize her but cannot recall her name. She is wearing a wrinkled pale-blue hospital gown. She turns away and yells, “I want to see the face of God!” The strings of the gown dangle in the back. She spins around and runs towards me with tiny rapid steps. Her legs are wobbling. Her voice crescendos, “I want to see the face of God!” I still cannot remember her name. I look around. I am in a dimly lit hallway of a nursing home. A Filipino woman steps into the hall carrying a half-eaten dinner tray. “It’s time for bed, Mrs. Anderson.” The patient strikes out and knocks the tray onto the floor. She bends at the waist and screams full volume, her voice emanating from deep within her chest, “I want to see the face of God!”

I wake from the dream. It’s 4AM. I’m in bed looking out the window of my bedroom. In the foreground is the silhouette of a redwood, it’s branches undulate and beckon. The lights of Oakland glimmer off in the distance, giving way to the velvet gray of the San Francisco Bay. The sky is chalkboard black with a dusting of moonlit clouds. The voice echoes inside me: I want to see the face of God! I want to see the face of God! It’s the voice from my dream, but it is more than that. It resonates within and elicits a feeling, something old and familiar, like a forgotten friend from grade school, someone I haven’t thought of for many years. I want to see the face of God! My heart buzzes. The vibration moves up my throat and explodes in my head with each repetition. I want to see the face of God! The resonance of the words becomes something I can see, something I can touch, and smell, and taste. I want to see the face of God! Like Proust, “I am filled with a precious essence; an essence that was not just in me, it is me…whence did it come, what did it mean?” …

Kurt Biehl ©2015

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.

 Kurt Biehl ©2014

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

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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.

Kurt Biehl ©2014

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.”

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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

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.

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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