“As needed?”
When I left the hospital last Saturday night a fat Vidalia moon was just peering through the trees that circle the campus. There were two cars and a pickup in the visitors’ lot. Lined up on the front bumper of a dented black Civic were three of those deer blasters, chrome-plastic gizmos four inches long that look like little jet engines. When you’re driving sixty they’re supposed to emit an ultrasonic whistle that spooks the deer so they don’t jump in front of your car. Gives you an idea of the kind of traffic concerns we contend with out here in Surry County.
As I crossed to the lower lot (there was only one car at the far end – mine) I glimpsed movement. I stopped and turned. A grey fox trotted across the pavement. Ignoring me. It sauntered into the bushes at the perimeter of the landscaping and never made a sound or quickened its step. Time to spring forward.
The big trees are still bare but this week the cherries blossomed. Canada geese in the hospital pond have paired off. Sunday morning I saw a pair of hooded mergansers and a wood duck eyeing each other near the nesting boxes I donated a couple of years ago. How long until fuzzy chicks leap unafraid from the nesting cavity and plop into the water like tennis balls? Everything is precisely as it should be.
What is needed?
Some day soon – five years? ten? – I’ll make evening rounds for the last time. There are plenty of things I’ll miss. The Monday mornings after a long weekend on call. Clowning around with the nurses – walk the halls with a big mug that says “DUKE” if you want to start a civil war. My partners: sitting down to puzzle out a confusing patient; cracking each other up with the deadly black humor that makes you shut the door of the conference room. And of course my patients. Figuring out what they need and being right a lot of the time. Figuring out who they are. Figuring out who we are together.
And I wouldn’t even mention that there are plenty of things I won’t miss, except that they fall into the category of things-that-piss-me-off and are mostly the same for everyone who has survived into the twenty-first century: mindless productivity-sapping bureaucracy; people that manipulate and take advantage of you; being unappreciated, or underappreciated.
But there’s one more thing I really won’t miss. Although it makes me irritable (ask Brenda and Carolyn at the office), it isn’t having to think about ten things at once – adrenalin just primes the pump, after all. It isn’t even the 3 a.m. calls from worried mothers – hell, that’s what I signed on for. And it isn’t fear, although there have been plenty of crisis situations when I’ve been scared, and I don’t like that. That thing I will be most glad to put behind me is something I might name “malignant uncertainty.” I don’t know what comes next, I’m not sure what to do, but if I don’t make a decision in the next thirty seconds something real bad is going to happen. Close corollary – I’ve given the order, the die is cast, and now I will sit and watch the outcome for minutes, hours. Will this baby’s breathing slow to normal? Will this old woman’s blood pressure come back up? Will somebody hold my hand?
What do I need?
Besides another weekend off? A couple of hours to write these lines? An insight bright enough to make sense of it all? A moon that pours through the branches while the fox and I pause to listen to spring peepers?
Will I figure it out before I’ve missed it?
Painted Trillium
. . . . .
The Geriatrician Ages
They don’t fly up at him, all these names,
no confusion of pigeons’ wings
in the parking lot; they don’t lock arms
to block him entering
the next exam room;
maybe they awaken him near dawn
but not by shaking. More like
the powdery flutter
of a moth disturbed in daylight,
the mute gray snowfall
of ash from burning newsprint.
Many he can’t recall, but all of them
he recognizes when their dry lips
whisper their presence
from the other side –
not accusations (their ease of passing
one more benediction
of his calling), not really thanks
though most are grateful,
mostly just an airy I . . . I
in his cluttered bag of memories.
So many, so often now, more and more.
Each murmur a spirit body bowed
into a wheelchair, curled mantis-like
in bed, pushing against a walker,
each of them pushing, pushing
against what held them here
and what let them go.
Some days he can’t remember
if he last saw them on evening rounds
or in a dream, and any moment
he expects the office door to open:
one will enter, speak
his name, one he had thought
was gone.
. . . . .
first published in the Journal of the American Medical Association, Vol. 304, No. 16, p.1754, October 27, 2010
V E R S E and I M A G E 
We all need to pay attention to those reminders daily. ---B