Anatomy of a Dream finally published

Anatomy of a Dream is now available for download on Smashwords, free for a limited time

...a first-year medical student finds his dissections invaded by the visions of a Bird Man, as he tries to realize his dream of becoming a physician in the Land of the Living Bible...

https://www.smashwords.com/books/view/249685

RELIGION

Dead. With perfect makeup. Thick died black hair, almost invisible white roots. She was wearing a frilly chemise under her hospital gown stained with vomit. Proper in fashion and grooming in the way that only the elderly can be. Her skin was yellow from the cancer that has torn through her liver. The same cancer that ate away her fat and muscle, so that she nothing but hollowed temples and scaphoid belly.

The goblin green line of the cardiac monitor scribbled electrical chaos. Ventricular fibrillation. Our patient, limp and grey, lay bonelessly on the CT scanner table. Her heart fluttered like a bag of worms. That sort of chaos can’t pump blood, can’t supply oxygen to the brain.

The CT suite had bland white and chrome features centered on an enormous metal donut. Surrounding my dead patient was a cadre of nurses, techs, her doctor, and me. The smell of death was cheap air freshener and cold sweat.

I do not suffer death in my presence.

Randy, sweaty and bald in scrubs that hung in all the wrong ways, held a finger over the orange SHOCK button.

“Everyone clear? All clear?,” I said, my voice certain and monotonous from thousand resuscitations. “Shock.”

The LifePak buzzed as it unleashed an electrical storm. My dead patient’s body arced upwards. All eyes went to the monitor. Still a scribble.

“Still in V-fib. Charge again,” I said.

“Charging,” Randy replied. The LifePak 12 whined.

“Shock,” I said. The LifePak buzzed, and the dead woman’s body arced upwards, as if trying to reach for heaven. Then she flopped down again.

Her doctor was talking on the phone to a nurse on one of the many floors of one of his many patients. Abdul Malek was a skinny dark guy with a belt of pagers and phones that seemed to weigh more than he did, all going off constantly. I looked up at him.

“It’s your Code, Big Guy,” he said, with a thick Eastern European accent and Gallic shrug. He knew it was my thing.

Code Blue was the euphemism for cardiac arrest. When they announced Code Blue over the loudspeakers, it didn’t upset the patients as much. Sick people didn’t like to hear that other people were dying around them. Other doctors ran away from codes. As an Emergency Physician, I ran toward them. On any given day I was a generalist, treating anything from runny noses to gunshot wounds, psychotic breakdowns to pneumonias. Resuscitations were the one thing I did best. So, when we heard “Code Blue: CT scanner,” on the loudspeaker overhead, Randy and I came running.

“Check the pulse,” I said. Randy, my nurse, had a sheen of sweat over his bald head. Shocking, childlike blue eyes under craggy brows, turned to me and nodded. The racing green line of the monitor showed fast regular complexes, like the same calligraphy letter written over and over again. Her pulse thundered in her wrist.

“She’s back,” I said. Her eyes were closed, and the oxygen mask steamed with each breath.

“Pressure is 180/120, doctor,” Randy says, swinging his stethoscope around his neck dog-collar style.

“She’s riding the ‘Epi’ train. It won't last long,” I said. Epinephrine is pure adrenaline. Shoot into someone’s blood like I just did, even a dead hearts will beat for a few minutes. “Hang dopamine at 10 mics, and let’s get ready to intubate.”

I look up at Malek. He puts the phone back on the wall and shakes his head. He claps his hand on my shoulder in a brotherly way.

“Listen, big guy, you did a great job. I just talked with her family. She’s a DNR.”

DNR. Do Not Resuscitate. The wisdom to realize when medicine has reached the end, and when the disease is our best friend because it will take the pain away. Malek looked sad, sad for me. He knew that I lived for the resuscitation. I got wrapped up in it, the battle between medicine and death, and I lost perspective.

I looked down at her. Her mascara wasn’t even smudged. She had recently done her nails with burgundy polish. This was a woman that wanted to live. She wanted to live.

“Elaine! Elaine, can you hear me?!” I shouted.

No response. She coughed.

“Elaine, we just restarted your heart. I want to put you on life support. Do you want us to do that?”

She coughed. Her mouth seemed to be moving, but I couldn't hear what she was saying. I leaned in closer.

“Are you a religious man?” she whispered from frothy, cracked lips.

I leaned closer. I was pretty sure I imagined her voice. Most people are unconscious that close to death. It makes tearing them open, shocking them, violating their deaths that much easier. She couldn’t be talking to me.

“Are you a religious man, doctor?” she asked again, and either from her lungs or my conscience I heard her.

I have heard this question a hundred times from my patients. As someone who stands with one foot on the border between life or death, these questions are of importance. It’s a question I frequently ask myself.

I can hear the clanging of bells in the distance. Ten arms falling as one, ten iron bells clanging. Chanting.

***

To Ho Ka Mi Eh Mi Ta Me.

I am no longer wearing scrubs and a stethoscope. I am twenty years younger, with wisps of beard clinging to my face. I am wearing a simple t-shirt with a logo of a mountain, and gi pants. Sennin Kai. I am chanting.

This is my first Misogi.

To Ho Ka Mi Eh Mi Ta Me. To Ho Ka Mi Eh Mi Ta Me.

Misogi is an ancient ritual of purification. We gather in the dawn light, when the dew still clings to the grass, on New Years Day. We are teachers, computer programmers, lawyers and accountants by day. By night we learn the rituals and meditations of monks long dead. Sennin Do means we live like the Sennin, the immortal ones who ate air and flew with the dragons. We are men and women of science and modernity, and we understand these rituals are only to focus our minds and clean our bodies, but that makes them no less magical.

The chant itself has no translation. It means what you want it to mean. There is no magic except the sweat of ten arms falling and the overwhelming clamor of ten bells and ten throats. I am benevolently obsessed. Absorbed.

The chant becomes faster.

Toho Kami Ehmi Tame! Toho Kami Ehmi! Tame!

***

She had gotten off the Epi train. Her heart was slowing, and the aggressive pink sheen of her skin was starting to fade to grey.

“Sinus brady,” I said. The calligraphy letters on the cardiac monitor were getting farther and farther apart. “We’re going to pace her. We can do that with a DNR, right?”

Malek shrugged.

“Right. Randy, give me a half-mig of Atropine and grab the pads.”

He pulled off her gown to show folds of excess skin over rotten ribs. Plastic pacer pads were stuck over her chest and back. Unlike an internal pacemaker under the skin, this was a cruder kind. Her own heart couldn’t give the electrical kick, so we would provide our own.

“100 milliamps, rate of 60.”

Another line of green.

“No capture.”

Malek looked sad. Not sad for the patient. Sad for me.

“Big guy, she’s got cancer. She’s only got a few months anyway.”

He stepped back, already divorcing himself from the drama. We were in sketchy territory here, legally and ethically. On the edge between life and death, it was each doctor’s decision. At least we thought so. Usually the choice was out of our hands whether we believed it or not.

***

Toho! Kami! Ehmi! Tame! Toho! Kami! Ehmi! Tame!

This is my second Misogi, that we do every year. I have become an instructor, the youngest instructor in his dojo. Twenty years old.

I sit on the right hand side of my Sensei. His eyes are closed. My eyes should also be closed, but I can’t help watch him. He has a handsome, childlike face with thinning brown hair and horrible brown teeth, likely stained from tetracycline when he was a child. Soon, it will be my turn to take his place.

Even through the chant, my mind would wander. I thought of running the dojo, how I would attract more students. How I would motivate them, inspire them. I would help people understand the peace and power that I had found.

Toho Kami Ehmi Tame!

***

I felt my hands shake. I was wasting my time. Let her die. Let her die. My mind, my training, my collegues are telling me to let her die. I’m not supposed to be here. I’m supposed to be in the ER.

“No capture, doctor,” Randy said.

Patients came to me and they died. That’s what it meant to be an Emergency Room doctor. They fell asleep while driving and roll their SUVs and they died. They drank for forty years and vomited blood and then they died. They smoked until their lungs were great useless bags of black paper and they die. They live in the wrong neighborhood and catch a bullet aimed at someone else and they die. They die and they keep dying.

Most days, I could handle it. Let it go, bitch to my friends, drink, laugh and forget.

Not today.

“Not today,” I whispered to her. “I can’t let you go, my dear. I’m sorry, I can’t let you go. I couldn’t lose another one.

“No capture.”

Fuck this.

“Randy, push two amps of bicarb. I’m going transvenous.”

Randy beamed me a relieved smile. We were in the meat of it, we had Code fever, and he was as invested as I was. Randy was of strong Irish stock. He understood fighting but not giving up.

A transvenous pacer is a long, sterile wire that feeds directly into the ventricle. I’m running an electrical cable directly to heart, through her peripheral circulation.

***

TOHOKAMI! EMHITAME!

My Sensei looked hurt when I told him the news. I was leaving the dojo. I was a young man, and my blood was too hot to sit and meditate while the world was being formed. I wanted to roam, to rage, to live a life outside of the dojo.

He told me that there would always be a place for me, but I knew that my place wasn’t at his side. It was out there. I still believed in the principles I had learned, but the dojo wasn’t my place to practice.

When you finish Misogi, you start to make your arm swing in a arc half as large. Then half as large again. Then again. Then again, until your hand is completely still.

I went to Israel, the land of the living bible, to learn my religion. I studied medicine. Then I went to the worst warzones of South Central and north Philadelphia to learn trauma and critical care.

It sucked. I hated it. I hated the hours, the abuse by patients and nurses, the constant complaints and lack of sleep. It made me tough and hard. I learned everything I read in books, practiced it a hundred times, lost ninety-nine, tried another hundred.

TOHOKAMI! EHMITAME!

***

I could feel my own heart beat in time with hers. Fighter pilots get it when they’re pulling three Gs. Boxers get it when they’re punch-drunk. The sort of horrible focus that blocks out everything. I've got Code fever. Just me and her dead heart and my technology versus the cancer and the entropy that all things die. My hands were sweaty in the gloves. It seemed like the air was a hundred degrees. I slipped past the sweet spot again. My hands trembled.

I stopped, and stood straight. Closed my eyes, calmed my breath.

I could hear Randy’s voice quaver. “Doctor?”

I relaxed my hand, and swung it to the side. In great arcs that became smaller and smaller. Smaller, smaller. Soon, my hand was still moving, but to any eye it was completely still.

“Doctor?”

I slid the electrode through. Slowly. With infinite calm.

“Capture!” Randy said.

“Give me sixty at sixty, Randy. Sixty at sixty.”

A powerful pulse thundered through her body. It hammered against my finger on her wrist. Her color returned. She sucked on the oxygen mask.

Her eyes fluttered open. She was confused, sweaty and alive. She'd live for a few weeks, a few months. She looked at me and I thought she smiled.

“We’ve lost it. No capture,” Randy said.

“Okay, I’m tubing her,” I replied automatically. It was a lifesaving procedure, I was good at it, I could save her.

Malek sighed. I looked up at him, and the fever broke.

“It’s not what we want, Big Guy,” he said. “It’s what she wants, remember that. It’s what she wants.”

I looked up at the clock. 11:55 pm. The code was over. It had been over for a long time, but I hadn't known it. I had fallen from the perfect crystalline rush of CPR and emergency surgery, mechanical ventillation and cardiogenic pressor drips, back to the world again.

“Do you a religious man?” Elaine asked me, in a voice that could not have been hers.

“Yes, Elaine. Yes, I am.” I said.

Randy looked up at me, waiting for my response. They all look at me. All movement stops. Each doctor, it’s our decision, but really, it’s her decision. I hang my head, and say those words I’ve said so many times.

“Time of death, 11:55 pm.”

A collective breath was let out. The drama was over.

The crowd started to disperse. Monitor cables were folded. Gossip exchanged. I flicked off a bloody glove into the garbage, let out a long ragged breath and took in a new one.

“Do you answer to God?” her corpse asked, with motionless lips and empty lungs.

Back in the ER, the patients were piling up. Headaches and runny noses and broken bones and heart attacks, waves of humanity that would never stop crashing on my shores.

Endings

Madame Ellie Mae Williams Davis began a tiny little poem

Six pounds three ounces of song

Eyes of shallow waters

And pale simpering flesh

All others fell in her father’s eyes

At seventeen her stanzas broke hearts

Brought grown men to weep

Stopped Studebakers on Main Street

She drained malteds and Cherry Coke

And dreamed of a watercolor tomorrow

At twenty three she combined with another work

Two verses together

Forming a couplet

From them sprung little inspirations

At ninety two she is slender and willowy and white

She pants with tongue dry and cracked

Back arching into me

Spongy lungs engorged

She no longer leans towards tomorrow

She falls back to the past

I watch her climax in front of me

She screams like a baby

“No no no no” horrible “no”

While she recapturing her youth

I will violate her death

I open her gates

Insert the tube to feed her breath

I pierce her with needles and pipes

When her poem ends

Endings are the most difficult part of any work

A return to the dominant chord

As the last echoes of her melody fade away

I write

“Time of death, 3:15 am”

-e2k.7

Different Eyes

I: Ghosts, 2:03 am

I was standing alone in a room filled with ghosts.

Talking. In complete silence.

The fluorescents cast a pale white light around everything, a light that is meant to reveal but instead obscures. That kind of light can’t even pierce a sheet of paper. The ghosts were lying on steel tables, placed in neat rows. Their blue and gray insides were exposed, leaving their secrets bared.

They were souls that have not been put into the ground. Cadavers are not allowed to rest. Instead they gave up their secrets to me and my scalpel. As I dissected, I revealed everything in death that could not be told in life. Every broken bone, every clot, every pathology imaginable laid itself open to me.

The conversation was bloodless. I asked questions with my scalpel and they replied with their flesh. There were no lies under the knife. Under the pale light, I revealed truth. Dirty, bloated, fetid truth. The truth cut me as much as I cut them. I would never be able to see pretty lies again.

All of the world I grew up with, the world of the known, the world of the accountants and Sunday football games and television and pro wrestling, they have all gone to bed. They rested peacefully with their delusions while I confronted reality. While they laid with their dreams, I interrogated ghosts.

II: Elegant Machine

“You have to understand, the bodies are just like cars.” Dr. Taitz had said in lecture that morning. “After the driver steps out of a car, only the machine and the chassis are left. There are no drivers here, just the cars. Just the machines are left.” This was our first and only introduction to working with dead bodies in medical school.

Dr. Taitz stood in front of the the Anatomy Lab, a white and chrome room in the basement of the University of Tel Aviv School of Medicine, where we would be spending the better part of the next year of our lives. We were arranged in rows of seats in the auditorium, immobile, waiting for wisdom to be showered on us. Just outside the auditorium seats, a solemn brigade of cadavers surrounded us. Each was outlined by a harsh overhead light, covered by a sheet, and again by a transparent plastic shell that kept the smell from escaping. Like the boogie man under the bed, they waited silently, and perhaps we believed if we didn’t turn to face them they would disappear.

Dr. Taitz was a sports physician from South Africa. He was squat and fit, and gave an impression of density, in incredible shape for 76 years old. He had treated the casualties from wars going back to 1967. Taitz’s job was to teach us about the upper limb, the arms and shoulder girdle. From the surface it seemed fairly simple but we learned quickly that appearances could be deceiving.

Taitz believed that functionality was its own aesthetic. He saw the body as an elegant mechanism for work and play, and wanted to impress his beliefs upon us. He used a Buddhist method of teaching. Taitz was trying to let us reach for a higher level of understanding. “Don’t learn it, just know it,” was one of his least-liked phrases. Many thought he was mocking us. He wasn’t. He was trying to show us the way of satori, true enlightenment, through Anatomy.

“Notice the elegance of the tendons going through the carpal tunnel.” He said, holding his own wrist, as if we could use X-ray eyes to pierce through his skin. He pronounced all his A’s as hard A’s. “Really amazing, isn’t it? The tendinous sheath keeps the tendons tight into the wrist. However, it can rub against the median nerve and cause carpal tunnel syndrome, like you chaps that are copying down every word I’m saying.”

Thousands of years of superstition wrapped each of the cadavers. Taboos about cutting dead bodies, causing the dead to rise from their sleep. Ghosts, ghouls, vampires, evil spirits. The Jewish tradition was to bury a body within twenty-four hours. Just by their very presence, the cadavers represented an affront to the religious among us.

I had never cut a human body. I wasn’t sure if I could.

Forget all of that, Taitz told us. They are just objects. They are just cars with the drivers missing.

Philosophically, Anatomy was rooted in strict materialism. Everything could be explained by some physical principle. Biology was just a concentration of chemistry which was really just a concentration of kinetic physics, which was nothing more than engineering. Doctors will happily explain your every thought and emotion by the preferential binding of one chemical to another due to microscopic electrical forces. No longer was the body a magical, impenetrable organ, now it became a complex machine to be understood in terms of kinetics and mechanics.

“Okay, now, make your first incision,” Taitz said.

I lowered the knife to my cadaver’s skin. The first cut was the hardest. I wondered if he felt it. I wondered if they were just cars with the drivers missing.

III: Mediums, 3:03 am

The ghosts didn’t have names. They had tags like 58E. They were white bodies on steel tables. Their individuality had been swallowed by death, but they were special people who had donated their bodies to the cause of science in a land that believed the body was sacred and inviolate.

They were perfect and untouched except two cuts in the lower abdomen, near the genitalita, with white cloths sticking out. I never found out what happened there. My gloves were wet with cadaver juice. It bubbled and squished underneath my fingers.

The interrogation had begun. Those who say dead men tell no tales never understood pathology. I was the medium who read their stories. Nothing in their lives would be safe from me. I could feel their stress in the hardening of their arteries. I could see the years of smoking in the blackening of lungs. 16 D had cancerous nodules in the lymph nodes of the neck. 45A had stiffening and shrinking of the kidneys. My own cadaver, 58E, had tiny clots in the vessels of his brain. I knew how he lived and how he died. My interrogation was precise, perfect, irrefutable.

58E. I tried to name him, but it seemed somehow inappropriate. His eyes stared blue and sightless. He had a big bulbous nose, with brown-grey nose hair. His mouth was blue and dry, lying open like stuck in the middle of a snore. A cloth covered his head, concealing the empty skull. His brain had been harvested for neuroanatomy long ago.

He didn’t really look happy, sad, or lonely. He was beyond such emotions now. My Sensei said once that the face we are born with comes from our parents, but as we get older that face becomes all our own. Reflecting our personality. Through life, he had made his own face. In death, I would read it and try to find some truth.

IV: Known and Named

We learned about the head and neck from Professor Rak. Rak was a warrior-priest for the cause of evolution, the knight for mighty Darwin himself. In the land of the living Bible, he preached the way of science. He had a set of skulls in his office, lined up exactly as evolution had molded them, from Austrolopithicus to Habilis to Sapiens after a short two million years. Those fetishes were part of his magic.

Rak was enormous. He was a huge man, solid as his namesake, and when he talked his arms would make enormous sweeps through the air. He was enormously intelligent, articulate, and thorough. He would make chalk drawings of key features of the skull. Here was the petrous bone, the rockiest part of the body. He was the architect of the thyroid cartilage, which forms the Adam’s Apple the cricoid cartilages, and the arytenoid cartilages, putting them together so that they formed the larynx.

“It’s even more complicated than that,” was his favorite expression. For Rak, the kingdom of the skull was the seat for something greater. Anatomy was about control. Rak learned things and controlled them. I wrote down what he said, and then I would control that knowledge. Make it managable. Rational. Sorcerers and alchemists believed that every spirit in nature had it’s own secret name, and that by having that name, you could have power over that spirit. Over the elements, over time and space.

One organism. Two arms. Two legs. A thorax and abdomen. A head. A penis, or a vagina. Sixty percent water, forty percent organic tissue. 216 bones, X arteries, X veins, X named organs composed of X types of tissue. A hundred billion neurons, ten billion hepatocytes, a trillion lymphocytes, ten trillion red blood cells. 75 trillion cells. 220,000,000,000,000,000 base pairs of DNA.

Over a thousand names to be learned, mostly in Greek or Latin. Almost a million details to be memorized and put into context. There were over four hundred points on the human skull alone. Known and named. I knew them all. Did that give me power over men’s minds?

Magic is an ability to grasp the ungraspable, to have power over the elements and the spirits, the unknown. Scientific knowledge is in itself a kind of magic, a sorcerous power that physicians wield in order to perform their acts of healing. That knowledge is a different kind of vision.

V: Details, 4:50 am

I raised from the dead (next to the dead, that is) and stretched my aching bones.

I got a Coke and a Schnitzel sandwich from the vending machine, a glowing black box in the dark grey corridor. That was dinner. Or maybe breakfast. The more time we spent on other’s bodies, the more our own bodies were neglected. Fat people got fatter. Skinny people lost weight. We all lost our Tel Aviv summer tans, and were gaining bright white flourescent skins. Our skins looked like bones, as if the insides were starting to come out.

I shuffled back into the lab, sat down next to my textbook, and stuffed the sandwich into my mouth. Whatever taste it had was blocked out by the words on the page. I turned the page of my textbook, but the words blurred and twisted on the page. Moore’s Clinical Anatomy stood on top of a pile of books next to my lab table. Underneath it were several notebooks, the Washington Manual of Medical Therapeutics, photocopied lecture notes, Essentials of Orthopedics, pens and flashcards, and my portable computer.

We had been studying at the University of Tel Aviv for four months. Medical school had reached the ultimate level, finals week. While the summer sun faded, and clouds of winter erupted from the desert sky, we learned. For the past seventeen weeks we had been going to classes six to eight hours a day, to follow up with two to four hours of private study every evening. The sun had flown on golden wings across the sky while our pens scratched and pages turned. Now six exams that would gauge how well we had absorbed that information. They would be packed into fifteen hours over seventeen days. The moon would sail across the sea of night while we prepared. For every hour of lecture and studying and review, we would have less than a minute to show what we had learned.

The trick to taking medical school exams is not to know the material or know it well, but it to know it such that it could be recited in your sleep. My own technique was to read the book and listen to lecture, and make a manuscript of notes that was an omnibus all the material for that subject. Then I would recopy that manuscript, by hand, over and over again so I could copy it without looking at the original. I copied my notes onto flashcards and spiral bound notebooks. I copied into the margins of books and notes. I copied in the library, in the Histology lab, in the coffee shop, in the mall, at my desk, in my bed. I copied while watching TV, listening to music. I copied in my sleep. The scrawl of my pen was like the relentless machinery of the human body, flawlessly copying millions of base pairs of DNA every second. Every detail would be remembered, a thousand times over, because every detail might some day mean a life.

I looked down at my notes:

Two phalanges, proximal and distal, articulated by a saddle joint. Attachment for a total of seven muscles. Connects to the trapezium of the wrist by a condyloid joint. Powered by the Thenar emminence: Abductor pollicus brevis, Flexor pollicus, and Opponens pollicus, which allow the joint to be abducted or adducted, flexed or extended, and opposed. Ennervated by the recurrent nerve, a branch of the median nerve from the lateral cord of the brachial plexus, from cervical spinal roots 5-7. Blood supply from the superficial branch of the radial artery. Skin sensation from the cutaneous branch of the median nerve…

All this for the thumb.

This little structure allowed humanity to use tools, to step off the ladder of Darwin’s evolution and make its own rules. I had never believed the thumb could be so complicated.

Life exists in the details.

VI: Death

In Egypt getting your own corpse means hiring a graverobber. In some places you buy a cadaver, some places you beg borrow or steal. In Taitz’s South Africa, with only two major medical schools and hundreds of people dying every day, you get a fresh cadaver for every class. People don’t appreciate how lucky they are to have someone’s body to study from.

I have heard some wild stories about medical students and their cadavers. Apparently one guy put the cadaver in the passenger’s seat of his car, and used the extra body to drive in the car pool lane. The time-honored trick of putting a live person on a cadaver table had been repeated every year. Either flaunt your reaction or rebel from it, but you can’t deny that the reaction is there.

Understanding the pathology of death, the microscopic details that shift so that the well of life no longer heaves, is not the same as accepting the end of your own existence. It is something we never truly face. Either you obscure it with religion and superstition, or you rationalize it with scientific positivism.

We all came to terms with death on the anatomy table. It had ceased to be abstract. Death would always be in the passenger’s seat.

VI: Different Eyes, 5:45 am

My eyes were burning from formaldehyde. I walked out of the Anatomy lab into the spring night. The glowing dial on my watch read 5:45 am. The bag on my back hurt from its weight. It was like carrying a bruise. It seemed like it took a week to walk to my apartment.

Walking up the stairs, I saw an old lady with her dog. She greeted me with a sweet smile and a ‘Shalom’.

I didn’t know her name, or anything about her. She always smiled and said Shalom to me. She always wore makeup a little too heavily, and brightly colored outfits that didn’t seem to fit her age, but walked with a reverence that came with age. I knew nothing about her, but with my eyes I could look deep inside her. I could see the muscles moving over bone, under skin. I could see right down to the most molecular level, the DNA unwinding and transcribing RNA that will make proteins that make life.

I had come on a pilgrimage to this faraway place, this cradle of the Western world, because I had eyes but I could not see.

The masses only allow themselves to see the surface of things, without significance, without consequences. They will take out stock in a high-paying fund that supplies money for weapons-brokers that sell arms to Iraq. For them a hamburger is meat on a bun, not ground flesh of lipids and peptides filled with bacteria, toxins and multicellular parasites. A sweating homeless man is an annoying inconvenience, not an alcoholic with thiamine deficiency and kidney failure producing renal frost.

Physicians see the reality of death, people at their worst, the lowest of the amplitude in the rhythm of life. As student-physicians, we will be exposed to the heights and depths of the human condition. As scientists, we see the causes and results of each folly of life. Innocence is forever barred from us.

Like the microscope, I will see the most basic building blocks of life. I will penetrate the undefined arche split open, classified and quantified. Like the madman, I will break through that invisible veil that separates the artificial wholeness of the world to the pulsing pathogenic masses inside. Like the scalpel, I will slice open a curtain of carefully-studied ignorance and live in a world of practical realities which allow for no vanity or delusion.

I can’t close my eyes pried open with knowledge. I will be forever set apart as the gatekeeper of sickness and health, life and death, as the one who sees with different eyes.

-e2k

One percent

It’s Saturday night in San Francisco. I’m huddled into a doorway against the gentle rain, in the afterglow of a date, when a distinguished black man walks by me frenetically and says “Shit!”

“Sorry if I bothered you there,” he apologizes.

“No problem,” I mumble, still trying to hit the little tiny keys on my Iphone. Illyana is a gorgeous Russian Jew with a nervous lip tic and red scarf. We drank Moroccan tea for eight friggin dollars a cup, stared into each other’s eyes and tried to pretend we didn’t meet on an internet dating site. I look good in my suit jacket and black sneakers, a dot-com dress-casual clone, but apparently not good enough for a post-date kiss.

[[Illyana, had a great time. You are beautiful and charming, and I hope to meet with you again.]]

The tea has an aftertaste of ash. The sky is wet iron, rusted yellow from the reflected lights of San Francisco. Rain patters the concrete, nips at the hem of my bluejeans.

“Listen, sir, perhaps you can help me out,” he says. “My name is Roland Chase. I’m from Burbank. I was driving up the coast when I was carjacked. They took my wallet, man.”

Up close I can see that his salt-and-pepper beard is shaved very close. Clean leather shoes, but a cheap watch. Drier than one would expect for someone that had been carjacked in the rain.

There is power in details.

Before I moved to San Francisco, I was a medical professor in Brooklyn. I used to hold court in my ER, surrounded by medical students. Every patient was a learning opportunity. Mr. Johnson had eyes like my well-dressed supplicant. He was a morbidly obese man. He proclaimed to be allergic to nitroglycerin, which medicine for the heart, and the only medicine that would relieve his pain was morphine. What about the EKG, I asked?

The EKG is normal, a student told me. Her short white coat is pressed. She smells like Ivory soap and textbooks.

And the intervals? I ask sagely. No one ever looks at the intervals on the EKG.

The intervals are the distances between peaks. When you’re hiking, no one ever talks about how long it takes to get to the mountain, but it’s all part of the journey.

“Listen, I’m not a bum, I’m a real estate broker, but I lost everything,” Chase says. “My wife and kids are in the car waiting for me. I can give you my watch as a deposit…”

I never give money to people on the street. Most of them use it for drugs, not food or shelter. I might as well give it directly to their dealer.

My phone blings a text.

[[Had a great time. Loved hearing about your adventures in Thailand, and your views on stem cells. Next time I can show you the stairways of San Francisco – Illyana]]

Ah, Illyana. Beautiful, educated, stylish. Snobby, priviledged, elitist. Potential but fraught with complications. Maybe fifty percent likely that I'll get another date, 25% chance that we'll actually start dating. What's the chance that she's the one?

I want to text her back, something witty and seductive, but the man’s need is burning in front of me. I can see despite his dark skin, his lips are white and trembling.

“I called the CHP and they won’t help me. It’s only 12.87 for a can of gas…”

I’m pretty sure I’m being hustled. He starts laying it on thick, about how his wife or kids are in the car. I must seem like another kid on the town with more money than sense. I wish I had the grey hair to match my almost-forty years of life and centuries of cynicism. Clouds pout overhead.

80% chance of downpour. 90% chance of scam.

I’ve lost a lot of patience for street people, and I’ve lost a lot of patients in the ER. I’ve worked in the worst neighborhoods of South Central LA, Philly, and Brooklyn. Sometimes they’d just bring dead people in, all grey and blue and colors that people shouldn’t be, and I’d pump on their chest for awhile and try to bring them back. I’d juice them with adrenaline, shock them with electricity, pump them full of saline and and plasma and blood, even cut open their chests to squeeze their hearts back to life.

Dead stays dead. When you don’t take care of your diabetes or your high blood pressure, you’re asking for reprisals. Crack cocaine, heroin and Mad Dog don’t make for good bedfellows. Dead stays dead.

With every death, I lost ground. I lose heart. I lose strength.

But I never lose kids, I used to say. No kids die in my emergency room. I had been beaten down, but I had drawn a line in the sand.

Baby Jessica was only eleven days old. She was tiny, small even for a newborn. I’ve eaten bigger burritos. Her mother said she wasn’t sleeping well. Her skin was grey and her arms lay limp at her sides, but she was still breathing.

We took her to the resuscitation room. We put a tube down her tiny throat and pumped in oxygen. We gave her saline and sugar, fluids and antibiotics.

We worked her for six hours.

She died at twelve days old. The intensive care pediatrician, a tiny little woman that could have been anyone’s mom, said I didn’t have a chance. One percent at best.

“Sir, can you just help me out with a little something….” Chase pleaded with me, pulling at the sleeves of his coat like a junkie.

One percent.

I was in my final year of residency. I hated medicine. I hated the hours and I hated pumping on dead people and I hated trying to take care of idiots that didn’t care for themselves.

They paramedics rolled her in, while she flailed in the throes of a seizure. She had just had a baby six weeks earlier, and her sister, stained with tears, told me she had been feeling depressed since then. She writhed around the stretcher, and the worst thing was none of us knew why. We pumped her full of sedatives but kept thrashing. Her blood pressure falling. Her brain was frying in her skull.

The bumps and lines of the EKG seemed like a trivial detail, but something was off. The QT interval was too long. Consistent with tricyclic antidepressant overdose. One of the most dangerous manmade toxins, caused unending seizures, a drop in blood pressure, and death. Turns your blood into acid. I picked up an enormous syringe of sodium bicarbonate. Baking soda in water. It is the only antidote.

My attending physician, an insightful man with a child’s face and a shock of grey hair, shrugged his shoulders. He had seen too many grey and blue bodies, grasped at too many straws, to gain any hope. I saw my chance and took it.

She woke up three days later, and admitted she had stolen the tricyclics from her brother. I watched her take the first steps of her new life. “My legs hurt,” she said. “Can I have a pain pill?” I guess I expected gratitude.

Every year on Christmas eve, I toast to myself that there is one less orphan in the world, one more mother at Christmas.

Yesterday I saw a gallon of blood drain out onto my shoes while I struggled to keep a man alive after he flew off his motorcycle on the freeway. At seventy miles an hour, asphalt is like a grinder. I still scream at them “Don’t you die on me!” and yet they still do. Even children.

I handed twenty dollars to my Mr. Ronald Chase, or whatever his name was. He who rushed off, his heels clapping wet pavement. Ninety-nine percent likely he was off to buy a 40 of Budweiser, crack or black tar heroin or whatever.

But maybe, just maybe, he would be filling his gascan and rescuing his family from a dark street on a rainy night. Maybe I’d get a second date with Illyana, and a third and a fourth, and maybe we’d fall in love and have kids and hold hands when we’re seventy.

I have to believe in my one percent.

One morning in Barcelona

“Eric, no puede dejar su bici aqui!” I hear, barely conscious. Rinaldo, my diminuative landlord, is tromping around my little flat having a hissy fit about the bike I bought yesterday. I pull the blankets over my head and hope he will go away. Only three days ago I was banging out overnight ER shifts in the hole known as Newburgh.

It has to be early, right? I think I was drinking last night. There’s light outside. My watch says 11 am. My Spanish class starts in two hours. Oh, yes, I was in the bar. Gran Foc, just off Plaza Catalunia, burnished brass and crushed red velvet. Antony was playing the trombone, and Martin was on the guitar.

My housemate, Berta, walks into my bedroom. She’s a German girl here in Barcelona studying in the university. “Don’t worry, he’ll get over it. Want some breakfast? I’m making tea.” She disappears into the kitchen, only a few steps from my bed.

Ugh.

Lessons learned from the sabre-toothed squirrel

Complete and total dedication to a task, with no thought of danger or self. Utter satori of purpose.

I have much to learn from the saber-tooth squirrel.