MINDFUL(L)

Mindful(I)-Jodi

By: Jodie (c2020), Photo By: Jodie (c2020)

 

The sign on the door reads,

“Mindfulness Course.”

My preceptor waves goodbye.

I walk inside.

 

One, two, three, four – four participants and a bearded therapist.

I know their backstories, these four strangers.

I begin to try matching files to faces.

Before I can complete my task, the request comes-

“Close your eyes. Focus on the breath.”

 

In… Out…

In… Out…

Cool… Warm…

Nostril… Tongue…

Chest Falling,

Abdomen Filling,

Noise Humming- Noise humming?

What is that noise I hear?

I cannot turn my ears off; they betray my mindful intent.

My thoughts are drawn out into the room,

In search of the noisy culprit.

Huummmm – Whoosh. Huummmm – Whoosh.

“What makes this jaunting sound?” I wonder,

Soft purring, punctuated with satisfying bursts of air-

 

Woops, I notice my distraction.

“Come on mind,” I tug it back to being.

Moments pass, Solitude, Solitude…

 

We wake up.

Back to solving my mystery.

Scanning the faces of my companions,

Seeking the source of the humming,

I find it.

I find her.

Black box, whirring, spurting,

Sitting beside her feet.

Long tube, clear plastic,

Slinking up across her lap,

Wrapping gently behind her ears,

And coming to rest just beneath her nose.

It sends oxygen whooshing into her nares.

Huummmm – Whoosh.

 

Now, who is the woman behind the machine?

One, two, three, four – She must be Stage 4.

I remember the file now.

Her pale skin and hollow cheeks tell the story.

Her bright eyes and astute words tell another:

 

“In some ways I’m ready to die,” she offers,

“And in some ways I’m not.

Because I know that things will carry on without me.”

“Like this course,” her friend chimes in.

“We’ll be here every Monday.”

“Yes,” she laughs, “Even after I’m dead.”

“Actually,” she interjects, “I’ll be here either way.”

 

A hand reaches out to wrap around,

Her long and boney fingers.

The hand belongs to a young woman,

Rosy face shaded beneath a ball cap.

As she turns her head towards mine,

My breath and eyes both catch-

As the pink ribbon tacked on to her white hat,

Comes starkly into view.

Could this be, number two?

The second stage 4 participant?

My mind wrestles to reconcile the record with her youth.

 

“I am ready too, but he is not,” she points across the table.

Stoic man, downcast eyes, participant #3.

A backstage figure begrudgingly yanked into the spotlight.

Father-daughter,

Wounded-wounding,

A duo desperate to heal each other,

Neither knowing how.

Fears fall on cowering ears,

Until the weight becomes too much,

And we turn again to practice.

 

And so it goes for the remainder of the meeting.

Breathing, calmness, stillness, quiet,

Then we join together,

Voices layer, slowly, faster,

Adding burden to the bars on which our weariness rests.

Comfort is tossed across the table,

Hearts unloaded, piling up within the space between us.

Cancer, pain, depression, shame,

It’s all laid out for viewing,

To which the therapist calms the swells,

With words of meditation.

 

 

“Focus on the breath,” he says,

“As it moves between your lips.”

But I focus instead on the single tear,

Slipping down my cheek.

 

“So much suffering,” number four,

Whispers between our reprises,

The therapist points out simple math,

“Suffering = Pain x Resistance”

None of us had learned this equation,

In all of our education.

He instructs, “Be with the pain,

Accept it in its fullness.”

He’s giving us the tools we need,

To complete the calculation.

 

Breathe in, Breathe out,

Four strangers sit around me.

In the stillness of my practice,

Joanie’s tank seems louder,

Making salient the bodily function that,

Occupies our attention.

 

Mind full, Mindful,

Mind full, Mindful,

The session’s hour passes.

 

The therapist makes a closing remark,

As we gather our belongings,

“This course has morphed into something different,

Than I originally imagined.

It seems that I forgot about,

The lives that drove you here in the first place.”

 

Group, palliative, family therapy,

The chameleon of Mindfulness courses.

We will gather again a week from now,

In all our states of being.

RPP Adaptation – MF1

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By Anonymous. Photograph by Paul Morris (@oldskool2016).

During the year that I worked, I had a few days off here and there due to the structure of my contract. I volunteered at a hospital, with the knowledge that I won’t be able to spend as much unfettered time with patients as a medical student, and eventually, as a physician. There is one patient who will stay with me for a long time to come. She was not the most pleasant patient to be with, and yet was the neediest of them all. I probably spent the most time with her out of all the other patients on the ward, and yet I only have one good memory of Josie. But I have many bad ones. On multiple occasions, she would cry and tell me that she did not want to die on the ward. She would alternatively be sullen and wish for death under her breath. I do not really have the words to describe what it was like to be in those moments. Even now, I have trouble thinking about it – a lump forms in my throat which refuses to go away until I shift my thoughts elsewhere. But in those moments, I would always attempt to comfort her, copying her mother in telling her that everything will be alright, that everything will work out fine, and that she will be able to leave the ward soon. But that changed the day that I took a look at the information that was provided to volunteers by the staff. I was told by the volunteer coordinator to read her file, given the amount of time that I spent with Josie. I found out a lot of things about her that I wish I hadn’t.

Among all the things that I found out about her, I was explicitly made aware of her prognosis, given her comorbidities. This was the summer prior to my entrance to medical school, and I had two degrees related to the biological sciences, as well as having spent a lot of time shadowing physicians so I had a relatively good grasp of how much trouble she was in. In reading the file, I felt like I was cheated of my plausible deniability; I realized in the moment how the weight of this knowledge would change our relationship. No longer could I look Josie in the eye and give her my full support, encouragement, and belief that she would one day be able to leave the ward of her own free will. Because I didn’t believe that anymore. If I were to tell her the same things that I used to, I would be a liar. I would have broken the trust that existed between the two of us (in my mind). But there was also no doubt in my mind that this was what Josie needed some days – someone to tell her that everything would be alright no matter how bleak her day had been. Someone who could provide her with unbridled hope and optimism when she had none to draw upon for herself. I was angry that the volunteer coordinator had taken that from me. That I could no longer be that person for Josie.

I had had my reservations about the amount of patient information that the volunteers were able to access for some time, but I finally mentioned to the volunteer coordinator after that day that I did not know how comfortable the other volunteers were with Josie given how much they knew about her. Some of them were in high school on their co-op placements, some just starting out in their university careers. The coordinator’s response was that she had asked them and that they said that they felt fine. I was slightly surprised and expressed mild dismay on the outside, but internally, I was apocalyptic. These were some of the things running through my head: How would the students know what they were okay with and what they were not? Many of them haven’t even developed emotionally enough to understand what they were feeling. In addition, it is such a coveted thing to volunteer in a hospital with so much patient contact at such a young age – would any of them ever jeopardize something like that by stepping slightly out of line in questioning the appropriateness of their duties? The power differentials were huge in my mind. And Josie is a complicated patient, even beyond the multiple comorbidities that she has. Josie’s suicidal ideations were nothing to scoff at – she was on suicide alert and not allowed to be provided with any vaguely sharp objects. Did any of these young men and women even understand the complete implications of someone attempting to take their own life?

And today, after relaying some of these thoughts out loud in professional competencies, I now realize that not everyone sees patients in this manner or is affected this deeply. I now realize that perhaps the volunteer coordinator’s response was appropriate given her knowledge and understanding of her volunteers. One of my longitudinal facilitators mentioned (correctly, in my opinion) that perhaps I may have been projecting my own feelings and concerns onto the younger volunteers – and I now realize that this is not the first time I’ve done that. After a tutorial session, I made the remark that everything that we’ve been studying so far eventually leads to death – we are essentially studying death. How to delay it, or how to make it as comfortable a process as possible. This was right after we finished the case with Teresa in respirology (aspiration of vomit, poorly controlled diabetes, difficult psychosocial situation, three days of vomiting) – the first case in my opinion where the outcome of death was a certainty. And no one in my tutorial reacted visibly to that statement. I understand now that I was projecting a bit – everyone deals with patients, medicine, and loss in their own way, and it would be extremely incorrect of me to judge my colleagues. Perhaps they felt a massive amount of internal turmoil that they did not have words for. Perhaps behind their blank (and tired) faces they felt as sharp a sadness as I did. Or perhaps I am just emotionally ‘thin’ and as such am easily distressed.

Unfortunately, in our line of work, it’s impossible to avoid loss. Even the ‘safest’ and ‘most insulated’ specialist will encounter death in one manner or another. I’ve realized that I need to figure out which ‘losses’ to carry with me as part of my professional baggage and which I need to let go for my sake and theirs. I wish I can share this realization that I’ve come to with my colleagues – but I’m afraid that some things are best learned through experience. I think I experienced loss in leaving Josie and that this loss accentuated this realization. I left her, saying that we’ll see each other soon. But even as I said that, I was pretty sure that I wouldn’t see her again at the end of my medical training.

This is my fifth week of medical school. I am learning to reexamine why I have chosen medicine, especially as it pertains to which specialty I might wish to pursue. I care about my patients – you can tell by the fact that I choose to use the pronoun ‘my’, even though I have never admitted a single patient into a hospital – nor do I have a single patient on my roster. And yet I already think of them as ‘mine’. I hope I do not come across as pretentious in saying so. This is just how I feel. I also am attracted to the intellectual aspect of medicine. But the deep yearning underneath is something I am afraid of. I am afraid that I have chosen medicine because of my attraction to loss, pain, and misery. I am reminded of a quote in the foreword of Cutting for Stone by Abraham Verghese.

“Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.”

In the context of this quote, I am afraid of what this means about me. That I am looking to heal the most broken of people. That I am attracted to cases of hopeless neuro-pathology such as Parkinson’s Disease. That I wonder on a regular basis about the future of palliative care. And serious cases of heart disorders. Or patients who have the bleakest of hopes like Josie. Because I kept on coming back and visiting her even after I realized her prognosis. What does this say about me if Verghese is correct in stating that people become physicians in the hope of healing themselves? What does this mean if my natural inclination is to chase after the hopeless, the lost, and the worse off of humanity? Is it Christ’s nature in me compelling me to chase after the lost, the weary and heavy-laden and provide them with rest? Or is it indicative of a need to dive deep into myself to find what it is that needs to be healed lest it be too late and I end up irreversibly damaging myself and my future patients? Perhaps time will tell. But more likely than not, I do not think I will obtain the answer in time to do anything about it. In my opinion, that is the course of most of life’s most vexing questions. They are vexing, and will remain so until one day they no longer bother you. And in the moment that you learn to let it go, the answer will be stumbled upon – and yet the answer is no longer useful and will be entirely inconsequential given the way that your life has run its course.

A Match

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By Nikki Reklitis (c2020). Photograph by Soroush Karimi (@soroushkarimi).

“Please be aware that most stem cell donors and patients never meet.”

     The Guide for Potential Unrelated Donors, OneMatch Stem Cell and Marrow Network. Canadian Blood Services.

     There’s a message on the machine when I get home from work. A red and flashing number 1. A rainy Thursday in May. I slide the balcony door open to cool, wet air. Still in my work clothes, hospital dress code. I take a deep breath. Across the apartment building’s parking lot, on the front lawn of Canterbury High School, the maples are wet and shining.

     The starburst of self-doubt explodes inside my chest. Again. Can I manage this new job? Do it well? Surely the Director doesn’t like me. The heat radiates to my throat. My stomach fills with churning, unfamiliar waters. A wave of awkward and then of clumsy and then of side-glances from strangers. Undertows of I don’t know what I’m talking about. I’m nauseous.

     In my galley kitchen, I poach an egg. A bowl of chick peas. Golden olive oil. Fresh parsley, chopped. I stand at the counter and eat. I imagine my two year old at Daddy’s for supper. Is she watching TV?  What did he cook for her? Did he help her wash her hands?

     We’ve lived in this apartment for a year. I like that she visits Daddy, but prefer her here. Where I can see her. Where I can pull her onto my lap, twirl her curly hair around a finger, kiss her neck. I lull myself with a song, a ballad, an old cantada about home. Here we are. There is no more pleading or wondering. The missed calls, the closed doors, the silence, the brick wall, the tension in his face: all behind us. I take a sip of Shiraz.

     The message. I listen to it twice, straining to hear. A young man speaks English from somewhere far away. Static. Dead air. The March of Dimes? Scotia Bank? I can’t make out the words. I try again. I jot down a 1-800 number and a question mark. I leave the note on the dining room table. I delete the message.

     I slip off my tweed pants, my pleated blouse. The sound of rushing bath water is like pulling curtains on a noonday sun. I’ve saved this jasmine blossom bath bomb since the weekend. Since dishes and laundry and swimming lessons and story time. I float and suspend in the soaker tub. I watch the green and pink tornado swirl above my breasts. It smells like honey, like mimosa.

     I close my eyes. I don’t know it yet but that blinking symbol, that distorted voice played back: this is the first sign of you. A far-away, barely audible bell sound. I don’t know it yet but there it is, your beating heart.

     I get the call that September, on a bright Saturday afternoon. I sit at the Wild Oat, a cafe in the Glebe. I watch people walking by: running strollers, re-usable shopping bags, light jackets. I shake cinnamon over my latte. I wait for a pedicure appointment at a spa nearby. I have time to take the call. I’m admiring the archway to The Fourth Avenue Baptist Church across the street when my mobile rings.

     A representative from the OneMatch Stem Cell and Marrow Network. A cheek swab I sealed in a Ziplock bag years ago is a match. The closest match among others. A possibly perfect match.

     You need a stem cell transplant. Likely bone marrow, maybe peripheral blood. More tests to be run. Tests for infectious diseases, confirmatory typing.

     I take a sip from my cup.

     A case manager from the Canadian Blood Services office in Ottawa will contact me for an information session, an interview, further assessment. She will coordinate a work-up, more blood work, a physical exam, and an ECG.

     Do I wish to proceed?

I read the sign across the street:
Sunday Service.
10:00 am.
Sermon: Give It Away!
All Are Welcome.

     I see a baby in a stroller with a string of brightly painted wood shapes strung around its neck. A rubber soother in its mouth.

     I hear the clink of forks on dishes, running water.

     I lick sugar off of my top lip.

     “Yes,” I manage. “I would like to proceed”

     I finish the call and for the first time, I come to know of you. You spring forward. I sit in the cafe and imagine you. There you are, hazy but materializing on the bench across the street, by the bus stop. Waiting. Waiting for me to finish the call. Waiting while I gather my bag. Waiting while I get my coat on.

     An hour later, on a leather throne high up, under soft lights, there are hushed voices. My feet are bare and soaking in a milky, oily bath. I talk to the woman sitting in front of me about new jobs, her dog, my daughter, break-ups, the weather.

     I read and re-read the same sentence in a novel, over again. I pick a polish the colour of Abrusco grapes, of a Cabernet franc, of blood. I close my eyes and invent you. My match. My best match. You’re a formation at this point. An outline. A frame. I can’t make out your details. You’re a smoky, opaque grey.

     I wonder:

               Where do you live?

               What part of the world?

               What do you do on a Saturday afternoon?

               What do you take in your coffee?

               Who are you?

               Person waiting.

     One month later, I move into my new home. When I first saw it with the realtor, empty and sparkling, it was like I’d been there before. I fell in love with the crab apple tree in the front yard, with the fireplace, the lush front garden, the bay window, the space on the hardwood floor for my daughter to fill.

     On a weekend that October, I pack up our belongings. Weeks have passed since the call in the cafe. As I lift boxes I wonder if there is a mistake, a mismatch, a complication. My family members help me unpack dishes, sweep floors, make food. My daughter tantrums. I fill out forms.

     The very next day, a busy Monday at work, the Ottawa office calls. The date of the donation is set. A bone marrow extraction. December 18, 2014. A Thursday. Day surgery.

     The end of this call is a careful review of a form that will be couriered to me in the next 24 hours. Once signed, a commitment to donate. I learn that it will trigger a series of procedures for you. That you will undergo high-dose chemotherapy and/or radiation in preparation to receive my stem cells. I understand that if I change my mind past this point, without a transplant, you will not survive.

     The call ends. I return to my work without hesitation. I don’t waver or pause. I’m focused, energized. I lock my office door and stop to think of you.

     I consider:

               What did your first home look like?

               Do you live there still?

               Who lives there with you?

               Who do you think about before you fall asleep at night?

On my drive home, the doubts in my mind are many: how I’m doing as a parent, can I write anything good, my job security, whether I’ll move on to love someone else. They are not about you or about this. Of this I’m certain. It’s the one thing I know I can do.

     On December 12th, in the early morning, I visit the Pre-Admission Unit at the General hospital for pre-operative teaching and an anesthesia assessment. The anesthesia resident is tall and thick and handsome with curly dark brown hair, sea-blue eyes and a Scottish accent.  I want to pet and curl up into his shawl cardigan sweater, an oatmeal-coloured wool with suede elbow patches. I want to fall back into the water of his warm voice, his gentle encouraging tones. I ask him if he’ll be attending my surgery, not only because he is beautiful but because he is funny and kind.

     After an exam he tells me that I have a “reassuring airway”. I’m flattered. As if he’s told me I’m ravishing, sexy, a fox.

     “Thank you,” I say.

     I’m happy he’s happy. For the first time in years I feel that dancer twirl and somersault on my chest. That familiar choreography, those footprints. The music in my ears turns up a tiny bit: a sultry tango, a funky bass, even some R & B.

     I tuck my hair behind an ear as he marvels at the amount of marrow that will be extracted: one litre. A Pepsi bottle. He asks me if I’m aware of this, if it’s something I’ve consented to.

     “Mmm, hmm,” I say.

     The dancer undulates down my belly and on to my lap. I fold my hands there and focus. I keep myself from smiling, relieved to be flush again, after all this time. I’m happy about this quickening, a desire still alive and crackling in my fingers, down my legs.

     The assessment is complete and I have an hour before work starts. I stop at the Second Cup cafe at the bottom of the escalators. I order a cappuccino and flirt with the young barista. I sit at a table and linger over the cloudy creaminess. The line-up around me grows: white coats, warm jackets, scrubs and suits. I wonder if you’re one of them, looking at your phone, ordering a drink, waiting for a friend. I project you into the chair across from mine: female with straight brown hair. Your blazer is draped over your shoulders. Your fingers are curled around your cup, nails shaped and coloured perfectly in a mulberry hue.  My imaginary friend.

In my mind’s eye, I ask you,

     Are you dating anyone?

     How do you meet new people?

     Ever go online?

     Do you prefer it when things move fast? or slow?

     Think you ever would again?

     It’s five minutes past eight in the morning on the day of the surgery. I’m wheeled on a gurney to the hallway outside the operating room. I’m shaky. The porter leaves me there. A nurse from the BMT team comes down the hall to greet me. She asks a few final questions. A repeat of the past assessments already conducted. Questions about risky behaviour and infectious disease. This time there is a new and unexpected query.

     “Have you ever had sex with someone from Africa?”

     I pause. “Yes.” My daughter’s father, although 22 years in Canada, is of Gabonese origin. Africa.

     She stops the interview, looks down at her clipboard. I swallow, worried that this is grounds to cancel the extraction. Worried that you won’t survive. We are both confused.

     “Have you not been asked this question before?”

     “No.”

     We continue. With her clipboard under an arm she pushes me through the theatre doors.

     Have you ever had sex with someone from Africa?

     I close my eyes against the bright overhead lights and there he is. There he still is. There are his eyes, large and round. His lips. The crease in his brow. His shapely arms. His muscular thighs in soccer shorts. His smile. There it is. It’s beautiful.

     I am on my back on the operating table. To my right is a nurse. His eyes are green and bright over his mask. He wears a colourful cap over his hair. He speaks to me directly, touches my arm, tells me about what’s next. Directly in front of me are three other nurses. They are silent, masked, far back. I don’t know why they are there. To my left, behind me, is the anesthesiologist and his resident. They introduce themselves. They set up an IV in my left arm and I start to sing Born To Run. To myself, silently. Bruce Springsteen. I know all the words.

     To my right, there are two surgeons that I recognize from past clinic appointments. I can tell them apart despite their gowns and masks. One has smiling eyes. One is taller. The taller one speaks. An introduction, an opening. He reviews the procedure about to take place. I take a deep breath. He is like a conductor, his orchestra behind him. He is like a football coach introducing an important play, a strategy. Everyone there pays careful attention. That’s when I zone him out.

     I take a deep breath and there is my daughter. I project her onto the ceiling above me. There she is in her navy blue bathing suit. A one-piece with white polka dots. Her lustrous hair has expanded, engorged into a wet crown of curls. She’s wearing a royal blue life jacket. Her thin and muscular legs. Barefoot. She’s standing on a mini diving board. Her swimming instructor Jeff is treading water in the pool beneath her, ready to catch her. She looks up at me in the stands and waves, smiling. “Hi Mommy! Look at me!” The oxygen mask is on my face. The nurse counts my breaths. I close my eyes. She jumps in the water.

     I open my eyes in the recovery room and hear a nurse to my left telling a story. Her daughter has a Christmas concert this afternoon, at school. She’s arranged with the clinical lead to end her shift early so that she can be there for it, hear her daughter sing, take pictures.

     I find it difficult to talk, to smile just a bit, to communicate with her. I try to use my eyes, my hands. Everything is heavy, frozen. Something the weight of a basket of pears is sitting on my chest. I don’t like it. It feels like I can’t breathe. But I can. I know I can. So I focus on that: my breath and her story about the Christmas concert. I ask her about her daughter and try to tell her about mine. This is the first time I’ve found it difficult to smile, to nod, to make eye contact, to connect with someone I want to connect with. It’s like I’m under water. A wall of thick water between her and I.

     It’s the most afraid I’ve been this day. The effects of the anesthesia have tricked me. I believe I can’t breath, can’t talk, won’t make it back out to my daughter. I want to push through. But instead I focus on my breath and think of you, waiting. Somewhere.

     My father drives me home from the hospital. He is 79 and strong, tenacious, a bull. He stays and waits for me that day; he doesn’t eat lunch, he pushes me out to the car in a wheelchair.

     I recover in my parent’s home for longer than I expect to. Twenty-four hours turns into three days. My daughter stays with Daddy.

     My mother prepares yourvalakia, a traditional Greek meatball soup in a white lemon-egg broth. It’s hearty and fragrant. The iron-rich ground meat is held together with puffy white rice. There are flakes of parsley. I dip a hunk of baguette. I eat two bowls.

     I watch Greek satellite TV: black and white movies filled with music, Christmas cooking specials, bright and loud game shows, the news.

     There’s blood on the beige and brown velour couch I’m lying on. The one that has sat in the family room since I was in high school. I’m surprised to find the incisions on my lower back are bleeding. I’m embarrassed.

     I lie down on my front in a bedroom upstairs. My father removes my bandages, cleans the incisions, and applies fresh dressings. My father, almost 80, with a bottle of rubbing alcohol and cotton batten. My mother stands behind him with a towel, looking over his shoulder. I put my head down onto my arms and close my eyes. I think to myself: this is the last time that I’ll need them in this way. The last time I’ll be in their care recovering, dependent.

     I take my pain medication. Before I fall asleep in the twin bed, a small pull-string lamp to my side, I wonder about you: who is caring for you, who your parents are, if they are with you, standing over your bed, watching you sleep.

     On Christmas Day I spend four hours with my family. We eat around two rectangular tables covered in red and green cloth poinsettias. There are green salads with dried cranberries, lemon-roasted potatoes with oregano, a turkey. There is a large tray of moussaka, a bowl of rice pilau and platters of spanakopita and tiropita made by hand.

     We drink white wine and Dr Seuss’ How The Grinch Stole Christmas plays on the widescreen TV. My daughter runs around from chair to chair and lands on my brother-in-law Rocco’s lap. Her favourite, her crush. My father is jealous. There is Stella, my sister’s miniature schnauzer. My daughter eats feta cheese and Kalamata olives and bread rolls and nothing more.

     My nephew, visiting from BC, gets up for seconds and there is an empty chair. I imagine you there with us, sitting, listening to my brother talk about work, watching my sister make espresso at the stove in a Bialetti, meeting my niece’s teacup poodle.

     Later, you would join in on our Secret Santa gift exchange. You might sit beside my father and listen to stories about his doctor appointments. You would surely enjoy the dessert table. Maybe you wouldn’t like the noise, the children, the dogs, the loud voices, the Christmas movies in the backdrop. Or maybe you would.

     I dream. You and I sit across from each other at a walnut-brown harvest table. Everything around us is covered in snow, except the water. The Ottawa River flows beside us. We sit under a weeping willow tree near Mooney’s Bay beach. It’s winter but we are not cold. There are platters and plates of food. A feast. There is a mulberry coloured wine in a voluptuous crystal decanter. Two full and fat wine goblets. White linen napkins.

     The dream version of you is radiant, resplendent. You have thick, dark brown hair, a deep maroon pea coat. You use your hands when you speak, gesturing. You tell me stories about home, your family, the sea. We eat roasted eggplant and dip chunks of homemade bread into saucers of olive oil, hummus, baba ganoush.

     You pour us sparkling water and ask me about love, art, music. The dream-you has dark brown almond-shaped eyes, skin the colour of toffee. You are taller than I am, with long elegant fingers. Your legs are crossed under the table.

     We stab heavy silver forks into large bowls of green salad: mesclun, arugula, parsley, red cabbage, slices of leek and raspberries. We share a platter of cheeses, fat purple grapes and walnut halves. We lick our fingers and watch the ducks glide by on the still un-frozen water. The snow falls off the willow onto the table from time to time.

     I tell you stories about work, a crush, my ex. You suck on the pit of an olive and tell me about your mother, the neighbour you admire secretly, your dog.

     We watch kayaks glide along the river behind you. There is no one in them.

     We raise our glasses for a toast:

               To our health!

               Stin ygeia mas!

               Sante!

               To life.

     We pass between us a bowl of strawberries and wild blueberries and spoon clouds of whip cream from a frosted glass bowl. We eat the berries with our fingers. We look up at the Canada geese flying overhead and I ask you:

     “Was it painful? The transplant.”

     “No,” you reassure me.

     You pick a blueberry off of my plate.

     “Did it hurt?” you ask me. “The extraction.”

     “No!” I wipe a crumb off the table. “That was nothing.”

     The harder part was knowing but not knowing. The grey spot. The black hole. The soundproof wall of anonymity. The shapeless shape you took.

     “I wondered if you were OK,” I tell you in this dream. “If you were cold, alone, comforted or sad.”

     You smile and squeeze my hand near the end of this dream. You pour me another glass of wine. We sit and drink in silence as night falls on the water.

     At my parent’s home on New Year’s Day we cut into a vasilopita. A traditional New Year’s cake commemorating St Basil, the shape of a full moon. It’s a buttery, sweet white cake, orange-scented and dusted with powdered sugar.

     A slice is cut for every member of the family with a long serrated knife. There is a coin somewhere inside, a shiny piece of good fortune, ready to surprise us. To fill someone’s new year with luck and brightness.

     I pour myself a cup of coffee and break my slice in two. There it is. A silver coin wrapped in wax paper. It’s mine. I’m the lucky one. I smile and call out to my daughter.

Later at home, I wrap up the coin and my piece of vasilopita in layers of cellophane and foil. I put it in the freezer and we head upstairs for bath time.

     Two months later, on a cold and grey morning in March, a reminder pops up on the computer at work. I close my office door and call the Case Manager at Canadian Blood Services. I’m permitted to inquire about your well being. She answers the call on the third ring and I take a deep breath. You lived. The transplant itself was successful, she said.You lived for three months post-transplant, until recently, when your disease took you. You didn’t survive. I end the call and there is numbness. A tingling in my hands and feet. A stillness.

     That evening at home, at supper time, before I pick up my daughter, I pull out the piece of vasilopita and warm it in the oven. I set the table with some butter, a silver knife with a ceramic blue handle, two of my favourite dessert plates and mugs for tea. Two napkins.

     The piece is already in two. I eat my half of the sweet slice and wish you luck. I sip my black tea and toast the year ahead, grateful. For you, for the day, for my daughter. I drop a golden cube of sugar into the cup and imagine you, in the airy space. On the other side of the thin wall. I’m sorry. As I finish my slice, I’m sorry. As I sip the last sip I imagine you in the chair beside me: clear, defined, solid. There you are: you are you, you are me, you are anyone, you are everyone.

Dr.

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Written by Marina Wang (c2018). Photo by Terry Thach (c2019).

He called me “Dr.” I am no doctor. Did he not hear me introduce myself as just a medical student? I open his chart full of tabs and labels but to me it is an angry mess of half-filled forms. Drowning under drug names, I barely have the sense to register that his medication list is empty. In his EMR I am confronted by bricks of consult notes and attacked by numbers that jest at my incomprehension. I get lost within wards in the east that are labelled “South” and lock myself into a wandering-patient hallway.

He called me “Dr.” I am the furthest thing from being a doctor. Awkward silence fills the room as I struggle to remember my history questions. OPQRST. Options, plan, quarantine, reflux, steroids, treatment? “Is there pain?” I ask him as he wilts away hyperventilating and near tears. No shit: there’s pain. Good. No actually: Bad. I run out of questions, certain that I’ve forgotten all the important ones. Clumsy and sweaty, I pull out my stethoscope to save myself. I hear his heartbeat… or is it my own?

He called me “Dr.” I cannot be his doctor. I look on helplessly as he laments his story of the frightening anguish he feels. Why does it hurt so? I don’t know. I am useless- wishing I can just hold this poor soul and bless away this undiagnosed monster. But I have to listen to his lungs now. It’s part of the exam.. My eyes water as I help lift him up from the bed, trying not to let his wince bother me. No crackles or wheeze, normal bilateral lung sounds. He is so heavy. He is so weak.

He called me “Dr.” I wish I knew how to be his doctor. He looks at me and I look at him. Is he really the one feeling pain or is he just mirroring my own face full of misery and despair? I am full of guilt. Guilt for not remembering which opioid is dilaudid. Guilt for not being able to do something more for the pain. Guilt for not being able to even offer an explanation. But mostly, guilt for not being the doctor he deserves.

And yet, he called me “Dr.”  he needs me to be his doctor. There is no one else right now. No one but me. So I tell him what I know, even though what I know is nothing. In fact no one on the ward has figured out what is wrong with him yet. And at that he laughs, boasting that he’s given us a real good problem to solve. I smile. And then I laugh. And then I start to remember how to be a functioning human being again. The silence is gone, replaced by small-talk in the middle of the ER. We speak of his family, of his hobbies, of the strange circumstance that brought him to the bed in front of me.

Because he called me “Dr.” so let me be his doctor. Though I can’t write orders or sign scripts, I am certain that I have some responsibility to him now. I search his charts and reveal information previously hidden in a forest of paperclips. I start to paint the art of medicine and hum the tune of consult notes. And from somewhere I have mustered up the courage to acknowledge the unknowns and the sympathy to know when he cannot tolerate more testing. And I look to him and vow to us both that we’ll smile and laugh again soon.

He still calls me “Dr.”. He shakes my hand vigorously for the last time. Nonchalantly, he asks how my studies are going and I realize that he knew all along I was a medical student. But of course it didn’t matter to him. It occurs to me that this ought to make me nervous, but it doesn’t anymore. He jokes again about how much trouble he’s been and we laugh, real uninhibited laughter. Then he jumps off the bed, out the door, and into the car back home. And me, I return to the wards ready to face a new challenge, understanding that the learning will never stop.

And one day, I will be the Dr.

Comfort Measures

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Written by Sabrina Lue Tam (c2017).

From the moment we are born,
We are dying—
But it doesn’t seem to matter
Until someone gives us a reason to doubt
We will wake up tomorrow.

Then we are afraid to fall asleep,
Every blink feels like a kiss of lidocaine
(2%, with fear)
Are we still breathing? (For how long?)

In that moment, you want to remember their faces.
The ones whose names probably
Glitter gold in the adipose tissue cushioning your heart
You want the texture of their smiles etched
On the insides of your eyelids
So even if you don’t wake up
You won’t be alone.

“Don’t let me forget.
Don’t let me forget that until I die
I am still alive,
And I still love you—
Even then, I won’t stop loving you when my heart does.
I won’t stop, ever.”

Their names will be held tight
In the embrace of the crinkles by your eyes
When you laugh.
You keep laughing
So you will not let them go.

It will be hard for them, but
They will remember the sound of your voice, the
Warmth in your touch;
They will remember your name as a feeling of home
Not as a carving in stone
That cradles raindrops in its curves and lines
And reminds them that you may be gone now,
But you were here, and
You are loved.

Please, do not ask
How much time you have left.
Do not ask me to count your days,
To measure the number of kisses your lips still have,
The number of thank-yous that will go unsaid
The litres of forgiveness you need to pour before they
Sour into regret—

If you want to share your
Could have’s and would have’s and should have’s, I
Will carry them as scars, like
Childhood lessons learned with sutures and skinned knees.

No, instead,

We shall make them will be’s and have been’s, and
If you don’t wake up in the morning,
I am here.
You will not be alone.

On Dying

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Written by Nikita Arora (c2018). Photograph by Giuliana Guarna (c2019).

A university student takes a picture in front of the fall foliage with a peace sign and a gleeful smile during his weekend hike
Depending on what colour the leaves are,
if they’re on the trees or on the ground
how long they’ve been there
His picture speaks of the dying process
              Of death
Of dead.

Autumn teaches us about death.

Autumn teaches us that death is every horror that we expected
Cold and slicing wind across the face
A sun so distant, it doesn’t feel warm even when it’s unobstructed by clouds
A darkness deep and prolonged despite efforts to counteract it *I’m talking about you, daylight savings*
Leaving everything bare and lifeless
And deafeningly silent

Autumn teaches us that death is beautiful
That death can be celebrated
Spattered with the artist’s strokes of red, gold and orange
An explosion of a thousand hues overlaid on each other
The leaves carelessly twirling down against the backdrop blue of the sky
The sound of a child jumping into a pile of leaves
The bickering of the geese bidding us farewell, until next time
The mischievous swaying dance of naked trees

Autumn teaches us that death is a part of the journey
That the fear and anticipation of death doesn’t change when it comes
It comes at different times for all – always unexpected
And so, even as they lose their photosynthetic green
And they know what is about to happen next
Because years of growth rings have brought them death upon death
Instead of dwelling on grief
The trees stand solemnly by
Meeting death with a sense of familiarity, with open arms
Deciduous not envious of evergreen
Because each chooses it own fate – as is right for each
And dust to dust is ultimately for all.

So maybe if there was one goddamn window in this hospital
We could look out to autumn to teach us
How to welcome death like an old friend
How to see its beauty
How to celebrate it
Even though it is indeed every horror we expected
In the end.

Order

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Written by anonymous. Photograph by Giuliana Guarna (c2019).

What is it about a messy house
What is it about skipping the gym for one day
What is it about not talking to him at the time of night you usually talk to him
What is it about missing lunch yesterday
What is it about not showering in the morning
What is it about running out of body wash
What is it about seeing one fruit fly meander out of the garbage can
What is it about missing your pill last night
What is it about one thing going wrong

That unwinds the tangled ball of thread that is your life
That pushes you over the tipping point
You didn’t even know you were at
That nudges you in the direction of hot mess
When you were just putting together a CV that said I’ve got my life together or at least I have high-functioning depression

When I’m at the clinic, I tell women that sleeping too much can mean depression
With the assumption that that’s not me – I sleep the societally acceptable amount of hours
Bouncing between the limits like some 90’s video game you played on your cell phone
But when I wake up at 5 PM
              Pressing snooze the 20th time since 7 AM
My muscles aching, rebelling against the stillness
My stomach growling like a dragon that needs to be fed
My brain exhausted from trying to wake me
The first thought I have is I’m sleeping too much
And of course, I know what that means
And of course, I can’t face it
And of course, I fall back asleep.

Something about order makes me feel like those days are just bad days
That the DSM is a game at which I’m winning
              Even as it tries to catch up – from 3, to 4, to V
Order makes me think I can handle it, this life thing
Order gives me the illusion of control,
              Even though of course, I’m never in control.
Even though of course, I’m never winning.
Even though of course, it isn’t just one bad day.