Declarations
Some people are better than others at converting their fear of all things medical into attempts to maintain some semblance of control over their lives.

From under a thinning mane of bottled red,
she offers declarations cloaked as questions:
"I'm going home tomorrow, aren't I?"
She grows whimsy into a fantasy challenge,
blurring the harsh lines we impose on her:
"I'm going skiing this winter, aren't I?"
She lives by herself, except for those who cook for her
and pick her up when she falls:
"The next time they're just going to pick me up, aren't they?"
She keeps weighing less
as we push Instant Breakfasts on her:
"You know I don't like that stuff, don't you?"
She denies the air-hunger she knows too well
and aerates her dyed strands with expensive oxygen:
"I'm fine and I don't need this, do I?"
She attempts to convince us that two heart valves
came with a promise, a guarantee:
"That surgeon said my heart would be perfect, now didn't he?"
She shoos away her skeptical friend
with an anemic, grizzled finger:
"I'm just fine now, aren't I?"

And who's to argue?

Hot Ticket
There's a tendency to think of aging, especially the dementia that may accompany it, as bringing an end to thought and feeling. But, in fact, it's just another chapter—and often a very vibrant part of the story.

She was opinionated.
Whether it was loving you or hating him,
she did it good.
She wore a long fur coat,
and the hell with those who didn't like it.
She had the brightest of bright red lipstick,
and left it on any cheek she damn well pleased.
She looked like she'd been a hot ticket,
and she acted like she knew you knew it.
She was just a tad paranoid,
but her imaginary plots were sure intriguing.
She didn't much understand anticoagulation
and took her pills pretty much when she wanted to.
She didn't like to talk about cancer—
she'd had two, they were gone, and there was no sense looking.
She said she was an old lady,
and she'd die any damn way she wanted to.
And she did.

And her paranoid dementia
didn't harm the truth when she said,
"I love you."

Hemiparesis
Physicians are scientists—we like to understand why things happen. But often we don't, and that makes disease so much more frightening. (Hemiparesis is a weakness on one side of the body—a condition that is sometimes, though not always, caused by a stroke.)

A lean gentleman with the telltale gait of left hemiparesis—
a hitch in his giddyup, as the locals say—
comes in to talk about his pile of meds.
He's knowledgeable and direct, traits expected
from a retired engineer and military man.
He does two hours of PT three days a week, walks a mile the
    other days.
He tells me he and his wife were hikers, skiers, and more.
He doesn't say, but I know they're good people.

I suggest Tai Chi and stopping some of his meds.
He agrees. We wish each other well.

Stupid, stupid clot.
He had no risk factors,
no more than me.

Smiling
Courage does not evidence itself only on battlefields. Sometimes it sneaks up on you when you least suspect it—such as during a "routine" office visit. ("CA" is medical shorthand for cancer.)

A thirty-eight-year-old woman comes in for a physical.
I ask how she is; she responds, "Pretty good."
Her chart reeks of oncology notes, CT scans,
radiotherapy reports, and chemo labs.
The smell leads to colon CA (familial polyposis),
which decided to move on to her liver, her lung,
and her brain—each time to be caught by tumor police
with knives and cautery and scars that didn't hurt.
The devious cells took up in her bones,
where it hurts like the other places didn't,
so the woman doctor radiated her hip and her shoulder.
And it feels better, and some hydromorphone goes further.
She says she really has no other complaints,
and she's actually okay about her husband leaving recently
'cause she realizes she can't take care of him, too.
She's upbeat, courageous, and has an infectious smile.
There's a good faith going on, but it seems more than that:
this person seems to have really climbed her mountain,

Taking the time to consider—
that's all, just consider
the microvascular injury pattern,
the burst endothelium . . .

when most of us complain about our hills.
I ask her if she writes any thoughts down.
She says no, but she has been considering it.
She seems to have a lot to offer, so I encourage her
to write stories, a diary, anything.
She says, "Okay, I'll do it for my seven-year-old daughter.
I want her to know who I am—or who I was."

Then she gives me that smile
and actually means it.

A New Hampshire Couple
There are some people, some situations, some lives where words just get in the way.

They come in together—
as New Hampshire a couple
as the law will allow.
Been married over seventy years.
Some would say they're a right cute pair.
They're lean, move briskly,
and spare their words.
He's always got a story,
she's always got a smile.
Sooner or later he usually shares his "secret" with me—
"Blackstrap molasses, Doc."
And she demurely whispers
that the secret of their longevity
is that he can't hear.

Taking the Time
In medicine, time is frequently one's enemy. For the physician, there is never enough time to do everything you want to do, need to do, must do. But somehow, you have to find the time.

Taking the time to think—
that's all, just think
about the intracellular flux
of potassium and calcium:
200

Taking the time to consider—
that's all, just consider
the microvascular injury pattern,
the burst endothelium:
300

Taking the time to ponder—
that's all, just ponder
the ischemic effects on the cerebral cortex
at four minutes:
360

Taking the time to reflect—
that's all, just reflect
about the person around
the heart you're shocking:
360

Taking the time, that's all.
Taking the time.
360
360