Trying my hand at “fiction”

Looking through some of my older writing today, I found a piece that I wrote in 2007.  I am terrible at writing fiction, and when I do try it always feels forced and sounds silly when I read it back to myself.  But this piece that I wrote back then isn’t all that bad, so I figured I would share it here.  The medical details are all true, woven together from different patient experiences I had on the medical ward as a third year student.  Enjoy.


The sun was shining, she could see it as she entered the room.  Mrs. Johns lay as she always did, a lumpy potato sack on the bed sprouting limbs like toxic green shoots when the rot is near.  Megan could hear the rasping breath she was called to assess; even without the stethoscope the wheezes were audible. For the umpteenth time that month the respiratory therapist would have to be called, and the comatose sack would breathe easy once more.  That is what Megan was thinking as she auscultated the chest.  Only months later would she remember the patch of sun lying gentle as a caress on Mrs. Johns withered cheek.  Then, the quiet beat of her patient’s heart would blend with the birdsong outside the window and the radio next door, into an orchestra of meaning that Megan would recall over a breakfast of runny eggs and soggy toast, made soggier by the surprise of salty tears.


But that afternoon, as the Internal Medicine student on-call, all she wanted to do was watch American Idol – it was on in a few hours, and like usual she and the nurses would try to get in a few minutes of what she liked to call “brainfritz”.  Punctuated by snores, coughs, farts, the beeping of monitors and kinked IV lines, the singing would at least drown out the quietest of the hospital’s cacophony of night noises.  As she performed a silent rectal exam on Mr. Crenshaw (who after days of constipation had managed to poop out a whole wad of blackish stool) she mused about what Thai specialty she could order for dinner.  Of course, there was no real question, vegetarian Pad Thai was her favourite with it’s peanuty goodness, but then again tofu in red curry had an edge to it…


Abruptly, the shriek of the call pager jolted her out of her Thai reverie; the stool on her gloved finger tested positive for blood as a disembodied voice called “Code Blue, E south” over the intercom.  She hurried out of the room to find the ward a sudden frenzy of nurses, all propelling her down the hall and into Mrs. Jones room.  The nurse taking Mrs. Johns vitals had noticed that suddenly her oxygen saturation was 80% and the wheezing was much worse, and had called a “pre-code”, to perhaps stave off the inevitable.


“ICU is on their way!”

“Want to intubate her?”

“Which meds would you like?”

“Should I call the family?”


The nurses all peppered Megan with questions as the patient’s respiratory distress worsened.  It should have been simple – try drugs, intubate, stabilize, send to ICU – but Megan’s gut revolted at the thought of putting this months-unresponsive woman through all of that.  She should have had some sort of back-up besides the ICU, but call at Santa Maria Hospital’s Medicine ward as a third year medical student meant she had no resident or attending physician in-house.  Aside from the nurses, RTs, one emerg doc, the ICU attending and a few other medical students on other services, she was the sole person responsible for preventing the deaths of all the patients in the entire freakin’ hospital.  Shrugging the angst aside, she quickly moved for the phone and before the ICU team arrived, she had managed to get the RT back in the room.  After another course of inhalations Mrs. Johns’ saturation perked up to 95%.


Crisis averted (at least temporarily), the ward quieted down again and she finally got time for a pee break.  Hospital toilets being what they are, the nurses on E-south had taken pity on Megan and given her the code to their personal throne.  Squatting with her stethoscope hanging on the doorknob and her white coat pulled up out of reach of the wet depths below, the scene replayed itself in crisp detail in her mind.  Had she acted correctly?  Should she have anticipated the emergency before it occurred?  Would Mrs. Johns do this again later, before night’s end?  What would she have done if the meds hadn’t worked and the ICU team was busy with their own patients?  Would she survive the rest of this night, let alone the rest of her career, if patients were always trying to die on her?


The night wore on, and she ordered her veggie Pad Thai along with a chicken one for the ortho student upstairs.  Someone sang a terrible song on American Idol, and a demented patient pulled out their catheter, leaving a pool of blood on the floor and calling for his wife to cook the chicken.  Mr. Romano harangued his 99-year old roommate for snoring, Mrs. Cordoza fell out of bed, Mr. Jenkins tried to jump out the window, and Mrs. French found scissors and tried to cut her hair off.  The family of Mrs. Johns showed up at ten p.m. and wanted a family conference, a nurse fell ill with vomiting and had to go home, the fire alarm went off about ten times, and strong winds blew out a window in the conference room.


Meanwhile Mrs. Greenspan wandered down the hall in her open gown, 85 year old behind flashing its’ sagging self as she passed the nursing station on her way to the elevators and wished freedom before the nurses reined her in.  Cantankerous and special, her temporal lobe seizures (that Megan had diagnosed!) caused her to become intermittently violent and abusive, which made her the least-loved patient on the ward.  Having admitted her from the emerg and pushed for her initial EEG when the attendings were convinced it was just dementia, Megan felt a bond of sorts with this maligned lady and always kept an eye on her.  After Mrs. Greenspan was man-handled back into bed, Megan went in to make sure she was all right.


“Time for bed, Elsie”, the young almost-physician said as she stood by the bed.


“Sit down, girl!  I’m not tired yet, and I want you to sit with me.”  Proud and feisty tonight, her patient commanded and was not to be ignored.  Megan sat on the chair by the window, facing the bed, elbows on her knees and hands cupping her chin.  “Did I ever tell you about my husband?”


For the next few minutes Mrs. Greenspan relived a trip to Israel with her family, illuminating beaches and markets, archaeological digs in desert sunshine and the walls of the Old City.  Megan sat, fascinated, sleepy, privy to the internal wanderings of this woman’s wise mind in the moments before sleep, when doors thought closed are opened a crack and the subconscious peers out.


Silence.  “Would you like me to go so you can sleep now?”

Pleading, vulnerable, – “Stay with me while I fall asleep, won’t you?”


A shaft of moonlight cuts the blanket, landing on a gnarled hand, the band of gold and a diamond glittering brilliantly in the night.  Soon, the soft slowness of breath a lullabye, arms braced on the bed railing and head cradled above, Megan’s eyes close and for a few minutes she finds peace in the darkness of her patient’s room.

Old Men of the ED

I see you, sitting in your bed, the gown askew on your shoulders.  Too frail to tie it yourself, or perhaps with aching shoulders that don’t allow you to reach behind to grasp the other end of the tie, you lie back instead and just leave it open so it slides around when you move.  Your thin white hair, what’s left of it, sticks up off your aged scalp underneath a worn kippah, and the thin skin on your arms shows abrasions and bruising from any little bump.


I come in, to greet you, and your eyes light up.  As we talk about why you’re in the Emergency Department today, the wrinkles in your face become animated and show me your personality.  Somehow, even ninety years later you still have a dimple when you smile, and are able to flirt like a man many years younger.  In your illness, you remain as dignified as you can be, and do your best to cooperate with my barrage of quick medical questions and physical exam maneuvers.  I spend only a few minutes in your room, but yet we form a relationship.  You imprint your kindness upon me when you graciously tell me how young I look, how smart I am for being so young, how pretty my smile is.  (I don’t believe half of it myself, but you do, and that is what makes me leave your room with a spring in my step).


Later, testing complete, I come back to your room to share the news.  I stand by your side and tell you how your tests are all normal, and you are free to go back to your residence in reasonable health.  You take my hand in thanks, and I look down to see that faded tattoo on your arm; a number, etched in so many years ago, still blue and painful to both of us.  I swallow tears as I rub my thumb across the horror you still bear witness to, and give your hand a squeeze as I wish you the best and say goodbye.


Across the way, another day, there is another room, and it contains another man.  He is the same age as you, and has seen the same horrors.  He has the same white whispy hair under the same style kippah, the same crooked gown, same wrinkled skin.  He has the same tattoo, albeit a different number.  But he suffers from dementia, and to him those horrors are happening today, every day, in these rooms.  He doesn’t know that the Holocaust ended in 1945, and that we are in 2018.  He believes, truly believes, that it is 1941 and the hospital room he lies in is a dormitory in Auschwitz.  Every examination by a nurse or a physician, he knows is being done by a Nazi doctor intent on experimenting upon and hurting him.  Every needle poke, every medication he is forced to take, are torture.  All night long I can hear him crying, screaming, moaning in agony.  Even after we stop investigating, and are just trying to keep him comfortable, he continues to fight and spit, hit and kick at everyone who comes into his room.  Though we wish dearly that we could send him home, to a place he somewhat knows, we can’t do so because his nursing home shipped him here for unmanageable behaviour.  All I can do is tell him it’s ok, every time I go near his room.  I try to calm him, like I would a small child, with soothing voice and calming demeanour.  But when he looks at me all he sees is a torturer, a murderer of his family and his people, and so he shouts and waves his fists still strong enough to wield a painful blow should I come too close.  When he is finally admitted to hospital and is taken upstairs to a room hopefully quieter and less frightening to him, I sadly breathe a sigh of relief because his shrill shrieks will no longer tear into my soul.


Every day, in the halls of medicine, we meet patients that touch our hearts.  These stories are only some of those I could tell about old men in my Emergency Department.  When I meet men like these, they stir deep emotion.  Before motherhood, I used to think of my father when faced with older men needing my help.  Now, all I can think when I care for these men, is, “I hope one day, when my son is an old man, a young doctor will treat him with as much kindness and compassion as I do with this patient”.


I close my eyes in the brightly lit hallway in the middle of a night shift and pray with all my heart that the good deeds I do today come back to me as a safeguard for my children.  Let all the light I bring to others brighten the future of my son and daughter, in a time when I will be gone and unable to care for them myself.


When the heart wants to stop

Recently I had a case that stirred emotion: joy, frustration, concern, pride.

It’s not every day that my heart feels such a range of flutters while at work; generally, while I love what I do, I don’t always want to jump up and down on the couch screaming “Woohoo!”.  With this case, I had a woohoo moment.


A reasonably healthy older patient presented to our emergency department after fainting.  Actually, he didn’t just faint.  Most people faint after feeling unwell, or having the classic sensation of light headedness, a black haze clouding their vision, ringing in the ears, maybe nausea…what we call a prodrome.  Rarely, a person will lose consciousness suddenly, without warning, and go down hard.  When a physician hears that kind of story, we call it syncope with no prodrome – and it always raises the red flag.  With these cases, we must always consider a cardiac cause, i.e. an abnormal rhythm, that makes the individual pass out without warning, like a shark in the water pulling them down.


This patient had a syncope with no prodrome.  When he was initially assessed by my resident, he felt reasonably well with no headache, neck pain, chest pain, palpitations or other symptoms.  He did admit to feeling generally weak for the last few days or so.  The exam was completely normal, and the first electrocardiogram (cardiac rhythm evaluation) was normal.  Completely normal.


We sent the patient for imaging studies to make sure he had nothing serious as a sequelae of his fall.  Trauma is a pretty straightforward field to an experienced emergency physician: it involves evaluation and stabilization of a patient’s airway, breathing and circulation, monitoring of vital signs, and head to toe evaluation for injuries.  Diagnosis is clear as well: CT, xray and bedside ultrasound, along with routine labs.  There are protocols and algorithms that guide us.  For example, this patient needed a cervical collar because as an older person he fell outside the range of our evidence based decision rules (which allow us to say that a patient does not need xrays of their neck to rule out fracture).  We asked for a CT scan of his head and neck.  When I saw the images of a brain full of blood and a fractured skull, I knew this patient needed urgent transfer to a trauma center, and urgent platelet transfusions to combat the anti-platelet medication he was on.


I called the trauma team leader urgently and discussed the case, but stressed the point that aside from the traumatic injuries, this patient still needed a workup for the cause of syncope.  I told the surgeon that I was concerned that the etiology was cardiac in nature, and that the patient would be at risk of further deterioration if it was not addressed.  His answer?  “I am more worried about the blood in his brain”.  Needless to say, I documented that interaction very clearly.


Shortly thereafter, the ambulance crew arrived to take our patient to the trauma center.  Suddenly, as I stood a few steps away from the room, and just prior to loading him on the ambulance stretcher, a code blue was called for our patient.  My resident and I ran to the room, and found the patient not breathing and staring into space.  He rapidly recovered but we rushed him to the resuscitation room with the immediate decision to intubate him for airway protection during transport.  While in the resus room and preparing for the procedure, I glanced up at the rhythm on the monitor and my heart skipped beats just as the patient’s heart was skipping beats.  Many beats.  Dropped beats.  Non conducted beats.  Meaning, this was, finally, a cardiac syncope.  The patient fainted not once, but twice – and the second time just happened to be here, in my ED, with his chest hooked up to a monitor that captured the rhythm as it happened.  And there it was: the heart was beating in a totally dissociated rhythm, meaning that the 4 chambers of the heart were not coordinating, not sending appropriate signals to each other.  A rhythm like this means that blood isn’t adequately pumped to vital organs, including the brain, so a person will faint.


Or the heart will stop.


His heart essentially did stop.  For a few seconds.  At least the major chambers of the heart stopped.  The atria, the smaller chambers at the top of the heart, were sending signals that the ventricles lower down were not receiving.  So the ventricles were not beating, for a good 15 to 30 seconds.  Lucky for him and for us, he came back without intervention and we were able to get on top of it by applying pacer pads to his chest in case it happened again.


I called the surgeon back.  Hello, his heart is the problem; the bleeding brain is the consequence.  GET CARDIO INVOLVED ASAP.  He agreed.


I shipped the patient off with a nurse, a respiratory therapist and my resident with a pocket full of lifesaving medication and a monitor that could start pacing the patient if needed – keep the patient’s heart beating in an organized fashion.


When my resident got back from the transfer, and I heard that he made it there without incident, only then could my own heart go back to beating smoothly.  Not that my heart rate ever increased – it doesn’t, when I deal with stressful cases at work.  But the feeling of my heart in my throat fluttering like a bird caught in a nest finally resolved.  My heart was free, and rivers of pride and relief flooded me like a hurricane.


This case was so great not only because we saved a life – because we did – but also because it tied together everything I learned in medical school, residency and attending staff life.  It reminded me, again, of the sheer scope of knowledge I have been blessed to possess after so many years of striving to learn it.  I feel so in awe of the physicians who came before me, who learned all of this through trial and error and hard hard work. They created protocols, wrote textbooks, trained learners and now I hold all that history, and power, of medicine, in myself.  And I am passing it on to residents, students, and the entire team I work with, every day.  This is the joy of what we do – constant learning, constant growth, sometimes fulfillment.


And saving lives, even when the heart wants to stop.


Today I am starting a new endeavour.  I signed up for monthly creative writing care packages from a group in Toronto called Firefly Creative Writing.  These envelopes are meant to inspire and open the doors to writing, in people like myself who don’t often find the time to sit down and devote ourselves to the task.

The stimulus word this month is Devotion, and we are urged to stir the creative juices around this theme all through this month.  Here is my first go:



To whom, to what, am I devoted?  The answer seems clear as day: my children, my husband, my parents, my sisters, my patients and medicine.  Am I devoted to myself?  This is one concept that is difficult as a full time working physician and mother.  I spent so many years working towards various goals: finish my studies, become a doctor, get married, have kids, make enough money to support a family.  When does devotion get returned to me?

I see love and caring in the eyes of my children, and yes, they are devoted to me – but they are also separate beings growing and changing and becoming spectacular souls.  My husband is devoted to me, but must spread that devotion to our children and to his own world of triathlon training and maintenance of our home.  My parents devote a portion of themselves to me, but also to my sisters, to each other, to their own patients and medical practice.

I suppose, then, devotion is by necessity something that is divided.  The dictionary definition, “love, loyalty or enthusiasm for a person, activity or cause” certainly sums it up correctly: one can be devoted to numerous things all at once.

It is time, then, to become devoted to myself.  Time for self-reflection, self-care, and improving my own core being.  I spend so much time trying to help others, that I get lost in the process.

As a physician mother, my life looks something like this: wake at 6 a.m. after a night broken up by kids having nightmares, needing to pee, or just needing a snuggle.  Do morning routine, get kids to school with help of husband, by 7:45 a.m.  Head to work for 8:00 am and work non-stop, usually mostly on my feet, with no breaks for snack, lunch or clearing my head, until about 6 pm.  Leave work and get home around 6:30 or 7 pm, join family in time for bath, stories and bedtime.  Snuggle kids and love them till they pass out around 9 pm.  Spend time with husband if he’s not already asleep, then sit down for late dinner (sometimes with, sometimes without husband) and watch tv or read news on my phone until I pass out somewhere around midnight.  Get woken usually once or twice a night by my warm cozy kids needing me, and start over again at 6 a.m.  Alternatively, if I work nights, I get up at 6 a.m., do morning routine, take kids to school, do all sorts of stuff all day long (academic commitments, housework, paperwork) and try to nap a couple of hours, pick up kids from school at 4, hang out with family, dinner, bath, bedtime and leave for work at 10:30 pm.

In all of this there is no time or space for me.  Today, as I write this, I have a total of 5 hours of sleep under my belt after a late shift last night, and I go to work at 10:30 pm tonight so won’t sleep again until around noon tomorrow.  I carved out a couple of hours this afternoon to take care of family finances, and to devote time to writing.  At the expense of sleep.

No one teaches us in school that life is hard.

It’s hard for everyone; there are very few for whom life is easy.  We are all on different paths that take us to places and situations we never dreamed, be those positive or negative.  Those paths are not usually straightforward, and the work it takes to arrive at our goals is not simple or light.

But in all this, in the maze we create for ourselves, there needs to be some devotion to our own souls.

Today, I asked my chief and ED scheduler to consider allowing me to work as a nocturnist; i.e., only night shifts.  Am I crazy?  Perhaps.  But working two or three nights a week will allow me to keep consistency in my schedule, stick to a sleep routine, and be there for my family in a much more present way.  Of course it will mean that I am absent from my marital bed for half my life (shocking to think of it that way) but that is what happens right now anyways – along with days, evenings and weekend shifts thrown into the mix.  I think it’s the best thing for me and for my family, and I don’t plan on doing it forever.  I see working nights for a few years, then re-evaluating.


I finally feel like I’m taking a step towards improving myself, and to me, this is the meaning of devotion.

Growing Up

Today I did the normal attending staff physician thing of going to grand rounds.  Grand rounds are mornings of learning, with a few hours of interesting talks by residents, staff and visiting lecturers.  This morning, an old friend was our guest lecturer.


Fourteen years ago we began medical school together in the hallowed halls of an old building on the side of a mountain, and every day we climbed hills both physical and figurative as medicine poured itself into our minds and hearts.  For 18 months of clerkship, when medical students first interact with patients, we grew into being doctors.  On so many occasions, he saved me – and perhaps I saved him too.  I remember those days as if they happened yesterday; they were days full of excitement, emotion, and exhaustion.  Probably some of the most illuminating days of my life, I grew from a little wee baby medical student into a competent trainee physician.  But it was not an easy road, and it really helped to have a friend to lean on.  This friend stayed my constant, as somehow we ended up in almost every rotation together.  When medical school was finished, we went our separate ways into residency and our futures.


As he said today, “look at us now”.  Both of us ended up as Emergency Physicians, he in the US and me here in Canada.  All grown up, we have both been attending staff for years now.  We teach and train our own crop of medical students.  Listening to him give a dynamic and passionate talk, his words resonated with me.  The years melted away and I remembered why our friendship took root in the first place: our hearts are in the same place with regards to patients.  We both value our patients’ stories, the person behind the sickness.  We respond to our patients with patience, compassion, and an open mind.


Listening to my old friend helped me remember, today, the emotion and joy of what we do each shift, each patient encounter.  Seeing him, hearing his voice, brought me back to that day in Geriatrics, in 2006, when a little old lady refused to get in her bed because she thought there were cockroaches.  No one could convince her otherwise, as she was delirious.  But this young man, this third year medical student with not much experience but lots of compassion, hopped in her smelly sick bed and lay down to prove the absence of said cockroaches.  Wouldn’t you know it, she smiled and got back in bed as soon as he got back up.


So thank you, my friend, for being the confidante I needed when life kept throwing pain and fear and stress at us.  Thank you for giving the smiles and hugs I needed back then, when often life was so lonely even in hallways full of people.  And thank you, for bringing back memories and emotions that can hopefully knit their ways back into my daily practice, and help me find joy in the every day at work again.


Night shift love song 2

To my husband


When I leave you

You are alone

My car pulls out

The house is dark


Inside you sleep

But you are awake

You keep watch

You keep them safe


You are by yourself

The bed an empty space

No one to hold you

No one to keep you warm


I am awake

Wandering corridors at work

I care for others all night

But I am not with you


You are my strength

You guard our treasures

You are their rock

You are our foundation


But you sleep alone

I walk alone

Our paths cross so briefly

We live far apart


Yet our hearts are one

We work as one

Symbiotic organisms

Each half of the other


And our home is warm

A place of love

A house of peace

A source of joy


When I come home to your arms

My world is calm

You fill me up

Our hearts are one.

Night shift love song 1

To my children

At home

The lights are out

You sleep soundly

Your little hearts peaceful

Your bright beautiful brains calm


No doubt weaving dreams of adventure like quilts in the night

Soaring on air through wide spaces and light

Your breath like warm breeze quiet and sweet

Your hands open, your fingers reach, touch things I can’t see

Your hair tumbling on pillows softly caress

Your voices at times rustle like a flowing dress


Yet you sleep on, safe, warm, cuddled snug in your beds


Where I left you, when I left, closed the door to our home

Stepped into the night and out of your space

Now I walk through bright hallways, not free as you are

Awake, in the nightmares that my patients live out


I am here, taking care of strangers

I sit on their beds as I sat on yours

I hold their hands, as I held yours

I listen to their stories, as I heard yours


I am here

In the light, in the chaos

Wishing I were with you

In the dark, in the peace

Warm and snuggled in your beds

With healthy hearts beating close to mine

And happy souls holding mine.

A physician mother’s take on the news

When I went to bed last night and when I woke up this morning, I heard the reassuring sound of my children breathing in their dreams.

I went in their rooms, kissed their heads, smelled their scents, and walked away comforted.

I am blessed to be free and able to do these things.

I am lucky to live in a country where my life is not threatened, where my children are safe, where we are at peace.

I am fortunate to have never been uprooted, never had to leave all I know and love to find a safe place for my family.


Today, I am troubled, shocked, dismayed, and viscerally enraged when I think of families being separated at the border of another ostensibly safe and free country; the United States of America.  All I can see in my mind are the arms of mothers reaching for children who have been ripped, crying, from their bosoms.  All I can hear are the screams for parents taken to detention without having been given time to say goodbye or comfort their little ones.


While my children slept peacefully with mother and father only a few steps away, thousands of children just like them have been drowning in a sea of uncertainty and fear.


My heart breaks to imagine the tiny child lying in a strange room, in a strange cot, surrounded by strangers and a strange language.  I wonder how my three year old boy would cope, without the parents he so depends on and loves.  I can hardly do it, visualize that pain, without feeling my soul slashed within me.  To consider my eight year old daughter, alone, at risk, in danger, spins my mind in ways I would rather not go.


And what about the parents?


If I were suddenly faced with my children being dragged off, crying for me, with no way of knowing what happened to them or if I would ever see them again, I’m not sure how I would survive.  We are talking about the children, and their trauma, but let’s also consider that their parents (who are only trying to find better lives for their families) are going through a different but equal trauma.  Who will soothe their pain?


Today, I find myself a part of a movement of people of equal minds, equal wills, who are trying to make a change for good.


Let us hope, pray and wish that these families will be reunited and that the pain they have suffered will eventually be calmed.


And let us also hope, pray and wish that enough of humanity will continue to take a stand against evil, so that we are not thrown backwards in a wormhole of time to another place, another face, another monster long dead.  Let us not repeat history; let us forge anew a world where children are safe with their parents and no one fears that their safe haven will be instead hell on earth.

My mentor

Dear Dr. X.,

I am writing even though you will never see this letter.

I am writing because in the trauma room of the hospital you trained me at, you taught me to be an Emergency Physician.  You took me, you molded me, you showed me how to teach and how to be taught.

You helped me reach a strength inside of me that I knew was there but couldn’t always grasp.

You took my weak, and made it strong.

Watching you work so hard to save the lives of some of life’s worst people, showed me how to turn off the judgement, and turn on the medicine.

Working side by side with you on a 14 year old gang member, shot in the torso, you guiding my hands to compress his heart inside the open chest, that made me grow.  Finally giving up and letting go, you telling me to let go – that taught me that often, all we can do is let go.

So Dr. X., thank you for guiding me to strength.

Thank you for not being easy on me.

Thank you for all the support, a hand in the small of my back in the worst of traumas.

I still feel that hand every day.

The River

These days, my work feels like a place I go to for money.

Sometimes, all I want is to get home and rest, read a book.

But then, with a rush, the shift starts and soon enough a patient’s story will draw me in.

Suddenly work turns into a journey, a choose your own adventure tale where every choice I make as a physician spins me down a new river.

Without warning, one story ends and I am thrown off the falls into a brand new place, a new space, a new raft with a new patient.

Abruptly, work becomes whitewater, with everything rushing by; pieces of stories like driftwood hitting me if I’m not careful.

Then, as fast as it began, the book finishes and I give the now empty pages over to the next doctor, the next ship’s captain.

I clean my stethoscope, put my pens and my oars away, and strip off my dirty scrubs.

Naked, I pull on my new uniform and head home to the next raging river, where I’ll most certainly be carried away anew.