Author: Kunal Patel
You don't offer ethics to god
Tiny bodies and ventilators fill the ward. The NICU cribs full of fresh, short lives. A place where adults cry more than the babies, a place where life ends before we can even pretend it started. Blue babies and incomplete spines abruptly end the miracle of life and birth. All of a sudden, I remember that palliative care isn’t only for the old.
K lies in a crib that might as well be a king-sized bed for his tiny body. He’s not breathing on his own, and as I stand in the room, I’m convinced his dad might stop breathing on his own too.
How can God do this to us? This isn’t fair, this isn’t right.
As the doctor tells them there’s not much else we can do for K, that his body is failing him, I think about how this family’s god is failing them. One day their faith might return, but they don’t seem to have it today. The image of K’s limp body, with more tubes and wires than human flesh, burns into my mind as I leave the room.
In the next room, M has been getting better. His parents hold his hand as we talk to them, they’re smiling, their eyes glowing. M should be alright, might even be able to go home tomorrow if everything stays on track.
At the end of my day, I hurriedly walk by K’s room as I’m leaving the hospital. It takes me a minute to realize the family isn’t in there. Pausing, I turn around and peek my head into the empty room. The crib is gone, and the staff comes in behind me to turn the room over for the next innocent child, for the next family who will doubt right and wrong, question what is just and what is unfair.
The next family might thank god for their blessings. Or, they’ll realize that you don’t offer ethics to god.
God does what it damn well pleases.
Author: Joanna Schneider
Live the Questions
"Be patient toward all that is unsolved in your heart and try to love the questions
themselves, like locked rooms and like books that are now written in a very
foreign tongue." -- Rilke
Who pulled whom into the bathroom?
Who locked the door?
Who suggested taking clothes off?
Who made the first move?
“Do you know how sex works?”
Why didn’t she scream?
“Do you know where this goes?”
Where was the teacher?
What did you see when he pulled down his pants?
What was that white stuff in his hand?
Why wouldn’t he let her leave?
Has anyone seen Lisa and Ben?
When is Lisa’s mom arriving?
Does mom know he has a history of sexual assault?
Sweetie, are you okay?
Mom, are you mad at me?
Are they going to sue to school?
Are they going to press charges?
Is school a safe place for special needs children?
Is school a safe place for anyone?
Lisa, can I ask you some questions?
Lisa, may I examine you now?
Lisa, will you stop me if at any point you feel uncomfortable?
Lisa, can you help me examine your private parts?
What is her developmental age?
Doctor, does everything look okay?
Given her developmental delays, do you think she’ll even remember all this?
Why do we examine children after sexual assault?
What is his developmental age?
Detective, will he be arrested?
Given his developmental delays, do you think he understands what he’s done?
Should he be tried as an adult?
What will mom say when she finds out that the school knew his history?
What will Lisa say when she finds out her classmate may go to jail?
What will Ben say when the court asks him if he thinks what he did was wrong?
What will the judge say when asked to decide?
How do you talk to a child in a 16-year-old’s body about intercourse?
How do you teach an autistic boy right and wrong?
How do you teach an autistic girl what consent is?
Mom, why wasn’t Ben at school this week?
Author: Neha Verma, UNC SOM
While You Were Sleeping
“That’s it, you’re doing great -- just keep taking deep breaths,” they said as you slowly drifted off. They pressed circular adhesive patches over your eyes to keep them closed and slid a plastic breathing tube down your throat. The creases in your forehead smoothed over as you settled into an artificial, yet peaceful, calm.
The surgeon and I then left the room to scrub our hands. We stood there in silence, side-by-side at two large metal sinks. She was an elegant mix of poise and confidence, while I was an anxious bundle of nerves. As I picked the dirt out from under my fingernails, she abruptly turned to me and said: “You know what this patient said to me when I first met her in clinic?”
Surprised that I was suddenly someone worth talking to, I looked up at her and blankly shook my head.
“About halfway through our appointment, she said: So why did you chose to specialize in bariatric surgery? I mean, as a thin, attractive woman who I’m presuming has never struggled with being overweight, I guess I’m just wondering how you could relate to me, because it’s important for me to have that connection with the person who will be doing my operation.” The surgeon paused, rolled her eyes, and laughed. “I mean, what a stupid question. Why do I need to be able to relate to patients who are overweight? Maybe I just think that this is a fun operation and figured if I did a fellowship, I could spend a little less time looking at butts and hemorrhoids than your average general surgeon. But it’s already hard enough to get patients when you’re straight out of training, so I eventually came up with some bullshit answer that I figured she’d like to hear.”
With that, we turned away from the sinks and walked back toward the operating room. I want you to know that I don’t think it was a stupid question. Maybe a little bold, but not stupid.
Before making the first incision, the surgeon gestured toward your abdomen, covered in small scabs, and said to me: “She has a history of anxiety and a skin-picking disorder.”
At this, the scrub tech said: “Well, I guess by giving her a few good scars, you’ll already be doing her a favor -- more to pick at! Never mind if the operation goes well.” Your face remained calm as the surgeon and the scrub tech shared a laugh.
Last night, I was so nervous about spending a full day in the operating room. I tossed and turned in bed so much that around two a.m., my dog stood up from her usual place beside me, let out a big, long sigh, and trotted off to go sleep on the couch. Watching you lying there so peacefully now, I can’t help but wonder if you were nervous, and had a hard time sleeping last night, too.
The surgeon made her incisions, inserted her camera and tools, and began to work. As she did so, she asked me a steady stream of questions: What are the indications for bariatric surgery? What are the medical conditions associated with morbid obesity? What artery supplies this part of the intestine? What is the name of this ligament here?
“Hey, I’ve got an easy one!” the scrub tech chimed in. “Given the fact that her liver is the size of three livers, you think she eats a lot of McDonald’s?”
I glanced at him to see if the question was rhetorical or if he was expecting a response. He was looking at me, waiting. I nodded. I shouldn’t have nodded. I’m sorry.
This morning, I read about the complications of bariatric surgery, dutifully memorizing the list of all the things that could go wrong in case I was quizzed on them by the surgeon during the operation. As I watched the surgeon cut, poke, and prod, I remembered this list. I studied the sliver of her face visible between her mask and her scrub cap, trying to discern if she was even a little bit scared. She just finished her training. There are so many things that could go wrong. I was once told that in order to be a surgeon, you have to be confident enough to fully believe that you are the best person to do a given operation, and that even when you mess up, you have to walk into the next case still thinking that you are the best one for the job. I wondered if I could ever be that confident. I wondered if anyone should ever be that confident about anything.
The incisions are closed. The surgery is over. In a few minutes, you will wake up with staples in your stomach. I hope that one day, you will find the peaceful calm I saw in your face while you were sleeping. I hope that the rest of us will, too.
Author: Joanna Schneider, UNC SOM
The labor and delivery floor is full of life. Women, families, babies taking their first breath of air. Sighs of relief with the effects of an epidural. Grunts of determination as baby's head descends. Cries of vitality from neonates touching their mother’s skin for the first time.
After helping deliver two babies and quickly seeing a “rule out labor” woman in outpatient L&D, I rushed over to the OR to see my first C-section. I wouldn't be scrubbing in because another medical student was already involved with the case, but the chief resident had invited me to come watch. It made sense at the time- I should probably see a cesarean before I try to assist with one. I didn't have time to read the chart. I didn't think it was important.
From my stool, I watched the residents open the abdomen. I waited with an anxious excitement. How crazy is it that we have the ability to cut little humans out of moms and then sew them back up? I tried to pay attention to the details of the surgery so I would remember what to do when it was my turn to assist.
And then they pulled baby out. Baby was floppy. No cries. No movement.
Why wasn't anyone doing anything?
They handed baby to a woman I had barely noticed before, who had been standing in the corner, silently waiting. The woman carried baby over to a small table. Still, it was quiet. Lifeless.
WHY WASN’T ANYONE DOING ANYTHING?
I looked back to the operating table. The residents were back at work on mom, sewing shut the uterus. No one said anything.
I walked over to baby. The L&D nurse, I now saw on her name tag, was cleaning baby off. As she gently wiped a rag along its arm, the skin peeled off. Like a really bad sunburn after a day of playing outside. Raw tissue was exposed beneath. A man who had been overseeing the operation came over to the table. He picked up the rag-doll infant.
Still, no cries.
It was as if the infant had been sculpted out of clay and someone had accidentally picked it up before it was fired. The form of its skull and ribs collapsed and bent as the man- the attending- examined it. He mentioned something about low-set ears.
I felt my mask become damp. When had I started crying? Why was no one else crying?
As he laid the baby back down, its soft features melted in a formless pile of dead human.
WHY WAS NO ONE ELSE CRYING?
I felt a hand on my shoulder. Any questions? I continued watching as the nurse took footprints of the child, being so gentle and yet still peeling apart the baby. I watched her put a tiny pink cap on, slowly, so as to avoid further crushing the already deformed head. I finally whispered, I didn't know what the outcome of this case would be.
He apologized. He said someone should have told me. Someone probably did, but at the start of my OB L&D week I was drowning in acronyms.
C/S. AMA. FM. IUFD. RIP.