Sunday, June 4, 2017

What we talk about when we talk about love


   I’ve wasted a Saturday afternoon, but it won’t be the last. But now that the days are longer, there are some salvageable daylight hours that weren’t there in the winter months, and I’ve dragged myself to a cafĂ© in the Neighborhood of the Arts where people sit outside, lounging, smoking cigarettes and having aimless discussions in the sun. There’s an illusion I have about productivity and what it really is, because on days I set out to read a chapter about heart failure or kidney disease, my ratio of time spent reading to time spent on social media is maybe something like 1 minute of studying for every 10 on Facebook/Youtube. Yet now, sitting here reading Jack Gilbert and having no intention of studying whatsoever, I can’t help but feel like I’m doing something good with my time. I consider all the things I’m behind on, all the paperwork and emails I could be catching up on, but do none of it. Instead, I’m content to sit, go through old books and old lines already familiar to me, and let my mind wander. 

   It occurs to me that if my family were home today, I would’ve taken them to the park, and maybe we would have ended the day out here at the coffee shop regardless. I imagine Kealia scampering in and out underneath the tables and between chairs, picking up leaves and dropping them in flower pots while Angie claps and cheers. It’s an amazing thing, I think, witnessing a toddler learn in real-time about the world around her, and while thinking this, I’m hit with a sudden pang of regret as I realize I’ve missed almost two months of this already. 

   Do I even know what I’m doing anymore? In just a few short weeks, I become an upper level resident. A while ago, I was finishing a rotation in the MICU, and spent my final afternoon there doing three family meetings in a row—all of them delivering bad news. I capped it off by telling a man and his mother that their estranged brother/son would probably never recover from the brain injury he sustained due to his heart stopping multiple times in the emergency room. And although I had only met them one day prior, I sat alone with them in a small room and talked about their rocky family relationship with my patient over the years, how they eventually stopped reaching out but never actually gave up on him, then how he proceeded to use the last months of his life drinking himself to death, unbeknownst to anyone until he showed up at our doorstep in cardiac arrest. 

   Then came the moment when I couldn’t delay the bad news any longer, and had to tell them that we weren’t expecting him to ever recover from this, that all of our tests were showing poor brain activity, and that he would likely die if we took him off the breathing machine. I watched the mother turn to her other, still-breathing son with a look of terror, and utter a few breathless, fragmented sentences—

“But, he—well, what kind of tests did they—I mean, what does he mean by—oh my God—”

—before breaking down in her son’s arms, filling our small room with her desperate sobs. I remember watching them across the table, and for the first time this year, I felt myself begin to unravel inside—this was the 3rd family I had destroyed that day. I took a breath, wiped a hand across my face, blinked several times to clear up my completely blurred vision, and held the mother’s hand for the next several minutes while we slowly talked about what we could do next. Then I led them out of the cramped conference room back to the dying son’s bedside, and quickly signed out, thinking I would not do another goddamned family meeting for the rest of the year. 

   In retrospect, I should’ve let someone else do at least one meeting. Other people did in fact offer to help, but I declined, partly out of a feeling of responsibility to my patients, and partly out of not realizing that I had reached my limit. I suppose it’s easy to think that a strong sense of obligation makes you a better doctor, but the problem is the toll that obligation can take on you. At the beginning of the road to becoming a doctor, I think we’re all driven to some extent by a feeling of wonder about what the job entails, hoping and believing that the job is more privilege than it is burden. After certain struggles, we ask how we win back that sense of wonder and privilege about what we do. 

I don’t know. 

   But about a week ago, Alice and Hai-Long sent pictures from Hawaii, standing on Kealia beach and pointing to the lifeguard tower about half a mile up from where we were almost pulled away to our deaths four years ago. I think back to that terrifying Christmas morning, then to the day almost exactly two years later when Kealia was born, and can’t help thinking that there’s a certain element of destiny in our lives. Not destiny in a sense where we’re saying we have some ultimate fate that we can’t escape, but in a sense that there’s a real purpose in how life unfolds. Not that God (if you believe in a God) is the seer and decider of your future, but that God helps you find the possibility in your future. That seeing the death of a tragic alcoholic, and the devastating love of a mother for her estranged son, perhaps heightens the possibility for us who witnessed it to be better to each other in the future. 

   My mother used to tell me that love carries an element of destiny too. “If it’s meant to be, then it’s meant to be forever,” she would say. I thought it was just her corny way of consoling me through bad break-ups, but now I wonder if this kind of belief is something I’ll be teaching my daughter one day. Faith being not just how we endure the world, but how we continue to find wonder in it. Maybe when she’s older and we take her back to the beach of her namesake, and tell her again how we were meant to live, how I was meant to be her father, how Angie was meant to be her mother, and how one way or another, whether a doctor in the MICU someday or just a young girl looking off into the sea, she was meant to love, and be loved. 

16 days and counting. Come home soon, loves. 

Tuesday, March 10, 2015


How I love you in this house today

In this world there are many ways
in which I could say this. One might be the way
I adjust the blinds of the kitchen window, below which
sits the supple veins of aloe we potted yesterday.
Or, it’s the way the lithe pothos vines might cascade
along the white trellis we’ve talked about
building for weeks now. It might be the red cactus
flower, blooming like a finned, downy mouth
on the cocked rail of the balcony. This life is all
I can think about these days. This soil and water.
Every slight wing of rain. It’s true, we have no money.
But look—watch the tillandsia today, the flickering
breeze through their tender stalks, peering over
the mouths of mason jars in blue daylight. Imagine
a world in which this could go on forever. Sowing and
reaping in green and blue infinity, letting the earth seep
into the golden oil of your palm. Imagine a world
in which I love you like this multitude of water
flowing over the dappled pebbles that cull it,
which is happening, here, in this house today, and
in this house, today which is happening, which is love.

So I'm falling back into old habits, like waking up at 4 in the morning and thinking, "Now would be a good time to write," instead of turning over and going back to sleep. It's been a struggle to keep writing this year, but in comparison, I've actually done far more this year than I have in all my years of med school combined.

But it nags at me. Makes me use up my precious sleep time on the first morning I go back to the hospital for clinical anything since last summer.

Angie stirs and I almost talk myself out of getting up. There's a fold in her waist, where her hip tilts up and angles into her side and back--I place my hand in it and count the lines of orange light cast down from the blinds. I remember in high school, I thought romance was things like film noir, smoke, mystery, black-and-white stills of Rita Hayworth or Ingrid Bergman under venetian blinds. Now I'm thinking this scene in my own bedroom could be that if the colors were just grayed out. But that's all less about substance and more about flare. There's much more to know in these silhouettes and the fold of my wife's waist than I would've imagined as a teenager.

A friend of mine once wrote, "All I want to do is love and write, in that exact order." He joined the coast guard about a decade ago to pay for college, and now they've also more or less paid for law school and two kids. As a recruit, he was once made to stand at attention and recite poetry for his ranking officers--

"What did you do before you came here, you useless turd?!"

"Sir! I was a poet, sir!"

"You were a what???"

He ultimately hung his hat up on writing for a while though. He gave some reasons, but I think it was just life catching up. You know how life tends to do that. On a recent phone call, we talked about Christmas cards, his son's diet ("What's that he's eating? No, I definitely see him chewing something."), and the Lego movie.

Sometimes, I also think what he used to. Love and write, in that order. Other times, I think maybe it's just enough to love. Just love, I think. But then I think, just write, too. Maybe they're the same for some people.

Anyway, good morning. It's a miraculous world that's happening today. HIV Team 6 starts in one hour.

Thursday, October 23, 2014

Que lastima, pero adios!

So I've been going to this writer's workshop downtown at Gemini Ink. Every Wednesday morning, I pick up my friend Susan, who is probably a good 40-50 years older than I am, and we make the drive down I-10 to 513 S Presa. We're a motley crew, the 6-7 of us that come every week. Loren's a graphic designer from Seattle. Wilburn is a whimsical old crackpot with rampant ADHD. Terry's a local haunt of the San Antonio poetry workshops, crossed the border with her family as a little girl and made a life here. Casey is tall, always in sandals, seems to have aversion to wearing bras, and likes political topics. And Susan, the sweet elderly lady with bad arthritis, is a retired lawyer, lives alone, her late husband a pathologist and missionary in China in a former life. Finally there's me, the med student who spends his Wednesday mornings writing fiction and poetry.

Terry shared some of her inspiration last week, a poem called "Adios, Fresno" by Tim Hernandez, a writer and performance artist of the west coast and southwest. She explained the idea of using it as a prompt--writing about a city she'd left and the reasons she did so. Then I got to thinking about doing the same.

(Hear "Adios, Fresno" here: Tim Hernandez Poems)

So I wrote about Seattle--40 lines about what I hated, what I loved, and why I needed to leave. I guess I didn't write about why I went back after. But suffice to say, it's always been love/hate with me and Seattle. The city, the rain, the floating bridges, the trees, the mountains over the Pacific, then the black hole of loneliness, the depression, the things I never talked about growing up. I read it in the workshop today thinking it was overly affective and splashy, and was relieved to hear that nobody thought that was the case.

Then tonight I went to TA my med lit class, the topic of which was soldiers and war, and the comparison to doctors and medicine. One thing that got me a bit was when we got to the subject of how we share our traumatic experiences with the people we love, and that ever-sweet notion that yes, love is enough to tear down that wall of isolation. But the understated nuance of reality is that no, love is sometimes not enough, that sometimes healing those wounds takes more, which Dr. Winakur made a point of saying. I chimed in with my agreement, offering up my own examples of how difficult it is to talk with Angie about bad days in the hospital, and really, it's true of any bad history. It's why I write so much, I said.

Finally, I get home, and here I am at 1:23 AM, serially recalling Seattle and every other city I've left. What's funny is that each time I've left a place, I've always promised to come back and visit often, which has been far from the reality of things. Call it irony, my fixation on the past belying my physical avoidance of it.

There's this old Julieta Venegas song - "Me Voy," that we used to drink and sing to all the time in Brownsville. I have it on loop, and listening to it, I feel as if it could be my anthem for all the cities I've left growing up. Mostly because of this one line: Me voy. Que lastima, pero adios! "I'm leaving. What a shame, but goodbye!" I know it's really more of a breakup song, but I'd rather sing this for the cities of my past than the women of my past. I hear this song and I want to get drunk, go back to the house on Guadalajara St. for one more dance, find my friends who've all dispersed and shout for one more song, stand shoulder to shoulder with the men and women I've loved and forgive myself for the general stupidity of my youth. Julieta goes on and on in the background--"Porque no supiste entender a mi corazon." Good Lord. I'll probably be singing this when I leave Texas eventually.

Thursday, July 19, 2012


[Sometime back in May]

Sometimes a train passes through, my father says, and suddenly you find out it's your train.

Turn the tables, wind the clocks, and we're not talking about good fortune anymore. Now we're talking simply about destinations. The idea that you're not waiting around for opportunity or that bit of luck you've dreamt about. That you're simply waiting to be carried off to the next place. If you strike it rich, is it really that you're lucky? Blessed? Or are you just on your way to wherever you were supposed to be next? And maybe death not really the end, but just another stop on the way to whatever is still ahead? Suddenly it's not so much just a ride to a temporary fortune or misfortune as it is an inevitable passage forward, and finally everything along the way matters more.

Is there a place after this? My grandmother asks.
Yes, there is, my father says.

Let's not talk about what we believe to be real tonight. One day we'll be old, and things that we thought were important won't be anymore.

A man sits beside his mother's bed.
He tells her there is a place after death:
whether it is called "Heaven" is uncertain.

Above all, God tells us, love one another deeply.

Wednesday, March 28, 2012

Poems from Lago Enriquillo

Holding clinic in Sabana Real

The road to Sabana Real is cut from rock
and soil by secondhand motorcycles and the many feet
of many women carrying clay-colored vegetables.
We take in the mountain and its people like manna
from God, sustenance firmed in secret before sun
or water. The caravan stops twenty miles in,
a crowd of men and women, children and chickens
gather around a cinder block hut.

A man with swollen hands comes
from a far off sugarcane field for vitamins.
A woman finds she is pregnant with her fourth
child. We have bags of lollipops for the children,
but no shade for the elderly. A frail man coughs
weakly as we put on masks, fearing the worst.
Someone’s toe is infected. Someone’s knee
is crooked. Someone’s baby is starving.
Someone is waiting, someone is watching,
someone is saying “The American doctors
are here with free pills.”

And the boys' feet are caked in mud and their guts
are filled with worms. But they laugh too,
and play, and terrorize the windows
with little furious hands and fingers—boys
who have appetites for lollipops but not soap.
And the girls squeal in delight under the squeeze
of a blood pressure cuff, run out with our butterfly
stickers on their eyelids. Perhaps the world
is not such a mystery.

Or is it? In the airport, I look for postcards
for my mother and father. The plastic rack
has pictures of palm trees and phrases
like "Carribean Paradise." No pictures
of the Haitian woman to whom I gave
a sack of granola bars, the girl in her arms,
or the one clutching her hemline.
Nor the tree canopy from the side of the mountain
road to Sabana Real, the children chasing down
our swaying truck of students and supplies.

I seal up these images in a place
that’s not home. And then, on the back, what
would I write? Maybe something bittersweet,
like "Having a great time, wish you were here."

Above La Descubierta

Back home, I would have dreamt
of these stars, the secret
wonder of being one body, sleeping
beneath them; the leveled rock path
leading up the mountain
and these unfamiliar constellations,
pouring out nameless loves and other
mysteries in droves as we go up.
Back home we were less deliberate.
Back home, no one got up before
daylight to climb into the coming
sun. It's that notion of how
provoking the new world can be,
because it's still new, and
because we might well be too.
It comes with a different craving
in the bellies of our hands,
our feet, a hunger for exhaustion
and the feeling of having earned
the windswept path we walk on.
It's not something we would have done.
Yet here we are, sweat-matted
hair in clumps, copper scours on
rubbed skin, bleating goats
muffled in the sound of our
breathing and nothing else: living
proof of ourselves, proof that we want
more of ourselves than we thought.

Tuesday, August 30, 2011

"Medium coffee, please"

There was a period in my life not long ago when I regularly spent 12 hours on the road each week. 6 hours from the valley to Houston, 6 hours back. My meals were taken in the parking lot of a Valero somewhere off highway 77, my car was covered in dust and dead bugs, my jeans smelled like cigarettes and B.O., and my best friends were John Mayer, Jimi Hendrix, and the Red Hot Chili Peppers.

I drove 6 hours in the dead of night to get to Houston, then 6 hours at the crack of dawn to get back 2 days later. A lot of people thought I was crazy, my mother most of all. My father thought I had a secret girlfriend in Houston. My boss thought I was a freeloading slacker.  My friends thought I was searching for something, which I suppose was as good a way to look at it as any. Things at that time seemed like an amorphous sea of shit, and I was looking for an anchor. Friday afternoon, I'd sit down in lab meeting, grind my teeth for a couple hours, and roll out without a second look back at the office. Throw some clothes into a bag, throw the bag into the car, and pull out of Sugar Tree Lane, saying "Hey I'll see you in a couple days" to my roommates, not knowing whether I'd hold true to that. So I drove the hell out of my car, which earned my respect and gratitude as the most reliable thing I'd ever owned in my 25-year lifetime.

And what did I find? What did I learn? Well gas ain't cheap, for one thing. Cops trying to make quota at the end of the month don't let you off with a warning, for another. Spend enough time alone and eventually you'll either start talking to yourself or to God. Having a destination motivates you to keep going, even if trivial. The return trip always feels longer than the departing trip.

Finally, unlit, grassy shoulders are the best place to see stars on the road at night. My favorite ritual during night drives was buying a coffee from Valero, heading down the road a ways and pulling into a truck stop. Turning off the car, stepping outside, lighting a cigarette and promising myself I'd never be too good to drink shitty, leftover gas station coffee. Looking back on that time, I still can't decide if I was searching for a way out or a way in.

Anyway, went to Valero and bought a coffee tonight, and that's what brought all this about. So I'm drinking to that and whatever stars I can see from the balcony in my new digs.


Wednesday, August 24, 2011

Med Lit 5038

I signed up for this elective in hopes of keeping my literary side alive. And maybe in hopes of starting a project or collaboration somewhere. Anyway, first assignment of the year, done:

Post an essay on Blackboard about a medical encounter, in which you tell about the same events from two different points of view. For example, Patient/doctor, patient/family member, medical student/family member, etc. You may structure the essay into two parts if you like.


St. Patrick’s Day, 11 PM. Anthony, my roommate, was next door pre-gaming with our buddies for an all-out St. Patty’s bash downtown. I was waking up and getting dressed for my rotation at St. David’s ER—the first rotation of my EMT clinical training. A required part of my uniform was a black fanny pack, which I wasn’t allowed to take off at any point during the rotation. I felt a bit self-conscious strapping it on before leaving the apartment.

The charge nurse on duty that night introduced himself as I came in and reported to the nurses’ station. Mike was a large man in his mid-30s, who had a vise-like handshake and sported various Celtic tattoos winding up and down his forearms. I saw his eyes shift to my fanny pack as he greeted me, and a faint smirk formed in the corner of his mouth. “You’re with Colleen tonight,” he said. “You can find her with her patient in room 30B.”

The woman in 30B was a narcotics addict. It was apparently not the first time she had been brought in for an overdose. Colleen waved me over as I came in. “You can help us hold her down while we get an IV in place,” she said. It was easier said than done—the woman was easily over 200 pounds and would not stay still long enough for anyone to place the needle in, not to mention the fact that her arms were already covered with needle tracks. Mike came barreling in after five minutes and began giving orders. Among them was an order for me to strap down the woman’s arm and hold it still with everything I had. I knew from the moment he came in that everything he said would be non-negotiable. With that in mind, I choked out any and all thinking and put my weight on the patient’s arm. After what seemed like an eternity of cursing and needle caps being thrown about the room, the IV was placed. The ER attending finally came in to give orders for oxygen and fluids, while everyone else funneled out.

Our next patient was an old man brought in for a heart attack, already intubated and stabilized by the paramedics. Colleen joined in with the other nurses as they wired him up with the usual mess of tubes—IV, Foley catheter, heart monitor, oxygen mask. Colleen handed me the ventilator bag and told me to hold on to it for a minute while she filled out some paperwork for the attending.

The night went on like that, patients coming in, getting tubes attached and then handed off to someone else. There wasn’t much time to ask questions or feel guilty about my detachment. I was a 6-foot, 180-pound pair of hands with a fanny pack and the word “dumbass” stamped across my forehead. Finally, at 6:30 AM, half an hour before my rotation ended, a technician found us and asked me to help with a patient. I followed her into the room, where a teary-eyed young woman was lying naked from the waist down on a bed, looking like she had been through a hellish night. A resident physician came in and explained the situation to us—the woman had a painful abscess in her lower groin region which needed to be drained and bandaged. Our job was to keep her calm during the procedure, and to make sure she didn’t move too much. She cried through the whole procedure as we clasped her hands in ours and told her it would be over soon.

Mike and Colleen smiled and waved to me from inside the double doors I walked out of the ER. I felt I could take some pride in Mike’s last words to me—“You’re going to do fine here.”—although I wasn’t sure how I had earned that. I left St. David’s just as the sun was coming up. Cars were beginning to line up for the freeway entrance, and coffee shops lining the streets were opening for business. It suddenly seemed strange that so many things could exist and function outside of the hospital.

Anthony was already up and making coffee by the time I walked in. I walked straight through the living room and threw off the fanny pack before stepping out onto the balcony and lighting a cigarette. Anthony came out with two cups of coffee, and we smoked and drank. “So how was it?” he asked. “Did you get to do anything cool?”

I thought back to my night, all the incoherent patients I met that I barely spoke a word to, people I strapped tubes and wires to, people I held down so nurses could start IV lines on, and finally the young woman whose hands I held as a doctor tore open a hole above her vagina. “No,” I said. “I didn’t do a damn thing.”


Nobody ever wants the graveyard shift for St. Patty’s day—it’s usually just a shit-show. Most of our patients are always drunk, crazy, or incoherent in some other manner. I guess it was just my turn to bite the bullet this year.

The night starts out like any other. I get my coffee, look at the rotation list to see who’s on for the shift, and then look through the patient charts. An hour into my shift, Colleen tells me that there’s an EMT trainee coming in later for a rotation. “Alright,” I tell her. “You mind looking after him?” She gives me the ok, and not long after, I see him walk in through the double doors, wearing a buttoned uniform, complete with what looks like a fanny pack hanging off his waist. I can't help laughing to myself a bit. The kid looks eager but clueless. With his gangly frame and remnant traces of acne, he can hardly be over 19. He comes around to the nurses’ station and I let him know where to go. Colleen’s already with one of our regulars—a heroin addict that likes to steal meds from vet clinics and overdose from time to time. The kid shuffles on over while looking back at me, like he’s half uncertain whether Colleen’s actually in the room or if he’s about to walk in on some elaborate prank.

After about 10 minutes, I get buzzed to help out with our dope addict—no one can get a line started on her. I crack my knuckles and walk into the room to get things organized. First off, I need to get her to lay still and stop moving her arm. I give everyone a job and tell the kid to hold her arm down for me. I can tell he wants to say something, but he forgoes it, instead snapping on some gloves and jumping in. I get the line started and Dr. Ramirez arrives to take over. We can tell right away he’s in a bad mood, so nobody stays to chitchat that isn’t needed.

The rest of the night goes about how I expected. Drunk old men, some homeless schizophrenics, one or two heart attacks. Colleen and the kid seem to be seeing a lot of action—they barely get a moment to sit still for the next 8 hours. The kid’s expressions seem to sway between confused and frustrated, but he keeps doing what he’s told. No job seems too dirty or trivial for him to complain about, and I like that about him. The ER isn’t really the type of place where you can take a lot of time to process things in your head; people come through, we plug up their holes and make sure they’re breathing ok, then send them off to whoever is next in line to treat them. It’s a completely new experience for the kid, but he’s trying hard to get acclimated.

I give him a pat on the arm as Colleen finishes signing his paperwork at the end of the night. “Good job tonight,” I tell him. “You’re going to do fine here.”

We wave at him as he walks out, and then get back to our charts as the double doors close. An announcement blares again on the intercom: another ambulance arriving soon with a Tylenol overdose patient.

What we talk about when we talk about love

Yesterday:    I’ve wasted a Saturday afternoon, but it won’t be the last. But now that the days are longer, there are some salvageabl...