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Rushing through the Foliage (秋色急馳)

The Poem in English 

green green   green yellow   green green red,          

yellow yellow   green green   green yellow red,        

red red   green green   red yellow green,                   

yellow green   yellow red   green green red.             

Pronunciation in Chinese

lǜ lǜ    lǜ huáng    lǜ lǜ hóng, 

huáng huáng    lǜ lǜ    lǜ huáng hóng,

hóng hóng   lǜ lǜ   hóng huáng lǜ, 

huáng lǜ   huáng hóng   lǜlǜ hóng. 

The Poem in Chinese

 綠綠綠黃綠綠紅、         

 黃黃綠綠綠黃紅、            

 紅紅綠綠紅黃綠、     

 黃綠黃紅綠綠紅.

Note*:  I was rushing through the New England highways, passing by shades of colors the foliage threw onto me.  I sometimes just felt the reds and yellows randomly cutting through the greens, but without thinking, without appreciation, without judgment. If I had some intention to interpret them, perhaps I could come up with certain meanings. I am sure that there are lots of people who want to and can find more meanings than those who try to interpret Impressionist Art, more meanings than a psychiatrist who meets a patient for the first time. 

Individual patient’s and significant others’ feelings have long been a key concern in psychiatry.  In public health research, there is an increasing emphasis on community participation research, which hopes to promote all stakeholders’ perspectives. This poem reports that a person may not have any perspective, any meaning, or even any feeling about certain things about everything at least some of the time.   

I ended up writing a poem to record such an experience. It is a new kind of poem that helps people share such impressions. This poem emphasizes a rough, ambiguous impression of three groups of colors: green, yellow, and red, while discarding the shapes within each. I am going to mix all these shades randomly into an impression of only three colors which reflects a state of mind free of meaning, free of feelings, free of intentions. As such, this poem must violate two major conventions of literature – by filling the whole piece with only three words, and all of them are adjectives, no noun, not even adverb.

Note**:  The closest format that helps me prune such an experience into a literary style is probably the Classical Chinese seven-character-in-four-line-poem. It fits the random line-up of short rows of colors along the highway, and I can still insert its rigid rhythm pattern that can be recited with a music-like sound effect. The carefully arranged framework enhances the rhythm effect of the whole poem (Try reciting this poem in Chinese, as shown in the block of Pronunciation in Chinese located next to the English version). Such a rhyming convention has been a key reason for the popularity of Classical Chinese Poems. It helps the spreading of messages. Over the last 3,000 years, millions of Chinese in each generation have been able to remember and recite at least a few of such poems, illiterates included. In addition to using only three characters to fill up all 28 slots, I have also to violate one more requirement of such convention – that there should be no more than one or sometimes two identical characters in a poem, especially not in the same line.  

Note***: Most Classical Chinese Poems require structured rhyming in every line and every location in a line.  While certain locations allow for flexibility, the last character in at least half of lines must come from one of several dozens of groups of tones. 

There are roughly two types of tones: Flat (F) and Ramp (R) tones. The location of each character must follow a certain pattern, unless either F or R is allowed (X). There are several sub-groups of the Classical 4 x 7 style poems, depending on the pattern of location of the tones. The version of this poem follows this pattern: 

X R X F X R F,

X F X R X F F,

X F X R X F R,

X R X F X R F.

Tom Chung, Ph.D., M.Phil., B.S.Sc., is a professor in the Fay W. Boozman College of Public Health. He has also maintained a life-long passion in the study of Chinese history, culture, and poetry. He is one of a few writers who has published in five Chinese societies and diasporas, despite their political differences.

Pain Lives in Both Misery and Joy (with Commentary by Billy Thomas, M.D.)

By Kacee J. Daniels

Pain lives in both misery and joy, respectively
it is the volume and projection that differs among them.

… at least that is what they tell me; I believe it.
It is my existence. I know no other way.

Force feeding me a game that destroys me by design
I swallow every bite and ask for more.

Blood drips from my lips–the glass shards.
I love them. 
At least I know the infliction to come when I see them glisten on the fork.
I love them. I really do. I must. I love them. 

Consuming them satisfies the sovereign, 
Who am I to disappoint?
So I crave them, and I ask for more…

Explanation:

This poem sheds light on the experience of a young black male who has learned to convert the conformity, discomfort, and pain required to become successful in a world not made for him into something digestible. As twisted as it sounds, he has convinced himself that he enjoys the very things that inflict harm to him internally. That young black male is the author, me — Kacee.  

Misery and Joy: Double Consciousness in American Medicine

Commentary by Billy Thomas, M.D.

Kacee Daniel’s Pain Lives in Both Misery and Joy reminds me of the concept of “Double Consciousness,” first presented by W.E.B. Du Bois. It is evidenced in the lines “Force feeding me a game that destroys me by design, I swallow every bite and ask for more.”

In 1903, during the post-Reconstruction period and more than four decades after the passage of the 13th Amendment, W.E.B. Du Bois introduced the term “double consciousness” to describe the internal conflict that existed in newly freed enslaved Black persons as they struggled to survive and assimilate into an environment dominated by a white majority. Du Bois states: “One ever feels his twoness – an America, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder.” These two warring ideals—to either join mainstream society or to reject it and define the world and relate it entirely from a Black perspective—are at the core of double consciousness, resulting in a struggle to establish one’s identity (Du Bois, 1903; Bonner, 2006). Black Americans lived in two worlds: one composed of like individuals who shared ancestry, culture, religion, values, and experiences and another world dominated by a white majority and a culture in which there were very few shared experiences, ancestry, or values—namely, a world in which Black Americans were not considered truly human, only property. In order to survive, formerly enslaved people found themselves in a position in which they had to conform and assimilate into a white society. In order to assimilate and progress socioeconomically, Black Americans were forced to take on the values, manners, ideologies, and the religion of a people that were foreign to them and, according to the ruling majority, pre-ordained as the only true human beings, creating an aspirational level or standard of humankind to be achieved by Black Americans. As is the case with many minority populations, this overwhelming internal struggle may give way to the adoption of the dominant group’s values and ideals, resulting in the dilution or even the erasure of the minority group’s values and structure—in this case Black Americans—leading to the loss of personal and group identity.

How does one make the transition to fit into a social structure that historically has been discriminatory, polarizing, and abrasive to individuals who are different from the dominant group? Black Americans were torn between trying to retain their true heritage, culture, and values as human beings (i.e., personal and group identity) and conforming to a system that demanded shedding all that was representative of their personal identity and culture in favor of adopting ways of life and thinking that were foreign to them and based on the norms, values, religion, and ideologies of a white majority.

In many ways the poem highlights the ongoing inner struggles of coming to grips with one’s efforts to become part of a culture and educational environment in which minority and marginalized people have historically been less valued. It is about retaining one’s personal identity in an ongoing struggle to assimilate and progress through an educational system and a society that was developed by and in many ways favors the dominant majority. It is about the day to day pain and exhaustion of attempting assimilation and navigation of social structures and educational systems along with the ongoing struggle to find one’s personal identity in a political, economic, and educational landscape normalized to the dominant majority. It is about an ongoing quest for knowledge and assimilation at the risk of losing one’s self.

Double consciousness is not unique to Black people and applies to any minority group of people who seek to integrate and assimilate into a large homogeneous majority population. It likewise applies to the large number of people who have immigrated to this country from around the globe. In many cases the difference in the level of assimilation has been determined by skin color as a proxy for race. The very visual evidence of skin color has been used to deny access at multiple levels. Although this affects all people of color, its overall impact is more pronounced on Black Americans whose ancestors were bought and sold as slaves and whose basic make-up has been shaped by generations of enslavement, discrimination, and marginalization. The result is a deep internal conflict with one’s self and a continuing struggle to overcome the internal racism, low self-esteem, and loss of self-created by systemic racism. Perhaps the best illustration of internal racism, the lack of identity, and the feeling of inferiority produced by racism is a series of experiments conducted by Drs. Kenneth and Mamie Clark in the 1940s in which Black children between the ages of 3 and 7 were asked to identify the race of dolls and which dolls they preferred. A majority of the children preferred the white doll and assigned positive characteristics to it. The study concluded that prejudice, discrimination, and segregation created a feeling of inferiority among Black children and damaged their self-esteem, resulting in a loss of self-identity and creating what we now consider internalized racism (Jones, 2000; Clark & Clark, 1939; Green, 1997).

Researchers have applied the term “toxic stress” to the effects of persistent adverse life circumstances—such as racism, discrimination, and poverty—that may influence the genetic predispositions that affect an individual’s emerging brain architecture and long-term health. Toxic stress has been shown to have a pronounced effect on those areas of the developing fetal brain that primarily function in our critical thinking, behavioral responses, cognition, linguistics, and ability to respond to stressful situations (Shonkoff J P, 2012). Long-term effects have been shown to be intergenerational. Historically, Black Americans are the descendants of a population that was subjected to an environment and culture of constant stress and fear of being beaten, killed or lynched, and sold at the whim of their owner (Blight, 2011). Along with the unmeasurable trauma of separation of families, this produced a level of chronic toxic stress that may manifest itself as both implicit and explicit changes in behavior, critical thinking, and ambiguity about one’s true identity. These long-term changes could serve as defense mechanisms and operate at the core of double consciousness. Black Americans continue to conform in an attempt to assimilate into a majority world that, in many cases, continues to be unfair and marginalizing. As our understanding of the long-term biological effects of toxic stress improves, we may be able to identify an unconscious and biological basis for double consciousness.

While double consciousness maybe the internal manifestation of biological processes (i.e., epigenetic) that have become deeply engrained in Black Americans and profoundly affects critical thinking and behavior, code switching may be considered the superficial manifestation of double consciousness. It can be unconscious or deliberate, and it may play a significant role in our daily behavior and activity. The foundation of code switching is based on linguistics (or language variations) and situational behavioral changes during social interactions (McCluney et. al, 2019; Nilep, 2006). Code switching is ubiquitous throughout society, more specifically in minority communities, and is a conscious effort to fit in or conform. It is controlled and applied at will and is readily used to fit into daily interactions, events, and environments. Although superficial, it creates a baseline level of chronic stress.

As long as there are dominant and subordinate groups, remnants of double consciousness will remain. Our goal should be to look at double consciousness from a historical perspective and try to understand its manifestations in Black, Indigenous, and People of Color (BIPOC). In order to do this, we must first try to understand the mitigating circumstances of slavery, segregation, institutional racism, and their generational effects on Black and White Americans in creating dominant and subordinate classes based on race. We must realize and take ownership of past wrongs and move to change. In order to move forward, the possible origins and realities of double consciousness must be recognized, put in context, and applied to our current state of racial tension. How did we get here?

Behavior is not fixed (nature) and is influenced a great deal by the surrounding environment (nurture) (Jones, 2000). Individuals and populations exposed to continuous toxic stress develop specific responses that can be heavily influenced by their support systems—such as families, communities, religious leaders, teachers, health care providers, and mentors—resulting in an increased awareness and understanding of existing social structures along with the development of skill sets that allow individuals to overcome social barriers and progress in a majority-dominated world. (Hughes, 2006). As is the case with many minority and marginalized groups, BIPOC must strive to overcome the barrier of double consciousness in order to find a place in which the very soul is at peace, where self-worth overrides external factors that could create barriers to attaining consciousness of self, development of personal and professional identity and fulfillment.

The intent of this commentary is to increase awareness, educate and promote change. As an African American male who has spent an entire career in academic medicine I’m very aware of and have experienced the external barriers and internal struggles that result from assimilation into an educational environment with very few or no minorities. I’m also the product of a segregated, and later, integrated public school system. Neither of these facts makes me an expert on poetry or an authority on the genesis, biological basis, and reality of double consciousness, but as one with a lived experience that encompasses many of the conflicts highlighted in the poem, it does give me a very unique perspective and insight surrounding the behaviors, perceptions, and perhaps critical thinking of students and faculty of color as they seek to become part of the medical community. Over the years my role as a faculty member as evolved from one as primarily a clinician and researcher to one as a teacher, advisor, mentor and coach. As a faculty member part of my responsibility (duty) is to share my perspectives and past experiences and possibly give meaning and basis for the feelings of isolation and ambiguity experienced by many students and faculty as they struggle to find themselves and develop their personal and professional identity. This has given me the opportunity, privilege and honor to be involved in the personal and professional lives of multiple students and faculty. Needless to say, it has shaped me personally and professionally.

Lastly, and maybe more importantly, the poem highlights the value and critical need of an institutional awareness and culture along with transitional programs and support systems that serve to mitigate the experiences of minority students and faculty as they adapt and maneuver through an academic environment that may not be inclusive and nurturing. In spite of what may seem an overwhelming struggle, I remain optimistic as local and national health professions institutions continue their efforts to address the lack of diversity in medicine through the creation of leadership positions in diversity, equity and inclusion and organizations like the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education continue to institute policies and provide guidelines and strategies that seek to increase diversity and ultimately change the culture of medicine (Association of American of Medical Colleges, 2020).

Notes

  • Association of American Medical Colleges. Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments. Academic Medicine. December 2020 Supplement, Volume 95, Number 12. S1 – S177.
  • Blight D W. Race and Reunion: The Civil War in American memory. The Belknap Press of Harvard University Press. Cambridge Massachusetts, and London England. 2001.
  • Bonner F A II. The Temple of My Unfamiliar. In Faculty of Color. Teaching in Predominately White Colleges and Universities. Staley CA, ed. Anker Publishing Company, Chapter 6, pp – 80-99, 2006.
  • Clark K B and Clark M K. The Development of Consciousness of Self and the Emergence of Racial Identification in Negro Preschool Children. The Journal of Social Psychology Volume 10, 1939, issue 4. 591-599. https://doi.org/10.1080/00224545.1939.9713394
  • Du Bois W.E.B. The Souls of Black Folk. Penguin Books, 1903.
  • Green C D. Classics in the History of Psychology. Clark K B, Clark M K. The Development of Consciousness of Self and the Emergence of Racial Identification in Negro Preschool Children. Journal of Social Psychology Bulletin 10 591-599. https://psychclassics.yorku.ca/Clark/Self-cons/
  • Hughes D et. al. Parents’ Ethnic–Racial Socialization Practices: A Review of Research and Directions for Future Study. Developmental Psychology. 2006, Vol. 42, No. 5, 747–770
  • Jones C P. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000 August; 90(8): 1212–1215. PMCID: PMC1446334
  • McCluney CL, Robotham K, Lee S, Smith R and Durkee M. The Cost of Code Switching The Big Idea Series/Advancing Black Leaders. Harvard Business Review. November 15, 2019. https://hbr.org/2019/11/the-costs-of-codeswitching
  • Nilep C. “Code Switching” in Sociocultural Linguistics. Colorado Research in Linguistics, Volume 19 (2006). https://scholar.colorado.edu/cril/vol19/iss1/1
    DOI: https://doi.org/10.25810/hnq4-jv62
  • Shonkoff JP, Leveraging the biology of adversity to address the roots of disparities in health and development. PNAS, 17302-17307, October 16, 2012, vol. 109, suppl 2. www.pnas.org/cgi/doi/10.1073/pnas.1121259109

 

 

 

Mama Tiger

By KateLin Carsrud

I am eating almonds. These days, I can’t seem to get enough of them. Something about the bland crunch of them pulls me in. Biting into an almond is like snapping a twig. It is firm until it is not anymore, solid and then suddenly broken.

My husband Liam has his head resting on my lap, near my pregnant stomach. I can’t tell if he’s napping or not. I softly scratch his hair and wait for a response.

“Sleeping?”

“No.”

Another almond. I place it between my back teeth and pinch it there for a second, not biting down. Then I apply pressure, more and more, until it snaps apart.

“Destiny.”

“What?” I smile to myself and wait for him to tell me to close my mouth when I bite. It’s something he would say.

“Mom wants to be there when you have the baby.”

Chewing my almond. “Of course, we’ll tell her when I go into labor.”

“She wants to be in the delivery room.”

I had placed another almond in my mouth while he was speaking, and I now let my teeth hover over it. I sit there a few seconds, paused, thinking. Finally, I close my jaws around the almond and break it.

I say, “She can’t.”

“It’s important to her.”

“She can’t. I don’t want your mom to see my stomach.”

“You’ll be in a gown,” he says it like it’s a suggestion because he knows that a hospital gown is not secure covering, especially during labor.

“You know it still might show.” My stomach. But not even really my stomach—the scars stretching their way across my skin, my stomach just being their home. My past, my secret; now Liam’s secret too.

“I know.” He says it softly.

“Tell her we want it to be an ‘us’ thing. She can be there and see us right after.”

“Yes.” It is a quiet answer, to pacify me while he tries to find a way.   

I begin to feel frustrated. I want him to have no hesitation in his voice, to be quick to come to my aid.

It is quiet for a few moments. Then: “Des, what if you just told her?”

“No.”

“Baby, she loves you. You are close with her. You could talk to her about it.”

I stare hard at him and only say his name. A warning.

“What?”

I hate him for pushing up against the line of my comfort. He wants to help me, see me grow. He thinks this is growth; I hate him for thinking that. 

“I shouldn’t have to explain this to you.”

He moves up more and sits by me. “This will hurt my mom so much.”

“I’m sorry. This isn’t her business. I don’t want her to know about my past like that.” A breath. 

“She’ll have questions, of course she will, and I don’t want to give answers. It’s in the past.”

“If you say it’s in the past then it shouldn’t be a big deal. Tell her you did it when you were a kid, she’ll understand—”

“She will not understand.”

“She will! She loves you.”

“That doesn’t matter. Liam! I said no, leave it alone. Fuck.”

“Then what do I tell her.”

“Be on my side.” I bite the words out, trying to press them into his skin, hoping to make him feel the same pressure that’s assaulting me from every angle.

He doesn’t look at me. “I am on your side.”

I turn my head from him, angry that he pushed me so hard, angry that this is a fight that ever existed.

The first time we began to take our clothes off together, I felt hot panic rise in me. What do I do, how do I say this, what do I do, what do I do? —these thoughts circled my head. Which words will I choose? How will I tell this man about the thick, mountain scars stretching themselves across my stomach—or, worse, how will I look at him and say: “I did that, but—trust me—it was just a phase.” It would have been better if it had been done to me—I could have been attacked, raped. I longed for a terrible excuse—something, anything to take the weight off me. Maybe if I had an abusive father who took his anger out on me with a knife—that would be an easier story than the truth. The truth was hard to grasp because the truth put a knife in the hand of a young girl and had the girl drag the blade across her skin—and, why, would a little girl do such a thing? What happened to you, girl?

Real life came so fast, though, and my thoughts couldn’t keep up with the hands that were running fingers through my hair, that were touching my face, that were tugging at the bottom of my shirt—the bottom of my shirt, and then the top of my pants. Quickly, without thought, I grabbed his hands and moved them up. I set them on my breasts, held them there, acted like I wanted that most. I thought: please, please keep your hands there—anywhere but the lower parts of my stomach. Safe now, I kissed him without thought, let him move me back to his bed, let myself fall onto the bed.

But his hands—damn his hands—he moved them slowly down again, down to the place that I had pushed them from, down to the lower stomach that I had decided a long time ago would never be touched. Because he felt good, and because I didn’t want to say no, I played the game of how far I could go. I promised myself that I would stop his hands after they traveled two more inches. I longed for those two more inches—and I had them and felt them and loved them. As soon as they were over, and his hands didn’t stop, I pulled myself from the feeling. I told my hands to move, to grab his hands, to pull them away. So, I did, again. I hated this, though, because I knew that this action was me saying no, when all I wanted to say was yes.

He pulled his lips away from mine, looked at me. “Sorry, I’ll stop.”

Immediately, anger filled me—anger at myself, for keeping us from the intimacy that we both wanted. I regretted it, the cutting, the nights alone that I imagined were secret and romantic, somehow—now, they felt like nothing. I was left, underneath this man, feeling like a stupid, inept girl. I was so tired of hiding, so tired of being afraid. The fear and embarrassment that sat on me was heavy—I wanted to throw it off.

I made a decision. “Give me your hand.”

“It’s okay, we don’t have to.”

“No, give me your hand.”

He did.

I grabbed his hand in mine and moved it to the place it wasn’t supposed to go. I placed his fingertips on the mountain scars. My heart was beating, fast and strong, and I was afraid. But, I pressed on. I moved his hands over the tops of the scars, to be sure that he had felt them.

“Do you feel that?”

Slight confusion spread across his face because this was not what he expected. “Yes.”

“Those are scars.” A breath. “Don’t ask me about them.”

I left his hand there, on the mountain scars, and I went back to his lips, to kiss him, to tell him to keep going. With each kiss my power grew—acknowledging what was there but refusing to talk about it. We were good now.

The next morning, I woke up on my stomach and buried in a blanket. I felt the heat of Liam’s presence, but I couldn’t see him. My thoughts were jumping up and down, wild. I could barely grab hold of them, barely settle them down. I was not in the present; instead, I was thrown back to my childhood, back to the girl who first decided to cut herself. I hated her, because of the difficulty that she was causing me now. I hated her, because she had left me a long time ago—her crazy, comforting thoughts didn’t feel as good as they used to, and I was left the consequences of her actions. I was left with scars that I could hardly justify or explain. I thought back to my childhood, to the night that I permanently changed myself.

I had been trying to catch sleep for a few hours, but there was something inside me that ran at a quicker pace than I did; it left me bored, the walls of my mind reverberating with the silence in my room. It was so quiet that it was loud, a startling loudness, one that made me think that the clothes in my closet were speaking to me. They whispered to me that I should come to the closet. They changed their minds and whispered that I shouldn’t, that it was bad. They hummed words that I couldn’t understand—something, something, something. They said that I should turn the lights on in my room. It’s too dark in here, they said. If I turned the lights on then it would be easier to breathe. 

I had a feeling lingering in my stomach—it had been residing in me for a while now. That feeling, mixing around with the silence coating my bedroom walls and carpet, left my mind anxious. It wanted to experience something explosive, just so that the silence wouldn’t be quite so loud. The feeling made me reckless.

This was the first time that I crept barefoot across the wooden floor outside my room. My head was hot with excited anxiousness. Sweat grew on my forehead, the sweat that comes with fever. As I continued forward, the sweat followed me, creeping down my body. It moved down my hair and wrapped itself around my neck, slipped between the front of my breasts, attached itself between my shoulder blades. It nestled in my lower back and somehow moved down to my feet—they stuck to the hardwood, making little clicking sounds as I walked. It was louder than the silence, and I thought that maybe my parents would hear it through the ceiling and stomp downstairs to question why I was out of bed. My mouth was dry from trying not to breathe. Everything felt loud. The sound of my feet, the sound of my in-breath, out-breath, eyes blinking. Every movement reminded me of a noise. This was the first time that I decided to do the thing that had been rolling around in my brain, settling down and taking root in my mind. I was afraid of my parents catching me. I didn’t want them to be involved in something so forbidden. They would label this evil, wrong. They would label me: sad, confused girl who had lost her mind.

Where had my mind gone, though? I didn’t lose it—I never stopped owning it. I had just decided to act on the thoughts that had always been crawling around my head. But, if I had lost my mind, if that were the case, then I decided that I wanted to keep on losing it. This losing of my mind wasn’t bad to me, or dangerous; rather, it was a good-bad and a dangerous-good. This was the real me, the one who was made to push herself to unknown depths and experience secret adventures.

I reached the bathroom. Grabbing the cheap, pink razor that my mother had recently given me to shave the thin girl hair on my legs, I prepared myself.

“Okay, okay, okay,” I whispered quickly.

I set the razor down, briefly, to pull my big pajama t-shirt over my head. Grabbing the razor again, my eyes found the flesh of my stomach. Except for the scattering of soft baby hairs, it was unmarred. I hated the cleanness of it. Quickly, before my fear could pull me back, I pushed the sharp silver onto my skin, until my skin wouldn’t bend inward anymore and the metal broke through me. Holding my breath, I pulled, and then I pulled faster—still pushing downward, trying to hold onto courage. It hurt, it hurt—a sharp, uncomfortable pain that made me breathe out hard. I let up on the pressure, but I still kept dragging. This splitting of skin was one of the most beautiful pictures. It was soothing, addicting. I saw it slowly in my mind. First, my hand moving, slipping over an empty canvas, coloring it; then, a canyon—a ridge of skin on one side, and then a ridge of skin on the other. Only for a moment, the canyon sat empty, but then it filled, flooding through and over with a dark red river. I watched it run over me. I loved it.

I am sitting in the bathroom, waiting for early morning nausea to pass so that I can begin my day. As I wait, I am distracted by the big belly resting in front of me. I am distracted by the life inside, a new life, an entire story to unfold; mostly, though, I am distracted by the skin that covers the growing life. It’s stretched taut, like a balloon about to pop, and the shiny smooth sections of skin look fresh and new—but rare. My stomach is covered with the scars that I have carried for most of my life. But now they are different. They have grown, they are worse—an even bigger reminder of what had once possessed me. With the stretching skin of my stomach also came the stretching of the mountain scars. Two times, three times the size they once were—pink, purple, red, mixing around with the stretch marks that appeared. It’s ugly.

Noise. I look up from my belly to see Liam in the doorway. Standing slowly, laboriously, I walk up to him and give him a hug.

“Morning, baby,” I say.

“Morning.” He gives me a small peck on the lips, then moves his eyes down to my stomach, to our child. Love for what we made flashes there, and he leans in to kiss me again. Then his hands softly caress the skin on my belly, moving around as if to feel the unborn child; but always, as if from long practice, he maneuvers his fingers so that they dance around the ridges of my skin, intricately weaving around the parts of me that he doesn’t want to touch.

Maybe he thinks I don’t notice.

While his hands play hide and seek with the pure skin on my stomach, I turn my face to look at his. I wonder when he began to be afraid of me.

“I don’t care if you touch my scars.” I don’t mean to say this so suddenly, but my chest is swelling with fear, a worry that he has become embarrassed of me. There was never a moment since we met that I felt insecure around him; but suddenly, I do.

“I don’t want to,” he says.

I feel the redness that begins to creep from my chest to my face. I try to push it down, to seem indifferent, but it won’t move. “Why not?” I ask him. My voice is softer now because I am trying not to break down.

This is what I feel: You love me. You said you love me more than anything. Why won’t you look at me—all of me. Why won’t you touch me? When did I become too much for you; when did my big stomach go from being what we conceived to a constant reminder of your least favorite part of me? When did you begin to see me as a weak woman who you can’t understand?

Liam sighs, like this conversation is too much for him. “I don’t want to talk about this.”

Panic. “We have to talk about this. I’m carrying your baby, Liam. Why don’t you want to touch me? Do you think I look gross?”

“Not gross.” His words firm and certain. “Something else. I don’t know. Your stomach looks like it could rip open. I never thought they would look this bad. I worry.” 

My voice becomes shrill, frantically grasping for his understanding. “I was confused, we’ve already talked about this. I was just sad, just alone.” I look into his eyes, not wanting pity, but needing it.

Shaking his head, he lifts his hands. He says this slowly: “Little girls don’t get confused like that. Sad girls talk to their parents. Lonely girls make friends—lonely girls don’t do that.” He waves his talking hands at my stomach, the scars on my stomach, as if to push them away or to make them disappear.

“I’m sorry they look so much worse,”I say. “But you signed up for this.”

He sighs. The air he blows out is covered in sadness, resentment, and love. He says, “I know.”

I can’t pull any words out from inside of my head, but they are swimming, rising, drowning me. It is quiet between us now. Neither of Liam’s hands are resting on my belly anymore, nothing holding me there, and all I feel is eagerness to escape this bathroom—to be away from Liam and the new insecurity that I feel while in his presence. But, before I can move, Liam quietly turns and walks out.

Alone, I lean against the wall and slide down inch by inch to the floor.

Pathetic sobs begin to fall from my lips, with each breath worsening, escalating with my panic. I gasp for big gulps of air in between my tears. Hysterical thoughts trample my brain; I think: When. When did this happen? When did he stop loving me—he must not love me anymore. If he loved me, he wouldn’t act afraid of me. He must not even like me anymore. He won’t even touch me anymore. But I’ve changed, I’m not that way anymore, why did he give up?

When we were young and new, he didn’t act this way.

A few weeks after we’d been together, even though I told him not to ask, he did. I didn’t want him to ask; but, at the same time, I was grateful that he did. It was a weight lifted off my shoulders, a relief. I needed him to care. We were eating popcorn. I had made it myself, the way my dad taught me when I was young. I put a bit of vegetable oil in the bottom of the big pot, let it heat up, and then poured in a fourth of a cup of kernels. They hit the bottom of the pot, loudly. Putting the lid on, I held both handles on the sides and shook it around so the kernels wouldn’t burn. My arms were tired by the time that the kernels had all popped.

Liam was sitting down, watching me, but mostly watching the TV. I threw a piece of the popped corn at him to get his attention.

“Hey,” I said, “popcorn is done. Get some and I’ll set up a movie.”

“Ok, ok.”

I put a movie on, and we sat side by side on the couch, hips touching. The bowl of popcorn that we shared was nestled evenly over us—half on his leg and half on mine. After a bit, I slouched down on the couch so that I could tip my head over and lean it on Liam’s shoulder. He turned and put his chin on my head.

Reaching up, he grabbed the remote and paused the movie. “Hey,” he said.

It was the tone of his voice, serious.

“Yeah?”

“I want to talk about something, but you told me not to ask.”

“Yeah,” I agreed softly, remembering, knowing exactly what he was talking about.  

But I knew that he would ask eventually. I thought he might ask me what it was from—who did that to you? I was ready for that question. I thought he was going to ask if someone had hurt me; that seemed reasonable—how did you get those scars?

Instead: “I won’t ask. But, Des?”

As he spoke, his chin dug into my head. I could feel his jaw tense, wanting to say more.

“What?”

“Please, don’t do it ever again.” His voice was pleading, quiet and worried.

I assured him. “No, I don’t do it anymore. Not for a while.”

I was surprised that his first assumption was this—that I did it to myself—but I was glad that I didn’t have to explain it to him. I didn’t want to have to say the words: my hands did that.

Pressing his chin harder into my head. “Never do it again.”

“I won’t,” I said with more force, needing him to trust me. 

I untucked my head from under his chin and turned to look at him. “I promise. The last time I did it was years ago. I don’t want to do it anymore. I’m done with it.”

He nodded “yes” to me, agreeing but not fully believing—that’s what I understood that to mean. He closed his eyes, sealed his lips, breathed in and out loudly, heavily. He exhaled and held it out for a bit, thinking, eyes still closed.

Then: “Will you take off your pants?”

By this time, I was used to undressing for Liam. Every time we had sex, I focused myself on him and the love and this was the way that I put the scars out of my mind, forgetting they were there. As long as I was taking my pants off for sex, then my scars remained in the background. That was safe. But, this was different. Liam was asking me to put the scars out in the open with no desire humming between us. This was real.

“I can’t.”

He tipped his head, and a slight smile grew on the left side of his lips, finding humor in the moment, somehow. “You can’t?”

“I don’t want to.”

“But will you?”

I would.

I stood in front of Liam and forced down my fear of exposure. I wanted strength, to be strong and fearless—and, well, if I was brave enough to cut the stripes of the scars into my body, then I should be brave enough to show them off; or, at least, I should be brave enough to not shy away from their existence. Quickly, before I could let myself think and run away from the moment, I put my hands at my hips and I pushed down on the elastic of my sweatpants. I stood in front of Liam with my pants around my ankles, and I stood.

Reaching out, he lightly grabbed the sides of my underwear and pulled. He pulled until the terrain of mountain scars smoothed themselves out into valleys, and then he stopped. My sweats at my ankles and my underwear stuck around my thighs, Liam placed his fingertips on one thick scar, and he traced it until it ended. When he reached the stopping point of that scar, the tips of his fingers lifted and then rested on the beginning of another. He traced. It ended. Another. He stopped. His eyes transfixed on the extended pink flesh crisscrossed around my lower stomach.

“God. This is bad. How old were you?”

“Twelve, thirteen—around there. I don’t know.” I turned my head to the left, stared at the wall.

He didn’t say anything then. It was quiet between us, and the only movement was his hand on me. His fingertips traced more, over the scars that he had already felt. He traced them, pressed on them, testing them and feeling them. Intently, he looked at the scars as he touched them, as if the skin was a mystery and he had to figure it out. When he touched my scars, it was different than him touching my regular skin. The scar tissue was thick, and the nerves not as strong. I could feel his fingers, but lightly. They were whispers on me, trying to know me.

He spoke again. “When was the last time?”

I rotated my head from the left side to up. I looked at the ceiling and then I closed my eyes, then opened them, remembering. But I couldn’t really remember. “Years ago.” I said that with certainty.

He nods his head up and down, saying that he wants to believe me, but he doesn’t say any words. Instead, he grabs my hips and pulls me to him, his forehead pressing tightly into my stomach, and his arms wrapped around my waist.

It’s only a few minutes. That’s how long I sit there in the bathroom crying. It feels like hours because my mind travels back in time and reminds me of the days that were full of forgiveness and free of judgment and fear.

Only minutes, though. Liam must have walked out of the bathroom and then across the house, only to turn and come back. Now, he shuffles in and sits down on the floor, at my feet.

He says, “I don’t know why, but I’m really struggling.”

I sit quiet, not knowing what to say, deciding to let him do the talking.

Gently, he brings his arms up and wraps them around my calves. He hugs himself to me and puts his forehead on my kneecap.

“What if it comes back?”

I sigh, and it tumbles out of my mouth, laced with defeat.

“I worry that after you have the baby you might fall back into it. Sometimes women do, you know?” He asks the question softly, trying to make sure that his voice doesn’t crack around the edges.

“I know.” Whisper. Clear my throat. Sniff. “I just know that I won’t.”

He moves his head from its resting place on my knee, looks at me. “I love you. I’m just worried. Maybe afraid. How can you know? The scars on your stomach are proof that you aren’t always in control.”

I want to argue with him, say that the scars are proof that I was always in control. I had all the control. That’s why I put the sharp metal on my skin and pulled. But, I know that those thoughts came from a part of my head that Liam would never understand. If anything, saying that would prove his point, reinforce his belief that I have the potential to fall apart.

All I can say: “It was such a long time ago. I barely remember it anymore.”

What I mean: I remember it like it was yesterday. I can’t think about those days and not feel a cloud of nostalgia unfurl and bloom inside of me; yet, I don’t want them anymore. I did change, and I’m different and the scars on my belly are the scars of the little girl who made them but not the scars of Liam’s wife, the mother of his child. I miss that girl sometimes, but I don’t want her.

“Yeah. That’s what you always say. It’s just so hard for me to believe you when I see the scars. They are so bad. Worse now than they’ve ever been.”

I feel the love between us; it’s years worth of love. It mixes with the oxygen in the room, and it makes the air thick and heavy, happy and sad and a little bit hard to breathe in. Anxiety builds in me, and I sense my husband is choking on the trouble that I have gotten us into. My past is too much for him. He might never trust me, no matter which words I use to tell him that I’ve changed. I wish that I had magic to make him believe me. I wish that I had magic to push the scars off my skin and my instability out of the room.

But there is no magic. There is just truth and words. Liam says these words, and he means them. I want to flinch when he says them. He says: “Sometimes I just wish I didn’t know this about you. I don’t ever want our child to see those scars, to know this about you.”

His words hurt me, tear me apart, butI only say what I know. “I want to always be happy. I want a happy family with you.”

“I want that too.”

“And our baby might see them.” I inhale deeply and speak with courage. “And I won’t hide myself from her. I’m her mama.” With one hand I gently caress my stomach. I’m talking to my husband as well as my child.

He unwinds his arms from around my legs and reaches both of his hands up to my stomach, and he sets them there, one hand covering mine, holding me—holding all of me. His hands feel light on the scars, as they always have, whenever he touches them. He talks to our child too, quietly, caresses my stomach as he speaks. He says: “Your mama will protect you, baby girl. My baby girl.” 

“Do you remember,” I say, “when we decided to create her? It was after we went to that movie. We got home and you said you wanted a family.”

“I said I wanted a girl that would be as pretty as her mother.”

“And that we would name her Florence.” Liam looks at me and we both smile. “She’s moving,” I say. “Feel.” 

Liam spreads out his fingers, makes his hands as big as they can be, and he covers my stomach with them, holds as much of my swollen belly as he can. I arch my back a little and press myself into his hands. I love the feel of them. 

“You’re my girl,” Liam says, and he moves one of his hands up to touch my face. “It’s me and you.” 

KateLin Carsrud is a graduate student in the Center for Writers at the University of Southern Mississippi. Her work has appeared in Baltimore-based literary magazine JMMW, The Closed Eye Open, Throats to the Sky, and EQUINOX, where she was awarded the 2019 David Jauss Prize for Fiction. 

The Story of One

By Margot Cameron

On top of the overgrown milkweed, a single monarch
butterfly searches for a bloom, or nibbles on the leaf, or
perhaps deposits one egg.
Seeing the butterfly gives me hope.
One butterfly, one scraggly milkweed, one egg, one
caterpillar becoming one more butterfly to float on the wind
and begin again and again and again.

Margot Cameron, a retired psychiatric nurse, finds joy in the simple miracles right outside her window.

Heart of Love

By Manjusha Kota

I paint flowers and landscapes to bring beauty into my world and into the lives of my patients.

Manjusha Kota, M.D., is a Medical Oncologist-Hematologist who practices at the Kota Cancer Clinic in Hot Springs, Arkansas.

Emergence

My wife is a Master Naturalist who has planted milkweed from seed for the last few years. This was the first year that we had a Monarch come and lay her eggs on the plants! I spotted 12 little caterpillars munching out like little machines, getting bigger and bigger with their instars. At their final stage, we put them in an enclosure outside to keep them safe from birds and wasps. If you have never witnessed that final stage of caterpillar becoming chrysalis, just whoa. Whoa. Talk about transformation. They attached themselves to the sturdy thin bamboo and to the underside of leaves, hung in their telltale J and started shaking, looking like a wiggly dance troupe. Then, like magic, they started to shrink and smooth into the jade green wondrous cocoon, topped with literal golden crowns and flecks of gold on the outer casing. Jewels of the natural world. 

We counted to make sure they had all safely transformed into their safe hang outs, a perfect glowing dozen. And we waited. And we watched. Eleven days later, the first chrysalis changed from green to black, transparent. I could SEE the wings through the shell of the chrysalis. We moved each of them carefully and tenderly to a bigger enclosure, a bright green pop-up tent we take camping, which looked like a giant chrysalis, too, now that I think about it. The tent would give them room to dry and spread their wings. We put late blooming flowers in there with them so when they emerged, they would have some nectar to drink before their long journey South to Mexico. I sat in the tent with them for hours watching each metamorphic miracle emerge finally, drop, and slowly open its wings. Over the hours, their wings dried and expanded— another dance. They practiced their flapping and fluttering in the safety of the tent, and the next morning, all twelve of the beautiful kings and queens lifted off from our fingertips to the open blue sky. I wanted to share this experience of cultivating a monarchy with you, in case you have never seen this miracle up close. This was my first time, too. 

Plant milkweed! Protect the pollinators! 

Kai Coggin was named “Best Poet in Arkansas” by the Arkansas Times and won the 2021 Governor’s Arts Award for Arts in Education. She lives in Hot Springs with her wife and their two sweet dogs.

Conversation with Dr. Susan Smyth, the College of Medicine’s New Dean and UAMS Executive Vice Chancellor

Image of Dr. Susan Smyth
Susan Smyth, M.D., Ph.D., began serving as executive vice chancellor of UAMS and dean of the College of Medicine on June 1, 2021.

By Tamara Robinson

UAMS welcomed Susan Smyth, M.D., Ph.D., as executive vice chancellor and dean of the College of Medicine on June 1. We sat down with Dr. Smyth for a Q&A to help team members and friends of the College of Medicine get to know this new leader of medicine in Arkansas. Our conversation ranged from Dr. Smyth’s insights on the college’s evolving role in improving health in Arkansas, to her path to becoming a highly regarded cardiologist and researcher, to how she enjoys spending her free time.

What is the most pressing challenge for health and health care in Arkansas, and what will be the College of Medicine’s role in addressing it?

Our most urgent challenge is to turn the tide on COVID-19 and do everything we can to protect our patients, students, colleagues and loved ones. The more highly contagious Delta variant of the virus is rapidly gaining ground in Arkansas, and this strain is making more unvaccinated people severely ill. I urge our team members and their families who aren’t vaccinated to get vaccinated right away. And all of us must remain vigilant about wearing our mask in public and when we’re around others at UAMS. It is important to follow established safety protocols. We cannot become complacent.

Aside from COVID-19, I think the most pressing and longer-term challenge for our state is the issue of health equity, and particularly the large health disparities we have in rural and underserved communities. It is imperative for us to ensure the best possible health and equitable access to excellent health care for every Arkansan.

Health equity crosses all health issues and diseases, and our college’s role in solving these complex issues is multifactorial. First and foremost, we have an essential role in educating and training physicians for Arkansas, and that means individuals who are well prepared to address these challenges and to work with communities to eliminate health inequities.

With health equity as an important focus, how will our work as educators, clinicians and scientists in academic medicine change?

Part of this is will mean training our students – and training all of us – to look at health and disease prevention through a slightly different lens. Historically, physicians have been incredibly well trained to take care of individuals, and that needs to continue. We will always be committed to looking at how we can best meet the needs of each patient.

However, we must also become adept in thinking about how to best meet the needs of the population and communities. Consider the analogies between caring for the individual and caring for the population. We are accustomed to hearing from an individual patient and collecting data – vital signs, clinical laboratory data, imaging data – and having a conversation with the patient about their various issues and options for care, and then coming together around a treatment plan.

We need to be able to do the same thing at a community level. And when we say ‘community,’ we can mean people in a certain area, or patients with similar health conditions and risks, demographics and so on. From the clinical, scholarly and educational perspectives, population health and addressing social determinants of health will become increasingly important in our work.

What are the challenges of this newer approach to improving health?

Some of the key questions are how do we collect, interpret, share and utilize health information about a community? Increasingly, there are data resources available to tell us about populations. Armed with this information, it is important to engage with the community and have conversations around their values. What do they see as important? As with caring for an individual patient, it is very important to come to shared decision-making that leads to a healthier community and population.

To do this effectively for communities, we need to train and educate ourselves differently. We must support more research that helps us better understand the best options and strategies for improving health at the community level, and how to effectively implement solutions. We also must continue to develop partnerships and relationships with our communities that allow us to have those conversations, much as we build our relationships with individual patients. Our partners will include community groups, churches, hospitals, other health care organizations, civic groups and many others. It will take the entirety of the infrastructure to tackle some of these challenges.

So, this is what I see as the future of health care, and really, what I believe is the future of our college – to prepare all of us to take on that role.

As you have met team members and learned more about the College of Medicine and UAMS in your initial weeks here, what has surprised or impressed you the most?

I have been impressed with the caliber of our faculty and staff and excellence in all mission areas – education, research and clinical care. The collegiality and kindness at UAMS has really struck me, as well as the dedication of individuals and the institution as a whole to the people of Arkansas. I had a sense of that from the interviews prior to my appointment, and frankly, that’s why I’m here. Hook, line and sinker, I am all in for making our core vision of a healthier Arkansas a reality.

I earned my medical degree and my doctorate in pharmacology at the University of North Carolina in Chapel Hill, and later began my career in academic medicine there. I am tremendously grateful to my home state for everything it did for me during my career, and I greatly appreciate the unique role a public, state university has. The opportunity to impact lives across a state is incredibly powerful and really what we at public academic medical centers have a mission and a calling to do.

Team UAMS is living up to this calling for the state of Arkansas. The commitment to solving health and equity issues, to giving back to the state of Arkansas, is clear and compelling. I am thrilled to work with everyone in the College of Medicine and UAMS in this pursuit.

When did you know you wanted to become a doctor – and a physician-scientist?

I’m not entirely sure how I came to the decision to become a doctor, but I can say that sometime in my senior year of high school, I decided that I was going to be a physician-scientist. I loved my biology class, and I entered college with the goal of preparing myself to be an M.D./Ph.D. Interestingly, there was not another doctor in my family at the time, and I did not personally know an M.D./Ph.D. My grandparents were both teachers, my mom was an elementary school teacher, and my dad was a philosophy professor.

What drew you to your clinical specialty of cardiology and your research focusing on arterial and venous thrombosis?

Like many physician-scientists, I enjoy a whole bunch of different things. While in medical school, I really liked my rotations in different clinical areas, and it took me a while to come to the decision to do my residency in internal medicine.

During residency, I was struggling to narrow down my future to one specialty. Then, the blood thinner ReoPro (abciximab) received FDA approval for use in patients undergoing coronary stent implantation. ReoPro is a monoclonal antibody that works against a major platelet receptor, and I had worked with that antibody while researching blood clotting as a graduate student. I remember working in the coronary care unit and giving ReoPro to a patient. I recall thinking, if I want to merge my scientific interests in preventing thrombosis with clinical care, the place to do this in in cardiology. It was really the development of that drug that made me see the connection between my scientific and clinical interests. Cardiology is a great specialty for me because we cover many facets of care and I have had the chance to have long-term relationships with patients as well as manage critical illness.

Later, as a cardiology fellow at Mount Sinai Medical School in New York, I had the opportunity to work with the physician who developed ReoPro, Dr. Barry Coller. Dr. Coller is world-renowned and an incredibly compassionate physician, and he became one of my key mentors. The drug he developed, and that class of therapeutics, has saved hundreds of thousands, perhaps a million, lives. The opportunity to work with such a person – it changed my career and my life.

Switching gears on questions now. You and your husband, Andrew Morris, Ph.D., a renowned lipid metabolism and signaling researcher, aren’t the only family members joining us at UAMS.

Right! Our English labs, Carmine and Selah, have had distinguished careers as therapy dogs at the University of Kentucky, and we can hardly wait to introduce them and put them to work at UAMS. They have their own Facebook pages, so our Arkansas friends can start to meet Selah and Carmine if they would like.

Carmine is part of a mobility team, so he walks with patients. He encourages patients, for example, to get up and sit in a chair, and then to move from the chair. We have had patients who weren’t out of bed for months, and Carmine enticed them first to get to the chair, and then to get up and walk with him. Carmine is the most laid-back dog you can imagine.

Selah, on the other hand, is very engaging. In Kentucky, she worked with stroke patients on motor skills by bouncing a ball back and forth with them. She’ll jump onto their bed and let them brush her to work on hand and arm movements. She will step up and down on platforms to demonstrate movements.

We also have a Maine Coon cat, Bernadette, who rules the house and keeps both dogs in place.

What do you like to do in your spare time? Have you had a chance to explore some of Arkansas yet?

I love to read and enjoy cooking and gardening. Of course, we do frequent walks with the dogs. We are very excited about moving them to our new neighborhood in Little Rock and have been counting all the other dogs we see on our neighborhood walks. We had a great time in Hot Springs recently and are really looking forward to seeing the rest of Arkansas.

OK, here are some quick and quirky questions. What was the latest TV show you watched?

“Mare of Easttown.” My show watching is a bit eclectic. I love Jane Austen, period dramas and “Masterpiece Theatre,” HGTV, and am a huge fan of the Marvel Cinematic Universe (MCU) and “Game of Thrones.”

What makes you laugh?

My husband, Andrew, and our two sons. They all have different personalities and senses of humor. Andrew is one of the best satirists that I know.

What would surprise people about you?

I am really into P!nk – how she empowers women and encourages folks to color outside the lines really resonates with me. And, wow, can she sing.

Who would be your guests (anyone living or deceased) for a cup of tea and conversation?

Goodness gracious. There are so many choices. Abraham Lincoln. Einstein. Martin Luther King Jr. I would love to talk to Mary Lyon, the founder of my undergraduate college, Mount Holyoke, which was the first institution of higher education for women in the country. I would love to hear her passion, first hand, about education for women. Probably Madame Curie, as a female scientist. Those are some of the folks I would love to sit down and talk with.

This interview was previously published on the UAMS College of Medicine website. Used with persmission.

A Life Struggled Well

By Conrad Murphy

Photo of Clarke Johnson

Everybody has one. Everybody has their person. The one who was “the reason for going into it.” Who knows how many different names show up in each medical school application? Clarke Wesley Johnson. Not born to but adopted by Hans and Judy Johnson; the first boy of the family. He had darker skin than the rest of the household and a large scar from the top of his chest to his belly button. 

When I came along much later and asked why, he told me that his parents were Native American, and his scar was a battle wound from fighting off a buffalo when he was a baby. Only half of that was true, but I was too naive to tell which part. That was all I knew about his biological parents, besides the other thing. Their unintended but nonetheless terrible thing they left him with. The thing that made his lungs fill up with what my seven-year-old self described as gunk. The thing that made him take a duffle bag worth of medicines every morning. The reason he couldn’t work at a job, the reason he floated from our house to my cousins’, to my grandma’s, and back. I could pronounce cystic fibrosis at the time even though I couldn’t spell it. CF was a household name for us. For all that Clarke was, it would be best to say that he was my person. My reason.

“Uncle Clarke, why do you look so much bigger in this photo?” We were glancing through albums that my mother put together and we came to his section — one picture of him as a child next to my mom and aunts, the other of his high school graduation. 

He pointed to the corner of the room where that duffle bag of medicines lay, always in sight. I never knew him without it. During one stretch of his life, he stayed with us in our house. When he was home, he’d take my bed, making me sleep on the top bunk every night. I used to hate that. The land my family owned was his playground — field after field of a cattle farm, ponds to fish in, deer to hunt, hills to ride over. We’d take his metal detector out to the old burned house; we’d walk the boneyards hunting coyotes so we’d stop losing cows to them. Those were the years that I hardly remember him having a cough. Times like that never last though. 

Years passed and I found him at our home less and less. I got my bottom bunk back. He would often go to the hospital for tests, back out to Oklahoma with other family. I would see him for one weekend at home, but he was gone the next day because he only needed to pick up a few things. 

“Can I come this time? I’ll be quiet and won’t get tired.”

“Not this time, but the next one, maybe,” Uncle Clarke said. The coughing started to increase, not enough for me to notice it at the time, but in hindsight it was more than in the years prior. I found myself taking back the top bunk in case he came home and needed his bed back. Waking up to the bottom bunk still made was always a disappointment. 

The first scary day was on the brink of summertime, during my last days of school for the year. I got home and mom was on the phone, getting her things gathered and ushering me back out the door toward her car. 

“Yeah, just meet us there, and it will be fine.” She dropped her keys several times on the way out the door.

“Mom, where are we going? I just got home; can I stay?” 

“Your uncle is stuck in Alma; he needs us to come pick him up. Michael is meeting us to help drive him back.” Her voice gave a little bit, but she steeled herself when she heard it.

“What’s wrong with him?”

“He can’t drive all the way back to the house, we’re going to get him. Just get in the car, now.” It was a quiet drive, a long drive. 

Two and a half hours later we arrived at a gas station outside Alma, seeing to find my uncle leaned back in the front seat of his car. My stepdad and mom helped him walk over to the passenger side door before we all drove back home together. 

“Uncle Clarke is going to be staying with us for a while now, so you’ll have to help him if he needs something,” Mom told us. Although I would have much preferred him back without the illness, I wasn’t going to complain. 

Life resumed; however, my uncle was approaching two duffle bags rather than one and we stuck to video games indoors rather than running around in the fields all day. He seemed to get better and later invited me to go with him to his hospital visits. 

Not many children would enjoy spending the day watching their uncle go through multiple offices, scans, or blood draws, but I enjoyed going. One reason was because I got to spend time with him, and the other was that he always bought me a video game afterward. We got up early in the morning, had breakfast, and I watched him open his duffle bags. I spent the day watching him interact with several doctors, nurses, respiratory therapists, and radiology technicians. All of these people were working really hard to make sure my Uncle Clarke could breathe properly. 

I walked the halls of the tall buildings at UAMS, and it wasn’t long until I knew my way around easily. My uncle could trust me to go find the vending machines without getting lost and the nurses came to recognize me since we were there so often. I watched him groan as one of the nurses said that he had to complete another breath test. We walked to a different floor of the hospital where he greeted a technician while unenthusiastically handing me his backpack and medications. 

“Another one already, Clarke?” she said while untangling some wires and logging into the software for this big machine she had next to her. 

“I’m going to be breaking records on this thing if they make me come down here any longer. I’m going to have to really try on this one or they won’t like me upstairs,” he told me as he slipped on a large plastic mask. 

The technician gestured to him like they had their own secret language. My uncle nodded and took a deep breath before he exhaled as quickly and completely as he could. His dark face turned a purplish hue for a few moments until he couldn’t breathe out any longer. He swiped a few very fast breaths and took a few moments to recover until he was going again. The technician understood him without any words. 

We then left to go to a radiology waiting room and I had to watch him drink something that looked like the glue my mom would use to paste his pictures in the scrapbook we looked through years before. 

“This one is grape flavored, apparently,” he said as I laughed, and he giggled and gagged his way through the large bottle. He told me that he had to drink it because they were going to put him through a scan that lights up his lungs to see if they’ve gotten any worse. He told me that the scanner was like a big white doughnut, and it took pictures of him while he was passing through the hole of it. These visits continued and increased over time. I found myself going almost every two weeks toward the end. 

It wasn’t long before he started doing worse on the breath tests, and the impressions on the CT scans became longer. I went a full month without going to the hospital with him because he had been stuck there for that long.

“Mom, why can’t they just give him a new pair of lungs? If he had new lungs, he’d be fine!”

“Honey, they already did that.” Suddenly all of the medications and the large scar down his chest made more sense to me. 

When my mother came home with doughnuts for breakfast one morning, I knew he had passed away. We only got those when a family member had passed. She walked into my sisters’ room while we all were playing just as the sun was coming up. She explained to us that he loved us very much and wished that he had more time but was happy because he didn’t have to cough anymore and could finally sleep for more than two hours at a time. I just looked down at my doughnut, imagining a tiny Uncle Clarke passing through the hole.

Clarke chose to donate his body to cystic fibrosis research in the hope that gains would be made in the fight against it. We had a memorial service at the Methodist church in my small town. Every part of the service was miserable for me. It was the first time I really understood the cost of death. There was nothing but sobs around our table as we listened to the kind words that were said about him. I remember thinking these words would have meant much more to him if he were alive to hear it. Months later we had a second small graveside ceremony when we buried his ashes. My mom stood consoling my grandmother because she knew that children were not supposed to pass away before their parents, no matter how much longer he lived past the life expectancy for CF. I stared at the small canister on the stand at the head of the grave, trying to envision that it held all the memories, lessons, and laughs of a life. 

I considered my Uncle Clarke a second father figure. He instilled life lessons into me. He taught me how to shoot a gun, hook a fishing line, and how to ask a girl for a dance. He didn’t have any advice on dancing, though. The reason his memorial service was so unbearable was because his presence was the complete opposite. He meant so much to people. It wasn’t until much later as a high school senior that I came across a paper weight in a stack of his old stuff. It looked like a glass coaster that you would set a cola can on, but it was engraved with a pair of lungs surrounded by the St. Louis Gateway Arch, the monument of the city where my uncle had his operation. Below the paper weight was a picture of him shaking hands with the doctors who performed his surgery. 

As I walk onto the UAMS campus again as a freshman medical student, that image continues to stick in my mind. Some friends ask me, “Why would you want to work in a place like that? It’s where people go to die.” They aren’t necessarily wrong. It is the place where my Uncle Clarke died. To me, it is more of a place that he returned from, over and over. Although they did not cure him, they gave him time. They gave him time to teach his nephew, to make his sisters laugh as he always had, to play video games with his family, to attend Thanksgiving and Christmas gatherings. That handshake in the picture was an understated social transaction between a hardworking uncle who wanted to have as much time as possible and a doctor who wasn’t going to give up trying everything for him. He was my person, the one who got me here. He was the one on my medical school application. 

Telling people that I want to work in a place like this is easy because I want to shake the hands of the mothers, fathers, uncles, aunts, sisters, or brothers that only want to teach their kids how to shoot a gun, hook a fishing line, or teach them how to ask a partner for a dance. That’s what I would say now, if we held another memorial for him today, if he were around today. I would tell him that I’m a medical student because of him. Not because he died, but because he struggled. You don’t struggle if you give up — you surrender. He didn’t surrender to CF. He struggled against it and struggled well. 

How could I expect to fight for future patients if someone didn’t show me how to fight first?

Conrad Murphy is a first-year medical student in the College of Medicine at UAMS. He lives in Conway with his wife Sarah and daughter Reuelle. 

Oh COVID-19 , why don’t you just go away!

Well, it has been since January 2020 that we have been talking about COVID-19. It was December 2019 when first cases of infection were described in China, or maybe when the first case appeared in these United States on the West Coast.

The disease or the pandemic as it is called now has affected several million folks in the U.S., India, Brazil and other countries. It has killed almost four million people. Some say the count is lower than in reality because we are not testing everyone, and others say we are overcounting as the hospitals are labeling many cardiac and pulmonary deaths as COVID-19 deaths to get higher reimbursement. 

The disease is affecting mostly elderly men, blacks and Hispanics, and those with heart disease, lung disease, kidney disease, immunosuppression, and others with diabetes and hypertension and smoking history. This is what our study in the American Journal of Cardiology showed.

There was much scare initially in Europe, and now all these countries are facing a second or third or even fourth spike. These countries have had lockdowns to contain the disease, and then intermittent opening of the economy – how long can they keep large number of people, young and old and in-between, in their homes? The schools and businesses are opening and closing and opening again. And then the teachers do not show up. What good is the opening of schools and businesses?

The incidence of lonesomeness and unhappiness is rising because people must stay home. The dynamics of interpersonal relationships between spouse and children have become strained as people are on each other’s faces all the time. No wonder the divorces are at all-time high, as is crime. The number of suicides is up, even among children, particularly among Blacks. Has anyone figured out why the suicides are much higher among Blacks?

We are animals that like to wander around, and go to the countryside, jungles, oceans, and skies, and visit our friends near and afar. We like to go to art galleries, symphonies, movies and take part in or just watch sports – which are all or mostly closed, or “on-line.” On-line stuff whether be educational or entertainment is not the real enchilada.

Despite an initial setback, the stock markets around the world keep setting new highs. I guess people have lots of cash that must be put to use somewhere. And playing in the stock market gives a sports-like high.

In February and March 2020 when the disease attracted everyone’s attention, I thought it would disappear by summer, and I was nonchalant about it even though I personally had almost all the risk factors. I used to help others think that it was a short-lived, mild problem that would just “go away.” Some believed me, most did not.

We had planned trips to places near and afar, including Florida, Montreal, Boston and Europe. We did not go to any restaurants, but I kept going to Kroger and Walmart and Sam’s, and occasionally to the mall, more for getting my walking steps than for shopping. Everywhere we went, we had a mask on. It was no fun.

We had visits from our children and even one from my then 9-year-old grandson Jasper who took his first solo trip ever. The visit was brief and pleasant, but I had some mixed feelings because we had to be ever so careful.

Now the summer or 2020 is gone, and so has fall, and it began to get wintery cold, and then came the spring and summer of 2021. Some days in Little Rock in winter were colder than in Boston. The year 2021 is more than half gone. We are still talking about COVID and new variants – Delta that originated in India and rapidly spread around the world. In Arkansas, the Delta variant is the primary cause of a new wave of COVID hospitalizations and deaths.

I guess a new reality has set in. I am not seeing new patients – just follow-ups, mostly by phone.

Even the patients I see in my clinic appear bored. Many come for a visit to get out of their house. Some like talking on the phone, but there is no personal connection, and whatever is there appears artificial.

The hospitals lost money for lack of patient visits and the “procedures” that were in any case meant to generate revenue and on the side “help” patients. Hospital revenue began to pick up around the winter of 2020. Patients in the hospitals were allowed minimal visitors to keep the bug away. But then as COVID-19 was controlled in the U.S., clinics and operating rooms and cath labs were opened, and all was back to “normal” around February and March 2021, and the healthcare industry started all its money-making operations.

Restaurants that closed for months began to open on a limited basis around the beginning of 2021. Even those that were open had to enforce social distancing and use of masks. So, you eat with your mouths closed!! Gyms were by and large closed and are now open, but people still manage to eat out, go out to establishments and use gyms. No wonder we have second and even third spikes of COVID-19.  Perhaps it is time we call it COVID-20 or COVID-21?

People felt lonesome stuck at home. Children were staying at home as schools were closed or open intermittently, studying at home on Zoom, and going berserk, as were parents, many of whom never had the experience of having children at home for spring, summer and fall and winter as they forgot about the on-line education. Even my daughter Asha moved with her family to Florida where schools were open and the weather was warm.

I had an interesting interaction with a patient. I mentioned it to Paulette and she wrote it up for me. In essence, one of my patients who was taking care of an elderly man was very upset not because she was let go from taking care of the elderly subject by his family, but more so because the man died of loneliness, not because of COVID-19, but from lack of his only contact. 

We expected one or more vaccines to be available to protect us from Corona virus, but the virus keeps changing initially into type A and B, or D614 and G614, and now it has mutated in Denmark in sheep. It will now affect mink prices since the government there has ordered culling of millions of sheep. So, the vaccine may not be effective, or only partially protective. And of course, the Delta variant which started in India and spread worldwide. More variations will come.

The vaccines came, initially from Pfizer-Biotech, then Moderna, and AstraZeneca and Jensen, and of course from China, India and Russia. 

The U.S. elections came and went (not really!); the Trump team did not believe the results. I will remember these elections forever. Very few people voted in person, yet more votes were cast than ever before – by mail because of the Corona fear. The former President is still contesting the election with fights in courts. Can anyone deny that (mis)management of COVID-19 cost him the election as POTUS? He claimed we will have the vaccine before the election; it never did happen. He himself had COVID-19. He got better enough to campaign mightily, but that was not enough. 

Well, Joe Biden is now the President. He has mobilized COVID vaccinations and almost 55 percent of the population is vaccinated, but COVID infections continue to soar in the U.S., India and many other countries, a result of people becoming more used to COVID and not following precautions. India until recently the world’s supplier of vaccines had a shortage of vaccines and oxygen for their patients; it is asking Germany and other countries for the gas generating plants.

There are now Indian variants, UK variants and South African variants. Vaccines may or may not be effective against the variants. And before I forget, the AstraZeneca vaccine has been associated with unusual thrombosis in the cerebrovenous sinuses and the hepatic veins, a picture mimicking TTP. I wrote a paper with Peppino in Italy and Pier Paolo in Ireland.

I am afraid I will get COVID and die of it, although they say that vaccinated individuals are unlikely to get serious infection and less likely to die, but with poor lung and CV situations, who knows? 

Oh, COVID, don’t be so proud. We will get used to you, or you will just disappear – after killing millions, a price to pay to pacify you.


Jay Mehta, M.D., Ph.D., served as the Director of the Division of Cardiovascular Medicine at UAMS. Currently, he serves as Distinguished Professor of Medicine, Physiology and Cell Biology, and Pharmacology and Toxicology.

Connective Tissue

By John Graham-Pole

‘Your voice is his. Your gestures, too.’
So his fleshless ash lives on in me. 
After Dad’s Cremation, 1991

A month after I retired from the University of Florida in 2007, two letters came in the mail from England: my birth certificate (February 23, 1942), replacing the one I’d lost somewhere on my travels, and my final pension award from Newcastle-on-Tyne. Newcastle is not only home to the British Pension Office but also the city of my father’s recent death. This full life cycle, tucked into two envelopes resting one on the other in my mailbox, sent me off on a journey of reminiscence.

The author’s father
John Graham-Pole, self portrait

In October 1941, my mother turned up for her weekly Women’s Institute fitness class in the village church hall. Mummy looked all set to deliver me into the world, but she reassured her friend Christine who expressed concern about her doing Jumping Jacks so far along in her pregnancy: “The doctor says it’s fine. Might even move things along a bit—after all, this will be my fourth.” No further argument from Christine; after all, Mummy was the Women’s Institute’s president. Her doctor was my dad, aka Dick, whose word on any health issue was law in High Bickington and the surrounding Devonshire hamlets. 

I have this conversation on good authority, because I met up with Chris seventy years later on the eve of her hundredth birthday. Once she had figured out who I was, she recounted a favorite memory — that of me bouncing up and down inside Mummy at thirty-six weeks while Mummy herself bounced up and down to the rhythm of Run, Rabbit, Run, which was topping the 1941 hit parade. She came by her nickname in college, “Tigger,” honestly, a lively leader in everything.

I was born at term, so I calculate those two gametes that created my very first zygote came together on May 29, 1941, my sister Jane’s second birthday: Dick’s sprightly young sperm flying solo through Mummy’s fimbria folds to pierce a single blushing ovum. They say the conception is much more fun than the delivery, but I never got to ask either Mummy or Dick their opinion on that. 

They were living in my paternal grandmother’s house in Golders Green in North London at the time, while Dick finished his surgical internship under William Girling Ball, Dean of St. Bartholomew’s (Bart’s) medical school. I like to picture the two of them cozied up like canned sardines right underneath squadrons of dog-fighting Spitfires and Messerschmitts. So began my replication towards the thirty-seven-trillion-cell being I would become forty weeks on. Meanwhile I spent my first blissful months of life tuning into the soothing rhythms of Mummy’s placental blood-lullaby. 

By delivery time (a mercifully swift one for both Mummy and me), the thunderclap of bombs would have been replaced by the evening chorus of blackbirds and wood pigeons in the hawthorn hedges of rural Devon. Dick had bought a 300-square-mile practice in the village of High Bickington, a Saxon settlement dating from 700 AD sandwiched between Exmoor to the north and Dartmoor to the south, where Conan Doyle’s hellish Hound of the Baskervilles had been wont to roam and ravage. Our home sat astride two country lanes that converged to form a long hill up to the village. In time-honored English custom, the house had at some time been given a name—Dobbs—though the origin and significance of this are lost. The ancient pear tree in our back garden still bore fruit and the seventeenth-century well yielded its spring water year-round. 

I was born in my parents’ bed, with Dick and Nurse Lumney— an old flame from medical student days whom Dick brought down from Bart’s for all of Mummy’s confinements — in attendance. He may have looked approvingly upon his firstborn son after fathering three girls, but my first day was hardly without its trauma. Having no truck with paragraph five of the Hippocratic oath — I will not use the knife … but will withdraw in favor of such men as are engaged in this work — he circumcised me at one hour of my extrauterine life on our dining room table: a heavy slab of 1920s oak upon which I am right now leaning my elbows as I write, flinching at the very thought. 

He brought to this work a special mix of sangfroid and ritual, while probably paying more attention to Nurse Lumney than to the suffering willy on the end of his scalpel. Circumcisions were bread-and-butter stuff to him, and he tackled the task without benefit of local anesthetic. True to most doctors of the day, he thought of neonatal nerve endings — boy ones anyway — as too immature to feel the knife. We now know that all of a newborn’s senses are finely honed from well before birth: mothers are quick to sing lullabies to their beloveds as soon as they start stretching their limbs within their cozy bedchambers, to the palpable pleasure of both parties. 

Mummy slept through my bris blissfully unaware of my agony as I pined for the blessed balm of her nipple. A surgeon manqué, Dick used that sturdy oak table for many other less minor procedures, from setting eldest sister Elizabeth’s fractured radius, sustained when after crashing off her bike on Ebberley Hill as she was cycling up to the village, to injecting the newly available penicillin into the cerebrospinal fluid of a toddler Dick suspected of meningitis. He was the only person for miles about with a car — a racing green MG Midget that dated from the earliest 1936 prototype. The villagers spoke of him as a fine doctor but a devil of a driver. I think he kept the hood down through winter as well as summer. After completing his early-morning house calls in the surrounding villages, he would roar into the driveway fronting our house with a screech of brakes and a scattering of gravel, barely avoiding his lovingly tended boxwood hedge. He would stride into his morning clinic hauling off his massive leather driving gloves, where his patients would have been gathering for some hours through our back door, each time triggering a bell to peel throughout the rest of the house. Two rows of farmers and laborers would likely be perched with their wives and children on the benches under the windows awaiting his ministrations with either eagerness or dread. 

For carrying out his physical examinations, Dick had two curtains on casters that Mummy had no doubt sewn and assembled. But there can have been few secrets in the village’s butcher or baker shop because he never lowered his voice below a bark. One morning when I was around four years old, I succeeded in easing open the door to his clinic enough to get a clear view of the scene unfolding before me. Lo and behold, a sight worthy of undiminished memory: a comely fourteen-year-old girl seated naked to the waist on Dick’s examining table, while he recounted his store of home remedies for period and growing pains. Her mother was clearly struggling to keep up, while her daughter looked utterly at home with the attention, if a little chilled. Perhaps she’d grown accustomed to such early-morning exposure to her fatherly-seeming doctor.

Dick had constructed pine shelves on three of the clinic walls to hold his multitude of medicinals, giving loving attention to each perfectly tooled edge and elegantly engineered dowel. He stored his placebos in amber-colored jars, mounted with ground-glass stoppers and labeled in his calligraphic scroll with names like Nux vomica, Chlorina liquida, Gentiana spp., Camphora officianis, reminiscent of an eighteenth-century apothecary’s shop.  He dispensed these identical-looking white powders and poisonous-looking potions with a customary flourish, to the obvious awe of his clientele. He always insisted that they be consumed in wine glasses, though was this last injunction ever followed? I do wonder: it’s hard to imagine such unworldly country folk laying their hands on a single crystal goblet between them. 

But his awesome authority surely served as an even more potent placebo, whatever the presenting complaint — asthma or angina, chickenpox or collywobbles. In the memoir he wrote shortly before his death, there is a verbatim account of one grateful patient, the broad Devonshire brogue readily detectable: 

“You been very good to I, Doctor Pole. I brought a big fat duck for ’ee, Doctor Pole; look ’ee ’ere. Us ’ud like another bottle of that there red medicine, Doctor Pole, thank ’ee kindly. ’Ere be your ’alf-a-crown.” 

When I first read this line it took me irresistibly to a Monty Python sketch of John Cleese playing the BBC interviewer and Terry Jones as the “local yokel.” 

The clinic’s remaining wall space was adorned with watercolors and pen-and-ink sketches, for Dick was as skilled an artist as much as he was medical scientist. Not only was he adept with the paintbrush and fine-line marker, but also he could construct a three-story doll house, glue together the intricate parts of a fully working model engine, and perform magic tricks with impenetrable sleight-of-hand. His espaliers of roses and apple trees ranged along the garden walls in glorious symmetry, while his beehives won prizes every August at the Exmoor agricultural and livestock show. 

Somehow he also found time and opportunity to indulge his fleshly appetites, indulging in frequent brief trysts with our two maids. But his younger women patients were also far from immune from his advances. He eventually came a cropper after an apparently passionate affair with a mother of two whom I’ll call Erica. When Mummy demanded he break it off or she’d head home to Grandma with us four children, he made some effort to put an end to his philandering. Erica promptly threatened to report him to the General Medical Council unless he left Mummy and married her. This brought him within a hair’s breadth of losing his medical license, and after several trial separations Mummy divorced him and moved us children sixty miles up the west coast of England to Weston-super-Mare in the county of Somerset, where her parents lived on the edge of the Bristol Channel.

I was three years old, and I have no memory of his leaving our home nor any warning of his imminent departure, though I learned later Dick wasted no time after the divorce from Mummy in marrying Erica. For the next sixteen years there was not a shred of a connection between me and my father. His name was barely if ever mentioned at home during this time, and the only trace of him was a photo—“Dick and Doreen, October, 1933”—taken in a moment of honeymoon bliss. They are sitting close together in the heather of a Scottish Highlands hillside, he sporting a meerschaum pipe and Mummy nursing a picnic hamper. Did this bliss make it through to my conception? Or was I the offspring of a momentary reconciliation after more shenanigans—a brief blip in the downward spiral of a marriage already dead? 

And was the sixteen-year silence between him and me of Mummy’s choosing or of his? I never found out, but I have a strong hunch my grandmother’s acrimony towards Dick played a decisive part, given his minimal, if any, financial support of us four children and Mummy’s almost total financial dependence on Grandma throughout my childhood. One wonderful irony of this whole debacle was that I was awarded a full scholarship to Epsom College boys-only private school from aged twelve to eighteen. The college had been endowed in 1855 and began life as The Royal Medical Benevolent College, with the express goal of “providing the orphans of medical families with free housing, clothing and schooling.” The college’s medical foundation saw me as an abandoned child and essentially an orphan, so not only did I become a fully paid-up Foundationer’s, but when in my last year at Epsom I won a Classics scholarship to Bart’s medical school (Dick’s alma mater), the foundation went on to pay every penny of my six years of tuition there too. 

I had one other small but significant connection to Dick during my schooldays. Just before my first term at Epsom College, Mummy brought down a fairly battered trunk from the attic to ferry my possessions on the train from home to school and back. On it were two address labels, one with Dick’s address at University College in London, where he had obtained a B.Sc in Physiology, and the other bearing his subsequent address at Bart’s medical college. They became a talisman of sorts for me during those years.

The sixteen-year silence between us was finally broken during my third year at medical school by a three-minute phone call inviting me to celebrate my twenty-first birthday with him and his new family. So at 7:30 p.m. sharp on February 23, 1963, I shook hands with my father on the steps of the Odeon Cinema in Leicester Square. He was a man I had no reason to recognize, having no visual memory of him beyond that thirty-year-old honeymoon photo. There followed handshakes with Erica and my two step-siblings, after which we sat in the Grand Circle of this palace of a cinema and watched four hours of Lawrence of Arabia. The total silence between us seemed somehow longer than the decade and a half that had preceded it.

But now we were connected once more and I spent many weekends with him, with medicine being a natural bond between us. He would tell me tales of several other doctors in our family tree, none of whom I had ever heard of. Among my medical forebears was my great-grandfather, John Nicholson, who graduated from Edinburgh Medical College in the 1870s, then traveled as a ship’s surgeon from Penrith in Cumbria to Benalla in Victoria. He attended the notorious bush ranger and bank robber, Ned Kelly, and was alleged on one occasion to have removed nineteen bullets from various gang members while never revealing the gang’s whereabouts to the police.

I had always thought my decision to become a physician was inspired by Mummy’s early death from cancer, but perhaps there is a doctoring gene that gets passed down through the generations. On the face of it, I was ill-suited to my chosen profession, given my early passion for the humanities —an aptitude matched by an equally intense aversion towards the sciences. After Mummy’s death, I moved to my Uncle Ken’s home in Yorkshire. He was Mummy’s brother and another doctor, and he did his level best to talk me out of following him and Dick into the medical profession. 

As the sole doctor for 3,000 miners and their families in the coal mining district of Yorkshire, he was soured by a never-ending attendance at the deathbeds of these men, almost all victims in their thirties and forties to the “black lung” (as pneumoconiosis was popularly known). He would rouse me from my bed in the early hours to hold vigil with him, probably thinking of it as a deterrent to my misguided career ambitions. But looking back, I think it was these experiences that drew me late in my career to fulltime hospice work. 

Dick’s marriage to Erica ended in acrimony. She evicted him from the marital home one Christmas Eve and dumped his possessions on the doorstep of his clinic. She then took him to the High Court of Justice where it was decreed that “the marriage be dissolved by reason that the Respondent had treated the Petitioner with cruelty. The Commissioner orders the Respondent to pay the costs of his wife’s suit.” (Dick claimed to not have the means to do so). 

He worked on for several years in his single-handed practice in Guildford, the county town of Surrey in the heart of the stockbroker belt. To the bewilderment of his sassenach patients he would make his house calls wearing the kilt of his family clan—Graham of Menteith—complete with belt and buckle, horsehair sporran, dark kilt hose and garters and a prominently displayed dirk. He no longer conducted formal clinics and I rarely saw him field a phone call that called for his attendance. When I visited him we would mostly spend our weekends at Farnham Sailing Club or at Kempton Park racecourse placing lavish bets on losers.

In time he retired with his third wife, Frances, who had been Erica’s children’s nanny, to the village of Milburn in Cumbria in the heart of Wordsworth’s Lake District. He spent most of his time in thigh-high waders casting his elegant bamboo rods into the local tarn to hook many a delicious rainbow trout. For several years he joined me for New Year festivities while I was working at the Yorkhill Children’s Hospital in Glasgow. Hogmanay was celebrated in grand style, with long lines outside the liquor stores throughout New Year’s Eve. It was at one of these celebrations that I tried to get him to talk about his severing all connection with me throughout my childhood. We were both fairly liquored up by then, so our conversation quickly turned into what he saw as bitter recrimination on my part. He took off home next morning, and this proved to be a final severing of all links between us: the second time in my life he had left me without so much as a wave goodbye.

Having outlived Mummy by fifty years, he died quickly at eighty-seven from acute monoblastic leukemia—a rare illness in the old. He had himself admitted to the Freeman’s Hospital in Newcastle-on-Tyne, where he challenged the interns with tests of his own concoction. My sister Jane phoned me the next morning while I was working at Shands Hospital at the University of Florida, where I was the attending pediatric oncologist. The call came through to our bone marrow transplant unit while I was sitting at the bedside of a seventeen-year-old girl who was also dying after a failed transplant for her refractory leukemia. 

“They don’t give him long,” Jane told me, “maybe a few weeks. But he’s determined to get chemotherapy.” 

It was a measure of the distance that had opened between us that Dick had made no attempt to contact me after his diagnosis, though he knew all about my quarter-century of close acquaintance with the very illness that had beset him. I shuddered at the thought of my aging father suffering through the rigors of intensive chemotherapy, whose horrid toxicities —devastating even to the young — I witnessed every day. I put in my own call to his hospital ward, only to find that he had died six hours earlier, lulled in the arms of merciful narcosis. I found out later that he had changed his will the night before his death, removing the names of five of his offspring, including me, while naming as beneficiary only my sister Mary, who had kept in close touch with him during his declining years. 

I stood in the nurses’ station of our bone marrow transplant unit and wept for the unresolved issues between us, grieving the bitter way our patchwork fifty-year relationship had ended in one final burst of disconnection. Ayman, my Syrian fellow, wrapped his comforting arms around me, then took over my attending duties without a pause while I flew home to Cumbria for the funeral. The next day I visited the ward in the Freeman’s Hospital where my father had died, and Judith, his nurse for his last night on earth, talked to me with tears in her eyes: “He was hiding all his terror behind outbursts of belligerence, until I was finally able to lull him into slumber with a blessed infusion of morphine.” At his cremation I was reunited with three generations of my family, including my two eighty-plus-year-old paternal aunts, Peggy and David. Auntie Peggy, whom I had not seen for thirty years, told me: “Your voice is his. Your gestures too.” 

So his fleshless ash lives on in me, leaving me with a lasting sense of sadness and failure — that we two human beings, both of whom had chosen working lives committed to the healing of others, had so failed to heal the sad disconnection between our common tissue. But what is left of my feelings for my father himself, some eighteen years on from his death? I have much more compassion than anger towards him for his lifelong narcissism, his petty cruelties, his arrogance, and his depravity.  But can this amount to love? 

Mister Rogers was said to carry a note in his pocket that read: “You can love anyone if you know their story.” I could claim that I never really knew my father’s story. But I have pieced together as much as I need to have a strong sense of him as a deeply troubled man—one who could never face up to the hurts he had inflicted on his wives and children—and who knows how many others. 

Despite his abandoning me twice without a word, I know that deep down he wanted to have me in his life – to share times of fun and whoopee, of good food and drink, and of deep and often metaphysical dialogue. For my part, I can feel not only affection but also awe towards him for all his skills and accomplishments as a multifaceted artist as well as a medical scientist. Would C.S. Lewis have recognized such feelings as love? The Greek word, storge, fits for me, meaning the two-way affection between parents and offspring.  . 

But how did I avoid most of the pitfalls that ensnared Dick, devastating his own life and threatening to do the same to all those he professed to love? I know almost nothing about his early life and upbringing, so I can’t begin to judge how far they molded his personality and his moral values. I do know that it took me until I was thirty-six — a university professor, twelve years out from medical school, and the father of two adopted children who had just ended his first marriage — to recognize my own deep-seated emotional trauma. Trauma, I came to recognize, that was born primarily out of Dick’s abandonment and Mummy’s early death. It took two years of skilled and intensive psychotherapy for me to begin to feel the kind of lasting joy and purpose that has sustained me in my life ever since. 

To the best of my knowledge Dick never acknowledged the need for any kind of psychological help, but trans-generational trauma is now a widely accepted entity. Is there perhaps a parallel between my family history and the recent revelations of clinical psychologist Mary Trump, the niece of the former President? Dr. Trump has diagnosed her Uncle Donald as suffering from malignant narcissism and a profound lack of empathy, which she attributes to the ruthless code of his “high-functioning psychopath” of a father. 

The hardest question to reflect on is this: what of Dick’s fleshless ash lives on in me? I too have had a lifelong desire for knowledge and a strong creative streak (I pushed myself against the odds to rise high in my profession as a medical researcher, then late in my career came to champion the arts over the medical sciences). I too am an extrovert, sometimes to the point of eccentricity (I used to run regular “play shops” for medical students and peers where we all dressed in silly costumes and played children’s party games). I too can admit to a potent sexuality expressing itself in a lifelong hunger for intimacy and gratification (more than fulfilled in my marriage to Dorothy after a lifetime of searching). 

Dick said to me on his eightieth birthday: “The biggest mistake I made in my life was to fail profoundly in my marriage to your mother.” He followed this up soon after by writing in his memoir that “she was kindly and compassionate toward all with whom she came in contact … greatly loved, I would say revered … a wonderful wife and mother.”  So whenever I feel anger toward my father for the largely self-inflicted screw-up he made of his life, these two affirmations — too little too late though they may be — free in me feelings for him that are as closely akin to love as I know how.

John Graham-Pole, M.D., is a retired professor of pediatrics and the co-founder of the Center for Arts in Medicine at the University of Florida. An author of numerous books, he lives in Nova Scotia, Canada with his wife Dorothy Lander.