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I Held Her Hand

By Jamie Jones

The emergency department, a bustling fray,
Trucks backed up in the ambulance bay.
A mother and child, full of fear,
Scared of needles, lots of tears.
So much the child couldn’t understand,
I took a moment. I held her hand.

In the dim-lit room, a girl of youth,
Afraid of judgment, skirting the truth.
Eyes darting around the room,
Feeling as though her life is doomed.
This was not the life that she had planned.
I stood in silence. I held her hand.

A young mother next, with babe in arms,
Bruised face and ego, escaping harm.
Head lowered, eyes to the ground,
Her quiet sobs the only sound.
So much in life she has had to withstand.
I sat in solidarity. I held her hand.

Midlife’s shadow looms, a woman sighs,
She’s heard it all, the deceit, the lies.
The speculum is cold, her eyes, morose,
As her thoughts consume her, her eyes, they close,
Remembering her life that used to be grand.
Knowingly, respectfully, I held her hand.

An elder then, with wisdom profound,
Afraid of leaving, of the final round.
Each breath uneven, her shoulders frail,
Her bones so fragile, her skin so pale.
She silently succumbed to eternity’s demand.
In quiet tears, I held her hand.

From tender youth to elder’s grace,
In every moment, I found my place.
Each heartbeat echoed in the air,
A silent promise to ease despair.
So, in the echoes of life’s symphony grand,
With gratitude in my heart, I held her hand.

Jamie L. Jones, Ph.D., RN, CNE, is a Clinical Assistant Professor and Academic Coach within the UAMS College of Nursing. With over 20 years of experience as a registered nurse, including intermittent work in the emergency department, and over 15 years as a nurse educator, Jamie is passionate about her roles. Jamie views nursing as a deeply human endeavor, centered on connection, warmth, and kindness. For her, it’s about more than completing tasks; it’s about fostering a sense of safety and well-being for every individual she encounters. Jamie’s overarching life goal is simple yet profound: to brighten at least one person’s day through her actions, every single day.

In the Season of Hospice

By Stephen Johnson

Like Aspen leaves adrift on yellowed-cold,
we flutter, down from youth – to frailty.

Bone overlapping nerve, vision narrower,
niggling fire- in an un-stoked furnace.
A familiar name, muted in the downdraft,
gait- become a trudge deliberate.

We swirl, blown about upon Time’s whim,
conjugating in our similarities.

Wisdom, begotten by present sorrow,
consoles- as does hot tea in deep winter.
Retrospection, wrings itself out upon us,
our frayed rag, draped on clean plates.

In groups, proliferous and alarming,
we settle, onto the still and waiting soil.

knurled hands laced with peace accepted,
feet – content to have at last arrived,
hearts, at-pace with the scope of quietude,
we bequeath the bustle, to those we love.

Stephen Phillip Johnson is a Mountain Home carpenter. Writing is his itch. Within the halls of medicine, where he’s been (repeatedly) healed, reside flocks of muses.

Transition States

By George Christopher

Transition states not stasis not static
No longer substrate, not yet product
Highest energy on reaction coordinates
Breaking and making covalent bonds

Pre-med, med school, residency, possibly a fellowship, attending
Changing roles, responsibilities, locations, people, relationships
In changes from good to good or good to better
Some-things and some-ones must be given up
For new some-ones and some-things to be embraced

Transition states not stasis not static
Present becoming past
Undetermined future becoming present
Adaptation from cellular to social contexts
Work through grief, move on
Welcome the future in the open-ended
In certainties that give direction
Uncertainties that open new possibilities

George Christopher is a physician who has transitioned into retirement. He and his lovely wife Linda live near their two grown sons and grandchildren in western Michigan.

Between Worlds

By Debbie Baxter

I watch my mom for signs she’s going to be leaving me soon, even as she’s still here. She looks more fragile. A little more lost. Is she? Is she between two worlds now? Who is it she reaches for when she’s sleeping? Is it her mother or maybe my dad? She told me he was sitting on the love seat, and when he didn’t speak to her, she thought he was dead, and then she said she knew it was a dream, a bad dream.

There are people in her room these days, but she says she knows they’re not real. She’s stopped talking about them like she once did, but she thinks they’re sitting on her sofa, sleeping in her bed, or having picnics in the floor with their children, waiting for her to join them. They don’t speak, but they smile, gather around her, and sometimes, when she thinks I’m not looking, she smiles and waves at them.

Other times, she worries the blankets between her fingers, touching, always
touching the fabric, moving her hands along the edges, reading the soft folds
as if it gives her messages only she can see. When she wakes from her frequent naps, she’s confused and slurs her words. I bring her water, say my name real loud. She turns blind eyes my direction. “Who are you again?” she asks, smiling.

“Just me, Mom, no one important,” and we laugh. But it’s not really funny.

Deborah (Debbie) Baxter is an award winning poet who lives in Chesapeake, Virginia, with her husband and 105-year-old mother. A graduate of Old Dominion University, Debbie continues her creative writing education at The Muse Writers Center in Norfolk. Her poetry reflects her Southern roots and ties to family. Her amazing mother is the inspiration for many of her poems.

Receding

By Christopher Fettes

Sometimes forgetting is willful, even hoped for.
How he carried himself as he walked across the yard,
Between one building and the next.
How his pant legs were cuffed,
But still grew damp from treading through the dewy morning.
How his eyes pierced your facade when he looked your way.
The way the smell of his sweat hung on him
Warm and intimate, not staid or dirty.
The way he walked past watching eyes, showing no sign he noticed.
The way he disappeared across the lawn.
The way you wondered if he knew your name.
The thoughts you kept to yourself.
It is easier to let the sting of memory recede
Into the past without wondering what
Might have been or revisiting what was.

Christopher Fettes was born and raised in Little Rock, Arkansas, where he lives with his wife and their beloved pets. He earned both a bachelor’s and master’s degree in English from the University of Central Arkansas. He writes poetry and fiction. He serves as Poetry Editor for Medicine & Meaning and is a reviewer for Slant. He is the author of a chapbook titled A Loneliness in the Distance Between.

A Radiant Horseshoe

By William Palmer

For a DaTscan
to confirm
I have Parkinson’s,
I am injected
with a radioactive tracer.

A few days later
my neurologist shows me
an image from my brain
that contains
what looks like
a radiant horseshoe.

The tip, or heel calk, on the left side
is gone.

The diagnosis is accurate.

But most
of my horseshoe
is still there.

Each day I will try to throw a ringer.

William Palmer’s poetry has appeared recently in Braided Way, JAMA, J Journal, One Art, On the Seawall, Poetry East, and The Westchester Review. He lives in Traverse City, Michigan.

Heaven, the Land, and Humans in 2023, 2023 天地人, 鍾倫納

1. Multiple Alarms from Heaven

Arctic icebergs are breaking up,
Melting Antarctica airport-runways need new sub,
Strong gales have torn apart buildings, Oops:
Flooding also moved houses like floating cups.

2. The earth responds

The green leaves don’t say goodbye,
The remaining yellow resists snowflakes from the sky,
The brown and red spread out in formation,
This defensive camp has nothing to hide!

3. Human self-determination

We have seen more natural disasters,
Plants are adjusting their lifestyle set by regulators.
Everyone should do their duty,
so why do we still find it hard to be adjusters?

……………………………………………………………

Recite in Chinese

1. Tiān shí yùjǐng 天時預警 (Multiple Alarms from Heaven)

běijí bīngshān liè,

nánduān jī jiàng nán

kuángfēng sī jiànzhú,

shuǐ yān yuè pínfán.

2. Dìqiú de huíyīng大地回應 (The earth responds)

lǜyè bùcí xíng,

cán huáng jù xuěhuā.

Hè hóng fēnbù zhèn,

hélì jié fáng yíng.

3. Rénlèi zìjué 人類自決 Human self-determination

tiānzāi yú shù fān,

zhíwù luàn xìng cán.

Rén rén yí jìnzé,

héyǐ wǒ réng nán.

………………..

2023 天地人 鍾倫納

1. 天時預警

北極冰山裂, 南端跑道融, 狂風撕建築, 水淹越洪鋒.

2. 大地回應

綠葉不辭行, 殘黃拒雪征. 褐紅分佈陣, 合力結防營.

3. 人類自決

天災逐漸繁, 植物亂興殘. 個個宜擔責, 為何我尚難 .

…………………

Tom Chung, Ph.D., M.Phil., B.S.Sc., is a professor in the Fay W. Boozman College of Public Health.

Tom 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.

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.