UAMS Online

You Never Eat Alone in Italy

Image of a large group of people eating at a table covered with fruits, cheeses, and various bottles.

I have always been impressed with the Italian way of life, it impacts everything — their lifespan and resistance to chronic diseases. We have good friends in Italy and have been going there two or three times a year for the past 25 years.

Eating together and being together is far more effective than the Mediterranean diet that people talk about.

Sadly being together may in part be responsible for the high number of deaths during the COVID-19 pandemic.

Jay Mehta, M.D., Ph.D., is a Distinguished Professor of Medicine and Physiology and Biophysics, and the Stebbins Chair in Cardiology at UAMS.

White Coats and Blue Collars

By Eric Moorehead

A sultry, sunny day greeted denizens of the mid-Atlantic region in July 2016. I was driving on Pulaski Highway—U.S. Route 40—with my wife, son and daughter on an exhausting, albeit enjoyable road trip that carried us through most states east of the Mississippi River and Ontario, Canada. Some 100 miles southwest of Philadelphia where we stopped earlier, I drove into another big city in a neighboring state. I exclaimed to them, “This is where I was born.” The grit of the city shrouded business after business and rowhouse after rowhouse that we passed as Pulaski Highway turned into Orleans Street. I drove under a railroad overpass with large letters spelling out “BALTIMORE.” We arrived in Maryland’s largest city – its indelible blue-collar image starkly contrasting that of the elite nation’s capital 40 miles to the southwest, its quirky ambience as colorful as the state flag. I wanted to show my family Johns Hopkins Hospital, my father’s employer when I was a small child.

We parked our mini-van on the street, got out and began to walk around the perimeter of the hospital campus to take pictures. “So this is where Dr. Ben Carson got started,” my wife said, referring to the man of Gifted Hands fame.

All I knew is that Johns Hopkins Hospital appeared unrecognizable to me overall from those erstwhile days of my childhood, with several modern buildings constructed decades after my last visit with my father when I was around five or six years old. Only the old red Queen-Anne style building – the original hospital, now the administration building – captured any familiarity. The old hospital was the place I remember telling my father’s work friends there that I wanted to be a doctor when I grow up. I didn’t know any better.

Let me continue to take you back seemingly eons before the revitalized Inner Harbor (which I haven’t seen) and The Wire (which I have). In my childhood, Johns Hopkins Hospital symbolized Maryland as much as the clams, the crab cakes and the Colts — pre-Indianapolis. My father worked there for three years. He was not a doctor – he was a technician who worked on medical machines. In fact, he worked on a machine that saved the life of my uncle following a brain aneurysm. He was one of several relatives of mine who lived in Baltimore in the 1960s. All of those relatives are gone. The historically black Provident Hospital where I was born is gone. P.S. 69 where my two older brothers and I attended school is gone. Yet, this historic Star Spangled Banner city lives on. I was happy to show my family a city that I really knew only as a boy. Of course Johns Hopkins Hospital still symbolizes Maryland – in the modern Ravens era.

My father earned an associate’s degree from Maryland Technical Institute – a trade school that no longer exists – in 1959. Shortly afterward, he started his new job at Johns Hopkins. Unbeknownst to me, as a kid I didn’t know Johns Hopkins was world renowned in medicine, but I was too young to grasp that concept anyway. I just took it for granted, like any other place. To me, the hospital was no different from Sinai Hospital in northwest Baltimore where my brothers and I would go to get vaccinations or anyplace else that required a trip to the hospital.

Then there was my mother. I don’t want to say she followed in my father’s footsteps, but she too worked at a hospital. I believe about a year after her first job as a cashier at a dairy store on Liberty Heights Avenue, a job that according to her lasted about three weeks (she admitted she wasn’t cut out for it – counting money fast wasn’t her forté), she began her first real job as a nurse’s aide at what was then known as St. Joseph’s Hospital, a suburban Catholic hospital in Baltimore County. I must have been six years old, maybe seven. Anyway, this job ushered in a long and more successful stint of similar positions at hospitals in Havre de Grace and the Army base at Aberdeen Proving Ground.

My mother held those jobs after my family moved out of Baltimore to be closer to my father’s next job in Cecil County. Following his years at Johns Hopkins, he began work at the VA Medical Center in Perry Point – a residential government village in the northeast corner of the state between Baltimore and the Delaware line and across the Susquehanna River from Havre de Grace – and spent four years commuting on the 80-mile round trip between there and Baltimore on Route 40 before we settled there in 1966. The facility houses many Maryland veterans with psychiatric disorders; its idyllic campus with stately, early-20^th-century architecture and white facades sits at the point where the Susquehanna flows into Chesapeake Bay.

Perry Point was an interesting place for a child to grow up. Forty miles from Baltimore, 75 miles from Washington and 60 miles from Philadelphia, this quaint, Mayberry-esque village was a world away from urban life. It comprised World War I-era houses, a police station, fire station, post office, credit union and community center, but no grocery stores – those were in nearby Perryville and Havre de Grace. Farms dotted the landscape a few miles to the north. Quiet streets where I rode my bike graced the neighborhood. Little League baseball occupied my brothers’ time as I, a less gregarious kid, was more interested in just watching Orioles games on TV. And all the working residents – primarily men – held positions at the VA hospital. Many of them were doctors. My neighbor friend’s father was a doctor, many of the guys I knew in Boy Scouts – that is, the ones who lived in Perry Point — had fathers who were doctors, and just about all the residents who lived on the street overlooking the Susquehanna were doctors. Yet again, my dad was a blue-collar technician.

It was during this time – elementary school and high school – that I vacillated in my dreams of a chosen profession. I wanted to be either a doctor or a writer. Medical dramas like Marcus Welby, M.D. — one of my favorite shows from the early 1970s – inspired me, with Robert Young as the friendly family doctor walking into his office wearing a stethoscope around his neck and donning a white coat. However, since I figured my parents didn’t have the cold hard cash and I didn’t have the scientific acumen for medical school, a reality check set in with a penchant for the latter profession (more precisely, a newspaper writer in my adult years). On summer days I would sit in my room writing stories when I wasn’t hanging out with my best friend, whose dad was a psychiatrist. By the way, we’re still friends some 50 years later as two old guys – he has long since left Cecil County.

I earned my driver’s license at age 16 around the time my father announced his training for a new job at a VA hospital in Little Rock, Arkansas. This occurred around the time he simply wanted to make a change for the family, as my middle brother and I set our plans for college. The nearest four-year school was the University of Delaware, 20 miles away, and apparently plans for living on any college campus were out. Anyway, due to the training, he would fly between Baltimore and Little Rock for weeks at a time over a period of roughly six months.

On return trips home, my father would mention the grades he received on tests in his training. Overall they were pretty good, even though I didn’t remember all the scores. I distinctly remember his pride in telling my mother, middle brother and me (my oldest brother had left home to join the military by this time) about an A he received on one test.

An adventurous type, I always liked to travel and experience new places. By this time I anticipated rather than dreaded the move not only to a new state, but also a new part of the country – well, new to me since I never considered Maryland a real Southern state like Arkansas, not entirely new to my parents since they grew up in Louisiana. However, I was dating, and I knew I would forfeit my senior year at Perryville High School in the town next to Perry Point, so I was prepared to eventually tell the girl and my classmates goodbye by June of 1975. Two months prior to that month, my dad made it official when he came home from work and asked me, “How would you like to move to Arkansas?” I expressed my OK. Due to his job transfer, my mother would leave her job at the Army hospital in Aberdeen for a same job at the VA hospital in Little Rock.

Initially he had prepared to move the family to Little Rock until some of his acquaintances at the VA hospital told him about a college town called Conway, 30 miles north of the city. I suppose he anticipated my brother and I attending college there following high school – yes, a new high school with a new mascot. My dad’s acquaintances told him about a Wampus Cat and he had fun explaining it to me.

I remember sitting in my bedroom and getting out a road map showing Arkansas as I tried to locate Conway, then wondered if the town was in proximity to mountains. I heard Arkansas had mountains. No, it wasn’t the desert, as my high school French teacher envisioned.

Summer break arrived as we began the 1,100-mile drive across four states from Perry Point to Conway. As my dad drove across the Susquehanna River bridge on Route 40 with my mother in the front seat, I sat in back, turned around and glanced in the rear windshield at Perryville, wondering if I will ever see that town and Perry Point again.

His official title as biomedical engineering technician, my father would commute to work at the VA hospital, a reprise of his commute to work during my formative years in Maryland — this time on Interstate 40 instead of U.S. 40, this time to Pulaski County instead of on Pulaski Highway. Gone was the camaraderie of kids whose parents were mostly in the medical field. Gone was the quaint village where those parents resided. Gone were the banks of the Susquehanna River where I played as a kid. I adjusted to a new environment of friendly high school students with Southern accents. I simply lived in a 1960s-era subdivision in Conway. I discovered a different river — the Arkansas River — and an adjacent place called Toad Suck. Furthermore, nobody rooted for the Colts – they called the Hogs.

Unlike the verdant surroundings and unique architecture of the Perry Point VA hospital, the Little Rock hospital was situated amid urban, bustling surroundings, its brown, high-rise structure towering above Roosevelt Road and Interstate 30. I don’t remember ever entering the hospital with my father, at least during his early years there. I certainly don’t remember meeting any doctors there. Anyway, both my parents felt contentment about the move away from the East Coast. So did I, although I found the tornado drill at my high school quite unnerving.

Eight years later, 1983. I had moved to Los Angeles almost two years earlier and returned to Arkansas to visit my parents for the Christmas holidays during a bitterly cold December. At least one night the temperature dropped close to zero degrees Fahrenheit and the snow stayed on the ground in what seemed like the entire two weeks of my visit. Anyway, I found it a nice change of scenery and climate from an early winter in Southern California.

I met some of my dad’s fellow technicians in the hospital basement. Talk among them and other hospital employees referred to the move to a new VA hospital under construction in midtown Little Rock. Many employees eagerly anticipated the move to more modern facilities compared to the dated atmosphere of the Roosevelt Road location, an east Little Rock landmark since the late 1940s.

A year passed until my next visit to Arkansas, again for the Christmas holidays. My father showed me the new VA hospital where he and my mother were employed for just a few months. I remember as he drove up to the hospital with what I viewed as its avant-garde architecture, he revealed it to me like a long-awaited Christmas present. “Ol’ Blue Eyes,” he called the hospital, referring to the blue circular shadows surrounding the outer windows of the octagonal pods on the upper floors, much of the hospital still surrounded by soil from the new construction.

We went inside. Its surroundings impressed me, quite futuristic I thought. It even had a robot that would roam up and down the halls like a voiceless teacher pacing back and forth. The interior kept the theme of the exterior circular designs in some of the walls. This time I did see some doctors but I don’t remember my father introducing me to any of them.

My father would remain employed at the new VA hospital until his retirement in 1988, ending a 29-year career as a technician working on medical machines, 26 with the VA. My mother, as a nurse’s aide, would then carry the mantle of the commute between Conway and Little Rock until her retirement a few years later.

* * *

It’s the 21^st century, a new millennium, a new age in medicine. In my layman’s mind I still demonstrate some interest in the field. Long ago I kicked Marcus Welby to the curb and recently streamed an episode of ER. I have an administrative position at a medical facility but insistently denied to my uncle in Louisiana – my dad’s youngest brother – that I followed in my father’s footsteps, even with my move back to Arkansas, even with my father’s pleading back in the ‘80s that I should apply for a job at the VA where I am not employed. Yet my closest inclination to anything technical is my love of electronics – audio and video equipment and computers, that is. Medical machines? Nada.

In February and March 2005, I would walk to the VA hospital to visit my father. Long retired, he wasn’t an employee this time – he was a patient. Gravely ill, he was connected to a machine – that very tool that epitomized his long career. Oftentimes in his critical state he would ask about my work, his work at his former employer remaining a distant memory. One day in March, I drove from home with my mother to visit him – it was a Sunday. That day would be my last time to see him before he passed away, in the very same place where he loved his career.

Neither of my parents had a four-year degree, nor did they have the desire to earn one. But if there’s one example they set for me, it is that anyone who contributes to the medical profession is just as important as the scientists and researchers at the forefront. I carried that notion back when I was a kid and still do today.

Almost five years after that road trip, I muse wistfully about my Maryland childhood and accept the reality that I can never get those times back. I’m settled in central Arkansas where fine health care exists without the marquee hospital names. I may never see Johns Hopkins Hospital again, except through documentaries and Hollywood-style renderings in movies like the Ben Carson one. However, through my blue-collar parents, I’ll never forget how hospitals managed to shape my life, regardless of my title or my attire. I’m also grateful for the professionals with whom I collaborate, and I’m grateful to be one of them without an M.D. or Ph.D. after my name. Most of those professionals work in administration, but I’m proud to say that I get to rub elbows with a few of those who don white coats.

Eric Moorehead, part of the Medicine and Meaning staff, is an administrator for the Institutional Review Board, Division of Research and Innovation.

A Surprise Visitor

By Fred Guggenheim, M.D.

Darrell and Donald, the Schwartz twins, are the last of the Schwartz’ eleven children. Donald would sometimes brag, tediously, that “I am older than Darrell, by six minutes.” A mohel performed a bris milah, ritual circumcision, on their eighth day of life. Parents Herman and Sadie Schwartz always dressed the twins differently to help them distinguish which was which. Even through college, the twins remained so similar in appearance that their dates, at times when stoned, could not tell one from the other.

The twins were never apart at night until they were eleven, when Donald, but not Darrell, went for a sleepover. Darrell and Donald did their bar mitzvahs at Detroit’s Downtown Synagogue. But after that, the twins became non-observant, to the consternation of their Orthodox parents. The twins kept using their secret language through elementary school. They graduated from high school with highest honors. Then, Darrell went to Stanford while Donald matriculated to the University of Michigan.

As adolescents the Schwartz twins were a muscular athletic pair, with curly brown hair, Schwartz brown eyes and Paul Newman good looks. Identical twins often have subtle differences in personality: Donald, usually the leader, Darrell the follower. Donald the risk-taker, the dominant one, while Darrell is more of a stay-at-home, submissive type.

The twins were the responsible ones of their peer group. They were doers, not much interested in just meditating or “being” for its own sake. They were potential Chief Operating Officers, not visionary CEOs. Darrell’s and Donald’s interest in computer science stemmed not from their interest in mathematics, but rather from their interest in finances. They followed Willie Sutton’s law: “Why rob banks? Because that’s where the money is.” Darrell and Donald were always competing, if not with each other, then with their peers. They both saw themselves as winners amongst their talented friends.

Darrell began dating Madeline Goselin when they were Stanford sophomores, both majoring in computer science and taking core classes together. Maddie is tall and slender, fair skinned, with blue eyes, fine blond hair hanging loosely past her shoulders, and generous cleavage. They often tried sitting next to each other in lectures and seminars. Like an extension of classroom work together, they soon began dating. They enjoyed sharing ideas, and sex added to their pleasures.

Then, while attending Stanford’s graduate program for their Ph.D.’s, Darrell and Maddie enrolled in similar, complementary programs. During this time they seemingly mutually decided to live together. Actually, Maddie invited Darrell to live with her in ways that were so subtle that he thought it was his idea. She would eventually marry Darrell.

About Maddie, she now is a lapsed Unitarian, far away from her high church Episcopalian roots. She grew up in Washington, D.C., and attended the National Cathedral School for Girls. In prep school, she played field hockey and lacrosse. She had a wide circle of friends. She never drank or smoked. She was not one of her class’s rebels. She was achievement-minded and became her senior class’s president and valedictorian.

Maddie is an only child. Her father had a high-profile position at the National Security Agency, so he wasn’t around the house much as she was growing up. She loved him, but hardly knew who he was. Then, when she was sixteen, he rapidly succumbed to lung cancer. Maddie didn’t let her grieving for him, which was brief, interfere with her school activities.

Maddie received a full merit scholarship to Stanford, which helped out with family finances. Then in her junior year, her mother, a dedicated middle school math teacher, suddenly died of a heart attack. With this death, at least Maddie was able to cry at the funeral, but most of the time she tried to put her mother’s “absence” out of her thoughts. After all, she’d been on her own in college. Her mother’s lawyer told her that she would now have a small trust fund that would allow her to maintain her independence for a few years.

Maddie was fascinated by mathematics, and the beauty of mathematical proofs, whether in geometry, calculus or in astrophysics. By nature, she was not competitive, since she knew she could always win if it was important to her. So, Maddie and Darrell were complementary, not like Bonnie and Clyde with their similar outlaw ways, but rather in letting each do his or her own thing without interference. They were pleased that they were both working in similar, but not overlapping, fields of study.

Maddie preferred to wear long skirts and Birkenstocks. Darrell would have been wearing Dockers khakis, a white button-down shirt with Gucci loafers if he wouldn’t have been mocked by his peers. So, he conformed to the Silicon Valley dress code of black jeans and a black T-shirt without a brand name. Darrell thought it was he that initiated sexual activity, but Maddie was almost always the quiet instigator. He was the predictable, responsible one; she was the serene maverick, marching to her own drumbeat, when it served her purposes. When Donald visited Darrell in San Francisco on some college vacation breaks, Maddie and Darrell often double-dated with Donald and whomever they fixed him up with. Back then Maddie had lots of sexual fantasies about each of the twins.

In their last year of graduate school, Darrell finally told his parents about his attentions towards Maddie, “I am going to marry her. You need to know that she does not want to convert to Judaism, but I have chosen her as my life partner.”

“Marry her, and we disown you!” his father, Herman Schwartz, cried out over the telephone in dismay, and then hung up. When the couple did marry at graduation time, parents Herman and Sadie Schwartz refused to attend. Maddie and Darrell chose the bare-bones ceremony available at San Francisco City Hall. Bachelor Donald flew in from Ann Arbor to witness and to be Darrell’s best man.

Soon after Darrell and Maddie secured their Ph.Ds., they land lavishly paid positions in Cupertino’s Apple Park. They hastily buy a condo nearby to work. She begins working in computer software, mostly consumer electronics. He starts off in Artificial Intelligence.

That’s when their troubles begin. Eighty-hour work weeks. Vacations planned, vacations cancelled. Meetings here, meetings there. Darrell begins a long-term plan to get in shape for Hawaii’s Iron Man Marathon. The couple does not have much overlapping bedtime. Copulation was almost athletic, especially after fighting. To the statement, “Why don’t you break up?” they would have answered “Because the sex is so good!” But after two years of lessened time for pillow talk, they even found themselves thinking of separate vacations.

Darrell leaves on a late spring bicycle vacation in Hawaii. “Bye, I’ll miss you,” says Darrell. “Good bye, go!” Maddie spits out angrily. Reluctantly, she stays behind.

Anyway, she is burdened with deadlines for Apple’s next Operating System update for cell phones. For the past three months she has been feeling somewhat distant, even some disdain, with guilt, rather than love. Now she begins to think, “Is he just one more significant person in my life that has abandoned me? Has he been using me at his convenience? Is the problem, maybe, that I’m not very emotionally available to Darrell?”

Darrell had been in Hawaii for a week when his parents call Maddie in the middle of the night. She has not spoken to the Schwartzs for two-plus years. Herman makes sure that he is talking to Maddie. “Is that you? I must be the first to tell you bad news. My son Darrell, he has been hurt. Bad, very bad, it was a hit-and-run driver. You hear that? He was on his bike, on Oahu. They just called me from the hospital. The only identification he had on him was a letter that Sadie and I had just written him. Anyway, we’re in the airport now on our way.”

Maddie is stunned. She thinks about getting airplane reservations, but is unsure what to do, as she imagines how both of the Schwartzs will be hovering over Darrell. Maddie spends some of the next morning hours pacing back and forth, then, paralyzed, she decides to go to work, which she does in a perfunctory fashion, not speaking to any of her colleagues. Back home, and long past her dinner time, it is Herman calling again. “Is that you? The neurosurgeon tells me my Darrell is as good as dead. They warn me they really should be taking my son off life support.”

Then mother-in-law Sadie Schwartz, always the quiet one, this time forcefully speaks up over the telephone in a plaintive tone, “The least you can do to honor my Darrell is to allow his body to be sent back to Detroit. My family has a plot in B’nai David Cemetery. All my family is buried there since 1903.” Herman Schwartz gets back on the telephone, “The Kahuku Medical Center will FedEx you some papers to sign.”

After a sleepless night, Maddie stays home, awaiting the papers, which duly arrive next morning. Maddie quickly signs the forms, not even reading them. She drives over to the local FedEx office to send their Rush Envelope back to the Kahuku Medical Center.

Madeline’s regular routines are blown akimbo. “I can’t believe it. I can’t believe it. Why?” She finds it difficult even to cry. She stops everything, including going to work, leaving a message on her boss’s cell phone, “I feel badly, I won’t be coming in to work for now.” Nothing more. She is barely eating. She is crying much of the time, agitated, ill. Her sleep is fractured, occasionally non-existent. She ceases going to the gym, and makes no effort to apprise her regular social contacts of the catastrophe that had just occurred. She keeps on ruminating, “If I had been there with Darrell, he’d still be alive. I’m so angry at him for deserting me.” She has no more telephone calls from the Schwartzs.

Maddie realizes that hers is a very complicated grief. Her feelings for Darrell are highly ambivalent. She hates him, she misses him, and she blames him for taking a vacation when she was not able to go with him. She is unable to put to rest her raging conflicts and can barely sleep.

The next morning, she makes an important decision, “The only way I can manage my grief is to get rid of all the images and remembrances of ‘the late Darrell Schwartz.’”

She flushes a pair of goldfish, named Maddie and Darrell, down the toilet. She begins singing: “I’m going to wash that man right out of my hair.”

A frenzy of activity. She knows Darrell’s passwords: She deletes his Facebook, Twitter, Instagram, Gmail and other app accounts. Deletes his Word files on Cloud, his backups with Carbonite. Pays off and closes out his charge accounts. She throws away his written work files, diplomas, toiletries. She puts all Darrell’s clothes, shoes, boots, tennis racquet, and Leki hiking poles into large plastic bags, with plans to drop them off at Good Will on the way to the airport. Takes off bed sheets, washes them and all other sheets and towels, also puts them in another plastic bag for Good Will. Orders new sets of bed sheets and towel from Amazon. Cleans out the refrigerator. Puts Darrell’s baseball cards, and his watch collection in a small Ziploc bag in back of her closet, out of site, to be dealt with later.

She gives Darrell’s 17-inch MacBook Pro to a neighbor she just met in the elevator of their condo. Calls the local NPR station, KQED, to donate their classic old BMW, that they’d bought together in graduate school, leaving the ownership papers, keys and location of that car with the condo’s concierge.

Yet she keeps on having the recurring dread that he will return to be with her, that he might reappear after she had trashed his mementoes, to chastise her for not grieving in the right way. She anticipates a generous bereavement package from Apple, although she lacks the energy to examine the fine print of her recruitment package. Then she leaves a message for her boss at Apple, “It’s because of my husband. I apologize for taking a leave on such short notice. It’s best for everyone.” No more details than that.

Maddie makes an overly simple plan for her near-term future. “I’m off to Paris!” She has never been there before. Since she will have rid herself from any remembrance of Darrell, “I’ll now be able to look at my life in perspective, do whatever grief work is supposed to be. Hopefully I’ll be able to re-establish my sense of self without Darrell.” She decides to be completely out of touch with her former world, except for her charge cards, which she expects will generously fund her stay.

Four-day supply of clothes in a large backpack with wheels. Sun glasses. Sun screen. Charge cards, $26,000 limit on each, passport and Kindle loaded with her ten favorite books. Over the internet, she purchases an open return-trip ticket to Charles de Gaul airport from the San Francisco. She will buy a Vespa and helmet when she gets to France. “I’ll spend down my charge cards until I’m ready to come home. No advance plans for me about cathedral-tripping, chalet-visiting, museum-marching, or pick-up sex.”

Puts her own MacBook Pro in a desk drawer, turned off. Same with her cell phone, on which she does not change her old answering message. Does not reorder her birth control pills. Tells concierge, “I’m to be away, probably for three months. No forwarding address. Just put my mail and packages in the front hallway.” Finally, after accomplishing all that, she drops off Good Will items and returns her own auto with its soon-to-be-expired lease, to the dealer. She gets to the airport by Uber.

***

By the time Maddie returns to San Francisco three months, and many two to four-star hotels and restaurants later, always as a solitary soul, she has maxed out her Visa Card. She is thankful for her MasterCard.

She returns from the San Francisco airport by Uber to her Cupertino condo. That late afternoon Maddie stops by a nearby stationary store to buy a batch of elegant paper invitations, with a detailed party list. The store also provides postage stamps and will mail out her invitations. It also will send out email party invitations to those on her list. Maddie wants to invite close personal friends, and work friends, to her Reintegration Cocktail Party.

Returning home, Maddie remembers “Oh shit, I haven’t paid my mortgage or my condo fees! Now they’ll be late charges,” for the one bedroom, one bathroom $850,000 condo. She forages in her very untidy desk, and is able to retrieve her check book, which does have an adequate balance to pay those burdensome overdue condo bills, but not sufficient to pay off what’s owed on her credit cards. New worries. But at least she isn’t obsessed with grieving. For the moment she puts her complex, strong feelings of anger toward Darrell in the back of her mind. She still occasionally ponders what is more than a theoretical question, “Was Darrell really my soulmate or was he just a handy solution to a complex set of issues in an unsettling time?”

Before the catered party, several days later, she realizes that “If I serve Dom Perignon Champagne I’ll be over the max for my second charge card.” Low on her priority list is recharging her abandoned cell phone and her personal computer.

Among those invited is Donald Schwartz. “I doubt he’ll turn up. I hope he does. I still do have some sexy thoughts about him…I’m still too bummed out to announce that my party is a memorial to Darrell.” She does use a magnet to pin a somehow-remaining photo of Darrell on the refrigerator.

As the Saturday late afternoon party begins, seeming hordes of her favorites invade. She is so busy hugging her first guests, she doesn’t even see late comers enter. It is a forty-person, crowded party full of busy conversations fully saturating her 850-square foot home. “I’m not sure who has come in, or who is yet to come. So what. Will Donald Schwartz arrive?” muses Maddie. An hour into the party, she hears the chime of her door bell, and, breaking off a conversation with a friend, she goes to answer it.

Maddie opens the front door. There appears a gaunt, slender, tired, dirty man, with some facial features strikingly similar to Darrell Schwartz. He has arrived, unannounced, ringing Madeline’s door bell. His head is partially shaven, with a blue-blackened area under his left eye. There is a drooping of his left facial musculature and his lips on that side. He is limping and using a cane to support his right leg.

Looking down at a piece of yellow sticky note paper clasped in his trembling right hand, and reading from it, without looking at Madeline, Darrell slowly stammers out, “Hello, are… you… Mrs. Madeline…Schwartz… at 204…88…. Stevens Creek …Boulevard?”

Totally surprised by the ghost of her suddenly non-dead husband, Madeline let out a blood-curdling shriek, and, for the first time in her life, she faints. Her guests, startled, are suddenly silenced. Donald, who had come in without greeting his hostess, rushes to the front door. He glances at bandaged, banged-up Darrell while racing towards the fallen Madeline, who gradually recovers her wits. Darrell, confronted by the unfamiliar, stands stark still, a pillar of stone, waiting for something to happen.

As Donald helps an ashen-pale Madeline to sit up, he glances up at his twin. He had known, unlike Madeline, that Darrell was indeed alive. But the hospital had not specifically informed him of any of Darrell’s discharge plans. Indeed, only his parents had known when Darrell was to be discharged to his spouse. Since Maddie had been off-line and unconnected, she has had no warning of Darrell’s imminent discharge plans.

Wordlessly, Darrell, Donald and Madeline leave the front door and go into on the living room where the party-goers as a mass have moved out of their way. Within five minutes, the celebrants have all quietly exited, leaving their plates and glasses where ever. The trio sits down in chairs not littered with dishes, trays, bowls, and wine bottles. Soon Darrell penetrates an unbroken silence, admitting “Can I use the bathroom? I really need to go.”

Maddie whines to no one in particular, “I guess I’m supposed to know what to do. I haven’t the vaguest idea of where to start, no inclination. What an ambush. I’m broke, I don’t know if I still have a job. The mortgage and condo fees are due soon. I don’t have a car. I’ve thrown away Darrell’s passport, driver’s license, credit cards, his passwords, his everything. And now this!”

In the minutes while Darrell is in the bathroom, Donald and Madeline update each other about what has transpired in their lives over the past months. Maddie indicates briefly, “Three months on a Vespa in France, off-line.” Donald shares, “My parents are furious at you for not responding to their emails and text messages about what to do for Darrell. They had no way to know that you must have been off-line during all that time.” Indeed, she had given no one warning of her unavailability. “I figured you might have just stashed away your cell phone in a fit of pique, or maybe sorrow, and moved on.”

But what to do? Donald comes up with some tentative proposals, “I’ll postpone my flight back to Ann Arbor for a few days. I can sleep in your apartment on one of the sofas, while Darrell can sleep on the other. Since I still have my Honda rental car, tomorrow we can take Darrell to the Apple HR office, to get him new identification papers, badges, and check out his insurance coverage.”

After Darrell rejoins them, Donald’s Google search reveals that there is a nearby rehabilitation facility. “We can go there for an evaluation by a physiatrist (a physical rehabilitation physician). Then Donald adds quietly, “Darrell has been sent packing, discharged, without being given any future plan of care by his Hawaiian general hospital. We need to know, what are the plans for his recovery?”

Maddie adds, “Me, I still need to find out if I have any pending Apple salary, or do I even an Apple job?” And she starts to think to herself, “What do I do about our marital relationship?” That’s the 800-pound elephant in the living room that no one could even approach.

Maddie was never much into being a social worker, a nun, or a selfless caregiver. She was not even sure if she wanted to be a mother. Donald is still a bachelor, although a highly pursued one. He is not in a committed relationship at the moment. He has a good IT/AI job in an Ann Arbor start-up. But his skills are immediately transferrable to many firms in the Silicon Valley. He still has warm feelings for Maddie, but that would have to wait. He wonders, “What kind of recovery can we expect for Darrell?”

No one talks much. It’s getting late. Donald opens Darrell’s carry-on suitcase and lays out Darrell’s pajamas and toiletries. Donald then tells his numb-appearing, quiet brother, who had been sitting in a chair in another part of the living room, “It’s OK to go to the bathroom. You can change into your pajamas there, and be sure to brush your teeth.” Which Darrell does, leaving his clothes in a pile on the bathroom floor. No initiative, just doing what he was told, automatically, as long as there is no more than two instructions at a time. Three simultaneous instructions would be too much.

Donald picks up Darrell’s clothes, folds them neatly, putting them on a chair in the living room. He goes to a living room closet for bedding, then spreads out a clean bottom sheet, a blanket and a pillow with a new pillowcase on a sofa. “Darrell, this will be your bed for the night.”

Maddie comes out to see how “the boys” are doing. She has never seen her formerly muscular, now scrawny husband in pajamas, as he had never worn them when they lived together.

Maddie, shaken, goes back to her bedroom, while Donald tucks Darrell in, saying “Good night, dear boy. I love you. I’m sleeping near-by and I’ll see you in the morning.” Darrell smiles a sweet smile, gets into bed, again without a word, and quickly drifts off to sleep.

Maddie, in the meantime, quietly sobs in her bedroom. She sits, still dressed, on what used to be her side of the bed. Paralyzed, ambivalent, scared, troubled. You name it: any negative-seeming verbs with an “ed” ending would probably be a good fit for her. After a few minutes, she calms herself.

A short while later, she hears Donald tucking Darrell into bed. Maddie comes out into the living room to observe, not to do anything for, Darrell. In a far part of the living room, she starts tidying up, putting dishes and glasses in the sink, taking left-overs that need containers and placing them in the refrigerator. A bottle of tequila has special appeal: she pours herself a hefty glass full, offering the same to Donald, who declines. Plopping down into a chair, she initiates a conversation with Donald. They discuss their perplexity. “Summing it all up,” she says, “Not much going on there,” looking at a sleeping Darrell.

With that, leaving for her bedroom, she suggests that Donald use the bathroom to prepare for sleep. The rest of the evening and the night passes quietly: Darrell apparently doesn’t have a clinical sleep disorder, what a relief. Both the Schwartz twins prove to be good sleepers, which was more than Maddie could say for herself that long night.

Breakfast proves to be a challenge, as there are none of the traditional makings yet in the kitchen. Maddie hadn’t thought about planning any meals after her Reintegration Cocktail Party. Donald, now in his undershorts, volunteers, “I’ll get breakfast fixings. I still have that rental car.” She waits impatiently as Donald dresses in the bathroom with the day-before’s clothes. Maddie gives him driving directions to a near-by Seven Eleven store. Donald’s departure leaves Maddie and Darrell alone for the first time since she first saw her battered husband at her front door, half a day ago. He says little when she asks, “Darrell, do you have any questions? I know there’s been a lot going on here.”

“No, I’m fine…just a little headache,” slowly replies Darrell. Nothing more.

The dearth of Darrell’s response leads Maddie to the conclusion that this is the first uncomplicated man she has encountered in years. “Here he is, at three months post bicycle accident. His thinking is concrete, simplistic.” She puzzles, “He seems to be trusting, yet he shows no sense of being capable of interest in future planning.” Maddie agonizes, “He’s zombie-like, a member of the walking dead, maybe more cognitively impaired than a kid with Down’s syndrome.” These observations remind Maddie that she probably didn’t want to have children anyway. “Darrell is nice enough, like a piece of furniture, but certainly not someone that can be my friend.”

After Donald returns, and breakfast is finished, Maddie announces, “Now it’s off to the Apple Personnel Office to see who has what coming to Darrell, and to me, if I’m still an employee.” After quickly cleaning up the kitchen, and taking bathroom breaks, they pile into Donald’s rental Honda.

They arrive at the Apple Human Resources office. There Nancy, about twenty-five, a slender cheery woman, dressed in jeans, a Grateful Dead T-shirt and Nikes, is very warm and supportive. She gives them the good news and then the other news. “Darrell’s generous disability insurance is ready to start with no mandatory 90-day waiting period. There will also be full health care insurance coverage including dental, with no co-pays. No more contributions to his 401c retirement account since he is now ‘retired.’ All applicable state and federal taxes will be automatically deducted.”

Turning to Maddie, Nancy continues, “Your job position here has not been refilled, but your salary was discontinued after six weeks of Family Medical Leave, since there was no application for its continuation. However, my notes indicate that you’ll be welcomed back if you wish.”

Then Nancy shifts to Donald, who has said nothing during the interview, and without missing a beat, Nancy says, “If you are interested in being hired by Apple, here’s a job application form.”

Next, off to San Jose and The Rehabilitation Center at Santa Clara Valley Medical Center. Maddie declares, “The best way to make an appointment is to be there, to see what is offered, what they can do. It’s just a ten-minute drive. This facility should be able to figure out what Darrell needs.”

As they drive to San Jose, Donald and Maddie, overwhelmed, quietly ask each other, in rehearsal, all those important questions, “Is Darrell capable of independent living? If not, what kind of living facility would he be best suited for?” “Would a person with a brain injury in recovery for three months get much better?” “Will medication help? Darrell’s on no medications now. Will he be susceptible to seizures later on?” “Should we apply for Social Security Disability Income now in addition to his private insurance disability payments?” “Could he be trained to do some useful employment?” “Would he be more likely to become violent or disinhibited later on?” “Is he competent to manage his own finances, or does he need some sort of guardian? How does one get a financial guardian, a legal guardian?” And Maddie thinks, but does not say aloud, “How does divorce work in California with someone who is mentally disabled?”

The front desk receptionist at the Rehab Center tells Maddie that, fortunately, “Dr. Peter Somoza, our highly qualified physiatrist, just had a cancellation for his eleven-a.m. slot.” The trio are led to his plaque-covered, comfortable consultation room to wait for Dr. Somoza’s arrival. He is a tall, dark man. Middle aged, mustached, dark tan, black hair slicked back. He is wearing a white coat, with a stethoscope around his neck and neurological hammer in one of his bulging white coat pockets.

After their pleasantries of greeting, Donald hands Dr. Somoza the copy of Darrell’s discharge summary from Kahuku Medical Center, which Dr. Somoza studies. The Kahuku medical staff had neatly tucked it into Darrell’s carry-on baggage. Then Maddie and Donald take turns, collaboratively, to detail what little they knew about Darrell’s post-discharge behaviors.

The initial quarter hour in Dr. Somoza’s office is devoted to background information gathering. Next, Dr. Somoza begins patiently, slowly, talking to Darrell, who, during all this time, had been sitting quietly in a corner of Dr. Somoza’s office, like a banged-up wooden chair.

Dr. Somoza begins by asking Darrell a thousand questions: “What is the day… date… month…year…what city are we in…which state?” Then comes a flurry of other questions, like “What was your most recent job? …What did you have for breakfast today, …dinner last night? …Did you make your bed this morning? …Where did you put your pajamas? …Who is the president of the United States? …Count backwards for 100 by 7s. …OK, since you’re having trouble with that, count backwards by 3s. …Can you remember this number, 86421? …Please repeat after me: 7439215. …Can you say it backwards? …Please draw a clock face to indicate the current time…How many animals or other creatures can you think of when their names begin with ‘A’? …I’m going to tell you a story about a man who lived in Cleveland and wants to get to New York City, and I want you to repeat it to me, so listen closely.”

At the end of Dr. Somoza’s cognitive exam, Darrell is exhausted, as the eleventh hour turns to twelve and even approaches one p.m. It’s time for everyone to break for lunch. Dr. Somoza tells them, “I will have a written summary available for you later in the afternoon. My schedule doesn’t permit our meeting face to face again today, since I’m all booked up. You’ll find many answers to your questions in my summary. We’ll see Darrell back here in a week, and you’ll need to set up appointments for neuropsychological testing, physical plus strength testing, and, after all that, with social services.”

Lunch proves to be another test of Darrell’s abilities, or lack thereof. The trio walk in tandem over to the patient and staff cafeteria at The Rehabilitation Center. Darrell can’t make up his mind amongst the choices of drinks, the salad bar, the grill for hotdogs, hamburgers, the pizza stand, and the three hot entrees with assorted vegetables. Donald places a hamburger, French fries, and a diet Pepsi on Darrell’s tray, while choosing other items for himself. Maddie has little appetite but munches on a pre-made chicken salad sandwich and lemonade.

Maddie is pleased to see that Darrell exhibits good table manners, including wiping some catsup off his lower lip. Maddie and Donald hide their disappointment at how poorly Darrell had performed on the brief mental status exam and in the cafeteria line. They know that there will also be a much more detailed evaluations later on in Darrell’s pending workup.

After more than an hour they return to the administrative assistant’s desk, outside Dr. Somoza’s examining room. She gives Maddie a copy of Dr. Somoza’s summary findings and recommendations.

The trio ride back to Maddie’s condo in eerie silence. Nobody says the obvious, “Well, what did you think about that?” in the car, but that’s what Maddie and Donald are thinking. Darrell stares out the window with a “never-have-seen-this-scenery-before” sort of amazement. He has an enviable ability to be in the present, with no memory of the past and no particular interest in the future. Not exactly a post-lobotomy case, but there are some similarities. Certainly not an Apple millionaire-to-be.

Back in Maddie’s condo, for the remainder of the tattered afternoon, it’s time to make long-term plans. That, of course, is impossible. Therefore, more calls to HR at Apple, to the Social Service department at the Rehab hospital, and to set up other appointments there. Both Maddie and Donald are questioning each other. Maddie wonders, “Darrell’s placement? Where? How can we get that covered financially?” Donald muses, “In the 19^th century, if someone received an incapacitating head injury, family members would place that person in a back bed room near the kitchen or the fireplace. But this is the twenty first century.”

After mindlessly watching the 5:30 p.m. news, the trio heads out for pizza and beer. They all need a reward after so grueling a day. Nobody is fessing up to their feelings, or fears.

Conversations at supper are inconsequential, except Donald comments, “The décor and the professionalism of the Rehab Center are commendable.” Then back to the condo in Donald’s rent-a-car.

Maddie excuses herself to start going through her stacks of unopened mail in zip locked bags labelled “BILLS,” “PERSONAL” AND “BUSINESS” that are piled on her desk in a corner of the living room. She has already opened some of her Amazon packages, which is where they all had new sheets and pillowcases from the night before.

Donald and Darrell sit in another corner of the living room, with Donald trying to nurture an otherwise faltering dialogue with his twin. Donald keeps on trying to use open-ended questions, but ends up getting “yes,” “no” and “I don’t know” answers. Donald is the frustrated one, although he tries hard not to show it. Darrell is the complacent one, just shining in the fact that he has been re-united with his twin: words, transfer of information, they don’t really matter to him.

A small clock on the mantel piece ticks and tocks, as Maddie sweeps through months of mail, and Donald sits quietly with Darrell with their intermittent, then truncated conversations. After a mostly quiet two hours, Maddie suggests they all watch her favorite news channel for the 9:00 p.m. newscast on KOFY-TV, not that it makes a difference to any of the trio.

At 10:00 p.m. it’s everyone’s time to go to bed. Maddie takes bed sheets, pillows and blankets out of the living room closet, plus Darrell’s pajamas, plopping them down on the two living room sofas, telling the twins to make up their beds. She then goes to the bathroom. Donald makes up Darrell’s bed, then his own. As Maddie is finished with her bathroom activities, and goes off to her bedroom, Donald points Darrell toward the bathroom to undress and brush his teeth. When Darrell returns, Donald tucks his brother in for the night, makes up a bed on the sofa for himself, then he’s off to the bathroom for a much-needed shower.

Darrell nods off to sleep immediately. Donald comes back to the living room in his usual pajamas, that is, buck naked. He turns off the living room lights. He is about to get into his newly made-up sofa bed when, impulsively, he spins on his heels and heads for Maddie’s bedroom. No thoughts of boundary violations, nor of complications of the trio’s relationships. No, it was just one of those “If it feels good, do it!” moments.

Maddie is lying quietly in bed when this hulk slips quietly into her room, and creeps into her bed. Donald lies on his right side, on “his” side of the bed. He instinctively puts his left arm over onto Maddie’s chest, on top of her nightgown, with his hand cupping around her right breast. Maddie says nothing; she doesn’t move. Donald promptly falls asleep, and a few minutes later, so does Maddie.

At this time of the year, late Spring, sunrise in Cupertino arrives at 5:45 a.m. But dawn begins to stretch out at about five in the morning, which is when Maddie awakes to see clearly outlined Donald, nestled soundly asleep in her bed. Lifting the light wool blanket and top sheet, she kissed him. Donald turns, and returns her kiss. They made love gratefully.

Afterwards, “What are we doing?” gives way to “That was nice. Look at what we are doing!” Donald retreats to his living room bed, Maddie to the bathroom to shower and cleanup for the day.

Darrell is quite interested in their pending travels, but not in his future. What would you expect from a four-year-old? Donald is interested, too. But he is interested in other things. “Would I be a good match for Maddie?”

And Maddie is occupied, too with the thought, “Was this thing with Donald a ‘one off,’ a ‘benefits from a friend’ kind of thing, or is this the beginning of something serious?”

Fred Guggenheim, M.D., is a Professor of Psychiatry and Chair Emeritus at UAMS and an Adjunct Professor of Psychiatry at the University of Nebraska College of Medicine. After training in internal medicine, Dr. Guggenheim assisted in a research project at NIMH on identical twins discordant for schizophrenia. He came to UAMS several decades later as the second Marie Wilson Howells Professor of Psychiatry and Chair where he served for 15 years. He started the Friends of Psychiatry philanthropic program and Arts of UAMS, art shows still ongoing in the UAMS Library. He has previously published pieces in several other narrative medical journals.

Woman in Black

By Drs. Jay and Paulette Mehta

It was almost time to go home after a busy clinic day seeing patients with a wide variety of heart diseases. I looked at my schedule – there was one more patient, a woman. She had been referred by a physician, who I respected, for my opinion for assessment of tachycardia. I thought this case would be simple. I could just OK what he had suggested.

The patient said she had heard about me and wanted to get a second opinion.

“Shall I call her in?” nurse L asked me.

“Did you see her already?” I asked my nurse. During these Covid days, the nurses were empowered to do more and to take extensive history. It saved me time, and I respected L’s ability to filter out the unnecessary and extract just the important information.

“Yes, Doctor, she seems a little anxious to me and her blood pressure is high and she is tachycardic. She seems a little depressed to me as well, Doc.”

“Let her in,” I answered.

I watched as she entered. She was tall, thin, and a little gaunt. She had very light-colored skin, blonde hair and blue eyes. She was dressed in all black. Her long dress was black as were her scarf, belt and shoes. Her hair was long and pulled back into a ponytail. She was wearing dark red nail polish but wore no makeup on. She looked much older than her stated age of 54 years.

“Please come in and have a seat,” I said as she slowly entered the room.

“Thank you, Doctor,” she said with a strong southern accent.

“What brings you here?” I asked.

“My cardiologist BG says I may need medications and perhaps a cardioversion, but I wanted your opinion first.”

“Why me?” I asked.

“Well, you’re the doctor who wrote about heart disease sometimes being a plea for help and I thought…,” she started as her voice trailed off.

I remembered the paper I had authored several years back about a friend who had developed atrial fibrillation while his daughter was having trouble with her then-fiancé and refused marriage a day before it was to take place. Friends and family had come from afar, and wedding preparations had been made. I listened to my friend and his daughter and comforted them, and he recovered completely after the daughter reconciled with her fiancé and the two were married in a traditional Indian wedding and later went on to have two beautiful children.

I could see her eyes water and turn red and her arm twitch.

I looked at the history that the nurse had taken. There was no mention of marriage or family problems or of any stress in her life currently. She had been successful, with grown-up children, and she had been widowed for about five years. So why was she bringing up this paper about a very different patient I had seen many years ago, I wondered?

I decided to ask my own questions:

“Have you had any stress in your life recently?”

“No, Doctor, I am not stressed. You know I am not working so there is no stress there. My children are grown up. My husband and I were very close, but he died quite a few years ago.”

“Tell me how you spend the day.”

“Well, I don’t really have a regular job anymore.”

“What do you mean anymore?”

“Well, I was an executive, a buyer at one of the big department stores. But then the virus came, and they fired me.”

“Why did they fire you?”

“Well, they downsized, the whole mall was going under and they had to let people go.”

“Then what did you do?”

“Then I got a job as a fund raiser for a college, but I couldn’t raise enough money in these Corona days, so they let me go too,” she said, tears welling up in her eyes again.

“I couldn’t find any job after that, I looked and looked, and there was nothing available. So, I decided, well, I am a caregiver I may as well give ‘care.’ After all, I know how to care for people. I cared for and raised two girls, but they are grown up. And I’m here all by myself. I may as well become a caregiver. Therefore, I signed up with care.com. And I had a few patients but there was one, who I spent most of my time with.”

“What did you do?”

“Well, I read to him. I would read the most beautiful books. My favorite book was Walden by Henry David Thoreau about living alone in the woods and his inspiration from nature.

“After we finished that one, we read the Bhagavad Gita together. I took the part of Arjuna and he took the part of Krishna. We read each other’s parts and we laughed together.”

As she spoke about this and other books, I saw her eyes sparkle and saw her smile and laugh.

Then I asked her. “Tell me more about this man you cared for. How old was he?”

“Oh, doctor he was 90 years old. He was everything; he could not see clearly, but he was so loving and jolly. He laughed at all my jokes; we had such a good time together.”

“Let me examine you.” I said, and I walked out of the room with her chart while she changed into a hospital robe. I went outside to switch out my mask to a N95 and to put on gloves, gown and face shield, and the nurse performed an ECG.

I wondered about the nature of her problem, which had just started only a week ago. I needed to find out more.

I knocked three times before entering.

“Come in, I’m ready,” she responded to the knock.

Meanwhile my nurse L came up to me, handed me the ECG and rhythm strip, which showed sinus tachycardia — heart rate 120 beats per minute.
I went into my patient’s room, and performed a physical examination, which was normal except for cold clammy skin and a fast heart rate.

“I have a few more questions I need to ask you,” I told her. “Tell me how often you see this man.”

“Oh no, Doctor, I don’t see him anymore. They let me go.”

“Who let you go?”

“His family.”

“Why did they let you go?”

“They fired me because they were worried that I could transmit Corona to him. They just wanted to minimize his exposure to outside people. Doctor, I don’t have the disease, nor have I been exposed to anyone with Corona.”
“Then what happened?” I asked. Tears started to gush from her eyes. I did not know what to do.

I held on to the edge of my chair, and asked again, “what happened? Tell me!” I was wondering had she done something to him; had she done something to the family? What was the trauma that she was hiding behind those blue eyes?

“And,” she said to me, “Doctor. He died. He died three days after they let me go.”

“Did he die from Corona?”

“No, it wasn’t Corona that he died from. It was the loneliness and the fear of getting Corona. The family was so afraid they fired me they would not let anyone come and visit him. They tried to protect him from Corona, but in the process, he died because of loneliness and isolation”

“And that killed my spirit, Doctor. I loved that man, I took such good care of him, he needed me, I needed him…”

Then I looked up. “You need to heal from what you have been through, and you need to go back to caring the way you used to do.”

She got up to leave; she was smiling now. Her eyes had a sparkle, and her muscles relaxed.

“Thank you, Doctor; I knew you could help me.”

I thought – fear of Corona and loneliness resulting from being alone can kill.

This story is by Dr. Jay Mehta as told to and recorded by Dr. Paulette Mehta.

Jay Mehta, M.D., Ph.D., is a Distinguished Professor of Medicine and Physiology and Biophysics and holds the Stebbins Chair in Cardiology at UAMS. He is also a senior clinician scientist with the VA Central Office.

Paulette Mehta, M.D., MBA, is a Professor of Medicine (Hematology/Oncology) at UAMS.

Sawhorses

By Tim Muren

First Place,
The Drs. Paulette and Jay Mehta Award in Creative Writing

Again, the cardinal assaults the back
porch window, speeding toward its own
reflection— stops short, hovers,

hesitates. Crazy bird, like to crack
glass, flaps back—maybe slightly
concussed—perches on slippery elm,

eyes my empty mudroom with what
I swear is anger. Come sit at the dining
table, give me a piece of your mind.

You should know this house is
my mother’s; be mad at her; maybe visit
her at Parkview Clinic—follow

me if you like, to the renovated church
to the long, white hall, to the queue
waiting for a cafeteria to open for dinner.

“That’s really good, she recognizes you!”
some other patron will say. There will be
movement along the perimeter;

there will be seats at round tea tables
under brittle feathers of a stuffed
rooster hanging from fishing line.

You can read the e-mails from her sisters
in California and St. Louis—watch
with her the construction outside—

expansion— a carpenter carrying
sawhorses through drizzle—
We can agree, “I wouldn’t want

to be him right now,” muddy
Levi’s cuffs under steel-toe heels,
yellow slicker’s hood over hardhat

as a backhoe operator pulls one
more stump from what is left
of 12th street woods. Trembling

witch-hair roots, crumbling
red-gray clay. Help me
decipher as my mother muses,

hums, yawns, raises her left
hand, shrugs. Laugh, as she laughs,
when she wants to say something.

She always does this. It seems
important. “See. Tee. Like. Bike…”
She growls, gnashes her teeth because

I do not know. Help me understand.
And once she nods and waves us
away, follow me back here again

and watch as I write this down—
in a poem no less—reach with me
for an epiphany, a translation of desire,

anger, fear— how would it manifest if
it came? As fear outdistancing fatigue?
As faith outdistancing fear?

As lucky combinations of hope and despair
hurtling out of nowhere into nothing,

As a bird attacking the back
window, as the construction workers

outside the clinic, as the distance
between, as a carpenter in clumsy

thermal gloves, walking toward unearthed
hickory trunks, carrying a green

thermos, carrying blueprints.
Sensible as anything,

comprehensible as any instructions
he ever spread out over

plywood and smoothed
over the backs of horses.

Tim Muren has worked at UAMS for almost 25 years, and for the last six years he has been head of the writing center that is part of the Student Success Center. Tim’s previous publications include poetry in Prairie Schooner, Cortland Review, and Antigonish Review.

Kitchen Communion

By Sara Shalin, M.D., Ph.D.

Third Place,
The Drs. Paulette and Jay Mehta Award in Creative Writing

Dishes are done and there is quiet.

Trading my phone for stillness, I

Pour half a glass of red in an old jam jar.

The wine runs down the side of the bottle; I

Draw my finger up its neck

And then suck as one does a bleeding paper cut.

Sitting and sipping, I

Notice the paint chipping- here

On the cabinet where the water from the sink is dripping; I

Smile (ruefully) at the stained countertop,

A result of recent riotous food coloring use. I

Recall the smell of that buttercream,

That taste of abundance

And then remember I forgot to eat lunch today. I

Can hear the hum of the dishwasher

And maybe a faint laugh down the hall?

Yes.

Here.

Now.

I am here now. I

Exhale the weight of another pandemic day passed

Then breathe in gratitude for this

Absolutely ordinary miracle

This holy moment of wholeness here, now.

There is quiet and dishes are done.

Sarah Shalin, M.D., Ph.D., is the chair of the Department of Dermatology at UAMS.

The Price of a White Coat

Click to read this poem.

Mason Rostollan is a second-year medical student and the president of the Interest Group for Neurodiversity at UAMS.

Mornings & Evenings After Retirement 退休後的晨昏

(Translated from 退休後的晨昏)

By Tom Chung 鍾倫納

1. 退而難休 Morning After Retirement

夢舊扣漣紋, [pronunciation: mèng jiù kòu lián wén, ]
Unlike ripples fading away,
old dreams can’t be kept at bay.

錶輕巳幾斤. [ biǎo qīng yì jǐ jīn. ]
The watch now weighs lighter by pounds¹,

雞鳴鐘不鬧, [ Jī míng zhōng bù nào, ]
No longer before the rooster, the alarm sounds.

何處獻辛勤. [ hé chù xiàn xīn qín. ]
No one knows where he is needed,
nor when again he will be greeted.

2. 現代天倫敘 Grand-Mom’s Dinner Nowadays

明窗伴靜几, [míng chuāng bàn jìng jǐ ]
Windows are bright, furniture is clean; ²

舐犢待晨曦. ³ [ shì dú dài chén xī ]
Dishes are plenty, soup is lean. ⁴

久盼同餐飯, [ jiǔ pàn tóng cān fàn, ]
It’s been quite a while having dinner together,

羹殘燕巳飛. ⁵ [gēng cán yán sì fēi. ]
Every child is gone, while the meal is barely over.

Notes

^1. Inspired by Dali’s melting watch.

² Everything was cleaned up the day before.

³ The translation uses a different metaphor to convey the anxious feeling of the grandmother who could not sleep while waiting to see the children. The original version contains a Chinese metaphor — “The cow woke up early, waiting to lick the calf, well before dawn.”

⁴ Serving lean instead of fatty soup is a healthy lifestyle promoted in the culture of traditional Chinese medicine, whether the soup contains meat or not.

⁵ Every swallow has flown away. The swallow in many Chinese poems is a symbol of birds leaving the nest upon growing up.

For Readers Who Are Curious About the Uniqueness of Classical Chinese Poems

These two poems follow a rigid style of the most popular format of Classical Chinese poems. There are four lines in each poem, five characters per line. Another major format is seven characters per line.

There is only one syllable for each Chinese character. One or more character/s (mostly two or a few) constitutes/constitute a word. The square shape of the characters, the fixed number of characters in each line, and the fixed number of lines (mostly four and eight) forms obvious visual rhythms.

The written version of the English translation obviously takes lots more words than the Chinese version.

Verbal presentation of a Classical Chinese poem takes a shorter span of time than poems in other languages.

Recitation of each 20-character poem takes about a third of the syllables and time than the English translation.

The Classical Style also requires that the pronunciation of each character share a certain tone, depending on the location of the character in each line. Moreover, the last character in each line must belong to a certain rhyme group. Such tone-and-rhyme-audio-patterns form very harmonic rhythms. You may try to read aloud the five syllables in English that following each line in Chinese to get an impression of reciting a Chinese poem.

While most Chinese writers think it is hard to follow such rigid requirements, they find the 4 x 5, 4 x 7, 8 x 5, and 8 x 7 audio-visual formats easy to remember, and helpful to condense/discipline their expression. Whether written with a rigid audio style or not, if the content is articulate, the expression is attractive or amusing, such poems would be widely accepted. Even illiterate people can memorize and recite some.

Among thousands of poems still popular today (many were written over a thousand years ago), most follow the rigid style because the rhythm, the rhymes and the order of the tones resonate well and are easy to remember.

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.

Waiting Room

By Chris Fettes

There are poems I intend to write
That land on the purgatorial backburner
Never to be revisited
Because the poem was conceived
In a distinct and fleeting moment, and
The moment passed, its magic
Became but a distant glimmer:
The mother who chose
Not to spank her young son
In the doctor’s waiting room
When he broke her rules,
But instead calmed him
And said she would not hurt him
Then asked if he understood what he did wrong,
In the protection of being told
He would not be punished.
I was in awe of the moment,
The moment was the poem
And I did not capture it
In the crystalline clarity
With which the interaction occurred,
But I thought of it again and again.
Here lies an observation, rudely captured,
After the moment lost its shine
In the recesses of my memory
And a long neglected note to self
To write, to write, to write.

Chris Fettes, M.A., is an Instructor and Program Coordinator in the Fay W. Boozman College of Public Health.

Hidden Treasure

By Marybeth Curtis, RN, BSN, WOCN

It was the first day of clinical in my Bachelor of Science in Nursing program. Time to actually bring real patients into the picture! We were visiting a local nursing home to work on our communication skills. Each student was assigned a nursing home resident. We were to spend the day with the patient, interacting, laughing, and assisting them with their daily activities. This was a time for making memories!

Our instructor went over the interpersonal communication worksheet that we would complete as our homework. Once we had our room assignments, we were on our way to meet our first patient! I remember walking into her room. She was lying in bed with her back turned to the door. I walked over to the bed and called the name that was on my paper. “Mrs. Taylor.” “Mrs. Ruby Taylor.” Nothing.

I patted her on her shoulder so not to startle her from her slumber. “Mrs. Taylor.” A wrinkled, slender face slightly turned to smile back at me. Dark brown eyes twinkled through the narrow openings. Some strands of thin, grey hair fell into her eyes as the remainder of her hair stood on end with static electricity working its magic. I remember hiding a startled expression as I noticed a tiny mole perched on the tip of her nose. All I could do was smile back.

I introduced myself. Talking a mile-a-minute, as I usually do when nervous, she just lay there smiling back at me. Never nodding. Never making a sound. Just smiling. I began to sit her up in bed, fluffed her pillow, and straightened her covers. One of the duties on our checklist was to dress the patient, assist them to their wheelchair, provide toileting as needed, and feed them their morning meal. During all of this, we were to make mental notes addressing questions on our interpersonal communication worksheets without being too obvious, of course.

As I leaned over to cradle Mrs. Taylor in my arms, and pivot her to the edge of the tiny bed, she reached her gnarled, little hand to the side of my face. She patted my cheek and pressed her forehead to mine. It felt as though time stood still. I have no idea how long we sat there. I loved her patting my cheek and no one ever pressed a forehead to mine so sweetly. I was in love immediately.

I ready my notes. “Non-communicative,” appeared by Mrs. Taylor’s name. She had not spoken in the past year! What was my teacher thinking? How was I supposed to communicate with her? How was I to complete my assignment? I felt a sense of panic creeping over me. As I looked back at the small-framed beauty at the side of the bed, it suddenly did not matter. I began to brush her thinning, grey hair. She had it in a braid. I brushed it out and sang to her as I gathered up the dangling strands. There! It was a beautiful braid again and Mrs. Taylor’s smile stretched from ear to ear.

I washed her gnarled hands and rubbed them with lotion. I rubbed her legs with lotion and placed socks and shoes on her tiny feet. We chose a blue dress. Well, I chose a blue dress. Mrs. Taylor just smiled and I took that as approval. I talked and talked as I did the things that were necessary to prepare for breakfast. Soon, it was time to eat and she patted my face and smiled as I spooned small bites of oatmeal into her toothless mouth. I noticed I was now the one leaning my forehead against hers as I offered her sips of milk and orange juice. Her happiness engulfed me.

How quickly the time had flown! It was almost time for me to leave. I could not think of leaving my new friend. I told her I would be back. I told her that she was my friend and I loved her. I wanted to have something for her to remember me by so I drew a picture. I drew a bright, yellow sunshine, green grass, and bright flowers. In big, red letters I wrote the words, “I love you, Ruby!” I held the picture in front of her for her to see. She took the picture from my hand and with her crooked index, finger she pointed to the words and said, “I…Love…You…Ruby.”

I was suddenly the one who was speechless! One of the nursing home staff told me it was the first time she had ever heard Mrs. Taylor speak! I was crying I was so happy. I hugged her and kissed her good bye. She patted my face again and smiled. I promised to return soon…to talk. I learned a valuable lesson in interpersonal communication that day I will never forget. As I reflect back, I understand now that you should never go into a situation without looking for hidden treasures. I definitely found mine…and it was a Ruby.

Marybeth Curtis, RN, BSN, WOCN, is a Nurse Educator in the Division of Community Health and Education in the Department of Family and Preventive Medicine at UAMS.