By Lindsey Johnson
Honorable mention, poetry

Sometimes, I wander around the house aimlessly. 

I feel lost. As though I’m forgetting something. Searching. 

My heart knows it’s you. 

I know it’s you I’m looking for. . . 

Trying to figure out how it is that you’re not here and the world kept turning. 

Subconsciously trying to place the pieces of the puzzle. . . 

What I’d be doing if you were here. 

What you would look like, the noises you would be making. 

Missed milestones. 

Imagining what the weight of you in my arms would be like again.

Instead, I feel the weight of your absence.  

My body has not yet adapted to your loss. . . 

Postpartum. Grieving.

Full breasts. Empty arms. 

Hope planned a nursey. Reality planned a funeral. 

And still, I keep trying to place you in my every day routine. 

Keeping you in my life, a part of me. 

Forever my son. Still my son. Always.   

My heart knows it’s you I’m looking for. . . 

My head knows you’re gone. 

Lindsey Johnson, RN, is a clinical coordinator for UAMS Kids First in Searcy.

A Collection

By F. Alex Wells, Jr.

Honorable mention, poetry

A Life Saved

He survived Cancer
Only to be plagued by unexplainable, intractable pain
So much so that he could only imagine escape by suicide

That didn’t work
So he tried again
That didn’t work either
Because they raced him to the hospital
They made it to the trauma bay in time

And on the recovery unit 
His heart stopped beating
Finally

But they crashed his ribs
Slammed his sternum into his heart
Mashing it over and over
Forcing blood through his body
Until his heart started beating again

A life saved?

Alone

Tears streaming down his face
He walked in and gently took her still hand

Pleading “Come on, wake up – get up”
He leaned to kiss her forehead

Then picking both of their backpacks up off the floor
He slung them over his shoulders 

Walking out of the hospital
Alone he carried their world on his shoulders

John A. Barns

Lying in his hospital bed
            Family gathered close by
            Telling stories of life and love
            Holding his hand to say goodbye

Lying in his hospital bed
            IV tubes and monitors gone
            No beeping, no buzzing, no numbers 
            Watching and waiting to say goodbye

Lying in his hospital bed
            His dad recalled a story 
            Of a little boy and his granddaddy
            Eating breakfast long ago
            Living now on cassette tape
                        “Just an ordinary breakfast
                        Between Daddy and Alex”

Lying in his hospital bed
            Alex… the A is for Alex
            And all this time I’ve been calling him John

One at a Time

One at a time
As if queued in line for a waterslide
Solitary tears would slip
Out of the corner of his eyes
Gently slide down the length of his nose
And hang, suspended, dangling off the tip
As if gathering courage 
To let go and take the plunge

Plunge they would, one by one
Into the steaming cup of coffee
He held to his lip but didn’t tip to sip
He simply held it there, gathering tears

And just like that, he watched his mother die.

Sometimes

Sometimes
Honoring a patient’s wishes 
Leaves a family haunted
With more questions than answers

Sometimes
Honoring a patient’s wishes
Leaves an entire community bewildered 
Scrambling to make meaning of unexpected loss – unimaginable pain

Sometimes
We’re left wondering 
If the patient’s wishes would have changed 
Had they known the road they would travel
Had they known the turns their path would take
Had they known how quickly they would arrive
At their final destination

Sometimes
This lived tension hits closer to home 
Affecting people we love
Leaving us standing in the space of knowing
Yet incapable of speaking
Yearning to comfort
Resting in the desolate and lonely place of doing right by the patient

Sometimes
This is a heavy burden to carry

Stay

Yellow eyes
Green skin
Bandaged sores all over his body
  Emaciated, with loose skin everywhere
Blanket kicked off
Gown pulled up around his ribs
  Restless, he writhes and wriggles
Mittens on his hands keep him safe from himself
Dried and fresh blood stain his skin 
  From a traumatic catheterization earlier in the day

Please take this sheet off my foot
Please… I beg you, please
As tears run down his cheeks

Stay
I tell myself
Stay and let him feel love’s presence
And he does
And his fragile voice, soft as a whisper at first, sings

Oh Jesus
My Jesus
Without him, how lost I would be

I joined him and we sang together
Over and over
Softly and tenderly

And then he prayed.

They Gathered to Scatter

Standing close
  Leaning in
    Intent on every word the doctor spoke

“So they got his heart back?”

“Yes
   We did
     But it is still a very serious situation”

As she walked out of the waiting room 
  Down the hall toward the patient’s room
Sanitizing wipes came out
  Gloved hands I hadn’t noticed until this moment 
    Wiped down every surface but the ceiling and the floor 
Then to their corners they went
  Like boxers in a ring
They sat like that
  Tucked into corners
    No two of them any closer than six feet apart
      And they waited with bated breath
        Hoping not to begin grieving this child together this night

Then
  Softly at first
    The sound of gospel music began to spill 
      Out of the mother’s cell phone 
        And into the waiting room
One aunt after another joined in the song
  Until the phone was on full volume
    And voices followed
Mom stood and rocked back and forth with her back to the room
  As if watching out the window
    Were the shade not drawn
      Her view must have been more beautiful
        More powerful

Only feet away
  Through walls of concrete and steel
    An army toils and sweats
      In masks 
      In gowns 
      In gloves
       To give a young man one more chance at life

F. Alex Wells, Jr., M.A., is a staff chaplain with Pastoral Care and Clinical Pastoral Education at UAMS.

By Jamie Watson

Honorable mention, Fiction

A preacher once said Dave Wooten was smooth as silk. He could talk you into anything, including, one time—to that preacher’s embarrassment—a lemon of a 1964 Ford. It was something about his smile. Or his eyes. I don’t know, really, but when Silky looked at you, you felt seen.

He never lost that look. Not till the very end, anyway. Even when he was lying in a hospital bed, twenty pounds too thin and coughing up a lifetime’s worth of tar, he could turn his head a little, squint one eye so that it sort of gleamed, and smile a smile that would tenderize the heart of a tax man.

Surprisingly, it wasn’t the cigarettes that laid him up like that, and he did not hesitate to point that out to anybody who suggested he might should have stopped smoking sooner. Not meanly or sarcastically, of course. He would flash that toothy grin and tell you softly what a pleasure it was to enjoy such a bitter vice for so long and still escape the specter of that demon so reviled by physicians and their confederates. It would have been cruel to disagree, and it was hard not to feel like he might be right.

For the record, I don’t think Silky was all that much of a liar. He bent the truth every now and then, as it served him. As most folks do. But I’m writing this down because a lot of people didn’t believe Silky at the end. About his friend Maria and what she could do. I ain’t so sure he was making it up. I knew Silky a long time, and when it came to something serious, there was no impurity in him. No prevarication.

By the time I made it up to see him, he’d been in that hospital about a week. Something to do with his liver, even though he was never much of a drinker. There was probably some irony in that, given how long he smoked. But he never saw fit to comment on it, so I didn’t mention it either when he told me. I could tell he had something else on his mind. 

A twinkle came into his eye, and he nodded toward the corner of the room. There was a big chair by the window for visitors with cushions covered in a green vinyl. Now, I could’ve sworn that chair was empty when I came into the room because I had looked at that green vinyl wondering who in their right mind would’ve chosen that color. But now, sitting in front of me, as if she’d been there the whole time, was a woman in a dark red dress with a big piece of black cloth tied around her middle like a belt. She looked dead at me, no smile or nod—like the kindness had been sucked right out of her. Of course, she might have been a little put out that I hadn’t seen her. She was maybe sixty years old, though I might have said younger if the light was different. She had dark skin and deep lines in her face like she worked outside a lot, so it was hard to tell. 

I startled a little, I won’t lie. I backed up and nodded my apologies and introduced myself. She didn’t speak, but Silky told me her name was Maria. Said she had come up to church a few times, and they had talked about the weather and the farming, and this and that. At some point, she told him she was a healer. Well, I’m sure Silky loved that. He had styled himself as a bit of a medicine man for years, selling pills and elixirs out of the trunk of his 1975 Pontiac Grandville Coupe. 

Now, I’d been Silky and his family’s doctor for as long as I had been practicing, and I didn’t approve of this at all. I want that on record. Nobody could be sure what was in that stuff he was selling. The only way I found out was that one of my regulars had been taking some pain pills they bought off of him. He didn’t deny it when I asked, but no matter how much I pleaded with him, he wasn’t interested in my opinion. Said he was doing a public service.

Anyway, I’m sure he and Maria hit it off. Silky wasn’t one to worry about competition. If anything, he’d be scheming to partner with her. On this occasion, Silky said she was just visiting, seeing how he was feeling. She stood up, nodded to him, and left the room. When I looked at him, he just shrugged and said he guessed she was through visiting.

Of course, I was not convinced in the slightest that she was a healer. So, more out of spite than anything, I asked if she couldn’t help his liver some. Silky closed his eyes and shook his head, said she couldn’t do anything big like that. Just minor things: lower your blood pressure, help you sleep better, heal gout. In one case, she told him she kept a woman from dying from diabetes for fifteen years. I asked what happened after fifteen years, and he grinned a little. Said the woman made Maria mad, so Maria stopped coming around. The woman got gangrene in both feet and died within the week. 

I think I coughed or grunted at this, not one bit convinced that the healer had anything to do with it. Silky must have caught my skepticism because he smiled real big again. Told me there was more to medicine than the medical school taught me. Told me I would see as soon as he was out of the hospital. I was right to suspect he’d been concocting something with this woman. He wasn’t one to skip an opportunity when it came his way. That’s how he got into the pills business in the first place.

Silky’s primary interest was used cars. He co-owned a dealership with a man named Dan Connor he had met in the Army during Vietnam. Dan was from somewhere outside of Houston and had told him there was a big car auction down there twice a year. After they were back stateside, Silky would go down to Houston and bid on cars with Dan. Then Dan would ship the cars up to Little Rock where they would split the profits from the sales.

But at some point, and I don’t know all the details, somebody down there in Texas told Silky that there was a little boat that left out of Galveston a few miles offshore, where it met up with another boat. Out there, Silky could get all kinds of medicines for dirt cheap. He told me he could charge twice what he paid for them and still be cheaper than any pharmacy. 

I asked him if that wasn’t dangerous, and he just shrugged. Said it wasn’t hurting anybody. In fact, he said, lifting a long, bony finger like an old schoolmaster, it was the same stuff the doctor gives you—penicillin, ampicillin, water pills, and what not. Most everybody he sold to already had a prescription, so they knew what to buy. They could even put in orders for specific dosages. Said they had anything people wanted on that boat. 

Silky said he did get nervous when truck drivers started asking for high-dose caffeine pills and Benzedrine inhalers—they were illegal by then—and then again when pain killers became the big thing. He was afraid word would get ‘round to the wrong people. But apparently it never did because the business kept steady, and Silky had him a new Pontiac about every year. He only kept his merchandise in the ’75, though, which he kept parked with the nose out the back of the dealership’s garage where nobody could get a close look at what was in there. I wondered if Dan Connor knew about the side business and whether Silky split those profits with him. But I never asked him about that. 

Anyway, by the time he met Maria, Silky was as much a medicine man as he was a used car salesman. And if he exaggerated one or two of the benefits of those pills, nobody complained too much. 

I can imagine he didn’t think too much of Maria the first time she came around. He probably thought her healing had something to do with herbs or roots or whatever. Some of that hippy, natural medicine trend had come into Arkansas from Austin and Memphis, so she could have been part of that crew. Or maybe she was Native American. Like I said, it was hard to tell from her face. She could have been what we used to call an Indian Healer. He never told me what she told him, but that little bit of small talk must have turned serious real fast because when Silky asked Maria about her herbal cures, she stiffened up and told him she didn’t use any thing for healing. She said she could heal just by thinking about it. 

Well, I’m sure Silky flashed her that hundred-dollar smile and told her kindly that he didn’t know what that meant. Maybe it was that smile or the way he said it that put her off. Maybe she didn’t like anybody thinking she was one of those hippie types or whatever. But he said that before he knew it, she was looking at him real funny, and his skin got all hot and itchy. He started feeling around in his clothes thinking maybe some ants had crawled up his britches. But there wasn’t anything there. He was just hot all over, and he was getting hotter every second. He said he was squirming around and about to come completely out of his clothes when he looked over at Maria. She was scowling and staring, but as he looked at her, that scowl smoothed out into the sweetest little demur smile, and then, just as quickly as it started, the heat and the itching stopped. I mean, stopped dead, and he was normal again. Right then, he told me, he knew exactly what she had meant.

She said that little trick was good for infections, then listed off ten or twelve other things she could cure just by thinking about them. As you might imagine, Silky saw dollar signs all over that. He asked her two dozen questions about how often she used that gift of hers, how many people knew about it, whether she’d ever thought about opening a practice. He even offered to bankroll a storefront for her. In exchange for a percentage, of course. She frowned and said she didn’t use her gift that way. Said it was for people who needed it, not to make money.

Silky said he was deflated for all of about ten seconds when an idea dropped into his head like a spring tornado. She wanted to help people—that was good. He wanted to make a little money—also good. She was clearly the real deal. So, he decided they could take a little road trip. Make a big circle over to Wynne, up to Mountain Home, over to Fort Smith, down to Texarkana, and then back to Little Rock. Nowhere too big, you understand. He didn’t want Big City attention. He wouldn’t be able to control the demand. Silky was always thinking like that, one step ahead. He had it all worked out. The used car business wasn’t going anywhere. And Silky’s brother’s boy could run the shop. They could slip into town with a tent, just like the old revival preachers, heal a few dozen people, fill an offering plate, and then slip right out again. A trip like that a couple of times a year, and he figured he could bump his take-home by a third.

“And they would really be healed!” he said, and his thin shoulders came up off the bed. I could see the yellow in his skin, and I worried whether he would get over that. But his eyes were as bright as I’d seen them, so… maybe. To Silky it was the perfect scam because it wasn’t a scam. 

They had things pretty well worked out, he said, when he started getting a pain in his belly. Then his skin turned a sickly color. Idiopathic liver failure is what we call it. Unknown cause. Your liver just stops doing its job.

Silky was hopeful that Maria would pull him out of it. He wasn’t sure all of what she could do, but if she could treat diabetes, surely she could help his liver limp along a bit longer. I guess by that time he’d bought into this Maria woman’s bag of tricks wholesale, like the saps who followed his smile down onto the dotted line of a questionable automobile. At least I thought he was a sap.

I could see that Silky was getting tired, so I told him to rest and that I’d come back the next day. He nestled himself down on his pillow and closed his eyes, but he still had a smile when I left.

That must have been a Tuesday, and I confess I didn’t go back the next day. I wish to heaven I had. Maybe I would have seen something or thought of something. Figured out some way to keep that woman out of his room. 

On Thursday—his last day, I’m sorry to say—I saw Maria, same red dress with the black cloth around her waist, turning down a hallway. She must have just come out of his room. I should have said something to her. Stalled her. I don’t know. What could I do?

I went into Silky’s room, and that sidelong grin was gone, no hint of a smile at all. No gleam in his eye. There was only fear. Silky was pale as death. His eyes were shifty and wild. He didn’t speak to me even after he’d seen me. Just pulled at his sheets, this way and that, up, down. Like he couldn’t get comfortable. 

I asked him if he was okay and whether he needed me to get somebody for him. Then he fixed on me. And I swear I got cold chills. He laid stock still and held that stare on me, and he said, “This is it. It’s over. I’m gone.” I asked what he was talking about.

He stopped looking at me started fidgeting with his sheets again. He told me, “You don’t believe, Doc. I understand. You ain’t seen it. But I have. She’s the real deal, and I can’t escape it now.”

I asked him what happened, and he looked over at the heart monitor. “Watch it,” he said. “It’s slowing down. It’s just gonna keep going down. That’s what she said.”

I have to say, I figured he was talking out of his head. Maybe his blood pressure had dropped or he had some infection or something. So, I stepped out and told the nurse he wasn’t doing too good. She said she knew and that they had been keeping an eye on him all morning. He was getting worse, but they didn’t know why.

Silky must have heard this last part because he started shouting. “I know why! I know why! It’s that woman! Find that woman!”

As gently as I could, I pulled the sheet up around his shoulders and talked him down. I got him to breathe deep and slow, and then I asked him to tell me about Maria, about what happened when she was in there.

He told me it was her plan all along. To meet him at the church. To show him what she could do. To get him to trust her. She told him that, about eight months ago, he’d sold her mother some pain medicine. Silky said he didn’t remember that, but she corrected him and said oh yes he did. Because she came back, and came back again. And again. And before long, her mother couldn’t do anything without taking the pills. And Silky just kept right on selling them to her. 

Then he got real quiet. He told me he did remember the woman. Remembered she did look a bit worse for wear the last few times he saw her. But she had a prescription. Showed it to him every time. Her doctor said to take them as she needed them, so Silky said he didn’t see the problem. It was the doctor, really. He was just helping her to afford her medicine.

Maria said that her mother started having trouble breathing. Less than a week later, she died. She told Silky that’s how he was going to go. It would get harder and harder to breathe. And his heart would slow down. He could watch it, she told him. Watch it and remember what he did to that poor woman who just wanted some relief from her pain.

Silky said he asked her why she couldn’t have stopped her mother’s pain. He told me, “I can’t believe I actually asked the question,” he said, “the impertinence.” He said it “im-pert-nence,” with the last little spark of the old Silky I knew. By way of an answer, she told him that his only grace would be that it would happen quicker than it did with her mother. Then she left.

From what I can tell, nobody’s heard from Maria since. Half the nurses say they never saw anybody visit Silky but me. The ones who remember Maria tell different stories. Some say she was young, some old. Some say she walked with her chin high, others say she slouched. 

Silky Wooten passed away while I was asking around the unit about Maria. If there’s a heaven, I like to think his wily ways weren’t to the level that would keep him out.

The body is a strange thing. If the mind gives up, the body often goes along with it. They say some kinds of monks can raise and lower their blood pressure by dint of thought. Silky wasn’t always a straight shooter, like I said, but I believe there was some truth to what he was saying. Either way, I don’t think he laid in that bed and scared himself to death. Maybe only Maria knows for sure.

Jamie Watson, Ph.D., is a clinical ethicist at the Cleveland Clinic.

By Jaleesa Jackson, M.D.

At the end of medical school, I found myself seemingly on top of the world. I had just received my degree from one of the best medical schools in the country, and was well on my way to becoming a first-rate surgeon. However, beginning intern year became, in a word, a fall from grace. I was no longer the carefree confident fourth–year medical student. I was in a new hospital, with new colleagues, and struggled to find my way as a new doctor. 

Medicine always intimidated yet fascinated me. No one in my family had ever attended college, let alone medical school. As a first-year medical student, I was surrounded by my classmates who hailed from schools such as Duke, Stanford, and Harvard. And there I sat, a black girl from a state school wondering the whole time if I was admitted just to fulfill enrollment quotas. 

Being a medical student is an amazing experience. The institution is steeped in history. One step through the main door and I was surrounded by paintings of medical giants: Osler, Halsted, and Kelly, none of whom looked anything like me. I immediately felt as if my being accepted to this school was some cosmic joke. As my confidence faltered, so did my performance. I went from being the all-star student that I was in undergrad, to the insecure medical student just scraping by. After narrowly avoiding failing a test my first year, I knew I had to make a change. I surrounded myself with people who motivated me. I met with mentors and discussed my reservations and insecurities with them, and my performance began to improve dramatically. There is a course at my medical school called Clinical Foundations of Medicine. It is designed to teach medical students how to perform physical exams and how to communicate with patients effectively, compassionately, and knowledgeably. Although I had struggled with other courses, this I knew I would be good at. A predominant part of the course was just being able to communicate with patients – to let them know you acknowledged their suffering and would do your best to alleviate it. I still think back on those days, awkwardly holding a stethoscope and trying to hear the faint murmurs or altered breath sounds that some of our patients had. That part made sense to me. Of course I had to learn how to correctly perform a physical exam. It was a vital characteristic of any aspiring physician. But patient communication? Why did we need a whole course for that? Wasn’t that common sense and common decency? What was the need in spending hours learning how to talk to patients? 

During my next three years in medical school, I was confronted with dying patients many times. On my internal medicine rotation, we had admitted a woman who had developed a bloodstream infection; she experienced severe mitral and tricuspid regurgitation. The infection was arising from her dialysis catheter; however, it couldn’t be removed, as she would not survive the procedure necessary to replace it. She had been evaluated by multiple teams and the goal transitioned to keeping her comfortable instead of focusing on surgeries and injections. However, she was still my patient and I presented her on rounds each morning. I would spend time every morning listening to her heart and trying to appreciate both murmurs. She would only groan or moan when I introduced myself, but each day at 5:00 a.m., I would place my stethoscope against her chest and just listen. One day, she began decompensating. Her heart rate increased and her blood pressure decreased. My resident called her family to come in, as we knew she only had hours left. Slowly, her heart rate began to fall, and I watched the monitor as her heart slowed then stopped. Her family was in tears, and my resident and I prayed with them, and then later returned to perform the death exam. For the first time, in two weeks of listening to her, I put my stethoscope on her chest and heard nothing. 

Death comes in many forms. It comes slowly like it did for my internal medicine patient, or it comes suddenly, as it does for the hundreds of young black men and women who died in Baltimore due to gun violence.  I watched as mothers broke down and cried after learning their child would never be coming home again. What struck me most was always mothers and grandmothers who then cried the soul-wrenching cry of heartbreak that became all too familiar to my ears. These were often teenagers –just children who grew up without social support and used illegal means to obtain money to help support their families. I would secretly head to the bathroom and cry with them. Cry for the youth stolen from their children, the lost potential, and for the other children in Baltimore who I knew would eventually suffer the same fate. 

What struck me most was the difference in the ways my attendings and senior residents would tell family members about the loss of a loved one. Some would sit down and gently explain that a patient had died, and allow for the family members to grieve in their own way, whether that was to ask as many questions as they could, or cry, scream, or sometimes beg. Others would simply state the facts and head out to answer a page or return a cell phone call. I was determined that I would be the former, that I would be the saving grace that a patient could lean on in times of despair or worry. I was going to be the difference. 

Surgical intern year is a physically, mentally, and emotionally demanding experience. As a new doctor, I identify one key word as “efficiency.” You are expected  to write orders and notes, see consults, take care of patients you have already operated on, and perform excellently in the operating room on new patients. This proved a daunting task for me. Our rounds are, on average, 45 seconds per patient. We quickly go over vital signs, lab values, checking incisions, and making sure our patients aren’t in any excessive pain.  We woke patients up out of deep sleep at 6:00 a.m. and they had one chance to ask all the questions they may have for the day. Afterwards, I placed necessary orders, wrote notes and headed to the pre-op area to see new patients for the day. As an intern, I, as part of my job, asked patients to sign a consent form for the procedure they will be having. In many cases, these are for major operations. I walked in to their rooms and could sometimes see the anxiety and apprehension on their faces. Part of me yearned to be there to assuage their fears and answer all their questions before proceeding to the OR. However, I know I have to see three more patients in the next 15 minutes, so I quickly hurried through the consent, wrote my initials on the side we will be operating, and headed to the next patient. Yes, I was efficient. But was I compassionate? Was I that ideal doctor that I was trained to be in CFM? The answer was absolutely not. Soon I found myself seeing a consult on a dying patient and ended my physical exam short after the patient requested no surgical intervention. A few weeks later, I asked myself: when did I become this callous person, who seemingly ignored a patient’s pain and suffering, and saw his questions as just another interruption to my day? 

The question is: how do I improve? How do we as a medical community improve? The answer is not easy. The white coats and stethoscopes are a stark contrast to the hospital gowns we lift up to examine incisions or press on the bellies of our patients, sometimes even without their permission. I believe the key to retaining humanity as a physician is to help our patients keep their humanity and dignity. Treating them not just as a patient, but a fellow human with goals, dreams and aspirations who just happens to have a medical issue. 

A few weeks before finishing my surgical intern year, I was wheeling a patient down the hall into the OR. Usually I looked straight ahead, ready to open the doors to the operating room so we may begin setup. That day I looked up briefly at the ceiling. I wanted to look at the same thing my patient was looking at as we headed to our destination. I wondered what he was thinking, an old man who just said goodbye to his family, and was now staring at the countless fluorescent lights passing overhead as we headed down the hall with hopes of repairing an aneurysm in his aorta. Was he coming to terms with his mortality? Was he thinking of the many loved ones he left behind in the holding room? Or was he simply trying to maintain a peaceful, positive outlook on his condition? It occurred to me at that moment that he was not another box to check on my daily list. He was another human being, just like me, hoping to make it from one day to the next. 

Jaleesa Jackson, M.D., is a pain medicine physician at UAMS.