Prizes are awarded yearly to authors of prose or verse works that are considered to be of exceptional artistic and humanistic merit. An outside judge determines awards, which range from $100 to $200. This year’s judge for the Kienle Competition in Literature is Marilyn McEntyre, Ph.D..
Marilyn McEntyre is Adjunct Professor of Medical Humanities at the UC Berkeley-UCSF Joint Medical Program. Her recent book, Patient Poets: Illness from Inside Out, offers reflections on what caregivers can learn from poetry by people with chronic or terminal illness or disability. With Anne Hunker Hawkins, she co-edited the volume Teaching Literature and Medicine. She serves on the editorial board of the Online Database of Literature, Arts, and Medicine.
© Emily Funk, MSII
For now, it is time to wash her hair. I hand her the washcloth, “Here, hold this against your forehead.”
The simple, practical gesture that provides the central image in this story about caring and being cared for by a person with Down’s syndrome gives it memorable poignancy. The movement from a childhood memory to an adult encounter with the same aunt, whose condition has kept her childlike, is rich with gentle irony, and a yearning to protect her from a painful present and future.
© Julie Baird Patient
The game was outdated even when she was a girl,
A vintage novelty found in the theater arcade.
Put in two quarters; try your luck,
Keep the ball aloft.
Her brother was remarkably good.
“It’s all dumb luck,” she scoffed, “You’re wasting your money.”
“Only for those who don’t have the skill,” he shot,
The coins clinking through the slot.
The ball soared upward—
Bouncing off bumpers, cascading into chambers, diving toward dents.
Lights flashed, bells pinged, whistles shrieked.
He stayed focused, the distractions lost between his gaze and the ball.
With ease he flipped the ball off the flaps,
A jerk with one hand, a calculated pull with the other.
Effortlessly against the middle, breathlessly off the tip,
Evading the inevitable for a few seconds longer.
Even he couldn’t direct every aspect of the game.
The ball suspended for a slice of a breath, half of a blink
And it would fall, cutting a perfect path right between the two levers,
Away from the control he had.
She didn’t have to watch the machine,
She only had to watch his face.
His eyes would narrow, the futile flapping of the handles,
The silent exhalation that the game was over.
This is different, she tells herself as she enters the darkened room,
Her normally wiggly toddler, quiet and still in her arms.
The technicians bustle around,
Moving monitors, locating tools.
Wires run from her son’s chest to the monitor looming before them,
His little fingers trace down the wire, straight and rigid.
He has learned not to pull things attached to his skin.
His head rests against her chest as she kisses his sweaty hair.
She smiles when her brother enters,
His white coat much too big on his thin shoulders.
Despite years and training, he is always little to her.
They talk briefly, the echo reflected in both of their eyes.
Her brother picks up the probe as he hunches over her son’s chest.
Movement flickers on the screen, distorted shapes bend and shrink,
Lights flash, bells ping, whistles shriek.
He stays focused, the distractions lost between his gaze and the monitor.
With ease he slides the probe around, the flaps of the heart lift upwards and down,
A movement with one hand, some typing with the other.
Effortlessly he navigates through the passages and chambers,
Evading the inevitable knowledge for a few seconds longer.
She doesn’t have to watch the monitor,
She only has to watch his face.
She knows when the ball has dropped.
She knows when the game is over.
This poem reminds us how memory leaves its traces and equips us for defining moments. The poem’s simple, matter-of-fact narration leaves the reader to discover points of emotional connection with the mother who reaches back to a shared childhood for a comforting image of the brother-doctor on whose skill she has hung her desperate hopes.
Liver Allograft, Deceased Donor
© Lisa Passmore Beyers MSIII
The call came Friday morning, 7:00am. A liver was available. Our patient had been in the intensive care unit for nearly a week. Intubated. Sedated. Swelling with fluids that can only be captured and excreted with the liver’s assistance. Unfortunately, our patient’s liver would not cooperate.
For kidney failure, we have dialysis. For hearts, a pacemaker. For livers, not much. A team of doctors and medical staff working around the clock with crude drips and medications can never take the place of such a perfect organ. We were fairly certain she would pass over the weekend. Some were surprised that she had made it through the week.
But the call came, and she was number four on the liver recipient transplant list. Fourth worst liver in the country.
We were shuttled to a hospital outside of Philly. It was a nice neighborhood. Clean. A banner on an overpass proclaimed “Best Place to Live!” according to some magazine poll. We parked at the ambulance entrance. We asked approachable, scrub-clad strangers for directions until we found our way to the OR. A few minutes later, a pair of physicians from a hospital in Ohio showed up, Igloo cooler and duffle bag in tow. Pale attending and eager assistant. They were here for the lungs.
The OR was a flurry of transplant coordinators and nurses of various roles. An anesthesiologist was attending to the tubes and wires coming from a woman on the table. This was our patient for the next few hours.
She was brain dead when we arrived. We would be the ones to kill her.
I didn’t think about this at first; I was part of the commotion. Trying to find a pair of gloves to give the scrub nurse, carefully noting her snide expression when I told her I was scrubbing in. She was too flustered to have some idiot medical student contaminating her instruments. Little did she know, I had already made those mistakes weeks ago. I scrubbed in like a champ.
Before incisions were made, the transplant surgeon asked for a moment of silence for the donor. A women brain dead before we met her. Her organs given to potentially save four separate lives. I bowed my head, but no prayers came to mind. I tried to find a sense of peace and respect. I tried to communicate that I was honored to be there and to take part. I was honored by the donor’s life, and the daughter she had raised to make such a difficult decision at a terrible time.
The moment was interrupted by the Ohio surgeon, muttering and tinkering with his head lamp, seeking just the right light. Everyone took their places. The operation commenced.
Skin was prepped. Incisions were declared and made. The vitals and heart rate of the patient beeped a song of oxygen saturation and perfusion. The scrub nurse’s precious instruments moved across the table, cut into the body, exposed its internal workings. Just like an image out of Netter’s, I could see the entire contents of the body from neck to groin, divided neatly and deliberately by diaphragm. I saw a live, beating heart for the first time. I saw how the Ohio surgeon used the ventilator to reinflate the lungs and how they responded neatly to the machines behind the curtain. It was beautiful. It was predictable and satisfying. But I could sense that this operation was going to be different.
The Ohio assistant stepped out to make a phone call, and the Ohio surgeon asked me to help him dissect the lungs from the heart. I was to retract the aorta, a task best done with two fingers. My chubby fingers, however, were no match for the contractions of the heart. I could feel its beats objecting. I braced myself against the table to get a better grip as the ventricles pulsed against my gloved hand. After a few minutes I was excused to the abdomen, still starstruck. Still reeling.
At this point, I noticed the abdomen was open a little too wide. Significant vessels were being tied off with string. The surgeons were trying to orchestrate something. What, I didn’t know. Tubing was inserted into the abdominal aorta and fluid was added into circulation. Not in the rhythmic drips of the standard IV line, but in gushing flows proclaimed by a nurse at the foot of the bed.
“One liter. Two liters. Two and a half.”
The Ohio assistant cut the aorta.
Four suction devices were stuck in the space where the mediastinum had been. Even maximum suction was just enough to keep the blood from overflowing. It was the fastest possible bleed, and it did the job.
Then ice! An entire bin of ice mixing with the flow of blood. Packed snuggly around the organs, the smaller, less jagged pieces reserved for the lungs.
The monitors of vital signs beeped in protest. Alarms went off as blood pressures dropped, pulses dwindled to nothing. I had one last glimpse of the heart’s pathetic beats as the blood spilled out. Looking down at the abdomen, a ghostly white snaking structure wound over the belly. I realized with shock that it was the colon, completely devoid of blood. The intestines changed from lively pinks and reds to a deathly white. She was dying. This was the moment of physical death.
I felt like crying. I felt like gasping and laughing and maybe throwing up all at once. This was exsanguination. Bleeding out. This was the end for this woman’s body. And the vital monitors were protesting all the while.
There is a phenomenon to explain the thrill of standing on the edge of a high cliff. The human brain, aiming for survival, is terrified. It knows the height means death, should you misstep. At the same time, the monkey brain sees the cliff as an opportunity to leap, as if from tree top to tree top. A means of travel. A birthright. An instinct. This interplay of human and monkey brain on the edge of a cliff gives people the lightheaded butterfly feeling that is a fear of heights.
This is how I felt standing at the end of the operating table. My human brain said, this is the task at hand, let’s take out the blood and preserve the organs. My healer brain said, this woman is dying and you are only concerned about the ice! And so I remained, gasping for breath behind my mask, at once in ecstasy at the spectacle of anatomy and terrified at the desperation of the dying organs.
The heart was cut out of the body, handed across the table.
“At some point this will be put back in the chest,” said the surgeon, “Per the family’s wishes.”
I picked it up off the sterile blue draping, and held it. Terrified it would fall on the floor, always trying to be helpful, as medical students aim to be. It was limp and lukewarm on my palms. A thing of force now cradled easily in one hand like a kitten.
My friend the scrub nurse whips around. Points to my hands. “What is that?”
“Uh… the heart.”
She snatches a plastic basin off the table. Thrusts it at me. I place it lightly, carefully avoiding the sharp edges of the dish. We continue.
With economy and clarity, the writer describes a moment in which life and death meet as an organ is carefully harvested for donation. Awe vies with cognitive dissonance as the speaker holds a heart that has just been beating for a strange moment before moving on to retrieve the liver that will keep someone else alive.
St. Michael’s, Passaic
© Anthony K. Sedun Son of Yvonne Sedun, R.N. Pain Management Clinic
After the vigil-eve liturgy for the Conception of Anna,
Danny shared the news: You had died.
The Garden State Parkway, your silver Audi, en route to visit
a sick priest. Unspecified internal trauma, pronounced dead
at the hospital. Cather wrote right: death comes for us all.
Bishop emeritus, 84 years old. You must have known
the things they’d said: autocrat, sunnuvabitch, and worse.
“His father used to beat him. That’s why he’s the way he is.”
Son of a cantor, server, childhood friend of my Baba.
I’ll always remember the way she remembered you:
“Andy, go put these flowers on the altar for me.”
Crook of Christ, Shepherd of Slavs, shake loose the bug dust
that clings to the coats of your flock. Shake loose the clouds
of creation climbing out of the kadilnitsa to the heavens in cauliflower blossoms.
I drove to St. Michael’s on a Wednesday. First Street, Passaic.
The second-half of services for a bishop in repose.
This was your vineyard. These were your brothers.
You could have been Joseph, David, or Jesus.
After all, even Wojtyła had his Wyszyñski.
A few blocks away, inside a high-fenced lot, young boys
cut through the darkness below the mango-colored lights,
calling wildly for the soccer ball with reckless joy.
Stopped at the light I believed I saw you there in that crowded commotion
of bodies and blacktop: face like a furnace in the cold night air,
eyes tracking movement for every advantage, lungs gulping greedily
the last minutes, pushing away what you always must have known
was coming, a holler from your daddy
calling you home for the night.
This poem mirrors the way memory and imagination mingle in the wake of loss to help the living come to terms with death. It shows us how death demands a story and how the finding a story and crafting a poem may offer a gracious way through the first throes of mourning.