physician | Elbrecht's Corpuscle

Allen Street

Posted on July 28, 2017 by Elbrecht

Author: Dr. Lewis Thomas (1913-1993)
Reprinted from “The Youngest Science: Notes of a Medicine Watcher”

Canto I: Prelude

Oh, Beacon Street is wide and neat, and open to the sky
Commonwealth exudes good health, and never knows a sigh
S collar Square, that lecher’s snare, is noisy but alive
While sin and domesticity are blend on Park Drive
And he who toils on Boylston Street will have another day
To pay his lease and live in peace, along the Riverway
A thoroughfare without a care is Cambridge Avenue,
Where ladies fair let down their hair, for passers-by to view
Some things are done on Huntington, no sailor would deny,
Which can’t be done on battleships, no matter how you try
Oh, many, many roads there are, that leap into the mind
(Like Sumner Tunnel, that monstrous funnel, impossible to find!)
And all are strange to ponder on, and beautiful to know,
And all are filled with living folk, who eat and breathe and grow.

Canto II

But let us speak of Allen Street—that strangest, darkest turn,
Which squats behind a hospital, mysterious and stern.
It lies within a silent place, with open arms it waits
For patients who aren’t leaving through the customary gates.
It concentrates on pending results, and caters to the guest
Who’s battled long with his disease, and come out second-best.

For in a well-run hospital, there’s no such thing as death.
There may be stoppage of the heart, and absence of the breath
But no one dies!
No patient tries this disrespectful feat.
He simply sighs, rolls up his eyes, and goes to Allen Street.
Whatever be his ailment—whate’er his sickness be,
From “Too, too, too much insulin” to “What’s this in his pee?”
From “Gastric growth,” “One lung (or both),” or “Question of Cirrhosis”
To “Exitus undiagnosed,” or “Generalized Necrosis”
He hides his head and leaves his bed, and, covered with a sheet,
He rolls through doors, down corridors, and goes to Allen Street.

And there he’ll find a refuge kind, a quiet sanctuary,
For Allen Street’s that final treat—the local mortuary.

Canto III

Oh, where is Mr. Murphy with his diabetic ulcer,
His orange-red precipitate and coronary?
Well, sir,
He’s gone to Allen Street.
And how is Mr. Gumbo with his touch of acid-fast,
His positive Babinskis, and his dark lunatic past?
And what about that lady who was lying in Bed 3,
Recently subjected to such skillful surgery?
And where are all the patients with the paroxysmal wheezes?
The tarry stools, ascitic pools, the livers like valises?
The jaundiced eyes, the fevered cries, and other nice diseases:
Go! Speak to them in soothing tones. We’ll put them on their feet!
We’ll try some other method, some newer way to treat
We’ll try colloidal manganese, a diathermy seat,
And intravenous buttermilk is very hard to beat
W’ll try a dye, a yellow dye, or different kinds of heat
But get them on their feet
We’ll find some way to treat
I’m very sorry, Doctor, but they’ve gone to Allen Street.

Canto IV

Little Mr. Gricco, lying on Ward E,
Used to have a rectum, just like you or me
Used to have a sphincter, ringed with little piles,
Used to sit at morning stool, face bewreathed with similes,
Used to fold his Transcript, wait in happy hush
For that minor ecstasy, the peristaltic rush…
But in the night, far out of sight, within his rectal stroma,
There grew a little nodule, a nasty carcinoma.
Oh, what lacks Mr. Gricco?—Why looks he incomplete?
What is this aching, yawning void in Mr. Gricco’s seat?
Who made this excavation? Who did this foulest deed?
Who dug this pit in which would fit a small velocipede?
What enterprising surgeon, with sterile spade and trowel,
Has seen some fault and made assault on Mr. Gricco’s bowel?
And what’s this small repulsive hole, which whistles like a flute?
Could this thing be colostomy—this shabby substitute?
Where is this patient’s other half! Where is this patient’s seat!
Why, Doctor, don’t you recollect: It’s gone to Allen Street.

Canto V: Footnote

At certain times one sometimes finds a patient in his bed,
Who limply lies with glassy eyes feeding in his head.
Who doesn’t seem to breathe at all, who doesn’t make a sound,
Whose temperature is seen to fall, whose pulse cannot be found.
And one would say, without delay, that this is a condition
Of general inactivity—a sort of inanition—
A quiet stage, a final page, a dream within the making,
A silence deep, an empty sleep without the fear of waking—

But no one states, or intimates, that maybe he’s expired,
For anyone can plainly see that he is simply tired.
It isn’t wise to analyze, to seek an explanation,
For this is just a new disease, of infinite duration.

But if you look within the book, upon his progress sheet,
You’ll find a sign within a line—“Discharged to Allen Street.”

From Here to the Sea

Posted on July 25, 2017 by Elbrecht

We had been driving for quite some time, our trip dotted with several detours, by the time we arrived at the final checkpoint. As we came to a stop, there were hundreds of people lining the road, the result of the clearly demarcated “point of no further progress”, which necessitated them leaving their vehicles if they wished to investigate further.

I had expected to find some sort of barrier to prevent further vehicular transport, as Joseph had earlier remarked there would come a place where security would be heavy.

As we approached the checkpoint, even from my seat in the back of the SUV, I could see there was only a small security station with an uniformed officer. He was flanked by an elderly gentleman who sat in a small folding chair holding a thin rope across the road. In retrospect, it would be an inaccurate characterization to call it a rope; instead, it was more like a cord.

Certainly, if we had needed, we could have carried through the checkpoint unabated, likely causing only a slight rope burn to the old man’s hands as it was torn from his grasp. I doubt there would even be a thread on the bumper.

If we had decided to forgo the minor annoyance of stopping at this point, the security officer would have needed to make a quick decision: either climb into his vehicle and begin pursuit, which probably would have caused hundreds more to climb back into their vehicles in an attempt to evade the blistering sun and proceed past the check point; or stood guard, calling for back-up, and awaiting our return at some point, knowing the road ahead only went from here to the sea.

Instead, the portly gentleman we had picked up at the last stop jumped out of the back of the SUV, where he had been napping since we departed Rameswaram. He had joined us at the medical clinic for our trip to the sea for this exact moment.

I had not caught his name when he was introduced, even though I had been asked to palpate the abdominal hernia protruding from his large belly when we met some earlier. Later, I would come to discover he was to return from Rameswaram to Madurai with us that evening in order for him to undergo a surgical repair the following day.

Joseph, who also had joined us at the medical clinic and was in charge of the Rameswaram Trust, remarked that this man had some connections with the police and would have some words with the security officer standing post at the check point.

He returned a few moments later, climbed into the back of the SUV again, and the elderly man dropped the cord separating us from the continuation of our journey. We slowly rolled through the security checkpoint to the amazement, perturbation, and perhaps disgust of those we passed by.

The road from here to the sea had been finished months ago, Joseph informed me, but it had yet to be christened by the government, an act set for the following week, which necessitated the security checkpoint. There had previously been only sand covering the narrow strip of land separating the Bay of Bengal from the Indian Ocean until that time.

It had been laid down as a means for tourists to safely proceed to a point where they might find what remained along its path: the remnants of a town destroyed by a cyclone over 50 years earlier. Joseph grimly told me how the cyclone had ravaged the area, resulting in more deaths than he cared to recall. Many people had tried to escape by train or finding cover in the church or school.

When I looked closely, I could see a few railroad ties left visible as we continued along the road; I didn’t need Joseph to describe the scene that must have occurred that day. I could imagine the terror.

The opposite side of the road was pock-marked with destruction. It was barely evident that a congregation had ever met in the structure I was told had been the cathedral. Now sand-blasted and with no signs of life, it was clear no one would have survived.

We proceeded to the end of the road, where a golden monument stood high into the air. The stanchion holding it was clearly vandalized with etchings of remarks and names. Either the elderly gentleman who held the cord was not on watch 24/7 or the two kilometer distance had not deterred scoundrels from walking to this point.

As we had made our way from the checkpoint to the monument, the stark contrast between the two receding coast lines was ever more apparent.

The Indian Ocean raged on the south coast, where we had passed the remains of the cathedral. But only 100 meters away, the bay calmly pulsated. I imagined the cyclone washing over the small community some 50 years ago, leaving nothing in its wake but memories, and then violating the bay, distorting its history to this day.

Despite these cruel series of events, our varied group did manage to get a few pictures for posterity’s sake. We snapped photos together in order to commemorate our trip and new-found friendships. The driver even proudly commented he would place the Polaroid photo I gave him on his refrigerator. I sheepishly thanked him for safely guiding us to this point.

Our departure from Madurai five hours earlier included the three-hour journey to Rameswaram with the Rose Marie and Davenandran, who led the telemedicine project I had come to observe and the technician to assure its functional capacity, respectively.

Joseph had been alerted to my impending arrival by Rose Marie and joined our troupe at the telemedicine clinic. A man, no older than myself, he was easily the least-accented Indian I had met to this point, I asked if he had studied away from home when he mentioned he was in charge of the Rameswaram Trust.

Expecting that he must have studied in a native English-speaking country, or perhaps had lived there for quite some time before returning to his home town, he reported having only studied at a Seminary more inland than Rameswaram for a short time.

On our trip to the sea, he guided our troupe to a small fishing village where we stopped to check-in with a family he had known for quite some time. They were incredibly comfortable with me as a complete stranger and quickly offered food and drinks. I had not seen another Caucasian person in three days, so my presence was probably tempered by Joseph and Rose Marie. After some time catching up, none of which I could understand, we proceeded on.

On our path back, Joseph guided us to another home, where he introduced me to a woman who cared for the HIV+ fisherman whose numbers were creeping up in their community. She apparently did her best to also educate the townspeople of the treatment and safety of these men, all of whom had been outcast after their diagnosis was made. Joseph informed me this often fell on deaf ears.

By the time I returned to Madurai late that evening, I was exhausted but also fulfilled in the days events. It had been an unexpected event to be transported so far from the familiarity of Madurai, which I had known only for two days.

There had been little expectation on my part for what would occur on the way from Madurai to Rameswaram; even less so, the events of what transpired on our trip back to Madurai, most of which I have actually not documented here.

But the day fit with the nature of my overall journey so far, one which has been full of surprises, catching up with old friends, and making new ones. All the way from here to the sea.

The Death of Magneto

Posted on June 10, 2017 by Elbrecht

The Birth of Magneto

The Rise of Magneto

The Opposition to Magneto

The Allies of Magneto

Magneto was beginning to feel a cool wave of energy course through him. So close as to almost be one with him, Dr. Bett calmly placed his left hand on Magneto’s shoulder and his right hand, with stethoscope resting in the palm, against Magneto’s chest.

As calmly as the placement of his hand, came the words from Dr. Bett’s mouth.

“Don’t be afraid. Don’t run away- stay where you are.”

Magneto, born from tireless experiences of Intern year, knew a last gasp struggle with Dr. Bett would be moot. The poison Dr. Bett had so effortlessly and stealthily placed on Magneto’s mucous membranes was already causing a microscopic cascade of cellular apoptosis.

“Et tu, Dr. Bett?”

It was all Magneto could think to say in the moment before his death.

“Only Magneto had to die for this ambition,” responded Dr. Bett, recalling Brutus in the moments after he joined the assassination of Caesar.

Since his birth, Magneto had anticipated the greatest threat to his existence to come from his progenitor, Ean the Intern. From Ean’s grueling experience, Magneto had arisen as a counterbalance to the unbridled instincts and passion necessary for survival in Medical Residency.

Magneto had provided the organization and realization necessary to prevent Ean the Intern’s passions from destroying himself from within and ending this fantastic journey in its infancy.

Inadvertently, Magneto became the genesis for the Super Ego, Dr. Bett, who would become the moral compass on their tenuous journey.

Having given rise to Dr. Bett, Magneto was astounded of his own capabilities, but even more so, he was in awe by the strides Dr. Bett had made.

Each step Dr. Bett had taken brought Ean and Magneto closer to their ultimate goal. It also provided them even greater strength. His passion increasing along every one of Dr. Bett’s strides, Ean became harder for Magneto to control.

Magneto’s sole purpose now seemed to revolve around keeping Ean’s passions in check and preventing them from obliterating their common purpose as the completion of Residency loomed ever closer.

Dr. Bett had entrusted this responsibility upon Magneto, from which he expected a long and successful existence.

His last moments, so close to the end of their journey, had not been anticipated.

As the end of Residency became a reality, Dr. Bett began to feel the weight of Ean and Magneto with each step he took. While both had been necessary for his own creation, he could not envision the next journey coming to fruition if he would have to be responsible for them both.

This misunderstanding, which blinded Dr. Bett ever increasingly, gave rise to The Death of Magneto.

While Ean could at times create trouble if not adequately balanced by Magneto, Dr. Bett believed Ean’s instincts to be invaluable to their next journey. Simultaneously, Magneto’s own strength, as a counterbalance and as his own entity, could not be overlooked.

Dr. Bett, after painful deliberation, could see Magneto becoming too powerful to control due to the opportunities awaiting them on their next journey. Eventually, Magneto’s strengths could make Dr. Bett unnecessary.

More importantly, Magneto’s relationship with Ean, while needed at this stage, was not deemed to be necessary by Dr. Bett in the future. Dr. Bett could harness Ean’s energy on his own.

And if Magneto eventually realized that Ean was beholden to him, and not Dr. Bett, it would be Magneto, and not Dr. Bett, who would truly be in charge of this journey.

This was a reality Dr. Bett was not willing to allow.

There was a brief moment when Magneto looked into Dr. Bett’s eyes as his vision blurred and the sound of his own heart faded.

Dr. Bett looked as caring and thoughtful as ever.

It was a moment not foreseen by Magneto. But he was comforted by it.

That was the moment. The Death of Magneto.

lost and found

Posted on August 19, 2016 by Elbrecht

{cast away}…

After a meteor shower of pages to the 4 beepers adorning my waist band, a series of perplexing admissions, and random patients causing ridiculously unnecessary stress, I began my lonely journey back to one of the hospital work rooms where most of my scant free-time in the past two weeks had been spent.

Once there, I was looking forward to spending some time with “Wilson”, a computer with whom I had cultivated a close relationship while navigating the seduction of Black Betty.

On this night though, I punched in the key code to the workroom door to find someone sitting at the computer beside Wilson.

I glanced at my iPhone and noted the time to be “2:07AM”.

In the previous two weeks, other than the aforementioned “life vest” I had with me on a few nights, there had been no other signs of life in this work room.

Wilson and I had discussed each phone call I received, him showing me the necessary data to make my decisions and cautiously warning me when a order I was about to enter was contra-indicated.

On this dark night, Wilson was not alone.

maxresdefault

Wilson did not seem alarmed by this strangers presence, but I approached cautiously from the far side of the dimly lit room.

Before positioning myself at Wilson’s helm, I jovially offered a polite “Hi there” to the scrub-wearing woman who appeared to be typing in a patient’s electronic chart.

She did not respond.

Her presence was mildly unnerving, though slightly comforting, but I dared not repeat myself, much less attempt to make eye contact with the stranger.

But before my curiosity could win out and tempt me to offer the stranger another greeting , pager #3 let out another bleeping roar.

I quickly punched the number into the phone beside Wilson while I waited for him to wake up from his electronic slumber.

The nurse who queried me over the phone was audibly confused; despite Wilson and I’s best efforts, we could not find her answer.

In an attempt to assuage her fears, I promised to come directly to the floor and work out the issue in person. Wilson would stay behind and keep an eye on the stranger.

I glanced again at the stranger, furiously typing away at the computer beside Wilson, but I did not repeat my greeting, or wish her a fond farewell.

I returned 20 minutes later having solved the mystery posed by a new nurse, but Wilson was alone. There was no sign of the stranger.

My body still ached. My mind was still heavy.

In that moment, I wondered if there ever had been a stranger sitting beside Wilson, furiously entering some record in a patient’s chart.

Mind-Numbing-Double-Exposure-Pictures-4

I sat down again, facing Wilson, wondering if I should ask him where the stranger had gone. Or if there ever had been a stranger.

Perhaps, I had imagined the entire encounter.

Not wanting to let on about my fatigue, I decided against asking Wilson. He had helped me enough these past two weeks.

And I did not feel like burdening him with the knowledge that I may have lost my mind.

As the clock struck 9AM, I slowly dialed my landlord’s number into my phone.

It rang.

And rang.

And then voicemail.

Sitting in the call room, I provided another detailed message as to my predicament, as if I was meticulously spelling “HELP” in the sand of a long-forgotten beach.

In the following moments, a wide range of emotions raged through my mind: fear, anger, sorrow, disbelief, heartbreak.

I laid down on the crisply pressed sheets of the hardened mattress, feeling lost beyond my worst nightmare.

But as my head jostled up against the pillow, the aches in my body lifted. The heaviness in my mind evaporated.

My Ego would not go down without a fight; it bullied my body from the call room and plotted a course for my landlord’s office.

Once there, I was met with disbelief.

Neither the office manager or the owner recognized the bearded man informing them of his sequestration in a small call room in the hospital down the street.

They were equally perplexed when I laid out my sojourn from the hospital to their office to relay in person the message I had left numerous times on voicemail.

I dared not mention to them how Wilson and I had survived the past two weeks; I didn’t think they would understand.

They apologized profusely for believing my lost keys had been found and returned to me by the handyman.

I calmly, but firmly, informed my landlord that he would proceed to walk me back to my apartment building; we found the keys locked in my mailbox.

My bearded face wondered aloud to my landlord if the handyman had believed me to possess teleportation properties allowing me to move my electrons and protons from outside the building into the entryway where the mailbox was located.

And if he believed me to possess the skills of Houdini to remove the keys from the mailbox without a key.

My Ego kept my Id from going bezerker on my landlord as he handed my keys to me.

I informed him I was in fact only a physician, not a teleporting magician.

The subsequent night was a maelstrom of terror.

If I had spontaneously combusted it would have been a fitting end to my Residency.

When the night came to an end, I was still cast away. My “life vest” had appeared and like clock work was torn from my being at midnight.

The night continued to be so punishing that I called my Chief Residents and another seasoned colleague summarily washed upon the shore of my deserted island.

He found me, lost amongst the bounding waves of pages and admission, barely keeping my head above water.

His effort to save me was seemingly futile as Black Betty enveloped us both, like a storm beating down on a small dinghy in the Aegean Sea.

But we both survived the raging storm; hoping to find a current that would take us away from this world.

I was rescued 24 hours later.

My final scheduled foray into Night Float had been completed as the sun rose that Friday morning.

I unclasped 3 pagers from my waist, handing them to the physicians who would dare navigate these rough waters.

Begrudgingly, I left behind Wilson, as my rescuers assured me of a job well done surviving this experience.

For him, I hoped the best.

Perhaps he would guide some other Cast Away from the path laid out by Black Betty as they washed upon the shore.