Angela Tang-Tan

The first time I witness a thorax opened, it is on a twenty-five-gram mouse. Heavier than most because she is gravid. The second time, it’s on a thirty-year-old man. In both, the yielding chest is laid open with scalpel and forceps, and my hand is inside. In both, I search for something invisible, elusive, sliding away from my fingertips.

I open a cage and reach for the mouse. It’s my research year of med school and we’re studying how neurons grow. We’d ordered the two mice online, the same way we order supplies—adding them to checkout just like boxes of slides and bottles of reagent ethanol. The act of procuring these living, breathing animals is as sterile as an operating field.

At first, the two huddle together in a corner, their warm bodies overlapping in the nest of shredded litter they are building in anticipation of their pups. As soon as the lid of the cage comes off, they skitter about to dodge my gloved fingers. Females are usually more difficult to catch than males because they are smaller and faster, but these two are swollen with pregnancy. I root around until my hand closes around the base of a tail. The choice is random. This one, then, will be first.

Her fur is black and glossy, soft as anything I have ever known. The harsh glare of the overhead lamp is reflected within her eyes like twin motes of starlight. I whisk her under the fume hood, into the chamber—a plexiglass container the size of a child’s shoebox—and the lid snaps shut. The gas is already on, hissing quietly through a labyrinth of valves and tubing. Inside, the mouse skitters around this strange new space, her whiskers twitching.

Is she afraid? In sight and in scent, this chamber is not too different from the other cages that have been her home. She cannot know the meaning of the scissors, forceps, and blue drapes laid out on the other side of the plexiglass. Yet, perhaps through some intuition, she perceives that this place is different. She is the first and the chamber is clean, so she does not smell the lingering fear from the ones who came before. I imagine it must be worse for the one to follow.

It doesn’t take long before she begins to sway. Her steps grow crooked, drunken. She falls, then staggers to her feet again. She circles the cage once, twice, pulling herself along on her belly. Then she collapses again, and this time I know she will not rise. The invisible wind rushing through the chamber ruffles her fur into spikes. Her eyes are half-open and dazed. Her hind legs jerk. Claws scrape soundlessly against plexiglass.

She lies utterly still for several minutes, though we wait a little longer, to make sure that she is fully unconscious. Then the animal surgeon removes her from the chamber and places her on the sterile field set up beside it beneath the fume hood. We must keep her alive, but insensate. Her heart must remain beating for long enough to drive clean saline through the brains of her young; only that will ensure a viable tissue harvest.

The surgeon waits a few minutes longer before pinching her hind paws, hard. She does not so much as shudder. Only then does he lay the mouse on her back, spread-eagled, lodging her muzzle into a nose cone, deftly taping each limb to the tabletop. His movements are quick with the ease of experience. The mouse’s belly is white and hairless, stretched taut as the skin of a drum. It pulses rhythmically with her ragged breaths, the beat of her heart. Her nipples are swollen, ready for her brood.

The thoracotomy transpires in a flash. Scissors pierce her chest wall, tearing through hide and sternum with brutal efficiency, unseaming her from chin to diaphragm. In a fraction of a second, her chest is splayed open. Her lungs heave, wet and purple, through a jagged wound speckled with stray pieces of fur. It’s not neat; it doesn’t have to be.

Under the ribs, between the lungs, a heart the size of my fingernail is pried into view with a pair of forceps. The pericardial sac is rosy and shining, like a semiprecious stone. The atria and ventricles quiver as they contract, one after the other, the ageless dance of survival.

A needle pierces the left ventricle, at the base of the heart. The whir of the perfusion machine fills the air as it drives a steady stream of phosphate-buffered saline into the aorta. The mouse’s still-beating heart flutters rhythmically, now pumping saline instead of blood to her brain and across a snarl of umbilical cords to her tiny offspring. We need the tissue we harvest to be clean.

Minutes pass. Watered-down blood bubbles onto the table in an expanding circle. We wait for the blood returning to the mouse’s right atrium to run clear, signaling that the saline has wound its way through the entire circuit of her body, from artery to capillary to vein. Gradually, as her blood drains away, her liver pales from crimson to mauve.

The surgeon widens the incision, and the mass of her uterus is exposed. V-shaped, it resembles a thick string of beads. Each bulge is a fetus; I count seven. One by one, each baby mouse is severed from its siblings and wrenched into the world, a crude approximation of a cesarean section. At fourteen weeks, the fetuses are milky-pale and nearly translucent; their shrimplike eyes have an almost alien sheen.

Beneath my microscope, each fetus’s skull tears apart as easily as the membrane of an egg. Even at this primordial stage, both hemispheres of the brain are developed in perfect miniature. The seat of consciousness is nascent, perhaps dreaming, but I must pluck it apart. I pry along the lateral sulcus to expose the hippocampus, deep within the recesses of the temporal lobe. Each tiny hippocampus goes into a vial of preservative solution. The rest of each mouse fetus is wrapped in paper towels for disposal.

On the operating field next to me, the heart of the mother mouse has gone still at last. Her carcass is spread out in a chaos of blood, viscera, and fur. Her entrails unspool in a tangle of gray. It is science, but it feels like a violation.

A lump rises in my throat, but I swallow it. She died for a good reason, I remind myself. We will learn from her sacrifice. The data we obtain will advance science and help many human patients in the future. We’ll make her life count.
I say it to myself once, twice. I say it with such conviction that I begin to believe it.
Behind me, the other mouse watches and huddles in her cage, awaiting her turn.

The beeper goes off. My resident takes one look and all at once he is striding for the elevator. I am on the first overnight shift of my surgery rotation, several months after my research year has ended. The resident downs the dregs of his Diet Coke while he’s on the move. “Thirty-year-old male, car crash, unconscious, no blood pressure. Arriving in fifteen minutes.” His words tumble out in the space of a single breath. “It’s gonna be bad.”

I scramble to gather my notes and the two of us sprint down to the Emergency Department, where a knot of nurses, emergency medicine doctors, surgery residents, and medical students has formed at the entrance to one of the trauma bays. We are greeted with curt nods. No one speaks above a whisper, and the tension is punctuated only by the clacking of computer keys and the beeping of monitors. The atmosphere is dark and thrumming, like the air before a storm. I watch the residents pull on blue gowns and shoe covers. I quietly do the same. We are expecting to get bloody.

The ambulance bay doors crash open. A burly medic is leaning over the patient, performing chest compressions, each blow reverberating through the gurney’s creaking metal frame. The trauma team springs into motion, slicing off the patient’s clothes, hooking him up to monitors, rapidly assessing his injuries.

The patient is young, bearded, fair-haired, his face pallid in a way that I have never seen. Beneath the seal of the bag-valve mask that is pumping oxygen into his lungs, his mouth is raw and bloody. His head lolls, the whites of his eyes stark beneath half-closed lids, insensible to the world. He is clearly in the midst of dying.

I step in to help the team pull him onto the hospital bed, and at once my gloves and gown are smeared with blood. A circle of blue-gowned figures quickly crowds me from the bedside, and I reflexively stand back so that I am not in the way of anyone more essential. Without seeing, I imagine the steps of intubation, the ultrasound probe pressed hard against his skin, the IV needles snaking into his blood vessels. Commands are shouted; vitals are read out. Minutes pass in a raucous blur. I feel my mind go blank and quiet. Adrenaline narrows my vision to only what is before me.

“Clear!” an emergency medicine doctor calls out. For a fraction of a second, the chest compressions cease. Everyone in the room seems to hold their breath as one. The shock is delivered in silence. I almost expect the man’s body to jolt, but he remains utterly still.

Compressions resume. Minutes pass, and another shock follows, then another. On the monitor screen, the tracing of his heart remains flat and lifeless. The air in the trauma bay grows heavier, though no one mentions it aloud. I can feel it—the shift, the specter of futility creeping in.

“Thoracotomy tray,” the chief trauma surgery resident commands. Her voice rings out like a thunderclap over the commotion, and all heads turn in her direction. Even as a lowly med student just a few days into my surgery rotation, I know that things are desperate when they say those words.

The thoracotomy tray is a brutal affair. Curving forceps, massive scissors designed to rend bone, a formidable retractor with a hand crank—the rib spreader. Each instrument is gunmetal gray and shining with cold promise. My breath catches as I watch the tray whisked into the melee, and I realize: we are about to tear a man open.

The junior resident grabs a scalpel off the tray and slashes a rapid U along the perimeter of the man’s ribs, from one armpit down to the abdomen and back up to the other armpit. It’s as fast as it is ruthless, slicing through skin, fat, and intercostal muscle. He flings down the scalpel and grabs the rongeur—a long-handled instrument with sleek blades the size of garden shears. He plunges the blades into the center of the chest, grips a handle in each fist, and bears down. There is a sharp crack, like a gunshot. The sternum snaps in two and rivulets of blood spring forth. My stomach lurches in reply.

The rib spreader comes next. It is exactly what it sounds like: broad, blunt metal blades wedging the incision open. The hand crank makes a rapid click-click-click with each revolution, ratcheting the edges of the tool apart inch by inch, the cleft yawning open. Bone and connective tissue creak. The ribcage hinges up toward the head until it almost covers the man’s face. The dull anterior edges of his lungs fan outward. In the center, his heart lies in a roiling pool of scarlet, a frightened animal shivering feebly.

The chief resident reaches in and wrests the man’s heart into the brightness of the emergency room. She rips into the pericardium with scissors to reveal the heart muscle itself, her gloved fingers scrambling to clasp the organ in her hand. She squeezes it and then releases. Squeezes and releases, again and again. Her white latex gloves turn black with coagulated blood as she commandeers the left ventricle, trying to force blood out of the heart and into the brain. Behind my mask, my mouth is slack. I have never witnessed an open cardiac massage. It is both brutal and miraculous.

After a few minutes, the chief resident steps back and the second-year takes over. His brow is furrowed deep. A bead of sweat courses down his forehead and slips beneath his mask. In his hands, the heart grows limp. I register that it must be futile if they are allowing the juniors to take a turn for practice.

Then—after how long, I cannot say—the resident turns and motions for me to take his place.

My feet carry me forward. My own heart thrums in the hollow of my throat. There is no time for fear, for reverence. This is something that I will likely never see again, much less participate in. I do not permit myself to hesitate. I place my hands into a nameless stranger’s thoracic cavity, unable to dwell on the intimacy of this act, the magnitude of my trespass. My fingers sink into a morass of congealed blood. I reach for the small creature of his heart and grasp it tight.

Unbidden, the memory of the mouse surfaces: another sterile field, another heart ceasing to beat. A different chest, far more fragile, but forced open in the same way. That body, too, had yielded to us—not to be saved, but so that those of us who go on living could learn.

The man’s heart, a smooth, sinewy knob of muscle, has already fallen utterly still. It is already growing cold in my hand. The emergency medicine attending announces the time of death—11:48 p.m.—and the group pulls back for a moment of silence. I withdraw my trembling, bloodied hands from the dead man’s chest and fold them in front of me. We bow our heads as one.

The trauma bay empties quickly as nurses step away to check on other patients and residents trickle out to write their notes. I find myself alone with the patient. As the medical student on the trauma surgery service, I am tasked with making the body presentable for the family, once they are found and informed.

The room is in catastrophic disarray: everywhere are lengths of discarded tubing, empty saline flushes, gauze pads, medication packaging. The bloodied tools of the thoracotomy tray lay out in the open, and everything, everywhere is wet, all five of the liters of blood that are meant to be in the human body now outside of it. My shoe covers squeak and stick to the ground with each bloodstained step.

The man is utterly exposed, his clothes torn into ribbons by trauma shears. I drape a towel over his genitals and survey the ruin that once was his chest. The arc of his ribs curve outward like the rings of a felled tree. The thoracic cavity gapes open, an unlidded box.

Gingerly, I grasp the piece of ribcage arching up toward his head and hinge it back down into place like a clamshell, folding his chest shut once more. His young face is cold and white as marble, yet the pillow beneath his head is vivid crimson. I fetch a needle driver and a coarse synthetic suture and begin my final task. I have closed skin before, sometimes fascia in the operating room, but I have never encountered an injury so great. The man looks as though he were slashed in two.

I start near his right armpit. The gauge of the thread is thick, the curved needle as long as my pinky finger. I make a row of enormous stitches across to the sternum. I need to yank hard on the suture to pull his ribcage back together. My fingers shake and grow numb from the strain. Little by little, his silent lungs and the shredded meat of his heart are secreted away. It takes several lengths of suture to close the cavernous wound. I manage to give him the barest facsimile of wholeness. It is not deft, not elegant; it doesn’t have to be.

I tie off the last suture, wipe down his body with a wet cloth, and survey what remains. I think of the mouse, pulled at random from a cage. I remember how we taped down her limbs, cracked open her chest, and allowed her heart to beat for just long enough to harvest what we needed from inside her—precious tissue that might one day help scientists treat human disease. This man, too, did not choose to give, but he gave all the same. His last moments were defined by violence, by the trespass of ruthless, seeking hands, first in the desperate hope that his life might still be saved, and then, when that hope failed, in service of educating new and future doctors.

But what was I meant to have learned tonight? When I placed my hands into the sacred dark between a man’s lungs and cradled his heart, what was I meant to grasp? Whatever it was, it slipped away from my gloved fingers.

The trauma bay dissolves around me, a tumult of blood and light. All I see is a man, a human animal, unnamed, unclothed, unraveled: so much wasted life. I remember the second mouse, watching from her cage, waiting her turn. I know that before long, another patient will arrive. Another body, another fate. And once again, I will find myself at their side, still searching for something flickering just beyond my reach.

Jacqueline Kolosov

2013 Winner, BLR Prize for Nonfiction

***

Again, somehow, one saw life, a pure bead—Virginia Woolf, “The Death of the Moth”

I.
“Why are there so many moths near the lamp, Mama?” my five-year-old daughter Sophie asked, as we sat at our patio table a few weeks ago, the purple-rose of twilight of late April having by now given way to night.

“They’re attracted to the light,” I said, registering the dozen moths circling the porch lamp. Moths are common enough here, especially at this time of year; still I would have expected two, four at most.

“I think they like Tiva’s locust tree,” my husband Bill said, and sure enough, a zigzagging flurry of dun bodies could be seen against the sky near that tree.

We ate our ice cream at the patio table as moths fluttered against the glass casing housing the lantern.

“What will happen if they touch the fire?” Sophie asked.

“They’ll die,” I said.

She scrunched up her nose, frowned. “Why do they do it then?”

“Like I said, they’re attracted to the light,” I replied, aware that this was not a very good answer.

A little Internet research helped me to discover the ‘why’: moths fix their flight by maintaining a constant orientation to the moon. Artificial lights—from candles or lamps—confuse that response, in part because the lights are so close. They create an unnatural situation, and cause the moths to “spiral to the source.”

---

Over the course of the next few days, the number of moths around the porch light escalated. The turning point came once again after dinner when I returned inside to find fifty moths swarming around the sunroom lamp, where we’d forgotten to place the screens in our aging windows. “You’ve got to see this,” I called to Bill.

“Moths?” he asked from the other side of the house.

“Yes,” I said.

“Well,” he called back. “Why don’t you have a look at what I found?”

I walked down the hallway to him. “What?”

And then I saw him standing in the bathroom where the brightly lit mirror was covered with moths, their dun-colored bodies battering themselves against the vanity’s bulbs.

The blockbuster newspaper headline—“Biblical Plague of Miller Moths in Lubbock, Texas”—took me by surprise, but the religious symbolism did not; how could it in a town of some two hundred thousand residents and perhaps two hundred churches?

By Lubbock standards, ours is an older house in the 1930-1950s-era neighborhood of Tech Terrace, not far from the university. The playa landscape is traditionally devoid of trees, but here the streets are filled with live oaks, locusts, cottonwoods, and especially the heavy-branched pecan trees. At harvest time, it’s easy to fill your pockets with the fallen nuts scattered across sidewalks and along the edges of lawns. What I didn’t realize was that our foliage-rich neighborhood would prove the ideal breeding ground for this year’s moth infestation.

The Miller moth, another less symbolically charged article said, is actually the army cutworm or Euxoa auxiliaris. It gets its name from the fine scales on their bodies that rub off; the powdery dust that remains is like the flour-covered clothing of a miller.

The reason for the so-called “Biblical Plague of Miller Moths” seemed to be the mild winter, for the army cutworm spends the winter as a caterpillar and it’s only in the spring that it burrows into the soil to pupate. With the lack of freezing temperatures this year, most of the population seems to have survived.

What the Miller moths needed to do now was fly west to higher elevations, specifically to Colorado, where there is an abundance of nectar plants, a journey in which I inevitably found symbolic resonance. Don’t heights suggest a wider perspective, a more expansive view?

How many are actually going to make it? I asked, as I swept up dozens of dead moths from shelves and windowsills and the floor over the coming days and weeks.

II.
Some eight months earlier, in late August, around the time the Miller moths were laying their eggs in my neighborhood, the academic year resumed at my university.

Once again I taught a three-hour graduate literature class, this one on Tuesday evenings. On one of these first evenings, just before class, I found my sixty-nine-year-old colleague Trudy in the mailroom, her left hand braced on the counter, as she struggled to reach the book bag on the floor at her feet. “Can I help you?”

From her stooped position, she turned her head to look up at me. “I’m afraid I’m stuck.”

“Here,” I said, pulling up a chair, and helping to ease her into it, no small effort since her body had gone extremely stiff, rigid.

She looked up at me, her brow furrowed, her brown-black eyes clear, direct. “Quite the situation,” she said, matter-of-fact.

I smiled at her and said, “Hold on, I’ll be right back.”

I rushed down the hall to the classroom where my six graduate students were gathered around the big oval table, chatting. “There’s a bit of a situation,” I said. “I have to help a colleague.”

They stared up at me, their easy conversation turned to silence.

“It’s a bit of an emergency,” I said.

“Do you need any help?” Maia asked.

“I think I’m okay,” I said, unsure of how Trudy would feel if I brought another person, especially a student, into the picture. “But thanks. I’ll get you if I do.”

Back in the mailroom, Trudy remained in the chair, handbag on her lap, book bag at her side, just as I had left her.

Thunder crackled in the distance, and through the windows I saw it had begun to rain.

“I suppose we’ll have a storm,” Trudy said.

“Looks like it.” By some small miracle there was an umbrella in the lost and found bin.

With Trudy leaning on my arm, I led her to the elevator and then outside to the parking lot, carrying her heavy book bag as I tried to shelter us both from the rain, and simultaneously asking if she was in any condition to drive—she still couldn’t bend down, for God’s sakes.

“I’ll be fine once I’m in the car,” she assured me, matter-of-fact.

Getting Trudy into her car—a big white truck that she needed to step up and into—proved no small challenge given the rigidity of her body. “Here, lean on me,” I said, as I tried to guide her right leg up and into the driver’s seat, hoping that somehow her left leg and she herself would follow.

I still have no clear idea of how I finally managed to get Trudy into the truck, but some twenty minutes later I stood in the rain and watched her drive off, wondering if I’d done the right thing. Or did my actions amount to the height of irresponsibility? (And I was simultaneously aware that I would have to spend the duration of my three-hour class in an absurdly air-conditioned seminar room wearing damp clothes.)

This was the first of many times that I helped Trudy’s body to un-stick itself. Yes, that’s how I came to think of it, as if she were the Tin Man (or tin woman) in Oz after a rain. It was a more than fitting comparison since the Tin Man’s quest is for a heart that he already possesses.

Trudy was the sort of person who might, on a first impression, appear to lack a heart, or at least that expected emotive feminine personality. She didn’t chit-chat or gossip or fuss over anyone’s baby. For as long as I could remember, she’d worn black or navy pantsuits to work, with white blouses and sensible shoes.

Trudy was a scholar of the English Renaissance and held strong opinions about the role of the classics in our increasingly digitized department. Perhaps the eldest member of the faculty, she proved level-headed, fearless and plain-spoken at meetings. Not once can I remember Trudy backing away from a confrontational situation, if the issue showed the signs of injustice or suspicious behavior. A few of my colleagues feared her, and one said, “There are people who’ve been burned by Trudy. Of course, that was before my time.”

“It must have been before my time, too,” I said, though I doubted that Trudy would “burn” anyone without just cause. “She’s always been absolutely fair to me,” I added.

Over the years, our brief exchanges about Renaissance literature and poetry had taken on increasing warmth. We talked about Elizabeth I and Christopher Marlowe—I’d earned my masters in Renaissance Drama—and I often quizzed her about Charlie Chaplin, her secondary specialty, though I never directly asked her what about him had piqued her interest.

III.
Some two weeks later, Trudy stood right outside the mailroom trying to pick up her keys with the cane she’d recently begun using. “Here,” I said, stooping to fetch them, “let me help.”

Trudy smiled. “I suppose I should get a cane with a hook on the end.”

“That might not be a bad idea,” I said, unable to imagine the frustration I would feel if the most fundamental actions—like bending down—were suddenly to become momentous challenges.

In the coming months, those challenges only escalated.

It was around mid-October that Trudy stopped driving and her husband began coming to pick her up. Often, I’d find her sitting on a bench outside the elevator where she was waiting for him, unable to stand without some assistance.

“Hello,” her husband would say to me, polite and dignified in his khaki pants and button-down shirt, his face partly hidden beneath a wide canvas hat that he wore regardless of the season. He was Japanese and had been a professor at the university, too—in the sciences I’d heard—though he’d long since retired.

“Hello,” I’d say, and get up before he helped Trudy to stand.

Not once did I introduce myself, and neither did Trudy’s husband, as if by not formalizing our meetings we could overlook the uncomfortable situation or at least move past it, the way I would move past my daughter’s tantrum over some desired object at the store, or the way my neighbor would look away when Bill and I argued on the front lawn.

The semester moved forward, and by early November the leaves on the trees had yellowed, and the daylight ended ever earlier; all the while, my encounters with Trudy continued. Generally I’d help her when she left the building, which coincided with the start of that Tuesday night class. The fact that the course focused on women poets and liminal experience (or experience outside of physical or spiritual boundaries) seemed an ironic, even troubling connection, as Trudy was in a place of profound physical transition, shuffling slowly down the hallway in the orthopedic shoes she now wore, her body stooped, so that a five minute trip from her office to class would routinely take her three times as long.

---

Near Thanksgiving I realized that Trudy was spending a good part of her office hours sitting in one of the orange hard-backed chairs in the common area, rather than in her office.

“Are you okay? Can I do anything for you?” I asked the first time I found her there, a hardback volume of Shakespeare’s complete plays open on her lap, her handsome gray head set at an awkward angle.

Startled, she raised her head, blinked at me.

“I’m sorry,” I said, suddenly self-conscious. “If I’m bothering you, just tell me to go away.”

“You’re not bothering me. It’s just hard to get up out of my desk chair,” she explained. “The wheels slip out from under me, and I can’t get my balance. So I’m sitting here.”

“The department should just provide you with a proper chair, right, Michael?” I said, as our Old English colleague emerged from his office. I felt sure that he, too, must be aware of what was happening to Trudy. “We could help you get a proper chair up here, right?”

“Well,” he said, leaning against the doorframe, “if it’s a registered disability, the state has a legal obligation to accommodate Trudy.”

IV.
It was as if someone had taken a tiny bead of pure life and decking it as lightly as possible with down and feathers, had set it dancing and zigzagging to show us the true nature of life—Virginia Woolf, “The Death of the Moth”

With the start of spring semester in January, I continued to encounter Trudy on Tuesday and Thursday evenings, and often early in the afternoon in the minutes before I taught my senior-level course on the History of the Essay.

During one of the first meetings, my students and I discussed Virginia Woolf’s “The Death of the Moth,” an essay I have been reading and rereading since my mid-twenties when I first fell in love with Woolf’s work.

The essay, which is not more than seven hundred words, enacts the writer’s meditation on a moth—“a tiny bead of pure life”—that is initially “set…dancing and zigzagging to show us the true nature of life.” I emphasize initially because in the course of this intensely focused narration, the moth finds himself “in difficulties,” and the creature’s struggle to stay alive enables Woolf’s simple and simultaneously sublime closing declaration, “O yes, he seemed to say, death is stronger than I am.”

… [The little hay-coloured moth] could no longer raise himself; his legs struggled vainly. But, as I stretched out a pencil, meaning to help him to right himself, it came over me that the failure and awkwardness were the approach of death….Stillness and quiet replaced the previous animation. The birds had taken themselves off to feed in the brooks. The horses stood still. Yet the power was there all the same, massed outside indifferent, impersonal, not attending to anything in particular.

In the crowded hallways and on the stairwells between classes, students and teachers bustled past, talking on cell phones, texting, eating, laughing. Occasionally, a blind student would navigate his route more slowly with a guide dog, and of course there were the inevitable students with feet in casts; but generally the pace between the ten-minute pause was brisk—and if not indifferent, the people hurrying by were not attentive to Trudy, who continued, with increasing frequency, to get stuck in awkward places.

“At least once a day,” she told me when I found her in the lounge, a banana peel at her feet, her slacks having slipped down so that her white high-waisted panties showed, for she had lost at least ten pounds over the Christmas holidays and seemed to grow thinner as the spring semester wore on, while her back became more bowed, and her balance increasingly shaky.

---

One sleety evening in early March when I sat down beside her on the bench outside the elevator while she waited for her husband, Trudy fixed her sharp brown-black eyes on me and said, “You’re being so kind—why?”

I no longer remember how I replied, though my mind focused on my own parents, now in their late seventies, and living two thousand miles away in the North Shore suburb of Chicago where I grew up. Yes, my mother, at seventy-seven, still practices yoga and can hold a headstand for five solid minutes; even so, her own spine has developed a pronounced curve, and she has shrunk some three inches and two clothes sizes in the last ten years. As for her hands, they are spotted with age and gnarled from arthritis. Yet she rarely complains.

And my father? At seventy-nine he is as healthy as one could expect, despite the fused discs in his spine and the chronic pain in his knees and back that the doctors treat with injections and nerve freezes that temporarily provide some relief. Ten years ago, he was still playing tennis and cross-country skiing. Today, he counts it a good day if he can walk a mile around the local botanic garden.

Did I tell Trudy that this was fundamental to my interest in her? Not exactly, though I did say that I’d like to think that someone would look out for my own parents if they needed some help. “Karma, you know?”

She nodded.

V.
Some ten days into the Biblical infestation of Miller moths, the situation showed no sign of abating. The articles said that the moths would leave an arid region as soon as possible—within ten days to two weeks at the most—once they were hatched. Thing was, the mild winter that seemed to allow them to hatch in huge numbers had given way to a surprisingly rainy spring. Arid west Texas wasn’t so arid this April, especially not in my garden, where I usually devoted hours every week to watering the extensive flower and vegetable beds I’d begun establishing four years earlier when we moved into this house.

To try to keep the moths out of the house, I took to turning off all the lights near the entryway at the back and at the front of the house. It took me a few more days to hang stockings filled with mothballs—my mother’s suggestion—at every door.

Still, the moths persisted.

Inevitably they got trapped in the garage, so we’d have to be vigilant about keeping the door to the kitchen closed, something that was difficult given that Bill had removed the lock on that door after Sophie had locked us out—on purpose. (Only later did I read that Miller moths avoid daylight and so are drawn to dark places like garages during the daytime hours.)

---

In late April, in the midst of this moth infestation, I found Trudy in the second floor lounge, her head bowed over that same tome of Shakespeare. “Are you okay, Trudy?” I asked. “Do you need any help?”

“No, no problem,” she said, though she was no longer able to raise her head so that she could look directly at me. Instead, for the last few weeks, at least since the March department meeting, her head remained tilted at an almost ninety-degree angle to the left.

“You’re sure?” I said, unable to imagine how she was actually going to make it to her class.

“If I need something, I’ll call you,” she said.

“Okay,” I said, and gestured at the Collected Shakespeare, if only to show that I could still talk about something other than health concerns with her. “What are you covering now?”

“Antony and Cleopatra,” she said. “I’m afraid I’m behind in my preparation for today.”

I imagined that the debilitation of her body—the length of time it took her to do anything, that she was reading the book with her face bent some eight inches from the page—had everything to do with the reason she was ‘behind.’

I said, “You must have taught that play dozens of times. I’m sure you can simply go in and talk about it.”

She smiled, a little uncertainly, or so I thought.

“You sure you’re okay?” I said.

“No problem,” she said again.

If I didn’t leave now, I’d be late for my History of the Essay class. “Okay,” I said, telling myself that other people would inevitably come into the lounge over the course of the next half hour.

As I climbed the stairs between the second and third floors, moths lingered everywhere in various stages of dying.

“This is just too depressing,” I told my students. “Wherever I look, moths; I just know that the moth I passed on the way upstairs—the one struggling to right itself—is going to be dead or smushed by the time I walk down the stairs again. And that doesn’t count the number of moths that find their way into my office—and die.”

A few people laughed.

“I vacuumed dozens of them off my screen door last night,” practical Katie said.

More laughter.

Someone pointed to the floor. “Oh my god, look—”

Sure enough, a moth was trying to regain its balance on the dirty linoleum.

“It’s like that essay I read in some class, the one about the dying moth,” Taylor said.

“We read ‘The Death of the Moth’ in here,” the always prepared Jenny corrected, “at the start of the semester.”

“Oh yeah,” Taylor said, and rolled her eyes. “It’s been a long couple of months.”

How could I have forgotten? Me, with my self-described Woolf-ian sensitivity?

Would Woolf have been able to write the essay had she been confronted with a moth infestation rather than the struggle for life of one moth? I asked myself, as I side-stepped around one powdery struggler on the stairwell after class. Would she have maintained her luminous, lyric sensibility if there were moths in her toiletries, nestled in her potted plants, and laying dead—their tiny legs tucked tight against their bodies—in corners and in dresser drawers?

As I neared my office, my other neighbor, Caroline, stepped into the common area, her eyes swollen, her face flushed and damp with tears. “Are you okay?” I asked.

Caroline just shook her head and continued to cry.

In the four years I have known her, Caroline has always been high-spirited and consummately professional. What was going on?

“It’s Trudy,” she cried.

My thoughts flashed back to how I’d left her in the downstairs lounge some two hours ago—I shouldn’t have left her. My students would have understood. “Trudy?”

“I was in my office, and luckily I had my door open, and I heard this voice calling, ‘Help me, help me.’ It was Trudy. She couldn’t move.” Caroline continued to cry. “What if I hadn’t heard her?”

“But you did hear her,” I said, gently taking hold of Caroline’s shoulders. “You heard her, and you went to help, right?”

Caroline nodded. “She was in her chair, and her body was all twisted up. I can’t imagine how long she had been sitting there like that.”

“Where is she now?” I asked.

“Her husband came to get her.”

I enfolded Caroline in an embrace, and then Rachel, the medievalist, joined us, and Caroline went through the entire narrative again.

“I shouldn’t be falling apart like this,” she said. “I’m a total mess. It’s just that it reminded me of my mom—she was so helpless. I was so helpless.”

And then I remembered: Friday, tomorrow, would be the sixth year anniversary of Caroline’s mother’s death from breast cancer. We’d talked about how she felt about losing her mother, how much she missed her. The very idea of losing mine terrified me. I knew enough about loss to understand that other events—like that moment with Trudy—could trigger a resurgence of grief such as Caroline’s.

VI.
“There’s something I should tell you about Trudy,” her closest friend in the department, fifty-something-year-old Margaret, another Renaissance scholar, told me some two or three days later.

She’d called in conjunction with the gift certificate for a massage that I’d begun organizing on Trudy’s behalf, convincing myself that such a gesture would somehow matter. At the very least, it would show that we cared.

“Yes?” I said.

“I just don’t know if a massage will do any good. You see, there’s a reason for what’s going on with her. No one else knows in the department. If I tell you—”

“I won’t say anything.”

“She has Parkinson’s.”

“Oh,” I said, recalling a neighbor from my childhood, a man whose hands shook when he walked with his cane; whose head craned forwards, like a turtle’s emerging from its shell. That man was in a wheelchair before he was sixty.

“She’s been dealing with it for the last five years,” Margaret continued, “but it’s become truly debilitating only this year.”

“Yes,” I said, almost adding that the disintegration from January until now—late April—was dramatic, like a steep roller coaster ride. Simultaneously, I felt real awe at Trudy’s perseverance. She never complains.

“That’s why I’m not sure the massage makes sense,” Margaret said.

“At the very least it will get the blood flowing in her body,” I said. “That will be good for her.”

“Yes, I suppose you’re right.”

We talked for a while longer about other possible strategies for Trudy’s future; apparently, Trudy had telephoned Margaret more than once when she’d gotten stuck in her kitchen and her husband wasn’t home. And there had been another incident in some public place—.

“Trudy needs a support network,” I said, though even as I spoke, I was unsure if I wanted—if I could—commit myself to being a part of that journey.

VII.
On the last day of classes, I led Trudy to the elevator, then out onto the bench facing the parking lot where I helped her to sit down. “My husband doesn’t want me to be alone for a minute,” she said in her usual matter-of-fact way. “What he doesn’t realize is that I usually just have one crisis a day.” She smiled.

For now, I thought, what Margaret said reverberating through my mind. In the interim, I’d read that Parkinson’s eventually impacts one’s cognitive and not just one’s physical abilities. I recalled the remarkable essays Trudy had written, the prestigiously published books, the praise from her former students. How long before Trudy’s scholarly, rational mind would be affected? Had the process already begun?

She thanked me again for the handmade card—with a picture of Charlie Chaplin—and for the gift certificate. “I’ll need to write you all thank you notes.”

“No, you don’t,” I said. “You don’t need to thank us. Really, Trudy—”

“I’ve never had a real massage,” she said, and laughed. “My husband’s no good at them.”

“Are you going to call him now, your husband?” I said, checking my own watch, for it was nearly 5:20, and I had to pick up Sophie at preschool within the next half hour. She hated being the last child on the playground.

Trudy nodded, but instead of reaching for the phone, she began telling me about the physical therapy she would start on Monday. “They want to stop me from plopping,” she said, and I understood that she was referring to the way she dropped, like a heavy sack, into a chair.

I looked down at her deeply veined hands, the knuckles enlarged like my mother’s, at the scratches on her forearms. How had she gotten them?

“I really do have to go and get my daughter, Trudy,” I said, touching her arm.

“I’ve seen her with Bill. She’s a real chatterbox, isn’t she?”

“Yes,” I said.

“My own son was quiet; at least that’s what the doctor said. Yet even he was too much for me.”

I stared, eager, despite the hour, to learn more, for it was hard to picture Trudy being overwhelmed by a small child; even harder, though, was picturing her as a woman close to my own age. Since I’d joined Tech, Trudy had been salt-and-pepper haired and the oldest member of the department. What had Trudy been like in her forties?

“Now my grandson tears around the house. That one,” she grinned, “is a real handful. I can’t imagine how they handle him. My poor daughter-in-law runs—”

“Trudy,” I said again. “Would you call your husband? I really do have to go. Sophie’s waiting.”

She reached into her handbag, found the phone, sent a text message—something I don’t yet know how to do.

“We’ll get together soon,” I said, looking directly into her brown-black eyes, as I had that first Tuesday evening last September.

“I’d like that,” she said, “as long as it’s at your house. My own sink’s full of dishes.”

“Of course,” I said, checking my watch: 5:35. I scanned the road for that white truck I’d helped Trudy into back in the fall.

“You know,” she said, just as that truck came into view, “I think this is going to be my last year of teaching.” She rubbed her brow, her eyes level with my own—despite her crooked head. “Question is—what next? The nursing home?”

“You’re far from that,” I said, far too easily, for what did I know?

She leaned into me then, and I breathed in her powdery scent mixed with the day’s heat and something greener, like spring.

Again, somehow, one saw life, a pure bead, Woolf writes as “The Death of the Moth” reaches its inevitable close. The moth gives up its fight—its body relaxes and its wings cease their shuddering—and in that moment, itself a bead of light secreting an inevitable darkness, Woolf sees life. Always, that ending creates a shock of recognition in me, the remarkable truth of it, the fact that the end of a living creature’s journey sharpens one’s knowledge, not just of death, but of life itself.

As I walked towards my bicycle, looking back just once as Trudy settled into the passenger seat of the white truck, a feathery thrumming buffeted my hair, and then a single moth escaped into the warm, evening air.

NYU & Bellevue Medical Residents

Hurricanes are not a common occurrence in New York City, but on October 29, 2012, Hurricane Sandy made landfall with extraordinary force. Lower Manhattan was dark for nearly a week, and NYU’s teaching hospitals—Bellevue Hospital and Tisch Hospital—had to evacuate their patients. Here are eyewitness accounts from several resident physicians from NYU’s Department of Medicine.

“Everyone was in good spirits as the evening came and you could hear the winds starting to pick up. At around 7 or 8 p.m., we lost access to the TV. Around 10 p.m., the 11^th floor window of one my patients—a sweet little old lady—blew from a broken latch. Thankfully she was not sitting nearby and was okay. This is when we pulled all the patients into the halls or to their beds to the far sides of the room with all the shades down.”

Meroё Morse

“I made my way through the deserted streets of Manhattan, shielding myself from Hurricane Sandy’s tropical cyclone winds and rain. I was relieved when I reached the gates of Bellevue Hospital, only to find myself peering into a sea of darkness, imagining this was what Bellevue must have felt like in the 18^th century. I envisioned that it would be difficult providing care without electricity, but I soon realized the darkness was the least of my concerns. I was unable to access any electronic medical records, the paging system, and most laboratory and radiology studies were unavailable. The limited excitement of attempting to provide medical care in a primal environment soon turned into fear and devastation as I was informed that the hospital telephones and water supply were failing. Without email, pagers, telephones, electricity, and now the lack of water for drinking, bathing, and plumbing, I could see that a full evacuation of Bellevue Hospital was inevitable.”

Brandon Oberweis

 “I remember the wind and rain falling on me as I walked from Bellevue to Tisch at 4 a.m. with a case of water bottles on my shoulder. We entered Tisch and it was clear that an evacuation was in process. In all honesty it felt more like a military zone than a hospital. We climbed up the stairs countless times and opened the doors to a blacked-out hospital floor with fleeting flashlight beams. For a hospital that I had worked in for the past two years, it was unrecognizable. It was clear that there were many patients that needed to be evacuated. We assembled teams and began the back-breaking work of carrying patients down 10 flights of stairs. This was no easy task. After carrying the first two patients, both over 200 pounds, I was physically exhausted with the only break being the walk up the stairs to do it again. But we managed to bring down each patient safely.”

Shaun Yang

“My fellow residents and I wandered over to Tisch Hospital and found the street filled with emergency personnel and ambulances. We entered with our flashlights searching for an open staircase that would allow us to go up to our patients on the 15-17^th floors. Upon our arrival to the 15^th floor medical ICU, there were no lights, no computers, and no obnoxious beeping that we so routinely hear in our daily life. There were nurses, medical students, residents, and an attending attempting to organize the chaos. They stood with flashlights and paper signouts attempting to triage which patients should go down the stairs first. The patients in this ICU are particularly sick and often dependent on respirators, infusion pumps, and invasive monitoring.  I was told the generators would only last another 15 minutes.”

Joshua Denson

“I was randomly assigned the task of keeping the sickest patient in the ICU alive—a 63-year-old man who was admitted for AV nodal ablation, who aspirated during the procedure, leading to pulmonary edema requiring intubation, followed by cardiogenic shock and then septic shock who, until a few hours earlier, had been on pressors, and was currently ventilator-dependent, on dobutamine, heparin, and fentanyl drips. Being the sickest patient, and therefore the most dependent on the still intact generator power, my patient was slated to go last. The resident was responsible for overseeing the entire operation and for carrying my patient’s lifeline, an epinephrine syringe, to restart his heart if it failed. The other intern was charged with keeping a flashlight aimed at the vital signs monitor. I trailed behind with the patient’s medications and remaining supplies, alongside a medical student with a spare oxygen tank. And so we began the longest descent of my life.”

Leila Tchelebi

 “Spiraling down the staircase for 16 flights was a line of heroism covered in sweat and gasoline. The fumes permeated our eyes giving a haze to the dimly lit stairwell. Scores of people—chiefs of service, residents, janitorial staff, nurses, IT support personnel, National Guard, administrative assistants—were lugging 5-gallon drums of fuel from the ground floor fuel tanker truck to Bellevue’s back-up generator upstairs. There was no division of labor, no complaints or hesitation, and no signs of stopping. Their faces were weary but, their aching legs catapulted them up the steps relentlessly. No one said it but, the pressure was obvious. Lives were literally at stake here. If they stopped moving, patients’ lives could end tonight. This went on for hours pushing the night to dawn. The drums passed hand to hand persistently like fluids dripping down an IV.”

Nick Amoroso

“It was interesting to see how the patients responded when they were wrapped up in sleigh beds and carried down: some were fearful, others were appreciative of our help, and one said “wheee!” while in transit. I was relieved by the day team at 8 a.m., who were following up where each patient was transferred in order to give an appropriate sign out to the accepting institution. Walking out of Tisch, with a strange combination of fatigue and excitement, I was taken aside by a Wall Street Journal reporter on First Avenue asking if there were any experiences I could share regarding the evacuation. I was too tired to speak and unsure how I could even attempt to put my night together in just a few sentences. Luckily, my co-night float intern answered “sorry, no comment.” I made it home to my dark, cold, powerless apartment…and I slept like a baby.”

David Zagha

“This experience reminded me that until very recently, medicine had been practiced without the aid of technology and that physicians relied exclusively on their own clinical judgment in making decisions. It is hard for me, a medicine intern who trained in an era defined by vast technological advances, to imagine that there was once a time when doctors had no access to what we now consider to be “routine” tests. During Hurricane Sandy and its aftermath, I felt transported to this other-worldly realm, if only briefly. When our modern technological advances left us in the dark, clinical instinct functioned as our guiding light.”

Anjali Varma Desai

Brandon Oberweiss assisted in collecting and editing these recollections.

Nikki Schulak

It’s impossible to think objectively about one’s death and still carry a tune.  

– Woody Allen

My mother wanted to see a whale before she died. In a boat off Montauk, Long Island, we puked over the side railings for the entire four-hour tour. No whales. We went on an Alaskan cruise—absolutely guaranteed to see whales—but we only saw harbor seals and a few scattered eagles. Then my mother died, without seeing her whale, which left me bitter.  

Whales. They’re so evasive with their beady little eyes. They sing and get all this attention. Every time one of them is stranded on a beach, there’s another story in the press. Please.

For my mother’s honor, however, I’ve continued to look for whales. I’ve even made a proclamation: I will see a whale before I die! At first, I didn’t try very hard. Swimming with dolphins in the Florida Keys didn’t count. The water was murky, and our time with them was choreographed and trite. You could tell they didn’t care about the money we’d spent. But when we moved to the West Coast and found everybody hiking around in vintage sportswear drinking kombucha, casually talking about whale sightings, I knew that someday soon I would be able to die fulfilled. 

Whale watching became a family chore, and we traveled to the coast every few months. We went during the migration south. Then during the migration north. Then we hunted for non-migrating whales. One late March afternoon in Depoe Bay, a few years into our search, my husband spotted his first whale. Actually he didn’t see a whale, just the spout, which I didn’t think should technically count. The next day, my kids saw spouts, too. But not me. I watched and waited. I watched people watching whales. In their fleeced bulk, gathered in a row along the seawall, they were mesmerized like gamblers watching a roulette wheel through binoculars.   

Our leader kept up steady encouragement. “Wait for it. Wait for it. A BLOW! 300 degrees at 45 millimeters!” The crowd murmured with excitement as though they’d seen David Bowie out there on the horizon. There was even an option to watch the action on a video monitor inside the whale watching station. Then you’d get a sticker that said “Thar be whales in Depoe Bay, Oregon—and I saw one!”

When I was six years old, I had a cerebral hemorrhage. CT scans were a brand new technology in 1973, and mine diagnosed an AVM—Arterio-Venous Malformation. This abnormal knot of blood vessels was lodged deep in my language center, and so I lost words as a result of the bleed. I eventually gained them back. The Decade of the Brain was still twenty years away. Surgery wasn’t an option. There was nothing to do but cross fingers and hope it didn’t happen again.  

“It’s in an ‘elegant’ part of the brain,” a neurologist told me of my AVM, when I had a seizure fifteen years later. No surgeon would be willing to risk removing the malformation when it was tucked deep in such elegance. “Don’t exert yourself,” the neurologist advised me. “Start anti-seizure medications. Don’t get constipated. Don’t lift weights. Don’t get pregnant. Keep up on the literature. Don’t orgasm.”

I could be a secret shopper for brain surgeons, I’ve done it so many times. I can rattle off the top departments in the country. I’ve met brain doctors who are pompous, others who are socially awkward. Some won’t shake hands. That I can understand—they have super important hands. A friendly young brain surgeon in his first year of residency once told me, “When I pass through the ER, white coats part like wheat in the wind.”  

My newest brain surgeon here in the Northwest is an awfully nice guy. Dr. W, according to his biography, likes hiking, bird watching, and spending time with his family. The first time I met with him, he looked through my thick envelope of scans, pulled out the newest ones, and slipped them onto his light board. Maybe he had some new ideas, some new tricks. I gave Dr. W a minute to consider the images, then commenced my barrage of questions.

“So, what do you think? Is it treatable? Is it worth the risk? What should I do? What would you do? What would you recommend if I were your—” I was about to say “daughter” but I stopped myself.  “—your wife?”     

“I can’t say, really, without an angiogram.”  

My first angiogram was when I was six. I’d been sedated, but I have a vivid memory of screaming as I was held down. The IV catheter was threaded into the great saphenous vein in the back of my knee, then fed through my body up to my brain. It sent contrast dye into my cerebral vessels so that they would show up on X-rays.  

I had a second angiogram when I was twenty-two. This time the catheter snaked from my groin to my brain. Despite the sedation, there was a shooting pain inside my head when the dye was injected.  Afterwards the insertion site bled profusely, turning an outpatient procedure into a two-day hospital stay.   

Dr. W listened to my previous angiographic experiences. “Well, it wouldn’t be like that with me.  No pain. No bleeding. You’d be completely comfortable. I’d make sure. Think about it, but not for too long.”  

I didn’t make the appointment. A year went by. Then six more.

In addition to subtle bragging about whale sightings, we here in the Northwest also chatter lightly about the Big One. When the megathrust comes, our bridges will snap and our schools will crumble. But what can we do? We live in a subduction zone. Out on the sidewalks after raking leaves, one of us will quip, “Let’s get together to set a time to have a neighborhood meeting about earthquake preparedness.” Thinking about earthquakes is part of our collective unconscious. I’ll be walking my dog in the cold, dark rain and the thought will cross my mind: I hope the Big One doesn’t happen right now. I worry about the fault lines in my brain in the same way. As I drive the soccer carpool over the Ross Island Bridge in rush hour, I think, I hope this isn’t the moment I go.  

After those seven years, I conceded that the angiogram was unavoidable. The once periodic episodes of numbness on my right side were now happening multiple times a day. My right hand had become increasingly weak and it was getting harder to hold a pen. I wanted advice from Dr. W, but he wasn’t going to give anything away without that comfortable angiogram. I called his office and scheduled an appointment, three months out.  

I saw my therapist a few times. I did sun salutations. I hiked with my old dog. What if, after the angiogram, Dr. W thinks I should do something? Like stereotactic radiation? Or embolization? Over the years, treatment options had tripled. People eradicate their AVMs all the time. I no longer have seizures. My headaches respond to Advil. Most doctors have told me that doing nothing is a reasonable choice. What if this is no longer true?  

The single worst artifact of my AVM is the sound in my head. It’s blood passing through an area of high pressure in my brain. A “bruit,” French for sound. I hear it when I sit in a quiet place. I hear it at night while my husband breathes deeply at my side. My bruit always impresses the doctors.  They put their stethoscopes against my temple. “This is an impressive bruit,” they tell their residents. “Listen.”  

When our friends talk about securing their foundation to their floor joists using Simpson Strong-Tie seismic attachments and titan anchors, I get nervous, because if they do it, then we’ll have to do it, too. Fortunately, our friends usually decide to spend their retrofit fund on a trip to Sun River, and I’m off the hook again. Our water heater ought to be strapped down. We should have hard-soled shoes under our beds. But we are more prepared than most people because my in-laws give us safety gifts for the holidays. We have several first aid kits, a hand-crank powered flashlight and FM radio, a wrench, and a Life Hammer that will break a car window and cut through seat belts. I have gallons of water in the basement that I haven’t changed in a decade. But if we don’t do the seismic retrofits, stale water in the basement won’t matter much.   

Although I swore to my husband before we married I would never live in an earthquake-prone area, when we explored Portland and interviewed for jobs, nobody we met seemed worried, so I didn’t worry either. My kids learn about earthquake preparedness as part of their standard curriculum. I check with them when we’re out for dinner, or at the zoo, “What would you do if there was an earthquake right now?” I know that in a tornado you kneel up against a weight-supporting wall and fold your fingers over the back of your head. But for earthquakes, I can never remember, does one go outside, or stand under a door? I assume the Big One will hit on a warm day in August when we’re all eating breakfast together. My husband won’t be out of town at a conference. I won’t be in the shower with shampoo in my hair. My daughter won’t be in the basement of her three story brick school.

I have meals ready in the freezer, childcare arranged, my hair cut and my eyebrows waxed. The pre-op information sheets arrive in the mail. One page says I can have clear liquids the morning of the procedure. Another page says no food or drink. I call the scheduler.  

“Can I have a drink before the procedure, or not?”  

She tells me that in the past, they’ve let people have a piece of dry toast and a cup of tea the morning of, but she thinks those rules have changed. She puts me on hold.  

“No,” she says when she returns. “Nothing to eat or drink.”  

Am I more afraid of the pending cerebral angiogram, or the possibility of being hungry? It’s a close call.  It’s easier to focus on food deprivation than on the catheter that’s going to be fed into my groin and up into my brain. The scheduler wonders if I have any more questions.  

“Will there be food after the angiogram?”

She puts me on hold again.  

“Honey, they’ll bring you a turkey sandwich when it’s over.”  

On the way to the beach that weekend, I begin to dwell on death in a casual, neurotic sort of way. I worry that if I actually do see a whale this time, I will die. Suddenly, I don’t want to see a whale anymore, but I worry that I might. When we arrive at the beach my kids scan the horizon.  I avert my eyes. My six-year-old son sees me not looking.  

“Mommy, you’re not trying. To see the whales you have to try.”  

Late Sunday afternoon there’s a phone call; I can tell it’s the hospital from the caller ID. I answer hesitantly. Maybe they’ve changed their mind about the turkey sandwich.

“This is a pre-registration call from OHSU. Are you still at the same address?”

“Yes.”

“Has your insurance changed?”

“No.”  

“Do you have a religious preference?”  

This question catches me off guard.  

“No,” I say quickly. Then I backtrack—I mean, I do, but an angiogram is an outpatient procedure. I’m not planning to need last rites. “Why do you ask?” I finally say.

“Because the clergy will visit you while you’re there. As part of their rounds.”

This idea disturbs me deeply. It’s not accurate to say that I don’t have a religious preference. If there was a gun put to my head, I would prefer a rabbi over a minister, and a minister over a priest, but personally I’d rather have the doctor visit me in post-op. I tell the caller this.  

She pauses. “So, you don’t have a preference?”

“Do you have a hospital magician? How about a post-procedure magic act?”

The woman laughs uneasily. The idea of having a clergy member visit me after my angiogram bothers me for the rest of the evening.  

Before inserting the catheter into my femoral artery, Dr. W shaves my pubic hair himself, which I think is a nice touch. We chat about body hair removal, a topic I happen to know a lot about. While he cleans the site and injects a local anesthetic, I tell him that as best as I can recall, angiograms hurt more than a bikini wax. Dr. W is determined that this will be the best damn angiogram I’ll ever have.  

I’m woozy afterwards, lying flat on the hospital bed to keep the incision in my groin from bleeding. Dr W stops by. He wants to know how I feel. I can see he’s fishing for compliments. I tell him it was great.  

“There are several aneurysms in the nidus of the AVM.” 

“Are the aneurysms new?”

“I don’t know.”

“Will they burst?”  

“I don’t know.”

“Can you remove them? 

“Yes, but it would be risky.” 

“What about the risk of not removing the AVM?”

The chance of the AVM bleeding increases 5% every year. But there’s a chance that I’ll live the rest of my life—perhaps a long life—with no bleed, ever. I could die from cancer in the next decade. Or be hit by a bus tomorrow. So could we all. How much should I worry? How much should any of us worry?  

He tells me to make an appointment in his office. “We’ll talk.”

I don’t call him. A year goes by. Then two.  

I’ve had a stressful month and my shoulders ache. I haven’t had a massage in years, but I’m suddenly desperate for one. I call around and find a clinic that can fit me in. The receptionist tells me to go into the room with the green door and prepare myself. I take off my clothes and crawl under the sheet.  

The masseuse starts on my shoulders, then moves in on my neck. I tell her to go deep, but it doesn’t feel good. I keep waiting for her to let up, but it doesn’t happen. She’s half my age. The deeper she goes, the older I feel. When I tell her it hurts, she says, “Breathe into the pain.”

It feels more like she’s wringing my neck, but I can’t tell her to stop. I don’t want to appear weak.  Finally I say, “I have an old injury in my neck. Can you work someplace else?”  

She halts the massage, cracks her knuckles, then yanks an enormous handful of my hair.

“Ow!” I scream.

“Breathe into the pain,” she whispers to me.  

The next day the left side of my neck is tender and throbbing. I take one Advil, then another. Does this warrant a call to the doctor? Is this a normal neck-throbbing, or an urgent neck-throbbing? And what am I going to say to the doctor? I had a bad massage?  

I wait a day. Maybe it’s a TMJ issue. My dentist has been trying to get me to wear a mouth guard at night for years. He’s certain I’m a grinder. I’m not a grinder. A screamer, maybe. But not a grinder.  

After another day of neck-throbbing, I do some soul-searching. What if the masseuse bruised my carotid artery? Don’t I owe it to my family to make sure I’m okay? I call my internist. The nurse calls me back. I tell her I have a philosophical question for the doctor. I’m a moderately healthy, active 43-year-old who has a potentially life threatening medical condition. If I choose to treat it—through a multiyear process of radio-static lasers, embolization or resection, I put myself at significant risk. If I choose to do nothing, I also put myself at significant risk. The end result is that I think about death all the time.   

The nurse pauses. “So, what’s exactly the problem?”  

“My neck hurts.”

“I’ll have the doctor call you.”

My internist doesn’t think I have a bruised carotid artery, but she calls in an order for an ultrasound. I don’t call the radiology department to make the appointment. We’re on our way to the beach for the weekend. What will they do, anyway, if it is a bruised artery? 

It’s cold at the beach. There are no whales. On Monday I call Dr. W.

It’s always depressing in the neurosurgery waiting room, but Dr. W’s office at least has a great view of the river. He’s behind schedule. I flip through Country Gardens, Neurology Now, and Cigar Aficionado. I’m nervous. I should have called sooner. I shouldn’t have waited two years. What if he doesn’t remember me?  

I want him to remember me. I want him to like me. I’ve put on lipstick, and the new musk oil that my husband favors. I need to make a good impression. Maybe he’ll offer me a treatment that he doesn’t offer his less likeable patients.  

I make charming small talk. Then I tell him about the knuckle-cracking, hair-pulling masseuse who tried to choke me. Dr. W is professional and kind. He tells me not to take methamphetamines, or get chiropractic work done on my neck. But massage is okay. He thinks I’m okay. 

I describe my recent short-term memory loss, my chronically cold hand. Are these peri-menopausal issues, or neurological problems? Are all these years of radiation from scans going to give me brain cancer? I’m running on and on. I can’t stop talking about my fears. I wish he would do an exam. I want him to listen to my bruit. I want him to touch me. 

I want him to confirm that what I’m choosing—to do nothing—is still a reasonable, rational choice. He says I could have a hemorrhage when I’m eighty. I could have one in the parking lot when I leave his office.   

“I think what you’re choosing is reasonable,” he says. Those are the words I want to hear.  “But,” he says, “the best way to survive an AVM is to treat it before it causes a problem. The treatment is almost always neater than letting nature take its course.”  

He pauses, then asks in a gentle voice, “What do you do?”  

The question catches me off guard. What do I do? Some students in my daughter’s class wrote me a note recently. “Thanks,” it said, “for taking time out of your moderately busy life to chaperone our field trip.”

“I used to be a teacher, but I’ve been home with my kids.” Suddenly, I feel like I’m failing the conversation. “I have two kids,” I tell Dr. W. When I come in to the ER with a burst aneurysm, I want my chart to look like I’m worth saving. What do I do?

“I’m trying to become a writer,” I tell him.  

“Oh?” He looks interested. “What do you write?”  

“I write essays. I write about my body.”  

“Do you write about your doctors?” 

“Sometimes. But I always change their names.”  

Dr. W has a southern accent. He has big ears. Pockmarked skin. His face and neck have turned slightly red in the last ten seconds.  

“I haven’t ever written about my AVM, though. I’ve wanted to. I just haven’t…yet.”  

There’s an uncomfortable silence, probably more uncomfortable for me than for him. He doesn’t say, “I understand.”  

I try to lighten the moment. “Mostly, I write comedy.” I tell him about a piece I wrote about buying my first thong.  

“Send me that. Can you? My wife would enjoy that.”   

Then, I remember something. “I’m going to be performing—with a comedy group.”  

“Really? When?” He’s interested. The conversation is taking a good turn. I imagine him in the audience at the comedy club, in the front, drinking gin. I’d introduce him. “I’d like to thank my brain surgeon for being here tonight.” He’s going to save me after all.  

“Where?” he asks. He’s ready to write down the name of the comedy club on his pad. I’m flustered. I can’t remember the date or the location.  

“Somewhere downtown. Sometime in March.”

“Send me the information.” His face and neck are still red. I’m sure my lipstick is worn off. “E-mail me. I want to come see you because…you seem like you’re probably…funny.”

When I make the plans for a family trip to the San Juan islands, I know full well we’re going to see whales. The captain of the whale-watching vessel absolutely guarantees we’ll see them. I feel like I’m settling a debt.  

The sun is bright and the air is clear. My kids are standing on the bow of the boat wearing orange life vests. They’re pointing and grabbing at my hands. We see a dozen orcas leaping and arcing out of the water. They move swiftly past the boat. They are chasing salmon and it looks like play. The orcas are everywhere around us—black and white and so close we can see their scars. The salmon are swimming for their lives. It’s beautiful. But I don’t want to die now.  

Can I do that?   

Dwaine Rieves

“A really great deal on batteries, you hear?” my father yells to me, his voice full of its old energy and a half-chewed biscuit. We’re eating breakfast, his attention on the television, mine on a newspaper photograph that captured President Obama at the groundbreaking of a new factory in Michigan, a battery manufacturing plant, as it happens. “A rebound from desperate times,” the caption says. I listen as the television commercial closes, the announcer shouting, “Limited time only.” My father snorts, nods in agreement. I like seeing him invigorated and, between his newfound energy and the president’s reminder of our desperate times, the morning seems perfect, if not providential, for a trip to the snazzy strip-mall farm supply store so my father can buy new tractor batteries, six of them. 

These days, my father does his best, as he calls it, “to keep up the place”—the place being two hundred acres of needy pastures and teetering barns. Before my mother died a few years ago, my father farmed the place and even some rented land, bush hogged and baled hay largely by himself. Now, he’s alone on the farm and, as my trip home last month taught me, he’s starting to hold on to things. Good batteries matter more than ever. 

I admire my father’s need to “keep up the place,” even if the purchase of six new tractor batteries strikes me as odd. Aside from the bulk purchase aspect, there’s the fact that his two tractors are used only to cut, rake, and bale hay for his cows and last year he sold the herd. “My kids made me sell out,” he told the neighbors who came to visit after his heart surgery. He still tells them that. 

It’s a new month and I’m home on a hot Mississippi morning, here once more to try to help my father. He’s eager and his stomach’s growling; I pull his pick-up close to the back door so he can shuffle directly from the air-conditioned house to the air-conditioned cab. I turn the vents toward his face as he closes the truck door and adjusts his portable oxygen to one liter per minute. He uses two in the house but one liter will work, he says. I imagine his other make-do situations—duct tape on a leaky watering trough, a single electric wire before the gaping hole in the barbed wire fence.  

The farm was always a sore spot in our family, mainly because my father seemed to value hay balers and breeder bulls over looming grocery bills and leaking toilets. Back then, my mother’s suppertime reality-check seemed indisputable to everyone around the table except the man at the head. Invariably, a new drill press or tractor tire trumped a balanced bank account. Still, we got by. 

It was no surprise that when my father retired from his day job twenty years ago, the farm was there to accept him as that full-time farmer he’d long wanted to become, a man free to discharge his dreams with more energy than six new tractor batteries could ever contain. Last year, on the very day he had his heart attack, a herd of postcard-perfect Charolais grazed over his pastures. He still shows the pictures to the neighbors who visit, those scenes captured before the surgeon bypassed his coronary arteries and scraped what could be taken from his carotids. Then a collapsed lung, heart failure and the final conclusion, “My kids made me sell out.” 

Son, I hate to admit it, but I think I’m gonna have to go to the bathroom as soon as we get there. 

Experience ripples through his voice as if he’s eyeing a gauge where the needle is almost, but not quite, in the red zone. 

I park close to the entrance of the farm supply store, open my father’s door, and help him out. He straps the oxygen tank holster over his shoulder while I hand him his cane. I walk alongside him, steer him through the store’s quick-eyed sliding doors. I know the bathrooms are in the back and he’s working to keep up with me as I lead the way. His crookneck cane taps the path, every wooden peck the latch of some insistent cog pulling him forward, a great wheel reeling him past the check-out counter, round the corner horse-saddle display. Here he pauses. Like that, he plants himself, rests both hands on the cane’s bowed neck, squeezes it tight. He works to breathe. Lips pinched, he issues shallow, face-changing breaths. Far behind us, two store clerks are collecting a customer’s cash while a man three aisles away picks among the brilliant metal bolts in a wall of machine part bins. 

My father is ashen, some kind of bodily, back-up power short-circuited, out of his control. He’s entranced by pain, staring beyond it, looking past me when he says, and he says it as if he can’t bear to hear it but must—

Son, I can’t make it. 

He sees it behind me, the needle in the red zone. Here in the middle of the fancy farm supply store where the cream-colored tile is kept pristine so the farmer-wannabes are dazzled by reflections of the nickel-plated horsewear and chrome, heavy-engine parts. My father clutches his cane as if this is as far as he can go, whatever energy he had this morning now completely dissipated. He stands inanimate as thick brown liquid oozes below the cuff of his pants, seeps down his left leg. As I move to his side, he turns his head and—with a voice powered solely by regret—says he needs to go to the truck. He turns, starts to waddle back to the front of the store.

“I’ll take care of it,” I say as I try to tactfully maneuver about, ready to steady him in case he sways too much. The brown goo pools in the back of his slip-on shoe, squishes as he steps. Brown spots mark his trail. “I’ll take care of it,” I whisper as a dusky red wave of humiliation surges across his face, as he suddenly ignores me and in an oddly energetic turn, steps away from my path. 

He rounds a corner, moves not to the front door but to the check-out counter where the men stand. I raise my whisper as I tag behind him. “I’ll take care of it,” I insist. I motion toward the truck. I’m sure he hears me, even more sure he’s ignoring me. I’d envisioned a quick retreat, the kind that suggested we’d simply changed our minds, maybe forgotten something in the truck. Once he was in the cab, I could quickly return to clean the floor before anyone noticed. Some toilet paper from the bathroom, a wad of paper towels. No one would ever know.

My father stands before the check-out counter. A man looks at him; several do. 

Mister…Mister, I’ve had an accident. 

I cringe as my father speaks. I wish he’d let me handle it, kept it a family thing. I have sisters;, we can handle him. My father ignores me. He sniffs at the oxygen until he’s consumed what he needs. The sales clerk is a concrete-cheeked man, serious as any farmer. He stands expressionless as my father explains. 

Sometimes I just can’t control myself. Spasms, they shoot through me, can’t help it. 

He says it clearly as if God and time were working out their disagreements within him, as if he had to explain the mess they’d made with his body, their illogical and desperate ways. He points his cane to the brown dollops on the floor, just as he might point to the kids who made him sell out. 

I can’t look at the salesman but I hear him, I hear him say he understands how bowels go, that his own father had problems like that. My father tells him he appreciates a good deal on batteries. Both hands on his cane, he leans on it, inching about until he looks at me, me watching him. 

Then he slowly trudges to the front doors where I’ve been standing. Far behind him, a young man with a bucket and mop swabs up my father’s accident. The man uses the bucket’s mechanical hand to squeeze the mop, and swabs the floor methodically back and forth as if this sort of thing happens all the time. He turns a floor fan to the spot, a yellow caution sign placed just so. The place properly cleaned, people amply warned. 

Back in the truck, I rev the engine because, even more than before, we need the air conditioner. I’m about to engage the gear shift when my father interrupts. 

Son, I’ll wait here while you get the batteries.

I look at him. I smell him. I want to see overwhelming desperation on his face, a justification for my inability to tell him we need to go home so he can shower and I can wash his clothes. Batteries, now? We’ll come back tomorrow or maybe I can return this afternoon. His face refuses the possibility. He’s determined, defiant. The desperation is solely mine. 

Six batteries, six nub pole pairs each, we need them all. 

I am silent. I obey. I return to the store, buy six new batteries. 

I turn on the radio as we drive home. As I turn the dial to country music, he says we saved at least a hundred dollars over what he would have paid at the Co-op. When I look at the batteries through the rear-view mirror, my eyes catch my father leaning contentedly against the door, his shoes full of shit and me trying to figure out why he had to have six new batteries for the two tractors that he no longer needs on a farm that can’t possibly continue. I think back to my first instinct to sneak back into the store and hide his accident from the world, to conceal all I could of his failing body—was I trying to protect him or myself?

At this point, I realize any embarrassment I’d sheltered wasn’t from the accident. After all, shit happens all the time, as any farm-supply store clerk readily admits. Instead it was the fact that my father had, despite my best effort to thwart him, announced his place in this world in a way that seemed as natural and proper as a pasture full of cows, the ones we’d made him sell. My father seemed to know I might hide his body’s failings but I could never undo them. And if those failings needed to be hidden, then they were his to hide, not mine. His lesson was trampled across the front of the store. My father and I had stepped through our desperate times, yet we’d now bought new batteries and here behind us was the potential for transformation of one form of energy into another, despite what time has done to us, a special deal.

Driving home, I’m not sure the country music fully camouflages the pain of our misadventure, but my father seems satisfied to eye the horizon as the fields and farms display whatever he needs to see. When a particularly weed-choked pasture rises before us, he nods his head in that direction as if to motion to me and the whole world what can happen if we let our places run down. 

Son, we shouldn’t have to see such things. But these days, I guess everyone does. 

I look closely at the neglected place before my father and I pass it. Once we have, I avoid looking back. Given six new tractor batteries and the dream of a new herd, so does he.

Hazel Kight Witham

I travel to Galveston to know my grandmother. I drive along the southeastern jaw of Texas, passing through towns named Cheek and Winnie until I veer onto the road that will take me to the Gulf. I stare out the window at the green land under a gray morning until the horizon disappears and I steer into the past.

My grandmother died six years before I was born. She never knew it, but she left me her old-fashioned name—Hazel—and an old-fashioned rose-cut diamond that became my engagement ring. She also left me an unfortunate sliver of DNA that has me traveling this two-lane road to Galveston.

Green marshland swims in the foreground. Silver slips of water roll away from the road and fade into a blur of mist. Oil derricks emerge, bowing their heads to the earth like horses wetting their lips at the trough. A line I cannot define is somewhere in the distance and I feel her gathering within me.

Galveston is an island tucked into a natural harbor along the Gulf of Mexico. At the turn of the twentieth century it was a bustling, prosperous port. It was the largest city in the state, full of Victorian mansions and long-limbed trees, beautiful beaches and people getting rich. No one expected the Storm.

Early on September 8, 1900, a Texas-sized hurricane pummeled the island. Flood waters surged over the banks, destroying nearly 4,000 buildings. More than 8,000 people died, crushed by debris and water. One in every five, gone. Countless unidentified bodies were cremated for public safety. Whole families died, making it difficult to track casualties. The dead took the details with them.

I search for details of my grandmother like gathering sea glass along a rocky beach—bright shards of stories I coaxed from my mother when I was young and we were driving at night, when the dark helped her remember.

Grandmother was born in Corsicana, Texas, and settled down 300 miles south in Orange with her high-school sweetheart, Robert. They had two daughters, eight years apart. 

A story I love: when they moved into the Orange house, the movers put the piano on the front porch and my grandmother played tune after tune as the men lugged all their belongings into the home. Every time they asked her where something should go, she said, “Just put it on the back porch,” and continued playing. As the afternoon wore on, one of the movers finally said, “Lady, have you taken a look at the back porch lately?” 

My grandmother started deteriorating with the move away from Corsicana. She didn’t know anyone in Orange; she didn’t have a job or any real hobbies other than piano. As her world withered in that unfamiliar town, depression colored her daily life. When she gave birth to my mother, melancholy overwhelmed her nearly to the point of catatonia, and she was hospitalized in the Galveston Psychopathic Hospital. 

The few things that remain in our family offer a glimpse of her. I know my grandmother had a brass chain-link purse that pooled in my hands like water. I know she had a fancy silver compact inlaid with lavender flowers. I know she hated photographs of herself. I know she didn’t drive. I know she hated Galveston. 

After the storm, Galveston took action with an intensity to match the hurricane. Residents cleaned up the wreckage, constructed a 17-foot seawall six miles along the Gulf coast, and pumped sand in from the sea floor to raise the island’s grade. 

But when another storm struck in 1915, the island was flooded again, killing as many as 400. In 1933, eleven storms pounded the coast of Texas. After each hurricane, Galveston had to reset itself. 

For my grandmother, Galveston was always a place of storms. In the 1940s, the Psychopathic Hospital was one of the few of its kind in Texas. Over the course of five weeks, my grandmother underwent a series of electroconvulsive treatments, that she might be stunned out of her depression. ECT induces seizures, resulting in convulsions and a loss of consciousness. It was hoped that her brain would reset. 

Like the cyclical nature of Galveston’s hurricanes, my grandmother’s moods stormed through her and periodically wreaked havoc on her life. Without much of interest to fill her days, her drinking increased. She stayed in bed more, glasses of Canadian Club sweating on the nightstand. She cried and grew restless. She would beg Grandpa not to take her back to Galveston, and at first he would acquiesce. But she would drift away in her bed, paralyzed, until she was surrounded by salt water and skies that held no light. She felt utterly hopeless, but she knew she didn’t want shock treatments. He had to take her against whatever will she had left. 

After her ECT, my grandmother would misplace the names of her daughters. The memory of her newborn child fogged over. Both her depression and its treatment seemed to inhibit her ability to care for the children. Her ability to play the piano, to do her hair, to keep house. 

I would ask my mother about the hospital and the shock treatments, long before I knew that I had inherited my grandmother’s illness. Every time there were new details and the same sadness. But so much was elusive and I needed something tangible. Something more than story to cast a light on what linked us.

So now I am going back. Along the same route, past fences her eyes must have tripped over, grasses the same green. I hit High Island and then Gilchrist. Suddenly all the houses along the shoreline seem as surprised as I am by the appearance of the ocean. They fear the worst, sitting high on stilts, lifting their skirts to show skinny legs where water can flow past and leave structures intact.

I wonder how deep the beams go, how firmly the foundations hold in a storm, what houses look like hovering on hurricane water. Which houses were here when Grandmother traveled this road? What did she understand of them when they returned from the hospital, her mind as fogged as this forgotten landscape? Nothing looks alive, despite the abundant green. The houses seem uninhabited. Vaulted in defiance of nature, shocked, and left in eternal awkwardness.

From the upper deck of a ferry I watch Galveston spread before me. Texas seagulls with black heads ride the wind off the bow of the boat all the way to the landing. I drive off the ferry and twist along the eastern edge of the 30-mile island. The old Psychopathic Hospital appears before I am ready: a great lawn opening up to a campus of tall buildings, pale brick, darkened glass. It is less than a mile from the ferry landing. She would have had so little time after getting off the boat.

The campus is larger now, I’m sure, with more buildings, but I bet that wide lawn was there on her first visit. She would have ridden by it on the looping drive toward the hospital. It could have been her last sight of grass for months. As the car nears the drive my body tenses and I cannot bring myself to turn toward the hospital. I’ve come so many miles to see this place and now I am flooded with the fear, the bone-deep dread of what awaited my grandmother here in Galveston. All I can think is how she wanted to be free of it and I cannot take us back. I hold my breath as I drive past.

My mother told me that once, after my grandfather had taken my grandmother to the hospital for treatment, she escaped the very next day. She walked to a local bar and convinced a stranger to take her on the ferry and drive her ninety miles back to Orange. And then my grandfather drove her right back again.

I marvel at how brave she was. Winding through the streets away from the hospital I wonder where the bar was, and did she get a drink before she headed back? She must have; my grandparents liked their liquor. I see her push past the swinging doors of my mind’s Western saloon, backlit by the dust swirls of noonday light. A handful of people propped on stools nursing hangovers. Worn cowboy boots and trusty Stetsons. Hazel steadies her hand on the cool wood of the bar and orders a beer. Pinches some salt into the foam like her husband always does. This calms her. 

How many people did she have to ask before some man agreed to drive her home, with the promise of money from her husband? Did she stand out or fit in perfectly? What was she wearing? Did they have those plastic hospital bracelets back then? And remembering my own hospitalization, what I want to know most: how did she manage to sneak out?

Thirteen years ago I fell into a depression during my first year in college. Unlike my grandmother, I had the benefit of medications for this illness I inherited. They worked and things got better, until the other side of our illness surfaced. The depression lifted and I promptly whirled into a mania that landed me in a psychiatric hospital for eight weeks. While I was there, thoughts of my grandmother came to me as I began to experience what for so long I had only imagined. 

Passing Grandmother’s hospital site I am back at my own, and the distance of thirteen years vanishes:

I walked the halls in stale scrubs, barefoot, scrounging cigarettes from other patients and staff. It became normal, acceptable, to pick up half-smoked cigarettes from the ground and massage them straight so they could fit into the safety lighter on the courtyard wall. As I smoked, I stared up at the strips of blue sky visible through the iron bars that secured the top of the cinder-blocked patio. Cigarettes were one of the few pleasures within that cage. 

My meals were on trays; I slept in a single room on a metal bed. Doctors and nurses wrote notes on charts, trying out diagnoses to find one that would fit. They drew vials upon vials of blood, sticking the awkward inside of my elbow almost daily. Twice a day there were little paper cups cluttered with pink pills, blue pills, white pills. 

There was nothing to do but climb around in the jungle of my restless mind. No art, no books, no music.  

I took showers as often as I could, water falling like freedom for a few moments. I took too many apparently, because that became one measure of my sickness. One answer to my constant question: When can I leave? When I take fewer showers. When I stop going in other people’s rooms. When I stop taking off my booties and walking around barefoot.

New conditions were invented at every turn, while a kaleidoscope of medications shifted my world from manic to catatonic, garrulous to thick-tongued, animated to anesthetized. I could refuse the horse tranquilizers, the anti-psychotics, but then I would be “resisting treatment” and that would only slow my release. 

Days ticked by in a vacuum and I saw my life narrow down to nothing. I became convinced I would never leave. 

Late one night, itching for freedom, I slipped out of my room. A horizonless exile compelled me to move. I flew down the long corridor, past the good sleeping patients, and aimed for the window at the end of the hall. I slammed into unyielding glass, pressed my head into the cold of it, whispering pleas to the night grass glowing in pools of lamplight.

Moments later, I was captured, like a wild mustang, and carried bucking back down the hall. It was a whirling chaos of movement—arms, legs, wrists, thighs, gripped tight and too close. I didn’t know where I ended and they began. I fought with everything in me, but they knew what they were doing. They opened the door to my room and pressed me face down on my bed, one at each limb. A figure darkened the doorway, armed with a tangle of leather straps, all silver buckles and precise holes. My grandmother filled my mind, and we fought together, terrified of what was to come. 

They strapped me down and I watched myself from above, an X across the bed, like I’d been shot in the back. A nurse plunged a needle into my hip and my sobbing faded and I stopped fighting. 

When I came to, the sheets were soaked, the room dark. I began the glacial process of undoing the restraints. It was a test: if I could pass it—if I could get out—they would let me go. They would know I was not really crazy. They would not shock me. 

I wrenched my right arm around, working one wrist out, straining for the next. I leaned back, knees twisting, to unbuckle the right ankle then the left. I was almost free when the faint stream of light entering the room wavered and I saw a head blacken the window in the door. 

They did not want me free.

During the seven days they had me strapped to the bed, the few facts I knew of my grandmother stormed through me like so much lightning, so much wind. I knew her in a way I never had: the rage, the fear, the certainty that they would shock me as they did her.

Years after my hospitalization, I read about ECT, tried to understand what it must have been like. As I drive through Galveston now, one patient’s comment echoes through my head: “Each shock treatment was for me a Hiroshima.” 

Those words confirm my worst fears.

Shock treatments back then, with their high voltages, were brain damage masked as therapy. Amnesia the goal, a deliberate fogging of the mind. 

Experts now say that shock treatments are better, underutilized even. Voltages are milder, anesthesia is given. Psychiatrists tell of success stories; patients attest to its miraculous effects. Shock is not used to subdue or punish like it was in the asylums of long ago. The asylums of my imagination. 

Part of me believes the experts, these cured patients.

But there remains in me an unquantifiable terror at having a body charged with so much electricity. Such a storm, so unstoppable, capable of losses that cannot be told. Part of me believes it was a Hiroshima.

Galveston has always sounded ominous to me. It was a long time before I realized that beneath its name another word lurks—galvanize: 

1. to stimulate somebody or something into great activity
2. to coat a metal, usually iron or steel, with zinc to prevent corrosion
3. to stimulate the nerves or muscles of somebody’s body using an electric current

One of the most difficult things about the hospital is after the hospital, when the self you are now searches for the self you were then. People don’t treat you the same because they no longer know who you are. You have gone somewhere they don’t want to imagine, and a new distance springs up between you. 

When I returned home there was the wreckage of a former self to sort through, and I am sure this is how it was for my grandmother, hospitalized at a time when such things were even more taboo. Her friends tiptoed around her when they stopped by to visit, talked about the safe details of their lives while steering away from the gaping hole that had emerged in hers. She told some more than others, but the shame of being shocked must have been overwhelming. How could she let anyone know the truth of it? How could I tell anyone that they tied me up for seven days?

I know my grandmother’s moments of darkness. Those moments are the same for everyone gripped by depression and utterly isolating when the dark closes in. All those days at home in bed, twisted in stale sheets—she sipping alcohol, me snubbing out cigarettes in overflowing ashtrays. So many days of hiding, avoiding a world that moved too fast for our molasses minds. Time stretched out before us like a Texas road in a Texas desert, and there was no horizon. 

Though I never experienced shock treatments, I know that feeling of being at someone else’s mercy. I know the rage and humiliation of having no say in your fate. Every time I ask my mother to tell Grandmother’s story, I am always hoping for a different ending. 

I drive along the sandblasted strip above the seawall, leaving the Psychopathic Hospital behind. The ward my grandmother stayed in is a ghost now, swallowed by modern buildings and medical advances. But I now know the drive she took, the scenery she tried to get lost in as she headed toward something that offered wellness through obliteration. Knowing that landscape brings me closer than the actual hospital would. I know her confinement; it is her glimpse of freedom that compels me.

I stare at my grandmother’s diamond on my finger. This stone of love and hope is what keeps her with me now. Sometimes in my everyday life, when I’m driving in the late afternoon, thinking of nothing, light will stream in through the windshield and tangle with the facets, spraying the dashboard with dancing points of the past. It is a pattern she knew, in the passenger seat of Grandpa’s Dodge, back when driving around with a new husband was fun.

And later, in the years that grew dim, perhaps she saw that sparkle when the sun streamed in through the window on the drive to Galveston. Before her flashed a constellation of diamond light, snapping her to the present, when a sunbeam dipped into a clear stone and painted the world new. Maybe for a moment she would forget what was to come.

I drive out of Galveston into a clear afternoon. There is blue in the sky, a line on the horizon I can hold onto. The details of this day illuminate a woman I never met. Her blood courses through me, while the knowledge of her experience remains sharp as warning, a dark sky in the distance. 

But now, against the blur of green that I pass—that she passed—if I move my hand just so, the new day will catch her diamond and send light dancing between us.

Kurt Magsamen

Cadavers don’t look much like anatomy drawings. They don’t smell much like  anatomy books. The drawings are clean, ordered, the striations of muscle cells combed out tight and smooth, like the strings of a harp. The nets of veins, nerves, and lymph nodes have been lifted out and colored blue, red, pale yellow, and black. Some drawings are not in books but are posters of skinless athletes posing in the gym reaching up one hand and tipping back a toe to make visible the Brachialis, Brachioradialis, and Extensor carpi radialis longus muscles. Their muscles are a beautiful red, more like the red of lipstick than the blackened red of blood on a floor or the purple of blood puddled beneath the skin. The models of anatomy have wide eyes staring out that cannot follow strangers walking past. They are calm in their exposing repose. Cadavers too are calm but much more muddled, and everything is obscured by fat. Press a blade through the skin and fat will emerge, not the clean white fat of cattle, but the jaundiced globules that fall away and stick to the steel slab, and if the slab is warm enough, melt there.

It was that cold, yellow color that made me think my dad was half cadaver. His skin had gone yellow, translucent, waiting to cool and coagulate. A fall had put him there. He’d fallen on his head, his face really, and below his eye was a bruise so swollen and purple it looked as if a spoiled plum rolled beneath his skin. But his neck was broken too.

Gray’s Anatomy: “The anterior cerebrospinal fasciculus which is usually small, but varies inversely in size with the lateral cerebrospinal fasciculus. It lies close to the anterior median fissure.” Four vertebrae were crushed. Wait until he comes to. Then we’ll know more.

Latin is so much like a prayer. In Nomine Patris. The extent to which the fibers of the ventral cerebrospinal, Et Fílii, cross in the cord is open to question. Et Spíritus Sancti, the influence of the motor cortex is preponderantly contralateral, there is a slight ipsilateral effect. There was brain damage. That’s called contracoup from the brain bouncing around within the skull. Again, there is Gray’s: “Its posterior surface is received into the fossa between the hemispheres of the cerebellum, and the upper portion of it forms the lower part of the floor of the fourth ventricle.” My Dad and I were close enough to have talked about life and death, and we both agreed never to let the two mix, not for ourselves, or each other.

So I wait for the gap to close and dread what I may do. Where are the combed tight lines to show us? Where is the man in the robe speaking Latin? “Other fibers conducting proprioceptive impulses pass upward in the dorsal spinocerebellar fasciculus.” Or am I left with the advice of my good buddy, Vladimir Nabokov, who once told me, “The cradle rocks above the abyss, and common sense tells us that our existence is but a brief crack of light between two eternities of darkness.” So now do I grip the rails of my father’s bed and tip him out of light, or do I lean in, and when the stubble of his beard grazes my cheek, betray him with a kiss?

Margaret Brosnahan

A dozen dead ponies hung from the ceiling, strung up by chains at each end, their ragged bodies in nose-to-tail formation like a ghoulish merry-go-round. In the recurring nightmare that plagued me throughout my remaining years of veterinary school, I was on that carousel of cadavers, spinning with no means of exit. The image of this basement anatomy lab remains vivid in my memory today, twenty-five years on. 

That morning, I’d taken the train to South Station, the same as I did every day. Dread obscured some of the sensations of my usual walk—the crisp air of a New England autumn, the crunch of leaves beneath my boots. It heightened others—the smell of leather as I passed the Italian cobbler’s shop, the sight of dead chickens hanging outside the Chinatown markets on Washington Street. I trudged towards school to meet up with my classmates and our professor.  

It was the late 1990s, and our school offered the most progressive veterinary education available when it came to teaching with live animals. Rather than using dogs bred solely to be killed for our dissection in anatomy lab, our teaching hospital developed the nation’s first canine cadaver donation program. We no longer learned surgical procedures on “disposable” animals who were killed right after surgery. Instead, our professors taught us necessary surgeries on animals who were expected to recover fully and live normal lives. The desire for a humane education was one of the reasons that I, and many of my classmates, turned down acceptances from older and more prestigious schools. Today, “no-kill” veterinary education is the norm, but back then it was revolutionary.     

It was therefore shocking when, shortly before the end of our first semester, our anatomy professor asked the class for volunteers to euthanize a group of ponies, in preparation for equine anatomy lab.  My initial reaction was revulsion. As someone who has been connected to horses since childhood, I couldn’t stomach the idea of a healthy animal being killed simply for the misfortune of being unwanted. My own horse, Sweetie, was the center of my universe, and letting him go to possibly meet such a fate was not something I could fathom. 

There was much discussion amongst the equine-oriented students in my class, many leaning towards helping, but I myself was paralyzed by contradictory feelings of betrayal. Would I betray the ponies if I took part, or would my help perhaps make their last moments on earth a bit calmer? Would playing an active role in their deaths betray my belief in the intrinsic meaning of all lives? Or was my reluctance to assist a betrayal of my commitment to my own veterinary education? 

Our professor emphasized that students with experience handling horses could greatly reduce stress for these animals. In the end, I decided to participate.

Downtown Boston made an odd backdrop for a stock trailer. Odder still was the clip-clop of hoofbeats on the concrete sidewalk, and then on linoleum, as a dozen scruffy ponies were led off the trailer and into the building that housed our anatomy lab. Two or three at a time we herded them into the elevator and down to the lab in the basement. 

A bony black mare stood quietly in the group, staring straight ahead, more likely from sheer terror than good behavior. Her coat was shaggy and dull, matted with dirt; her hooves badly in need of a trim. Gray hairs on her face suggested advanced age. On her head she wore a faded purple halter with a piece of silver duct tape wrapped around the cheekpiece. Scrawled on the tape in black Sharpie, in all capital letters, was: “My name is Cheyanne.” 

Making a lifetime commitment to an individual horse is a monumental undertaking, something many people won’t do despite their significant involvement in equestrian activities. Lifetime care for a horse requires a far more enduring commitment than for most pets. While dogs and cats live into their mid-teens, it is not uncommon for horses to live well into their twenties and thirties, and they require intensive and endlessly expensive husbandry. Household pets usually retire to the couch in their old age, but horses require costly housing of their own and large quantities of forage. 

Horses exist in a precarious space between companion animals and livestock. They can be a cherished family member, a lifestyle, a passing interest, an athletic pursuit or a business, and in many cases a perplexing combination thereof. They are foremost in someone’s life while winning ribbons or producing foals or while a new hobby retains interest, but even the most dedicated horse lovers  often get rid of horses once their usefulness has ended or interest is lost. The reasons cited range from the heartbreaking to the infuriating, and as an experienced veterinarian, I’ve seen them all. In some cases, the horse and rider are mismatched in temperament or ability and the human-animal bond never gels. Some owners have unavoidable changes in circumstances that make caring for a horse no longer affordable; others simply lose interest. Competition-level horses are frequently passed on when injuries or arthritis prevent them from performing at the desired level, despite a perfectly acceptable quality of life.

Small ponies most often are passed along simply because children have a habit of growing and graduating to a full-sized horse. With luck, the pony goes to another small child. I’ve had the good fortune of providing veterinary care for a rare few ponies that, twenty years on, had found a way back to their original rider, now an adult with independent means to care for a retiree. These pairs have been some of my most treasured professional relationships, centered around a unique bond born of a child’s innocent love for a pony seasoned with an adult’s wisdom of what it means to care for another living creature for a lifetime. But all too frequently, the last stop for an aging pony is a public sale barn or auction. Sometimes it ends up in a kill-pen. 

This time, it was an anatomy lab.

Cheyanne’s heart resonated in my ears through my new stethoscope, a Master Cardiology with my initials engraved on the bell. With little muscle or fat padding on her ribs, the breath sounds were easily auscultated. I imagined this heart, these lungs, powering sturdy, compact legs across a meadow with a young child astride, effortlessly clearing stray logs and narrow streams. Distant memories of my six-year-old self resurfaced, out with my best friend on her pony, riding together, devoid of adult supervision.

What value in assessing her vital signs, I wondered, when her fate was sealed? But my stethoscope moved on, as I focused intently on each part of the physical exam that would soon become automatic for me. I paused the bell on the right side of her abdomen, waiting for the cecal flush we’d been taught to assess for proper intestinal functioning. But all was quiet. How long had it been since her last square meal? 

Despite Cheyanne’s obvious neglect and the fear I could see in her eyes, she was sweet and gentle with me. I cautiously placed my hand above her shoulder and tenderly scratched that sweet spot so many horses enjoy. Her soft nose nuzzled my other hand as she leaned into me for more. The thought that she was about to die filled me with unbearable sadness. I surveyed the room and wondered if I could somehow spirit Cheyanne away, to be mine and loved by me forever. More than anything, I wanted her to know that someone cared.

The day was meant to be educational—hands-on training in a year when most of our time was spent sitting in lectures. It was especially valuable for those of us planning to become equine veterinarians. We would practice physical exams and learn to place intravenous catheters. We would get experience administering anesthesia. 

We would also perform our first euthanasia. 

The word euthanasia means “good death,” but at the time, it was still an abstract concept to me. I was fourteen years away from putting down my beloved Sweetie, so I was naïve to the full impact that a horse’s life ending before my eyes would have on me. I rationalized that euthanasia by someone who cared deeply would be preferable to the typical fate of unwanted ponies: a long trailer ride to slaughter. But try as I might to convince myself of this, I couldn’t help feeling like her executioner.

Cheyanne’s jugular vein rose as I applied pressure over the jugular groove. My hand shook as I attempted to steady my catheter over a bleb of lidocaine. I tried to block out what was actually happening, narrowing my focus to the immediate task at hand. I pushed the tip of the catheter into the jugular until I felt a pop, and reminded myself that I was learning a procedure to use for the rest of my career. I slid the needle tip off the stylet and glued the catheter in place. Wasn’t the point of this education to save lives? I couldn’t let go of the fact that I was ending one. 

I injected the anesthesia and watched as Cheyanne buckled slowly to the floor, positioned strategically by the drain with her catheter side down. I tried to comfort myself with the fact that she no longer knew what was happening, that the anesthesia would protect her from any pain. We inserted a cannula in her other jugular—and then the blood, so very much blood, flowed from her small body. Her mucous membranes turned pale and then white as she was emptied of life. I watched, shell-shocked and speechless. Her pulse slowed and then stopped; a tap on her cornea confirmed death. The part of my heart that had somehow grown so attached in such a short time ached in a way I could barely comprehend. 

One by one, each pony met the same end. Exsanguination under general anesthesia is considered to be a humane procedure by the veterinary powers that be. It was chosen that day because embalming fluid can’t be injected until the blood vessels are completely empty. We did our best to prevent the ponies from watching each other die, but I’m sure they knew. Dead horses strewn across the floor looked like a battlefield of yore. 

The halters were removed from the dead ponies and tossed into a pile in the corner. I surreptitiously slipped Cheyanne’s purple halter into my backpack; someone had loved her enough to tell us her name and I couldn’t let it go to the trash. Chains, hooks, and pulleys then hoisted the ponies up to the ceiling, and there they waited in uncanny solidarity while we enjoyed our Christmas holiday before returning for our second semester of dissection. 

Piece by piece, we took Cheyanne apart. We’d returned from vacation, the impending academic rigor competing with private reflections of our recent experiences as veterinary students. Our first task was to remove Cheyanne’s skin. Our scalpels struggled through the matted hair, then sliced easily through the underlying fascia as we lifted off her protective layer of skin. Oddly enough, that helped ease the sting of my grief, as she looked less like herself, and more like the black-and-white line diagram in my textbook–all muscle, tendon, and fascia. As I held in my hand her silent heart, I remembered counting its beats, not long ago. I studied its chambers and valves and great vessels. At the end of each day, we covered her up to keep her from drying out, her body requiring care even in death.

We opened Cheyanne’s abdomen and spilled her bowels onto the floor, spreading them out to identify the segments of the equine gastrointestinal tract.  This was a significant part of our comparative anatomy curriculum, the prominent cecum so different from the rumens and spiral colons of other large-animal species. We examined liver, spleen, and kidneys, and the ulcerations in her stomach. We opened her lifeless eyes, tracing the optic nerve back to her brain, so noticeably small relative to the size of her body.

What I remember most, though, after all these years, were Cheyanne’s teeth. They told the truest and most sorrowful story of her neglect. Some teeth were missing, the opposing ones so sharp and overgrown they caused sores inside her mouth. Chewing would have been painful and likely ineffective. How much had she struggled to eat? That is, if she’d been fed at all. 

As we completed our anatomical dissection, each of Cheyanne’s body parts was relegated to a red biohazard bag. The bags were carted off for incineration. All traces of her life extinguished. 

Death is a certainty for all of us, no matter our species, be it by natural causes, by illness, by the hand of another, or—for that most peculiar species Homo sapiens—by the hand of oneself, as occurs with alarming frequency among veterinarians. Taking lives takes a toll on veterinarians, even when medically justifiable—far more so when not. Hospice care is slowly becoming a more acceptable option for some pets, but the vast majority of companion animals and horses die at the hands of veterinarians. The gestalt that I had of becoming a veterinarian was a mix of hard science and attunement with my patients. First, understanding horses on a molecular level, and then serving their health needs with knowledge and compassion. To a great extent this has been true, but we don’t work with our patients in a vacuum. Far too often we are confronted by a human-animal bond that isn’t what we think it should be, and the realities of a society that confers upon our patients the legal status of property.

I still struggle with my feelings about Cheyanne’s death, even after decades of practice and countless euthanasias. In the state she was in, and given where she was headed, the death she experienced was relatively kind. But basic wellness care and good husbandry, one might argue, would have been kinder, as her medical conditions were not terminal. Cheyanne’s faded purple halter travelled with me for years, as I continued my veterinary training through an internship and residency. I kept it to honor this pony, who had given her life for my education (or more accurately, had her life sacrificed for my education). I kept it for the child who’d probably believed with the purest of hearts that her pony would end up in a loving home with another little girl who would still call her Cheyanne. I kept it for every horse across time that had been used up and then cast aside like a pair of old jogging shoes when they could no longer fulfill a human’s self-centered expectations. I kept it to remind myself that all living creatures have intrinsic worth, and although life is not always fair in situation or outcome each unique being is worthy of remembrance. 

It is undeniable that veterinary medicine exists as a profession only because of the humans who seek care for their animals. I’ve learned through years of practice that the human–animal bond has as many variations as there are humans and animals. Working within that bond while staying true to one’s own beliefs has proven to be the biggest challenge. Facing death is inevitable in this context, and a decision for euthanasia always involves a weighing of suffering and circumstance. Well-timed euthanasia is truly a gift.  But the fact remains that our patients’ only enduring value is that which is bestowed upon them by their people. Cheyanne had someone that cared enough about her to make sure her name was known, but once she was sent on her way, that protection was gone.

I often reflect upon how my memories of that day in the basement were affected by the fact that I knew Cheyanne’s name. I remember her all these years later, and so perhaps the small gesture of writing her name on the halter was in fact a way of ensuring that her life had meaning that endured. She is a part of not just my foundational veterinary knowledge, but who I became as a veterinarian. One small, black, aged mare is a part of every life I have saved, and every life I have ended.