fixed and dilated

We gather today
for a teachable moment:
a bedside skill rehearsal,
the "cold calorics"
a demon-ic-strated tool
for a final decision.

One could never sense
the pain and suffering
that would be cast over
this moment:
the making of another
diagnosis.

Holding back your lids
I watch intently
as the cold slurry
is sent awash
deep into the canal
an attempt to tickle
the most basic of
human
reflexes-spinal-carnal.

And in a moment,
I see the students,
in pairs:
the one's intent on the
'skill'
watching the master
hoping for an ounce of "see one" -
and the others
disgusted
at another therapeutic maneuver
of human indignity.

My mind
now tormented
sitting idle,
for all I can see
are your pupils,
fixed and dilated
staring towards the heavens,
reaching forth beyond words
screaming for a somber
release
from the captivity
of a broken body.

My horror
now magnified
as we "elicit"
the necessary stimulation,
to define
death
as it howls
in banal clarity.

'L" Taravell

The beast shutters in the darkness,
as we course outbound
away from the salt licked shores
of the bay.

You slip into position
the seat providing solace
I suppose,
from the concrete
and the cold.

I view you now
through my trained lens:
diagnosing the seborrhea
and the burgeoning alopecia
for in my other speak -
"appears older than stated age."

The stains grow deep
into your weathered surface
yet what draws me closer
are the blackness,
the decay
of the finger tips.

Digits the tinge of midnight,
in the heart of a March eve,
for my mind runs the differential
of your sadness
and your madness.

I wager the stain
grew in the cold nights
when numbers #1-3
crept out of an encased sleeve
into the numbing crisp air.

I wonder of these digits
black from an acrid burning
an escape into a moment
of synthetic bliss.

Yet, the diagnostic lens
worries of organic poisons coursing
through your veins;
a heart and its chambers
a permanent home to your
impending death.

Your eyes close now
in a moment of rest
or escape
or transcendence;
allow me to sit and worry
for a moment
about the differential
of your demise
on an outbound train.

livedo

Here again,
in these halls,
the putrescence
is horrific this morning,
yet I push on
past the fungating wounds,
and the emesis basins.

I see you
from the moment I turn the corner,
and I know,
in a single glance,
that death is at hand.

Your palms cold and pale,
a sign of the catastrophic hemorrhage,
that is suffocating
your mind;
a heart screaming
to keep up with
the brains demands.

You have passed beyond
pain,
and for a moment I take solace,
and sit;
filling the void
to prevent another soul
in this hell of a place
from dying alone.

Your hands limp,
and peaceful in mine;
my hands
full of anger and sadness
as I had held these hands
just days before,
when life was vibrant
and hopeful.

Now sitting
with my hand in yours
watching the slow
decline
in breaths
and heart beats;
I see you escape
from this mortal prison.

I pray now
that you sit
in peace,
in love,
and with hope
for a better day.

rage against

I am here again
in the darkness
screaming for you,
raging against
your pulseless arrest.

My hands now gripping
a final salvo
the squeal of the charge
growing in the morning
light;
you jump then,
at my touch,
a final
burst
of energy-artificial-iatrogenic.

I pace around your bed
a general at battle,
loosing yet again,
to the war in you heart.

Five weeks now
I have watched you
die;
some quietly overnight,
slipping away from this earthly grasp,
other though, died,
with a warrior by your side,
raging against
your premature escape.

I want you to know
that despite our different origins,
the barriers of culture and language
I have loved you
I have ached for you,
and my heart has
broken
for you.

Standing now
yet again,
as the battle
comes to a quiet close.
I watch you take
your final breath
agonal and deep,
your last effort
to consume this world
one final time,
until you expire-
my hands still
on your empty chest.

Touching you now,
your raging heart quiet,
at last
their is a moment of peace;
until I walk to the next bed,
and my rage consumes me
stoking the fires of war
once again.

Into Africa

I left you today,
flew away in the darkness
of morning.
The rain falling
like tears
in anticipatory anguish,
of the loneliness to come.

No words can express
the pain and sorrow,
as you wear it freely
etched in your amber eyes.

I know not to where
I will tread,
but this I know;
without you by my side,
I would wander, lost.
You have given me
this life,
of boundless possibility
of maddening love,
of bliss.

The color of your eyes,
the taste of your lips
lingers with me now;
a memory I thrust
into permanent storage
as to draw upon you
for my ongoing strength.

For into Africa
I fly,
with an ounce of abandon
and a gallon of
anxious anticipation.

I know not what
this world holds in store,
but I promise to
drink it to the fullest;
to challenge my soul,
my convictions,
my knowledge and beliefs.

I promise you my love,
that your sacrifice
will not be in vain,
for I will take
the love and trust
you have blessed upon me
to serve the suffering
and heal their wounds
with you at my side.

Sleep tonight in solace
that I travel
as your vessel of hope,
and with your fortitude
will strive to bring
pride to your heart.

the violins

I did not order the violins
singing down these sterile hallways,
in the florescent glow
of ward eight.

I did not order the sadness
streaming in glistening tears
down the faces
of your seven sisters.

I did not order the agitated delirium
that has plagued your mind
switching your days to nights;
a circadian beast.

I did not order the carcinoma
diagnosed on hospital day six,
which has answered the wrenching question,
of your rapid decline towards death.

Yet, I did order the comfort
of your family at your bedside,
holding vigil
in your honor.

I did order the tincture's
to relieve pain and the disquieting confusion,
in a final salvo
against an unnatural death.

sitting

They say that as you go along,
you learn to sit with it:
with the sadness,
with the hopelessness,
with the trauma,
with the terror and the horror,
with the nightmares and flashbacks,
with the memories.

I have been told,
that the sitting gets easier,
that you can listen to the story,
within the story,
like some sort of Jedi mind trick.
That you can sniff out,
the trail head towards redemption;
a bloodhound in the darkness,
bounding through the fog of memories.

The sitting continues,
day in and day out,
yet the sitting is never the same,
the themes, the plot lines, though,
seem to repeat,
sparkling around the room,
a mirrored disco ball,
of dysfunction.

The sitting today,
fresh and plump,
of excruciating pain and shear agony,
of torture,
of madness growing in the depths,
of anger in the bowels,
retching forth with each syllable,
and sitting,
I reach out,
and attempt to pluck,
the words out of thin air,
in a feeble attempt,
to make the bleeding stop.

escape

Return to me,
my lady,
as my somnolence
has been an evil
holding my thoughts
beneath the surface.

The sanguine ink
in my glass
makes these words
escape with far more ease.

You lay in candlelight,
my olive princess
with the sweet smell
of jasmine and mint,
penetrating my limbic recesses.

I have yearned for this moment,
for far longer than I could bare;
we make for the sheets,
one more time
in an attempt
to make me whole
once again.

silence

I will keep asking myself,
if their was something else
I could have done
for you.

The days that turned to weeks
standing at the foot of your bed
on morning rounds,
and during the rapid response.

We seemed to have
quelled the fire
in your bowels
and the arrhythmia in your heart.

Or so it seemed,
on the day of discharge;
yet now as you lay
silent...

I will keep asking myself,
if their was something else
I could have done
for you.

what I know

What I know,
about you,
is renal cell carcinoma,
metastasis,
hemorrhage,
ischemic bowel
renal failure,
continuous veno-venous hemodialysis,
norepinephrine and vasopressin,
anuria,
pressure ulcers,
anasarca,
liver failure and jaundice,
and finally,
digital necrosis.

What I know,
is a loving wife,
devoted and vociferous,
three daughters,
one with child,
(your grandchild)
full of fear and hesitation,
a faith in God,
and a favorite dog.

A Sunday paper,
an obituary,
and what I learned.
A Vietnam veteran,
a Marine,
a soldier and survivor,
a Purple Heart,
a hero.
A businessman,
a Miller brewing man,
and a husband of 43 years.

What I did not know,
could be kept in volumes,
of that I am sure,
but what I do know,
and what I learned,
will live in me forever.

a toast to better days

Your mind has calmed,
the raging paranoia
the tirade of fear and persecution
has escaped
as the serotonin was silenced.

You smile this morning,
shake my hand
and swallow hard.
The agony of each word
visible
on you sullen face.

Swallowing, that simple masticatory endpoint,
now an experiment in razor sharp pain,
testing a man's tolerance for anguish.

We discuss Labrador retrievers
and laugh when you mention your wife's
love of animals and your love of Nascar.
Yet as the humor subsides,
the chuckle turns to tears,
as you speak of family
and "helplessness,"
as the disease and its treatments
have ravaged your body
and stolen your mind.

Holding onto each moment,
it seems is all you can bare.

We sit silent
my head nodding in agreement
"that this sickness sucks."

Those words hang above
for minutes it seems.

You speak of hope
as I leave the room,
to continue the rounds,
and I hope too,
that I will see you again
tomorrow.

bad news

Holding your hand,
resting my grip on your shoulder,
looking into your anticipating eyes,
speaking in soft tones,
only minimally alleviates
my inner suffering
as I convey the diagnosis
you have been dreading to hear.

You always ask
about time,
as if by some measure
of temporal information
will make what I have just said
any more painful and agonizing.

Nothing I say, can prepare you
for the desolation that lays ahead,
but I promise that as much as I can
I will be your guide,
your pilot down this river,
of your disease.

I will attempt
to steer this vessel
through the calm shallows now,
and the treacherous swells
to come,
yet I can only be a guide
I am afraid,
for only you can bear
the weight of your disease,
as mortality stares down
from above your bed,
cloaked in a tired white coat.

libido

The feeling has returned
that stench in the depths,
the lower cortical function
that drives yearning and lust.

A mind soaked
in feral desire.
A pestilence
has infested
every synaptic transmission.

I have regressed
to reflexes of suckle and root,
perseverating on the return
to the aromatic origin,
of my limbic poison.

odd couple

I walked with you again today
hand in hand
down the sterile hallway,
as you slowly shuffle
your way through this maze.

You squeeze my hand
a signal I slowly learned
was how I could gauge your mood,
since it had been years since
you have said a coherent word.

The nurses watch this odd couple,
the frail and the young
the patient and the physician
pace these hallways
day after day.

I learn with time
the subtle reality
that no medicine
in my vast armamentarium
will quell your agitation
as much as the subtle act
of holding out my hand
and taking a walk
down these hallways
once again.

east and west

for W.H. Auden

A fallen comrade
passes into the dark night,
one moment standing at your bedside
holding your hand
as our digits intertwine
the warmth passing between
our skin.

The next:
your skin growing pale
the ashen fetor slips between your
dermis and subcutaneous tissues,
the funeral blues,
as you pass
ever so quietly
into eternal sleep.

You are taken
from your love;
their are no planes passing overhead
painting messages unto the sky,
for the only sound
is the respirator
switching to the off position.

Their are no stars
to extinguish in the night,
only cardiac monitors
and pulse oximeters
to disconnect
allowing silence,
in finality,
in your time of death.

the rose city

Seeing you again,
slinking through your streets,
sun soaked
and under the cover of summers darkness.

You are my lady covered in sweat,
the funk, the stench of my years
between these hallowed shores.

How dare you change around me,
without me.

Forcing me to explore you again,
to trace the path
of the evolution of my youth
under your new skin.

I want to embed these streets,
into my soul.
Roll in your grime and grit,
and tattoo this earth,
permanently,
deep into my dermis.

family meeting

Down the hall
in room fifteen
she lays in the darkness;
the tentacles of polyvinyl tubing
infusing sustenance
and filtering toxins.

I stand in your doorway
this morning making my rounds
as dawn breaks in the distance.
You know not of the new day
birthing force
as it seems your belly
would hope to do with its roundness
of the sun basking light
into this glass chamber.

Viral wrath has claimed your heart
as its own possession
and has stolen your intricate
defenses
against the dark art of microbes and
infectious agents; harbingers of your end.

Yet we will not let that pass,
as a mother agonizes over the
passing of another child into the night.

We speak yet again
of "multi-system organ failure"
the words passing as discourse
and conversation,
when in reality they are merely
cloaks with which we wrap ourselves
to shield our souls from speaking truth:
"I am sorry ma'am,
your granddaughter is dying,
their is nothing more that we can do."

The nurses pace about bearing
the weight of this burden daily,
some shield it beneath their loving care
and others project their disgust at dying
upon the young doctors
weighing the balance
and attempting to stem the tide.

lillie

Looking to the floor
the bleakness in your eyes
as you speak of a life
in your dreams.

A family, a husband
a house to clean
and a dinner to cook;
a man to wait on hand and foot.

You speak in rapid religious outbursts
shifting from one rapid thought
to the next
as reality fluctuates.

Tears now as you
spill the pain of the life
you never had the chance of living
because of your mental illness.

Your mind broken,
damaged by the torrent of thoughts
years of untreated illness
and moments of chemical bliss.

A verdict handed down from on high
as if despite your unwavering faith
the spirit was taken
from you child.

shaking hands

My back to the door
as I exhale the heartache;
the words of childhood beatings,
a drunken fathers pain continues into today.

I cannot help but stare
as you speak of sadness, the hollow in your soul,
at the fresh wounds on your wrists
the dried blood still clinging as a foreign reminder
of your attempt to escape into the night.

I wonder how your wife
would have heard the news of your
suicide
had you not stopped at the superficial dermis
and allowed the scissors to work true to fashion
into those pulsating vessels beneath your weathered hands.

The air now acrid
an admixture of tears and days old scotch
breathed into the daylight
of a hospital morning.

Your hands tell the depth of your story
not the wounds on the surface
but the grime worn into the keratinous layers
wringing with each word of "manhood" and "death."

Your hand-shake a firm grasp
conveys respect, anger, frustration
and your pain buried in the torments of youth
at the hands of a father,
and the resilience of time.

wounded

Gleaming metal in hand
chills course through each nerve ending
as a Christmas eve birth unfolds;
sanguine sadness with each contraction.

She lays silent in the glow
of hospital sheets and fluorescent lights,
slow tears in the dark corners of her olive eyes
where whimpers replace words.

A drop of blood falls to the floor
a sparkling contrast on the sterile linoleum-
'deck the halls with bows of holly'
plays on from the nurses station .

Peering into the birth canal
the life blood ends
in dark clots, as the miscarriage continues
into the holiday eve.

We do not speak the same language
our origins far from similar
yet I reach forward and stroke the sweat soaked
wisps of hair from your face
and whisper "bless you child"
into the night.