Small, Good Essays
The following four essays were written by students in a Special Topics course focusing on the medical humanities. After reading Raymond Carver's short story "A Small, Good Thing," the students reflected on small, good experiences in their own lives.
After I graduated from college, I spent a year living in Washington, D.C., doing an AmeriCorps program for the National AIDS Fund. I worked at a Harm Reduction Organization called Prevention Works that served intravenous drug users and the communities they lived in by providing education, safe sex materials, and a syringe exchange program. I worked on the mobile unit, a Winnebago that we drove to different red light districts throughout the city to perform our duties.
At the time that this story happened, my contract at Prevention Works was nearly over, and the organization was going through a lot of changes. Our program director, who had trained every employee who worked on the mobile unit and who was one of my role models, had been fired. My co-worker on the mobile unit had quit shortly afterward. I was the youngest person working at Prevention Works and was now the only employee at the organization who really knew how the mobile unit was supposed to be run. I was exhausted, emotionally drained, and ready to move on.
Yvonne walked onto the unit. She was one of very few white women who lived in a black neighborhood; she was also one of the most beloved and well-protected characters in that neighborhood. Yvonne was a sex worker. She traded sexual acts for money and for drugs. She habitually used crack cocaine and heroin, and I saw her at least once a week on the unit for needle exchange. She was a very petite, fair-skinned brunette who looked at least a decade older than she actually was. She looked the same as usual: tired, dirty, and strung out.
At the time, I was running the mobile unit with a volunteer, Katie, who was a registered nurse. Yvonne was having a problem. She had been trying to shoot heroin into her femoral vein, which our participants referred to as “going in the groin,” and she shot “pink blood.” I had never heard the term before and asked some co-workers later what it meant. Apparently, shooting pink blood refers to missing the vein while injecting the drug, either emptying it into an artery or the surrounding tissue instead. This not only ruins your high, but also is very painful. Most users know better than to shoot pink blood when they see it, but Yvonne was in a hurry and made a mistake.
She told us that she immediately felt a searing pain tear through her entire body that left her convulsing on the floor. When she recovered, she noticed that her vagina was very sore, that she was experiencing painful urination, and that the area that she shot into was tender and red. She also confessed that she had some pus draining from her vagina. Katie said that she would be happy to take a look and make sure that there was no serious problem.
Yvonne stood up. Instead of moving into the back of the unit, where there were a curtain and blinds for such private instances, Yvonne pulled her pants and underwear down to her ankles. Keep in mind that we are parked on the side of the street, next to a housing project, in one of the worst areas in D.C., with a line of heroin addicts standing outside waiting for clean needles. Yvonne looks me in the eye and says very seriously, pointing at her exposed vagina, “Rebekah, this cannot be broken. This is the money maker.”
The entire situation was absolutely hilarious: Yvonne, standing with her pants down, completely exposed, pointing to her money maker. We laughed about it then and later as Yvonne healed. Her complete honesty and lack of shame were refreshing and touching. Her situation, and her total understanding of that situation, was at the same time funny and heartbreaking for me. It gave me an enormous amount of perspective that Yvonne could simultaneously realize that she was, in stark reality, a prostitute with a serious drug problem, while still maintaining her humor and humanity. I still think about that interaction with Yvonne and cannot help but laugh out loud.
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My community elder partner and I crossed some train tracks as we heard another train approaching in the distance. We were on our way to our first visit to our 96-year-old community elder, Mrs. Crum. He had his iPhone out, trying to figure out where to go next. Mrs. Crum’s neighborhood was packed with houses, each with its own personality and color scheme. We finally found her house and let ourselves in as she had instructed. The living room was very dark, and we found her sitting in a chair opposite the front door. She was so happy to see us and very pleasant and gracious, but a little confused about why we were there. As we sat down, she abruptly asked in her tiny, wispy voice, “So, are you going to take my pressure?”
Our assignment was to get to know our community elder and do a review of systems. Being first-year medical students and still in our first semester, we were still trying to grasp how to talk to patients without even beginning to think about the physical exam, even something as basic as taking someone’s blood pressure. We were only armed with pen and paper.
My partner and I looked at each other, not knowing exactly what to say, when my partner replied, “Well, that’s not exactly why we’re here.”
He went on to explain our lowly status in the medical world and that today we would not be taking her blood pressure. When he finished, her eyes drifted towards the ground and she sighed, “Well, O.K.”
Realizing her disappointment, my partner suggested she call the fire department to come to her house to take her blood pressure. Her options were limited as she no longer drove or had a regular means of transportation. She perked up at the suggestion and asked for the number. My partner found it in his trusty iPhone and gave it to her. After we left that day, we even found the fire department and informed them that they might be getting a call soon from Mrs. Crum. I was actually surprised that the fire department offered this service.
On our second visit, we asked if she had called the fire department, but she said she had lost the number and again asked if we would be taking her blood pressure. Like before, we didn’t have the answer she wanted.
On our third visit, her daughter called while we were there. Mrs. Crum told her daughter some doctors-in-training had come to visit her but that we weren’t able to take her pressure. That is the only comment she made concerning us. I could hear her daughter on the other end ask, “Doesn’t the nurse that visits you twice a week take your pressure?”
Mrs. Crum replied, “Yes, but I just had hoped they would take it today.”
My partner and I looked at each other and smiled. Apparently we just hadn’t lived up to her expectations. Knowing her pressure was regularly checked did make us feel better, and despite the comment to her daughter, we knew Mrs. Crum enjoyed our visits.
On the way to our fourth visit, we discussed how we wished we had a blood pressure monitor to bring to avoid disappointing Mrs. Crum yet again. We found her sitting in a little nook off the kitchen. We talked with her a bit when the question came, “Are you going to take my pressure?”
On cue, we both looked at each other, and my partner again suggested the fire department. She again asked for the number, and he began looking it up. As he was writing it down, Mrs. Crum suggested, “Why don’t you just call them right now?”
My partner glanced at me while he dialed the number. I talked with Mrs. Crum while he was on the phone, and after he hung up, he turned to us and said, “The women I spoke with said they would send someone.”
I asked under my breath, “They didn’t think it was an emergency, did they?” He shook his head no as he began asking Mrs. Crum another question.
A few minutes later, we heard the siren. I hoped the noise would fade, but of course it didn’t. It stopped outside Mrs. Crum’s house, and three men let themselves into her home, one carrying a very large bag for medical emergencies. My partner explained that there must have been some confusion in the relay of the message because this was not a hypertensive crisis, and he had just requested a routine blood pressure check. The firemen looked at my partner and I like we were children who shouldn’t be allowed to play with the phone.
Then I looked at Mrs. Crum, and she was beaming. She looked up at the five of us standing in her tiny kitchen and said, “I’m so happy you’ve all come to help me with my pressure.” The firemen took her blood pressure, and Mrs. Crum was sure to save their number in a safe place before they left.
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Thankfully I didn’t struggle too much academically during my first two weeks of medical school. This was not surprising though, since that those two weeks were dedicated solely to a short curriculum titled Patient, Doctor, Society. PDS, as it was called, was designed to serve not only as our first introduction to the very doctorly art of acronyming every possible phrase, but also as a kind of ceremony in which we, as Medicine’s latest batch of would-be acolytes, sat at the feet of our elders as they prepared us for the transformation at hand. Our assigned readings taught us that before we knew it, we would be overcome by a harrowing rush of emotions, as one by one we would be thrust into the thick of the high human drama that is life, possessing neither a script nor even a vague idea of the plot, save of course for its one constant, silent, yet screaming element—the inescapable death of each and every character.
There were many things I wished I had been more prepared for at the beginning of medical school. For a number of reasons though, the screaming inevitability of death was only third or fourth on my list. I was worried about biochemistry.
And not without reason. Over the four years of my undergraduate liberal arts education, perhaps the closest course I took to biochemistry was a seminar on Nabakov—and only because in it, I had to look up most of the words. I was a humanities man through and through. One of the chief reasons I chose to attend my university was that it didn’t require me to take even a single course in any subject that displeased me. And I was displeased by most subjects: math, biology, physics, chemistry, economics, computers, psychology, sociology, and on and on. My topics of my intellectual taste tended to inhabit the region just beyond the periphery of useful knowledge. Out there, I diligently studied Old World archaeology, art history, and visual art and dabbled seriously in philosophy, music, and the history and literature of Russia (from where partially came my relative comfort with human tragedy—or at least the parts of it capturable on paper).
Two years prior to my arrival at medical school, I had been mere hours away from mailing my portfolio and applications to art schools, thinking I would be a painter, when I abruptly changed my mind. For reasons that were, in retrospect, completely confused, I decided that an M.D. would suit me better than an M.F.A. Soon after that I was heading down the path toward medical school, a place I knew nothing about. But two years later, even after being accepted and moving across the country to begin my medical education, the realm of science nevertheless made me feel like I was in a strange land, one in which I didn’t really belong. As happy as I was to have arrived, I was still very worried that I wouldn’t pass the citizenship exams.
After PDS, we embarked on our science curriculum proper. On our first day of Fundamentals 1, a professor famed for his unflinching bluntness rose to offer some introductory comments. After a brief overview of the topics and the timeline, he broached the topic of workload. Exactly how hard was this going to be?
He paused to think, and then said, “A lot of people are worried about biochemistry.”
(Nods of acknowledgement bobbed throughout the lecture hall.)
“But the truth is, if you were pre-med or did any kind of science, chances are you probably picked up most of this stuff along the way. You’ll be fine, it’s not that bad.”
(Sighs of relief.)
“Now, on the other hand, if you studied something crazy—something like . . .”
(Looking up and to the side, upturned hand slowly twirling, thinking.)
“abstract expressionism . . .”
“. . . then frankly, you might be in trouble.”
Well, that’s just perfect.
Oh, how I wish that my favorite professor and mentor, the late Kermit Champa, were alive to hear this. He was a serious man, deeply thoughtful, his brow permanently furrowed. He was also enormously witty and could be quite wry when the situation warranted. If he—arguably the world’s most brilliant and original scholar of abstract expressionism—had not succumbed to cancer two years prior, and was instead here to witness this comment and grasp its tragicomic implication—that my passion for Pollock, Rothko, Still, and de Kooning, the very passion he himself helped kindle, might one day thwart my efforts to become an oncologist—he would have died laughing instead.
A few days later I ran into the doctor who had made the abstract expressionism comment. I just had to tell him how funny it was—how I had in fact studied abstract expressionism, how I was worried about biochem, and how, by trying to come up with the zaniest imaginable example of an utterly unhelpful topic of study and miraculously blurting out “abstract expressionism,” he had thereby nailed, at least as far as I was concerned, a 60-yard field goal of cosmic irony.
As I was telling the story, he cut me off, saying, “I didn’t come up with abstract expressionism randomly. That’s what I studied when I was an undergrad.”
He continued, “Yeah, after college I was trying to decide between getting a Ph.D. in art history or getting an M.D., and I almost did the Ph.D., but at the very last second, I changed my mind and applied to medical school.”
We then had a long discussion about art, aesthetics, life, and about being a humanities man in the world of science. When we were done talking, I didn’t feel like I was in such a strange land anymore.
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Since December 25, 1998, music has taken an unprecedented role in my life. That was the day I received my first drum set, something I had requested for three consecutive Christmases. Since then I have continued to learn other instruments and rarely complete a day without picking up one of them. When medical school began, I, like every student, had the typical fears of failure, etc., but what weighed just as heavily was whether I would have time for music—either listening to it or creating it. As Fundamentals II grew progressively harder, I soon watched this previously underappreciated hour or two slip away from me.
One frigid day in December of that year (my 10-year anniversary with music fast approaching), I was leaving Volker around midnight after a full day of studying. As I slowly sauntered down the hallway of prestigious doctor paintings (probably mumbling expletives at each one successively), I scrolled through my iPod for something that might stir up my spirit and shake my foul mood. I came across a Panda Bear remix of the Notwist song “Boneless,” and after pressing play something happened. As I crossed the threshold into the chilly air, it was as if my spirit had been patiently waiting outside the door all night, waiting to take my hand and dance in the moonlight. The next four minutes and 11 seconds were the most memorable I had had in months. I skipped, I howled, I laughed, I spun around the lampposts. I didn’t look back to see if anyone was coming, because I had left the possibility of self-consciousness at the door. This moment could not belong to anyone else. It was mine.
After my performance I realized that my previous fears had become my reality: I had lost ownership of my time. And needless to say, this became my ritual every night as I walked to my bike. These were minutes I looked forward to every day. Minutes that belonged to me.
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