BJZ Poems and Musings

One of the things I learned in my 36 years practicing as an emergency physician was that caring has to occur in a judgement free zone. If it doesn’t there is the risk of becoming callous and less able to connect with people in their time of need. One of the benefits of aging and experience in practice is that you come to understand that good people do stupid things, harm themselves, and ignore or deny their medical issues. As a physician you can advise, recommend, educate, even admonish if you have the right relationship with a patient, but you have to accept their choices and the way they live their lives. This poem, initially published in 2012, describes a patient, (name is a pseudonym), who I saw earlier in my career when I maybe hadn’t fully learned this lesson about accepting, not judging.

Bad Combination

Doris had smoked Lucky Strikes for 55 years;
but her alveoli eventually popped like party balloons;
emphysema turned her lungs into dead space;
she inhaled a steady flow of bottled oxygen.
Her latest Lucky, lit with an old Zippo lighter,
ignited her O2, too—the flash of flames
blistered her cheeks, charred her tender nares;
her eyelashes curled as if by a cruel beautician,
eyebrows all but erased; her polyester nightgown,
blue with yellow daisies, melted into her chest.

Her hoarse, singed voice cried out:
‘‘Doc, pleeease! Something for the pain!’’
We rushed to pop an IV into her thin arm —
merciful morphine; now she sucked precious oxygen
through a tight mask that puckered her scorched face;
I observed all this, without much fire in my empathy furnace.
I regarded her ribs as she heaved breaths in and out,
like the tired bellows in an old steel factory;
her skin was leathery and wrinkled, as soft to the touch
as the chaps of the Marlboro man; her upper lip had weeping
blisters with remnants of lipstick; I imagined her ashtray
at home, filled with Lucky butts, each with a pink halo kiss.
‘‘When will it stop burning?’’ she moaned
‘‘You’re probably through the worst of it.’’
As I slathered her face with burn ointment
I was pretty sure she would live—
there was a toughness about her—
I was pretty sure, too, that she had not had her last
Lucky Strike—some doctorly advice was in order:
‘‘Doris,—cigarettes and oxygen—bad combination,’’
‘‘Yeah, Doc,’’ she grimaced, ‘‘Tell me about it.

Brian J. Zink – Originally published in Academic Emergency Medicine –
2012 Oct. 19 (10): 1216. This version revised with one less paragraph