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What We Carry

When I was an intern, we carried everything.
We carried manuals and little personal notebooks, frayed and torn,
crammed with tiny bits of wisdom passed on by a senior or attending.
Yet when a midnight patient rolled in with a myocardial infarction
we didn't look anything up because there were only four drugs we could use:
morphine for the crushing pain,
nitroglycerin to flush open the vessels,
lidocaine for rebellious rhythms,
and furosemide for sluggish fluids.

I'm old.

We had nothing to block the betas or the calcium channels,
nothing to inhibit the ACEs,
no fancy clot-dissolvers,
just the patient and the strip.
Some made it, some didn't.
Our white coats carried splatters from blood and iodine and no one even noticed.


When people quit smoking, they just had to quit.
There were no nicotine substitutes,
no patch to stick on or gum to chew or spray to spritz or inhalers to sniff.
No varenicline or bupropion, just quit.
So many smoked, and so many died.
For a while I kept a list in my head of everyone I knew who had died from tobacco, but it got too long.
The corpses between piled up into the millions,
and I felt I carried that load on my back every time I talked with a smoker.
I still do, every time, trying to put the right words together that will turn the switch.
It's a heavy task that often fails.


Now there are so many drugs and treatments and diagnostic tests
that no one can know it all, yet on rounds I carry almost nothing.
No books, no scribbled notes.
I don't even carry the apps for my phone because when a question comes up
I just challenge my residents to see who can find the answer first.
They dive into their phones, like gleeful pirates plunging into a slender treasure chest of knowledge,
and someone surfaces in seconds with the shiny golden answer.
And they're almost always right.


So I also try to carry the feelings for them.
Point out the sadness when we asked about that woman's family,
notice the exhaustion when a resident seems disorganized or short-tempered,
mention we haven't asked that man why he's drinking so much booze.
I've got three years with my learners, and then they are on their own.
I try to visibly carry my thirst for knowledge and my curiosity and my drive to do things right,
to show that this burden is not as heavy as the burden of giving up on them,
and that this passion in fact lightens the load.



About the author:

Sandra Miller has been a faculty member at Banner Good Samaritan Family Medicine Residency in Phoenix for more than twenty-five years and is a clinical assistant professor at the University of Arizona College of Medicine. "In college I majored in creative writing with a minor in anthropology; I encourage all physicians to journal and explore their personal relationship with medicine (and the evolution of that relationship) through writing."


About the poem:

"This poem is the result of a group writing exercise based on reading the first chapter of Tim O'Brien's book The Things They Carried, a moving and brilliantly written novel about the Vietnam War. We tried to write about what the reading triggered in us regarding what we 'carry' with us in medicine when we are 'on patrol' in the hospital. This exercise is a great way to explore your own burdens."