James O. Ballard, MD
Penn State College of Medicine, Hershey, Pennsylvania, United States

Poet’s statement: Those of us who care for patients at the end of life realize the importance of closure (i.e., the settling of unfinished business, misunderstandings, and disputes between patients and their families and friends before death). This poem begins and ends with images of an early December day seen from the window of a patient’s room in the ICU. The woman on life support was dying from complications of treatment for cancer. She had separated from her husband after the death of their son in Iraq. The poem depicts the tragedy of a dying patient unable to speak and her estranged husband arriving too late—both denied the opportunity to attempt reconciliation.

 

December fall

Late fall’s sun pierces gray clouds and glass,
Splitting the portraits on the sill into dark and shiny patches
Of lost soldier-son and husband, away for days.
It streaks across tubes and wires,
Reflected in the sparkling sweat
And unruffled sheets that enshroud her
Solitude.

A machine with muffled whoosh
Makes her chest rise and fall,
Silencing the story of how it happened as it did.
The fault: theirs both, mostly hers.
Alone now with lines to say
But no words, no audience.
Will he come?

High up he flies, summoned at three by worried news
That all is worse—hopeless, actually.
Bitter scenes whir past as painfully
He practices what he’ll say.
The fault: theirs both, mostly his.
But who now should hold the blame?
Will she hear?

The elevator ping announces its cargo:
A chattering clutch of hopeful visitors.
I find him buried among them,
Walking lockstep in evening shadows
Down halls decked out in yuletide cheer.
One look and he reads my face,
Seeing all.

The incandescent room is now too still:
No whooshing sound,
No gasping breath,
No shrill alarm.
He looks past the portraits,
Beyond the sill,
Asking why.

Outside, brown leaves float unmoored,
Here one, there two or three together.
Caught up in brisk eddies
Of almost-winter breeze
They fall through fading light,
In release
To rest.

leaf
Photography by Benjamin Haile

 



JAMES O. BALLARD, MD is professor of medicine, pathology, and humanities and holder of the Doctors Kienle Chair for Humane Medicine at Penn State College of Medicine. For 35 years he has been a faculty member at the Penn State College of Medicine where he teaches hematology and medical humanities, and serves as attending physician on the clinical hematology service of the Penn State Hershey Medical Center. Since 1989, he has implemented programs focused on end-of-life care practice and education at the Penn State Hershey Medical Center and Penn State College of Medicine.