Stony Brook, New York, United States
|Hospital ward, circa 1969.|
T.S. Eliot’s poem “Burnt Norton” begins with the famous lines: “Time present and time past / Are both perhaps present in time future, / And time future contained in time past.” 1My memories are a part of my present experience. I recall clinical experiences of all sorts, good and bad, life-affirming events and times of futile suffering, but my medical errors are among the most persistent and present. A mistake that harmed a patient may have occurred many years ago, but it remains “present in time future.”
The first medical mistake I remember is when I killed an old woman by giving her an overdose of morphine. During the winter of 1970, I entered the Women’s Medical Ward at the Hospital of the University of Pennsylvania, a huge room of thirty-two beds, a high altitude ceiling, institutionally pale walls, suspended fluorescent lights, and a network of tubes for pulling “privacy” curtains around the beds.
Alabama’s curtain was drawn. She had appeared gasping for breath in the Emergency Room the night before, a tiny, gnarled, black woman wearing a pink knit cap and a heavy red sweater. She had a clear-cut case of pulmonary edema, although there were no medical records available to review. The patient herself was too sick to talk, except to say that she hailed from Huntsville, Alabama, and wanted to go home. I am sure I learned her name at the time, but in my memory, where she continues to live, she has always been “Alabama.” The ER doc must have dubbed her “hypertensive heart disease,” so that is what I wrote at the top of the differential, although her blood pressure was normal for a woman about to drown in her own fluids.
To treat pulmonary edema in those days, we had oxygen, Mercuhydrin (a diuretic), morphine, and rotating tourniquets. We also had a spanking new Intensive Care Unit, but admission to the Unit was far from routine. Alabama’s condition had stabilized and improved in the ER, so she wound up in the general medicine ward rather than in critical care. I remember how disheveled she looked when I was called to see her during morning rounds. Her wig was cocky-wampus, her red sweater mashed and twisted around her neck. But she was quiet and breathing comfortably. She even gave me a lopsided smile until I reached over to straighten out the wig. Swatting my hand away, she whispered, “Lawdy, Lawdy, Lawdy.”
I pushed a bit more diuretic, adjusted the oxygen, and went back to finish rounds. An hour later I was called back. Alabama was thrashing around, breathing a mile a minute, once again in florid pulmonary edema. I cannot remember exactly what happened at that point–surely it must have included tourniquets, morphine, and a stat call to the ICU team. Those fifteen minutes seem impenetrable, but I remember standing by Alabama’s bed a few minutes after she died and reading the label of an IV morphine vial. I had given her an overdose. Not egregiously too much, but sufficient (I thought) to make the difference in tiny Alabama between life and death.
What should I do? I was not able to focus on shadows during x-ray rounds later that morning, or eat my sticky, dry spaghetti for lunch. I told my resident about killing Alabama. He pooh-poohed the whole affair. “Makes no difference,” he said. “That lady was dead when she got here. Before she got here. Her heart was just worn out.” Later, I screwed up my courage and told my attending physician, a famous cardiologist. He was a small man, even shorter than me, who sported a crew cut and horn-rimmed glasses. “Not to worry,” he told me. “You’ll learn.”
About twenty-five years later I wrote this poem:
In the ward
behind a curtain
with a sleeping cap
akimbo on her wig,
like a locomotive,
Let me go.
In some brown place
above her bed,
my stern professor stands
at my attempts
to stoke the boiler
in her chest.
Wrinkled and abused,
this Alabama lies
in some deep structure
of my mind
where still I kneel
beside her freckled arms
pumping morphine, merc
The distant locomotive chugs.
I slap her, Dammit,
The poem came to me one day for no apparent reason. Several things about it were surprising. For example, who is the stern professor standing “in some brown place / above her bed”? The main corridor of the hospital was bedecked with 19th and early 20th century Philadelphia physicians, but there were no paintings on the walls of the Women’s Medical Ward. And why did Alabama develop freckled arms? Her skin was actually very dark and smooth. The biggest surprise, though, was Alabama’s whispered, Let me go. Let me go? She never said that. In the poetic version, I do not kill her. Far from it. She dies despite my desperate attempts to save her, despite my imperious command, Dammit, Live!
Let me go. Where did these words come from? Was my subconscious mind simply trying to ameliorate my guilt by making Alabama welcome her death? Perhaps. But I think the Let me go is also me—my voice—begging Alabama for forgiveness, and the “stern professor” above her bed is my nagging conscience. It is not a poem I can explain rationally, yet its effect on me was clear. The poem acknowledged and embraced Alabama’s presence and allowed her to heal my memories, at least in part.
- Eliot TS. Burnt Norton. The Complete Poems and Plays. New York, Harcourt Brace and Company, 1958, p. 117.
- Coulehan J. Alabama. Literature and Medicine. 1992; 11, #1 (Spring).
JACK COULEHAN, MD, MPH, is an Emeritus Professor of Medicine and Preventive Medicine and former director of the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University. His latest collection of poetry, The Wound Dresser (2016), was chosen by Robert Pinsky, former poet laureate of the United States, as a finalist for the Dorset Poetry Prize. In 2012 he received the Nicholas Davies Scholar Award of the American College of Physicians for “outstanding lifetime contributions to the humanities in medicine.”