No bulwark here but

No bulwark here but
barren land—
filtered arctic
beats the aseptic cowl—

White desert—
stippled with silver
shepherds herding patients 
into rooms

Black collars
of diaphragms and bells
haunt the halls
to calibrate the ill

The sterile wraith
drifts from room to room— 
counting the numbers and
the numbers—

the whispering and the
muttering— the shuffling
of papers measuring the day’s
worth of living for the dead

Within the hundred awakenings
in the middle of the night
I awake— called to purpose
a singular demand

Broad-faced son
stands with family huddled
I tread across
to greet them softly as a monk—

a sigh here, a murmur there—
a sign here, a scribble there—
mechanize the ritual
and automate the vow—

for whether in sedation
or distraction our lives thrive—
our expectancy in this world
expires

Machine and tube
now absent— she speaks—
she calls for her son— for
a life’s width she speaks

light and precious things—
lulling and cooing to him
as she is held—
head inches from the head

Before she passed
like a cloud in the night—
before she dimmed
into the dusk—

her son emerged from
her gloom— face of moon—
affirming flame against
a darker mountain—

countenance of new
sure of death and after—
differentiated flash— swallowed
whole— and I was blinded

After she died
he laid his hands on me
until I was unhood

I know a man—
Vision has a face—
What can thrive a life—
the world or unfair hand?

1. Cowl – Middle English “cou(e)le,” Old English “cugele, cūle” < Late Latin “cuculla” monk’s hood, variant of Latin “cucullus” hood
2. Hospital rounding – usually involves medical students, residents, fellows, attendings (and even nurses, pharmacists, social works, etc) gathering as a team in the morning to examine and discuss management of patients. Residents teach medical students how to “present” a patient accurately and concisely to the attending physician. In addition, attendings teach residents to come up with a plans of care. This can involve towing a computer around to do orders and notes.
3. Winter B, Cohen S. Withdrawal of treatment. BMJ : British Medical Journal. 1999;319(7205):306-308. – “Withdrawal of treatment is an issue in intensive care medicine because it is now possible to maintain life for long periods without any hope of recovery. Intensive care is usually a process of supporting organ systems, but it does not necessarily offer a cure. Prolonging the process of dying is not in the patient’s best interests as it goes against the ethical principles of beneficence and non-maleficence. However, withdrawal of treatment does not equate with withdrawal of care. Care to ensure the comfort of a dying patient is as important as the preceding attempts to achieve cure.” When we withdraw aggressive forms of treatment in the ICU, this usually involves removing the breathing tube and ventilator. Patients may pass away within minutes to days.
4. Psalm 8: 2-4 – “When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, and the son of man that you care for him?”
5. September 1, 1939 by W. H. Auden – “Yet, dotted everywhere, / Ironic points of light / Flash out”
6. Exodus 3: 1-6 – “And the angel of the Lord appeared to him in a flame of fire”
7. Luke 9: 28-36 – “And it came to pass about an eight days after these sayings, he took Peter and John and James, and went up into a mountain to pray.”
8. Ezra Pound – liked to “make it new”
9. Revelation 21: 1-8 – “And he who sat upon the throne said, “Behold I make all things new.” Also he said, “Write this, for these words are trustworthy and true.””
10. Acts 9: 1-19 – “So Ananias departed and entered the house. And laying his hands on him he said, “Brother Saul, the Lord Jesus who appeared to you on the road by which you came has sent me””
11. 2 Corinthians 12: 1-10 – “who fourteen years ago was caught up to the third heaven—whether in the body or out of the body I do not know”
12. Thrive – “from Middle English thriven, from Old Norse þrífa (“to seize, grasp, take hold, prosper”) (Swedish trivas), from Proto-Germanic *þrībaną (“to seize, prosper”), from Proto-Indo-European *trep-, *terp- (“to satisfy, enjoy”).”