The Prodigal Son (sketches, first draft)

When Song was nine, his country friends taught him how to swim in the local river.  They took off their shirts and waded into the rapid frothy water.  Song clung to a basketball with the whole weight of his upper body and, to his delight, floated.  Oh, to be weightless!  He closed his eyes to enjoy the bright sun and the warm water.  Suddenly, he heard giggling and felt firm hands wresting the ball away from him.  For a second, he was submerged in bubbling indigo.  He swallowed, tasting the bitterness of the water, which was also swarming into his eyes and nose.  He fought blindly.  He kicked his legs.  He waved his arms.  Anything to battle against the weight of his mortal body.  Then just as suddenly, there was a rush of buoyant light and air.  When he was able to sustain his head above water and open his eyes again, his friends were already resting on the bank, cleaning their teeth with sharp blades of grass.     

“Scoundrels,” he yelled.  “You almost killed me.”

“But now you are swimming,” they said.  “Just move your arms a little more.”

They joined him in the river again and showed him how to move his limbs like a frog and how to glide on his back.   They played till sunset and then he walked home in soaked trousers. 

His father had listened to the events of the day and laughed—a sense of humor, which evaporated years later when Song led his younger brother Didi into the same stretch of the river and kicked the ball away.  After watching Didi thrashing wildly for a minute with no apparent progress, Song whisked him out of the water.  On the bank, Didi doubled over and heaved up spoonfuls of the river water; then, he ran home, crying.

When Song finally straggled back into the courtyard, Didi aimed his trigger finger at him and yelled, “The egghead almost drowned me.  I choked for hours.  The fishermen said my face was blue.”  His father paced around the veranda and shook his head with fury.  Song had to kneel over a bench with his trousers bunched up at his ankles and only his drawers for coverage in front of his mother, his sisters, and the housekeeper--they winced with every downward stroke of his father's belt.  Didi hovered in the corner, gloating.  It was unbearable and unjust, Song thought as tears pooled in the corner of his eyes.  Why did his father, a Confucian scholar who lectured his family daily on the importance of rationality, did not practice ‘li’ in real life?  Why did his father approve of his friends and the way they treated him but could not tolerate how Song treated Didi?  Song crouched for what it seemed like an eternity over that bench, his knees crunching into the cold pebbled ground, before his father threw aside the belt and retreated into the study.  Song's buttocks burned for a week afterwards yet it was the inequality of his father’s love that marked him and nettled him for decades.

Rabindranath Tagore

After reading mostly only American modern fiction (Jonathan Franzen, David Foster Wallace, Bret Easton Ellis), I found myself writing dialogue that meandered, narrators that went rogue, and characters that by the conclusion I just wanted to punch in the face.  I think I filled my reading cup to the brim and it splashed over, so to speak.   I love American short stories for the quirks and the tragicomedies that no other culture has developed as richly, but I've come to realize this can be to the detriment of the story.  The tone tends to be overly-conscious as the writer strives so hard to leave his own mark; the overall intended meaning of the work may suffer at the expense of style.

Recently, I've been reading Jhumpa Lahiri's newer books The Namesake and Unaccustomed Earth.  She writes simply; her stories are lovely and perfect. Sometimes, one paragraph alone of hers is enough to cause my insides to crumble slightly.  Mark has introduced me to Rabindranath Tagore, a Bengali writer who won the Nobel Prize for Literature in 1913.  "Surely," he said, "surely, Lahiri read Tagore.  Tagore's stories are simple and short.  He's devastatingly good.  He'll cut your heart in just a sentence."

And so it goes.  I limit myself to two Tagore story a day because he is just that devastating.  Here's an excerpt from "The Postmaster":

When he rose at dawn, the postmaster saw that his bath-water had been put out already for him (he bathed according to his Calcutta habit, in water brought in a bucket).  Ratan had not been able to bring herself to ask him what time he would be leaving; she had carried the bath-water up from the river late at night, in case he needed it early in the morning.  As soon as he finished the bath, the postmaster called her.  She entered the room softly and looked at him once without speaking, ready for her orders.  "Ratan," he said, "I'll tell the man who replaces me that he should look after you as I have; you musn't worry just because I'm going."

No doubt this remark was inspired by kind and generous feelings, but who can fathom the feelings of a woman? Ratan had meekly suffered many scoldings from her master, but these kindly words were more than she could bear.  The passion in her heart exploded, and she cried, "No, no, you musn't say anything to anyone- I don't want to stay here." The postmaster was taken aback: he had never seen Ratan behave like that before.

A new postmaster came.  After handing over his charge to him, the resigning postmaster got ready to leave.  Before going, he called Ratan and said, "Ratan, I've never been able to give you anything.  Today before I go, I want to give you something, to last you for a few days." Ecept for the little that he needed for the journey, he took out all the salary that was in his pocket.  But Ratan sank to the ground and clung to his feet, saying, "I beg you, Dadababu, I beg you-- don't give me any money.  Please, no one need bother about me." Then she fled, running.

The departing ostmaster sighed, picked up his carpet bag, put his umbrella over his shoulder, and, with a coolie carrying his blue-and-white striped tin trunk on his head, slowly made his way towards the boat.

When he was on the boat and it had set sail, when the swollen flood-waters of the river started to heave like the Earth's brimming tears, the postmaster felt a huge anguish: the image of a simple young village-girl's grief-stricken ace seemed to speak a great inarticulate universal sorrow.  He felt a sharp desire to go back: should he not fetch that orphaned girl, whom the world had abandoned?  But the wind was filling the sails by then, the swollen river was flowing fiercely, the village had been left behind, the riverside burning-ground was in view.  Detached by the current of the river, he reflected philosophically that in life there are many separations, many deaths.  What point was there in going back? Who belonged to whom in this world?

But Ratan had no such philosophy to console her.  All she could do was wander near the post office, weeping copiously.  Maybe a faint hope lingered in her mind that Dadababu might return; and this was enough to tie her to the spot, prevent her from going far.  O poor, unthinking human heart!  Error will not go away, logic and reason are slow to penetrate.  We cling with both arms to false hope, refusing to believe the weightiest proofs against it, embracing it with all our strength.  In the end, it escapes, ripping our veins and draining our heart's blood; until, regaining consciousness, we rush to fall into snares of delusion all over again.

Fire of Ice (pieces from intro scene, first draft)

It is a well known fact that people like him happen almost exclusively to people like me.  I am the sort who relishes scribing in daily planners, who frowns upon ice cream flavors outside of the Neopolitan spectrum.  Stereotype or not, I flourish in forgotten corners; I sit in igloos of anatomy books, tracing on notebook paper the supplies of veins and arteries, the torsion of muscles and bones.  He is the sort who walks up to a person he’s never talked to before.  It is the first evening of December.  

“Hello,” he says, slumping down at my table.  He rests a set of metal crutches on the floor.

“Hello, your name’s Julian, right?”

“Something like that,” he says.  

“I’ve never seen you before in class.”

“I’ve never been to class,” he says.  “It discriminates against nocturnal minorities.”

“What happened to your legs?” 

“Fracture of the heart,” he says.  “Category, you may ask: open compound.”

“It is Julian, right?” I say.  

“Listen,” he replies, leaning in.  “Did you know that we’re just particles floating in a lonely white space?  That we adopt new atoms and lose old atoms everyday?  So that if identity is configuration, then who you are today is not who you will be tomorrow?  That who you were yesterday already died?”

The study group across the aisle close their laptops, preparing to relocate; the girls watch us  as they walk by and whisper to each other.  I try to assess Julian’s pupillary diameter but his dark pupils extended into his dark irises.  Yesterday, we learned smaller than normal suggests narcotics; bigger than normal suggests either cocaine, methamphetamine, amphetamine, ecstasy, or marijuana.  So I smile, not knowing what to say.  

“Try throwing a different smile at me,” Julian says,  “I am not a barking dog that you’re trying to silence with a juicy bone.  I am a friend.  I am a messenger.  I am here to prophesize billowing electron clouds and bitter nuclear divorces and abandoned baby neutrinos.  I am talking to you even when that ‘you’ and ‘I’ have fictitious borders.  That’s right, Madame--if you’re lucky and a believer, you can dip your finger through this desk, that is a gazillion carbon atoms, and feel nothing but air.  Try it.  I insist.”

Welcome

Disclaimer: "Internshipped" is a comic strip about fictional residents in a fictional hospital working taking care of fictional patients. 

Irreversible

On a sleepy Saturday morning, I was typing notes into the electronic medical record when my team was paged.  The patient in question seemed less oriented than his baseline.  He flinched reflexively to pain but did not respond to any other stimuli.  "I think he's just tired," the nurse said.  She tried spooning jello into his mouth.  We stared as he smacked his lips with primitive rage.  His pupils which had been asymmetrical prior to admission seemed grossly more asymmetrical: one was normal sized, the other reached the rim of the eye.

"Neurology consult, CT scan of head STAT," my resident said.  One of us left the room to call neurology and in-house radiology & CT tech.  The nurse drew a basic metabolic panel, type & cross, and an arterial blood gas.  The beepers screamed in rapid succession.  Page: patient upstairs vomited bile--his abdomen was tighter than a drum, suggesting that his small bowel was obstructed and ready to perforate bacteria-laden stool into the abdomen.  Page:  the radiology attending asked that we call neurosurgery because the initial read for the CT scan was worrisome.  Page: patient downstairs spiked fevers with low blood pressure, concerning for septic shock.  Page:  the tubes for the unresponsive patient were incorrectly labeled; the lab allowed no exceptions for labs drawn during a code and these tubes had to be redrawn with the correct labeling.  The three of us on the floor ran from task to task without barely a breath in between.  Hours later, the neurosurgeons arrived in matching strides.  The scan showed a massive subdural hematoma, a dense collection of blood under the thick protective layer beneath the skull--the vital control centers of the brain were now pressing into each other.  The attending explained that given the patient's age, his co-morbidities, the magnitude of the bleed, he would not be an appropriate candidate for surgery.  We could only manage him medically with watchful waiting.

Diseases progress over time.  Cancer cells multiply in the bone; bacteria seed the heart valves; the lung tissues harden and thicken.  It is the difficult duty of the physician to declare the moment of irreversibility.  We classify human suffering and call it diagnosis; we predict the length of suffering and call it prognosis.  I found that these were the moments that suspend themselves in time:  A young man with a malicious brain cancer slept in the intensive care unit, losing gradual touch with memory and sensorium.  His family knew that he was faring poorly, but they still had faith that somehow these new and strange medications will would help him evade his final end.  As the mother caressed his forehead, she still harbored hope that he would stir and recognize her face.  She did not know what we knew--the recent brain scan showing further dissemination of cancer refractory to chemotherapy--until the meeting.  She did not feel her stoicism vaporize until a doctor uses the word "dying" and she was suddenly overcome with loss. She did not feel weakened until she realized that her only child would leave her.

In many cases, medicine cannot reverse the escalating suffering at hand--at which point, our practices are at best measures of the remaining iotas of life.  As our elderly patient laid dying, her heart failing, her kidneys failing, her liver failing, bleeding and clotting all at the same time, dropping blood pressure even on fluid boluses and all of the most powerful vasopressers, we could only stand at the bedside and be with her as she passes onto the next stage.  The heart monitors showed initially the high waves of ventricular tachycardia, then the smaller beats of ventricular fibrillation and then nothing--we watched as she exhaled and curled her neck slightly.  After confirming the absence of a heartbeat, we silenced the monitors and withdrew the catheters and then, we pulled the curtains to a close for the family.