Tess Aldrich CWA 2007

Creative Writing Awards 2007

Class of 2009

Tess Aldrich, 09 graduated from the University of Michigan with a BA in Sociology. She also received an MSc from the Harvard School of Public Health, concentrating in Population and International Health. She is a first year student at YSN and plans on specializing in Womenis Health. A gifted writer, she was the recipient of two writing awards for her fiction work while at University of Michigan and a Thesis Award from Harvard. 

Transcript of the Reading:

Our Own Arrangement of Details

A friend of mine refers to the work of nurses, doctors, and all others who provide care with humanity and skill as “healing.” I’ve always liked this word and the pictures it conjures up in my mind’s eye: an old, wizened doctor speaking gently to a man lying in a cot and grasping his thin hand; a calm, dark-eyed nurse stretching her own strong palms knowingly over a woman’s round belly, feeling the tiny silhouette of the figure within. Long before I began to imagine myself in this role, I think that I did view nurses as healers of sorts and felt a deep reverence for them, similar to my regard for great photographers and painters and writers. All possessed a finely sharpened awareness of people’s innermost frailties and beauty; they could examine someone they barely knew with a quick and startling comprehension, informed in part by years of disciplined training but also by some innate and hidden faculty.

Oddly, an excerpt from a patient’s chart that I read one evening the first week of nursing school amazed me. Somehow the layers of minute detail devoted to one elderly El Salvadorian woman who’d arrived at the hospital with abdominal pain and postprandial vomiting caught me off guard. I’ve spent the last few years crafting and often struggling with the complexity of questionnaires, study design and statistics, compelled by public health interventions that aimed to affect wide and certain change: women in Pakistan or Egypt who die from bleeding in childbirth versus a population where hemorrhage is controlled by uterotonic drugs. I know that change unfolds on many levels, that lives are marked by one word of empathy as well as the constancy of support and structure; so I was humbled by my fascination that someone would write such a meticulous note on one woman’s head-to-toe anatomy, her post-op vital signs, heart sounds and 2+ bilateral pitting edema, but also her quiet anguish when she laid eyes on her ostomy and listened to the translator describe its care. My first thought was: there is immense illness and poverty in every corner of the world, and here is a single person who happened to walk into the hospital today and receive a scholarly, descriptive, written account of her pain.

Days later, I met my first patient on the infectious disease unit: an old-young man who looked up at me with eyes sunken into his head like heavy black stones and whose bones protruded from his frame. He did not want to talk. “No questions please.” I introduced myself (too timidly, I thought immediately afterwards) and he stared steadily back at me. He did not want to bathe. As I took his vitals, sweating under the protective gown draped over my scrubs, I fumbled awkwardly with the blood pressure cuff that appeared, cruelly, too large for his skeletal arm. “…chronic weight loss and malnutrition, severe anemia, disseminated MAI to GI and bone marrow, PCP, candida esophagitis, CD4 count undetectable,” the chart had read. I’d looked up his 31 medications the night before. His eyes closed while I sat next to him, counting diligently as his chest rose up and down and encircling his wrist with my gloved fingers. Excepting this man’s severe gaze, his pulse was the only strong feature that I could discern. There were some crumbled biscuits on his bedside table. “…likes chocolate Ensure,” the nurses’ note had read.

The next morning he was waiting in his johnny coat in the doorway to his room, planted solidly on two feet and hunched over slightly. His arms hung stiffly at his side and his head was bowed, though his dark eyes lifted to fix intently on the corridor as people passed: the doctors’ morning rounds. He wanted to go for a walk, so I’d overheard in morning report. Three of us had arrived eagerly on the scene, hoping that he would first let us help him to the shower, now that he was standing, and grateful for a concrete mission. But he shook his head no, and we all stood a little awkwardly around him, shifting our weight and glancing at one another, then at him. Maybe later? I briefly had the illusion that we were standing on his stoop asking him to join us for a movie. Perhaps some other time? “Just go do your thing,” he said, not unkindly waving us away. But he did want to walk, so I offered him my arm and the two of us ambled slowly down the corridor. He took short, quick steps and leaned his delicate weight against me, holding to the rail along the wall. “You’re doing fine,” I said, unused to hearing my voice this way and questioning the sincerity in its tone. After a minute he paused. There was a marked draft in the hallway and we were nearing the cluttered and chaotic nurses’ station; I could feel the uncertainty in his steps. Frizzy wisps of hair clung to his scalp in tiny cornrows. “I don’t like this,” he said simply, and we turned around. Back in the room I helped him lift his stiff, swollen legs onto the bed, smoothed his blankets, and left him to sleep.

This man has crossed my mind several times since September, and each time I am touched by the strangeness of our interaction–an interaction that I feel becoming ever so slowly more instinctual as months pass. Public health alone inspired but overwhelmed me. It is easy to become weighed down by the vastness, the sheer mystery and out-of-reach peace and agony of populations, of people we don’t know and never will. But I see more clearly that one can also feel overwhelmed by the mystery of people, by the corners of their minds and pasts that are remote and forever inaccessible to us. There is a pleasingly concrete science and skill to learn in nursing, to commit to memory in our hands and brains: but the amazing ambiguity of health and sickness manifested in one person is of course another realm completely. Perhaps healing takes place somewhere within these details, both those we can discern and comprehend and those we simply can’t.