Robert A. Burton - Articles and Short Fiction/Poems

Short essays, stories, poems, and personal observations that explore the many paradoxes and contradictions inherent in scientific inquiry. (available at Cambridge Quarterly Journal of Healthcare Ethics).

Where Science Meets Story: Notes from an Extended Field Trip
ROBERT A. BURTON

A young woman with a viral brain infection believes that she is dead. You put a
stethoscope on her chest and have her listen to her heartbeat and feel her pulse.
She agrees that her heart is beating but swears that she has died. Being a savvy
neurologist, you suspect that the woman has Cotard's syndrome—the rare illusion

of feeling dead associated with certain brain conditions, including viral encephalitis.

In that brief gap between hearing someone insist that she is dead and settling into

the ritual of diagnosis and treatment, your mind is flooded with odd emotions and

suspicions as disparate as what it means to feel that you are dead to the possible

neurological basis of self-delusion. You sense that you are on the edge of an

important insight about the human condition, but time intrudes, another patient

beckons, the experience—so difficult to label and categorize—slips beneath consciousness,
relegated to the dusty interstices of distant memory.

Check out the peer-reviewed literature on Cotard's syndrome and you will see
fascinating descriptions and speculations, but no detailed descriptions of how it
feels to see such a patient. Traditional scientific exposition works through carefully

reasoned argument and supporting evidence; unsubstantiated meditations
and ineffable feelings are the stuff of personal essay and memoir. And yet, if we
accept the prevailing cognitive science view that thoughts arise out of subconscious

brain activity, it seems self-evident that such encounters with the unusual, even if

long forgotten or inaccurately recalled, are the experiential building blocks with which

we address the complexities of human behavior, including ethical dilemmas.

Though we commonly feel our thoughts as simply popping into our heads, we also

have the occasional wonderful sense that we can both summon thoughts up into

consciousness and then shape them into compelling lines of reasoning. But this marvelous

feeling of a personal self endowed with sufficient personal agency to consciously

manipulate thoughts is itself a phenomenon arising out of involuntary subliminal

brain mechanisms. As I have previously discussed at length,1,2 the involuntary
mental sensations of self, agency, causation, and a feeling of knowing collectively make

it impossible to accept that conscious reasoning is likely to be an illusion foisted on us by

our biology. My reason for downplaying our ability to consciously manipulate our
thoughts is to challenge the notion that tough ethical decisions that affect mankind's

future must be addressed primarily via argument and evidence—the tacit assumption

underlying most public discourse from academic debate to political talking heads.

Early in my neurology career, fascinated by the nature of personal identity, the role of

biology in determining intention and responsibility, reason versus faith, the limits of

agency and choice—I found myself writing a novel that imagined what it might feel like to
find out that you were one of 10 identical clones. After doing the necessary research,

I stepped back from hard facts and sat quietly, allowing characters to bubble up, often

with unexpected perspectives that I did not know that I had. By listening closely and

not editing my thoughts, I was able to grab a glimpse of how the raw me thought and felt.

Though the arguments for and against cloning have since become fuzzy and oddly

unpersuasive, the characters remain vivid and compelling.

After nearly two decades of writing about the relationship of the brain to the mind, I

have again decided to step back from hand-picked data and tidy conclusions and allow

my uncensored mind to offer up potentially new perspectives on age-old obsessions.

What are emerging are loosely interwoven stories, poems, personal reminiscences,

clinical narratives, and ruminations unfettered by explicit purpose. My hope is that these
meanderings will collectively offer a kaleidoscopic yet coherent sense of a senior neurologist's

late-night meditations on being human. By the way, the Cotard patient fully recovered from

her encephalitis and no longer believes that she is dead. However, she remains convinced

that she was dead during her illness.

Notes
1. Burton RA. On Being Certain: Believing You are Right Even When You're Not. New York: St.
Martin's Press; 2008.
2. Burton RA. A Skeptic's Guide to the Mind: What Neuroscience Can and Cannot Tell Us
About Ourselves. New York: St. Martin's
Press; 2013.

Cambridge Quarterly of Healthcare Ethics (2020), 29, 651–655.
© Cambridge University Press 2020.
doi:10.1017/S0963180120000390 651
https://doi.org/10.1017/S0963180120000390 Published online by Cambridge University Press

Plague Journal

Given a strong family history of early heart attacks, the future has always been an iffy proposition.

Miraculously, I have bypassed the early off-ramps and find myself approaching 80, stents in place,

considering the very real but previously unimaginable possibility of still more. But what kind of more?

With dopamine on the wane and no longer supercharged by the push and shove of unbridled ambition

and pride, bigger and grander are out of the question. Tired clichés poke through the widening cracks in

my thinking to become uninvited bulletins of compromise and consolation. Be grateful. Relax, reminisce,

enjoy sunsets, learn the backyard birds' names, maybe even sing to them, and count blessings.

Yet, there are moments in the day when I feel a brightly colored butterfly fluttering in my chest.

My earthbound cardiologist diagnosed a benign atrial arrhythmia; I know better. It is a new me

beating furiously against the constraints of old memories and habits. It wants out, to have its own

brief moment in the sun.

Of course, a new self is impossible. Few legitimate observers of human nature seriously believe

that we can cast aside our basic stripes. Perhaps great effort can modify; redo is beyond discussion.

At the same time, sages warn us that the self, like free will, emerges from inescapable deep grooves

of biology and habit and is a purely fictive evolutionary trick to embody coherent desires and actions,

meaning and purpose.

If the mind is primarily subconscious chatter and inclinations, my choices are limited: I could either

regard the self as a set-in-stone hardwired illusion or as a free-floating blank page for continuous rewrites.

From the vantage-point of the former, I opt for the latter; if there is no free will, there is no harm done

running uphill against reason. Reinvention would be my late-life project.

I could go Thoreau. Practice deep breathing and mind-emptying. Purge myself of desire. Start an

experimental novel or a collection of poems. Learn to improvise in Dorian mode. On paper, the options were endless.

I got out my scratch pad and was halfheartedly weighing choices and jotting down possible baby steps to get

beyond myself when, without fanfare or prelude, the virus struck and I was stripped of daydream and personal compass.

Thoughts were compressed into the complex logistics of how to best avoid unnecessary contact with

people, surfaces, objects, and even potentially tainted air spaces. Given my age, selfisolation was likely to fill up

the rest of my dance card. Going Thoreau was a necessity, not a choice. Spending your days in enforced solitude

no longer constituted an accomplishment.

I have been left with the free time of the condemned awaiting execution, the lazy quiet of a secluded

island resort, the sleep in late and stay up late of winter break or holiday weekend. All is down time and at last

I am my own next chapter's blank page, ready to be written on or over. I have my pencil and eraser ready.

At last, I am free.

Cambridge Quarterly of Healthcare Ethics (2021), 30, 188–189.
© The Author(s), 2020. Published by Cambridge University Press.
188 doi:10.1017/S0963180120000663

When Will the News be Bad Enough? Group Effort Prior to Covid-19

The cardiac rehab nurse calls out each of our group's blood pressures and pulse rates. It is my first posthospitalization class and I am relieved to be in the middle of the pack. Although fully aware that numbers are not fate, I cannot help wondering if the worst performers will fully satisfy the dark needs of heart disease statistics. I presume that others are making similar calculations, yet wince at the ugly direction of my mind. Maybe it is not necessary to do better than another; if we take our meds, eat wisely, and exercise to the max, it is possible that our entire group will do well.

The nasty thought of a health contest triggers memories of the first day of med school with its grim grades-trump friendship undercurrent, followed by the shrill take-no-prisoner clawing and scratching of subsequent faculty life. I am primed to see competition everywhere. Education has not helped; universal acceptance of survival of the fittest and the notion of selfish genes have fully prepped my suggestible mind to see human nature at its worst.

And yet the other rehab participants are gracious, reassuring, and encouraging each other without condescension or smugness. When finished with an exercise machine, each takes the time to wipe it down as though offering a gift to the next user. With a circling index finger, an elderly white-haired man peddling on a nearby exercycle urges me to go faster. I oblige and crank up the treadmill. He gives a friendly thumbs up. A middle-aged man with a fresh purple scar peeking out from under his collar joins in with his own thumbs up. A couple women nod in agreement.

When the session ends, we mill around long enough to wish each other well. Several of us say in unison, "See you next time," triggering a momentary awkward uncertainty that is countered with savvy hand shaking and pats on shoulders. To my utter surprise, suddenly all feels right in the world. The group's collective kindness has transported me far beyond personal concerns. Despite being an inveterate nonjoiner, I belong, am part of a shared community, one of a dozen complete strangers whole-heartedly rooting for each other.

Although anxious to leave, I am already looking forward to the next class. My skeptical prove-it-to-me medical background argues that the good feeling is nothing more than a rush of exercise-induced endorphins, but I know better. I am seeing humanity at its best.

On the way home, a young woman in a shiny red Range Rover cuts me off on the freeway. I honk; she sneers and gives me the finger. We are enemies. There is an insistent knock at the rear window to my mind; my rehab class partners are trying to get my attention. Shifting gears, I try to imagine how I would feel if the Range Rover lady were suddenly relegated to my rehab class, or worse. But it is too late. My mood has soured and once again I am a solitary traveler in a hostile world.

Several months later, after having uneventfully completed rehab, I often find myself missing my group. The initial exhilaration of their camaraderie has faded in the light of ordinary days with ordinary pleasures and concerns. Even so, there remains a quiet undercurrent of hope—not just for our small group, but potentially for all of us. Maybe, given the right circumstances, humans are capable of mutual respect and well-wishing. As supporting evidence, my mind offers newsreel images of World War II victory parades and reminds me of the sense of solidarity most of us felt immediately following the 9/11 attacks.

And here is the rub. My mind balks at conjuring up such feelings on a grand scale during ordinary times. My personal rehab experience plus my reading of history remind me that a close proximity to death and annihilation is necessary to rise above personal differences. If so, here is the scariest of questions: How bad must the world get before we can rise above the mutual antagonisms that blight our times and threaten our future?

Cambridge Quarterly of Healthcare Ethics (2021), 30, 190–191. © The Author(s), 2020. Published by Cambridge University Press. 190 doi:10.1017/S0963180120000675

Lost in Translation
Robert A. Burton

In the Beginning

"Scleroderma," the rheumatologist said after examining my stiff swollen arms and legs. "Unfortunately,
given your biomarkers, it's likely to get worse before it gets better, but you never know." She gave a quick
rundown of what I might expect—rapidly progressive skin and joint tightening, GI symptoms, high
likelihood of multi-organ involvement…. "Let's hope for the best." She paused, then asked if I had any
questions.

Nothing came to mind. Despite being caught off-guard by the news that I had a severe form of a
dreadful disease, one that was likely to maim if not kill me, my normal play-by-play, moment-to-moment

mental chatter was strangely absent. Having previously read about and seen a few patients with
scleroderma, I had a strong sense of what to expect, but this knowledge was purely visceral—

unaccompanied by imagery or words. I just knew.

After what seemed like an eternity, my inner voice rallied against the emptiness and fired off a salvo of
questions, many of which had already been answered. For example, in response to the rheumatologist
carefully explaining that the disease was so rare in men of my age that it was impossible to predict what
might happen, I blurted out, "So what's my prognosis?" Not at all what I meant to say. Not at all what I
was thinking. Embarrassed, I shook my head. She nodded, prescribed immunosuppressants, and
suggested a palliative care/pain management evaluation.

Only later, back in my car and replaying the consultation did I hear the proper translation of what I
had been thinking since I heard the word scleroderma—oh my god, I'm going to die.

Getting Worse

My primary care physician asks, if necessary, would I want full resuscitation measures"in the event of…"
He stops and looks at me as though it isn't necessary to spell out what might go wrong. My nephrologist
chimes in, would I consider dialysis in the event of kidney failure. My rheumatologist is next, but I
interrupt her. "I know, 'in the event of….'"

And so on, with each new complication.

Now (Two Years Later)

Despite lengthy hospitalizations for acute kidney injury and massive gastrointestinal bleeding and the
expected progressive loss of use of my hands, not to mention a cornucopia of aches, pains, itches, and
physical limitations, overall I am feeling better. My skin is softening, breathing is easier, and I can finally
bend forward enough to yank on my socks (barely). Doctors are surprised but unsure whether these
improvements are due to my medications, the natural history of my rare variant of scleroderma, or both.
They are cautiously hopeful, but no one is willing to place a bet on my future—I am a textbook case of
uncertainty.

So, How Do I Feel?

I tell myself and others that I am enormously thankful, glad to be alive, not doing so bad, fine thank you,
have great doctors, could be worse.… I pluck ready-to-wear clichés from the surface of my mind while
simultaneously appalled at the depth of my shallowness. The palliative care nurse asks me how I feel

about my prognosis. I say,"The future is vastly overrated." Undaunted, she follows with,"Would you be i

nterested in spiritual counseling?" "No thanks, I'm happily married."

Friends marvel that I can still make fun of my circumstances. It is hard to explain that my bravado is
absurdity and despair tightly holding hands in the waiting room. There are flurries of …apprehension?

Discouragement? Resignation? Darker unmentionables? Spontaneous moments in the neighborhood of

acceptance, as though the demons have gone on lunch break? Who's to say? Certainly not me. My

bedrock thoughts have a life of their own, perhaps nudged by language, but almost certainly not derived

from it any more than are the thoughts of animals and newborns.

Having been constrained by illness plus avoidance of others during this time of COVID, I have had
more than enough time to sit quietly and listen for deeper murmurings, but I have a tin ear. Words scrape
against each other, jockey for position, struggle to understand what I am thinking. My father used to tell
me that talk is cheap. He didn't know the half of it.

I am lost in translation. I am bits and pieces, a kaleidoscope of contradictions. I am sunlight, clouds,
wind rustling in trees, shadows, a deserted alleyway, darkness. I am Dr. Burton in the treatment room,
Mr. Burton on the hospital wristband, no one in the big picture (a direct quote from my mother just
before she died).

I am a stranger to myself.

© The Author(s), 2023. Published by Cambridge University Press.
Cambridge Quarterly of Healthcare Ethics (2023), 1–2
doi:10.1017/S0963180123000403
https://doi.org/10.1017/S0963180123000403 Published online by Cambridge University Press

Truth Be Damned

Though the pharmacy was closed Sundays, everyone in the neighborhood knew that my father was
available if needed. One Sunday evening, a particularly demanding customer phoned to get her
prescription-strength cough syrup refilled now. On our 15-minute drive to his store, my father
muttered that the woman was an inconsiderate hypochondriac who could have easily waited until
tomorrow. He railed at the indifferent universe and the general failings of mankind, yet when he
arrived at the darkened store, he greeted the waiting woman as though a bosom buddy. Moments later,
still wearing his public posture, he handed her the cough syrup, patted her hand, and wished her a
speedy recovery. As soon as she had left, he explained that cough syrup was mostly placebo and
resumed his rant against humanity.

"Instead of getting all worked up, why did not you just tell you her that you were sick and could not
make it tonight?" 9-year-old me asked.

He pointed to the sign on the front door:"In case of emergency,"followed by our home phone number.
"A promise is a promise." On the drive home, he was initially silent, then, at a stop light, said softly, yet
firmly, as though explaining himself to himself, "Personal feelings do not count. You never lie for
convenience." He squeezed my thigh and looked me square in the eye. "Agreed?" We shook hands and
waited for the light to change.

****

Shortly after beginning my neurology practice, I consulted on Eleanor, a 35-year-old bookkeeper with
a 2-week history of mild numbness in her feet, an intermittent sense of unsteadiness, fleeting double
vision, and a tingling sensation in her arms and legs whenever she flexed her neck (Lhermitte's sign).
Family history revealed a sister and an aunt with multiple sclerosis (MS). Despite a normal neurological
exam, her symptoms and family history raised the suspicion of early MS—a frightful diagnosis made
worse by the lack of any specific treatment being available at that time.

I was debating what to say when Eleanor reached across the table, grabbed my hand and said, "My
sister is in a wheelchair. Please tell me that I do not have MS. If I did, I would kill myself."
"Do not get ahead of yourself; it could be a nonspecific inflammatory response such as you
occasionally see following a viral infection."

Prior to the introduction of CAT scans and MRIs, we relied exclusively on the history, physical exam,
and a spinal fluid examination. The lumbar puncture results were in the borderline range—a few white
cells and very mild nonspecific protein elevation. Absent the suspicion of MS, they could mean nothing.
But with her history, I remained concerned.

"It is MS, isn't it?" Eleanor began the follow-up visit. "I can see it in your face." Her eyes were red; she
stared down at her damp handkerchief and said, "Can't do it, just can't do it."

"There is no clear-cut evidence for MS," I blurted out. "I still favor nonspecific inflammation," which
was technically correct, but not what I was thinking. Before I could explain, she rushed across the desk
and gave me a huge hug. "Thank God." She sat down again and said, "I can live with that."

Too late. Not what I had planned on telling her. I wanted to retract what I would have said without
making a retraction. I gave a slight nod and scheduled a follow-up visit. Fortunately, her symptoms fully
resolved within a few weeks, and I decided not to bring up my suspicion.

Over the next 4 years, the same scenario played itself out a half-dozen times. Eleanor would have a
brief flurry of subjective complaints. Between attacks, she remained an avid tennis player and rock
climber. By now, it seemed likely that she had an uncommon form of so-called benign MS; her long-term
prognosis improved with each passing year without detectable neurological deficit.1 I continued to
reassure her, skirting frank discussions, instead sticking with oblique references to hard-to-pin-down
inflammation. "Sometimes we never find a definitive cause," which was semantically true in that, at that
time, we had no idea what caused MS.

Then, without any specific further episode, she showed up in the office and requested a second
opinion. Through her tears, she told me that her sister had gotten dramatically worse, was unable to take
care of herself, and was now in an assisted living facility. Part of Eleanor's salary as a bookkeeper would be
going toward her sister's bills."You've always been reassuring, but I need to be sure that I will not end up
like my sister."I arranged for her to see another neurologist at the University. I wanted to explain to him
why I had waffled in my discussions with her but said nothing.

A few days later, I received an excoriating phone call from my colleague; "How could you have not
told her?"

"Did you find something on exam?" I asked.

"No, her exam's normal, just as you described it, but so what? She has MS and I told her so in no
uncertain terms. Frankly, I think she was relieved to finally have an answer. As for you…."

The next day, a medical supply house phoned. Eleanor had walked into the store demanding that I
authorize her request for an electric wheelchair. "She tells me that she has Multiple Sclerosis. Is that
right?" I approved the purchase.

A week later, while passing the neurology clinic waiting room, I came across Eleanor in her new
wheelchair. After an awkward silence, she said, "Down deep I always knew, but recognized how
uncomfortable you were telling me the truth. I guess we were both humoring each other."
The receptionist called her name. Eleanor secured the wheelchair, and before walking into the
examining area, said to me, "No hard feelings. I know that you did all that you could."

****

After a couple of heart attacks and persistent chest pain unresponsive to medical management, my
father reluctantly agreed to coronary bypass surgery. According to the Stanford surgeon, all the major
involved vessels had been successfully grafted."We could not get one minor marginal artery, but I do not
see the point in telling him. It supplies a small area of the heart and is unlikely to cause symptoms. He
should do fine."

But my father did not do fine. His chest pain did resolve, but he was moody, had difficulty sleeping,
and became uncharacteristically depressed (a common but usually transient sequelae of open-heart
surgery that was not widely recognized in the early 1970s). Obsessed with the thought that something
had gone wrong with the surgery, he consulted his long-time internist. "He's one of the few doctors who
always tells the truth," my father said before the visit.

The internist confirmed that the surgery had gone smoothly and that his vague symptoms should
resolve. Being thorough, he did tell my father that one of his smaller arteries had not been bypassed,
but that it was unlikely that the artery was causing his symptoms. My father heard only that a diseased
artery had been left unrepaired, and that the surgeon had lied to him. He went home and gave up.
After a nearly house-bound year, my father cleaned his desk, balanced his checkbook, cancelled his
pharmacy license, and, on our daily evening call, told me that he loved me. At dawn the following day, my
mother found my father dead in his easy chair, hands folded in his lap, wearing his favorite robe. My
mother glanced at the open medicine cabinet cram full of pills but said nothing. I closed the cabinet door.
"Too much information. Besides, what good would it do to know?"

Moments later, his internist phoned to offer condolences and an apology for not having been able to
help him following his surgery. "Why did you mention the inoperable artery?" I wanted to ask him, but
instead said, "thanks for being so honest with him. That's what my father admired most about you."

1. Hawkins SA, McDonnell GV. Benign multiple sclerosis? Clinical course, long term follow up, and
assessment of prognostic factors. Journal of Neurology, Neurosurgery, and Psychiatry 1999;67:148–2;
available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1736487/pdf/v067p00148.pdf.

Cambridge Quarterly of Healthcare Ethics (2021), 30: 4, 713–715
doi:10.1017/S0963180121000219

Death and Disbelief

ROBERT A. BURTON
A middle-aged woman had a massive stroke and would be dead within hours.

The husband was in the ER waiting room. I took him aside and explained the

grim prognosis. He paused, his expression blank, his lips searching for

something to say. Finally, he blurted out, "I think I'll go home and take a shower."
****

I was telling an old friend—a wellconnected advertising executive—that my college chemistry

lab partner, a Nobel Laureate in Medicine, had just died of pancreatic cancer. My friend's

puzzled response: "How could he have died? He knew everyone."
****

Some years ago, my wife took my 95-year-old mother to Macy's to buy a new blanket.

The saleslady suggested one that was both reasonable and durable.

"Does it look like I need durable?" my mother said, summarily dismissing the saleslady.

On leaving the store, my mother told my wife that her old blanket was quite adequate.

"Besides, I won't be cold for that long."
****

I called the telephone company to cancel my mother's phone service. The representative

asked why. I explained that my mother had just died. "OK," the rep replied,

"I'll cancel the local coverage, but you should keep long distance, just in case."
****

My wife's ninety-year-old aunt agreed to hospice care for her terminal cancer. The admitting

nurse explained that palliative-only care meant that she wouldn't be getting any

treatments aimed at prolonging her life. Her aunt thought for a minute, looked out at the

garden beyond the admissions office, nodded, then asked, "Would it be okay if I take my vitamins?"
****

Cambridge Quarterly of Healthcare Ethics (2020), 29, 403.
© Cambridge University Press 2020.
doi:10.1017/S0963180120000134

Gratitude
Robert A. Burton*

While window-shopping for his wife's birthday, a businessman was struck by a speeding taxi that jumped
the curb at 55th and Madison. In the few minutes it took the ambulance to reach the University
emergency room, he had lapsed into a coma. Brain imaging revealed a large blood clot compressing the
brain. The only hope for his survival was immediate drainage of the clot.

The on-call neurosurgeon was primarily an animal researcher, a deeply lined other-worldly looking
man with thick glasses and massive salt-and-pepper eyebrows that extended across his forehead like a
bird in flight. Because of the extreme urgency, the patient was taken directly to the operating room,
where, without anesthesia or even placing the patient in proper restraints, the surgeon drilled two large
burr holes in the man's skull.

As soon as the neurosurgeon drained the clot, the patient awakened. Unrestrained, he began to flail
his arms and legs; it took several aides to hold him down. The neurosurgeon remained expressionless. He
read the patient's name on his I.D. tag, leaned over, inches from the wild-eyed man's face, and calmly
said, "Do not worry, Vinny. We're just operating on your brain."

The patient's mouth opened wide. Startled at hearing nothing coming from what undoubtedly was
the scream of his lifetime, he tried to rip off the surgeon's mask. The neurosurgeon stepped back, but the
nurses fought to secure the leather restraints. Once the patient was pinned to the operating room table,
the surgeon told the senior resident, "Finish the case. I've got to get back to the lab."

The man quickly recovered his strength but remained speechless. Each day, on morning rounds, the
operating neurosurgeon told him not to worry, that his speech would soon return. On the fourth day,
after hearing the reassurance yet again, he glared at the neurosurgeon. The surgeon said, "Trust me,
Vinny."

The man blurted out, "Fuck you, Fuck you, Fuck you." The neurosurgeon patted him on the hand.
"Fuck you," the man repeated himself.

"Very good," the neurosurgeon said. As though the patient was not there, the neurosurgeon explained

to me that, with resolving aphasia, the first words to return are often the most emotion laden. "Do not

take anything they say literally. Look at body language and listen closely to intonation and context as if

trying to understand a stranger speaking a foreign language." He turned back to the man. "Isn't that right?"

"Fuck you forever," the man said.

"Be patient."

"Fuck you," he said again. "My name is Vincent."

"See, Vinny, you're going to be just fine."

"Fuck you, Doctor," Vincent said, extending his hand.

Cambridge Quarterly of Healthcare Ethics (2022), 31: 4, 572
doi:10.1017/S0963180122000366

Double Talk
Robert A. Burton*

The freshly minted neurologist
Watched himself
Assess the unconscious young woman.

A week ago,
Before the burst aneurysm,
She had been wife, daughter, and sister.
Now she was Do Not Resuscitate,
He informed the family
Huddled at the ICU bedside.

Terrified by the randomness of catastrophe,
The observer warned the doctor
To tone down his brusqueness,
Allow hope to fade into acceptance.

In the bony grip of high drama,
The doctor was out of earshot,
Offering statistics and condolences,
Platitudes and Kleenex,
And quiet time in the family room.

Let them see that you care.
Be what they will want to remember.
The observer pleaded,
But was drowned out by the
Roar of ritual.

The observer acknowledged a bitter truth:
As the neurologist's narrator,
He was a kibitzer,
Not a player.

If asked,
He would readily forego
His self-righteous asides
For the opportunity
To grip the respirator tubing,
Feel the power.

Purpose and meaning are rare moments.
If they demand tone-deafness to self-deceit,
So be it.

The doctor made preparations.
The observer retreated.
To the far corner of the neurologist's mind.

Together they disconnected the patient.

© The Author(s), 2022. Published by Cambridge University Press.
Cambridge Quarterly of Healthcare Ethics (2022), 31: 4, 570–571
doi:10.1017/S0963180122000354
https://doi.org/10.1017/S0963180122000354 Published online by Cambridge University Press