BYPASS | Benjamin Drum
2013 Essay Contest Winner
A poem sequence exploring the complexities of mental illness from the perspective of the family, the patient, and the doctor.
Lucy- A twenty-five year old woman newly diagnosed with schizophrenia
Frank- Lucy’s newlywed husband
Dr. Wares- The hospitalist in charge of Lucy’s car
Frank
Lucy’s going to need surgery they told me
after I received a phone call asking me to come in urgently,
and I thought to myself, luck has never been on her side.
She hasn’t been home in eight months,
even though they told me the average stay was seven days.
I guess minds have a way of making themselves up.
When we married, there was no reason to suspect
that she’d fall into this. They told me schizophrenia
usually presents at age 25 for females.
So why was I excited to marry early, when she was 24?
I had a dream that a squirrel was living inside of me.
If I only knew that dream would become her reality
as soon as she stopped being able to sleep,
that she would name the squirrel Frank,
and rewire her brain to only recognize one Frank,
and panic when I told her we were married.
Pull a knife, try and cut out the squirrel
to show me that I was not Frank,
that Frank was someplace deep within.
I have visited her 78 times, but maybe 79 will trigger something.
Maybe my chin will prove my, of Frank’s, humanity,
Or my dimples will cause her to smile back,
Or my voice will remind me that it’s not my fault.
The doctors have been clear.
They keep everything logical,
like her mind is a math equation to be solved.
But when they deliver the news,
it’s as if a final cherry blossom has fallen
away from the tree, leaving only a skeleton.
And, after the form, I feel like I signed her life away.
Lucy
I felt very mathematical this
morning, like everyone in
the world was a number
and some added and some
subtracted. The nurse tells
me I only slept three hours,
but I still woke up on time.
The clocks here are messed
up so the birds send me messages.
They say, eat now or
mind your tongue or
come with us but this place
is a sin. It’s the cavern it’s in,
and when the doctor says it’s
an escape to structure I wonder
where my playground has
fallen, and what it might take
to make some swings and fly.
I am the girl with Klonipin eyes.
I lost my ignorance of what they do
to me here early on, and now that
they know that I know about them,
I have to use my instincts.
But I don’t know if they are right
or wrong. I wish I could trust
my mind but they tell me it’s sick.
So every time they get close to finding
the key I change the lock.
And when they noticed me gasping
in my sleep they thought it was just
a bad dream. I told them that I was
a piano, and that
like a piano
I don’t move well.
But they kept pulling me
out of tune and now that
the gasping hasn’t stopped
they’ve told me
my heart is bad.
I already knew that.
And besides, it’s not so much
a heart as it is a bass drum.
Let us open you up they said, confident
they could fix me. But I don’t want them
to touch me. They might kill Frank,
and then I would be alone, but it’s not
so easy for them to claw onto these things.
There is no one
here to love,
no one to love
me back. And so
my heart finds other activities to do,
and sometimes they aren’t good
and sometimes they are bad
and then the doctor wants to open me up
and look at the bass drum,
maybe change my rhythm.
But that won’t change my melody.
And bad is such a mathematical term anyways,
much too subtracting for my liking.
Who’s to say that my heart isn’t more like a
thirteen-sided stop sign?
I know it is a little different but
that’s just because it has more facets,
that I can feel in different dimensions
and can hear the melodies that everyone exudes.
My doctor plays a funeral dirge,
and Frank dances a tango
so is it so unnatural that I prefer Frank?
Besides, Frank and I’s song go along in perfect rhythm
and when the birds chime in it’s like the Fourth of July.
We play and sing in 6/8 time.
1, 2, 3, 4, 5, 6
1, 2, 3, 4, 5, 6
So when you tell me to count to five
I give Frank a tender squeeze
and hope for the best.
1…
2…
Dr. Wares
Ms. R is a 25-year-old-female who presents with delusions culminating in a suicide attempt.
Your wife is very sick, I told him,
And we don’t have a diagnosis yet.
I avoided the label “schizophrenia”
until we were completely sure,
and until Frank could handle the word.
How do you tell someone
with no insight on their condition
that they are very sick?
We think your mind may be playing tricks on you
results in a story about magic.
Why did you try and cut yourself open?
just ends in tears,
either from frustration or depression,
I don’t know which.
Aggressive drug treatments coupled with cognitive behavioral therapy have not seemed to have an effect on Ms. R. For these reasons, I believe Ms. R fits the clinical profile and could benefit from involvement in the initial trials for this experimental drug.
Frank keeps visiting,
hoping I might have a new insight,
and when I tell him about the drug
he is desperate enough to try it,
because at least the drug is action
and after five months we are no closer to Lucy.
I try and hide my own fears about her,
but all the medical words I use just isolate.
There’s no obfuscating the delusions,
or the emptiness in her tone that juxtaposes
the rhythm in her step.
Ms. R is a 25-year-old female with a history of schizophrenia who presents with orthopnea, atrial fibrillation, and chest pain for the last two weeks.
When I tell Lucy her heart is bad,
she thinks it is from lack of love.
In my office I cry for Frank,
who has visited her countless times,
and for me,
who would never do all Frank has done.
EKG shows S-T elevation and q-waves in leads V1 and V5. Angiogram shows severe stenosis in left coronary artery close to its root at the aorta and a second partial obstruction in the right coronary artery in the right atrioventricular groove.
Where can the weight of guilt be placed?
Is it my fault for trusting the drug,
or Frank’s for trusting me,
or can we blame the drug companies,
or blame God for Lucy’s disease,
or blame genetic susceptibility,
or something else that we can’t name,
something lingering just below the surface,
eating away at our roots and leaving us as skeletons?
Congestive heart failure is secondary to coronary artery disease, probably due to a past history of hypertension and drug-drug interactions. Patient was enrolled in an experimental drug trial for schizophrenia that ended three days before symptoms started.
When I see Frank, I know he knows.
He is already sitting down,
he can’t make eye contact with me.
And after I tell him, he covers his ears,
as if to make sure it can’t get worse.
So as he holds my words inside his head,
not letting them escape,
I put my arm around him,
trying to hear something in his tears,
a melody that might stir in me
the same love that he has shown for Lucy.
Coronary artery bypass graft surgery recommended.
Giving bad news is a skill you can’t train for,
but at least we have seen it dramatized enough
that we are used to the clichés that are allowed.
The I’m so sorry or I can’t imagine your loss
or I’m going to fight through this or
It’s my time.
But when those words won’t be there,
when your patient won’t comprehend the weight
of your voice and the breaking of your spirit,
what is there to say?
When I say surgery to Lucy,
she tells me I will kill Frank.
And even though she means it about the squirrel,
she is right.
Bypass
You see white coats, feel a pinprick sting.
I tell you to count to five
but you only make it to two.
Your body will now become
a demonstration of human boundaries.
Your body will now be systematically deconstructed.
In the prescreening, you told us a story:
“I have a squirrel sleeping in my stomach,
and every so often he wakes up and whispers
‘You will die alone.’
I am relieved that, after his whisper, he leaves.
But then I realize the hole in my stomach—the emptiness.
I beg him to return; he obliges.”
Super-fluous veins are coronated:
The humerus chuckles as we tease the radial out
The saphenous cries in its eviction.
The night before the surgery,
you asked if we could let the sink drip in your room.
The consistent sound helps you cope with your insomnia.
I am captivated by the movement of light
over the iodine bag dehumanizing your body.
Your sternum splits and smells of fireworks.
If you could,
you would twist and writhe.
It’s in your DNA.
When we moved you out of the room,
you told us you were afraid,
you told us only love could conquer the fear,
you told us you had been in love before,
you told us you knew it was love because
it tickled your nose and made your blood tango.
“Tell me you love me,” you said
as we entered the operating theatre.
“You don’t have to mean it.”
You depulse in prime numbers.
The EKG disintegrates its syncopated discordance
before settling onto a pure tone.
We will breathe for you.
The B-flat recalls your first visit,
when you said your heart had changed its shape.
I was only convinced because you said it with so little air,
as if your lungs had burst in the metamorphosis.
When I told you about the narrowing,
you thought I meant depression.
I did not have the heart to tell you the heart was a machine,
mathematically explained and emotionally void.
Instead I told you to count the days by the number of people born
rather than focus on the one that will take your life,
informed your consent of organ donation.
Do you want to die alone?
Yes:
These detours will not cure your depression.
This tissue is not capable of thought.
As far as you can feel,
we will return you as you came.
You will forget everything we did to you.
As we restart your body,
the memories you despise return
faithfully from their hibernation.
You welcome them like sparklers.
No:
I find the squirrel and slit his throat,
but in his final breath he claws and clips
your aorta. The blood splays and drips
a popular beat. We remove our scrubs
and dance as your body B-flats.
The arteries unstitch and bump the twitching squirrel,
his buckteeth grinding your heart in six-eight time.
Your blood clots his furry tail.
His furry tail tickles your nose.
Benjamin Drum, MD, PhD, graduated from the University of Washington School of Medicine in 2018. He works in Salt Lake City, UT and 1 other location and specializes in Internal Medicine/Pediatrics, Internal Medicine and Other Specialty.