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Gold Foundation Essay

The Gold–Hope Tang, MD 2016 Humanism in Medicine Essay Contest

First Place: Your Soul Is Not Concrete (Survive, Anyway)

Izmaylov, Michelle

Author Information
doi: 10.1097/ACM.0000000000001451
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Nobody kisses here. His wife is a shadow fallen over the chair beneath the ever-curtained window. Their love forms the silk-soft threads of a noose hung around her throat. When I come in to pre-round on her husband, she smiles as if waiting for the moment when I will kick the stool out from under her. The metastases to his brain are incurable, she knows.

I lay my stethoscope on his chest but feel the draft between my own heart valves from a window left open somewhere in my soul. Her eyes on the back of my neck are the cold wind blowing through me.

He’ll be okay, won’t he?

Looking at her is glimpsing ten thousand ways a soul can bruise. I check on his room again in the afternoon. He greets me with a sunlight smile. His wife sits by his bed, lost in a gray moment. Her hand rests on his bone-fingers splayed against the sheets. Her eyes ask if I know how much it hurts her to touch him, knowing in the morning she may wake up alone. Love on the wards predisposes to a special kind of hemophilia. She gently holds his hand and is still bleeding from the contact when I check on them the next day.

Is the radiation working?

I read something technical off a warm, freshly printed hospital record. I suddenly feel white-blue fingers on my wrist. Two silver bangles clink on her arm. She repeats the question. This time, I hear the unspoken:

He’s dying, isn’t he?

Later, on rounds, the attending asks how she’s feeling. She says, I’m okay, a little bit too loudly.

The following morning, I find her husband sitting all alone.

I ask: Where is your wife?

She went home. I told her to go home. I miss her. But I can’t stand seeing her look so hurt.

The morning after, she’s sitting in her chair again. I say, hello, too quickly because I’m afraid of the silence here. I’m afraid of the pauses between our words. I’m afraid of breathing. The air is saturated with too much sadness for us to swallow.

I keeping telling her to go home, he jokes. Already there, she keeps telling me.

Love on the wards is wet-wet eyes, but instead of tears, seeing strained smiles and people beating their hearts unconscious, pretending they don’t feel anything. I see her scratch at her eyelashes. I offer her my stethoscope so she can hear his heartbeats for the music that they are. She takes the instrument from my open palms. It’s a little harder waking him this morning, but she places the eartips in his ears and lets him listen to her heart. She lets him listen to her belly, too. Pregnant, she tells me. She thanks me with a small bundle of song-soft words.

The Gold–Hope Tang, MD 2016 Humanism in Medicine Essay Contest

Each year, the Arnold P. Gold Foundation holds an essay contest to encourage medical students to reflect on their experiences and engage in narrative writing. The contest, launched in 1999 and open to any student enrolled in an accredited U.S./Canadian medical school, asks students to respond to a specific prompt in a 1,000-word essay.

The 2016 prompt was “Sometimes the most important thing in a whole day is the rest we take between two deep breaths.”—Etty Hilliesum. Talk about a time when you or a team member had to step back and practice self-care while helping a patient.

More than 160 essays were submitted and reviewed by a distinguished panel of judges ranging from esteemed medical professionals to notable authors. The top three essays were selected along with 10 honorable mentions. Winning essays were published on the Arnold P. Gold Foundation Web site ( and will be published in consecutive fall issues of Academic Medicine.

The contest is named for Hope Babette Tang-Goodwin, MD, who was an assistant professor of pediatrics. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor, and deep compassion for her patients. She was an exemplar of humanism in medicine.

The Arnold P. Gold Foundation, founded in 1988, is dedicated to creating the Gold Standard in health care—compassionate, collaborative, and scientifically excellent care—to support clinicians throughout their careers, so the humanistic passion that motivates them at the beginning of their education is sustained throughout their practice.

A few hours later, a blown pupil is identified. The team goes in to tell her. I follow to the door. I follow until I see her eyes bleeding heartbreak. Love-induced hemophilia.

The attending goes in. The resident goes in. The intern goes in.

I do not go in.

The door is closing, closing, closed, and still I do not go in.

After, my resident asks if I’m okay. I ask for a few minutes before I continue rounding. I’m given the rest of rounds off to breathe. For the space of one small hour, I take the long way to a nearby urban park and its little lake. I dip bare feet into clean and quiet water. I look at the sun-glint surface and remind myself if these waters can calm themselves, then so can I; we are both air and fluid mixed with light. I try to remember this despite the dull ache beneath my sternum from a heart beating so hard it bruises against the bones caging it.

I sit by the lake, and my skin wrinkles from the truth slowly seeping into me. Sometimes, our patients die. He is my first patient with a soul already half-extinguished. He is my patient. My first one. Dying.

I write this sitting by the water.

I write: Love hemophilia.

Someone dies, someone we cannot save, and sometimes we never stop bleeding.

Being a doctor is knowing your hands will sometimes feel like a magnet for white bones. Being a doctor is walking every day in halls where is turns into was. This is the price of healing. Your spine will creak under the weight of what your hands can’t stitch together. In the breaths between seeing patients, sometimes you will be a river swollen outside its banks. You will feel like too much muddy water. You will find yourself somewhere between swimming and slow drowning.

But being a doctor also means taking a moment to come up for air when you need it. It means taking a breath to cough up the water filling you. It means taking a pause to remember your bones are still strong arches even when the bridge of your body sinks somewhere underwater.

Your femur is stronger than concrete. Your femur is stronger than the buildings our despairing colleagues keep killing themselves in from the perceived weight of their own failure. Remember this.

Remember you are human, too.

Remember that momentary absence is not the same as leaving. Take a moment when you must. What matters is how you return after the rest you take.

I write this standing outside the ICU room where he was transferred. I write this as she sits at her husband’s bedside.

He’s dying, she tells me.

She asks if I will let her hold my fingers. I swallow air into my lungs and hold the memory of the calm lake inside me. I breathe, I hold out my hand, I let myself be her tether to solid ground.

I watch her kiss his forehead.

I watch her kiss him, finally.

Copyright © 2016 by the Association of American Medical Colleges