I recently had a conversation with a friend on the steps of my apartment building. It was late and we had just finished studying, and in our exhaustion were susceptible to philosophical musings. We talked about keeping an open mind, whether I should put “pathologist” back on my list of potential careers, and why these decisions are hard to make. The future was tangible, full of choices and opportunities. But as our energy waned, we ended with: “We are like ants. We run around trying to save each other because we think it’s noble. And then we will all die.” Not an original metaphor, but still apt: the microscopic scurrying, the cosmic insignificance.

That feeling of being so small that it does not matter — it can be disabling, if you let it catch you. As a child, I used to lie in bed wondering whether I existed, and was sure I did not. My stomach was heavy with the conviction that even if (a big if), I was lying in my bed at that moment, it would not be for long. Death would take me. When my sister was 9, she asked me, “Tasha, am I alive? I think I’m in a dream.” I’m not sure whether to blame genes or a morbid environment, but I knew just what she was talking about.

This is no way to live life, whatever that is. I reassured my sister, and I try to do the same for myself. I’ve prayed, but religion has failed me, or I’ve failed it. Perhaps if I were less rational, I could believe in God; if I were more, I wouldn’t care so much — as it is, I’m stuck envying those comforted by prayer. The easiest way to forget about my mortality is to keep some part of me running — my body, as I’m late to class; my brain, as it battles to put facts in boxes. It’s harder to have an existential crisis when you’re worried about failing your next test.

Strange thing, then, that I decided to become a doctor. As a doctor, it’s hard to escape death. It’s there in lecture, a cut away on the operating table, stained on the hospital walls. How will I face it, day after day? I can’t know for sure. Here’s what I’m hoping: that it will give me purpose, and that my scurrying will be useful. That helping others fight death, or gracefully accede to it, will teach me to seek, rather than fear, the quiet, unembattled moments. That I will learn to be present, and at peace. That I will be a noble ant.

—Natasha Kim


53, I guess. 500 and some pounds.
Hasn’t left home in days.
Skin folds full of yeast
And birdseed.
Breathe through your mouth.
Imagine not being able to move.
Remember that you got to use shampoo
This morning at 6 o’clock and every day before.
She must love birds.

—Hannah Qualls

Pain Contract

She is sitting in the examination room, and we all know what’s going to happen. She’s not going to be happy. She may storm out. She’ll probably cry. Either way, she’s not going to be happy. The doctor shows me a urinalysis printout so I’d know what to expect. The contract is broken and she has no idea. She has no idea, sitting in that examination room, that a team of doctors is about to walk in and cut off the pain medication she takes to function. I think for a moment that we could just leave this moment be, and move on to the next patient, and she will never know. But she needs to know. She needs to hear from her doctors about the results of this test.

We bring in several people just in case she lashes out, and so, legally, no one can be held accountable for something. I am unclear on why, really, because she doesn’t seem all that dangerous to me. She was even happy to see us when we entered the room. It is difficult for me to smile when she smiled at me, knowing what I knew. I almost wish the doctor hadn’t shown me so I could live in this bliss with her for another 30 seconds.

Finally, he tells her. The disappointment behind his voice is deafening as he says, “Your urine tested positive for methamphetamines,” and she reacted the way we’d expect. “WHAT!? I haven’t done any meth! That’s impossible!” The doctor said nothing as she went through her rationalization of her innocence. “I haven’t done meth! I’ve done lots of things in my life, but never meth! I’ve never done meth!” The doctor ignores her assertion and goes on to explain that her pain contract is broken, and while he can manage her other medical issues, he can no longer prescribe her narcotics. “What will I do? How am I gonna live?! I’ve never done meth!”

He attempts to give her some options as far as other providers, but makes it clear to her that he will not be able to omit from his referral to other doctors why she must see another doctor. “I don’t care, doctor! I need SOMETHING! I can’t live without SOMETHING!”

He walks out of the room to get a referral, and she asks me, “They can tell if you did meth, like, two days ago?”

—Jessica Thackaberry