Sunday, October 31, 2021


 Op Note IX

I was alone at a research station in Antarctica.  No assistants available. No high end equipment. I had gone south in order to experience absolute zero. Foolish. Conceited. But I needed everything to slow down, be still.  A place where even piercing screams hung silent in the frozen air. Nothing moves, neither particle nor wave. When the pain came I acted quickly.  Knife, iodine, a mirror that kept fogging.  You say you could never do it but we cut into ourselves everyday.  Claw at the inside of our skulls. Promise enduring ardor and then break the hearts of our very own souls over our knees. We feast upon our most secret treasures. You do it.  We all do it. This was more of the same.  If I didn’t get it out in time I would die. I could feel it about to burst.  So I worked for a bit, packed with ice, worked some more, packed with ice, worked. You get the idea. You can sweat even when all liquid has to freeze.  I dug and dug with frozen fingers and spread a path all the way inside.  Layer by layer. Skin, fat, fascia, fat, fascia, muscle, fascia, muscle, peritoneum, and then in, the warm squiggly guts. This is the entrance to agony. The only place to find warmth. You see, the deepest empathy arises in the context of self harm. Where one’s own actions elicit instantaneous feeling.  The stove is hot.  This knife is sharp.  You never forget. The very essence of truth. I am doing the thing that I am feeling. This is the pain I can tell by the look on your face, just before you cry.  To call yourself names and believe they are coming from someone else. The absence of delay except at the level of the synapse. Without intermediary. By the time I found it I could only chuck it into the snow before I passed out. There was no formalin. No morphine either.  Now we’ll never know what it was. But it lies perfectly preserved under layers of ice, patiently waiting for a someday thaw, tightly coiled in a motionless menace.    


Friday, October 29, 2021



Sitting in my car with the windows rolled up in the parking lot waiting for my clinic to start. A small part of me legit thinks I might run out of air, get light headed and pass out, maybe even die.  Don’t thousands of babies and pets cash out in locked cars every year?  Yeah, I know it’s mostly the heat but still.  And I’m a goddam doctor thinking nonsense like this.  People are always like, oh doctor this and doctor that and my doctor says and my doctor told me and I'm like for god's sake.  What if your doctor kept warning you about the dangers of low oxygen levels while you scarfed down Chick Fil A during your 20 minute lunch in your car at the office park?  You’d stay the hell away.  I wouldn’t let a guy like that come within 20 feet of me with a syringe.  Excuse me sir, kindly keep that cold ass flat diaphragm of a stethoscope off my bare chest.  This lady last night kept thanking me over and over.  Oh you saved him, thank you so much for saving him, I don’t know how you doctors do it.  By him, she meant her bachelor older brother who had been popping naproxen on the hour for the past week to self treat his trick knee and ended up blowing a hole in his stomach that I had to patch.  I was just calling the out of state phone number listed in his chart, just due diligence stuff.  She kept praising me and going on and on, profuse as all hell.  Lady, I just sewed it shut, ok?  I wanted to say.  Do you go this overboard for your tire guy when he plugs a flat?  Your damn dentist when he glues in another cap?  Your brother had the good sense to go to the hospital when he got tired of feeling like he’d swallowed a dozen knives.  Good on him.  He saved his own damn self. Everybody else was just checking boxes, closing tabs, showing up when called.  Lowest form of heroism, believe me. That’s the honest truth. Took me like 45 minutes and I was a total dick nearly the whole time to the guy running the camera, Andrey, this giant hulking mass of a dude from the Ukraine who plays hockey Sunday mornings in a men’s league at the rink where my kid used to play.  Andrey, Andrey, come on man.  Come on.  Keep me in the center.  Follow me out.  Come on man.  I need more from you.  This is a tough one. Andrey.  Andrey.  Like some bastardy old coach riding the ass of an insufficiently engaged backup linemen. I’m sure everyone in the OR was rolling their eyes.  Andrey never says anything. He’s got this gentle teddy bear mien like a friendly bodyguard who has to take shit all day in some Joe Pesci mob film. His eyes, though, sometimes get a little glassy with menace.  That’s when I tend to tone it down.  He’s actually ok.  Used to be a doctor in old Ukraine.  Maybe even a surgeon.  I’m sure he has moments when he imagines violence being inflicted on me.  Scrawny little Napoleonic me.  In any event, it ended up being a nice little repair.  Two layer intra-corporeal stitching.  Pretty slick.  This is like a memoir or something, I’m allowed to brag.  I’ll give myself that.  Not like I get off on it anymore, the surgery stuff, not like I used to.  A lot of people go through life without finding a single damn thing they’re decent at.  So I found one thing. I count my blessings for that at least.  I can whack out a damn gallbladder at 10pm in 20 minutes flat.  Now I'm like, big deal.  It used to wake me up, the surges of adrenalin.  Now I can do it in my sleep.  It just doesn’t light a fire for me anymore. The psychologist who runs my hospitals’ Physician Assistance Program (PAP) -- which, if we’re being honest, is a bald faced euphemism for “time out table for troubled docs who can’t come down off their assholery”--- tells me that disengagement and apathy vis a vis one’s own accomplishments is a classic sign of professional burn out.  I tell him I do, in fact, give a shit, I really do, just that it takes a bottle of 11 dollar wine and some background Chet Baker while I’m scratching out a few self pitying stanzas at night for all those old emotions and feelings to float to the surface. Like a batch of dead bodies tossed into a fetid pond the week before. It’s all still there.  That’s resurrection, my man.  Coming back to life.  In real life. All those dead feelings, all those frayed bits of human connection, every last shred of innocent self-becoming, long forgotten, drifting in slow currents deep inside you, like inky creeks trickling alongside some untended cemetery in the center of whatever the hell you want to call it, your soul, your self your spirit, the place where all your ghosts go, just waiting for circumstances to change so they can return to haunt you again.  Usually late at night, an infantry of faintly familiar zombies that you must let back in. This is the house of no locks. There they are. Populating your foyer, spilling into side rooms. Pretty soon there’s nowhere for you to sit or even stand. All the moaning and braying. You thought they had sunk too deep. That you were safe.  Well, surprise, here they are. Apparently, they get less dense the more time passes.  They physically can’t stay submerged. Most days, anymore, I see at least a few of them on the way out the door in the morning, hanging about near the coffee maker in the kitchen. It’s enough to make you feel like you're always walking three inches off the ground. I could use a little ballast.  No one ever tells you all your old ghosts come back to life.  Just like Christ Himself. Streaming in, right through that secret hole in the back of your head.  

Anyway, I’m probably being a little too harsh. It isn’t all that bad.  I won’t lie, I like the old ladies who come in after a week on the vent, half their guts in the morgue, and a long jaggedy-ass scar that I etched into them some witching hour several weeks ago, who tell me about their grandson at Brown or Dartmouth or wherever, how proud they are, who laugh at my dumb jokes.  I still get a kick out of shaking hands with the Andreys after a good case wraps up.  This realm where I am a person and not yet a ghost.  Yeah, I’m still down with it.  I’ll keep patching up holes. Reading Jim Harrison and Louise Gluck in my car at lunch with the windows up. Enjoying every last molecule of oxygen I have left.  


Thursday, October 28, 2021


 Op Note VIII

I immediately found a good plane of dissection. One realm simply fell away from the other. Clavipectoral fascia. White line of Toldt. Space of Retzius. All completely bloodless.  As if the various compartments had been individually wrapped in cellophane.  Scissors shearing along Christmas paper in skating linear strips.  One plane opened up into another. Like peeling layers of onions.  But I wasn’t getting anywhere. Just gliding between the pre-partitioned.  Moving about in the borderland frontiers.  At some point you have to go against the grain. Sink your teeth into something bitter. Cut across the striations of the soft and warm and beating. Leave a jagged tear that spreads in your wake. This is how it hurts. This is when it begins to bleed.  It’s the only way to get anything meaningful done.  Otherwise you’re just traipsing across ice. Tossing the heads of daisies into swift rivers. Watching.



 Teeth: A Short Story

They aren’t as hard as you think

Even diamonds can crack

I knocked out the one in front

When I was just ten,

An incident involving a Huffy bike

And an ad hoc ramp made

From bricks and a sliver of plywood/sheet metal 

We didn’t have enough to get it fixed

Back then. I wore a “flipper” for years 

Which was a pink palate mold

Melded with a fake in front

It was a dicey contraption.

I had to take it out when I ate.

A couple times at school I had to fish it out 

Of the dumpster behind the cafeteria,

My friend Eric holding me by the ankles.

I wore braces for 8 years because 

We ran out of money or something

And the orthodontist never took them off

But I didn’t mind because the metal wires

Held the fake in place

Like a wig that obviously wasn’t hair

But at least hid the baldness.

People get you slotted 

The minute you forget yourself

And let slip a smile.

So I re-learned how

By watching myself in a mirror.

What to do with my lips

How to angle my head

And crink my neck to the right.

More of the pained rictal grin of

Primitively carved jack o’lanterns.

Man, it’s a deep cut to realize that

Even joy can be a betrayal

All’s well that ends well, though.

I studied hard and hit the books,

Eventually earned enough to 

Buy a tooth of my own.



But it’s too late.

I smile just the same,

Crooked and awkward,

Despite the implant

And I come at apples from the side

With skyving flanking attacks.

Once you think you know who you are

It’s too hard to try to forget again

You have to wait until you’re old

And the face in the mirror is a stranger

With caved in cheeks and thin

Desiccated lips encircling

An edentulous gum-pink hole.

You just have to laugh, I guess.

The way it ends is so ridiculous.

Laughter is all you have left to deploy.

I like to think this is what drives

Cherubic babies to babble and smile 

With such toothless radiant joy


Tuesday, October 26, 2021



Some like to gaze up at the stars

While others prefer the strobe-like flashings of summer fireflies

And then there are those who weary of goodbyes,

Stay up late and watch from bedroom windows

For the shimmer of headlights from familiar cars

That suddenly appear on the road

At the top of your neighborhood hill.

It’s hard to fall asleep

Without knowing for sure

There is still a reliable light 

To burst forth from the pitch dark


Sunday, October 24, 2021


 Light Reflected

This October moon is so bright.

Enough to forget about the sun

That lends it all its light.

Is it because it’s so close 

Tonight or is it just

Feeling exceptionally bold?

Does this cold dead rock

Even know that it shines so

As it spins through space?

To be loved is to be a mirror

Reflecting mysteries of a face

In the middle of someone else's dark sky

I’m not much and neither are you.

We stopped wondering why.

We’re getting so old.

Patterns of decaying elements,

Shifting sands, flickering flames,

And neither of us know the source.

But let’s be kind 

And say love

Is the light we shine

And I will shine as hard as I can for you

With a luminescence maybe not my own

With a promise to always be full

Never a crescent

Never an empty new   


Sunday, October 17, 2021


 Op Note VII

She was afraid we wouldn’t find anything. That she was completely empty. I assured her we always did.  But once we unzipped her we all gasped.  It wasn’t there.  Nor was anything else.  A cavity of vast emptiness.  Of course we didn’t tell her this.  We called her loneliness a pancreas.  Her sadness became a liver.  Her anger morphed into a spleen.  We described her future death as a tumor nestled amongst critical structures and way too dangerous to resect.  It would have killed her.  Of course this was all make believe. But she was full of ideas now.  At her follow-up visit, she seemed serene and pleased. She loved her life again. She was a body again, full of indescribable mysteries. She smiled when I said her name out loud. She rested both hands on her swollen belly like a mother bearing twins.



 Op Note VI

All hands on deck. Turn the music off.  Keep the quiet austere formality of a state funeral. It’s a transplant.  Everything needs to match.  Name, record number, date of birth.  Blood type.  Don’t fuck it up. Stern serious faces for serious times. Whatever I take out of me and put into you is an act of faith. We’re both taking a risk. This warm throbbing gift of life might not fit.  You have to protect yourself.  It’s only natural. I don’t take rejection personally. Besides, I presumably need everything I have to make it through myself.  Isn’t that right?  Who am I to give anything away? It was never mine to begin with. But here we are. And there’s a time crunch.  Douse myself in ice. Shock the cells into thinking they’re not dead. Until you bring them back to life.  I've already picked out three spots where it could be placed inside you. My arms around your heart when it tries to skip a beat. In the enclave behind your eyes to know what you see just before you cast a smile at me. And in that empty slot that once housed the thing you gave away when you were young and dumb and self-loathing.  You’ve always been hoping it would one day come back.  It’s like a black hole you’re always on the verge of disappearing into. A negative pressure vortex straining to drag you under.  I may not be exactly the thing that was lost.  I’ll never be that. But I knew this was where I had to go. This was always it. Now I’m starting to settle in. I can feel your blood surging against my skin. I’m warming up.  And I’m starting to feel that I fit.  


Tuesday, October 12, 2021



Please stop that

It hurts too much

It isn’t numb yet

Don’t leave until

You say goodbye

Promise to come back

My dish is bland

Could use a pinch of salt

A dash of savory spice

I’m not afraid

Of losing blood

My bones are hard

I’m not allowed 

To be beautiful

I have to be tough

I don’t feel anything now

Sink a needle into my flesh

Cut as deep as you want 




 Op Note V

The patient had broken his heart.  Or at least that’s what he claimed.  So we cracked his chest and slit the hazy film of pericardium.  The restless red muscle thrashed about within its cage like a trapped animal.  Cardioplegia solution was infused and we packed  it in crushed ice until it went still and gray.  I searched every chamber.  Examined the atria and ventricles, front and back.  Nary a scratch or fissure to be found. Even the coronaries were soft and pliable. This was a good heart.  It wasn’t broken.  It just needed to rest.  The potassium citrate was stopped. The ice was scooped out. . We waited for it to warm, to wake up.  A true heart doesn’t have to be told. It happens on its own. Maroon fibers begin to flutter. It pulses with the menace of a downed wire.  It starts to beat.  You can’t decide to love.  When it’s time, you feel it pounding pounding pounding deep inside until it’s just too much, there's not enough space, and it bursts forth into the pounding of someone else’s life.


Monday, October 11, 2021


 Poem #30

there is no narrative, only experience.  there is only wow, never why or how come or who was that. only a surge of adrenaline that pistons off the line in hydraulic burst but fizzles out in a sputtering series of strung together words. just words.  that’s all we ever think it is.  there’s one thing and then the next one and then the one after that and none of it was ever meant to be. we make it so. but love demands the deepest hate and the darkness of void flickers with the mightiest light. we refuse to accept the capricious whimsy because we believe everything that is must be named using words we already own so that a story can be told before it has a chance to wisp away because we cannot imagine a lost world of words who have forgotten their meanings, drift unmoored, eternally unclaimed until a strong field draws them to this forlorn, yet elegant space. imagine a small glass-fronted gallery, well lit, unvarnished hardwood floor, a single piece on the back wall receiving them all, the giant white canvas spattered with innumerable inscrutable squiggles and Jasper Johnsian hash marks, a graveyard gathering of dead words reduced to patterns of arching curves and softly intersecting lines, the most beautiful rococo intricacies you’ve ever seen, which, here, in this room, right now, can only be first experienced. let this last. but then it must be named, a story must be told, it all starts again. you can’t help yourself. sounds slip from your lips, an inchoate language you're forced to conjure on your own.


Sunday, October 10, 2021


Op Note IV

The pain came on like a shark attack and wouldn’t release it’s grip.  She was writhing in the ER.  We advised surgical exploration.  She gave a panting, wild eyed consent.  But when we opened her up, everything was in its right place.  The liver unfurled itself beneath the diaphragm like a majestic manta ray undulating through depths of ocean.  The spleen swelled with purplish turgidity. Bowels squirmed with restless unscripted life like anemones.  Curtains of yellow fat glistened under the glare of the OR lights like kelp.  Everything was perfectly fine.  We shouldn’t be here, is what we were all thinking.  Another virgin ecosystem unnecessarily violated. This was a breach. Pain is the most private of experiences. It’s can’t always be cut out. The ocean is enormous and vast. No one ever knows what lurks in its deep shadows. We dragged her in to shore and waited for her to breathe again on this white beach.



 Op Note III

The patient presented for surgery after a long discussion of the attendant risks.  He had been referred to clinic with the diagnosis of anhedonia.  He had been deeply unhappy most of his life.  He had tried everything.  Psychotropic medications, dozens of them. Electroshock.  Talk therapy.  Group therapy.  He was psychoanalyzed by a Freudian from Antwerp.  He even did a week-long silent Vipassana retreat in Sedona.  Nothing seemed to work.  He drank alcohol to numb the pain.  But that only revealed what lay beneath the pain, which was worse.   He tried to fall in love.  Got married.  Had a few kiddos.  Even those joys didn’t last.  He received an award from his local Kiwanis Club.  It became harder and harder to smile.  He struggled to rise from bed. He began to appear unkempt. He lost his job. His wife left. He sought help from doctors from quacks from shamans from celibate monks.  He tried tripping on acid.  As in many things, I informed him, surgery is the option of last resort.  He understood the risk of death of paralysis of permanent unconsciousness.  He signed all the forms.  He felt this was his last chance.  Once he was shaved and sterilely prepped we used the saw to remove a generous bone flap.  As part of the protocol, he was kept awake.  We used probes to interrogate the amygdala.  Nothing seemed to elicit the desired response.  But then the assistant briefly lost control of the suction tip and, in the process of retrieval, the monitors lit up, the patient's heart rate surged and his eyes teared over with pleasure. His body arched in unguent ripples. He was shouting and delirious, saying yes that’s it, that’s it, that’s it yes yes yes and we came close to having to sedate him.  He kept saying please make it last.  Please do it again. Please doctor.  It became a prayer of reverential whispering.  I spent the next hour and a half meticulously probing the area of his brain where the suction tip had struck, to no avail.  It was getting late.  You can only do so much. It may have been a fluke.  The bone flap was replaced.  The scalp was reapproximated.  The patient was brought to the recovery room, shuddering and crying, shoulders heaving, shivering like he'd been left out all night, refusing to open his eyes.  


Saturday, October 9, 2021


Op Note II

The patient was wheeled in.  We did a safety time-out.  As part of the new process, everyone needed to account for themselves.  We all needed to be known.  The anesthesiologist was a pompous genius. When he was 13 he had elucidated the basic mathematical conceits of Boyle’s law before he’d ever heard of it.  When he found out his discovery had already been made, that it would always be Boyle’s Law and not a law named after him, he retreated from scientific inquiry and spent his free time compiling lists of objectionable traits in all the souls he encountered in preparation for a dystopian novel he would never write. The scrub tech had a teenage daughter who’d run away to Texarkana with a boy who spent his nights reading Ayn Rand.  The locket around her neck opened to a fuzzy picture of the girl when she was a happy gap toothed second grader.  The circulating nurse ate baby carrots dipped in hummus everyday for lunch, and never once offered to share.  Her name was "Kathy" or "Mrs Savoya".  If you called her just “Savoya” she would write you up.  The orderly was named Jim but everyone called him John due to an orientation week error.  By now, even the people who knew his real name called him John. His employee tag was sort of smudged.  The surgeon had been in the room waiting all along, arms crossed, a scowl on his face.  He was late and his clinic was calling.  Everyone looked the same to him, the way all cars appear in the middle of a traffic jam.  We mispronounced the patient’s name.  He was too drugged to protest.  Then he was an object with a medical record number.  A date of birth.  A blank space for time of death.  An oxygen mask was placed on his face.  Something began to shift.  Everyone began to move around and do the things that needed to be done.  People moving objects into the places where they belonged.  Yes, there was a liver and a spleen.  Yes, the diaphragm arched above the stomach like a summer pavilion. The rhythmic coil and churn of pink bowel spattered with a rosacea of arborizing capillaries.  None of this had ever been seen.  It had only ever been an idea. The image was immaculately beautiful on the screen.  We all suddenly felt safe, as safe as we would ever feel again.


Thursday, October 7, 2021


 Op Note I

They rushed him in, the child who’d been shot.  There was no time for the usual banter.  We identified him as a boy, maybe 11, a Johnny Doe, a person with parents who didn’t yet know, a school bag splayed across the street, a history of previous laughter.  While someone removed his bloody shoes and stripped him of his corduroys, another splashed betadine across his belly and chest.  Amidst the chaos and clamor there was silence inside the boy and we were anxious to find out why.  So we cut him open only to find his grown up self.  He had it all figured out; what to do the rest of the way and when.  What he was going to say at the right time to this miracle of a woman he never would believe he deserved.  He had it all worked out.  Please doc, just give me that chance to choose, he said.  But we were very busy.  We pretended we couldn’t hear a thing he said even though we got the gist.  He was in the way.  We knew it couldn’t be.  We had work to do and we did what we could.  We did our work. Please doc, he said.  But it couldn’t have been. We were just imagining things now. It takes a boy to become a man. It was time to whip-stitch our futile gash closed.  There would be no great love. No decisions to be made, no paths to choose. A sarcophagus closes like the period at the end of a sentence.  Breathless wordless empty pages that you keep flipping and flipping and flipping, hoping to find the thread, another word, at least, a scratching of ink against empty page, until the OR became a white-out blizzard of blanketing silence.



 Night Time Routine

I want to hug my damn son again

And feel his little form unstiffen 

Just like old, when he smelled 

Of warm mittens

Fresh from the dryer.

The sound of his little feet

Thwocking across the floor to me

When I’d come home at night

Late from the hospital.

I want to squeeze him so tight.

I want to sit on her bed

And read to my pre-teen daughter

Our old bedtime routine.

I’d even let her choose

The book or the poem,

Anything from my collection

Of mystical runes.

She didn’t use to scroll her phone

Or ask me for a little privacy

In the minutes before another day died. 

I don’t want them to end up like me

Forgetting what it’s like 

To feel you can let yourself go,

To collapse into the arms

Of love or melt into the sound

Of a reliable voice

Of soporific solace.

I've grown too hard to be truly hugged

And there are too many stacks of books

Left on the nightstand

I can only read to myself.


Tuesday, October 5, 2021


 Poem #29

Words mean only the thing

We arbitrarily assign.

This space I share with you

Is meaningless without time.

The aim of all poetry

Is the realm beyond meaning

Which you won’t know

Even once you’ve arrived.

Verses are the girls

Who inexplicably turned

And smiled at you

That one time in class

Across the cafe

At the red light

But you lacked

The courage to 

Fall out of time

To step out of space

Because you were stuck

In a place that had a name 

And late by a magnitude 

Of words that 

Describe a duration.


Sunday, October 3, 2021


 Clouds Like Blankets

The low dark clouds are pretty cool,

I guess, in that faintly ominous

But ultimately harmless sort of way.

It’s Ohio, the sun likes to hide.

By noon the sky is a high cerulean blue

And all that’s left of the cold morning dew

Clings to the canvas and laces of old shoes

I’ve tossed in a heap in a corner of the foyer, 

Collapsed together like penitent hands. 

I would pray:

For more rain

For peace of mind 

For less ankle pain

For longer days

A life not so bereft

A life less inane

For the power to wrap oneself in clouds 

When October sun isn't enough.

But what’s the use;

The morning is gone

The clouds have drifted away.

Everything succulent dries out

Like fallen December leaves

Scuttling across the concrete

Before the first deep snow