SIGECAPS

by Yevin Roh, MD Candidate 2018

Honorable Mention  2017 Gerald F. Berlin Creative Writing Award

Mrs. TR, a 52 year-old female, arrived to the hospital for the sixth time this year

With a slew of acronyms:

SOB,

CP,

+N, -V/D,

Elevated CRP,

concerning chest CT,

s/p partial lobectomy,

EKG WNL…

All secondary to bronchopleural fistuas

Maybe caused by an unknown autoimmune disease we ended up calling

“Crohn’s of the lung”

Or maybe caused by a fungal infection that elbowed its way past her white blood cells,

weakened by steroids for her rheumatoid arthritis.

And it was psychiatry’s role to consult on an acronym more elusive,

A sickness of her spirit:

Sleep disturbances,

(Lack of) Interest,

(feelings of) Guilt,

(Decreased) Energy,

(Decreased) Concentration,

(Changes in) Appetite,

Psychomotor Agitation,

Suicidal ideation.

Or,

SIGECAPS–

Depression contained in eight letters

An acronym in my textbooks

But each letter personalized by the patient

And if Mrs. TR’s depression could appear on paper,

The G, her Guilt, would overshadow the rest,

Its curved side would squash the SI together,

Its curled tail would choke out the ECAPS

G would appear in bold, underlined, in a font size so large that it would

Blot out her H&P

Guilt for not being able to be a mother to her four children,

the two youngest being teens

Guilt for not being able to bake a cake

for her son’s 14th birthday

Guilt for being a burden to her husband,

Who quit his job to care for the family

Guilt for leaving a legacy of loss by slowly dying in the month of December

The same month she lost her own parents

In Mrs. TR’s mind, her illness’s etiology was not biologic,

It was caused by the only other G larger than her Guilt:

God

“I’m being punished by God” she said between purulent coughs

“You do things when you’re young, and they catch up with you” she sobbed while sitting up,

unable to lie supine without a sensation of suffocation

“I’ve done things God wouldn’t approve of” she said, hiding her face with a tissue made

transparent by tears

With voice empty of emotion and eyes full of liquid grief, she said

“I had two abortions when I was younger”

“But God gave me them back with my two youngest kids.

“I didnt think I could get pregnant again”

“They were– they are– miracles.”

Medical school didn’t prepare me for this conversation,

(Neither did attending Sunday School

Nor donating to Planned Parenthood)

There was no void of multiple choice bubbles to darken with pencil

Whatever answer I would give to Mrs. TR

Would be in verbal sharpie

“Do you think God is capable of forgiveness?” I asked with a sincerity

that I hoped would not betray all the times

I fought fatigue and succumbed to sleep during Sunday sermons

“Yes,” she said, “God loves everyone, no matter what you did.

Even if you're a murderer…”

An implied “murderer… like me” (to which, I disagreed) at the end of her sentence poisoned

the silence between us,

She inhaled sharply and coughed

till her intercostal muscles lacked the oxygen to force up more phlegm

“Do you think that God’s forgiveness extends to you?” I inquired

She slumped forward with a wet wheeze, still trying to cough but too drained to do so

I asked again,

this time, with my hand on top of hers,

and was met with a nod.

We spoke until she could no longer stay awake,

Exhausted from coughing all day

And the pain growing inside her chest

It was not until the next day an x-ray

showed her coughing fit fractured a few ribs

To me, it was a sign of the seriousness of her disease

But to her, I wonder if she saw it as another sign of punishment

From God, who gave her miracles and maladies

We recommend her mirtazapine, when I wonder if what she needed was Mercy

Would she have prefered remeron or redemption?

We recommended her lorazepam, when I wonder if what she needed was love

Would she have prefered ativan or absolution?

Unable to prescribe her medications or offer her forgiveness,

I wondered about my own role:

Medical school prepared me to be a student

To live in constant acceptance of my own ignorance,

to cultivate curiosity,

And to defer to a “real doctor”

Perhaps, the one thing I was qualified to prescribe Mrs. TR,

Was hope,

To toss her a rope down a dark hole of depression

Ultimately, leaving it up to her to grab on, or to dig deeper

Til she was claimed by either a cave-in of her guilt and shame,

Or by the fungus in her lungs

I wished I could concoct a cure for her,

Though the cure to her depression is on the opposite side of the coin containing

The cure to her lung disease

But in the absence of such a coin,

I wonder:

Perhaps my role is to lower down a rope of hope,

long enough to begin her deliverance from depression,

and buy her enough time to find inner peace before her demise

For death, is inevitable

But depression, is not.