Maggie Dubris has had several parallel lives as poet, medic, and New Yorker. For 25 years she was a 911 paramedic with St. Clare's Hospital in NYC, the first hospital in the city with a dedicated HIV ward. On her rounds she saw parts of the city never talked about and now forgotten by many.

These experiences are all woven together in her new book Brokedown Palace, which we talked about on #SholemsBias. Among other things, she read the poem below (first published here).

1982

My realm is a jumble of mazes and labyrinths
illusions, riddles, mysteries. It’s fun
to solve a mystery, when you
live amongst the gods. Immortal, dealing out
mortality, night after night. A summer evening in
New York City. A basement apartment. A young man
barely out of his teens. Sitting on a wet bed
beside his dad. His breath smells funny.
Like bread. His face is finely sculpted, as if all the fat
has been burned away in a terrible fire.
It’s a look I will later come to associate
with gay men. He’s pale, with purple blotches
like pomegranate seeds, on his face and arms.
So weak he can’t walk. He doesn’t know what’s wrong
with him. No one knows what’s wrong with him.
But I do. Buried in one of my medical magazines
was an article on Kaposi’s Sarcoma. A previously rare
and benign cancer of elderly Italians. Now showing up
in an apparently mutant form in young gay men.
On the west coast, doctors are calling it GRID.
Gay Related Immune Deficiency. Very rare.
452 cases in the whole United States. 453 now.
I wish I remember being afraid, or even
feeling sad for this man, to be so sick so young.
But I was besotted by my own powers. Proud
to have made this impressive diagnosis. Not yet able to see
that Mount Olympus was scaled long ago
Our palaces sacked, our gorges flooded
with germs and sorrow. And I am not Demeter but
Persephone, damned by the mortal pain
I so carelessly consume.

Bill (not his real name) is a knowledgeable resident, sure about his goal to do the right thing for the patient.

I was supervising him in clinic today. We were talking about the patient, a lady in her 70s who had survived cancer but was somehow still well enough to be a primary caregiver for her grandchild. I saw the child gamboling in the hallway -- bright-eyed and fleet footed in a sequined shirt. Not a kid forgiving of malaise.

"So there's a bunch of stuff she should do but hasn't," said Bill. "She had some thyroid nodules found incidentally. Her thyroid tests were normal, and I don't see anything on exam, but she should follow up on--"

I was impatient, I admit. "Do we know it would be better for her to follow up on a small thyroid nodule, or prioritize her other conditions?"

"Well, anyway," he continued, half acknowledging my objection and half laughing it off. "She should be on a statin."

"Or you should ask her whether she wants to be," I countered.

"But I know I am doing the right thing for her."

"Do you know her preferences? We doctors are not good at guessing such things."

"She'll do whatever I want," he said. He meant it, but even as he said it, I am sure, he knew what it sounded like.

Such an attitude is all too common. And while I spend a lot of time thinking about and teaching patient-centered care, it still feels like a steep uphill climb when someone is not already one of the converted.

And the worst of it is - the hierarchy rules. He is right. The patient would probably have done what he said. Or at least, been unable to object.