Lying in fetal position, turned to right side, on furthest edge of mattress.
Past midnight, room dark, neighborhood quiet.
Staring through frost-rimmed window at stark moon.

Anti-abortion activists on undergrad campus earlier today,
Decrying murder of potential lives.
If potentiality is the criterion,
Then every adolescent boy in history has committed genocide.
Into wads of Kleenex, old socks, and toilet bowls.

Future entrepreneurs, researchers, concert pianists, presidents,
Pulitzer winners–millions at a time–mercilessly flushed to the sewer
Or tossed
Among the banana peel
And Pop-Tart crust
From this morning’s breakfast.



Overcast Sunday morning.
Brisk north wind.
Two boys play soccer in practice field next to deserted high school.
One wears olive green hoodie, red mesh shorts, fluorescent orange cleats.
Friend wears grey beanie cap, black Adidas sweats, blue t-shirt over black long-sleeves.

Early teens, perhaps thirteen or fourteen years:
That tender age when child’s body stretches
Over a lithe, growing frame;
When youthful energy meets budding strength,
Resulting in effortless, tireless athleticism;
When cell phones and Snapchat porn
Vie equally with Legos and hide-and-seek matches;
When dreams begin their inexorable march
Against the onslaught of daily existence.

Hoodie boy scores goal against friend;
Yells in victory, voice cracks;
They switch places.
In ten, fifteen years’ time, where will the boys be?  Who will they be?
Will they remember this cold November morning?
Will they remember to dream?
Do I?
Would that I could talk to my fourteen-year-old self.
Why does it take us a lifetime to figure out how to live?

Hold a Child

I lost a kid in the ER today.  Only the second one in my career.  Nothing in medicine or in life is more devastating.

I wept as I drove home.  I wept for the girl.  I wept for her parents.  I wept for a fucked up universe in which children die.

Whoever you are, wherever you live or work, whatever your family situation, hold a child today.  Your son or daughter, sullen teen or ebullient toddler, little brother or sister, baby niece or nephew: it doesn’t matter.  If there exists a child in your life who means something to you, tell them so.  Wrap them in your arms, hug them tightly, sit in the sunlight with them.  Say you love them.

Please.  Hold them.

Fires of Suburbia

Across the darkening park grounds,
The indistinct hillocks of which glow softly in the purple aestival dusk,
Tens of thousands of fireflies scintillate,
Their caudal luminations streaking upwards from the loamy earth
Like sparks borne aloft from the coals of a smoldering campfire.

We too arose from Wild Horse Green:
Alex and Trevor,
Taylor and Brent and tomboyish Stace.
The hillocks then were castles,
To be defended with stick swords and pine cone grenades;
The fields were African savannahs,
Teeming with housecat lionesses and Old Man McIntyre’s Labrador hyenas;
The elm copse was a military fort and, later, a shelter to adolescent trysts.
During college, the pavilions housed picnics and occasional, accidental, baby showers;
Now, graduation parties and wedding receptions and more baby showers;
Eventually, retirement celebrations and funerals.

The graveled path clicks and rasps underfoot.
Few of the entomic flashes crest the treetops,
For the park employs many wardens:
Bats and nighthawks,
Strategically spun spiderwebs,
Children with cheesecloth nets and Mason jars.

One flare breaks free, blazing—a reverse meteor—into the mauve twilight,
Adding to the starry firmaments
Its fleeting, chartreuse fluorescence.

Do Fish Sneeze?


Students (incredulous): Wait, are you, like, a PhD doctor or a real doctor?
Me (amused): The latter, though some of my grad school colleagues might object to the distinction.
Students (confused): Huh?
Me: I’m a real doctor.
Students (suspicious): No offense, but why is a doctor subbing high school chemistry?
Me (cagily): I have a gap year before starting my residency and figure sub teaching is a nice way to give back to the community.
(Truth: I took time off to ‘find myself’ and, after finding myself drunk, unemployed, and penniless in Costa Rica, found myself living at my parents’ house and substitute teaching in the school district I had attended as a youth.)
Me (redirecting): And on that note, could everyone get out the worksheet that Mr. McKinley gave you yesterday?
Female student (cheerleader, archetypal Valley Girl, annoyed): Um, Mr. ‘Doctor’ sir, we don’t actually work in this class.
Me: You do today. Now, who can tell me about ionic bonding?


Unknown teacher: Hi! Are you covering Mrs. Finny, today? I’m Ms. Ellmon, just next door, English lit.
Me: Pleased to meet you. This is my first time at the middle school; I usually do high school sciences.
Ms. Ellmon: Oh, well, welcome! The kids are great. 8th graders, ya know? Enthusiastic, but too cool to show it.  They’ll turn anything you say into a ’69’ joke.
Me: Do they even know what that means?
Ms. Ellmon: A couple we found under the gym bleachers last week certainly did. Anyways, watch out in fourth period for a kid named Wayne Fleeton. Crazy. Already suspended twice this year—robbing the soda machines and setting a desk on fire.
Random student (enters classroom): Whoa, sub day! Hi, Ms. E. Did you warn him about Wacko Wayne?
Ms. Ellmon: Terrence! No name-calling…but, yes, I did.
Terrence (appraising me): You don’t look like a softie. Maybe Wacko won’t kill you on the spot.
(Truth: Mr. Fleeton is a quiet, well-mannered, intelligent lad who is criminally bored in a watered-down public education system filled with ‘phonies,’ to use his own Salinger reference.)


Me: …and that covers most of what Ms. Hammel wanted you to know on forensic odontology. Remember, for the quiz tomorrow, focus mostly on the slides about tooth development and dental records. Any questions?
Sophomore male (jet black hair, Metallica t-shirt, urban camo pants, bright pink boots, earnest mien): Is it true that zombies can tear out a person’s windpipe with just their teeth?
Male chorus: Yeah, is it? It was on ‘Walking Dead’ last night.
Me: Hmm, mechanisms of injury during assaults by the undead. Excellent question. If I remember my neck anatomy correctly, the trachea—or ‘windpipe,’ as you call it—has three major cartilaginous anchor points, the most superior of which is often…


Intercom: Attention teachers. We are under lockdown. Secure your classrooms.
Me: What the hell?!
Students (7th graders, tittering): Did you hear that? So cool! He said ‘hell.’ I like this sub.
Me: Guys and gals, is this a drill? The office didn’t mention it.
Students: They never tell us nothin’.
Me: Watch the double negatives. Ok, we’ll treat it as legit. Lights off. Close the door. Everyone into that corner, away from the windows. Now!
Students (alarmed, yelling): What if there’s really a shooter? I don’t want to die. So cool! Our Father, who art in heaven… Is the door locked? My brother said the glass is bulletproof. Your brother’s full of shit. Does anyone have a phone charger?
Me: Shut it! Sit down. No one talks, got it?
Intercom: Attention teachers. We are under lockdown. Secure your classrooms.
Students (whimpering): Oh god, oh god, oh god.
Young boy (sandy-haired, class clown, suddenly stands): Guys! What are we worried about? If anyone gets shot, we’ve got the Doctor Sub!
Classmates (pausing, considering): Hey…that’s right. We’ve got Doctor Sub!
Me: Shhh, be quiet. I can’t do much if the gunman kills us all.
(Truth: I can’t do much, regardless. The only gunshot wounds I saw in medical school were in PowerPoint slides during trauma lectures.)
Principal (several minutes later, opens classroom door): Excellent! Looks like you’ve got things under control. In case the office didn’t tell you, we’re having a lockdown drill this morning.


Me (taking attendance): Wow, where is everyone today?
Students: There’s track, tennis, and swim meets all week. Football team’s on a training-camp field trip. Baseball’s getting ready for tomorrow’s pep assembly. Cheer and pom are at nationals.
Me: Odd, I thought sports were extracurricular activities.


Substitute teachers, ephemeral creatures,
Filling in quickly when staffers fall sickly.
Oftentimes pressed, though not knowing squat-diddles,
Answer they must life’s important big riddles:
Is it possible to break a penis?
Why is smoking so heinous?
What exactly does a spleen do?
Coffee makes you short. Is that true?
How did the Earth’s rotation start?
When should you listen to your heart?
Can ice freeze?
Do fish sneeze?


I sat down on the pool’s wooden deck and reclined against the surrounding chain-link fence, feeling its sun-warmed metal wires imprint their rhomboid pattern across my bare shoulders as I supervised the campers splashing in the shallow water.  The mid-July atmosphere lay heavy and still over the dusty campground, while far overhead a small airplane with red wings droned lazily across the sky.  Surrounded by empty fields of tallgrass that had turned brittle in the summer heat, the camp pool was an oasis.  A knee laceration suffered the previous day during a particularly competitive volleyball tournament with the other camp counselors had restricted me to the poolside, and I could only watch—and perspire—as the dozens of campers and most of the staff dawdled away the afternoon in refreshing, aquatic amusements.  “Shouldn’t really feel sorry for myself, though,” I murmured as I gazed upon the assortment of wheelchairs, crutches, and leg braces that littered the deck.

Six weeks earlier, I had noticed on a bulletin board at my medical school a recruitment flier calling for volunteers for a youth camp put on by the Oklahoma chapter of the Muscular Dystrophy Association.  According to the flier, the camp takes place every summer, and any child in the state who has muscular dystrophy can attend, free of charge.  Because of the fragile health of the campers, the organization prefers to have medically trained individuals serve as camp counselors.  This year’s session fell perfectly into the narrow slot of vacation days that I had available before the start of my third year of clinical coursework; and using that time to mentor disabled youth seemed a somewhat nobler endeavor than my original plan of backpacking across central Europe.  I emailed the contact person listed on the flier, and after completing an impressively onerous rigmarole of paperwork, liability waivers, and background checks, I received my counselor welcome packet—which, tellingly, included a complimentary 120 ounce water bottle and instructions to pack “enough mosquito repellant to fumigate an entire village.”  Because I had been assigned to lead the preadolescent boys cabin, ages 7-12, my packet also contained a yellow sticky-note with the anonymous, handwritten message, “Heaven help you.”

Back at the poolside, acrid chlorine vapors mixed in the air with the campers’ excited yelps and laughter and with raucous country music blaring from the cheap, crackly speakers nailed to the lifeguard hut.  One of my campers, a seven-year-old boy named Asher, climbed out of the water and tottered over to me.  Asher’s lithe little frame sported an overstuffed, moldy orange life-vest and neon green swim trunks; his smiling, freckled face shone with merriment and with streaks of white sunblock that he had been too impatient to rub in fully.

“Couns’r Ty, can I go on the divin’ board?” he asked politely, though the gleam in his eyes told me he intended to go with or without my permission.

“Sure, Ash, just make sure the lifeguard says it’s okay. I’ll watch from here.”

“Aw’right!” he whooped, revealing a white smile full of gaps from recent baby teeth losses.

I watched as Asher ambled along the deck towards the deep end of the pool.  In his barely containable excitement, he quickened his pace to an open jog, drawing the shrill warning of lifeguards’ whistles.  He grinned sheepishly and reduced his speed just a notch.  To a casual observer, he seemed every bit a normal, vigorous young boy at summer camp.  Subtle findings—enlarged calf muscles and a tiptoed gait—hinted at his grave truth.

Muscular dystrophy refers to a family of genetic diseases caused by mutations in genes related to muscle cell structure and/or function.  They vary widely in severity, epidemiologic distribution, and exact pathophysiologic mechanisms but share a common symptomatology: progressive weakness and degradation of proximal, large muscle groups.  In milder subtypes, the clinical consequences are relatively benign, consisting of difficulty climbing stairs, easy fatigability, etc., and do not substantially affect a patient’s life expectancy or quality of life.  In contrast, the most severe form, Duchenne muscular dystrophy, ranks as possibly the most tragic of the thousands of diseases I’ve studied in medical school.  Because of the specific chromosome carrying the mutated gene, it affects males almost exclusively, but does not manifest immediately after birth.  The boys seem to develop normally, and parents believe they have a healthy, happy young son.  That is, until he starts to lag behind his peers when running on the playground at preschool; until he begins to stumble and fall more frequently than can be explained by usual boyhood clumsiness; until they take him to their pediatrician, who refers them to a neurologist, who tells them the terrible news.  Their precious little boy has an incurable disease in which the muscles of his arms, legs, heart, and diaphragm will steadily and inexorably disintegrate, replaced by useless fibrous tissue.  In his early childhood, his leg muscles will swell noticeably and force him to walk on his tiptoes; by age 8 or 9, he’ll require some sort of ambulatory assist device; before puberty, he’ll be in a wheelchair; by his mid-teens, he’ll likely need a ventilator; and by 20, he’ll die from heart failure and/or repeated respiratory infections.  Throughout, his cognition will remain unimpaired, leaving him fully cognizant of his condition, its relentless course, and its ultimate conclusion.

Ash suddenly tripped on a loose plank projecting from the deck.  He crashed forward onto his arms and chest, and lay prone for a moment to recover.  Among the very few things to upset Asher was receiving immediate and overly sentimental aid from people who, presuming him frail and incapable, rushed in to save him from any stumble; he was fiercely independent.  Having learned this lesson firsthand on the first day of camp, I made no move to help him.  Instead, I watched as he slowly and methodically raised himself back to his feet: placing his hands far in front of his body and steadying his legs widely beneath him, creating a sort of tripod, and then walking his hands backwards along the ground and up his legs to push his trunk into a vertical position.   “My god…” I whispered.  It was the Gowers maneuver, a classic sign of Duchenne muscular dystrophy.  I had only ever seen it in the safe, sterile pages of neurology textbooks; now it was here, tangible, in the copper-tan body of a cheerful and intelligent young lad whose continual joking, pranks, and unfettered vivacity filled our cabin nightly with laughter.  Behind dark sunglasses, tears welled in my eyes.  A minute change in one or two letters among the six billion characters in Asher’s DNA had condemned his bubbly step to a premature end, while the rest of us blithely walk on.

I looked from Asher to the other campers.  They shared his fate.  “Damn it,” I muttered with a cold vehemence that shook my chest, “God damn it.”  Can’t scientists hurry up and cure this disease? Fuck it, why does the disease even happen?  If a loving, omnipotent god really does exist, I’d like to hear the sick bastard’s reasons for doing this to innocent children.  The tears flowed freely now, merging with the sweat on my face to produce a briny mixture that ran across my lips.

Asher arrived at the diving board.  His left shoulder was slightly abraded from the earlier tumble.  With the help of a lifeguard, he scrabbled out onto the white platform and, grinning and giggling, surveyed the world around him.  Disney-themed beach towels hung on the fence and swayed gently in a weak breeze that had begun to sir.  A chorus of cicadas buzzed from a nearby fishing pond.  The red-winged airplane was still moving slowly overhead.  The rich loamy odor of clay soil, weird chemical fumes of sunblock, and sweet scent of spilled fruit punch filled the air.  Alternating shouts of “Marco” and “Polo” arose from the younger campers, while the older ones lazed and talked and flirted with each other at the pool’s edge.  Sunlight glinted off the steel rims of the parked wheelchairs.  The hydraulic lift that ferried the weaker kids in and out of the water clanked loudly.  Several feet to my left, a late adolescent in the end-stages of disease lay in a mobile hospital bed and breathed noisily through his tracheostomy tube.  Asher’s eyes caught mine.  For an instant, his youthful face looked ancient, resigned, and wise.  He nodded once, as though to say, “It’s okay, Couns’r Ty, I know.”  Then he smiled, stuck out his tongue, gave me two thumbs up, and leapt.