Some memories of medical school and residency are like dreams. I recall certain details vividly but can’t make sense of them—largely because I have forgotten much of what I once knew: facts, entire bodies of knowledge. Rare diseases and syndromes, medications I haven’t used in years, rules we were forced to memorize (CD4 counts at which to start antiretroviral therapy for HIV, for example) which are no longer relevant or true. Much of it remains relevant and true, but I have simply allowed the knowledge to fall into disuse, to stiffen and atrophy. It is amazing how quickly it happens. The metaphor “commit to memory” is perfect. My commitment to those facts, to those particular bodies of knowledge, was weak. And like any weak commitment, its gradual, almost complete demise has left me confused, at once bitter and regretful.

William Carlos Williams reportedly said, “Medicine is my wife, and writing is my mistress.” I have always hated that quotation, its misogyny and entitlement. An absolute righteous conviction that he should have it all, that he should never have to choose.

One such memory: A young woman, 26, with some rare dermatologic disease that caused her skin to peel off, layer by layer, until she was left with nothing to protect her from the world outside her body. I haven’t the foggiest idea, now, what disease she had. I also cannot imagine a more horrible way to die: being eaten from the outside by her own errant immune system, which destroyed her epithelial cells, one at a time, dissolving the only fragile layer that stands between any of us and the insidious, destructive world: dirt, disease, other bodies, the physical things that surround us. The softest objects, even the sheets of her hospital bed, would destroy her body by their faint touch.

The pastor on the palliative care service had asked me to speak to this woman. She suggested that I offer to help her write her life story. Studies in palliative care had shown that the exercise of remembering and recording prior life events could be deeply comforting to young people going through a dramatic and prolonged death.

She was lying in the bed when I entered, supported by a special air mattress that was supposed to minimize external points of pressure on her fragile body. Nurses had carefully tented a sheet over her torso and legs; I imagine she was naked underneath. Her face and arms were exposed, bare except for a thin, shining layer of some kind of ointment or medicated plastic covering every inch of her body. Under this slick, glinting stuff, her skin was, as far as I could tell, absent. Her arms, neck and hands were like our anatomy textbooks: red and striated, fat and muscle. She barely moved, but as she lifted her fingers almost imperceptibly from the bed, I thought I could see the tendons of her forearm rippling. Her dark hair was pulled back from her head and covered in some more clear plastic, like a shower cap that had been suctioned to her head. Presumably her disease affected even her scalp, the roots of her hair. She had been treated with so many steroids that her face, mottled and raw from the disappearance of her own flesh, was also swollen like a grotesque moon, her cheeks puffed like dough, her eyes red-rimmed and watery within the gruesome mask of her face.

I stood in the doorway in my crisp white coat over a red-and-cream flowered blouse, my blonde hair pulled into a ponytail. All I could think was that she and I were exactly the same age.

I said something, I hardly know what—an introduction, an explanation, an apology? This is what I mean about it being like a dream. I can recall only floating in for a brief moment, hovering in my tongue-tied state of horror, uttering something useless, then floating away again, back to the pastor’s office, where I cried selfish, fragile tears over what I had seen and who I was and who I was not.

The pastor was wise, and I think she had sent me there for exactly this reason. The exercise, I now understand, was for my learning, rather than for the patient’s benefit. Probably, hopefully, the young woman in the bed barely registered or cared that I was there at all—a dream. For me, it is a dream I still cling to in my vague, troubled way. For her it would have dissolved in the moment of her death, undoubtedly years ago. Or, depending on what you believe, her dreams and memories persist in the form of her disembodied soul. To me this is the more comforting possibility, because it makes the whole encounter seem infinitesimally tiny and insignificant, in the whole of eternal space and time.

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