What Comes Next

Move the probe slowly,
across and back
your round taut tummy,
across and back to be sure.
Turn the screen,
point out head…spine…feet…
pause at the place
the beating should be.

You clutch at each other,
him bent at the waist.
Hands on your belly,
then looks away.

There are no words
for what comes next –
you need to undress, endure
silent, desolate, drawn-out labor,
the call to push
towards grief.

Excoriating beauty of your quiet child’s face.

No words for leaving
alone through double doors
with leaking breasts,
arms light with ache.

For crib that will wait
empty, tiny clothes unworn.

Bewildered friends with failing gestures
and broken glances,
pregnant mothers at the wake.

Dedicated to all the mothers, including my own, who have endured the loss of a child. Your babies are not forgotten, nor your pain. And to every patient and mentor who taught me the importance of leaning in, remaining present, and being available throughout the experience of birth and grief – thank you.

Dr. Shannon Arntfield, MSc, MD, FRCSC, is an Associate Professor in the Department of Obstetrics and Gynecology at Western University, Canada. She completed her Master’s of Science in Narrative Medicine at Columbia University in 2010, after which she developed and ran the Narrative Medicine Initiative at Western for 10 years. Her clinical, academic, and creative interests revolve around the ways in which narrative can improve the process of receiving and providing care.


Hiding under the
hospital bed, he
refuses to come out,
he knows his cancer
is back.         His

mother lies on the cold
sterile floor, asks what
he needs.

                      He wants to go home,
                      eat her food,
                      play with his cousins,
                      sleep in his own bed.

                      When I tell him goodbye
                      he says

Come home with me, come live with me.

                      I never see him again or his
fierce drawings of open-mouthed animals,
insects the size of feet, and man-eating plants
with serpentine tendrils.

Janet Hull Ruffin is an artist, poet and retired arts educator. She worked at The Children’s Cancer Hospital, University of Texas, M. D. Anderson Cancer Center for over ten years as an art teacher. Poetry was her artistic response to the lived daily moments she encountered working there.  Janet was also part of the team that created “Street SmART,” a creative arts project for Harris Country Juvenile Probation in Houston.

Janet states, “The Expressive Arts have always been my passion. My poems are a testament to the healing power of art for patients, families, and health care workers.”

Jonathan Humston’s essay highlights the critical role of emergency responders within the healthcare continuum. Often the first ones at the scenes of death outside of controlled clinical spaces, they carry a particularly public burden of professional grief. 

Target Located

I had fallen asleep with my two sons when my wife woke me. “Have you checked your phone?” That question usually means she has texted me to help with our newborn daughter. Not this time. “Teenager missing near a pond. They’re requesting dive team.” As a fire captain, she follows the emergency calls in the area and knew before I did. Other than me, our small public safety dive team consists entirely of police officers, firefighters, and veterans. I’m a volunteer, a civilian, a chemistry professor.

First thing next morning, we convene at the edge of a farm field near the pond in a neighboring county. I ride across the field with the sheriff on his ATV. Through a row of trees and a hole in the fence, we make our way to the pond on foot. It is isolated, with a dock, a small beach, and an old tin-roofed shelter. I admit it’s a good place to party, which is allegedly what the teenagers were doing, celebrating the last day of school, when they realized their friend was missing. We set up our operation off the dock. As we work, local authorities, family, and friends are searching the surrounding areas. We rotate through positions and it’s my turn to search. A few feet below the surface it is already pitch black. I continue the expanding arc search pattern where my teammate left off. My nerves subside as I get to work. In the mud. Rope tight. Sweep hand. Move slowly. Stop. Turn around. More rope. Continue.

This is a strange job that brings with it a tension of emotions. I’m excited to put my training and skills to use underwater. The technical work engrosses me and requires my complete focus. At the same time, this family is up there living a nightmare as strangers search for their 16-year-old son at the bottom of a pond. The dive operator part of me is thrilled and hopes that I find him. The rest of me is abashed by such thoughts and prays that I don’t.

My turn ends and we rotate positions. When I am the backup again, we have cleared a third of the pond. With every pass, the unexamined area decreases and the probability of finding our target, if here, increases. The sound of the pumps, the brightness of the sun, the coolness of the water, all at once evaporate as my attention focuses on the words in my headset. First an expletive, then, “Target located.” Only the line tender and I hear it. No one else knows. All the others, searching the grass, the woods, the ditches, they don’t know yet that they won’t find him. He’s right here.

Discreetly, I ask for the mesh body bag and someone hands it to me. A commotion brews on the shore as people begin to see what is transpiring. I ignore it, clip onto the rope, and make my way down. My teammate is at the head, and when I get there, I position myself at the feet. Stay calm. Get to work. In total darkness, communicating only through our headsets, we orient the bag. Through the gloves of our drysuits, we find the zipper and begin to painstakingly work the bag down around the body. I touch every part of him along the way to make sure he is in. The minutes anxiously tick by on the shore, but I have no concept of the time. I reach the end and feel the zipper stop. Done. We retake our positions at the head and feet and signal to the tenders. They pull us back to the shore with bag and its contents in tow. There is complete silence on the surface but for the wailing. At the sight of the large yellow mesh bag, the boy’s mother breaks down and sobs. After a few minutes, we solemnly pack up our gear and return to the trailer.

Getting back to the road, the tension of my emotions persists. It seems the whole town has shown up at the farmhouse near the field. They don’t know who we are, and it is best to keep it that way.  I am proud of our work but not happy about it. We have accomplished our mission but there is no celebration. I am honored to serve but humbled by the magnitude of what we have just done. I quietly get in my truck and head back home to my family.

Jonathan Humston, PhD, is an assistant professor of chemistry at Mount Mercy University. He is an educator, writer, and scholar of many things, especially the intersection of science, education, and information. Dr. Humston is a volunteer public safety diver on the Johnson County Metro Dive Team. He has used writing to help process the tragedy and grief experienced for the sake of others. He lives in his hometown of Iowa City, Iowa, with his wife and three young children.

Death Rattle

Back when the five and dimes
still made black and whites,
I loved the cloudy bubbles

made by pouring soda over
brown-syruped vanilla ice cream.
Today, the ShopRite-brand Dark

Roast is bitter without complexity.
I donate the open-but-full can
to my office. I leave my Blackberry

behind, on my white desk
calendar as I rush off after hours.
I blame it on hunger. Someone else’s

turkey pot pie is in the toaster oven.
At the ICU family meeting, we talk
favorite stuffings until the latecomers

arrive. Then we ask a man’s family how
much they understand before
we recommend taking their father

off the ventilator while keeping him
comfortable. On my way past shops
on Arkansas Avenue, I glance

sideways at the inside of Skechers,
an intense, white fluorescent
island floating in the asphalt night.

Shoeboxes, white with pink lids
like thousands of iced cakes, cover
every wall. I’m looking into a dollhouse

bakery. Black Friday sale signs make
dark silhouettes that block the fairy light.
On the Expressway, a series of bright blue

billboards shout white lettering:
Nice try, Sandy, but we’re Jersey strong.
I’m not cheered or encouraged.

Near home, I hear a soft rattling,
like a chain saw, off in the distance.
So many trees need to be dismembered.

A dry leaf is caught in my wiper blade.
It oscillates in the wind,
as it sings in a deep register.

Deborah Bayer is a (mostly) retired Infectious Diseases physician. She left hospital practice to concentrate her attention on the HIV clinic in Atlantic City, NJ. Her writing has appeared on Doximity OpMed, in Levee Magazine, Cider Press Review, The Stillwater Review, and in the anthology Still You: Poems of Illness and Healing. About “Death Rattle” she says:  “This poem describes a day-in-the-life of an essential worker in the aftermath of Hurricane Sandy. Despite the recurring motif, there is little that is black and white in end-of-life decisions.”