There are always questions at the end of the visit.

It’s only natural. Nobody remembers everything. I’m used to clarifying and reiterating.

But your question catches me off guard.

“Did you know that hummingbirds remember every single flower they’ve ever visited?” 1/

I smile, and shake my head. “No, I didn’t know that.”

You nod at me, “Well, it’s true. I’m gonna send you a bill now.”

I laugh, and the layered masks muffle the sound.

I was consulted because your kidney function is dropping.

Clear yellow urine now turning dark amber. 2/

Your room is on a COVID unit.

The plastic sheets you have to zipper yourself through. The cool hiss of the air flow. Donning and doffing.

There was a time when this was a pulse-quickening ritual, when adrenaline would flow.

Now it is a necessary nuisance.

Numbing. 3/

Every time I see you, the visit finishes with an exchange of trivia.

You tell me something I didn’t know.

I try and tell you something equally interesting.

It’s a sort of game. A challenge.

I realize that it’s something I’m looking forward to, every day.

A little joy. 4/

Late in the evening, when I get home, I sit down with some books and skim through for interesting tidbits I could use.

“Schott’s Original Miscellany” is a godsend, as is The Guinness Book.

I enjoy the peace.

No screens. No one monetizing my attention.

Just pages turning. 5/

A dark cloud has descended, cloaking everything in gray.

It isn’t just me.

One of my colleagues, Tony Alvarado (@TexasKidneyDoc), is one of the most upbeat and outgoing people I know.

Now he’s quiet.

His trademark smile is faint, and the light has faded in his eyes. 1/

Tony texted me the other day.

The most I’ve heard from him in weeks.

“My dad died last night.
COVID.
Pretty fast.
2020. Hell. On. Earth.”

I responded as best I could. Told him I was there for him.

His father was a kind man.

He didn’t have to die.

Not like this. 2/

It’s Fall 2008, and I’m a resident in Internal Medicine.

I’m attending a forum where I’ve been invited to read from the journal I’ve kept since medical school.

These are my thoughts that have been slowly consuming me.

The documenting of a downward spiral. 3/

I’m growing increasingly aware of a numbness within me. Moments that would move me before, now they evoke nothing.

The crucible of residency is forging me into a cold and unfeeling alloy I never wanted to be.

I write about it, and read my words to others who also know. 4/

I’m a guitarist, and I compare the sensation to the gradual numbing of fingertips against sharp steel strings, as the skin thickens and calluses form.

I want to tear off the calluses so the pain remains fresh, and real.

I would rather bleed on the strings than forget them. 5/

There are moments now and then when, if I imagine hard enough, it’s like it was before.

I don’t feel the ear loops from the mask.

I don’t notice the red signs on the floor, saying “6 ft apart!”

I don’t feel... the heaviness that tinges every single hour.

There are moments. 1/

I’m standing in line at the post office. It’s a beautiful day and sunlight streams in through the windows.

Miraculously it’s relatively deserted.

A bored little boy looks through the stamps for sale with his mother.

A man stands behind me, elderly, leaning on a cane. 2/

He’s tall, lean, and wears a “GO ARMY” sweatshirt paired with sweatpants, and those brown sandals that seem ubiquitous in South Texas.

I nod hello.

He nods in return, “Hi, doc.”

For a moment, I feel that queasy discomfort of being unable to remember.

Do I know him? 3/

I know patients expect me to recognize them, and I often remember, but there’re just too many.

Then I realize, he’s not a patient.

I forgot to unclip the hospital ID tag on my shirt pocket.

He grins, “What kind of doc are ya?”

I unclip the ID tag and smile, “Kidneys.” 4/

“My kidneys are just about the only damn part of me that works!”

He laughs. A choppy sound, dry.

I nod politely, saying nothing.

He continues with that easy familiarity that comes from being sociable, and lonely.

“I busted my knees jumpin’ outta planes for the army.” 5/

When she was a child, her dream was to be an artist. She would chew her lip, and grip her crayon far too tightly as she tried to stay within the lines.

“Be practical,” her father said.

“Enjoy art in your spare time. Work hard. Then, maybe someday.”

Maybe someday. 1/

She puts on the vest that completes her uniform. At her last job she had a name badge, but not here.

Just the words “ENVIRONMENTAL SERVICES” in block letters.

Her granddaughter once asked her if that meant she was saving the environment.

“Sort of, mija,” she laughed. 2/

She has been “Janitorial Staff,” “Hospital Housekeeping,” and “Cleaning Crew” over the years.

The job remains the same.

She gets the equipment ready on her cart. She is detail-oriented. Everything in its place.

The little walkie-talkie on her cart crackles to life. 3/

Her first assignment is a room cleaning.

It will be the first of many.

She is often under immense time pressure, as rooms must be cleaned before a new patient can use them.

It’s a time-consuming process, even though she has become extremely efficient at it.

Laborious. 4/

She makes her way into the elevator, maneuvering her equipment cart and the trash container on wheels.

There are two other people on the elevator. She says “good morning.”

One nods hello. The other doesn’t.

She’s learned not to expect thanks, but a hello would be nice. 5/