This is the JAMA article I tried to send to you. Sorry! I forgot that access
is restricted unless you tried to open it on a Hunter computer. Mrs.
Wood-Hill 
  _____  


When I taught English, my students and I read Anne Bradstreet (1612-1672). A
Puritan and a mother, she was also America's first published poet. Her
syntax and use of unfamiliar allusions sound old-fashioned to our modern
ears, and her reliance on Christian faith can prove difficult for secular
readers to understand. But I loved teaching Bradstreet. Her poems always
proved to be more than they appeared. 

In "Before the Birth of One of Her Children," Bradstreet addresses her
husband about an upcoming birth: "How soon, my Dear, death may my steps
attend/How soon't may be thy lot to lose thy friend" (7-8).1
<http://jama.ama-assn.org/cgi/content/full/298/3/266?eaf#REF-JPO70018-1>
She counsels him that if she dies in childbirth, he should marry again, but
"if thou love thyself, or loved'st me, . . . protect [our children] from
step dame's injury" (23-24). 

At first reading, this fear of death-by-childbirth seems overwrought, but
read in context of 17th-century realities, Bradstreet's entreaty to her
husband is moving: the notion that pregnancy does not also foreshadow death
is a 20th-century idea, and even now a luxury only the developed world can
afford. Maternal and infant mortality in Bradstreet's day was high, and
enough to make delivery of even the most wanted baby an occasion filled with
dread. In this context, Bradstreet's pleas to her husband are not
melodramatic: they are a frank assessment of what the couple faced when
pregnancy represented not just beginning a new life, but the possibility of
death. 

Once my students understood this connection between pregnancy and death, we
unpacked other particulars of Bradstreet's life. We learned that because she
had eight children-and a heart weakened by rheumatic fever as a child-she
faced death eight times. We calculated that eight births meant eight
pregnancies and that eight pregnancies meant she spent 72 months, or six
years, of her life pregnant. Eight births also correlates with nursing eight
babies, and in a time when women breastfed for about 18 months or until the
birth of their next infant, this means Bradstreet spent 154 months or almost
13 years of her life lactating. Moreover, these numbers only reflect babies
she carried to term. Bradstreet likely lost additional pregnancies to
miscarriage. But even if we only count births we know about, these numbers
mean that America's first published poet composed while dedicating 19 years
of her life-some concurrently-to work surrounding childbearing. 

Having sorted through these details, my students and I read Bradstreet
again, and even to our 20th-century ears, she made more sense. As poet and
critic Adrienne Rich argues, "to have written . . . the first good poems in
America, while rearing eight children, frequently lying sick, keeping house
on the edge of the wilderness, was to have managed a poet's range and
extension within confines as severe as any American poet has confronted."1
<http://jama.ama-assn.org/cgi/content/full/298/3/266?eaf#REF-JPO70018-1>  No
kidding. 

I have been thinking about Bradstreet a lot lately, not because I am a
mother or a Puritan, but because she understands something about the
commingling of birth and death, and because doing the mathematics of her
life is helping me make sense of my own. Two and a half weeks ago, or about
18 days ago, I finished a residency in emergency medicine and started a new
life as an ED doctor. This reality is as complicated for me as the fact that
Bradstreet bore eight children. As I have concluded the process that turned
me into a physician, I am struggling to comprehend the math of my own life,
and to understand what I have lost-and gained-along the way. 

When I finished residency on 30 June 2007, I had been working at becoming a
physician for nine years. This includes two years of pre-med, four of
medical school, and three of residency. Medical training has taken up my 30s
and consumed almost a decade. 

In addition to time spent, there have been other costs. The most obvious of
these are financial. I emptied my savings of $35 000 to pay for pre-med, and
then the real spending began: I owe lenders about $150 000 in student loan
debt. After consolidating my loans at an interest rate of 4.375%, I will owe
$813.40 a month for the next 30 years, or until I am 71 years old. My loan
money went for tuition but also bought groceries and paid rent. What loans
did not cover went on credit cards, leaving me with balances too
embarrassing to reveal in print. 

Other losses hurt more than money. Deciding to go to medical school meant
leaving a beloved teaching job at Bentley College in Waltham, Massachusetts,
so I could return to college and accumulate prerequisites. It also meant
leaving friends. On the Saturday morning I moved, neighbors gathered at my
Cambridge apartment and helped me pack. My mother and I then drove to my
office, where I loaded books into a moving van and began the process of
trading one life and career for another. 

But the process of accumulating losses had just begun, and over time, the
list of important and mundane things lost grew longer. I missed weddings,
Christmases, and too many dinner parties to count. Church services, time to
exercise or to hear a favorite band play, all went by the wayside in the
name of medicine. So did weekends, meals eaten with a fork, all my size
eight-and then size ten-clothes, and sleep. Yes, lots of sleep. By my
conservative reckoning, I have lost more than 200 nights of sleep in the
last nine years, a number that includes only time spent in the hospital
taking care of patients, not all-nighters pulled studying for exams. Of
these 200 sleepless nights, more than 50 were spent on 30-hour in-hospital
shifts, where going to work on Monday meant not going home and not going to
sleep until Tuesday afternoon-only to do it over again every fourth day
until the end of the month. Nights away from home also represent time lost
for family and personal relationships. 

Not surprisingly, when I think too long about these losses, I feel bitter
and self-pitying-feelings that make me wonder if the last nine years were a
mistake. This is when I start doing math in the other direction, to remind
myself there are also things I have gained. I have gotten a medical
education, I say, and start counting what that means: at 15 to 25 patients
per emergency department shift, I have seen about 7500 patients. This
represents 7500 opportunities to learn from another human being, and to try
to provide some help. These numbers also represent opportunities to do
procedures. According to my procedure log, I have placed 24 chest tubes,
reduced 13 dislocated shoulders, performed 25 spinal taps, and intubated 109
patients. I have performed 45 trauma and more than 139 medical
resuscitations. This, in turn, has given me the sad responsibility of
telling two families a month that someone they love just died-and giving at
least as many people the news that a family member has been resuscitated and
is now in ICU. At the same time, I have looked at more sore throats, done
more vaginal examinations, and sutured more limbs than I can count. 

I recognize that these numbers mean I have gotten the "medical education" I
call to mind in dark moments, so I add the numbers up regularly to remind
myself it is a blessing that for the rest of my life I get to do a job that
I love and be paid well enough to make a living. But because I have
experienced loss, when doing this math, I still wonder if I come out ahead.
I say this not because I am ungrateful for my education, but because I did
not go to medical school to have a good income, or even to become a doctor
with a capital D. Whatever money or prestige comes with my job means little
to me: however sexy placing a chest tube or intubating someone looks on
television, these skills alone do not make up for missing my nieces'
birthday parties and having to calendar, months ahead, chances to make love
with my husband. 

These realities lead me to look for other ways to make sense of the last
nine years, and answers come in a list of experiences that are less
quantifiable, but still real. Often they have to do with patients: the
Native American woman who called the spirit of her dead daughter into the ED
to heal an ailing loved one (and ended up healing me); the drunk trauma
patient who at the top of his lungs forbade us to cut off his pants because
"I've got a really small penis and don't want anyone to know"; and the
parents of a dead baby we had not been able to resuscitate who allowed me to
cradle their infant daughter while we all grieved. 

Other gains have nothing to do with medicine but are equally important. When
I started medical school, I thought there was light and dark, day and night.
I knew something about the way shadows fell in the evening and how that was
different from the way light looked at dawn, but I had not yet had enough
sleepless nights, or worked enough days in a row without seeing the sun, to
know that indoor, fluorescent light looks different in the day than at night
and that a peek at outside, ambient light on even the cloudiest February day
can be something beautiful to behold. I did not know the difference between
not sleeping at all and getting 20 minutes of sleep or that what I called
"insomnia" prior to medical school meant I had not slept well-not that I
actually had not slept at all. I did not know how precious an afternoon off
could be after a night on-call or how dear it could feel to climb into bed
at the end of a shift with a loved one-or even a dog. 

To be honest, until medical school, I did not know what life and death and
suffering really meant. Until I paid my $150 000, I had not known that dead
bodies are genuinely cold or that the fluids that come from living
bodies-blood, vomit, feces, urine-are always warm. I had not yet had the
humbling experience of telling someone that a family member had just died or
felt the impotence of knowing there was nothing I could do to help the
patient or spare the family its grief. In short, until I was a good long way
into all that debt and sleep deprivation, I had not understood very well
what it meant to be human. Maybe not even what it meant to be alive. 

Anne Bradstreet opens "Before the Birth of One of Her Children" with these
lines: 

 All things within this fading world hath end, 

 Adversity doth still our joys attend; 

 No ties so strong, no friends so dear and sweet, 

 But with death's parting blow is sure to meet. 

 The sentence past is most irrevocable, 

 A common thing, yet oh, inevitable. 

As I look at the last nine years and ponder the "inevitably" of death and
the "irrevocab[ility]" of "adversity" attending "joys," I realize I have
been miscalculating the math of Bradstreet's life-and my own. Thousands of
dollars poorer and many sleepless nights more tired, I wonder if the
important calculation in Bradstreet's life is not how she managed to write
"the first good poems in America" while "keeping house on the edge of the
wilderness," but how carrying, bearing, and nursing eight children enabled
her to do so. Rather than being a heroic figure scratching out time from
child-rearing activities to write, I am coming to believe that Bradstreet
simply lived. I also suspect that the gains and losses of her life-"confines
as severe as any American poet has confronted"-are the very things that
generated her "range and extension" and left us with poetry still good
enough to be read today. 

When I think about Bradstreet now, I try to stop counting the months she
spent lactating and hours she spent delivering babies and look at the big
picture. I see her at a hearth with a ladle bent into a pot and her foot
rocking a baby in a cradle. She may be pregnant or maybe not, but there is
always a pen, nearby. For this Anne Bradstreet, to live was not to account
but simply to experience and, when she had time, to set it down. This woman
understood something in 17th-century America that I am just beginning to
comprehend today: that life is not a zero-sum game. A gain in one column
does not necessitate a loss in another, and winning does not correlate with
being debt-free or having the fewest losses in the final tally at the end of
life. Rather, all losses are gains. All gains have corresponding losses.
This is not harsh or bleak or cruel. This is being human. This is life.
Sometimes you are talented enough to write it down. 

And sometimes you are lucky enough to read what a wiser writer had to say
about it 329 years ago. 

Acknowledgment: This essay is dedicated, with gratitude, to everyone in the
emergency department at the Nebraska Medical Center. 

 


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