Encephalopathy’s Muse

May 4, 2018

By Gregory Rubinfeld, MD

The thick and sultry August outside,

The stale ammonia scented inside,

James The Poet, bedridden, writing in a fury,

Charlotte on a chair next to him, yawning.


So too have I become…

My whole frame taken, turned,

The very color of my flesh

Yellowed like the pages of an old book.

Moribund, we living antiques,

At the eternal doorway.

The snickering sardonic Footman ever beckoning.


The deep blue ink on the napkin ran some

But the words were still clear, burnished.

I asked The Poet,

Why of all places on a napkin

Well you know,

They are, by convention, condemned to disposability.

I believe they may last.

Ah, what a devil of a fix I’d be in

If not for my words.


Routine winged slow and languorous like birds of the season

Would bring the same old, same old,

Saccharine lactulose,

This diuretic in that dose,

That diuretic in this dose

Stack ‘em up next to the napkins, growing now

Prolific as my bowel movements

James smiled.


Yes routine beats out the rhythms

Thank goodness,

Cause my feet have two left feet

And my iambs are am nots

Twisted in knots, falling over themselves.

Oh well, here I go.

Can’t erase on these damn napkins,

Sweet reader bear with me

Like when you feel addled by the drink

S’okay, you think,

It’ll be gone by tomorrow

But it stays and overstays it’s welcome

Takes your mind that you once prided your—

Ah, blast there I go again,

I’ll die before I get purple and melodr—


That sweet thing, little Zoe

Asked when we were pregnant with our second

“Daddy daddy why is Mommy’s belly so big?”

Well, dear, cause there’s life growing in there.

Man, if she saw me now.

“Daddy daddy why’s your belly so big?”

Well, pumpkin, cause there’s death gro—


I cut him off

Like I did every morning

To tap on him, listen to his organs

Eavesdrop on those private internal conversations.

How we clung to our routines.


The nights, he said, were the hardest.


Charlotte, my beacon in this dark fathomless sea

Conked out while I whittle away.

See, in this vale of death still she shines,

How I lean on you, my angel,

You can never know

This thing will take my liver

Then my life

But my heart will love you

Beyond the sick corporeal,

Sleep, sweet angel, for tomorrow

Begins again that routine.


That routine, beating and beating

Measured feet and meter down to the syllable,

Down to the milligram

The same olds meds again and again

The creeping madness edging in

Closer and closer

Despite your sickeningly sweet drink

Bet if you just let me my drink—


Feel it now.

She’s getting tired of this

Her arthritis acting up too

What a great test I am to her now

How long can she shoulder this weight before—



Small breaks from routine glare

Like a slight increase in creatinine,

An insignificant drop of white cell count

Or a missing Charlotte.

The disease, running low on organs to hit

Found a new target


Think it was getting hard for her.

Seeing things slowly… uh… slowly


They’re goin, these parts of mine,

Ha, little Zoe, wonder if she’d see me now,

When we were pregnant with our second, she asked

“Daddy daddy why is Mommy’s belly so big?”

And uh… I said… uh….

Well, poetry is poetry, know what I mean?

So anyways I was telling Char—

Huh? Like I’m stopping traffic?



Routine guides our footsteps when our will flags.

The stack of napkins stopped growing,

Till one day they vanished all together.

The Poet didn’t seem to mind,

He was, after all,

Wanting for health,

Then willing to settle for his mental clarity,

Then willing to settle for his wife’s company,

Then willing to settle for his words

Until finally that too was taken

And left him,

In a sense,

Wanting for nothing,

Bereft of everything.

The Poet didn’t seem to mind,

Encephalopathy’s apathy,

A parting gift,

The Poet didn’t seem to mind.

Dr. Gregory Rubinfeld, is an internal medicine resident at NYU Langone Health