Editor's Note: I found this selection to be immensely challenging, at times even cryptic, but deeply compelling nevertheless. Stick with it. It is very much worth the effort.



A Personal Statement

by Joshua Francisco Ceñido, MSIV


I. Weakness in Strength

The alarm. Getting hold of that phone. Eyes adjusting.

The rush and push of traffic, of which I've learned to become a part. Laser beam boring.

"Stand clear of the closing doors, please," a charming recording, sarcastic comfort, chimed at every stop.

The stomp up steps. A different rush and push. The air. The same flow.

The gentle tap and rustle of prideful plastic. Professional face on the ID, professional face on the face. The sterility, the change in temperature. The overhead hum of reconstructed light, of altered air, of people-movers, machinery. In this stronghold, the beeps and tones, hisses and gurgles, of pumps and monitors, sounds to direct eyes to numbers and waveforms. My pager on me, somewhere.

The gamble of a greeting to and from my dream team. Yes, I've dreamt of them, and of this life, in one form or another. Form: The greeting. The service. The cordiality1. The consent. The trust. The responsibility. The agreement. The exercise. The confidence. The conference. The application. The years of work behind and ahead. The humanity.

The clean inertia. Plastics and metals, Measured, calibrated, lubricated. Flow. Solutions, formulated, signed off on. On. Off. Hold. Administer. Push. Observe. Monitor. There are silences between each beat, silence heard over the ringing hum of reconstruction. Between, breaths and sighs, the sounds of shared struggle, trampled to a whisper, lost in small talk. One of many voices of one of many stories.

That greeting, that simple cordiality, is part of a solution. An essential component, a sincerity that underpins our understanding, that makes our goals, spoken and unspoken, achievable. So that we, I, in the Babel of silences, may better grasp the purpose to this day and the next.

This exercise. This responsibility. This dream. This real and partially-documented exchange. Activation energy2. Worth the investment. Because at the interpersonal, individual, cellular, and even atomic level, healing begins with a greeting.

"Stand clear of the closing doors, please."

Doors shut and the capsule embarks, trundling toward its targets. The journey isn't supposed to be the problem. I'll find my nutrients as I do my other substrates, as do my fellow humans, as I work to become one of a select few, as I endeavor to meet criteria beyond my control; criteria dictated by ever-changing variables. Its rays permeate, elucidate, permutate, and destroy.

A cell cannot think; it merely does. It performs compartmentalization and transformation, responding only as a result of its programming and stimuli. A person chooses. A person despairs, curses, doubts, cries, fears, envies. A person can choose hope. A person can care. A person can ask questions. They can find, refuse, and question answers. A person can choose to be uncomfortable. A person laughs, chooses to love, chooses to believe. A person prays and dreams and dreams adjust.

A person can train to compartmentalize, to transform. But Q: What heals beyond physicality? A: The sweet longing that lies behind the bitter science. Behind the real and partially-documented exchange. The Humanity. The dream of practicing that humanity, that shared, often-overlooked push. The original pull.

Convergence. Setting my alarm. Accommodation3. Eyes adjusting.

The cell does not choose to adjust. A cell turns out a product. It performs a painfully finite purpose. Its value lies in its efficiency, precision, and endurance. But for all its understated complexity and intelligent grandeur, it is frequently lamented for its dysfunctions, failures, and death.

Affairs in order. Alarm set. Eyes adjusted. Sheltered in darkness, perchance to dream. Before the next cycle.

II. Strength in Weakness

And now she has cataracts. So my movements have to be more and more exaggerated to get a response. And her hearing is going, so that the filmic scene of yelling to her from across a busy street, lives on only in our minds.

Or at least in my mind. Do I mind that her mind lies enmeshed in plaques and tangles4? Am I allowed to mind? If I didn't mind, would that make me any less human? ‘She minds less every day,' might be what the science will say, but what does that make her? Even all of science and all the words of every language, present or lost, cannot define a person. Asymptotic. She'll trend towards an unattainable; but then again, she always has.

Or, at least in my mind.

Her humanity has no X-axis5. Her function defies all rules and expectations. And though you knew in what direction she was moving, you'd never know the place, and you'd never know time.

So as I watch her, in a state she may never remember, I am destroyed. By her rays, that smile, she meant for me, that polite-then-empty gaze. Timeless, with all of time contained, but without enough to take her full history and memorize her. Our eyes observing the same light. That clean inertia, pushing every one of my desperate cells, firing. Ringing. Fizzling.

She once told me that she missed my smile.

She won't see me wink, or smile. She can't hear me whisper, and her eyes don't look the way they once did. She won't hear me wake her up with some song sung breathlessly.

She may not even know who I am. Not even in the scrambled images of me I hope are still holding on.

But maybe she can see my despairing, caring, cursing, questioning, loving, doubting, faithful, tearful, fearful, envious face. And she'll be too polite to ask who I am.

In this blessed moment, I feed her the eggs I prepared, as I've prepared them countless mornings before.




  1. Form of "cordial" adj. warm and friendly; n. a term for liqueur; n. a comforting medicine
  2. "Activation energy" n. (chemistry) the minimum quantity of energy that a system of chemical species much possess in order to undergo a specified reaction.
  3. "Accommodation" n. the process of adapting; (medicine) the adjustment of the optics in the eye to keep objects in focus on the retina
  4. "Plaques and tangles" (pathology) are the identifying features for the definitive diagnosis of Alzheimer's Disease.
  5. "X-axis" n. (sciences; mathematics; statistics) the horizontal axis of a Cartesian coordinate plane to which continuous independent variables are usually assigned, e.g. time


Supplemental Note from the author: "I was inspired by my interactions with people from all walks of life, with patients I've had the honor of working with, and with my grandmother, who was my original inspiration for dedicating my life to the career of medicine. She is a wonderful woman who has moved on to the next life after a long battle with Alzheimer's Disease. I have since met with other patients who suffer from dementia and their families, and in those moments of despair, what I wanted to take with me was that all that suffering and uncertainty, pain and loss, and sacrifice, all stems from the love of one person for another. I had the privilege of attending an 8 part workshop in Narrative Writing at NYU-Lutheran Medical Center with Stephanie Adler-Yuan and Fred Nenner, who helped me develop this piece. With the tenets of narrative medicine in mind, I wrote and revised this piece in hopes that I could communicate this human and essential component of the patient / family / physician / illness interaction."