Kathleen M. Ogle, M.D.

A clinical assistant professor in the department of medicine, division of hematology-oncology, at Hennepin County Medical Center, Kathleen Ogle is also honing her craft as a writer at the Loft Literary Center in Minneapolis.

Photo by Scott Walker

This is the second time Kathleen Ogle, M.D., has been a winner in Minnesota Medicine’s writing contest. In 2005, she won for her story “Caring for Diana.” Ogle says writing occupies an even more important place in her life now than it did then or even a few months ago. Last February, she started an intensive two-year apprenticeship program at the Loft Literary Center, which requires her to meet with a mentor and a group of other writers and do coursework on such topics as memoir, dialogue, and essay writing. She says she’s much more productive because of the inspiration she’s receiving from her newfound community of writers.

What prompted you to write this piece?
This was a real patient that I took care of maybe 10 years ago. The impetus to write about her actually came when I was taking a poetry class. I read a poem about someone meeting somebody that evoked a lot of senses. That reminded me of my initial meeting with this woman.

Why did she stand out?
It was such a surreal experience for me … to have this person who seemed to be pretty well-educated and successful and had access to medical care and yet had gone down this path of not seeking medical care for something that was so obviously wrong. It was such a horrifying and sad, and really heartbreaking thing. She had only finally come in because she had been struck blind.

The sense of smell is so important to this story. Have you ever written about this sense before? Not in this way. I’ve talked about other medical smells—the way hospitals smell, certain parts of the old university hospital, for example. I can walk through the corridors, and even though it’s been remodeled, it still smells the same. I remember what was there before. Smell is so evocative.

You seem to link her sexuality and her health. Was that deliberate?
Yes it was. I was speculating. But it didn’t seem like a big leap to me. Her husband was very explicit about the fact that they hadn’t been intimate for some time even though they still lived together. And she later was as well. It seemed to me to be a logical connection to put that together. … This couple had been kind of coexisting for what must have been a pretty long time. It was another element of the tragedy of her life.

Why did you write about the husband’s and wife’s clothing?
I was really reporting what I remembered about them. They were kind of an odd couple. I later learned that they had been high school sweethearts and married for many, many years. She’d moved up the ladder in the corporate world, starting out in a clerical position, and he held a working-class job. They needed to dress very differently for their work. It seemed another way to illustrate what I was taking some poetic license with and speculating about—that their lives had diverged.

At the end, you describe one of her gestures. What did that mean to you?
There is a sort of odd grace that smokers have. ... The way they hold their hands. There’s a certain quality to the movements. She had that. It was such a jarring statement as well—that she thought she’d get lung cancer, that her lungs would get her—as she was pointing to her chest. It evoked a lot of memories of family members who were heavy smokers, of aunts and uncles and cousins, holding cigarettes.

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 July 2007 | Back to Table of Contents

Writing Contest

Winning Entry-Physician Category

Homonymous Hemianopsia

By Kathleen M. Ogle, M.D.

What brought her in at last was the near miss. The oncoming traffic was blurry—well, had disappeared. So odd, right in the middle rush hour, almost hit someone, pulled off at the next exit, drove to the nearest emergency room. In 15 minutes, she is gliding into the scanner. The neurologist on call is alerted for the stroke protocol. The radiologist views digitally transmitted images from his desk at home and calls the ED. No stroke, he says, worse than that.

Horrible scan, the neurologist says, can I see her first thing tomorrow? There’s a mess smack dab in the optical tract, amazing she didn’t kill herself, didn’t kill someone else, can’t see a thing to the left of her nose. It has to be metastatic from elsewhere, can you figure out where it’s coming from? He hasn’t noticed, no one in the ED or neuro would notice such a faint odor. Focused on homonymous—on the same side, hemianopsia—hemi, half; an, absence or loss of; opsia, vision. Onset, acute. No one would, of course, ask about anything below her neck.

But immediately I smell it, beneath the smoke that thickened skin, clothes, voice. Beneath the carefully chosen fragrance. Beneath layers of hand-laundered silk bra, dry-cleaned blouse, and linen jacket. I know what I will find. The answers begin: married, no children, marketing executive, 27 years, retirement in five, but hey who’s counting? Long commute; traffic started her smoking again after a decade of abstinence. No regular doctor, can’t remember the last time she’s been to a doctor, too busy. No, she doesn’t feel sick, really she’s fine, oh maybe an ache or pain once in a while, but nothing important. Nothing about her is important. No, not losing weight, despite the expensive clothing that sags on her frame, well maybe some but she’s been so busy, too busy to eat. I say, tell me about the blindness. Calmly, she relates the story of the vanishing lane of traffic. Anything else? No, she feels fine, really. Well, perhaps her right hand has felt tingly sometimes. Anything else? Well, she supposed she should mention the little sore on her breast, been there for a while, she doesn’t know exactly how long and no it doesn’t hurt, nothing hurts. She’s sure it’s not important.

I step out of the examination room to allow her to change into a gown and have a sense of déjà vu. I’ve seen women like her before, a “little sore” on a breast growing for who knows how long. How can they ignore it? How can they cope? Doesn’t it hurt like hell? I don’t understand, I will never understand, what someone like her is thinking.

The human nose is designed as a defense against the common, pervasive stink, perhaps a vestigial need from the days when the back of the cave was filled with rotting meat, or the front room was really just an open latrine. But the olfactory nerve fatigues of perceiving the same smell if it persists in our environment and rapidly learns to ignore it. We can no longer smell it, unless we leave the environment and return. What if the source of the stench is a foot below your nose, and you can’t ever leave it? You’ll quickly get used to it, and the odor will vanish, like the traffic.

But the human eye is not so equipped. We cannot so easily blank out something that stays within our field of vision. If every time you take off your clothing something huge and ugly is staring at you, jutting from the left half of your chest toward the mirror, I suppose you just avoid mirrors, avoid looking down at your body. When you strap on your bra in the morning or take it off in the evening, you do it by feel. And sensation doesn’t dull with time, though the brain does its best to accommodate, to play possum. You learn to ignore what you are feeling, too. You conclude that it is normal to bring a bag of bandages with you to work so you can replace the ones that are soaked through by midday. The neocortex adapts beautifully to the most astounding ugliness and eventually concludes that it is normal. You become blind to what you are too afraid to see until, perhaps, “a mess” lands in your optic tract and you truly lose your sight.

But what goes through the conscious mind, I wonder. What story has she constructed to explain this? What fear drove her to deny its presence? What long, lonely road, devoid of hope, could lead her to say to herself, It’s nothing important? When the raw, open wounds are on the body of the person you love, you can get used to anything. You can lean close to it, delicately care for it, gently clean and dress it. But when it is your own body, and you have watched it grow and break through and decompose, and you have done nothing to find out what’s wrong, nothing to intervene, what do you say to yourself? Not I love you no matter what. Maybe, I’m too afraid to hear the truth. Maybe, I’m not worth it, why bother? It’s too late now anyway.

And, of course, it is too late now. Her breast has been replaced by a tumor that distorts it and has eroded her skin. An oozing cavity, the source of the smell, sits in the center. Her other breast, too, has lumps beneath the surface, and there are lumps under her arms and above her collarbone. Her liver is enlarged, her lungs are congested, and her bones are tender to the touch because they are brittle and full of holes. The surface of her brain is coated with a thick rind of it, and a small lump of it has landed in her optic chiasm—the reason she finally came in. Homonymous hemianopsia. I estimate the whole thing probably started 10 years ago, if not longer. She has never had a mammogram, not that it matters now.

She sits listening with deadly serenity while I tell her what she already knows, denying pain until I discover that she has been taking 20 or so aspirin a day. I order blood tests, a perfunctory-but-necessary biopsy. I have to prove the obvious, I have to test for the hormone receptors that I know will be there, because otherwise she would have already been dead, because the other kind of breast cancer kills you much faster. I order X-rays to see how many bones are about to break. I write prescriptions for pain killers, stool softeners, a pill to soothe the poor lining of her stomach subjected to all that aspirin for all these months. I tell her I want to see her again in a week, to review the hormone receptor test results so she knows the choices she has, as if she has any choice now but to wait until this burden is too great and can no longer be carried.

I ask her if anyone is with her today. Her husband, he’s in the waiting room, until this moment she didn’t want him in the room, but now she thinks he should hear this. But she doesn’t want to hear it again herself. She waits in the exam room while I stand in the hallway and repeat each word to him and try to describe what will come. He says he knew something was wrong, but it has been so long since they have been anything other than. . . . He struggles to find the right word and fails. He says they are still friends, he will do his best. I look into his face, and I like him for that. As fashionably and expensively dressed as she is, he is wearing a working man’s clothes, and he smells even more strongly of cigarette smoke than she does. His face is sorrowful, and the sorrow is old. His hands are big and rough, and he looks gentle. Later, I learn he is a welder, he has inhaled vaporized metal for years and lost his sense of smell a long time ago.

As we stand there, I wonder how what drew them together slowly decayed until it now simply occupies the space where their coexisting lives overlap. Did she stop wanting his touch, or did he stop wanting hers? How long has it been since she touched herself? How did she know to select that particular perfume? Was no one courageous enough, no colleague, no neighbor, no relative, however distant, to have said, Listen, honey, is something wrong?

When I am done talking and wondering, I open the door to the exam room, and we stand looking at one another. She laughs sadly and says she always thought her lungs would get her, not something like this. Her hand flicks with heartbreaking grace across her chest, two fingers pressed together as if a cigarette is clutched between them, a smoker’s gesture. The harshness of exhaled burnt tobacco is for one moment the strongest scent in the air.

. .