Elisabeth Preston-Hsu


Sunlight seemed elusive the year I was a physician intern: I arose before dawn and came home after dark. Getting enough sleep proved challenging, an unattainable goal as a new physician. Even trying to take breaks felt impossible. I felt violated every time my pager went off and happened to be in the bathroom. Interns everywhere expected this stress during our first month of work, but it didn’t make it easier. Days locked together for me in this microcosm of wonder and terrifying responsibility for others’ lives. I met angry families, sick patients, organized nurses, and physicians, old and new. I needed the calm of a forest, something I wouldn’t find in the fluorescent-lit hallways of a central Illinois hospital. After my first day in 2006, I sat in my car and cried.

I discovered the calm on the Crate & Barrel website soon after that day. I’ve never much cared for flowery designs on clothing, curtains, or bedding. I prefer the green of leaves. The fresh feel of a forest around me. An enveloping canopy. Pockets of light. Calm was woven into the Marimekko comforter and sheet set on my computer screen. Kukkula design. Iced green and white. Kukkula means “hill” in Finnish.

I needed to make my bedroom something I had some control over, inviting and separate from work. A leafy-patterned sheet and comforter set encouraged escape and respite. I imagined myself inside a hill, this Kukkula, while attempting to climb the mountain of Medicine.

My husband and I had married eight years prior but we’d never chosen a queen-sized bedding set together. We defaulted to his bachelor acquisition of a pinstriped blue duvet. Buying a bedding set for $200 wasn’t possible with our student stipends and loans. Kukkula felt inevitable, no matter the cost.

The comforter stared at me from the computer screen. Buy me, it called. Stop thinking so much. I clicked “Add to Cart” and a week later unfurled it onto my bed. I wrapped myself in the crisp new comforter at bedtime, trying to block worry and stress from the day. My gossamer-soft cat announced himself with loud purrs. He cuddled into my armpit so gently one night, I couldn’t tell if I was dreaming or still awake. I prepared myself for many contented full nights’ sleep.

Except I had to wake up, again and again. I faced another day, watching people die, watching them barely live. One night on call at the hospital, a patient summoned me to his room.

“Doc, I know I’m gonna die.” He said this matter-of-factly, a warning. “Soon.” He was coherent and medically stable despite his advanced cancer. His labs and oxygen requirements looked better than the day before. He talked to his daughter daily and his medical team had planned to discharge him home with his trending improvement.

I encouraged more conversation with him without expecting to go further on the topic of death. We discussed his long-standing pain and he circled back. “I’m tired. I’m okay with dying.”

Hours later, he fell into gasped breathing, nurses confirming his thready pulse and slowing heart rate. We were all surprised. None of his improvement had predicted this quick decline.

He had signed a “Do Not Resuscitate” order so the nurses and I stood sentinel to this man’s last steps to death. I returned to my cold call room after midnight to make a difficult phone call to his daughter, the one he adored.

I had no choice but to keep going that year. Sacrificing so much on the altar of Medicine, I couldn’t turn back now—I had taken so much time and borrowed thousands of dollars in student loans to become a physician. I steeled myself to not turn into one the jaded doctors who often supervised me. Compassion waned when fatigue overtook me. Seeing patients, writing orders, communicating with staff, and following up with attending physicians made my daily to-do list. I’d tick off each task with a sense of satisfaction, only to have more duties added to the list. I quickly became one of the discontented despite my attempt to fight it.

Compassion diminished further when chronic exhaustion and anger cuddled together. Almost every morning, I’d hear the birds chatter when I arose at 5AM. The chirping changed when the seasons did, to what felt like earlier and louder. I’d think Those damn birds! Shut up! What are they singing about? I later learned songbirds at dawn sing to establish territory and attract mates, not for joy. I likened the birdsong to my pager, interrupting me over and over, warning me of the territory of my chosen career.

The margins of that territory became indistinct between my work life and non-work life. I did not appreciate birds invading my leafy-patterned forest. I looked into the inky dawn, trying to decide if I could throw a rock far enough to hit the tree where I suspected the birds roosted. I couldn’t. I wanted silence from them and my busy mind. If I could just sleep in a long, uninterrupted stretch, then maybe I’d be open to finding some appreciation in birdsong. My life involved nothing but taking care of others. That in and of itself wasn’t the problem. I was less able to give to others or be joyful when parts of me disappeared in sleep deprivation. I wanted to protect the pieces that remained. I learned to ignore the untimely birds and compartmentalize my bird-anger while continuing to make lists and tick boxes in sleep-deprived automatism.

Pigeons cooed on my window-set AC unit a year later, now a welcome lullaby in our new Chicago home. The comforter sat rumpled on our bed when my husband and I brought home our first child five weeks earlier than expected. Her skin felt like soft butter and she looked like a pink cloud. The downy gray light in the mornings showcased her rosiness and the icy green comforter. She and I smelled sweet, like ice cream, like fresh, new life. Joy opened in my overly-busy life as a medical resident physician and mother. An anxious contentedness imbued my exhaustion during the hours I spent in my Kukkula bed with my baby. My old new thing and my new new thing—together.

More life happened. We moved across the country three years later. I had another baby. I started a new job. The Kukkula fitted sheet became thin and pocked with holes. The repetitive slide of my arm under my pillow when I rolled into bed to nurse my babies in the side-lying position over the years took its toll. So threadbare that one fell swoop into bed caused a huge tear where I caught my thumb, the sound waking up my son, our second-born. The ripping sounded like the world tearing apart. In a way it was: my safeguard gaped with an irreparable gash. There was no way to heal this worsening wound. “Sorry,” I whispered. I shoved my breast in his face to lull him back to sleep.

I replaced the fitted sheets with a cheap impulse buy, patterned with multicolored polka dots. I went for cheerful, like a party. A way to help me pop out of bed in the morning. I mourned the trauma of my cotton forest against my sleep-deprived, milky body. My husband shrugged and moved on. He never needed Kukkula like I did.

The pillowcases had similar fates. I used them as rags to clean the house when the holes prevented proper pillow coverage. I still used the comforter, my favorite part of the hug. It tore last and I made a sacrifice to save it. I cut the matching flat sheet and repaired the tears on a friend’s sewing machine. I’m not a surgeon but I felt like one then, trying to suture this damage with a needle and thread. My third-born child crawled at my feet sucking on bits of cereal. I patched my fading Kukkula to feel like new again, Cheerios caught in its folds.

Years later, the refuge of Kukkula remains important even more deeply. The COVID-19 pandemic has animated an anxious nihilism in me, and for healthcare and essential workers everywhere. There are days when I am so weary from it all. Though I don’t take care of acutely-ill people with COVID, I see them for other medical needs after they’ve been discharged from the hospital. I fret about how certain patients are doing, if I’m doing enough. I address patients unhappy with their care. I smile at appreciative comments from patients and colleagues. And still, an unease sometimes hums me awake in the flutter of my Kukkula’s fading branches. I’ve frantically searched Crate & Barrel for a replacement bedding set. It doesn’t exist anymore—discontinued.

But I continue. I stare at the computer screen at work. One phrase is in italics and the next line is not. The pattern of text continues. If I blur my vision a little, the rehabilitation interdisciplinary care note has the same houndstooth pattern on some rarely-used sheets stuffed in my messy linen closet. The zigged-zagged angles poke me. They feel like the shrill of my pager.

My career has evolved since Kukkula has joined my family. I am older and more experienced. I don my face mask and shield at the hospital, speaking to patients louder and more muffled than I did years ago, hoping we understand each other. We find connections though anxiety, fear, and grief rustle constantly during this pandemic. We have hope in vaccinations. If we are lucky, we find peace in little places.

My scruffy Kukkula edges in, with curves and curls, light cool green with a sun print of fluttering leaves. It usurps the hardness, the splinters. The white of the shadows is the opposite of the ominous darkness lurking in corners of my anxiety, in patients’ rooms wrestling with illness. Kukkula pushes me to climb through my sweet rill of sleep, a potion to refresh and reconfigure my goings-on. My compassion rouses from its hibernation. My hill to help climb a mountain.

I continue to patch threadbare holes with new parts of me and the remnant flat sheet. No checklist. No irritating birdsong. Watching children grow. Helping patients with their medical care. Kukkula scoops me, and others, into a years-long hug. I pull the comforter over my youngest daughter on her bed. She sleeps, cocooned in light silhouettes when I curl up next to her and dream.

Elisabeth Preston-Hsu is a Physical Medicine and Rehabilitation physician in clinical practice in Atlanta, Georgia. Her writing has appeared or will appear in Bellevue Literary Review, Chicago Quarterly Review, North American Review, and others. Recently, she was a finalist in New Letters’ Robert Day Award for Fiction in 2021 and a runner-up in North American Review’s Hearst Poetry Prize 2022, judged by Natalie Diaz. Find her on Instagram @writers.eatery.