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Straight arms. Lock elbows. Depress three to five centimeters down into the chest. Stay perpendicular to sternum. Keep rhythm. Do not relent.

“If you don’t break ribs, you’re not doing it right,” my classmate jokes. He must know — he is one of three experienced paramedics in the classroom.

He has seen this all before.

“There is a high risk, during cardiopulmonary resuscitation, that the ribs will be broken.” Our training pamphlet makes it clear. It is common clinical collateral — an expected expense.

A necessary evil.

There is a green, gated door in Kaohsiung, Taiwan that I have passed through since before I could walk. It is two blocks away from a small, dusty tributary overhung with bright red lanterns at all times of the year and three blocks away from a rather spontaneous-looking temple interweaved with elaborate dragons wrapped in golden scales. If you walk two blocks forward, three blocks left, take a right, and then a left, you will come upon a bustling market with some of the best street food you’ll ever taste. It will be served from pots that are of questionable hygienic standards, slopped into old cracked bowls by ungloved hands, scooped with flimsy pink plastic spoons, and despite the cacophony of clucking chickens and aggressive bargaining, you will revel in every bite.

I do not know the names of these streets, or what to call the market, or who to pray to in the temple. I could not tell a traveler how to get there. I only know their locations in relation to the green door, in relation to the place where my father’s family has lived and loved for decades. It is where we gather around a bowl of fat, seeded grapes, fresh longyan, slices of vibrant starfruit, and creamy wedges of guava. This green door has watched my father come home from elementary school, watched me return from America, watched my cousin as she left to be married. It has watched our family grow larger.

And now it has seen my family grow smaller.

Two days ago, my grandfather was found slumped outside the green door without a pulse. Two blocks from the weaving red lanterns, three blocks from the golden dragons, six blocks from the busy stalls with flimsy pink plastic spoons.

I imagine that the green door watched as the paramedics broke three of my grandfather’s ribs in their attempt to save him.

A necessary evil.

Straight arms. Lock elbows. Depress three to five centimeters down into the chest. Stay perpendicular to sternum. Keep rhythm. Do not relent.

They tell the class that in our attempts of CPR, it is likely that ribs will snap beneath our one-and-two-and-three-and rhythm. That while we hum “Staying Alive” to keep the beat of our compressions, we will oftentimes splinter the safeguards of the heart. We may not even realize what we have done. We will be spurred on by our adrenaline, by our inexperience, by our overzealous fervor to save a life. They tell us with a chuckle. They tell us like it is a rite of passage.

We listen in class as if our professors will tell us how to solve the mysteries of medicine. We study our books as if they will give us the answers to health and healing. We apply ourselves as if memorizing these facts will teach us how to be good doctors.

“If you don’t break ribs, you’re not doing it right.”

My grandfather, at 89 years old, cannot take the pain of his bruised, cracked, and broken ribs. He promptly signs a DNR — Do Not Resuscitate. It is now unlawful for the doctors to try and save him if his heart stops again.

He does not imagine that opening his eyes one more time is worth waking up to more of this pain.

The doctors cannot fix what they have broken.

As I sit here, surrounded by lecture notes and anatomy atlases, flashcards and color-coordinated study guides, my parents are flying home to Taiwan. My father will enter that green door, but his father will not ever again. This is another loved one that I will not be able to say goodbye to because I cannot afford to leave school.  This is the second grandfather that will pass while I am sitting at my desk miles and miles away.

“There is a high risk, during cardiopulmonary resuscitation, that the ribs will be broken.”

It is unnerving to watch a creature crawl out of the pages of a book.

The last time I saw my grandfather, he was leaning on his cane, ushering me into a taxi. I can see the green door behind him.

He told me to study hard in medical school.

Jennifer Tsai Jennifer Tsai (11 Posts)

Writer-in-Training and in-Training Staff Member

Warren Alpert Medical School of Brown University

The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.

I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!

  • Sarab

    Beautifully written and it reminds me of much of the suffering of the beginning of medical school.

    Hold onto your humanity, kicking and screaming if you must because this process attempts to take it from you.