The Patch of Nothingness

A Sensible Medicine Guest Post

I’ve always thought that reflective writing (or narrative medicine, or health humanities, or whatever you want to call it) can be an important tool for managing the intensity of medical training. David Deshpande wrote for us when he was a first-year student. He is now a fourth-year, and I am thrilled to publish another one of his essays. This one is a bit longer than our usual, but I think every word is worth it.

Adam Cifu

I stood on the glass-littered sidewalk at the edge of our apartment building and stared into the Patch of Nothingness—an expanse of dirt between our fence and the sidewalk. Like so many others around the neighborhood, it was scattered with weeds, old dryer sheets, fast-food wrappers, and a sparse layer of cheap landscaping mulch whose artificial brown dye had faded in the sun.

In the weeks before my third year of medical school, I felt exhausted and missed home, where I would sit by the perennial gardens planted with my family. Where those gardens had once grounded me, this patch seem to untether. It epitomized the longing I felt to exist and learn in place where I was connected to the soil, the plants and animals, and the people in the community—where the ecology of things felt in balance.

This disconnect cut deeper because the social fabric around me also felt frayed. Shootings plagued the surrounding streets. Families I treated struggled to get enough to eat or to find a safe place for their children to play. In the hospital, these conditions magnified—each patient revealing the unfathomable toll that years of scarcity and suffering take on the body.

Standing by the Patch of Nothingness, I thought of Ms. B. She was the oldest resident in our building and a life-long South-Sider who naturally assumed the role of our de-facto building manager. My neighbors and I would often stand in the backyard with her while she shared— always with a perfect mix of sass, humor, compassion, and deep-rooted wisdom—local history and stories about her life and our neighborhood. She spent hours moving a sprinkler across the grass with quiet precision. A recurring theme in our conversations was her longing to have flowers outside the building, like she’d tended at her last apartment. Ms. B had a gift for plants, but her current collection lived exclusively inside, each one carefully chosen based on what she could carry home on the bus. “I know how to garden,” I thought. “Why not plant some?”

I slid open my small wooden seed box and sifted through, admiring my great grandmother’s handwriting. She’d gifted it to me over twenty years earlier in the first of many summers we gardened together at home in Wisconsin. “Fast-growing, resilient, and luminous,” I thought, holding the packet of zinnia seeds. The zinnia sprouts—along with marigolds, ageratums, and bachelor’s buttons I’d sown with my fellow neighbors—were pushing seven inches tall around the time I started my emergency medicine clerkship. After the chaos, suffering, and unpredictability of the Emergency Department, I relished tending the plants each day, anticipating their maturing and blossoming. The ritual continued—water, pick up trash, pull weeds, inspect the plants—and finally, the first flower popped. It was a lush and deep red so vibrant it was visible from down the block or across the street. Then came the others, like fireworks, until the whole patch began to glow with color.

Soon came the bumblebees, gold finches, and various butterflies—life was returning. On Saturdays, as crowds passed on their way to the nearby farmer’s market, I sat in the yard with my neighbors—many of whom had taken on their own roles in caring for the plants. “These flowers are so beautiful!” group after group exclaimed. Children would stop in awe, often drawn to one flower in particular, and we’d step out to greet them and help them cut the one they liked best. The reaction from the community was staggering, overwhelming, and repeated itself each week.

But perhaps nobody was prouder than Ms. B. She basked in the compliments, standing in her typical posture: feet shoulder-width apart, hands on her hips, lips curled into a prideful little smirk as she stood—all five-feet five-inches of her—in her matching seasonal pajamas and glasses. She had even planted her own potted flowers around the building, and she’d kept a hawk’s watch on them, alerting us with a suspicious tone whenever a flower seemed to have disappeared without permission.

Our evening conversations with her followed a typical rhythm. As the flower rush died down, we’d encourage Ms. B to pick some for herself, but she insisted it would ruin their appearance for the neighborhood. But, if we offered to cut them for her, she’d gladly point out which flowers she preferred, standing, naturally, on the sidewalk with one hand on her hip while she pointed with the other. “The flowers show that we care, and that the community can be beautiful,” Ms. B told us. She was excited to plan the next round with us in the spring.

These flowers grounded me through the most challenging months of my life. During my time on trauma surgery, they helped me hold steady after witnessing violent deaths, including a child shot a dozen times. In neurology, they calmed me when I came home heartbroken from memory clinic, having seen families overwhelmed by caring for loved ones with dementias. On vascular surgery, I found solace in the flowers after sawing off legs ravaged by complications of poorly managed diabetes. But nothing prepared me for the phone call I received from my neighbor: “Ms. B got hit by a car and died.”

Nobody knew any details—only that she’d been struck at a crosswalk and was taken to the very trauma center I’d spent the month prior. I could picture it all with painful clarity: the radio call from the ambulance crackling into the ED radio room, the urgent chorus of pagers. I knew the route the trauma team would’ve taken as they walked, routinely, downstairs from the workroom, the bed (Bed R52) where they’d have slid her lifeless body to perform a few rounds of CPR. I knew where the white body bag would be pulled from—the tan cabinet between R52 and R56—and the route they’d take to the elevators, rolling her down to the morgue until the County Medical Examiner could collect her body. I knew every detail of that final journey. And I imagined her there, all five-feet five-inches of her, hands at her side—though I still picture them on her hips.

Ms. B’s death made me enraged and cynical. The sheer unfairness threatened to unravel me: that she commuted by foot and bus to Jewel Osco for groceries, that her friends and other family members lived to the south in neighborhoods with even worse pedestrian infrastructure—it was all so bitterly, senselessly horrible.

It took a lot of tears and talking, but slowly, it was through her love for the flowers—and our reflections on what they meant to the community—that I found some peace.

I think often of how the flowers mirrored and facilitated my own development this year, each of us growing roots in a patch of land that felt at first unfamiliar and barren. Their need for regular care has required me to pause and slow down on the most gratifying, stressful, or heartbreaking days in my medical education and life. And most of all, transforming the Patch of Nothingness into a flower garden has reconnected me to the full person I am beyond the hospital walls—to the passions and practices that first called me to become a physician. The flowers remind me of the person I want to be: fast-growing, resilient, and luminous.

Although I had a lifetime of gardening experience, cultivating a public flower garden—grown for beauty not function—opened a different kind of relationship with the world around me. Through it, I came to know every resident in our building, talked with dozens of families in the neighborhood, and learned the layered history of our building and our block. It helped me see more of what was already here—not just the hardship and heartbreak, but also the beauty.

Ms. B had already known this. She had done the same kind of tending throughout her life, understanding the quiet, cumulative power of small acts to nurture one’s health and the spirit of a community. Our flowers didn’t solve everything, but they made a real difference—to me, and to hundreds of others.

A couple months after Ms. B died, I ordered a new package of zinnia seeds, along with a few other varieties to mix in. As the ground began to thaw, I texted my neighbors about the new seeds and waited for a warm, sunny day to inspect the soil. To my delight, hundreds of zinnias had already sprouted from the seeds of last year’s flowers—volunteer seedlings, as they’re known to gardeners. Their sudden return felt like her doing: persistent, radiant, and impossible to miss.

David Deshpande is a 4^th year student at the Pritzker School of Medicine, University of Chicago. He is deeply grateful to Dr. Ranjana Srivastava, Dr. Jacqueline Stuhmiller, Christopher Mueller, Erika Doane, and Sydney Steinbach for their generous feedback and support in shaping this essay

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Photo Credit: David Deshpande