Magical Realism in the Pediatric ER with Rachel Kowalsky
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What is the premise of Rachel Kowalsky’s short story “The Delivery Boy”?
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You're listening to The Nocturnist Conversations. I'm Emily Silverman. The ER in New York City can sometimes feel like the Tower of Babel. Both the patients and the people taking care of them arrive from all different backgrounds and often speak very different languages, either literally or metaphorically. Today's guest, Dr. Rachel Kowalski, navigates the ER daily as a pediatric emergency doctor. A three-time nominee for the Pushcart Prize in fiction and winner of the inaugural New England Journal of Medicine Fiction Contest, Rachel's writing brings the hospital alive in such a fresh and magical way. Today, we'll be discussing her short story, The Delivery Boy, which shows us the ER through the eyes of a young boy from Guatemala, as well as the team of clinicians who care for him.
Rachel's work has appeared in publications like the Missouri Review, the Atticus Review, and the Intima. She teaches health humanities at Weill Cornell Medicine, and in our conversation here today, we talk about the scrupulous research that she did to put together this piece, as well as what is lost and what is gained when things get lost in translation. Take a listen to Rachel reading a passage from her story, The Delivery Boy.
Alta Gracia, the Mexican intern who had been educated in the United States, Tuesday, 8.30 p.m. The trouble with English speakers was that they always made you wait for the noun. The girl was having an unprovoked first-time afebrile seizure, but by the time Iris got to seizure, precious moments had gone by and Alta Gracia had ridden a roller coaster of uncertainty and from dog bite to migraine to asthma attack. Unmoored with no noun, she had forgotten what she hoped for in this world, let alone the sentence. This was how they wore you down. Let's go, said Iris, fast. She hesitated. Safe, correct, fast. That was her hierarchy of intention. Fast was for bandits and birds of prey. When she'd first entered the delivery boy's room, the psychiatrist hadn't arrived, so it was just herself and De Los Santos Marcos.
She'd meant to bring ice cream to room five on her way, but Bonifacio, what's apter? Faced with competing urgencies, her boyfriend, room five, the delivery boy, and a sudden oppressive hunger? She'd chosen to do her work. I'm Dr. Tierrafuego de la Paz. Please call me Alta Gracia. I'm from Yucatan, Mexico, and I've brought you ice cream. That's very good, he said. The boy on the bed was awkward, out of context, fidgeting with the stress ball they gave teenagers at triage. His eyes darted around the room from countertop to ceiling to floor as though following an insect's flight. They were dark and serious, close set. His upper lip was the cupid's bow of a movie star, a bird in flight. He reached for the ice cream.
She handed him a plastic spoon from the breast pocket of her coat. He wiped it carefully on the sheet, pulled up the top of the single-serve container, and peered inside with interest. She tore open another package, fished out a spoon, and fell to eating. Her patient wore the uniform of New York City delivery boys, worn jeans, clean but faded, a T-shirt and cheap sneakers. His thick hair stood straight up and had dust in it or maybe lice. Where, she wondered, were the Latinx prep school boys, the lacrosse players, the heirs of rum and sugar? They had pediatricians and bicycle helmets. De Los Santos, do you remember how you got here? Oye, he said, looking up from his untouched ice cream. It was an invitation to listen, a turn of phrase she loved in her grandmother's mouth, but not in this mad place.
Do you know San Lucas Toliman? He asked. No, I'm sorry, but do you remember colliding with a taxi? It is my town. He glanced up above the supply cabinet, then back at her.
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Chapters
7 chapters
1
What is the premise of Rachel Kowalsky’s short story “The Delivery Boy”?
0:00–7:32
2
How does Rachel describe the moment she first read her story aloud on the show?
7:32–16:50
3
What inspired Rachel to become a pediatric ER physician and a writer?
16:50–24:11
4
How did Rachel research Guatemalan culture and language for the story?
24:11–32:53
5
Why does Rachel use magical realism and multiple points of view in the ER setting?
32:53–42:13
6
How does language affect patient‑clinician communication in the emergency department?
42:13–49:17
7
What role does trust play when the delivery boy agrees to a head scan?
49:17–52:12