Anatomy of an Alarm

You are a fist-sized ember perched above each kidney, twin sirens disguised as glands.

At 3:17 a.m. you uncoil, no alarm clock, no predator, only a vignette of failure flickering behind my eyelids.

A hypothalamic whisper becomes CRH, becomes ACTH, becomes the metallic bloom of cortisol surging into every capillary.

You flood the perimeter with catecholamine, commanding heart to drum, bronchi to flare, gut to abandon its slow alchemy.

I sit bolt-upright, palms slick, mind frantic to name the threat you swear is real.

“We are late, we are lost, we are dying,” you chant through a pulse too loud for the small bedroom.

I used to curse you: a laboratory of misfires, an evolutionary relic that cannot distinguish e-mail from saber-tooth.

But in daylight pathology, I memorized your grammar: zona glomerulosa, fasciculata, reticularis, three stained glass panels of well-meaning messengers.

You do not intend harm; you practice protection in the only language you know surge, sprint, survive.

So tonight, I will answer in a dialect of diaphragm and vagus nerve.

Inhale four counts, suspend, exhale eight.

I picture you as a startled animal offered an open gate; your vasoconstricted corridors widen, cortisol ebbs toward basal.

Heartbeat decrescendos in a quiet room.

Thank you for arriving, I say, but the fire is out; stand down.

You listen, reluctant, faithful, and settle once more into blood-warm ash.

Acknowledgements: I am grateful to the patients who have entrusted me with their stories; their courage and candor inspired every line of this poem. My deepest thanks go to the psychiatry faculty at Houston Methodist Hospital, whose mentorship has shaped both my clinical practice and my writing voice. I also thank my family and friends for their unwavering support during long nights of study and reflection. Finally, I extend sincere appreciation to The Journal of Humanities in Rehabilitation for fostering a literary haven where medicine and art can meet in dialogue.