First came night, and then black rage upon the

     Gloaming. And from the silence of the harrowing

Gates came Rape, riding a tubercular mare, and

     Towing a rusty pickup truck, upon which trainees

Took turns doing practice pelvic exams on an

     Anesthetized patient; her first surgery, she clung

To a stuffed rhino in the pre-op area, her parents

     Uttering soothing words about how only the smartest

People got to be doctors. Next came Bankruptcy, a

     Furious conflagration through which countless

Hearths were burned to ashes, as the vanquished

     Watched in horror, humiliated and debased they

Succumbed to the roaring shadow. Descending on

     A giant vulture was Substance Abuse, wearing a

Hat that said Adderall for Every Simp and All; from one

     Arm it hauled a bag containing the spirits of those

Slain by barbiturates and benzodiazepines, trailing

     Were the phantoms that frantically sought to put

Their souls back inside their bodies, the fiend always

     Just out of reach of their forlorn and wretched

Grasp. And lastly came Murder, a skeleton riding

     Atop a frothing Tyrannosaurus whilst toting a

Shotgun and donning a bandolier loaded with Vioxx

     And OxyContin, the bodies of mangled patients

Dripping from ghastly maws. And these four horsemen

     Defiled wolds upon the main, they stole the weeping

Babe, they moaned on mottled ground – they loosed

     The Hadean tide – they clove the prairies of the dawn