ASCENSUS : Journal of Humanities at Weill Cornell Medical College Vol. 6

Ascensus Journal of Humanities Volume VI August 2017 • Weill Cornell Medicine

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Ascensus

Ascensus Co-Leaders: Herie Sun & Daniel Wang Editor-In-Chief: Herie Sun Visual Media Editors: Yujin (Stacy) Joo, Evguenia (Jenny) Makovkina, Hassan Muhammed Written Media Editors: Shellie Dick, Rahul Grover, Andrea Liu Design Editor: Hassan Muhammed Events Director: Daniel Wang Events Team: Iliana Gutierrez, Yujin (Stacy) Joo, Evguenia (Jenny) Makovkina Faculty and Staff Advisors: Susan Ball, MD Randi Diamond, MD Allison Lasky Front Cover Image: “Where The Light Gets In”, by Shahnaz Mohammed Back Cover Image: Digitization of front cover image, by Hassan Muhammed Layout: Hassan Muhammed, Herie Sun and Peter Hung Contact us at wcmc.lit@gmail.com With special thanks to the Liz Claiborne Center for Humanism in Medicine and support from the Office of Academic Affairs and NIH grant “Enacting the Social and Behavioral Sciences in Clinical Training”.

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To Our Readers: (Without whom, none of this would be possible) It’s hard to overstate the importance of humanity in medicine.

Whether it is in the interactions we have with patients in the clinic, the discoveries we make in the lab or the passion that we impart onto new generations, humanity is woven into the fabric of everything we do. Weill Cornell Medicine has been celebrating humanity for a long time now, in all that it does for its community and the people therein. But this is the sixth year that we have compiled and made a physical manifestation of the humanities represented by the incredible people – the physicians, the nurse-practitioners, the students, and so many more – that form the backbone of Weill Cornell and its affiliate institutions.

This year, we again dutifully sent out the call for submissions to our community, and were blown away by the response we received. We received submissions from all facets of the Weill Cornell community, in a wide variety of mediums and topics. Not all of these submissions directly touch on the topic of medicine. But, as anyone in the medical field can attest to, it can sometimes be far too easy to lose perspective when you spend enough time in a world of medicine that never really ends. We believe that every piece within this journal offers a unique perspective that will allow the reader new insight into the field of medicine, and perhaps inspire them to better pursue the humanity in their own lives.

At its heart, this journal is a student-led initiative, made of an editorial team of graduate and medical students. For those of us at the beginning of long careers in medicine and the medical sciences, it is inspiring to see the wisdom offered by our peers, as well as by the professionals we will one day become and work alongside. We hope that, as you read through the pages of this journal, you too start to see the world around you a little differently. If you enjoy this edition, please share it with your friends and colleagues and help spread the humanities at Weill Cornell Medicine.

With All The Best, Herie Sun & Daniel Wang Ascensus Leaders

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Table of Contents Full Term

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Meditation

3

Eldridge Street

4

Men At Work

4

In the End, It's Nothing but a Pale Blue Dot

5

Counting Miracles

6

Looking at the Stars

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Rest

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Olivia Mae Sutton | MD Student, Class of 2019 Colored Pencil Gary Kocharian | MD Student, Class of 2018 Poetry James Ryan | Graduate Student Photography James Ryan | Graduate Student Photography Kripa Ganesh | Graduate Student Photography

Robert Meyer, MD | Professor of Clinical Medicine Prose Sylvia Haigh | Research Technician Conte Crayon and Pitt Compressed Charcoal Sylvia Haigh | Research Technician Vinn and Pitt Compressed Charcoal

Extracellular Fluid

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Effort and Ease I

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Effort and Ease II

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Lawrence Palmer, PhD | Professor of Physiology and Biophysics Poetry Jaimie Uva | Registered Dietician Photography Jaimie Uva | Registered Dietician Photography

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Tears

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Rainstorm Blues

13

Palu Shungu

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Obstructed

15

Roses

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Nectar

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Small Vase

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Cup with Pouring Lip for Mom

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Lost and Found

20

The Universal Language

23

A Private Moment

24

Perspectives

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Daanish Chawala | MD Student, Class of 2019 Photography Harold Moore | MD Student, Class of 2020 Photography Ana Zambrano (Palu Warmi) | Registrar Oil Painting Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN | Nurse Practicioner Poetry Sara E. Cain | Senior Medical Secretary Poetry Hassan Muhammad | Graduate Student Digital Natalie Wong | MD Student, Class of 2018 Ceramic Natalie Wong | MD Student, Class of 2018 Ceramic Sasha Hernandez | MD Student, Class of 2018 Prose Sasha Hernandez | MD Student, Class of 2018 Photography Tiffany Huang | MD Student, Class of 2020 Photography Paul Paik | MD Student, Class of 2020 Prose

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Certainty

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Edge of the World

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Lakeside

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Countertransference

28

Bright

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Bare

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Rafting Offshore in the Antarctic Peninsula

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Drake Passage, Southern Ocean

32

Writing from Afar

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Directed Evolution

34

The Cabin

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A Great Win

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Anonymous, MD-PhD Student, Entering Class of 2012 Prose Peter Hung | MD Student, Class of 2018 Photography Kevin Chan | MD Student, Class of 2020 Photography Katherine Li | MD Student, Class of 2018 Prose Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN | Nurse Practicioner Pastel on Paper Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN | Nurse Practicioner Pastel on Paper Paul Miskovitz, MD | Clinical Professor of Medicine Photography Paul Miskovitz, MD | Clinical Professor of Medicine Photography Arpit Gupta, PhD | MD Student, Class of 2020 Poetry Ben Campbell | Graduate Student Photography Gary Kocharian | MD Student, Class of 2018 Poetry Christine Frissora, MD, FACP, FACG | Associate Professor of Clinical Medicine Poetry

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Cactus Spikes

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Nostalgia For An Era I Didn't Know

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Sun Salutation

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Intersection

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Fatality-Free Curiosity

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Perched

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Our Home and Beyond

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Settled

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Seasons

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Waiting Room

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Botany Class, Hyderabad, India

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Vernal

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Peter Hung | MD Student, Class of 2018 Photography Tiffany Huang | MD Student, Class of 2020 Photography Adam H. Trotta | Graduate Student Photography Joanna Luo | Graduate Student Photography A.C. Antonelli | Graduate Student Photography Harold Moore | MD Student, Class of 2020 Photography Tapojyoti Das | Graduate Student Photography Shahnaz Mohammed | Administrative Assistant Photography Herie Sun | MD Student, Class of 2020 Poetry Ishani Premaratne | MD Student, Class of 2020 Photography Deepika Ika | PA Student Photography

Usama Mikhtar | Graduate Student Photography

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Edgar & Edgar Calling to Sol

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Manhattanhenge Disciples

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The Architect

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Red Rock Roof

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Guangzhou Overture

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Lil Boat

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Lanterns In Tokyo

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The Hidden Ocean

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The Hidden Ocean

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Imagination on the Stroke Ward

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Dinosaurs

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Paint Blob On 69th and York, NYC

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Arpit Gupta, PhD | MD Student, Class of 2020 Photography Peter Hung | MD Student, Class of 2018 Photography Danny Kramer | MD-PhD Student, Entering Class of 2015 Poetry Karthik Krishnan | MD Student, Class of 2020 Photography Olivia Mae Sutton | MD Student, Class of 2019 Photography Herie Sun | MD Student, Class of 2020 Photography Herie Sun | MD Student, Class of 2020 Photography Benet Gresely | Postdoctoral Associate Prose Adeline Berger | Postdoctoral Associate Painting Peter Hung | MD Student, Class of 2018 Prose Brandy Holman | Adminsitrative Assistant Composite Sara E. Cain | Senior Medical Secretary Photography

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Above All Else

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Starlings

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Discharge Sonnet

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Skulls

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Stranger Skies

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Sky On Fire

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Hand-Off

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Tagalong

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Questions

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090516

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Chihuly Boat Accent

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Love Letter to a Classmate on Clerkships

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Shahnaz Mohammed | Administrative Assistnat Photography Shahnaz Mohammed | Administrative Assistant Photography Ashley Aaroe, MD | Neurology Resident, PGY2 Poetry Brandy Holman | Administrative Assistant Drawing Nimra Asi | Graduate Student Prose Lynne Rosenberg | MD Student, Class of 2019 Photography Paul Jeng | Graduate Student Photography Harold Moore | MD Student, Class of 2020 Photography Herie Sun | MD Student, Class of 2020 Poetry Karen Chu | Graduate Student Digital Lia Logio, MD | Herbert J. and Ann L. Siegel Distinguished Professor of Medicine Photography Katherine Li | MD Student, Class of 2018 Prose

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Cycle

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Wituk Painting

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Costa Rica

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Departure

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Blue

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In the Canyon

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My Escape

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The Forever Soldier

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Il Sogno

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Modern Medicine

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Hazey in Green

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Priorities

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Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN | Nurse Practicioner Poetry Ana Zambrano (Palu Warmi) | Registrar Photography Rana Khan | MD Student, Class of 2020 Photography Michelle Chua Siao | MD-PhD Student, Entering Class of 2010 Poetry Samantha Shetty, M.S. | Assistant Clinical Research Coordinator Photography Illiana Gutierrez | MD Student, Class of 2020 Photography Amelia Kelly | MD Student, Class of 2018 Photography Danny Kramer | MD-PhD Student, Entering Class of 2015 Poetry Jaimie Uva | Registered Dietitian Photography Ghaith Abu Zeinah | Fellow, Hematology and Oncology Satirical Drawing Herie Sun | MD Student, Class of 2020 Photography Olivia Mae Sutton | MD Student, Class of 2019 Colored Pencil

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My Hypocritical Oath

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From One Mouth to Another

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The Ghosts of a Thousand Bunker

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The Squirrel Who Mistook His Lunch For A Specimen

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Tunnel

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Upper East Side

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Daanish Chawala | MD Student, Class of 2019 Poetry Tiffany Huang | MD Student, Class of 2020 Photography A.C. Antonelli | Graduate Student Photography

Jennifer J. Chia | MD-PhD Student, Entering Class of 2010 Photography Yujin (Stacy) Joo | MD Student, Class of 2020 Photography Yujin (Stacy) Joo | MD Student, Class of 2020 Photography

Knowing You

Chris Gamboa | MD Student, Class of 2020 Poetry

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ascensus journal of the humanities

Full Term Colored Pencil

Olivia Mae Sutton

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Meditation Gary Kocharian

A blanket of gold Drapes its sunny warmth Atop my shoulder blades.

A bed of soft green grass, The only placemat Below my pyramid of bones.

A breath of cool morning breeze Whispers across my bare torso, Telling secrets long held In Nature’s withering grasp.

My spine stacked straight Is a gleaming ivory tower, As the lighthouse of Alexandria, Ever-reaching to the heavens above.

My legs are entwined, As the thick twisting roots Of a blooming ancient Oak Firmly anchored to sweet Earth.

My breath is a metronomic wave, Splashing against the rocky shoals Of my ballooning lungs.

Thusly entranced I rest, My focus waxing and waning To the rhythmic wave.

As the light of my core, Powered by the golden rays Of enlightening sun, Mounts the ivory temple To shine incessantly From the all-seeing orb Of my open brow.

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ascensus journal of the humanities

Eldridge Street Photography

James Ryan

Men At Work Photography

James Ryan

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In the End, It's Nothing But a Pale Blue Dot Photography

Kripa Ganesh

NYC is beautiful, a city that never sleeps, a city that so many people dream about, a city that overwhelms people. In the end, it's just a part of a pale blue dot.

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Counting Miracles B. Robert Meyer, MD She had come by my office one day a while back to assess our efficiency and productivity. Her red hair was pulled back in a bun, she had what looked like a newly purchased work suit that was well pressed, held her laptop firmly at her side, and was well armed with the knowledge from a newly minted Masters Degree in Health Care Administration. She told me that the hospital had hired her to let them know if we were using our resources well. Are we maximizing our efficiency? What is our “thruput” and are we getting our product (a visit) produced at a rate that justifies the number of examination rooms and consultation offices in our practice? Are our examination tables being kept warm, or are they turning cold from lack of efficient use?

One afternoon not so long after her visit an elderly patient had begun a story. We had already dealt with her blood pressure, her cholesterol, and talked about the financial concerns that led her to lie about her age to Walmart and to keep going to work even though she was now about to have her 80th birthday. I was bringing the visit to a close as we talked about our plans for her care and her next visit.

Then, her teeth ajar, one jutting forward awkwardly when it should have stayed put, several missing, she started to talk about her husband. He was in his eighties. He was getting confused at home. He was forgetting things. He was not getting dressed to his usual high standard of elegance.

He had always been a proud man who was careful about his appearance, worked hard, and was self-reliant. Now, along with his increasing confusion had come nastiness. Anger had taken over as he raged against everything that made him feel ignorant, slighted, or incompetent. He did not want to be coddled like a child. He was “a man.” That meant he was a provider, a protector, and a source of strength. Sometimes, she reported, if she tried to correct him or to help him with a simple thing like getting his shirt buttoned, he would become enraged. She had begun to feel on pins and needles around him, unsure and anxious about what to do. She no longer felt secure and safe in their home. Once, in the kitchen, when she corrected him about something, the anger emerged. He had picked up a knife and had a look on his face that scared her and made her want to run out of the house, or to call her son to come running from his

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home a mile away, or to call her daughter thousands of miles away in San Antonio. “How terrible,” she thought, “after 60 years together, to end this with a knife.”

She talked as well about when they met, in Harlem, now more than 60 years ago. A smile appeared, and she rocked back and forth slightly as she spoke. “Ohhh Doctor, we had a time we did… That first date we sat there, in the living room looking at each other…. we had some wine…. he looked fine. I was a young girl who had never…. well…. never thought these things. And then, well….” Her smile broadened, she leaned forward, and her eyes looked past me. “Well… we just had a time… And after that, we have had 60 more years.”

“So can you help me? He is outside. He doesn’t have an appointment, and he is carefully dressed and will talk smart to look good and try to fool you. But I am scared. Scared for him. Scared for me. Scared for us.”

And we did maybe help a bit. We put him in the hospital. I said he had cellulitis. There was a little of that, I think. Maybe we could have gotten by with some oral antibiotics or maybe even just some careful local care.

That might have done the trick. “But you know,” I opined to the house staff, “he is old and these things can turn nasty.” And besides, there is no DRG for “threatening to kill his wife with a kitchen knife.” We called in experts from geriatrics, psychiatry, and neurology. They wrote long notes and suggested “Adult Protective Services…” Which didn’t sound like such a good solution for this couple of six decades. I spoke with the son in the Bronx and the daughter in San Antonio, and we (the social worker, intern, and I) tried to find some options. We eventually got some services set up…. The job at Walmart was helpful. She was out of the house and he had someone there with him during the day who could be trusted.

The Home Health Aide kept him moving, got him tired, and managed somehow to let him feel he was in charge while getting his clothes on and his walk taken and his meals consumed.

It was as though, it seemed, he now had his own personal butler…. befitting a man of some consequence and respect. And when she returned to their home each day and the butler left, he treated her with the respect and honor due to the wife of a distinguished gentleman.

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“You know doctor,” she said at our next visit, “I feel very safe at home with my husband. He is a special man, and I am grateful for the time we are spending together in our 61st year of marriage.”

If it was not a minor miracle we had pulled off, then it was just a small good thing. It didn’t cure cancer like those medical miracles we talk about. But it did make the world a bit happier than it might have been.

It also didn’t help our examination room utilization. I know the exam room was less than optimally used that day… if you are counting bodies and visits as our product. But if you are counting minor miracles or small good things, then how many do you need to adequately fill up an exam room for a day?

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Looking at Stars

Conte Crayon and Pitt Compressed Charcoal

Sylvia Haigh

Rest

Vine and Pitt Compressed Charcoal

Sylvia Haigh

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ascensus journal of the humanities

Extracellular Fluid Lawrence Palmer, PhD

The sea slips softly up the sand Deftly drawn by evening tide.

Old shells come tumbling onto land, A final, surf-swept ride The brine seeps sadly through the hand.

A yearning sends me from the soil, A force unseen I must abide.

Ensnared by sirens’ salty coil, As fluid moves from moist to dried, To water’s want my body loyal.

Nestled in a natal womb, Nadir next to swollen side.

Nascent love of swaddled groom, Promised to a nameless bride, Then naked seeks a nacreous tomb.

For now this water is my own, Each wave a tree on my estate.

By morning it will all have blown Like echos searching for their fate To urge its spray on distant stone.

And yet the sea repays the loan.

Each tide that rises must abate.

Each crest that falls will be regrown.

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Effort and Ease, I and II

Photography

Jaimie Uva

Taken literally 2 minutes apart on Fire Island last summer; sun to my left, moon to my right. I stood in one place facing the ocean and took both photos, completely mesmerized and in awe.

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ascensus journal of the humanities

Tears

Photography

Daanish Chawala

I was struck by the contrast of a beautiful city skyline across a beautiful sunset, yet my window was covered with water droplets from a rain that had just passed. So often - in this city especially - the stress and sadness one feels can obscure a lot of beauty that exists in the world beyond the internal.

And sometimes no matter how intense that beauty, the best one can behold is an image obscured and made blurry by one's own tears.

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Rainstorm Blues

Photography

Harold Moore

A bass player at exactly the moment the rain began to fall at an outdoor jazz concert.

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ascensus journal of the humanities

Palu Shungu Oil Painting

Ana Zambrano (Palu Warmi)

Kichwa word, meaning heart of snake/boa.

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Obstructed Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN My Malaysian, speckled friend Don't be disappointed By your marriage, so new Being stolen from you Your bowel now like a snake choking on a rat I feel your heart shining Which your cancer cannot steal from you Your fate is "for heaven or for earth" So you tell me And I wonder if these words In Cantonese traveling through the blue phone cord Mean the same thing that your eyes are telling me Your parents hover over you in the bed Like trees Weeping over fallen fruit As they did, I imagine, When your infant body burned 41 years ago Leaving your skin With its glorious pattern

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ascensus journal of the humanities

Roses Sara E. Cain I caught the scent of roses Walking home this afternoon Soft velvet, warm fragrance of summer nights Memories wafting past Tendrils of wind caress my face I hear your laugher in the crackling leaves Rustling petals echo the shades of autumn fire The smell of your skin emanates pungent soil Your voice is the pattering rains As it pools about my feet Thorns anchored deep within my weary soul Sweat that beads upon my skin Stillness amid the chaos A phantom kiss to ease my mind Life speeds by in a whirl of traffic The clamor of a million heels I caught the scent of roses A moment of clarity Substance to sweep the fringes Of this dank and dusty day I caught the scent of roses As night began to fall And we pushed forward on our way A city of sleepwalkers Shambling through a concrete prison

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Nectar Digital

Hassan Muhammad

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Cup with Pouring Lip for Mom

Ceramic

Natalie Wong

Small Vase Ceramic

Natalie Wong

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ascensus journal of the humanities

Lost and Found Sasha Hernandez In the midst of my second year of medical school, I was lost. In my never-ending days of lectures, studying, and memorizing, hopelessness overwhelmed me as I found no trace of the humanism that had called me to medicine. But the most terrifying part was the feeling of absolute isolation as everyone but me appeared passionate about medical school.

It wasn’t the first time I felt this way. A couple decades earlier, as a newly immigrated ten-year-old from Colombia, I experienced fear and isolation on a grander scale, as I couldn’t grasp why my single mother would move us across an ocean. Those feelings soon morphed into excitement about my new country and gratefulness for my mother, as I understood that she had sacrificed her home to raise us in a country where education wasn’t a negotiable aspect of life.

From these early life experiences, I began to see education as a way to acquire agency and independence as a Colombian-American woman. Yet here I was, fifteen years later, questioning the driving force that had taken me from an honors high school, to an Ivy-league college, to education work abroad, and now to what seemed like the culmination of it all: pursuing a doctorate in medicine. Realizing I drastically needed to change my surroundings I serendipitously found myself as the new Programs Coordinator for a small NGO who uses health education to help reduce maternal mortality in rural Guatemala.

This new title meant that after my third year of medical school I would be living in Guatemala for a full year supporting a training program for Mayan traditional birth attendants (comadronas).

After a thrilling third year of pre-rounding, morning conference, scurrying after my team on rounds, and experiencing death, suffering, and the magic of birth, I was off to Guatemala. Three flights, two rickety buses, and one moto-taxi ride later I finally reached the tiny mountain town, San Martin Sacatepéquez, I would call home. My main responsibility during my initial weeks was to grasp how to deliver a clinical curriculum to mostly illiterate comadronas from the on-theground director. As an intent observer, a skill every third year medical student painstakingly learns, I quickly appreciated the challenges of teaching fetal heart rate ranges. Understanding that the appropriate

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fetal heart rate range was between 120 and 160 was a simple lesson.

What would take hours to draw out on the chalkboard, explain, review, and then review fifteen more times was recognizing the actual written numbers on the fetal Doppler. As I quietly observed each lesson I was finally grasping the weight of this training program and, more importantly, the resolve of the women.

Six weeks later I was ready to lead a class. Buzzing with nervous energy, I began to relax as the class of comadronas filed into the classroom and during our customary greeting gently sighed in my ear different iterations of “I don’t know if I can do this”; I wasn’t the only one with jittery nerves. The tense energy in the room was heightened as I began to hand out the midterm exam. I sensed this part of the class would be difficult since test taking was a foreign concept for our comadronas; most of them hadn’t finished primary school and were now in their mid 60s. Each comadrona timidly accepted her exam, sharpened pencil in hand, and began to intently and slowly murmur every test question under her breath. Thirty minutes into the midterm I noticed some of the comadronas nervously shifting in their seats and stealing side-glances at each other. Realizing something wasn’t right I paced around the room and began to see every single answer choice circled on every page of the exam. I suddenly realized that the comadronas didn’t know how to take a multiple-choice test.

I tried my best to hide the astonishment that flooded over my face. Sure, I had known that these women never studied past the first grade. I had witnessed how printing a name was a five-minute task. I had neurotically reviewed with them how to recognize numbers on a Doppler screen. Although the dedication to these different tasks gave me deep respect for them, it took a multiple-choice exam, an innate concept in my own career of learning, to show me how truly extraordinary these women were and, more importantly, how alike we were. I recognized that they were seeking the same autonomy I had already found through education. We intimately shared a desire to attain knowledge in order to better help the women we take care of.

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After regaining my composure I spent the next three and a half hours methodically explaining the ten test questions and confirmed that everyone understood how to choose just one answer. When the last comadrona turned in her exam the room erupted with celebration. As each woman left for home I was embraced and thanked profusely for my patience during their test. I struggled to express my pride, admiration, and respect in return. How could I convey that I was floored by the commitment they had made to be better healthcare practitioners despite their lack of formal schooling? I understood that taking a multiple choice exam was not just a simple test of knowledge but a real way for these women to stretch the strict boundaries that their traditional Mayan culture had placed on them.

Coming to Guatemala I thought I would be fundamentally changing the course I had been on for so long. Yet by placing my academic world on hold I rediscovered my love for health education by witnessing its simple but transformative nature on the comadronas and the lasting impact it would have on their patients. As I continued to hug each comadrona I knew words would do no justice; I could only hope that through our physical touch they understood that they had helped me find the part of my self, that part that believed in the power of humanism in medicine, that I thought was lost forever.

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These two beautiful women met in rural Guatemala a decade ago and , although neither speaks much Spanish, it's these simple joys in life that not only keeps them connected but reminds everyone around them what makes us beautiful.

The Universal Language Photography

Sasha Hernandez

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The summer after my sophomore year, I was slated to work at a summer camp for 3 months. However, I only made it through 2 weeks before I got sick and was sent home. At the time, I was a little upset--my summer plans were ruined and I was stuck at home with my grandparents for 3 months. 19 months later, my grandfather passed away and I realized God makes no mistakes--that summer after sophomore year was the last time I ever saw my grandfather in good health, the last time I ever had coherent conversations with him, the last time he ever got to enjoy the company of his granddaughter. I captured this beautiful moment that summer and every time I look at it, tears come to my eyes because I'm still waiting for him to turn around and smile at me.

A Private Moment Photography

Tiffany Huang

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Perspectives Photography

Paul Paik

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Certainty Anonymous

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Edge of the World

Photography

Peter Hung

On a fine winter morning in Caye Caulker, Belize, he looks over the water.

Lakeside Photography

Kevin Chan

On a lake entrenched in the heart of bustling Hanoi, two strangers find refuge and share a moment of solitude.

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Countertransference Katherine Li I love the way she dresses. Today, she is wearing an Aztec-patterned knit cardigan over a black t-shirt and skinny jeans. Yesterday, it was chambray on denim. Along with her burgundy-streaked bob and her pointed-toe flats, she could be any stylish architecture student sitting in a Brooklyn café.

She could easily be sketching building designs in her Muji notebook as she waits to meet me for lunch, preparing to tell me about her latest allnight project over Stumptown coffee and scones. But she is not. Instead, she is compulsively writing the same sentence over and over again as she waits to meet me for rounds, preparing to tell me about the three times she attempted suicide last night.

Sometimes, her thoughts don’t seem so strange. So she wants to shower at the same time each day. So she doesn’t like having strangers watch her.

Who among us hasn’t had these thoughts before? She tells me about her dance classes and her fluffy white poodle and the architecture education she has put off for years due to illness. Her descriptions are thoughtful and articulate. My spirits rise, and I encourage her to keep talking.

Sometimes, she makes no sense at all. She needs to touch every object in the room in order to stay on track. She cannot access her memories or find her words. She wants to hang herself with curtains. Her face becomes blank and she closes her eyes, rocks back and forth in silence. I despair, and I hasten to fill the gaps between her hard-won words, to snap her out of this mysterious illness that flattens and encloses her.

She smiles when she’s nervous. Laughs uncontrollably, even. I know these are symptoms. But I still like to see her smile.

When she tells me about her abusive, suicidal ex-boyfriend, I fly into a rage. I’ll rip him apart, I think, before I remember that he is already dead, as victim to his illness as she to hers.

She becomes a part of my story. On the weekends, I check her chart obsessively to verify that her suicide attempts were thwarted. During the week, I scour the web for treatments we haven’t yet tried. I am suddenly, poignantly grateful for my own health even as I pray for the power to restore hers.

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She improves slowly but surely. Her appetite comes back. She sleeps through the night. And one day, her smile reaches her eyes and lights up the room. On my last day, she is doing well enough to leave the hospital.

She high-fives me as I exit the unit for the last time.

My attending tells me that patients like her relapse more often than not.

But sometimes, I still daydream about running into her in a Brooklyn cafĂŠ, sketching away.

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Bare

Pastel on Paper

Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN

Bright

Pastel on Paper

Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN

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Ascensus Journal of the Humanities

Rafting Offshore in the Antarctic Peninsula Photography

Paul Miskovitz, MD

Drake Passage, Southern Ocean Photography

Paul Miskovitz, MD

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Writing From Afar Arpit Gupta My mind searches for a word A word that sails across oceans A word that soars over boundaries A word, fair like your skin A word as expensive as postage A word as cheap as air ticket A word, sweet like your voice A word redolent of your fragrance A word warmed by your touch A word, peaceful like your embrace My mind searches for a word

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ascensus journal of the humanities

The E. coli colonies growing on this 10 cm agar plate are expressing a semi-randomly mutated mRuby fluorescent protein gene library. When I illuminated the plate with UV light--expecting to see only dim red colonies--I was surprised to find a galaxy of glowing colors: mint green, banana yellow, red, and even ethereal far-red. Apparently, multiple amino acids contribute to fluorescence color tuning in mRuby. I selected several orange colonies for further mutagenesis and eventually evolved a variant that can be switched on and off with blue light. Photographed through a plastic yellow emission filter, some of the UV light could not be filtered out, imparting a deep purple glow.

Directed Evolution Photography

Ben Campbell

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The Cabin Gary Kocharian A whirlwind envelopes him Like a million white petals Pulling him into their depths.

Clear blue eyes peer out Like two bright sapphires Gleaming through a thick mist.

A cabin covered in white, Preparing to be wed, Awaits the return of its lover.

A light in the window, A beacon of hope, For the weary traveler Coming home.

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A Great Win Christine Frissora, MD, FACP, FACG It was just a day a beautiful day because I was going to play tennis with my friend Alexia Nicky couldn't play she needed a sub I see her Alexia is there already green cat eyes smile We play we laugh we run we win We lose we laugh more WHAT?!!! the girls leave they have to take the tram at noon I don't leave - I have my car it won't save any time for them to drive but Pedro will hit with me for 10 minutes I am sweating Pedro it's great! you go to your next lesson I'll pick these balls up then, "Christine- do you want to play with us?!"

Do I want to play with us?

I look over - one pro and 2 guys they need a fourth Ilovetoplay OK thanks! but only for 10 minutes I have patients at 1 We hit I volley we laugh we win I have to go "We are both David's easy to remember" the guys laugh I wave goodbye "I hope we can play again" I check out pay my bill Sign up for tennis team "Call 911!" It's Pedro Is someone hurt? I am a doctor There’s a man down?

Get me the paddles

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Let's go to court one I see him Lying still a gash to his right temple bleeding an agonal breath He fell?

He has a heart valve- he is on coumadin the men standing around him say there might be a thready pulse "He is breathless" I say Lift the chin and head back I breathe into him there is gravel and blood on his face in his eye I lift the shirt place my hand over his heart still no heart beat the paddles are coming a few more breaths he is cold clammy still staring into space Unresponsive I have lost him An agonal breath?

Did he breathe?

The paddles are small stickers they are on the chest Back up green button analyzing CLEAR Shock I breathe into him Heartbeat under my hand is strong now! Fast!

The breaths are agonal I assist him Pedro brings me the oxygen It is cranked up and I mask him I breathe into him and he keeps breathing

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I keep my hand on his heart. Strong beat. Perfect.

Take the pads off I don't want him shocked accidentally He gets stronger he fights me "David, I am a doctor breathe slowly don't move!"

He is agitated now moving everything He is strong!

He was dead now he is strong!

EMS arrives He fell - he has a valve on Coumadin I breathed into his chest and he breathed No Epi but he is agitated "Yeah, that's what happens when you bring them back" I am so happy relieved surprised I am beat up exhausted I go home I shower I clean my mouth where I cut my lip on my own tooth Scrape off the gravel and dried blood I go to the ER He is awake alert talking!

His EKG is normal He is perfect There is a hush of excited admiration among the doctors I am happy so happy so grateful so glad I am at peace I call my son and tell him the whole story and now He wants to be a Doctor I am happy so happy so grateful so glad I am at peace

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_______________________________ Nothing in life could have prepared me for everything life prepared me for.

I have always been an avid reader. A few years ago, I was struck by Ernest Hemingway’s biography and read a book about how he wrote. He cut words. Sliced everything down to the most bare meaning. Chose the single best word. The fewest words. Said to include the weather whenever you could. It is sometimes hard to read – it is prose. Last year I took a course at Juilliard with Professor Lauren Whitehead, “Poetry and Performance”.

At the time, I was going through a tennis tournament – a novice – but my partner was strong and if I kept the ball in play we got the point. Still, I was fraught with anxiety, being the weaker player. I started writing poems full of imagery – slice the ball, cut the ball, close the point. Choose the best shot – the same way Hemingway chose the best words and cut the unnecessary.

All of this is described in my book, “Beyond Onomatopoeia”. So here I am, a year later, with Alexia subbing in for her friend and having mad fun. I am going back to the office for 1 o’clock fellows’ GI clinic at Weill Cornell when the pro comes to us at check out “Call 911”! The rest… is history.

Dedicated to Alexia Fernandez who could have played with anyone.

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Cactus Spikes Photography

Peter Hung

Taken at New York Botanical Gardens.

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Nostalgia for an Era I Didn't Know Photography

Tiffany Huang

Whenever I visit rural Taiwan, I am always imbued with the eerie feeling that I've stepped a few decades back in time, contradicted by my acute awareness of the modernity around me. This old Mitsubishi minibus rolling down a quiet road, backlit by the sun's warm rays perfectly captures this feeling.

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Sun Salutation Photography

Adam H. Trotta

I was home for the holidays this winter, and my family decided to go for a walk in the woods. My mom, aunt, cousin, and I went to the campground near my parents' house with the family dog. Our dog, Suko, is part Alaskan Malamute and has always loved being in the woods, chasing deer, and bounding through the snow. Something must have caught his attention in this photograph, as he came to attention right as I took the picture.

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Intersection Photography

Joanna Luo

I was exhausted by the end of first year orientation this past August, so one night I escaped by biking to Central Park. I ended up at the 90th street entrance, taking a moment to breathe and admiring the day drawing to a close. The night was an intersection of contrasts: between the rippling water and the smooth sky, the blocky buildings and the gentle horizon. And despite this, I felt a deep sense of calm. It was a moment I will always carry with me, from the time I stood at the intersection between my life before graduate school and my life about to begin.

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Fatality-Free Curiosity Photography

A.C. Antonelli

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Perched Photography

Harold Moore

A baby leopard placed high up in a tree by its mother for safekeeping from hyenas and lions.

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Our Home and Beyond Photography

Tapojyoti Das

This is the view of the night sky from our camping ground, 11,000 feet above sea level in the Himalayas. Besides our home galaxy, the Milky Way, our neighboring galaxy Andromeda is also clearly identifiable, which happens to be the farthest object visible to unaided human eye (2.5 million light years away). Unfortunately, light pollution from the cities are silently shrinking the dark sky places, limiting our ability to enjoy such a view. [ISO 6400, 10mm, f/3.5, 30s, enhanced and color corrected]

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Settled

Photography

Shahnaz Mohammed

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Seasons Herie Sun The seasons change But I still remember you In New York City Of all cities It can be hard to forget I see your face in old haunts that we knew like the surface of our skin And in each new place that I explore I wonder what you would have thought Wonder if you would have smiled Or frowned Or just stared I see your face in the crowds of strangers that seem to ebb and flow With the life and vibrance you gave to the world I see you in our friends and our family Your smile, your warmth and your stature Pressed into each one of them Like a stamp on an envelope Ready to be sent off to some place we can only imagine I see you in my mind And in the memories that we’ve shared Loss is a terrible thing We have all known it Some, more than others Some, lucky and young enough that, for them, It is a distant branch of the family tree Or a memory to be made in the far-off future But at some point Loss touches us all Through winter snow And summer heat We bake and we freeze

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But time doesn’t stop for us It keeps marching And all we can do is strive to make those we’ve lost Proud of us The seasons change But we still remember

Waiting Room

Photography

Ishani Premaratne

A family of three waits to see the doctor in a health clinic in Dar Es Salaam, Tanzania.

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Botany Class Photography

Deepika Ika

Inside the walls of the "Old City" neighborhood, Muslim traditions and ancient architecture have remained nearly untouched by the increasing modernization of Hyderbad, a hotbed for multinational corporations including Microsoft, Amazon, and Novartis. An all-girls Islamic school lies in open view from the stone street, a time-capsule from the 16th century when Muslim kings, or Nizams, ruled the Indian subcontinent.

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Vernal

Photography

Usuma Mikhtar

Vernalization of Eastern Redbud.

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Edgar & Edgar Calling to Sol Photography

Arpit Gupta

Two geese sharing the same name, residing in the same place an hour out of Portland (OR), looking for the same source of warmth.

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Manhattanhenge Disciples Photography

Peter Hung

Taken on 42nd Street at 2nd Ave.

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The Architect Danny Kramer A single glance, a subtle gaze, Leave memory a foggy haze.

Upon the facts I dare not dwell, Emotions tend to heave and swell, And gloom upon my heart befell.

And the chance, away to there, Beyond that to which I can compare.

A silence, pause, a hesitation, A manifest of trepidation.

None else knows the quiet there, The one across who’ll always care.

A chasm space set in between, A vacant lot that goes unseen.

The thoughts of mine so circumspect, I’ve yet to be the architect.

Time arrives, it’s come to pass, A ticking clock not to contrast.

Heavens move and seasons change, No status quo yet rearranged.

Tis the static one cannot bear, The air is still, but fires flare.

Why am I forced to lament?

This self-pity does breed contempt.

I see the lot, I see it there.

But no move I can prepare.

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So much form, such space and green.

Off self-restraint one must be weaned.

The thoughts of mine less circumspect, I long to be the architect.

That is enough! None else for me!

There is so much more that this can be.

To see a lot I now refuse, My heart shan’t stay such a recluse.

To myself I now bequeath, The hard hat I must unsheathe.

There is work yet to be done, A web here still to be spun.

I reach the lot. I cross its span, The labors now have just began.

There’s brush to clear and bricks to lay, Building, toiling, day by day.

There is a plan, a grand design, A blueprint shall unfold in time.

An edifice shall fill the space, Show of sanctity for the place.

By belabored breath it will appear, And two sides shall be brought near.

My thoughts no longer circumspect, I have become the architect.

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Red Rock Roof Photography

Karthik Krishnan

I shot this while hiking through Coyote Gulch in southern Utah. A few hours into the hike, I found another campsite by a natural arch while following the stream that cut through the gulch. I thought there was a great contrast between the shelter provided by tents that took a few minutes to pitch and the stone tent overhead that was carved out over tens of millions of years.

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Guangzhou Overture

Photography

Olivia Mae Sutton

An unexpectedly beautiful dance to spot in the middle of a night market in Guangzhou, China.

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Lil Boat Photography

Herie Sun

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Lanterns in Tokyo

Photography

Herie Sun

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The Hidden Ocean Painting

Adeline Berger

The Hidden Ocean Benet Pera Gresely

When the mist of his thoughts cleared, he was surprised to find himself at his own apartment door. He sank his hand into his autumn coat and removed a noisy bunch of keys. The first one he tried slid into the lock with no effort, but quickly became stuck. It was the same error he’d made for the last five days, as if sleepwalking: His friend had entrusted him with the key to his apartment before leaving on business, and he had put it on his own keyring to avoid losing it. He never imagined that, out of eight possibilities, fate would tease him every day at dusk by offering his friend’s key first.

He twisted the key left and right in an attempt to unstick it. Then, in a moment that felt like an eternity, the door opened as if that had always

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been the key’s purpose. Stupefied, he examined the key closely: It was indeed his friend’s, not his own.

He gently pushed the door open and entered the gloom of his apartment.

When the door shut behind him, he remained quiet, submerged in the silence, like a diver penetrating the darkness of a shipwreck that nobody had dared to explore before.

Through the window, he saw the sparkling city lights reflected in the river and imagined that they were the lights of an undersea palace. He lowered his gaze into the deserted square in front of his apartment building, its only inhabitants the statues of forgotten heroes commemorating a distant war. Lost in thought, he caught sight of a shadow behind a petrified soldier. Unblinking, he focused his gaze on the spot and held his breath as he realized that it was the outline of a beautiful white shark.

An immense calm had come over him, and the incoherence of what he was witnessing did not sway him. He watched the shark swim around the monument and vanish around a corner. Then, as he did when he was a child visiting the aquarium with his father, he pressed his hands and face against the window glass, longing for new findings.

A floor below, he spotted a metallic school of sardines following an ocean sunfish. The big fish turned abruptly, and the sardines changed course at once to avoid colliding with him. Further down, between the parked cars, he saw what appeared to be extended fire hoses. But a second glance revealed that the hoses moved, swirling and retracting, leading back to a vast shadow behind the cars. Suddenly, a giant squid emerged from behind the vehicles. It passed in front of the now-submerged coffeehouse, crossed the square, and disappeared from sight.

What a wonderful show! was all he thought.

Not wanting to miss any detail, he ran to the window of the adjoining room to find out what course the cephalopod took. From his new observatory, he could see the rest of the square, including the old secondhand bookstore that had stolen his heart. The squid reemerged into view, but a colossal figure pounced on it, covering the scene in a cloud of ink. Then, slowly, like a black and white photograph that shyly reveals its image in the dark room, the ink dissolved and a beautiful humpback whale emerged from the black nebula. The leviathan remained

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peacefully suspended, occupying the entire square and looking through the window with one of her deep and ancient eyes.

Again he placed his hand on the window glass, and soon the whale began to move, her blue skin filling the entire view until her immense tail appeared, paddling slowly away. When she was gone, the square was once again immersed in the submarine silence.

As tired as he was fascinated, he sat on the bed and realized that on the bedside table, next to a dusty glass of water and a box of painkillers, lay that old book he had purchased at the shop across the square. He remembered the rainy Saturday afternoon when he discovered the mysteriously titled Sea Giants, a fascinating volume written by a Spaniard forced into exile in Buenos Aires after losing the War. The book had stoically endured over time, and some of its pages were illustrated with beautiful engravings of whales. He recalled how enjoyable it was to read.

Then, he wondered whether using his friend’s key after having read the mysterious book explained the spectacle he had witnessed. And as he closed his eyes, he resolved to find out when his friend would be traveling again so that he would know when to reread his favorite childhood book, When Dinosaurs Ruled the Earth.

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Imagination on the Stroke Ward Peter Hung

“What mazes there are in this world. The branches of trees, the filigree of roots, the matrix of crystals, the streets her father recreated in his models… None more complicated than the human brain, Etienne would say, what may be the most complex object in existence; one wet kilogram within which spin universes.”

So writes Anthony Doerr in “All the Light We Cannot See,” a brilliant novel that won the 2015 Pulitzer Prize for fiction. It’s the book I’ve been reading this week and (sadly) the only novel I’ve read all year. Between my shifts at the hospital, I crack open the covers, unfurl the pages, and fall into the universe that Doerr spins with his sharp sentences. I follow two characters, two unusual children in extraordinary circumstances: Werner, a scrawny albino orphan prodigy conscripted by the Nazis and who fights to retain his humanity; and Marie-Laure, a blind French girl hiding in a walled seaside city who becomes a vulnerable courier but who finds space to dream. For hours at a time, I am transported by the book’s words into the vividly bleak realities – albeit fictional – of two children in the maelstrom of World War II. But every night at midnight, I force myself to shut the book so that I can awaken punctually in my own reality. At 7 am, I become a medical student on the neurology stroke team, and I resume caring for patients whose brains have recently suffered catastrophes. Our job is to evaluate their deficits, coordinate scans and biopsies and vEEG studies, and prescribe grueling treatment courses. All the while, in those crucial first days, we protect their bodies as their brains begin to mend themselves.

Most of our patients* we expect will survive, but they are enduring some harrowing disease processes: a venous sinus thrombosis leading to ischemia in Wernicke’s area, a perioperative embolic stroke, GuillainBarré syndrome. As I learn about the proper workup and management of these conditions, my mind wanders away from the medical science and dives into the minds of my patients. What does their world look like to their damaged brains?

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Wernicke’s area of the brain is charged with comprehending language, and the woman who lost hers to a venous clot lies in her bed calm and unconfused, watching Netflix on her iPad. She can’t comprehend the words the characters are saying and can’t read the subtitles. She doesn’t understand our medical questions either and resorts to answering with completely random responses. What is it like to be lost in a world once familiar but now encoded in gibberish? Why isn’t she panicked by the senselessness of it?

What about the young man who awoke from his minor vascular surgery to blurry eyes, uncoordinated fingers, and a sluggish tongue? He was told it was a harmless procedure and his disorientation was dismissed as the aftereffects of anesthesia. Only when his deficits persisted for days did he finally realize that his brain was accidentally carpet-bombed by a shower of dislodged plaque.

And the girl my age with Guillain-Barré, whose immune system made a grievous error and gnawed away her nerves’ myelin sheath. Weeks before, she sensed a tingling in her feet, then a rising weakness, then a rising paralysis, and now she lies paralyzed, cross-eyed unable to close her eyelids, mute with her jaw lolling open, unreined heart racing, and with a machine breathing for her through a slit in her throat. All she can do is barely nod when her mother points at a chart to spell out messages letter by letter. We reassure her that she’ll recover eventually in a few months. Then, we walk away and she stays there trapped in her immobile body.

At 5 pm, I go home, shed my white coat, and resume my life outside the hospital. I try to let the plight of our patients fade away and instead lose myself in other worlds.

“Toiling with your blood / I remember something In B, un—rationed kissing on a night second to last Finding both your hands / As second sun came past the glass And oh, I know it felt right / And I had you in my grasp” So writes Bon Iver/Justin Vernon on their third album “22, A Million” which was released this weekend after a 5-year silence. I’ve been listening to it on repeat, and it’s entrancing. It’s simultaneously electronic and rustic, pensive and lonely, chilly in timbre but warm in expression.

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Bon Iver’s music always reminds me of winter; his falsetto voice and enigmatic lyrics transports me to the isolated wood cabin in snowy Wisconsin where he creates his music. How privileged my mind is to be free of insults and free to be enriched by these artists’ creativity.

Of course, as a medical student, I must return to my scholastic duties.

Yet, as I pore over my neurology books and lecture notes to pack my brain with information, my mind flits back to our patient with the Wernicke’s infarct who is currently incapable of language comprehension. As I teach my brain how to interpret MRIs and CTs, I’m reminded of our patient who is relearning to see anything at all. While scrolling through his slides on our digital lightboxes, I see the bright hyperintense plumes blooming in the dark folds of the brain causing his inability to see.

Brain imaging is close to magical; doctors can scan straight into the internal structures of the brain, one step closer to peering into the minds of our patients. Unfortunately, as much as we can see, we don’t have the capacity to heal the brain’s microscopic complexity. All we can do is protect and wait and try to empathize.

For our patient with Guillain-Barré, we’ve tried IVIg and PLEX therapy, but she keeps on worsening. We moisturize her eyes that she can’t close, load her with opioids to combat the myopathic pain, roll her around and clean away her frequent diarrhea. Every day, we shut off her ventilator and ask her to try breathing on her own, even though she can’t.

Every day, we walk in and ask her to hang in there while her nerves mend themselves. Every day we walk out, powerless to help. I don’t know what frustration fills her mind when we leave because she can’t communicate.

I can only try to imagine. Maybe when she’s fully recovered next year, she can write a book about her poetically strange predicament and help us understand her – remarkably nonfictional – vividly bleak reality.

It has been a gloomy week. The spires of Manhattan’s skyscrapers are shrouded in clouds, and the sky is a blank gray canvas. Underneath them, I shed my white coat and shirt and run through the misty streets and the shadowless Central Park. My mind wanders, replaying Bon Iver’s frigid musical textures, envisioning the smell of Marie-Laure’s ocean-scented hideout, thinking about our patients on the stroke ward.

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I hate that we have no disease-modifying interventions for them.

When I’m out running, this troubling thought echoes in my oxygenhungry brain. For our paralyzed patient who struggles to breathe at all, I dash around outside on her behalf and train my lungs to withstand hours of strenuous exertion. For our patients staggering down the hallway on new wobbly legs, I strain my own legs to propel me further faster. I know it doesn’t translate, but I think that’s my way of trying to help from a distance.

Something about the stroke ward draws me in closer than I should be.

Imagination is the heart of compassion, but I haven’t found where one ends and the next begins. *Patient details altered for privacy

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Dinosaurs Composite

Brandy Holman

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Paint Blob on 69th and York Photography

Sara E. Cain

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Above All Else

Photography

Shahnaz Mohammed

Starlings Photography

Shahnaz Mohammed

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Discharge Sonnet Ashley Aaroe

The patient came here unable to speak.

Unfortunately testing showed a stroke.

While somnolent at first (and rather weak), with time and care she gradually awoke.

Atorvastatin 80 started first.

We recommended Plavix - aspirin too.

Nutrition said that she could drink to thirst, and PT judged that home would work in lieu of going to a SAR she didn't like (as long as there was ample help nearby).

She was advised "if further symptoms strike, you might need to return for MRI".

Acknowledging the risks of GI bleed, the benefits of treating supersede.

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Skulls Pencil

Brandy Holman

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Stranger Skies Nimra Asi I am fading away. Like the faltering last act of an unsuccessful play. Wellmanicured hands cover genteel yawns, smooth brown heads turn this way and that and the woman in the front row is leaning over her husband to complain to their neighbor about the chicken course at dinner. Small feet stuffed tight into shiny best day shoes are swinging above the linoleum floor and gaily printed program guides seem to hold the ghost of crumpled gray balls in a trash can. The community center really should recycle more.

A slight man is on the stage, sweat is pooling above the curve of his lip and too many nights like this one pull at the corners of his mouth; the discontented knowledge of talking into emptiness is tucked into the furrows of his permanent scowl. My days, lately, seem like that play. An inexorable march towards an inconsequential end. Junior year seems much too early, and paradoxically too late for this existential angst. “SPF and good living,” my mother’s voice says in my head.

But my skin is growing thinner, or at least slipping off…I’m a new breed of orange. ‘Self peeling!’ the telemarketing ads will proclaim and that’s not drama, its basic biological fact. I walk and talk and eat and everywhere I go, tiny bits of skin and hair and the dryness at the backs of my heels is shed. An invisible layer of white, coating my food, tangled in the bristles of my toothbrush. Saliva, gleaming wetly at me from the back of a ballpoint, my teeth marks etched into blue and white plastic forever.

Pieces of me are lying on the sidewalk, miniscule ones to be sure but I still want to gather all these discarded bits up. “They show that I was here,” seems like a pretty justification for such untidiness; maybe even now a fine white trail is marking out my route past the cafeteria and to the dorms.

She stopped at the corner to drink her diet coke, it says…she was jiggling her foot extra hard in the back seat of that auditorium….the economy of breadcrumbs made of skin is pleasing, but a gust of wind blows and the imagined lines are an imaginary mess, sad dirty flakes curling at the edges, an undoable jigsaw with a thousand pieces.

“From dust to dust” we should go but if you push the trail back together, will you get the edges of my shape in black grime and leftover earth? “As is the earthly such are they also that are earthly and as is the heavenly such are they also…” I think I’d rather be one of the “heavenly ones;” no fears of

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skin too thin to brave the world.

Thursday morning, nine am class and fading seems like a problem of the past. I wish I could fade! Sink through the bottom of my chair to melt into my bed. We are looking at protein crystal structures, and by looking I meaning bouncing short wavelength radiation off fragile structures to make up for the deficiencies of things too small for human vision. The trick is to capture the picture before the X-rays destroy your structure; a glorious implosion of painstakingly collected crystal.

But we have the image and it must be a trick. Where is the symmetry, the promised precisely order? All I see are white spots blurring across black film. “It’s a Fourier transform,” the professor says, bouncing on his toes and I flip through my notes for the formula. The squiggle of numbers in my hurried handwriting is still where I left it: the ink has smudged on the summation sign and the edges of my x’s trail off like questions marks but now it seems like magic; a one line code to transformation.

We can’t just see the crystal,” our professor tells us. Of course not, that would be too simple. What we have is the best image that science and very expensive equipment can buy. Never mind that it looks nothing like my obviously naïve preconceptions. Now, it’s up to us to work out the secrets.

Turn noise into clarity. The whirr of the air conditioning is making me sleepy; I slouch lower in my seat hoping that I won’t be called on. But I don’t need to nudge reluctant brain cells awake…it’s already been worked out. The scientists who came before figured this out – they spent twenty five plus years doing it. It seems a hopeless proposition: that if life has a formula, it takes a quarter of it to work it out. The image we have, the diffraction pattern exists in another space from the crystal. Ostensibly this space can be reached via a formula. But finding it for the first time…that’s like mapping the constellations of a parallel universe - strange stars in a stranger sky - and to determine their positions from distant pinpricks of light reaching across to our dim twilight… I imagine an old man, bent over a lab bench, awake in the dark of the night at his desk. The line of his spine, lit by moonlight is a pure, clean curve. An inverted S, a slightly lopsided question mark. Years have frozen his spine into a permanent asking. The hunch in his shoulders is a kind of victory. The joyous triumph in the knowing - that this fragmented white on blurry black film is a shining, many mirrored object in reality. Which reality? And all the while you have

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to believe that the lights are real, that there are shapes in their winking and not just illusion. Life has a pattern, a formula floating in the ether, waiting to be found, you just have to look hard enough…Who says faith and science don’t go together?

I am looking now; back and forth between what I have been told actually exists and what I can see with my eyes, grasp with my fingers, the picture smooth under my hands as though somebody had not curved his back over a bench for decades to pry out its secrets. Decades! A little old man with ink on his fingers and light in his eyes. *** Why crystals? “It amplifies the symmetry,” the professor says, “makes the patterns easier to spot.” A crystal is just a unit structure repeating itself.

The amplification of meaning: I play with that idea all day; pushing my chair in at the lunch table so that it’s corners line up, in the neat array of pens in the corner of my desk. That if you repeat yourself over and over perhaps a greater design will emerge. That there is space for meaning to grow in the places where things meet. It helps as I run from class to lab and back again but no matter how fast I run, I can’t dislodge the lump between my throat and the knob of my sternum. “And death will have no dominion,” I mutter under my breath and my lab partner gives me a strange look. But I am caught up in how it sounds: not a rallying cry but a last desperate appeal. The “death of the essential self,” buried under wilted lettuce leaves in crumbling sandwiches (they are deadly things those sandwiches) and the taste of toothpaste cool on the tongue. Dissolving into gas bills, smudging like the cheap printing on ATM receipts, running into the black ink on hundred rupee bills. Lost in the confusion of old Quaid’s face. Daal for lunch today, the yoghurt swallowing the yellow on my plate, the sticky feeling of food under my fingernails.

1 Corinthians 15:54: …death is swallowed up in victory.

Food in the cafeteria and the roar of people talking is deafening. Kanwal is sitting across from me. She is talking too but all I can focus on are the breaks in her bright pink nail polish. I imagine them expanding to reveal the ragged edges of black and silver stars. Skin as fragile as paper over spinning galaxies and the infinite coldness of outer space. Except in this case it’s inner space stupid. A whizzing star bounces between my lungs, off my vertebrae in a shower of white sparks. Dislodging things I’ve hidden in the spaces between my ribs. Is my skin bulging outwards? Dark cracks

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like hungry mouths extending over the hidden universe; “oh this fragile mortal skin.” A bit of food drips onto my lap. Kanwal snickers and hands me a tissue. The world’s just been saved by curry I want to tell her, but I remember that she has a quiz next period and so I shrug and shake my head. Maybe after I will…and if the cosmos makes it that far.

Tuesday morning, we’re in reciprocal space. That’s the space where the measured diffraction pattern exists, so named because take its inverse transform and we’re back in real space. I am in the gap between understanding and not, staring desperately at the board, hoping that the force of my glare will bounce meaning off black ink on whiteboard.

We’ve moved onto grids, the neat boxes defining a regular area. There is a simple demarcation; areas where reflections off the crystal can be detected and the blind spots where anything falling is lost information.

“So what can we do to enlarge our perception sphere?” the professor is asking expectantly. There is silence. “Tilt the crystal,” he says and there is a note of disappointment in his voice that communicates that it should have been obvious. Tilt the crystal and we will capture more of its image.

It’s a fine hypothesis (if I tilt my head will the world shift: new corners springing into existence at that moment, or is it just that you’re tilting your head Nimra?). It’s an interesting question but I am caught up in the more pressing one of what the heck is an Argand diagram and have we ever covered it before? Am I supposed to know this? Should I ask? But the class has already moved on and nobody else seems to be wondering…The professor catches the question in my gaze and pauses in the profusion of arrows he’s drawing on the board. “It’s a diagram for representing complex numbers, there’s the axis for the imaginary bits,” he says calmly and I am washed in gratitude in that moment, for not having to ask. And then I imagine a giant cartoon hand coming out of the air, and smacking my head. Panicking at not knowing things! Not asking questions won’t get you anywhere! Think. I hunker down over my notebook but my brain always feels slow as molasses in this class, a thick brown trickle rather than the smooth, oiled running of gray matter. Like I’m behind everybody else, a second too slow to know the answer, and every time it happens that second twists, becoming larger and larger. So that the girl next to me shoots out the answers while I’m still mouthing “uh.” She gives me an apologetic look at the end of class which makes it worse: “everybody sees it!” I think wildly.

They all know about the sick crawling in my gut, the blankness pounding

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in my left temple. This is a voluntary class, I don’t have to be here, sitting in on this module because the teacher is a good one and because these are things I think I should know. I’ll study up before the next class and then I’ll know what everybody else does, I tell myself. The thought of white pages, black writing underlined in my dark blue pointer is a great comfort. There’s a textbook for this one.

“Fear is the mind killer.” If that’s true then the fear of not knowing things must be some kind of cosmic irony, or a sick joke. *** My room is at the end of the hallway in the newly built U shaped building. The red brick and black glass of people living in the center of the U stretches out to the left of my coveted corner room. If I lie on my bed I can catch glimpses of shy stars; one here, a couple there, caught within the frames of other people’s windows from the gaps between my curtains. But they are only visible when those rooms are unlit – pale light flowering out of darkness. And so I wait every evening for the lights to go off and the stars to wander in, the last waking person on my corner of the planet. A soft pillow shoved beneath my head, an open book next to my out flung arm. Joveria lying face down on the bed across the room, the soothing peace of a clean room. It’s easier to think about Fourier transforms with the wood grain of the shelves above me so steady in warm yellow light. I remember the formula now, but that moment of shining clarity hasn’t happened. “The yes I get it!” where a black and white blur transmuted into silvery, perfect crystals seems like the simplest thing in the world; the best kind of alchemy of the mind; to rest the sense of things even in the bones of my hands, the rough skin at the tips of my fingers. It’s happened before, that moment of blinding illumination and I wait for it, it is easier now, in a pool of lamplight around my bed and the promise of sunlight through my window at eight am.

Dawn. The sky turning lighter blue and I know that wisps of white clouds and the fierce yellow Sun will be cut up between those glass panes; divided reflections multiplying the sky. For now there is only a glorious pink edge to the universe. Like the insides of grapefruit skins, spilling juice and secrets in transparent drops. The curve of the thick peel cracked open, spurts of wetness, tart yet sweet on the tongue, with the danger of turning bitter in a bit.

It’s strange, I don’t know the people living across from me; white doors

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closed tight are the first impenetrable barrier to knowing. I can see only the discarded bits of their lives in the neat row of dustbins spaced evenly down the corridor. Three oh one had chicken curry for dinner, the smell lingers in the hallway. Three oh two is a health nut, there are only fruit rinds and protein bars in her wastebasket, three oh three uses Nivea body lotion. Three oh four must have a big assignment coming up judging by the empty Pepsi bottles stacked outside her door and three oh five is an against regulations smoker. It’s a peculiar kind of knowing, a sort of secret gloating; that I have knowledge no one else sees; that I see what they don’t mean me to. Then I wonder what my wastebasket says about me.

I see these people pass me in the hallway every day but they are only unfilled outlines to my untutored eye (am I an empty shape to them? I frown at the threat of insubstantiality). I can conceive of their existences only in the most tenuous of ways: in the contents of their wastebaskets and the gray shadows I see moving against lighted squares come evening. And yet, I know what the Sun looks like rising in their window panes. One day perhaps, we will look out at the same time. Lean into the cold blue light of morning, an ecstatic dip into the freezing air before the day warms it up and pollution blurs its razor blade sharpness with gray. The concrete window sill, cold, grounded against our elbows, the same wet sniffle developing in our nostrils. But then I remember that the window screens are bolted shut.

I must wait for the morning to reach inside my room and find me. That is one wait I do not mind: I know that the cold and the light will come every morning. Morning after morning without end and the promise of time hangs heavy in the air at the beginning of the day.

Mornings are my favorite time of day. It is afternoon now and the air has heated up as expected. It is a heavy, unmoving soup but a little better under the trees. The invisible steps are back to following me around. Not just my footsteps but some extra space that my shadow seems to take up; tilted weirdly across the edge of the sidewalk, as if a greater darkness were crouched in it. I fancy that it’s the shadow of stars spinning under skin. But it has been another one of those days: same as the one before it, the promise of the morning lost in petty annoyances and the taste of old lettuce, and it seems vanity to think that I could have entire universes centered around some grand inner self. Instead I imagine iron in the soul, as Sartre did…

And the sharp creeping edges of rust, blunt orange flakes where I have allowed disuse to take root. Is there an unguent for polishing your insides

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and if I don’t, will they crumble into indistinguishable (undistinguished) pieces?

Foolish thoughts and I must have finally cracked, hard shell peeled off like a boiled egg’s. And my insides are spilling not star dust but organs.

They are steaming on the sidewalk in a pile of red, bulging out of the old, discarded covering. I am letting myself lie down and it isn’t the ending I feared. The sky glows blue in a faraway dome, the shaking leaves are a sweet, new green and the earth rotates slowly beneath my shoulder blades.

Shoulder blades where wings might yet one day grow – reverse evolution, hello Archaeopteryx. But for today, there is weight to this great red splash I am making (its edges are bleeding permanently into the concrete, so that weeks from now people will walk around it) and the problem of knowing (knowledge? Being known…know thyself…) seems a little more manageable for one more afternoon. *** In other spaces, a perfect crystal is gleaming with a secret luster. Light slides off its parallel planes and an old man is smiling in the dark.

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Sky on Fire Photography

Lynne Rosenberg

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Hand-Off Photography

Paul Jeng

Wedding ceremony in the town of Gobichettipalayam (Tamil Nadu, India)

Tagalong Photography

Harold Moore

A mother Japanese Macaque followed by her offspring in Nagano, reflected in a hot bathing pool.

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Questions Herie Sun It's been 284 days Since someone asked how he was doing Really, really asked He knows he might not have known What to answer if they did School is good Basketball is good He has lots of friends Life is good (?)

That punctuation mark haunts him Hangs onto the end of every Sentence Thought Day In his life Some days it creeps and whispers Some days it roars It's been 284 days Since someone asked how he was doing He drives slowly to the bridge Asking himself questions as he goes

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090516 Digital

Karen Chu

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Chihuly Boat Accent

Photography

Lia Logio, MD

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Love Letter to a Classmate on Clerkships Katherine Li Dear Classmate, Between wheeling patients into hallway walls and getting reamed by family members in the ED, I never got a chance to tell you the important things.

That month we rotated on the same service was one of the angriest months of my life. Far too many were the days when I would ask if 4:35 am was a reasonable time to meet to jot down vital signs. But then, you would respond, “Reasonable in no other context,” and my resentment would dissolve into humor. In fact, your presence was my salvation throughout the day. In the mornings, when the sub-intern dashed past me into the patient room so he could open his gauze packet before I opened my gauze packet, I met your eyes and collapsed into disbelieving laughter instead of indignant rage. Six hours into retracting a cirrhotic liver, I would imagine you in the OR next door, retracting a different cirrhotic liver while nodding surreptitiously to Taylor Swift.

After your OR case and before mine, you took on the pleasant tasks I hadn’t finished, like rectal exams and Foley removals. You even forgave me that one time I gave you an incorrect lab value to review with a 14-South patient. Sometimes, during our two-hour afternoon rounds, you poked me awake. But more often than not, you let me continue sleeping while skillfully shielding my face from the rest of the team.

One time, we had a last-minute request for an 11-hour case on a Friday. Do you remember that? This was after we had both been in multiple cases the previous day, while we were in the middle of meticulously preparing presentations for rounds with the department chair. You stood up and said, “I’ll go.”

I think that was the first and last time I fell in love.

I guess what I’m trying to say is, thank you. Thank you for pulling your weight and having my back and teaching me far more about altruism than any ethics class. Soon (but not that soon), we will both be professionals, respected in our chosen fields. Only we will know of each other how terrified, bewildered, and utterly furious we were during our

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serendipitous time together.

I hope I did right by you too.

Love,

Your classmate on clerkships

•

Cycle Lara Wahlberg, DNP, AGPCNP-BC, ACHPN, OCN We are fragile; We are strong Life is short, but also long We awaken, and we sleep Float on the surface; dive down deep Sometimes we crash, and then we mend Come to the finish, start again At times life hurts, and then turns sweet It shines, then fades, becomes complete

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Wituk Painting Photography

Ana Zambrano (Palu Warmi)

Painting by the indigenous artist Sofia Gualing aka Sacha Warmi, following her roots from the Amazonian region of Ecuador, Sarayaku.

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Costa Rica

Photography

Rana Khan

How did you lose your tail?

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Departure Michelle C. Siao Warm in knitted scarves, A wool hat, and down coat but Missing one mitten.

Blue

Photography

Samantha Shetty, MS

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In the Canyon Photography

Iliana Gutierrez

Don't spend too much time focused on what is near or far, just take it all in.

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My Escape Photography

Amelia Kelly

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The Forever Soldier Danny Kramer What is this life but a constant battle?

What can I do without the key?

Nearly all the time spent in the saddle.

Is there any hope for me?

But through the endless war,

I stand at the entry with steady gait,

With shield and sword so worn.

The forever soldier set to wait.

There was a blinding, mesmerizing, sight that stood before.

I shall not worry, I won’t despair, All things the hands of time repair.

A castle arose in iron vest, Taller than near all the rest.

The right key I will one day find, My patience I will stand behind.

Approach with caution, yet to see What it was standing before me.

I have one thing to comfort me, There are worse things than uncertainty.

I approach the entry with steady gait, The forever soldier set to wait.

What is this life but a constant battle?

Nearly all the time spent on the saddle.

For on the door that stood before me, Was a padlock of uncertainty.

Until the moments come, Saved for worthy some.

I examine this lock with curiosity,

From which there is no way to run.

Thinking that I have the key.

No turning back, but no way ahead, A key that’s soft, a key that bends,

There is no other way instead.

With anything this key contends.

From what’s inside I can’t turn away, But lo to my eyes, for they knew,

When I cross the threshold will come the day.

The true key was out of my view.

I stand at the entry with steady gait, I think, I ponder, I ruminate, With myself I still debate.

The forever soldier set to wait.

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Il Sogno Photography

Jaimie Uva

Montalcino, Tuscany.

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Modern Medicine Satirical Drawing

Ghaith Abu Zeinah

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Hazey in Green Photography

Herie Sun

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Priorities Colored Pencil

Olivia Mae Sutton

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My Hypocritical Oath Daanish Chawala Patient 000525.

Combatant, enemy of the state, and prisoner-But not of war.

Looking through the slit in the door, With two faces, My mission is to keep him alive. But my duty, Is to do no harm.

He would never trust me, how could he?

I wouldn’t.

A government operative, informant, “a devil,” In his eyes.

And I can only swear that I am here for mental health.

We speak, Through the same interpreter always present, In his interrogations.

But of the beatings, the cold, the rape, The abuse, We would never speak.

I provide, Excellent care. Or so they say. My expertise, Drawing from, Everything I never learned in school.

Histories are, Incomplete, blind to the root of it all.

My diagnosis: Will allow it all to continue, With no end in sight.

Their testimony still valid so long as,

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The madness is treated.

In five months, I’ll be honorably discharged, To home.

My patient may one day make it out. Released, As a shell.

But I will stare at myself one day and face true terror, Has my covenant been broken?

What have I done?

From One Mouth to Another Photography

Tiffany Huang

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The Ghosts of a Thousand Bunker Photography

A.C. Antonelli

On that day, the sun rose over Hampton Bays to reveal thousands upon thousands of dead bunker shimmering along the surface of the Shinnecock Canal, which separates the Great Peconic Bay from the Shinnecock Bay and the Atlantic Ocean. It had never happened before, and most believe it will never happen again.

The Squirrel Who Mistook His Lunch for a Specimen Photography

Jennifer C. Chia

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Tunnel Photography

Stacy Joo

Upper East Side Photography

Stacy Joo

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Knowing You Chris Gamboa You knew better than most how to feel for another, taking up vicarious triumph, taking on referred sorrow.

You knew better than most, what to look for to bring light to life’s unanswered questions.

You would probe the depths of prose & poetry, combing through the Sands of Foam, collecting the pearls of Mary Oliver-esque ephemeral wisdom, crawling through the web often seeking a salve, but insatiable as you were, seeking something deeper salvation.

You knew better than most, that to love deeply is to open yourself to another, inviting them in to take residence and precedence.

It is to willingly bind your heart to theirs in a thorny bramble such that if one pulls away from the other each one feels the torturous tension.

You knew, still, that to love and be loved IS salvation - and you loved with abandon.

As such, you came to know me my dreams, my being, my soul as I came to know you - better than most.

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You knew loss better than most, and in infinite wisdom you suffered, succumbed to grief, and in consequence learned you could withstand more, as wary as you were of any further wrenching away of loved ones.

You shared your struggle and we all grew though I had not known how much at the time.

Ever full of energy, driven to hike the desert plains, rolling hills speckled with wildflowers, familiar mountain terrain with Spero and camera in tow, so it was that you departed into the Great Unknown.

I imagine you rapidly ascended high above the land and sea into the southward winds carrying dandelion seeds far and wide, the vibrant sunlight bathing turtles, resting dogs, and fields of flowers alike, the moonlight and stars thus filling the night sky with memories of you.

In consequence - as I knew when I accepted your love the slack, thorny rope binding me to you would tighten and tear.

A thousand tiny barbs pierced my heart leaving a trail of tattered flesh before me, a mess my one-week-fresh medical student self would have to quickly clean up.

Yet in those sullen moments I knew - perhaps better than most that love knows no end.

I knew that I could shake the shroud of grief that left me tender and often on the brink of tears.

I was scarred - deeply true but it wasn’t long before I felt surrounded by your gentle, knowing, comforting spirit undoubtedly a shoddy second but a loving embrace around me ‘erywhere I go, thanks to you.

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Ascensus Volume VI Ascensus is Weill Cornell Medicine’s annual journal of the arts and humanities. It was founded by a group of medical students in 2011 to provide a space for students to reflect on the practice of medicine. Since then, it has grown to feature work from all members of the Weill Cornell community, including faculty, house staff, medical students, graduate students, nurses, social workers, and more. Over the past six years, Ascensus has featured rich visual and written work by many members of the Weill Cornell community.

The editorial team takes pride in the quality and diversity of the work showcased each year and hopes to continue serving the community through this publication for many years to come. We believe that this journal provides an important voice for members in our community as we come in contact with patients and their stories, and think of our own.

The mission of Ascensus is to bridge humanities and medicine through publishing an annual journal, along with holding lectures and other events.

We would like to encourage all members of the community to continue creating artistic pieces and reflections on medicine and the human experience. We look forward to receiving submissions for next year’s journal! Please reach out to us at wcmc.lit@gmail.com with submissions or questions.

Lastly, we would like to thank our faculty advisors, Dr. Susan Ball and Dr. Randi Diamond. Ascensus is published with the support of Weill Cornell’s Office of Academic Affairs and the Liz Claiborne Center for Humanism in Medicine.