apenndx - Issue 1 (Spring 2020)

apenndx

Spring 2020 • Issue 1

Letter from the Editors Dear Reader, In August 2019, the Penn Med Class of 2023 congregated for the first time in the sunlit halls of the Jordan Medical Education Center, just a few floors from the patients and medical staff of the Perelman Center for Advanced Medicine. Assisted by our backgrounds in writing, editing, graphic design, publishing, and website design, we—a handful of those first-year medical students with an intertwined passion for the sciences and humanities—banded together and made plans to craft a student-run publication that could feature anything from science journalism to experimental fiction. Our first meetings took place on cushioned benches outside our classrooms and at coffee tables in the hospital downstairs; we decided print logistics, distributed editing assignments, and discussed the title of the magazine. As we welcomed submissions from our talented classmates, we began to see the interdisciplinary nature of our publication materialize in the form of creative nonfiction, artwork, poetry, and beyond.

Our team couldn’t have known that, just two months into our second semester at Penn Med, a pandemic would leap out of our lecture slides and into our reality. In the unpredictable weeks that ensued, as our preclinical curriculum moved online and our classmates dispersed across America to quarantine with family, COVID-19 became a centerpiece of our community’s consciousness.

We have since received a new wave of submissions focused on experiences from the pandemic, which we are proud to feature alongside the works previously collected.

We do not know when we will be able to reunite with our classmates in Jordan Medical Education Center, nor do we know exactly how the pandemic will shape our careers as physicians. But what we do know is that in this time, perhaps more than ever, there seems to be a heightened demand for compassion, openness, and clarity. Whether you are reading this as a classmate, a professor, an aspiring medical student, or a friend, we hope that you see these qualities reflected in the stories and art that comprise apenndx.

It is our pleasure to welcome you to our first-ever issue. Thank you for your support.

Sincerely, The apenndx Team

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Table of Contents Essays

How a Fifteenth-Century Painter

Will Help Me Become a Better Doctor (Someday).................................................p. 6-7

Is A Surgery Just A Surgery?....................................................................................p. 8-12

A Mile In Their Shoes.............................................................................................p. 13-14

When you talk about my sister............................................................................p. 15-16

Bad Blood...............................................................................................................p. 16-17

Checking In.............................................................................................................p. 18-20 Resilience: Visualizing Global Women’s Health.....................................................p. 21-23

Women Leaders at Penn Med: Looking Back, Looking Forward........................p. 24-29

Football and the Brain: Our Current

Understanding of Chronic Traumatic Encephalopathy..........................................p. 30-31

Art & Poetry

Room 210.....................................................................................................................p. 34 Water Woes..................................................................................................................p. 35 Drawings from Anatomy Lab...............................................................................p. 36-37 The Workshop........................................................................................................p. 38-39 “Miren me”..............................................................................................................p. 40-41 Girl with Bull...........................................................................................................p. 42-43

Scenes from Quarantine

Out of the Frying Pan into the Fire......................................................................p. 46-49

Running from ‘Rona’.............................................................................................p. 50-51

Dwelling..................................................................................................................p. 52-53

The Smell................................................................................................................p. 54-55

A Seat by the Stream.............................................................................................p. 56-57

Happy Hour............................................................................................................p. 58-59

Living Among the Dead.........................................................................................p. 60-62

Cherry Blossom...........................................................................................................p. 63

Thursday Afternoon..............................................................................................p. 64-65

First Wave...............................................................................................................p. 66-67

Coffee in Church....................................................................................................p. 68-70

A Modern Passover Story.....................................................................................p. 71-73

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ESSAYS

How a Fifteenth Century Painter-Turned-Scientist Will Help Me Become a Better Doctor (Someday) J. Reed McGraw, MS1

“The blood is always too cold,” she told me. “I wish they would let it warm up before they started.” A heating pad from home rested on her forearm, covering a tube of crimson red that snaked out from underneath, winding its way up to its source. Dangling from a hook, a bag of red blood oozed its chilled contents into her arm.

This was my patient, Mrs. M, receiving a blood transfusion. She needed them every three weeks. Often, I would have the opportunity to join her in the hospital. As a first-year medical student, I was assigned to follow her in her care, to better understand and appreciate what it meant for her and her family to grapple with the chronic medical condition she faced. Our days began with that same ritual: cross-check the blood type; hang the bag, fresh from the fridge, on its perch; place the IV; start the drip; and see that same grimace as the cold blood started to flow. One of those days, she turned to me, chiding, “This hotel art they have hanging in every room sure isn’t doing much good.” I gathered that she wished the doctors, nurses, and hospital administrators had noticed the small things—the cold blood, the tasteless art—that might make all the difference.

There has arguably been no better observer of those details than Leonardo da Vinci, the Renaissance painterturned-scientist responsible for painting the Mona Lisa, credited with the definition of atherosclerosis, and acknowledged as the creator of the first form of engineering technical drawing. Leonardo was a man of broad interests and incredible talent across disciplines ranging from the fine arts to the natural sciences. The root of that broad success was his incredible skill of observation.

Trained as a painter, Leonardo learned to see the world around him with unmatched acuity and curiosity. To paint faces, he would converse with people in the streets of Florence, study their expressive muscles, their wrinkles, their contours, seeing how light and shadows played off of each other as their faces twisted into smiles and frowns. He would draw these faces, from memory, in incredible detail in a notebook that never left his side. He would do the same for plants, landscapes, and the world around him. He was obsessed with detail. One of the items on a to-do list from his surviving journals asks him to “Describe the tongue of a woodpecker”—a detail that most of us would be fine missing.1 Leonardo built upon this curiosity-driven observation skill from painting in his endeavors as a scientist.

In his era, much of science in Europe was rooted in superstition as the continent emerged from the Dark

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Ages. Leonardo believed that science should be rooted in observation and experimentation based on testable hypotheses. He created detailed anatomical drawings, some of the first of their kind, based on careful dissection and study. These illustrations depicted arteries, veins, nerves, and muscles from different angles and perspectives in order for surgeons to better understand the intricate anatomy of their patients. He even revised his depiction of a man’s neck in his painting Saint Jerome in the Wilderness when he discovered that the sternocleidomastoid was, in fact, a pair of muscles and not just one.2 Taking this skill even further, Leonardo was able to deduce many natural laws later published during the Enlightenment. In what began as studies for his paintings, he observed the wings of birds as they flew, noting the varying velocity with which they beat on the air. Combining this with experiments conducted on fluid flow, he inferred Newton’s Third Law of action and reaction—formally published centuries later.

But what does this painter-turned-scientist have anything to do with healthcare delivery in the 21st century?

It was by a chance recommendation that I picked up a Leonardo biography to read in my (little) free time in medical school. I had no idea that what was originally intended to be a distraction from studying physiology and pharmacology could prove so rich in skills and inspiration for becoming a better doctor in the future.

Studying Leonardo has inspired me to become a better noticer, to slow down, to look deeper—despite how quickly the days fly by. In the lab, this means being more curious and using close observations from experiments to drive better hypothesis development. In the clinic, this has heightened my awareness of the expressions and body language of my patients—to see beyond the words coming out of their mouths, to more clearly understand their hopes and desires for their treatment. Noticing is seeing the human details, that cold blood drip or that tacky wall art, that matter more to our patients than most of us realize.

Many of the frustrating details of medical care for patients, unfortunately, cannot be changed. Temperatures for blood transfusions are tightly regulated, for instance. I recently visited Mrs. M before another transfusion.

We joked about the frigid blood she was about to get and how this transfusion room had borrowed its wall art from a different hotel. As the nurses were cross checking the blood, I offered to heat up her warming pad for her. “That’s the first time any of you have ever offered. Thank you.”

And she smiled.

References 1.

2.

Windsor, RCIN 919070; Notebooks/J. P. Richter, 819.

Martin Clayton, “Leonardo’s Anatomical Drawings and His Artistic Practice,” lecture, September 18, 2015,

https://www.youtube.com/watch?v=KLwnN2g2Mqg.

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Is Surgery Just a Surgery?

Nolan Kavanagh, MS1

I grew up in Macomb County, Michigan. In many ways, it’s the idyllic Midwestern community: charming, welcoming, buoyed by the automotive industry, and full of apple orchards and classic car shows. But despite being in the upper third of the state in socioeconomic status, it’s in the bottom third in health outcomes. And it leads the state in number of opioid deaths, second only to Wayne County, which includes Detroit.

Many of my friends, family, and neighbors have chronic health conditions, and some of them struggle to afford health care. And yet, despite the Democratic Party’s emphasis on affordable care, many of the same people voted for President Trump in 2016. Between the 2008 and 2016 presidential elections, Macomb County swung 20 points toward Republicans.

In 2016, the physician-sociologist Jonathan Metzl interviewed white men in communities not unlike mine, all across the country. In Tennessee, he met Trevor. “Ain’t no way I would ever support Obamacare or sign up for it,” said the 41-year-old white man. “I would rather die.”

Yet Trevor was dying. His liver was failing due to chronic substance use and hepatitis C. Because he was uninsured and low-income, the medical care that could protect his liver and cure his hepatitis C eluded him.

Under the Affordable Care Act, states had the option to expand Medicaid coverage to more low-income Americans. But Tennessee hadn’t.

When Metzl asked Trevor why he felt this way, the dying man replied, “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.”

If you spent a day in Macomb County, I’m sure you’d meet plenty of people just like Trevor: low-income, uninsured, white, and stringently opposed to the expansion of Medicaid or any government “interference” in health care, despite being clearly positioned to benefit from it. The details of their motivation are often opaque and rooted in complex cultural, economic, and political histories. But one aspect of their decisionmaking is perfectly clear: Medicine doesn’t exist in a vacuum.

Health is one of the defining political and economic issues of modern America. We spend 18 of every 100 dollars on health care; as voters, we’re captivated by the torturous details of health insurance reform.

It’s all for good reason: Health status and medical care interact intimately with our experiences and societal structures. Social, economic, and political movements shape the health of individuals.

But what about the opposite direction? That is, what impact do health and medical care have on the world outside the hospital?

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An easy example is disability. The proper functioning of our muscles, bones, and minds allows us to engage with the world. For example, hip replacements are performed on adults of any age, even into their 90s. This is despite the manifold risks of surgery. So why do them? Because they dramatically improve quality of life.

My grandmother recently had a hip replacement in her mid-80s, and her new self has reengaged with the world. Able to walk with greater ease, she roams her senior living facility, cheerily plays cards with neighbors, and ventures out to worship, shop, and dine. (Or at least she did before COVID-19.)

The research is clear. Hip replacements improve the physical and mental health of recipients and may even extend their lives. More quantitatively elusive but nevertheless important are their social benefits.

Let’s try a deeper cut: Teeth. We as future physicians — and Americans in general — often overlook teeth, yet they take center stage in our lives: eating, speaking, smiling. Tools of expression and symbols of status, they dominate our interactions. We couldn’t live without them.

Teeth can also insidiously impede our worldly pursuits, setting us onto lower economic trajectories. In her book, Teeth, the journalist Mary Otto tells the story of Aida Basnight. Aida used to work as a secretary in Chicago. Starting in her 30s, however, she experienced one oral infection after another. Early on, she lost her molars, then many others. In her 50s, she lost her job and home and began sleeping in a park in D.C. Despite her wit and work ethic, no one would hire Aida.

She recalls her mother saying, “Nobody’s gonna hire you with that bunch of gaps in your teeth.” Aida added, “I always feel self-conscious about them in the interviews. I can’t smile because I’ve got no teeth.” Now, Aida lives on the streets of D.C., selling a newspaper produced by the city’s homeless. She is “careful to smile with her mouth closed.”

Aida’s experience is not unique. In a 2015 survey by the American Dental Association, nearly 4 in 10 lowincome Americans felt embarrassed to smile because of the condition of their teeth. About the same number believed that it inhibited their ability to interview for a job.

While teeth are not the sole reason that many Americans struggle to find work, they contribute to the economic struggles of many. About 100 million hours of productivity are lost each year because of oral health problems, and the least privileged among us shoulder the greatest burden. So profound is the impact of health on how we lead our lives.

Let’s keep going: Our health even appears to shape our political orientation. A burgeoning subfield of public health research suggests that health status predicts whom we vote for. A number of recently published articles (including a forthcoming one by yours truly) have shown that people with worse health are more likely to vote for Trump, Brexit, and populist parties across the European continent.

The effect isn’t small: When we control for socioeconomic and cultural factors, health exerts a greater

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effect on voting than education and how comfortable we feel about our paychecks. This finding is especially surprising since many populist parties have threatened to reduce access to affordable medical care. It suggests that health strikes at a deep vulnerability that radically resets our political mindset.

Which brings us back to Trevor. His decision to vote Republican — despite the refusal of Tennessee Republicans to expand Medicaid — reflects the rich interplay between our health and social context. This interplay is messy and begs for more explanation, but it makes one thing clear: no medical or public health decision is socially neutral. Every drug, surgery, and behavioral therapy that we provide is as much a medical intervention as a social, economic, and political one. This conclusion raises an important question: What is the role of (future) physicians in society? And should we be paralyzed by its expanse?

As a guiding principle, we must treat all patients with dignity. For example, we absolutely should not strip health resources away from low-income people if we want them to vote a certain way. But we must also recognize that our work intervenes broadly on our patients’ lives, unmistakably altering the memories that they make, the way they earn a dignified living, and what they envision as a just society.

We should be especially careful with decisions about the distribution of health care resources within our society. For this reason, I believe that we as (future) physicians should insert ourselves into more social and political conversations than we do. We have a lot to say.

But at the very least, we should think about our impact on people like Trevor. Even though he sees us for only a few hours each year, we continue to have a presence in his life during all the other hours, too.

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A Mile In Their Shoes Nick Rizer, MS4

I always feel like I should be running when I am pre-rounding. A light jog at least, to keep pace with the thoughts racing inside my head. I’m lost in simultaneously trying to map the quickest route to my patient on Founders 12, finalizing the plans for my patients, and trying to remember if this new service has morning conference. I realize if I don’t hurry, I won’t have time to run the list to the fellow before rounds. So I focus on the hollow thud of my hand-me-down black cap-toe shoes and begin apologetically weaving my way to the elevator bank.

As I step onto the elevator next to a patient, I recognize the small talk she makes with her overworked attendant. I have heard it before. “My daughter once had an MRI of her knee, but I don’t know anyone who has ever gotten an MRI of their head. It will probably show nothing, they never show anything.”

In an instant, I am back in the MRI, the interrogating thuds of the machine closing in on me. Waiting for the test to be over, waiting to be better.

Ding! It’s my floor, and I focus on the quickening thuds of my shoes as I speed away from the elevator. The constant clacking provides momentary distraction. I start to mentally prepare myself to try to sort out my patient on Founders 12, cursing myself for not seeing this patient earlier. I still don’t really understand what is causing their dizziness “that just won’t go away.” We’ve ruled out the serious and the common, and I’m unsure where that leaves us. Why did I leave this patient for last?

Finally off the elevator and onto Founders, my eye catches a room. It’s a room I’ve been in before. It’s bedside rounds, an anxiety inducing clerkship year tradition. The attending is beginning her teaching point on biliary pathology as she finishes palpating the abdomen. The medical student, uncomfortable in his unfamiliar attire, stares back worryingly at his attending, hoping there won’t be a question about some longago forgotten point of pathophysiology.

Suddenly, I am back alone in the exam room stuck between two worlds. My brain is still mired in the thick fog of a concussion, unsure if I am allowed to use the word “anterolateral” as a patient. Reflexively, I dread the questions about spinal cord localization interspersed during my neuro exam, but I welcome the momentary distraction they provide from being a patient.

My head snaps back forward and I side-step a linen cart rumbling by. I focus harder on the clack of my wellworn leather soles. The time between each thud of my soles grows longer as I approach my destination. I fall back into routine to calm my nerves. I scan my list. Review the name. Check the room number. Take a deep breath in and cross the threshold.

As I gather the unchanged history and unchanged exam and answer questions about the plan for the day,

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I prepare to head for the safety of the door. Then the patient asks me the question I’ve been dreading the whole morning.

“When will I get better?”

I sit there wanting to say so much. I want to tell him how I have asked myself that question so many times.

I want to tell the how desperately I have searched for an answer to that question. I want to tell him he is not alone, that I am not alone.

I sit on his bed silently. I have sat on this bed before. Shielded by the lessons I have learned day by day, I muster forward the only answer I know to give. “I don’t know.” And I sit there a little longer.

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When You Talk About My Sister Jeanne Farman, MS2 jeanne.farnan@pennmedicine.upenn.edu

“I’m so sorry.” My youngest sister, Annie, was born during the spring of my freshman year of high school.

These words, spoken by one of my closest friends, are etched into my memory, integrally intertwined with the events of that spring.

“I’m so sorry.”

I remember these words so clearly because they clashed dramatically with my own experience of my baby sister. Her birth was an occasion for joy, not consolation. She had been born without complications and in good health. She was a beautiful baby. She had come into the world with only one significant medical challenge: Down syndrome.

My friend’s well-intentioned but, in this case, misplaced attempt at consolation was my first direct encounter with the all-too-common conception that the birth of a child with Down syndrome is unfortunate, something to be avoided. I realized, for the first time, but not the last, that many people see my sister’s life primarily as an instance of Down syndrome, rather than as a life with intrinsic worth, a life to be celebrated.

What is my sister’s life like? Well, like most third graders, she plays on the soccer team at her school. She enjoys painting, and, for the last few months, painting her nails. She has friends at school, her own set of interests, and a unique, complex personality that has enriched my family. In short, my sister is happy, and that she has brought happiness and love to my family in a way that we could never have imagined. Her condition has not defined her. Annie might not live the typical, “perfect” life, but she lives her life perfectly as a beautiful and unique individual. Like all lives, hers is one of great potential, and of great worth.

In medical school, I have observed that our profession’s perspective on those with Down syndrome is somewhat complicated. On the one hand, I have seen my peers cultivate an ethos of sensitivity and caring that extends to all their patients, including those with Down syndrome. I have been so genuinely impressed by their thoughtfulness and kindness, and I know that in the future they will give my sister – and others with a disability – great medical care and great respect. Yet, on the other hand, I have sometimes felt that the concept of “Down syndrome” and the abstract discussion of those with this condition lacks the empathy that is afforded, in practice, to the individual. Here, I am thinking in particular of discussions that arose during our Genetics and OBGYN courses, when we learned about prenatal screening for Down syndrome.

Although individuals with Down syndrome were always discussed with respect, I sometimes felt that the emphasis placed on the success of these screening programs made the birth of those with Down syndrome seem less than ideal.

I am aware that any discussion of this can be precarious, as this is often a sensitive and sometimes deeply

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personal topic that has affected many more families than just my own. I do not intend to cast aspersions on any members of the medical profession, or to claim that prenatal testing cannot be beneficial to families as they plan for the birth of their child. Rather, I simply want to say that, as medical professionals, we should be cautious in these prenatal discussions not to imply that the life of a person with Down syndrome is undesirable. Certainly, it is true that the medical challenges associated with a diagnosis of Down syndrome are less than ideal. However, I think we must be careful to ensure that our admirable desire to avoid these complications does not simply slide into the easier solution of avoiding the individual, and the unique impact each of these individuals can have on the world.

If I could impart one piece of advice on behalf of the Down syndrome community, it would be simple: listen. Listen to the person with Down syndrome, and listen to their families. When you encounter a person with Down syndrome, whether it is in your medical practice, or at your child’s soccer practice, do not jump to conclusions about quality of life, or rush to offer a heartfelt but misplaced “I am so sorry.” Do not impulsively attempt to empathize, or assume the value or quality of a life merely because you know the medical challenges that the extra twenty-first chromosome might entail. My sister’s life has certainly had challenges – most lives do. Yet, it has also been beautiful and complex and full in a way that no prenatal test can predict.

Furthermore, to my fellow medical students and future colleagues, I offer a challenge: do not settle for the deceptively simple solution. Do not confuse elimination of the problem with cure of the condition. Instead, work for medical solutions and innovations that will better the care of those with Down syndrome.

Finally, I would invite you to reach out if you have any questions or comments regarding this piece. I know that it is a complex topic, but to me, to many others, to my sister, it is an incredibly important one as well.

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Bad Blood Jay Garcia, MS3

Ms. P did not enjoy running. Her two toddlers and their feisty “Cat” the cat didn’t give her much choice in the matter.

All three were committed to getting into trouble. That morning, one of the three had made a mess at breakfast, and she missed the bus. She was almost back to her jolly self that evening when she walked into a free community clinic. She had no medical conditions and was only here for a checkup. She was happy to let two med students tag-team a simple blood pressure. Though I was only a few weeks into medical school, I had taken a few hundred as an EMT, and was now teaching another student. His gloves trembled with uncertainty. “160/155.” I put my finger on Ms. P’s wrist to verify the systolic.

Ms. P looked uncomfortable. “Shouldn’t you be wearing gloves?” “I can, but it’s safe,” I replied. She began to cry, “No, no, I have bad blood - I’m so sorry.” She was HIV+ and had forgotten her meds with the morning rush. She had come in to reassure herself that she was safe, but was now feeling guilty that she had exposed us. I tried to verbally reassure her. Even if she hadn’t been on a powerful combination of antiviral drugs stopping the virus from reproducing, it was impossible to get infected from touching her wrist.

For a split second, however, I had a doubt. She said something akin to “I think you have it now,” but what I heard was “You will die a slow and painful death” like the two loved ones I’d lost to the same virus as a child. I looked down, but I did not see the kind and joyful mother of two toddlers and Cat. I don’t think I even saw an arm. In that fleeting, regrettable, irrational, and inevitable moment, I felt a threat.

It is a distinctive, visceral uneasiness. The perception that a patient may present a threat has time and time again led to discrimination, stigma, and substandard care for patients with infectious conditions. People with HIV, especially, were neglected and abandoned by the medical system in droves. But it goes beyond that.

I recently witnessed an entire team of nurses refuse to lend care to a patient with bed bugs. In retrospect, I think they feared bringing it home and spreading it to their children and communities. Underneath the

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disgust and the jokes they expressed, I recognized fear.

As an EMT, I grew accustomed to that sensation. I dodged blood, mucus, and unattached body parts in houses, alleyways, and street corners. I had no idea who had what, so I had to assume that every drop of blood had everything. I was trained to ensure “scene safety” and don PPE before even looking for a patient.

In med school (especially as someone interested in anesthesiology), I have been reconditioned to start my patient encounters with the “ABCs” - or “Does this patient have a patent airway?” To be sure, hospitals and clinics tend to be safe environments, and donning PPE is standard procedure before starting an encounter.

Even viruses, originally defined by their ability to sneak through filters, are held back by our N95s. But those masks cannot filter out fear.

We are evolutionarily predisposed to scan our environment for threats - and protect ourselves accordingly.

Our self preservation instinct responds to perceived threats, like an invisible virus bent on using our organs as disposable copy machines, poisoning our lungs, our mind, and ultimately, our compassion for our patients.

That night in the clinic, I almost let it come between me and Ms. P. The all-too-familiar feeling of danger kicked in. I tried to remember whether HIV was +ssRNA or not, enveloped or not, helical or not - and whether that meant skin-to-skin transmission. Somewhere in that search, I found my old training and just thought “scene safety.” I was able to take a second and rationally think through the exposure risk. It was negligible. I was safe. It was only then that I was able to see Ms. P, still sitting in front of me. Here was this wonderful human being who lived unduly terrified of her own blood. I assume a well-intentioned provider had scared her into adherence, making her think that even one missed pill could make her hurt the people around her. But what she as a patient and as a human needed was compassion. I was able to take her hand and tell her the truth she needed to hear, “You’re okay. We’re safe.”

We all strive to provide compassionate care to every patient. In a pandemic with incalculable asymptomatic carriers and healthcare workers dying from the virus, it is difficult not to perceive every person as a threat.

This thought inevitably jeopardizes our ability to be empathetic providers as we put physical and emotional barriers between ourselves and our patients. But that fear, caused by an instinctive drive towards selfpreservation, can instead be harnessed to ensure we take the necessary precautions and do no harm - to ourselves or our patients. All it takes is an intentional, deliberate assessment - when you ask yourself “Am I safe?” make sure that you can hear it, and answer.

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Checking In Amara Prato, MS1

Daniel lay in his lofted bed and stared at a lone cobweb on the ceiling. Too tired to properly dry his hair, he felt the rumpled comforter beneath his head grow colder and wetter. He knew that intern year wasn’t supposed to be easy (he’d once said the same thing about medical school); but he hadn’t anticipated losing the energy and stamina of a pre-med college student by the time he turned twenty-eight, and he definitely hadn’t accounted for a global pandemic. After another 20-hour shift, he’d flopped onto his unwashed sheets and landed in the shape of a homicide chalk outline: legs splayed, one arm slung towards his forehead, the other angled towards his hip as if he’d been pumping his arms while running. When was the last time he’d gone on a run?

A text message awakened his phone screen. Without lifting his head, he strained his extraocular muscles to read the sender’s name, expecting his younger brother asking what classes to take next semester or his girlfriend telling him when she might be in town again. He winced at the potential tease and his hip-angled arm drifted further south in anticipation.

“Hey”—properly spelled and capitalized, no punctuation or emoji. No inflection, no clues. A lawful neutral text.

When he recognized the author he jumped to reply, ignoring the cool trickle of water down his neck as he sat up at attention. “Hey, how are you?”

“I’m good. I’m just checking in because I remembered you were doing an Emergency Medicine residency.

And how you’re on the front lines. I hope you are okay. I don’t know how it is over there.”

He warmed at the thought of being wanted or at least cared for.

“Sorry, that was a lot. I know it’s been a while.”

It had been over a year. He counted again; it seemed like so much longer.

He still remembered everything. Granted, there weren’t that many isolated experiences to remember. They had seen each other a handful of times in a very practical, physical context. And he had a girlfriend now, who actually considered him her boyfriend.

Years, miles, and girlfriends notwithstanding, Daniel thought often about Grace. How she looked even better than usual somehow that time she came from the gym and was late to meet him at her apartment.

Her hair piled on top of her head, sports bra peeking out of a sleeveless shirt, strong, supple legs almost wholly appreciable in spandex shorts. He’d never seen her in makeup, but her cheeks blushed from exercise

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and embarrassment for her tardiness. She still needed to eat and shower. Daniel had already eaten dinner but accepted the homemade noodles she offered when she reheated some for herself. She wouldn’t go on a real date with him, so he’d take what he could get.

Before her, he had been intimate with four people, two of them girlfriends. At twenty-six, he’d been afraid to ask her numbers in case she might return the question. When she learned he was about to graduate medical school she asked, “Have you ever done it in an exam room? When it’s been cleaned, of course.” He hadn’t.

There were a lot of things he would do with and for her for the first time.

He hadn’t been sure what to expect. They had interacted only briefly before defining their (lack of) relationship.

He knew she would be moving in a few months to take a job closer to her family. He was lonely and wanted to spend time with someone outside of the medical school—to feel like a guy in his twenties, not a Hippocratic robot running on flashcards and crass mnemonics.

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The first time they’d planned to get together, she’d had to cancel. Her grandmother was sick and she didn’t know when she would have another opportunity to spend a long weekend with her. If he’d told any of his friends about Grace, they probably would have warned him that she was flaking. But he didn’t, and she wasn’t. But he had realized early on that Grace said what she meant and meant what she said, even if it made other people unhappy.

She had texted him most nights after her family had gone to bed. What started as casual flirting escalated into scrolling paragraphs about why he’d chosen to pursue Emergency Medicine and how she worried about financially providing for her parents and grandparents as they aged. When he’d felt a residency interview had gone well, she had been the first person he’d wanted to tell about it. “I can’t wait to celebrate with you soon,” he’d written. She hadn’t reciprocated explicitly but indulged him with “Congratulations!” and an emoji with a small smile.

Their first night together had been weeks later after Daniel finished his OB/GYN rotation. Conducting pelvic exams was not any kind of preparation for being with a woman as a partner, and he fumbled with even non-suggestive moves such as offering her a bottle of water. What was he, her Lyft driver? Erring on the side of gentleness even before any medical school soft skills indoctrination, he asked for consent at every “checkpoint” as a middle schooler might define them, from taking off his shirt to moving to the bed. “It’s your shirt, your choice,” Grace had laughed, and he was willing to make as much of a fool of himself as necessary to be the one to make her laugh like that again.

When he touched his lips to hers he felt her smile, tasted her sweet mint lip balm as she exhaled. He remembered discovering and tracing each of her tattoos and watching her pupils dilate when they turned the lights off. He hoped because her brain was getting a surge of dopamine to match his, that her nucleus accumbens might be sufficiently stimulated for her to reconsider their original agreement as he had. That she might want something more, too.

“It’s tough, but I’m okay.” He replied less than a minute later. Always too eager. “It’s good to hear from you.”

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Resilience:

Visualizing Global Women’s Health Zoë Ruhl, MS1

This project, at its core, is about the resilience of women. I have not quite finished it, thus my full hypothesis has yet to be solidified. I will continue to work on it this summer and throughout medical school and my MPH training. But what I have now is real and concrete and valuable, and that is the stories and faces of women.

For the years between college and medical school I created a fellowship where I traveled to 5 countries on 5 different continents. I sought to spend time getting to know women from a broad range of living environments, socio-economic statuses, races, and backgrounds. I wanted to ask women what they felt were the biggest threats to women’s health in their countries. I wanted to know what negatively impacted their lives, but also what made them feel strong, what gave them hope, and what made them happy. I sat in on sex ed classes and spoke to mothers in Fada N’Gourma, a small village in Eastern Burkina Faso. I taught at a preschool in the mornings and interviewed women in the afternoons in the Din Daeng District of Bangkok, Thailand. I played with goats and shared meals with female weavers in Cusco, Peru, venturing out to speak with women in villages throughout the Sacred Valley. I then met with activists and roamed the streets of Dublin, Ireland, before returning to my home city of Atlanta, Georgia. I chose each country because it stood out in its region as posing specific threats to women’s health. I ended my journey in my own American city because each threat to women’s health that I witnessed internationally was — and still is — a problem not only in the United States, but specifically in the city of Atlanta.

I believe in putting faces to stories. In these days of anonymity and distance, I think that apathy is far too common. I also believe that it is very hard to feel apathetic towards a real person. So accompanying each interview is a photograph — a real woman who spoke truth to power and shared her life and image with me.

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While I have much more work to do to compile all of my transcripts of interviews, my photographs, and my ideas for further research, what I have already put together is that there is a current that runs between us all, a stream that connects all the women I spoke to. This current is one of strength and power, resilience and dignity. Across countries, continents, and experiences, the unifying thread I saw come up everywhere is that women are strong. Women felt that their countries and the world at large did not have a true grasp of their lives. I spoke with a woman in Patabamba, Peru who told me that one of the biggest problems for women in Peru was husbands abandoning their wives and leaving them to raise their children on their own. She said that, while the government was focusing on other issues related to women’s health, providing psychological support for children and job opportunities for single mothers would make their lives better. She told me that her biggest advice for her two daughters was that they study, move forward, “do better” than her in life.

These 3 photographs are just a snippet of my project. The first photograph was taken at a tiny village called Chahuaytire, in the Sacred Valley of Peru. She is a weaver for a women’s weaving collective and a mother of 3. She told me that when she went into labor, she walked an hour and a half to the nearest health center because she could not afford any other means of transportation from her village. She also had to walk with the babies to the health post for mandatory check-ups. If she had failed to give birth at the health center or missed the mandatory check-ups, she would have been fined; the government had instituted these monetary punishments in an effort to lower maternal mortality rates and improve child health.

In the next photo, the woman with her eyes closed works making children’s toys in Bangkok. She told me about her upbringing in Bangkok, that she’s happy to have found a job and to have money. She told me that she thinks she is ugly and that she has struggled emotionally when her relatives have fallen ill. She talked

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about how her community and friends make her life better but that she sees more and more unplanned pregnancies in her community. Her biggest advice to young women was, “Be a good person and take care of your body.” I asked her what she wanted the world to know about Thai women. She replied by telling me that they are good and beautiful. In her 61 years of ups and downs, she has remained positive focused on the future. I am so happy to have caught this moment of contentedness and hope.

Finally, the young woman with the short black hair.

She is a 15 year old transgender girl from Dublin, Ireland. She told me that she was “born a boy.” She told me that coming out was one of the happiest experiences of her life. She said that, to her surprise, her immediate family took her coming out really well, but that her extended family is still coming around.

She spoke to me about the atmosphere in Dublin — how it is is moving in a progressive direction, having just passed one referendum legalizing same-sex marriage and another legalizing abortion. “I don’t see the point in not letting a woman choose what she has to do with her own body,” she said, adding that every woman should “feel safe in their own country.”

She finished our interview by saying that women’s lives would be better if “gender didn’t have to come into things as much as it does, you know? [If we] just saw everyone as people instead of as these labels.”

These women do not speak for all women of their backgrounds, countries, or even for women as a whole.

They are, however, snapshots — glimpses into lives of women around the world. Disparate in so many ways, but each carried along by the undercurrent, the stream of resilience that my years of travel have convinced me is universal to the female experience.

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Women Leaders at Penn Med: Looking Back, Looking Forward Faith Arimoro, MS1

In 1917, Clara Hillesheim became the first woman to earn an MD from the School of Medicine at the University of Pennsylvania. After graduation, she moved back to her native Minnesota, spending two years performing autopsies at the Mayo Clinic before transitioning careers to become a beloved high school teacher, then a caregiver for her aged parents and two brothers, and later an avid traveler.1 Despite her successes, Dr. Hillesheim was never licensed to practice medicine in Minnesota. A year after Dr. Hillesheim graduated from Penn, the school graduated two more women: Dr. Alberta Peltz and Dr. Gladys Girardeau. Dr. Girardeau served as the art editor of the medical school yearbook and would go on to become a pathologist.2,3 Dr. Pelz became a well-regarded obstetrician and fellow of the American College of Surgeons.

As with many other institutional changes, Penn’s move to accept women into the medical school came gradually, as the culmination of many decades of progress, setbacks, and backlash.4 Though the School of Medicine first began allowing women to attend lectures in 1869, it took almost 50 years before women were formally admitted. This delay was in part due to protest from male students who felt having women classmates violated the day’s views on modesty. Financial concerns also posed a barrier: admitting women students meant expanding the class size, an initiative for which the school lacked funding. Despite these barriers, the national women’s suffrage movement brought to light a growing demand for women’s medical education, pushing medical schools throughout the nation to accept female students. Progress was slow: by 1950, women made up a mere 6% of the physician workforce.5 Today, women make up 36% of the physician workforce and about 50% of medical school enrollees.6 Considering these statistics, women have made many gains in medicine. At the same time, challenges remain: here, several women physician leaders at Penn Med reflect on their experiences as women in medicine.

Dr. Cindy Christian initially aspired to be a veterinarian but, after finding the application process daunting, decided to apply into medicine. Currently, she is a child abuse pediatrician, professor, and Assistant Dean for Community Engagement at the Perelman School of Medicine. When Dr. Christian began her pediatrics residency at CHOP in 1985, women made up about half of the 23 residents in her cohort. Over the years, however, she has noticed fewer men and more women going into pediatrics. In fact, among all specialties currently, pediatrics has the highest percentage of active physicians who are female at over 60% (orthopedic surgery has the lowest percentage of women at around 5%, followed closely by thoracic surgery).7 Throughout her training Dr. Christian noticed small instances of gender bias: on occasion her superiors gave her assignments without asking for her input, something they did not do with her male co-residents.

Like Dr. Christian, many of the other physicians I spoke to described minor instances of bias directly related to their gender. As a member of an all-female team on her oncology rotation during residency, Dr. Jennifer

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Kogan, an internist and Associate Dean for Student Success and Professional Development was often mistaken for nutrition support. Similarly, Dr. Rachel Kelz, an endocrine surgeon and Associate Program Director of the General Surgery residency program, recalled an instance during residency where she was made acutely aware of being a woman. “During the second year of my residency an attending made a very vulgar remark which he would not have said had I been a man. Then I suffered silently—I was in shock.

Later, on an ICU rotation, a similar thing happened. It became apparent to me that not everyone saw me simply as a surgical resident, a small but significant subset of people saw me as a woman surgical resident. It was shocking. [That second time], I spoke directly about it with the fellow who made the comment.”

At the same time, several of the physicians I spoke to noted that they were able to make the most out of the challenges they faced as women. For Dr. Kelz, being seen as a “woman surgeon” was not always a bad thing. “In my training I had many allies and champions who saw me as a woman surgeon, but thought it was exciting and a welcome change. They gave me and my female coresidents a feeling of belonging. They made the process easier and substantially less threatening.”

When Dr. Suzi Rose, Senior Vice Dean for Medical Education, was training in the 1980s she was one of a few women in her medical school class and one of even fewer women in her Gastroenterology fellowship.

By the time she graduated as an attending, only 4% of practicing gastroenterologists were women. Though it had its challenges, the experience was not always isolating: “About thirty years ago, I was at a Program Directors’ meeting. There was only one other woman in the audience. We looked at each other across the room and met later in the bathroom, while all of the men had to wait in line. We spent the evening together, having dinner and then shopping and now we meet yearly at our national meeting. It’s great to have someone to rely on and to be a friend, sharing professional and personal milestones and being a source of support.”

Over the course of her career, Dr. Rose has seen more women enter the field and more diversity overall.

At national meetings she no longer sees “clearly sexist” slides. In addition, the gender imbalance in clinical trials has improved over time. These changes have been made in part because of women’s advocacy. Dr. Rose insists that despite the challenges, “being a woman in medicine is an amazing experience. There can be challenges with balancing and prioritizing choices, but the opportunities are immense and will lead to a fulfilling life and career, helping others and making a difference.”

Despite these opportunities, data shows that barriers for women in medicine remain significant. A 2019 study published in JAMA Network Open sampling 486 physicians from multiple specialties found that women physicians were 7.8 times more likely to report not working full time compared to their male counterparts.8 Six years after residency almost 40% of female study participants were no longer working full time compared to none of the male study participants. Despite investing more than a decade into the profession, many women walk away from medicine early in their careers. Part of this is because household responsibilities still tend to fall more heavily on women than on men. The vast majority (78%) of women physicians who were not working full time cited family as the key factor that influenced their decision to reduce their work hours or drop out of the workforce. For instance, even among academic physicians, women spent eight and a half

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more hours per week on domestic activities than male academic physicians.9 Several of the physicians I worked with mentioned that they at one point had concerns about balancing work and a personal or family life. For some physicians, they were able to find a balance by pursuing satisfaction in their career. Dr. Kelz remarked, “In medical school I saw that role models who had children were more prevalent in non-procedural specialties. So, I did some internal assessment on whether there were true barriers. I found that the same issues with work and personal life were there in other professions and came to understand that the issue was not isolated to medicine…The happier I was with my chosen specialty, the happier I would be in my personal life.”

For other physicians, the support from family, friends, and colleagues was key. Dr. Kogan recalled a particularly revelatory conversation she had that changed how she viewed the balance between work and home. “One of the most transformative moments for me, as I navigated frequent guilt trying to integrate my work and home life, was when my mother told me that I could do both well. That my then-6-year-old twin daughters knew that they were important and number one, even when my work was also important. That simple affirmation lifted a huge weight off my shoulders.”

Structurally, bridging the gap between institutional policy and practice might help prevent women from leaving medicine due to family responsibilities. Dr. Meghan Lane-Fall, an anesthesiologist and Co-director of the Center for Perioperative Outcomes Research and Transformation, notes that while there are initiatives the institution has taken to address challenges women face related to career flexibility, salary reviews, mentoring, and other issues, there is a gap between policy and lived experiences. For instance, while there are parental leave policies, she and her colleagues have been made to feel guilty for taking leave or have had their work schedules changed without their prior agreement.

Discrimination based on maternal status is unfortunately not an uncommon experience in medicine. One study found that nearly a third of physician mothers have experienced discrimination related to their maternity.10 During residency, Dr. Suzi Rose recalls an instance where she was written off when she suggested to a supervisor that rather than go to grand rounds in the morning, she wanted to see her infant son after a 28-hour work day. A culture change is needed, but is complicated not only by gender, but by the realities of being in a multigenerational workplace where there are varying expectations of work-life balance in medicine. However, many speakers noted that work life balance is not only a women’s issue: men also face challenges balancing family life with medicine as well. The fact that men are also demanding for a workplace that is more accommodating to family is a good thing; that men are speaking up as well makes it more likely for the field to change.

Several other factors pose barriers to the success of women in medicine, such as pay disparities and difficulties with re-entrance into the field, but leadership is one final theme frequently mentioned. Dr. Lane-Fall describes one reason women are underrepresented in leadership roles: “Even at Penn, when a leadership position opens, it may be more easily filled through word of mouth rather than a formal call for applications. Relying

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on word of mouth makes it more likely that successors are chosen based on prior relationships. It is easier to choose underrepresented minorities and women in a more formal application process where selection is based on who is most qualified.”

To obtain her current leadership roles, Dr. Lane-Fall asked for them directly, though she notes that she should not have needed to ask for them. Perception poses another barrier women may face in attaining leadership positions. Dr. Lane-Fall notes that women physicians are more subject to critiques of their physical appearance and voice level compared to their male colleagues. Simply put, a woman may not be seen as leadership material because of the way she dresses or sounds. Similarly, Dr. Rose remarked that certain personality characteristics may be viewed more negatively in women than in men. Though a broader culture change is needed, this is something that leaders can work at consciously, by avoiding comparisons and biased critiques.

Most of the physicians I spoke with credited their success, especially in the face of challenges they may face as women, to a strong support system. Though Dr. Nadia Bennett is currently a hospitalist, professor, and Associate Dean of Clinical and Health Systems Sciences at Penn, her decision to go into medicine was occasionally met with discouragement and doubt. Despite the opposition Dr. Bennett faced in her decisions to pursue a medical education, she has received tremendous support from her parents, sister, friends, and mentors. She especially credits her hospitalist group as a great model of a supportive environment for women and men. Working in a department where people are used to seeing women in leadership positions also helps.

Likewise, Dr. Christian has a job she loves. The first in her family to go into medicine, Dr. Christian credits some of her career success to her mentors. “Many of my role models in medicine were women who started their careers in the mid-20th century, when there were few women in medicine. Before I got to know them, they were intimidating. But they turned out to be generous, giving, smart, tough cookies, who taught me much about science, determination and generosity.” Despite the challenges and overwork, Dr. Rose has positive memories of her residency years—in part due to support, taking great vacations, and not thinking much about it. “You can have it all. But you can’t do it alone. Being a woman in medicine requires support and mentorship from other women as well as from men.”

Today, Dr. Bennett believes the greatest challenges facing medicine today are related to physician wellbeing (specifically burnout and depression), the electronic medical record, and health system issues such as reimbursements and insurance. Dr. Christian describes the greatest challenges facing medicine today as related to our ability to manage the amazing breakthroughs in scientific advancement with the reality that many basic things—like immunizing children and health access—haven’t been satisfied. On a positive note, Dr. Lane-Fall notes that over the years, medicine has seen improvements in the role of women in the workforce. Though it is still difficult to be a mother and a woman in medicine, it is not a question anymore whether having women in the workforce is good or if women should be paid equally. Parental leave and lactation spaces are no longer novel. As previously mentioned, men are also more involved in family life and are demanding more of a work-life balance in the field. Several initiatives exist to address challenges women

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face in medicine at Penn. FOCUS, an initiative to advance women’s leadership in medicine, is one prominent organization.11 Though there is still some room for growth, there is plenty to celebrate.

References 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

Correspondence with City of Sleepy Eye, Minnesota government office Women in Medicine. Perelman School of Medicine University of Pennsylvania Alumni. https://www.alumni.upenn.edu/s/1587/psom/index.aspx?sid=1587&gid=2&pgid=27680 Dr. Alberta Peltz Wills Bulk of Estate to Two. December 11, 1952 (page 22 of 48). (1952, Dec 11). The Philadelphia Inquirer Public Ledger (1934-1969) Corner G.W., Two Centuries of Medicine: A History of the School of Medicine, University of Pennsylvania.

“Timeline of Women in Medicine.” American Medical Association, 25 Sept. 2018, www.ama-assn.org/practice-management/physician-diversity/timeline-women-medicine.

“Total Enrollment by U.S. Medical School and Sex, 2015-2016 through 2019-2020.” American Medical Association, 2019, www.aamc.org/system/files/2019-11/2019_FACTS_Table_B-1.2.pdf.

“2018 Physician Specialty Report Data Highlights.” AAMC, www.aamc.org/data-reports/workforce/interactive-data/2018-physician-specialty-report-data-highlights.

Frank, Elena et al. “Gender Disparities in Work and Parental Status Among Early Career Physicians.” JAMA network open. 2.8 n. pag. Web. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344–353. doi:10.7326/M13-0974 Adesoye T, Mangurian C, Choo EK, et al. Perceived Discrimination Experienced by Physician Mothers and Desired Workplace Changes: A Cross-sectional Survey. JAMA Intern Med. 2017;177(7):1033–1036. doi:10.1001/jamainternmed.2017.1394 https://www.med.upenn.edu/focus/

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Football and the Brain:

Our Current Understanding of Chronic Traumatic Encephalopathy Natalie Neale, Alumni

Does football cause dementia? Those who have seen the movie “Concussion” starring Will Smith or heard about chronic traumatic encephalopathy (CTE) in the media may wonder if playing football is damaging to the brain. First observed in boxers and named “dementia pugilistica,” CTE is a controversial diagnosis, but evidence in favor of this disease is growing. The truth may have major ramifications for powerful organizations such as the NFL and American sports culture as we know it.

In 2013, McKee et al. published a study in Brain which analyzed the post-mortem brains of 85 subjects with histories of repetitive mild traumatic brain injury. In 68 of these brains, they found evidence of CTE, seen on pathology as a unique deposition pattern of neurofibrillary tangles, a biochemical maker of dementia.

The majority of these patients were athletes, and their brains were compared to age-matched controls who did not have history of repetitive brain injury. The amount of neurofibrillary tangles varied and was classified into different stages (I-IV). Patients in stage I had experienced mild concussive symptoms like headache and loss of attention, while stage IV subjects had experienced advanced dementia. The authors also found evidence of axonal loss in the white matter in all of these brains, suggesting damaging of connectivity between different brain regions. The stage of CTE correlated with increased duration of football play. This group went on to publish a study in JAMA of 202 brains of American football players, of which 177 showed signs of CTE. The authors acknowledge the role of selection bias in this study as the brains were from a brain bank, and many of the families donating brains may have been motivated by clinical signs of dementia they had noticed in the participant. Nonetheless, the body of evidence in favor of CTE cannot be ignored and warrants larger studies.

Despite McKee et al.’s characterization of CTE as a disease entity with different stages, however, not all neuroscientists accept this diagnosis. Neuropsychologist Christopher Randolph argued in 2018 in the Archives of Clinical Neuropsychology that the evidence is not strong enough to call CTE a true disease. He acknowledges that while the brains in the previously described study show a specific pattern of p-tau deposition, this may not necessarily correlate consistently with clinical symptoms of dementia. Another study at SUNY Buffalo found no increased rate of dementia in a study of 21 ex-professional football and hockey players compared to players of non-contact sports. However, there was some concern of conflict of interest because this study was funded by the Buffalo Bills football team owner.

Where do these studies leave us? So far, the NFL and other major contact sports leagues have made a few changes to mitigate risk of CTE. For example, the NFL has banned players from initiating contact with the crown of their helmet. Nonetheless, some argue that the NFL is using tactics similar to those of tobacco

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industries to shut down claims about the dangers of their sport. Football is clearly an important part of American culture, but the potential risks of dementia should not be ignored. Larger studies that minimize selection bias would be informative, and the influence of NFL funding on outcomes should be considered.

Even if CTE is an undeniable risk of contact sports, however, this doesn’t necessarily mean we need to ban football entirely. At the very least, people considering going into the sport should be well-informed about risks, and investment should be made into more protective equipment and safety rules.

References: 1.

2.

3.

4.

5.

Chen, I. (2020, February 1). Exactly How Dangerous Is Football? The New Yorker. Retrieved from https://www.newyorker.com/culture/annals-of-inquiry/exactly-how-dangerous-is-football McKee, A.C., Stein, T.D., Nowinski, C.J., Stern, R.A., Daneshvar, D.H., Alvarez, V.E., et al., 2013 Jan 1. The spectrum of disease in chronic traumatic encephalopathy. Brain 136 (1), 43–64.

Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360–370. doi:10.1001/jama.2017.8334 Randolph, C. (2018). Chronic traumatic encephalopathy is not a real disease. Archives of Clinical Neuropsychology, 33(5), 644–648. doi: 10.1093/arclin/acy063 Willer, B. S., Zivadinov, R., Haider, M. N., Miecznikowski, J. C., & Leddy, J. J. (2018). A Preliminary Study of Early-Onset Dementia of Former Professional Football and Hockey Players. Journal of Head Trauma Rehabilitation, 33(5). doi: 10.1097/htr.0000000000000421

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ART & POETRY

Room 210 Victoria Moffitt, MS2

Each day we enter this dried River Styx, death’s water taken to air on colorless wings.

As its tendrils become my breath, I find myself at its banks long after I thought I’d left.

Not too much.

Not too much.

Not too much.

Here we work in a river evaporated, passing through its fumes like water over stones hardly slowed by their presence;

Bodies in buckets Scalps splayed like flowers Fat plucked from sockets Cotton stuffed in skulls

Heads bisected.

Not too much.

I cannot say whether water knows it is flowing over stone or if it simply acts, propelled forward by the forces behind, endlessly fulfilling its prescribed motion.

Sometimes I catch its scent in the pre-morning haze, as if it whispered through the window that I gaze through, watching frozen dewdrops on dead branches.

I flow forward too, forget that what I’m breathing is no longer air, forget what I’m touching was never a stone;

But the current is strong enough to make you forget you’ve become it And in a breath the scent is gone as the dewdrops turn to phantoms in the morning light.

Gloves help with separation in these remnants of a river, a river meant to enshroud the dead.

It holds a current, motionless to the eye, the dead suspended on steel but ferried forward all this time; Bodies shedding, losing substance to the fumes.

They say that it’s toxic —but only somewhat.

We’re monitored to be sure it’s not too much.

Lungs tossed atop legs

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Water Woes Zonía Moore, MS1

“Governmental policies and programs that allocate water based on socioeconomic status contribute to the structural forces that negatively impact the health of poor individuals. Without clean water, an individual is at risk for infection both from ingesting unsafe water and from lack of personal hygiene. Equitable provision of clean water is the most basic of public health services that governments are responsible for.”

Water engineers in monsoon Mumbai Control what neighborhoods get water when The trickle in poor hoods is minimal Dripping drip dripping out of leaky pipes In the grid the engineers don’t wanna lid In secret they’ll signal the wasted liquid Is sufficient to supply all people Sadly their million dollar idea?

Is to dam yet another damn river while the drip dripping pipes go undamed Common people do not mind paying for Water that flows like a serene spring It is foolish to expect payment when Water trickles today, skips tomorrow Are victims to blame for stealing water for their woes?

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Drawings from Anatomy Lab Jennifer Siegel, MS3

I studied studio art in college and have always found drawing to be a source of comfort. During my first year of medical school, I often turned to sketching as a means of incorporating wellness into my daily activities and to de-stress. In particular, I turned to drawing during our anatomy course, creating "mini" 15-20 minute sketches of anatomic structures as we learned about them in lab. These drawings not only helped me to reinforce the material through an active process, but they also provided me with a creative outlet. Using art as a tool in medical education has been a passion of mine and led me to start Penn Med's Arts & Medicine Student Group during the Fall of 2017. These drawings motivated me to initiate "anatomy art" drawing sessions, which parallel the anatomy lab experience as part of the Art & Medicine group. Seeing my peers involved in these drawing sessions has been inspiring and hopefully provides others with a creative outlet as a means to cope with medical school stresses.

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The Workshop Lake Walsh, MS2

I help my dad upstairs.

I hold my hand on the small of his back.

I wait at the door as he gets out his keys.

It takes a while.

No matter.

He opens the door.

We walk down the hall to a second door.

He opens the door.

Inside: dust, dirt, bits of dry glue, splinters of wood, splinters of oak, of ash, plywood, splinters of pine, sawdust, wires and cords, copper wire, solder, a soldering gun, a little dry sponge for cleaning the tip of the soldering gun, chisels, saws, nails, screws, shards of glass, glass vacuum tubes, shards of glass near the window too.

My dad gets to work.

I watch as he jerks the hand-plane back and forth, I watch his whole body rock back and forth.

When I watch my dad work I can’t help but think of Muhammad Ali, not as he was near the end of his life, shuffling and stone-faced, but rather in the ring in his prime, swaying back and forth against the ropes, rope-a-dope.

Swaying back and forth he bumps into the circular-saw resting on the edge of the workbench.

It falls towards my feet, I move just in the nick of time as it crashes to the floor.

As I catch my breath I trace the power cord across the floor and up the wall.

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My dad doesn’t turn around, instead he seems to pick up steam, pick up the pace, so many unfinished projects to complete.

The table for my sister Faith, the altar for his best friend Ric, the speaker cabinet he burnt with a blowtorch, in the style of “shou sugi ban” which he says is an age-old Japanese weatherproofing technique.

The guitar amplifier he is making for me, which is on the table across the room with its insides splayed open, a mess of wires and wood and beautiful little ceramic capacitors, little paper resistors circled by brightly colored lines a meaningful code, like the wings of a butterfly, like the belly of a bee.

I walk over to the wall and tug on the cord.

Come back and pick up the saw off the ground.

Put it back where it was.

Sometimes I fear for his life too.

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“Miren me” Zonía Moore, MS1

This beautiful little girl had all the confidence in the world as she jumped in front of the camera. Armed with a bright smile, she wins over the hearts of all who pass Color Alley.

Girl with Bull Grace Wheeler, VS1

I made this in high school, when I was discovering that linoleum printing is one of my favorite forms of art. I like this piece because the girl doesn’t look like she’s struggling too much — she’s shouldering a gigantic animal and doesn’t seem too distressed. I had several feminist issues in mind while making this (the invisible burdens that women carry… also, ox are referred to as “beasts of burden”), and also wanted to work with the natural qualities of the linoleum. Interestingly, my art teacher did not like this piece at all even though it is one of my all time favorites. I think she truthfully just did not like me.

When I made this print I imagined that the ox was imaginary (only visible to the girl).

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SCENES FROM QUARANTINE A series of stories from the COVID-19 pandemic

Dear Reader, The Perelman School of Medicine’s Extreme Noticing course presents: Scenes from Quarantine. As part of this writing class, medical students were asked to describe a scene from their life during the COVID-19 pandemic. These true accounts reveal some of the feelings, challenges and changes that many people are facing. Even as we quarantine separately, we are connected by the common threads of our experiences. May these stories inspire your own reflections and remind you that you are not alone.

The Students of Extreme Noticing, March 2020

Out of the Frying Pan into the Fire Brooke Bernardin, MS1

When Trump banned travel from Europe to the US, many Americans abroad were awoken in the middle of the night by concerned messages and calls. Instead, I was alerted by practical joke. My partner, who had woken up first and read the news, came in and sat on the edge of the bed expectantly. He waited a few moments for the slant that his weight created in the mattress to wake me up. “Look!” he said and held up his iPad. When he is invested in a prank, Jonny’s eyes get a mischievous glimmer that usually gives him away even if he doesn’t smile. This time, though, I was so groggy and undercaffeinated that when I read, through the spiderweb cracks on his screen, that Trump had banned all travel from Europe to the United States, I admit that I was more than mildly alarmed. “Wait what? When is this happening?” “Friday,” he said, as a grin spread across his face. I continued to complain about switching flights and the stupidity of our current president.

His joke had succeeded. “But US citizens can keep traveling, so it doesn’t apply to you,” he admitted, as he gave me a consoling pat.

With the travel ban in place, Geneva airport, already low volume by international standards, is now desolate.

I stand for only a minute with my toes at a masking tape line on the floor, two meters back from the family ahead of me. When I travel to Geneva, I usually try to guess which families are American and which ones are Swiss, but even without knowledge of the travel ban, this one – clad in sports T-shirts with luggage in an assortment of gaudy colors and patterns – is clearly American. Before I am called to the counter, I examine the cartoon characters on the youngest daughter’s suitcase. I am officially too old to know who they are. The airport worker who takes my bag fumbles in oversized, lunch-lady type gloves. She tries, unsuccessfully, to peel luggage stickers off without them adhering to the nubs of extra glove at the ends of her fingers. After a French profanity that she assumes I don’t understand, she looks up cheerily and says “All set! Enjoy your flight!”

Security is the definitive hurdle of the flying experience, but this time the ease seems almost criminal. “Le sac entier?” I ask. Yes. I am supposed to put my entire bag – liquids, laptop, stash of marzipan and all – directly onto the conveyor belt. Something feels deeply wrong when I walk through the metal detector with my shoes, jacket, and dignity intact. I can’t tell if this security area is some special section usually reserved for UN diplomats or if security is just a joke now that the most dangerous threat won’t set off a metal detector or hide in a shoe. Regardless, it is a relief to not have to unpack half my bag before sending it through an x-ray machine that can literally see inside of it anyways.

Although most people complain about waiting in the security line, I am of the opinion that the most disagreeable part of the security experience is the moment that you make it to the front of the line. The pressure is on. The whole line is behind you. What have the TSA agents been saying for the past forty-seven minutes? Shoes on or shoes off ? Does my iPad count as a laptop? Is hand lotion a liquid? What is this guy doing with his shoes on? Wait… he’s dressed too nicely to be one of the plebs in regular security. I bet he

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paid upfront to keep his shoes on.

Worse than this confusion is that years of taking the trash out as my childhood chore has given me a distain for people who dump liquids into the trash. Memories of garbage liquid leaking onto my flip-flop-clad feet prevents me from emptying my water bottle or coffee thermos into the trash can. As a result, whatever liquids I reach the front of the line with, I am compelled to chug on the spot as travelers still within the winding maze of tape give me dirty looks. On the way to Geneva, I had awkwardly perched in the neutral zone between the two conveyor belts to chug twenty ounces of water.

This time, though, security takes all of five minutes, and, after a vigorous disinfecting with hand sanitizer, I leisurely make my way to gate C91. The Geneva airport hand sanitizer has some sort of moisturizing element in it which allows me to re-sanitize with impunity every time I pass another dispenser. At the C91 waiting area, every other seat has black and red caution tape stretched across it, marking it “interdit.” The heterogeneous mixture of masked and unmasked people waiting to fly to Newark is reminded periodically by a robotic French voice to stay two meters apart. Anyone could be coughing, sneezing or speaking a cloud of coronavirus into the air.

This is United’s very last direct flight from Geneva to New York for the foreseeable future, and, one week into the travel ban, it has drawn a motley crew of US citizens. Although the backmost middle seat which I’ve been assigned is objectively the worst in the entire plane, one must admit that it is excellent for people watching. A couple of teens have moved behind their mom so that they can pull their masks down to their chins. Later in the flight the mom would strike me as being a tad overprotective when she pre-emptively ordered a seltzer water for each of her children before they had the chance to choose a sugary juice or soda.

In fact, she asked for both a water and a seltzer water for each teen, ensuring that they would be adequately stuffed with sugar-free liquids. Diagonally from where I sit in the back, there is a man dutifully cleansing every inch of his seat. He is thin in an effortful way that makes me sure that he weighs himself each morning.

It is still early in the pandemic, so he and the overprotective mom are among the only people on the plane wearing masks.

As the disinfectant man is taking out another wipe to advance his virus killing expedition beyond the tray table and armrests, I lean across the empty seats next to me to ask the flight attendant if I can go change to a window seat. Mildly rotund with a not-too-neatly trimmed beard, he is one of the rare flight attendants who appears at ease both in his stiff, starchy uniform and the narrow space of the airplane aisles. He is leaning casually against the head of an empty seat when I catch his attention. “Sure! Go shopping!” he exclaims, gesturing with delight at the three quarters of the plane that is empty. For the circumstances, he seems all too cheerful, but it strikes me that it might be a relief for him to grant everyone a seat of their choosing.

Having been alerted to the flexibility of seating, the disinfectant man jumps up to vanquish germs elsewhere.

“If you want my seat, I’ve cleaned it quite thoroughly,” he offers. “Yes, I can see that,” I think to myself, but instead, I just say “thanks!” and take my chances with a contaminated window seat.

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Flying, in general, is an absurd experience. You, and a number of other humans, are neatly packed into metal tube with wings that will soar through the sky, guided by a pilot who appears, each flight, to be a small variant of the same confident, middle-aged, conventionally decent-looking white man. An otherwise unacceptable drink to food ratio is established, which permits passengers to periodically rise, stand outside the “in use” bathroom wondering what could possibly be taking so long, and eventually empty their bladders. Flying during a pandemic pads this absurdity with an odd sense of luxury.

I can now comfortably sprawl across two seats as I gaze out the window at the retreating Alps. My book, of which I will read approximately three pages, can occupy the seat next to me instead of being stuffed into the magazine bin where it will be dangerously camouflaged. I amass pillows from the surrounding seats to cushion my entire area just because I can. When I ask for a second and third cup of coffee, the flight attendant fills a paper cup to the brim. “You take your coffee black, right?” he checks casually, asserting that he remembered my preference. I am brought extra Stroopwaffels and a toiletry bag from first class. The rotund flight attendant does all of this with glee. I feel such a sense of luxury that I splurge on the in-flight WiFi. With a ten-foot radius of empty seats, no one cares when I loudly engage in a two-hour BlueJeans call.

I am even allowed to use the fancy front-of-the-plane bathrooms with minty face spray inside. Alongside the face spray is lotion so thick that it adheres to the sides of the container and won’t come out of the pump.

When I unscrew the cap to examine the inside of the bottle, it gives off a pleasant, peachy aroma. Calming, blue lights make the bathroom feel like an oasis. The lighting also makes me look surprisingly acceptable as I gaze into the mirror, watching the minty face spray dry. Somehow the usual smells of previous bathroom use and the one, obligatory piece of toilet paper stuck to the floor are not present in this high class bathroom.

After the face spray dries, I have no more excuse to stay and make my way back to my seat.

“Traveling in a pandemic is the way to go,” I think to myself before immediately realizing the gaping flaws in that logic. Throughout my travels, I feel a confusing mixture of enjoyment and guilt. On the one hand, I never imagined that I would so thoroughly enjoy a 9-hour flight. On the other hand, I feel, as my plane rockets across the Atlantic from one pandemic epicenter to the next, that I am giving new meaning to the phrase “out of the frying pan into the fire.”

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Running from ‘Rona’ Bianca Nfonoyim, MS4

I decided that today was a beautiful day for a run. As I stepped out of my building, I looked up at the overcast sky, clouds gathering. Perfect, I thought. The Schuylkill will be deserted. I put in my headphones and began jogging to the beat of a random, high-energy song. My feet pounded on the concrete sidewalk, adjusting awkwardly to a surface besides the carpet and wood floors of my apartment. I sped past the familiar apartment buildings of my West Philadelphia neighborhood, sardined uncomfortably close together. They were an eclectic collection—fragile-looking homes that housed the memories and generations of a single family abutting the brick towers designed to replace them. Each building was a familiar friend—the only friends I had seen in person for some days. Cars lined the street, unmovable rocks intending to collect moss.

The wind picked up and howled around me as I turned the corner, filling the vast, eerie silence of my usually bustling neighborhood. I smiled, enjoying the calm of the day, the crisp cool air and the rush of being outdoors. Wow, I really needed this. But what exactly did I need? Yes, I needed the exercise, giving my stiff right knee a chance to stretch and move. Even more, I needed the escape—from the loneliness of my moderatesized corner room, which now seemed stifling; from the inundating emails and news alerts that greeted me each morning, from the realities of necessary restrictions with an uncertain end. I ran faster, fully embracing my escape.

Eventually, the Philadelphia Art Museum came into focus, a beautiful giant that now stood dejected. The entrance to the Schuylkill river trail was across the street from the museum. I charged forward in anticipation, hopeful that my prediction of a deserted trail would be accurate. Faster. Pick up the pace. You’re almost there. My breathing was heavy, but even. As I closed the distance between myself and the trail entrance, my anxious thoughts gave way to shouts of praise. Oh, thank God! There were only a handful of people, all running, embarking on their individual escape journeys. Surely we’d be moving too quickly to exchange respiratory droplets, too quickly to be within a six foot radius for long. I joined the trail, enjoying the certainty of calm brought by the likelihood of rain. On my right, the river was black and still, mirroring the continually darkening sky above. I fell into a rhythm, music blaring, feet now accustomed to the concrete, my heart fixed at a comfortably fast rate.

Within a few short minutes, the serenity of my run was broken as I saw a group of three runners approaching.

Oh no no no. In an instant, multiple thoughts ran through the processor of my mind—confusion at their numbers and proximity to one another, concern for their health, my health, the health of anonymous, medically fragile individuals. I could feel my heart rate increasing beyond its initial set point. Though it felt completely irrational, I found myself inching towards the edge of the trail, towards the grass. My legs accelerated beneath me, trying to escape the possibility of contagion and the uncertainty that now surrounded any human contact. When I returned to the silence of my solitary run, I felt a sadness surfacing from the

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edges of my mind. I’ll always be running from something. I had traded my escape from the seclusion of four, suffocating walls for another escape. This time, I was running from what I needed most— human closeness and connection. Was this to be my new reality, a tension of simultaneously running from and toward solitude?

I prayed not, not only for my sake, but for the sake of all those who, like me, were running from ‘Rona’.

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Dwelling Catherine Yang, MS1

It is 6:50 AM Central Time. The basement blinds are open, but the bleak Minnesota sky has no light to impart. I have been in self-quarantine in my parents’ house for eight days. In eleven minutes, I will be one minute late to a BlueJeans conference call with five of my medical school classmates to discuss local, inhaled, and IV anesthetics. At the moment, I am eroding my teeth with the hardbristled toothbrush that Mom tossed down the stairs last week. My quarantine starter kit also included a bottle of water, a handful of chocolates, and a sleeve of Oreos. All additional means of nourishment since then have been delivered to the top of the basement stairs on a navy blue baking tray. Breakfast invariably comprises a croissant and a hard-boiled (sometimes fried) egg. Lunch includes a bowl of berries. Dinner is portioned into four fist-sized ceramic bowls.

I have perfected my basement gremlin crawl, clambering up the carpeted stairs on all fours.

The only thing missing is a dinner bell and a sterile vial to collect my saliva at the top.

Last Monday, on the morning that I left my Philly apartment to catch my flight to MSP, I spent my last ten minutes at home dumping out a pint of generic almond milk, sorting my favorite earrings into a pouch, and giving each of my stuffed animals a goodbye pat on the head. I exited the building in a hurry, Samsonite carry-on suitcase in tow and beloved Extra Soft Colgate toothbrush forgotten in the bathroom caddy. Eight hours later, I said goodbye to the outside world for good as I slipped on a surgical mask and got into my parents’ car.

My return flight to Philly is scheduled for the Sunday after Thanksgiving. At the rate that things have been going in self-quarantine, I will have eaten 251 Costco croissants (4216 g of saturated fat!) by then. But, I have to remind myself, things aren’t so bad down here. There’s central heating. There’s a couch to lie on. Unlike the shower in my Philly apartment, the shower in this basement bathroom has a functioning drain, so I don’t have to stand in a murky puddle as I attempt to cleanse my body of the coronavirus. There are wide windows facing into the backyard, where I can admire the barren trees and watch the local deer do their business.

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I have the entire floor to myself, which means that I can do poorly executed somersaults and arm-wavey dances when I’m bored. The only downside is the solitude, and the fact that I am not allowed upstairs into the kitchen, where all of the tools and ingredients necessary for baking and cooking reside.

My one reliable form of social interaction has been my learning team’s daily BlueJeans conference calls.

Every day, as my eyes register the morning darkness and my brain attempts to clear the haze of some mundane dream, I begin to look forward to the moment that I click “Join Meeting.” The disembodied, somewhat frightened voices of my family members from upstairs cannot compare to the direct gaze of my friends through my warm laptop screen — an acknowledgement that I still exist, not as a reverted underslept high schooler but as a medical student who at one point served a purpose in her academic community. It has become harder and harder to conceive of the grand (truly irreplaceable) contributions that I would have made to the world this semester, especially as my physical movement — my “distance traveled,” as they say — dwindles to mere hundreds of steps per day. For every moment that I spend lying supine on the basement couch, I spiral deeper into the depths of my dismay. There is nothing like a pandemic to show a first-year medical student the long, long distance between her and the medical professionals on the forefront of an economy-crushing war.

I take a peek at my FitBit screen: 6:57 AM. The time is nigh for my morning ritual. Out of all the aspects of my life, most of which I have abandoned recently — writing, sketching, socializing, making travel plans, changing clothes regularly, responding to emails in a timely manner, having faith in society’s ability to respond to and function in an emergency, believing that I will one day have a meaningful and positive impact on said society — the one habit that remains unscathed is my eyebrow sculpting routine. It takes twenty odd strokes of an eyeshadow brush and two minutes of my time, but with an effect so impactful that I am now loath to witness my own naked face on a video call, even in the bottom right corner of the screen. The only word to appropriately describe this concern is inane. But soon, as I inevitably begin to abandon even my most crucial academic work for the likes of Animal Crossing: New Horizons and 2019 Oscars contenders, these two facial adornments will be the only remaining evidence of my vanquished adult life.

After tucking the brush and eyebrow palette back into my toiletries bag, I flip the light switch and walk out of the bathroom. I assume my usual perch at the basement table, then lift the lid of my laptop at precisely 7:00 AM. As the WiFi bar loads and the Outlook page flickers, I begin to wonder when my breakfast will arrive at the top of the stairs. Will the egg be fried or hard-boiled? Will there be avocado spread inside my horizontally bisected croissant? Despite my uncertain future, my intrepid eyebrows and I face the screen.

This is our contribution to the fight against coronavirus.

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The Smell Likhitha Kolla, MS1

Ten hours into my journey back to Philadelphia, I catch a foul smell ventilating back to me, lighting a fire up my olfactory bulbs. It is akin to a rotting cabbage. No. A bucket of dirty socks soaking in rainwater. A rotting cabbage in a bucket of dirty socks soaking in rainwater used to put out the flames of burning rubber. Nausea and a headache waft over me.

I would do anything to take back time, if only a couple of hours to my serene morning in Madrid. I had woken up to our window cracked open an inch, carrying in crisp, fresh air, and dimmed chatter from our neighbors discussing the spread of the virus into their homes and their hearts, speculating that it was brought in by the gringos next door. We made one last round down the checkered aisles of El Parque Retiro towards the peacock house tucked in the back corner behind the blue Hydrangea bushes. It was easy to practice the six-feet-apart rule here in this palace of wanted solitude, surrounded only by the beautiful cobalt blue and fluorescent green feathers lifting in unison. The growls of our stomach grew louder as we followed the mixed aroma of paella, recently roasted coffee beans, and fried churros around the corner for our last real meal in the next thirty hours.

I close my eyes for a moment to remember these distant memories of crisp morning air and freshly ground coffee beans, but they are not enough to overcome my awful sensory experience. In a pandemic you are allowed to point your finger at anyone or anything but yourself. So, I ask A sitting next to me, “Did you forget to take a shower before we left?,” knowing well that he is someone who cares a lot about his hygiene; the kind who would opt to brush his teeth after every meal if he could.

“No. I showered.”

A looks back at his phone and starts to mumble about all the reckless college students partying in Florida. I try to think about something other than a “flattened curve” or a crowded beach with waves crashing on its shore, followed by a stronger and more unseasoned second wave.

A shoves the phone in my face. “These spring breakers are going to kill us all,” he says. So are we. Our viral baggage is getting heavier with each airport we inhabit.

“Well, I certainly showered this morning,” I try to put up a fight. A does not pick up on my cranky cadence.

His attention is seized by COVID-19 related news sprinkled with lost updates from Bernie and Biden’s campaigns. When did our upcoming presidential election become a distraction from our more immediate crisis?

I need to feel something familiar. I reach out for A’s hand before I catch myself. Physical contact feels taboo.

“I’m going to get some coffee. I’ll be back,” I jolt from our shiny, fake-leathered black seats glistening with

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either Lysol or sweat (God, please let it be Lysol) at the boarding gates before A could even offer to join me. The airport is not crowded with its normal hustle and bustle. Its outgoing foreign residents–the spring breakers and European travelers, probably on their gap years— are replaced with scatterings of bleary-eyed nomads displaced from their vacation rentals after President Trump’s travel ban imbroglio. All of us come from different walks of life, but we are united in our confusion and anger towards an invisible, insurmountable threat.

The closest person to me now is at least twenty feet away, yet, the inescapable smell persisted. It is coming from under my own mask; my blue paper mask, drenched in guilt and germs. I probably should not have eaten that soggy tuna sandwich a couple hours earlier. Priced at €7, the sandwich was a good deal for airport “Grab-n-go” food. I needed to save money after I gambled, and lost, $600 in airplane fare. I cancelled my flight from Madrid to Rome when Italy became the epicenter for COVID-19, then cancelled my flight from Madrid to Barcelona when Spain claimed the title. “The Blob” is growing and chasing me out.

Maybe I should have brushed more thoroughly in anticipation of our long journey. I had lacked this forethinking since the beginning of this trip when I insisted we go on it at all against everyone’s warnings.

I walk back to the seat next to A, feeling guilty for doubting him earlier but also unapologetic. Twenty hours later, I arrive in Philadelphia. I let out a sigh of relief at the sight of Rittenhouse Square Park, its benches gathering dust and the bronze statue of a lion crushing a serpent, erect without an audience. Are we the lion or are we the serpent? I finally brush my teeth when I get to my apartment, marking the end of my journey and the beginning of a new one.

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A Seat by the Stream Fengling Hu, MS1

Last Thursday morning, I decided to go for a jog. I’d done enough COVID-19 doomsday scrolling for the day. There are only so many times you can see the disease projection numbers before it really starts to get to you.

It had been a while since I had last run. Over the summer, I had stuck with it three times a week for three miserable months, until one week it rained for three days straight. I promised myself I’d make up the missed runs when the weather improved, but three days away from running reminded me how much I loved not running, and I happily broke that promise.

For the first time in days, I stripped out of my way-too-long pajama pants (with the exception for showers); donned socks, shoes, and a jacket; and headed out the front door. The near-freezing Chicago spring air burned my nostrils. It felt good. I remembered how much fun it was to be outside and free. I remembered that, before the apocalypse, I had loved feeling the wind whip past my face as I biked to school. Nothing woke you up faster. How long would it be before I could feel that again?

Minutes later, with my fingertips numb and my breath coming in ragged gasps, I remembered something else: I hate running. After an effortful half-jogging, half-walking mile, I found myself at a nature preserve centered around a bubbling, drainage-water stream. One could call it “quaint.” I paused to catch my breath for the 20th time and saw a picturesque suburban scene: mothers and fathers taking their children for walks, leashless dogs enjoying a few minutes of sniffing euphoria, and bundled-up joggers effortlessly surpassing my top pace. Their gaits looked so light and joyful, taunting me with what I could be if I spent less time in front of the computer.

Yet, in the details, the apocalypse was evident: school-age children not at school, parents working from home, joggers leaving muddy footprints six feet from the sidewalk, everyone with downcast faces and wary eyes. I passed people from a distance and compulsively yelled out cheerful “Hello”s so I could show I did not hate them. Despite their equally enthusiastic responses, I felt fake for seeming happy. Seen by the people of the apocalypse, I felt ashamed for being happy.

By then, I had jogged a whole 0.2 more miles and felt I deserved a reward for my athletic feats. I sat down beside the stream to enjoy the sounds of nature around me. As the dry-to-the-touch stream banks slowly soaked through my pants, I closed my eyes and opened my ears.

The flowing water. The symphony of birds. The rustle of leaves as the wind whispers through. Beneath it all, the drone of cars. In awe, I listened to the symphony of the world around me – happy to live in the moment.

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I felt at peace.

It’s funny how when you focus on listening, a “moment” feels a lot longer than it is and “peace” is actually pretty boring. By minute three, your mind has repeatedly tried and failed to find any semblance of rhythm, and the stream has yet to learn the concept of musical phrasing. You begin to think, “How much longer must I enjoy nature before I can count it as a ‘thing I did’ today?” I figured ten minutes was good enough.

I closed my eyes again and let my mind wander. Surrounded by the freedom of the outdoors, I could not help but feel caged by the inability to choose anything else to do. If this were a week ago, I’d probably have been studying with friends over a delicious cup of coffee. Basking in the sun, I could not help but think of the invisible terror spreading through the world and the false optimism that had brought us here.

I got up, jogged home, and washed my hands.

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Happy Hour J. Reed McGraw, MS1

I stood in the beer aisle at the supermarket mulling over the choices. I was getting back together with my college friends for a virtual happy hour later that evening. The recent circumstances had forced us to get creative with distant socializing. I opened the fridge door to grab a six-pack of Miller Lite but paused midreach. Maybe I’d better get something from Ohio—support small business. I closed the door and pushed my cart over to the Local Breweries section. I grabbed an IPA from one of my favorite Columbus breweries, Seventh Son, rationalizing the extra cost, and I tossed it into my cart, and I crossed beer off the shopping list.

I turned the cart around and wheeled it back towards the main aisle to check out. I passed a man mulling over his own choice. Nestled just above a crumpled, damp surgical mask, his eyes darted back and forth, scanning the options behind the cold glass. I recognized those eyes from the operating room. They had the same scrutiny and intensity as the surgeon’s studying the opened abdomen of a patient. As I passed, I caught a glimpse of his gloved hand reaching into the fridge to grab his selection. Miller Lite.

I got to the checkout line and began unloading my cart. It was fuller than a typical trip for me. I was picking up groceries for my family, too, since the virus had forced me to come home from Philadelphia to stay with them. I pulled my ID out of my wallet to have ready.

“Seventh Son!” she exclaimed as she swiped the six-pack across the scanner. I put my ID into her gloved hand, and I watched her examine it through what must have been a newly installed, clear, plastic sneezeshield that separated her from me. “I hope they’re doing okay with everything that’s going on. I’d hate to see them go under.” She handed the ID back to me. I smiled and nodded in agreement. I wondered if I should’ve been wearing gloves, too, as I slipped the ID back into my wallet.

I noticed the masked man with the Miller Lite getting his ID checked a few registers over. High school kids must be loving this. Steal an older brother’s ID, throw on a surgical mask, and fool the cashier into selling beer for a virtual party in their unsuspecting parents’ basement.

“Receipt with you or in the bag?”

“Bag’s fine. Thanks.”

I packed the bags into my cart and headed back out to my parents’ car. The parking lot was full. Masks and gloves swarmed in and out in search of hand sanitizer, toilet paper, and bottled water. They must have known the store was sold out of all of it. Maybe futile searching helped take their minds off the paranoia. I hadn’t bought any survival items to stock up on and considered turning back for them, almost out of obligation, as

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I drove away.

When I got home, my brother helped me unload the groceries. He asked what I was doing later that night. I told him I was going to a happy hour with friends. My brother crumpled his face. “Please tell me you’re not doing happy hour over FaceTime.”

I laughed as we went back into the house and shut the garage door.

I fished the beer out of the grocery bags, and I grabbed my laptop and headed down to the basement. Maybe it is dumb to be doing this. Maybe virtual happy hour was just a euphemism to justify talking at my computer and drinking beer in my parents’ basement.

Outside of a couple visits for football game weekends, my friends and I hadn’t all been together since we graduated the previous May. A few were still in school, but most had started jobs or graduate school and moved away. We were all excited to see each other again, even virtually, and I had been looking forward to it all day.

I opened my laptop, and I cracked open a beer. My friends logged onto our group call and did the same.

“To COVID-19 for bringing us back together,” my friend Austin said.

“Cheers!”

I raised my can to my computer webcam and heard a metal-on-plastic click.

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Living Among the Dead Amara Prato, MS1

“There were trucks out back filled with frozen bodies that couldn’t fit in the morgue.” Mama takes a bite as if she’s just updating us about the never-ending construction on Route 1.

My family eats dinner together regularly now because of quarantine. My sister’s nursing school and my medical school have moved virtually until further notice. Papa is an IT specialist for the Swiss equivalent of Dunder Mifflin. No one leaves the house but Mama, a registered nurse at two hospitals and one clinic, now for six days a week.

To save a trip, Mama picked up groceries after work. She went out of her way to go to Edison, our favorite town for errands. H Mart and 99 Ranch have more than one brand of ready-to-steam frozen dumplings, and none of them claim to be “authentic” (they are) or “organic” (they aren’t). Asian groceries stayed wellstocked long after Target and Costco shelves emptied. Now that Edison has the second-most COVID-19 cases in our county, Mama surrendered her right to choose her bok choy and assented to curbside pickup, ordering ahead in brisk Mandarin.

Tonight, Papa has prepared thin glass noodles in probably-expired boxed broth with frozen salmon steaks seasoned with too little garlic and too much lemon. For Papa, it is a rare opportunity to nudge us toward his militant keto diet, which he insists will protect him from disease despite his immunodeficiency. For me, it is a rare opportunity to see my father cook something that doesn’t come out of a can. I am grateful he cooks when my sister and I have exams and Mama is working, because no one can do it but him.

“The trucks were full of patients?” asks Papa innocently. My future-nurse sister looks at me and we wince in synchrony.

Mama is unfazed. “They were.” Barely a beat passes. “Your papa is getting better at cooking!” she exults, beaming at us.

On Holy Thursday, the day we remember Jesus Christ’s betrayal and condemnation, Papa’s aunt died of COVID-19. She was on a ventilator, her kidneys were failing, and she was almost eighty years old. She was an immigrant and a single mother, and other socioeconomic determinants of health were not in her favor.

She died in New York, where currently there are more cases of COVID-19 than any single country outside the U.S. People around the world had prayed for her: that she would pull through one more night, one more day, and so on. And for a few more nights and days, she did. She seemed to improve slightly but suddenly declined and then died. We cannot pay our last respects. Her body will be cremated, and her daughter has no choice;

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there will be no memorial service, no wake.

I did not know her enough to mourn her person fully. I mourn Papa’s loss, but mostly I mourn how death is advancing toward my immediate family by degrees.

The morgue is full. Was Auntie loaded onto a similar truck? Are the bodies padded at all, even with crumpled newspapers? Or do they rattle, jostling each other when the driver hits one of many potholes on the highway?

Did her daughter, also a nurse, know where they might take her mother’s body? Woman, why are you weeping?

Why do you seek the living among the dead? Because no one can do it but her.

Dinner proceeds uneventfully with Mama asking my sister about her grades and not asking me about mine. I try not to stare as Mama wolfs down the salmon-topped noodle broth that my sister and I can barely finish.

I wonder how long it’s been since she’s eaten or even sat down. I check on the boiled water steeping Chinese herbs for Mama to soak her swollen feet.

Mama is not an ICU nurse, but all nurses are being floated wherever they are needed. She is the most senior in her unit and when the 22-year-old nurse calls her crying because their patient’s test has come back positive, her voice is even, soft, and firm. “You were wearing your N95 and gown, right? Take a shower and go to sleep. Your job is to stay healthy so you can help your patients. Because no one can do it but us.”

Just an hour ago when Mama came home, she stripped down to her underwear in the hallway by the washer and dryer. I ran the wastefully small load of laundry on the hottest setting while my sister ran a rag soaked in vinegar water across the surface of Mama’s belongings. Mama ran upstairs to the shower I shared with my sister, careful to avoid contact with Papa. She was pale, thin, and soft like she has been my entire life. A proud and modest woman, she tried to cover her body with her arms and hunched as she scurried, scrunching together loose, stretch-marked flesh on her midriff. Her C-section scar looked sore and angry although it had been made to deliver my sister, wearing her umbilical cord like a pageant queen’s sash, almost 23 years ago. I look up from my bowl now and notice the indents and faint bruising on Mama’s face, tattoo outlines of her goggles and N95.

“Thanks for dinner,” I rise to clear my spot at the island. I feel strange, embarrassed that none of us seem very sad. I am waiting for some emotion to rise out of someone, anyone, even myself. But all of us are fine, at least for now, with this reality. “I have to study now. Exam coming up.”

“Did you like the salmon?” Papa asks brightly. “I can give you the recipe.”

“Sure,” I smile, providing the lie he needs.

I carry upstairs the pot of steeped herbs, so full and so heavy. So Mama can stay healthy. So she can help her patients. So I can help her. Because no one can do it but me.

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Cherry Blossom Sonia Wang, MS1

A petal gently nudges my face as I sit in a hammock threaded of blue, yellow, red, and green. As I stretch out in the shade of a juniper tree, I can smell the faintest hint of pink cherry blossoms from a tree in our neighbor’s yard. A breeze whips past me, shaking the tree with a dull whoosh as the petals fall over the fence and sprinkle across a planter carpeted with weeds. Against the green, they seem insignificant, a mere dusting of flour. I pick one up, feeling the velvety texture of the petals, the faint dusting of yellow pollen, the translucent web of veins running across the surface.

Last April, I was in Japan, running my hands through waters covered with fallen cherry blossoms next to the red temples and stone walls of Tokyo’s Imperial Palace, after bumping into thousands of people strolling through pathways of cherry blossom trees illuminated with scarlet and goldenrod. They shared trays of takoyaki and matcha ice cream, laughing and hugging their way across the park. This year, the only remnants of cherry blossoms in my life are this tree, a computer full of static photographs, and a few memories from my trip last year.

When I walk outside, I see a neighbor lead his dog into the empty street in an effort to avoid my path on the sidewalk.

I begin to wonder where we will be—in a few weeks, in a few months, in a year. The world has shifted profoundly since COVID-19 appeared. Parties have converted to tea parties held in Animal Crossing or wine parties held via Zoom. Medical visits have shifted to telemedicine via FaceTime and Skype. Movie theaters are closed; grocery stores have lines rivaling those for a Disneyland park ride; restaurants are no longer places to socialize, but purely to get food. Vacation and travel plans are on hold for the indefinite future. I wonder: will I comfortably sit on a plane at any point in the next few years? When will be the next time I walk through a crowd without fear?

Furthermore, borders between people, and groups of people, are even more apparent. Borders between countries and even states are shut down. Trust (or tensions) built up over years are eroding and corroding, with an increasingly accusatory tone taken to shift blame. A family was stabbed in Texas for being Asian. In New York, there have been multiple incidents of harassment on subways, buses, and in Chinatown. What will the world look like, once the government-imposed borders are taken down, and the only ones left are the once people have internalized in response to what the media has hammered into our heads over, and over again?

But despite how our world seems to have come to a tense standstill, nature continues at its natural rhythm— the orange blossoms continue to turn into oranges; the dandelions continue to scatter across the wind; the cherry blossom petals continue to fall. I sit back in the hammock, and continue to feel the wind blow across my face, the same as it always has.

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Thursday Afternoon Mia Fatuzzo, MS1

Last Thursday, some combination of unseasonably warm weather and quarantine snacking finally propelled me off the couch and onto the Schuylkill River Trail. When I ventured outside, however, I quickly realized that I was not alone in my desire to stave off boredom and quarantine pounds with a socially distanced run.

The river trail, normally crowded only on warm weekend afternoons, was teeming at 2 PM. Runners, walkers, dogs, and children on scooters battled to maintain a suggested radius of germ-free air and bikers were forced to a standstill.

I’ve been a loyal albeit casual runner since maybe the eighth grade. When I swam competitively, running was part of our pre-pool warm up and in high school, I gamely jogged five kilometers to score a few extra points for our small cross country team. Now, I just enjoy the meditative futility that comes with running slowly in a large circle.

Thursday was anything but relaxing. My boyfriend, who I had dragged with me, dutifully plowed a path through the throngs of strollers and scooters and I followed behind. Someone from the city had carefully stapled dozens of signs to the trees lining the trail reminding us to remain six feet apart. As we ran, my mind wandered to the width of the narrow trail and the volume of restless joggers. I began a series of calculations that all ended in the uncomfortable inevitability of proximity. Would holding my breath during these unhygienic encounters stave off the virus? Was my boyfriend holding his breath? Why should I run winded and breathing through my nose if he was going to contaminate the both of us anyways.

In high school, cross country was a communal endeavor. Practices were run together and finding myself alone in a race was usually a sign that I had missed a turn. We chased individual goals too, but trying to run faster wasn’t mutually exclusive of chatting with teammates between sets or even encouraging a competitor on the course. Running is generally a solitary activity for me now, but a vestige of collective spirit remains from tracing and retracing the same five miles among strangers in pursuit of a common goal I stared down the ponytail of the jogger in front of us as I focused on maintaining our required separation.

Perhaps this was our new shared goal. My mind wandered as I imagined us all taking part in a large, unusually well-organized cross country race. She paused to take a phone call, and we curved around her. Our imaginary cross-county team had disbanded.

In high school, our coaches told us to grind through difficult races by breaking them up in our heads. It wasn’t ten kilometers, it was four easy two-and-a-half kilometer pieces. We didn’t think about the imminent extra distance, the foreboding hills, or the inevitable difficulty of the sprint to the finish because a good athlete maintained the perfect balance of dissociation and focus to run piece by piece until the pieces added up.

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As we moved further down the trail towards the art museum, the crowds of walkers and families thinned out.

I started to see some familiar faces; the people who also seem to enjoy running this same five mile stretch of trail several times a week. I offered nods to a few, but we were all distracted by the crowded trail, the looming cyclists, and the general feeling of unease. Running on such a crowded trail was exhausting and we were almost ready to turn around when we heard shouting behind us. I turned around and saw that two cyclists had collided as one tried to merge into the flow of moving bodies. Luckily, the collision looked low impact.

However, the irony of such an entanglement amidst the mandate of separation was not lost on onlookers, who seemed to shift even further apart as they observed the cleanup.

My runs bookend otherwise dull days spent on the couch, but they feel open-ended. With races cancelled and no plans to maintain, I have no goals yet plenty of time. Despite this, I remain unmotivated to adjust my training. Why start now, when this could all end in two weeks or a month. I feel unsettled. Exponential growth, by definition, feels more frantic every day. Quarantines, closures, and cancellations remain disconcertingly indefinite. This pandemic can’t be halved and quartered into manageable pieces.

We turned around and started down the hill. Initially, it had seemed like another crowded afternoon on the trail, but the façade was starting to crack. Walkers clutched cups that smelled suspiciously of wine. Harried parents juggled both excitable children and work phone calls. Rumors of where to buy toilet paper and Lysol wipes floated past. As we jogged back towards center city, a warm breeze blew my ponytail directly into my mouth. All previous efforts to remain sterile now seemed futile, and I brazenly plucked the hairs off my face.

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First Wave Sophie Libergall, MS1

The offseason in coastal Rhode Island is usually quiet. The breeze whipping off the Atlantic that draws the city folk during the oppressive heat of summer is exactly what keeps them away during the winter months.

The ubiquitous clam shacks, surf shops, and ice cream parlors shutter their doors. Boxwoods, chiseled into bright green geometric shapes in the summer, wither into ugly brown knots.

Today, however, one would hardly be able to tell that it is still mid-March when walking down the seawall in Narragansett Pier, the tiny beach town where my family resides. A long sidewalk, hugging the open ocean, stretches from Monahan’s clam shack to the town beach. As in June or July, the narrow tunnel between the fence of parked cars and the rocky coast was packed with families walking, donning down jackets and scarves in place of bathing suits. It appeared that nearly all of the permanent residents of southern Rhode Island had flocked to the shore for exercise and the solace of our shared sea in this time of uncertainty.

As my dad and I joined the ranks of walkers, we sensed a new edginess. In the summer as you traverse the seawall, you must always be prepared to be bonked by a surfboard, sniffed by a sandy dog, or licked by someone’s sweaty bare skin. We watched from across the wall as two groups of walkers approached each other. A strange dance ensued. Both parties slowed as they neared. Each walker was visibly calculating whether they could maintain a six-foot berth while both remaining on the sidewalk between the cars and the sea wall. As noses and mouths grew visible, chests rose ands breaths were held. At some point, they accepted the impossibility of passing side-by-side on the four-foot-wide sidewalk. Thus, in the finale of the dance, there was a standoff. Shoulders broadened, eyes narrowed, fists clenched, until one group ceded and hopped off the sidewalk. They darted between bumpers, to pass on the road inside the line of parked cars.

I was startled by the stricture in my own chest as the displaced group neared us. The mere fact of existing in separate bodies is often enough to forget that another individual possesses an experience and perspective as rich as my own. What is further lost when we increase the physical distance between us? Or when we cloak half a face, our usual window into the inner life of another, in a mask? When a stranger becomes a viral vector first, and a neighbor second?

As we continued down the seawall, I surveyed the little sliver of ocean that has become mine over my years in Rhode Island. A thousand shades of blue were compressed into the line between the water and the sky – the flux below set against the stillness above. The open sea has always struck me as a place of refuge, the edge of normal life. Gazing into its vastness, as it churns with the emotion of the barometric pressure, is a reminder that great swaths of our planet are free from the frivolity of human affairs. At this moment, however, the sea suddenly feels more like a barricade than a haven. The virus is creeping, riding on the backs of New Yorkers and Bostoners fleeing to rental properties and summer homes, multiplying within

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the ranks of Rhodies. And I wait, squeezed up against the rocky coast, pressed against the edge of a world descending into panic.

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Coffee in Church Kathleen Davin, MS1

I brought my dog to church on Sunday.

Well, we’re bringing church to our living room and our dog is asleep on the couch, so he’s coming to church too.

This is the first time any of us have missed Mass since nobody knows when. We’ve never done this before, and we’re not quite sure how to act. My mom sits on the couch with my dog. He lays on his back, head dangling and ear flopping down over the side of the flowered cushion, occasionally wriggling and stretching in case my mom didn’t get the hint that belly rubs were expected. My dad sits in the pink striped rocker with his tea, my sister on the blue-checked armchair wrapped in a fuzzy polka dot blanket from her bedroom upstairs.

I curl up with my coffee in the corner armchair, wearing a high school sweatshirt and too-small sweatpants, a gift from my driver’s ed teacher after I got my license in 2013. They have two cars crashing across the butt.

More casual than I usually am for Mass, but I only packed for a week at my parents’ house, not months. I’m relying on decade-old t-shirts and Christmas pajama bottoms until I can make a trip back to Philly.

“What are we supposed to do for this?” I ask, already awkward, “Like am I supposed to be singing?” My vocal talents are best appreciated in a full and lively congregation, where no one can hear them. My living room would not do them justice.

“You don’t have to stay,” my dad replies, fiddling with the remote for the new TV. I stay. We don’t sing. I sip my coffee.

“In the name of the Father, the Son, and the Holy Spirit. Amen,” the priest begins. His name is really bugging me. We bless ourselves in our living room.

I know I know that priest from my undergrad days, but his name escapes me. He has red hair and teaches French literature. EWTN, the Catholic channel, always livestreams Mass from Notre Dame—the University of Notre Dame in Indiana, not Notre-Dame in Paris, an important distinction that is confused more often than it should be. Last spring, some unwitting BBC reporter used a Lou Holtz quote about Notre Dame football to mourn the loss of “the treasures of Notre-Dame.”

The basilica is wonderful, but it’s no Notre-Dame. It looks small and cold on the screen. Cavernous and

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quiet, with its night sky ceilings and serene saints, it’s usually a peaceful place, warm and welcoming in the bleak South Bend winters that numbed me for five years. Today it is empty but for a handful of priests, dutifully spaced six feet apart in their rose-colored robes. It is Laetare Sunday, the fourth Sunday of Lent, where Catholics—and maybe some Anglicans—take a brief break from the solemn fast of Lent and look forward to the brighter days ahead. It’s the spoiler alert of Lent, the reminder that we’ve got good things coming if we run the race, fight the good fight, and do whatever else Paul said in that one letter to somebody or other. It also means that priests wear pink.

“The Peace of the Lord be with you,” the priest welcomes.

“Are we supposed to, like, do the responses? And with your spirit?” my sister asks. We make eye contact and I shrug. I sip my coffee.

I let my legs dangle over the side of my armchair as the priest reads the Gospel. It’s a good one this weekend: Jesus healing a blind man but breaking the Sabbath in doing so. I like this one. It feels fitting for a Lent full of Sabbaths that we won’t be able to keep holy because of a plague. I wonder what the medieval Church did during the actual plague. Went to Mass and died, probably.

I swirl the dregs of my coffee, watching the trail of stray grounds spiral in the bottom of my mug.

Is this sacrilegious? I wonder. Me, flung sideways in my chair drinking coffee, my mom, petting my dog and turning away from the TV to remind him that he is a very good boy. Or is it right somehow? Bringing worship into our home, with its faded carpet and mismatched furniture, into the fabric of our imperfect lives.

That’s the point, isn’t it? I wonder.

“Is that Father Pete? The one in the second pew?” my dad asks, pointing at the back of a head on the screen.

Carolyn and I answer in the affirmative.

My mother, five minutes later, asks, “Is that Father Pete?” The other three of us exchange looks.

“Yeah, the guy in the second row with the dark buzz cut” I say, letting her selective attention slide.

My sister is less willing to let go, “Yeah Mom, Dad asked that literally five minutes ago.” My mom makes a face at her before continuing to pet the dog.

A Notre Dame favorite, Fr. Pete is so well-beloved that ND football made a hype video of him preparing for Mass that they play on the Jumbotron at every home game. I wonder if there will even be a football season this year. Heaven forbid God’s favorite university doesn’t have its football season. What will the devout do on Saturdays?

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I should pay attention. I finish my coffee.

“Father Gregory! That’s it,” I say, finally remembering the name of the celebrant. My mom shushes me.

The cantor sings “Let us pray to the…” and the sparse congregation joins in “Lord hear our prayer,” making one continuous song out of the Prayer of the Faithful. This is usually a lovely exchange of prayer and intention, but now it echoes oddly in the empty space of the basilica.

There’s only one cantor instead of a full choir, and her chair is spaced an awkward six feet from Fr. Gregory’s.

Somehow, I know that her name is Danielle. She has a beautiful voice, but the hymns are thin without the congregation participating “with full heart and voice” as Fr. Rocca always used to say.

She sings “Amazing Grace” as the priest prepares Communion. It isn’t usually sung during this part of the Mass; they must have chosen it intentionally. It’s a song of hope, of being found and known, of perseverance.

I know they mean it to be uplifting and unifying, strengthening us through the darkness and fear. But it’s not the same. “Amazing Grace” echoing to an empty basilica catches in my throat and makes my eyes sting for the first time in this pandemic.

I hide my face behind my empty mug and hope my family doesn’t notice.

My dog snores.

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A Modern Passover Story Ezra Brooks, MS1

It’s an odd world we’ve entered and to keep pretend busy, I’ve started running to use up time. As the old medical mantra goes, time is brain, and TV time is destroying mine.

I lace up my shoes one afternoon while contemplating the meaning of it all. I was thinking about my most recent conversation with my grandma.

“It’s biblical,” she proclaimed, “G-d is sending us a message and we should listen.” I’m still not sure what message that is, but this situation does seem awfully Old-Testament-y. Reading CNN often feels like the passage from the Haggadah about the 10 plagues in Egypt. It starts with the loss of toilet paper, continues to the social distancing from our friends, and ends with the loss of loved ones. Life is now a modern Passover story.

I love feeling the slap of my feet on the pavement. The first few minutes of a run are always my favorite.

I’m full of energy, feeling like I can run forever. I watch as the cracks in the sidewalk go by underneath me, rhythmically. My formerly white shoes reflect the sun back at my face as they bounce up and down.

The trees wave as I jog past. I don’t wave back. Waving is what I have been reduced to when I see my neighbors on my runs. Waving, and running around them at a gentle radius of 6 or so feet. This is no longer a time to stop and chat, the environment is too intense; the worry lines on everyone’s faces are too deep. I run past the usually most put together neighborhood mom. She is in sweatpants and her face is wrinkly and sullen, entirely devoid of make-up. What is happening?

I feel the first bead of sweat slowly drip down the side of my face, tracing a path to the corner of my mouth.

Does coronavirus travel in sweat? Why am I scared? I definitely can’t give myself coronavirus from my own sweat. My heart is thumping in my chest. Is that from the fear or the running?

As I round a corner, two couples come into view. They are talking and smiling tightly. Well, sort of talking.

One couple is standing in the middle of the street—which is an acceptable thing in our neighborhood for some reason—and the other is on the sidewalk. There is easily 15 feet of semi-mandated social distance between them. So, really, they are yelling.

“Josh used to have soccer practice every day at 3 PM and now I have to deal with him every day at 3 PM,” I can hear one lament, as I get closer.

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I have to get past these couples. I glance up at their faces. They are watching me. All of them are watching me. I see uncertainty in their eyes, and I imagine they can see it in mine. One of the women is slowly rocking her child in the stroller as I approach. I feel very slow. I make the split-second decision to run between them rather than run into a tree or make an enormous circle.

As I start running through, they part. Like the red sea parted. They spread in unison for me to pass through, on both sides, smoothly. The movement is seemingly practiced and entirely unnatural. I look to either side of the canyon I’ve entered and keep running. I’m trespassing and so vulnerable.

I emerge out the other end of the pass and sigh with relief. I realize I’d been holding my breath subconsciously, for my own health as well as for theirs. I turn around to watch the waters reclose on the coronavirus chasing me. The couples now resume their former social distance, swallowing the Egyptians and Pharaoh in the closure.

My Grandma was right. There really is something deeply unusual about this whole thing. Maybe it is biblical.

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ABOUT US

apenndx was founded in 2019 by a diverse group of first-year medical students from the University of Pennsylvania School of Medicine. Centered around both the humanities and the sciences, apenndx offers an outlet for health professional students to engage in science journalism and to share prose, poetry, art, photography, and more. We hope that it offers you, the reader, a holistic view into our medical community and lessons we have learned from within it. apenndx is student-run and independent of the University of Pennsylvania School of Medicine. apenndx is published bi-annually.

CONTACT US

Our website can be found at apenndx.com.

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For business or media inquiries regarding apenndx, contact Andrew Ahn via email at andrew.ahn@ pennmedicine.upenn.edu.

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For all other inquiries regarding apenndx, contact our team via email at apenndxmag@gmail.com.

STAFF LISTING

The 2019-2020 apenndx team includes the following students:

Editors in Chief Catherine Yang Diane Rafizadeh Sonia Wang

Publisher Andrew Ahn

Editors

Jackson Bowers Likhitha Kolla Susannah Colt

Design & Illustration Cammille Go Carina Guerra

Social Media Prateek Sharma

Production & Web Development Chris Streiffer Angela Chen