apenndx - Issue 2 (Fall 2020)

apenndx

Fall 2020 • Issue 2 -1-

COVER ART: fragmented Claire Lu, Grade 12 To me, resilience represents the ability to overcome obstacles and continue even after failing. Sometimes the journey of resilience results from physical injury, and other times, from the mere feeling of brokenness. The dancer restrained by ropes, yet still graceful, is meant to represent this idea: in this moment, she is pulled down by heavy sandbags but strives to move forward. She is fragmented, but still in control. And though she’s surrounded by darkness, she carries her own source of color – resilience comes from inner strength and cannot be found elsewhere.

ISSUE DESIGNED BY CAMMILLE GO WITH HELP FROM BEATRICE GO AND BRIAN HUANG -2-

LETTER FROM THE EDITORS Dear Readers, A year has passed since we started planning the first issue of the magazine on the couches of the Jordan Medical Education Center. Now, as MS2s, we head into the hospital wards, and apenndx is transitioning to a new student board helmed by first- and third-year medical students.

This year has presented unprecedented challenges to our community, overturning our collective social, economic, and emotional stability. For this issue, we wanted to reflect on Resilience as a theme of the COVID era. Resilience is a complex matter— while it is often understood as a journey of overcoming hardship, its reality demands that we acknowledge and address the systemic problems that necessitated fortitude in the first place. Nevertheless, we believe this concept and the paradoxes that accompany it are worth grappling with.

In this issue, we are grateful to our students, faculty, and patients who have shared both their moments of strength and their periods of vulnerability so that we can begin to explore and unravel our notions of resilience. An array of experiences are captured—accounts from cancer patients who share their journey from diagnosis to treatment; one pastor who relies on his faith during his recovery from leukemia; a poem from an MS2 (“The Opposite of Resilience”) depicting scenes of a patient who feels isolated in the confines of the clinic; a “failures” echo board weaving in anonymous anecdotes from our peers; and more.

As we pass on the responsibility of keeping apenndx alive, we look forward to seeing where our new board takes the magazine next. Working on this last issue gives us a sense of nostalgia—about many team Zoom calls, a lengthy discussion about whether “apenndx” should have an extra “p,” two discussions we attended with local high schoolers, and dozens of brilliant pieces edited and published. We hope that our team’s final issue finds you well wherever you may be, and gives you strength as we move forward to a new year.

Sincerely, apenndx board Sonia, Catherine, Diane, Andrew, Susannah, Jackson, Likhitha, Prateek, Chris, Angela, Cammille, Carina

-3-

TABLE OF C RESILIENCE, 6

8 The Silver Lining of Shared Suffering, Anonymous 14 The Mourner’s Kaddish, Ali Herman 16 The Opposite of Resilience, Sophie Liebergall 18 Failure Echo Board, Anonymous

COVID, 26 The Social Needs Response Team: expanding patient care outside of the

28 hospital, Sweta Narayan 30 Resilience, Noa Cutler 32 What I thought when I streamed Easter Mass, Jeanne Farnan 33 Some Thoughts, Mila Tamminga 34 Re-evaluating Priorities, Jose Saucedo 36 White Coat Too Short, Mila Tamminga 37 What Covid means to me, Jose Saucedo 37 Meaning, Jose Saucedo 38 An Adjustment, Christopher Fiorina

-4-

CONTENTS PROFILES, 40

42 Mints on my closet shelf, Joia Hordatt Brosco 46 Dr. Amanda Swain: a visionary for the humanities at PSOM, Carolyn Chow Holding Hope: facing therapeutic limitations in mental illness,

50 Alexis Chaet Lopez 56 Lightening the Weight of Life., Justine Wang 60 Jack Ivey, Jeemin Kwon 64 More than a cure, Faith Arimoro 68 I may curse and shout at you; please don’t be alarmed, Jennifer Wineke

LOWER MERION & HARRITON HIGH SCHOOL, 74

76 Chocolate & Vanilla, Justin Robertson 79 Resilience, Nathan Yu 80 Stand Tall, Pauline Voelkel 82 A Resilience Too Foreign to Me and My Country, Claire Sun 84 Concert Night, Dario Arash Bencardino 87 Flower of Fire, Liam Gurevitch 88 Healing Dreams, Lucy Zheng 90 Beneath the Skin, Olivia Lee 92 Salmon Dreaming, Catherine Wan -5-

-- 66 --

-- 77 --

The Silver Lining of Shared Suffering Anonymous

- -88- -

Before the chaos – the constant instability that would come to define much of my life – I had a childhood that many dream of. I was a white male, born into a middle-class family, in a predominantly white, suburban town. While my family tree was a bit complicated, the first few years of my life were comfortable, stable, and supportive.

When I was six, the stability that I was accustomed to quickly unraveled. My parents divorced after my dad cheated on my mom with a neighbor. Within a month, my dad had gotten my mom sent to a psychiatric hospital, kicked my half-sisters (his stepdaughters) out of the house, destroyed my mom’s home daycare business, and moved his girlfriend in to live with me and my younger sister. I didn’t see my mom or half-sisters for months, and was forced, under threat of verbal and psychological abuse, to call my dad’s girlfriend “mom”.

After nearly a year, my mother began regaining custody, and for the next two years my younger sister Charlotte and I had to split time between our mother and father. Eventually, he lost interest. Unwilling to attend a single courtordered counseling session, he relinquished his custody. We haven’t spoken since.

“

As I matured, the complexity of our situation became apparent.

Charlotte and I had to have We were comfortably middlebeen the reason he left, right? class, but my mom was reckless He seemed to have room in with her finances. She had erratic, his heart for other kids. Why impulsive spending habits that not us?

I quickly caught on to. To help her save money, my siblings and I often cared for the children attending my mom’s daycare (which she reestablished shortly after regaining custody of us) in place of an employee. My mom’s mental health started to deteriorate rapidly as well. Sometimes I would tend to her when she would come home drunk after a night with her new boyfriend, cleaning her up after she vomited. After she and her boyfriend broke up, her mental health took another turn for the worse. She started taking a host of medications that would often leave her incoherent at night. Most evenings after finishing my homework, I would go into my mom’s room to console her as she sobbed and threatened suicide with the few words she managed to get out. I would lay with her and rub her back, holding back tears as I questioned why I was the one taking on this burden.

Throughout our childhood, I often tried to provide my sister Charlotte with parental guidance. Despite only being a few years older, I was the primary -9-

father-figure in her life. What made this dynamic even more bizarre was our close physical proximity to our biological father. Not only did he still live in town, but he was a middle school teacher and the high school basketball coach. For years, Charlotte and I would see him in passing and hear stories about how fun his class was. Sometimes, I even found myself in the same room as him, both of us avoiding eye contact at all costs. These interactions inevitably led to a feeling of guilt. Charlotte and I had to have been the reason he left, right?

He seemed to have room in his heart for other kids. Why not us?

“

As a high schooler, I felt anxious about our family’s financial While my new college struggles and my mother’s poor decision making. To help out, I classmates were enjoying got a job at a local restaurant. It orientation week, I was wasn’t much, and I never let my filling out paperwork mom know, but I would pitch to hastily transfer legal in to buy groceries and pay guardianship of Grace to bills whenever I could. I knew one of my older half-sisters. that we had plenty of money to get by, but I worried about my mom’s long-term financial stability, and hoped that she would save more if I covered some of the costs.

She didn’t.

During the summer before my senior year we found out that 13-year-old Charlotte was pregnant. After months of defending her from bullying and trying to ascertain how we were going to support an infant, I became an uncle to Grace. With the baby’s father out of the picture, I took it upon myself to act as the predominant male figure in young Grace’s life, just as I had done for her mother. I was determined to provide Grace with the stability we never had.

In the months after Grace was born, I spent most of my free time with her. I did my best to make sure that she felt loved and secure. I spent so much time with her that “Unkie” – baby talk for “uncle” – was her first word. Though my mom and I helped care for Grace in the early months, Charlotte quickly rose to the challenge. She transferred to an online school for her first semester of high school so she could focus on parenting. To everyone’s astonishment, she excelled in school and became a phenomenal mother. Resilience runs in the family.

When it was time for me to apply to college, I decided to move several hundred miles from my home, hoping to avoid being summoned back for every crisis.

Right before moving out, however, my mom’s daycare was shut down. She had been running it over capacity, knowingly ignoring multiple warnings from the - 10 -

state until her license was terminated. Stubborn and not knowing how else to make money, she had continued to operate the daycare illegally. Eventually, she was caught and summoned to court, presumably on her way to prison.

Since Charlotte was under 18 years old, if my mom became incarcerated, Grace would have been removed from Charlotte’s custody. While my new college classmates were enjoying orientation week, I was filling out paperwork to hastily transfer legal guardianship of Grace to one of my older half-sisters.

Knowing my distance limited me, I made plans to enroll in a university closer to home. Fortunately, the judge spared my mom from jail time and I did not have to transfer.

The examples that I’ve laid out are some of the most formative experiences of my life, but this list is far from comprehensive. Every month it seemed like a new earth-shattering crisis arose, followed by fleeting moments of stability.

This distress was often accompanied by mental abuse from our mother when she felt particularly overwhelmed. She made sure that my siblings and I knew that we were the source of the chaos. The unending stress took its toll: I now have moderate anxiety and an adverse childhood events (ACE) score of 6 out of 10. The groundbreaking ACE study, a discussion topic in our Psychiatry block, found that individuals with a score of 6 or higher are at risk of their lifespan being shortened by 20 years.

“

Despite all of the turmoil, my family endured. My younger sister is in How were we different? her third year of nursing school, What made us so resilient? where she lives on campus with her 6-year-old daughter Grace and her boyfriend. She gets fantastic grades, has raised an incredible child, and developed a healthy relationship with Grace’s biological father – unwilling to make the same mistakes as our parents. I graduated college with academic success and now attend one of the best medical schools in the US. My half-siblings have similarly remarkable success stories. Unfortunately, countless families throughout the US face similarly incredulous challenges with less favorable outcomes. How were we different? What made us so resilient?

Over the past several years I have spent innumerable hours trying to answer these questions, and three themes stand out to me. First, despite our many challenges, we were still a middle-class, white family living in an affluent suburban town. We lived in a safe, green community, and had access to good housing, nutritious food, and great schools. The positive impact of this stability on my mental and physical development cannot be discounted.

- 11 -

Second, the robust social networks that we had established within our community also played a critical role in nurturing resilience within my family.

We became very close with many of the families who attended my mom’s daycare. She often helped them out, giving them deals or offering them a place to stay, and through her generosity, she formed rich connections that we could call upon when we struggled. If we needed help solving a particular problem, we almost always had someone to turn to. For example, if the sink needed fixing and we couldn’t afford to pay for it at the time, we had friends who helped for free because my mom had previously been generous to them.

These communal bonds brought with them a sense of security that was key to my family’s resilience.

The third, and probably most fundamental, influence on our resilience comes from my mother’s boundless compassion. Despite her shortcomings, my mom is one of the most selfless people that I have ever met. She didn’t run the daycare at double the legal capacity to make more money, in fact, she probably lost money from the extra staff she had to hire. Nearly half of the families couldn’t afford to attend, and their daycare fees were covered by the state at an unsustainably low rate. The kids who weren’t poor enough to receive state funding, but still couldn’t afford to pay, simply attended for free.

My mom frequently offered up our house, inviting families to live with us for months at a time, free of charge, while they got back on their feet.

These decisions ultimately led to a toxic and stressful home environment for me and my siblings. Our physical needs were met, but emotionally we felt neglected. At first, we resented the hardship that my mother brought upon us. However, we were also exposed to the hardships of our neighbors, and over time we developed intense empathy towards them. Consequently, we began to identify more broadly with others who were experiencing misfortune. We may not have gotten to live a “normal” life, but we were a part of something bigger: we offered up our own stability and comfort to others who had it much worse at the time. Most importantly, the sadness and anxiety that my siblings and I felt paved the way for us to find passion in helping others. This perpetuated a cycle of selflessness, which spread throughout our social network, giving strength to those that we had helped. It became clear to me that shared suffering begets empathy, which begets selflessness, which begets resilience, which begets more empathy.

While my family’s story is unique, the circumstances that fostered our resilience are not. In fact, I believe that building a life around compassion and community is well within reach for most, especially those enduring hardship. This is not intended to downplay the importance of the external factors and privileges I benefited from, but to offer a pathway to hope and success as we grapple - 12 -

with the intense suffering felt by so many around the world right now. Issues such as racism, COVID-19, climate change and inequity are ravaging the globe, especially America. At times, these monumental issues seem insurmountable.

The absence of clear solutions, diminishing trust in our political institutions, and disagreement on basic facts have left many hopeless. While the path forward is not yet clear, one thing is certain: coming out of these crises as a better nation than we went into them will be incredibly difficult work, and we need to be resilient to stand any chance of achieving this goal.

How can we foster such resilience when the future looks so bleak?

Empathy.

Much of the suffering that we witness and endure is senseless – a consequence of the individualistic identities that dominate American culture. Rather than empathy, our identities are rooted in political affiliation and self-preservation.

This needs to change. A silver lining of these devastating crises is that they have given us an opportunity to feel empathy on a colossal scale. Extraordinary empathy, in turn, opens the door to extraordinary selflessness. Like COVID, selflessness is a contagion – able to ripple through communities with incredible force. Unlike its deadly counterpart, however, selflessness leaves hope and resilience in its wake, beginning the cycle anew. Resilience is the solution, and empathy is how we will get there.

The author is a medical student at the University of Pennsylvania. To maintain anonymity, all names in this story have been changed.

- 13 -

The Mourner’s Kaddish Ali Herman, MS2

In the Jewish religion, the Mourner’s Kaddish is a prayer recited after the death of a loved one and on the anniversary of the death. It helps us— as a community and as individuals—remember those who have passed.

Losing all of my grandparents at a young age made it difficult for me to understand death and feel connected with those departed. Going to services with my father and listening to him recite this prayer underpinned the way I experience and cope with death. As a medical student entering my clinical rotations, I will face death in a new, more intimate way. I carry the words of the Mourner’s Kaddish with me always and they comfort me in times of loss. Speaking them quietly to myself will help me keep the memory of my patients alive.

I hold the package close to me in hands that shake with devastating cold. Alone.

I breathe, and tear the paper back to see my siddur just like I remembered it.

I grab the note he tucked into its page that reads—“I love you girl, so please enjoy.

Your dad.” I sit, legs sway.

A little girl between the rows of tallitot that hung on men’s shoulders. The sun, it danced through windows splashed with dazzling color, the synagogue filled with ricocheting light. And I was dressed in Saturday best, and dad, he draped his jacket around my arms so I was warm. My feet they dangled short, too short to firmly plant below me then. And dad, he grabbed my little hand in his and sang the ancient Hebrew songs that flowed through bodies like the souls of those that are gone. I found the meaning in meaningless words, - 14 -

in music full and rich with grand emotion: Yitgadal v’yitkadash sh’mei raba, amen An ordinary day or so it seemed.

Our dining room was set for guests to come that night, a feast for family with meat and drink and expected joy. She sat, so grey, uncomfortable, before us then. Zach’s hand in mine we talked to her until she was no longer there.

Her eyes went dim, her mouth, it did not move.

I screamed—“Zach close your eyes don’t look come on.”

We ran. And grabbed my dad and brought him to the black chair. b’alma di v’ra khir’utei v’yamlikh malkhutei Now, every august light a candle white, held softly in the Hebrew words that warm the dead. Recite b’hayeikhon u-v’yomeikhon u-v’hayei d’khol beit yisrael So easy to forget perhaps but just so hard to remember.

I light the candle by my bed, not white, a slight shade of pink, her made up lips.

The flame it flickers kissing my forehead.

Ba-agula u-viz’man kariv, v’imru amen.

Translation courtesy of Sefaria: The Mourner’s Kaddish Exalted and hallowed be God’s great name in the world which God created, according to plan.

May God’s majesty be revealed in the days of our lifetime and the life of all Israel—speedily, imminently, to which we say Amen.

Blessed be God’s great name to all eternity.

Blessed, praised, honored, exalted, extolled, glorified, adored, and lauded be the name of the Holy Blessed One, beyond all earthly words and songs of blessing, praise, and comfort. To which we say Amen.

May there be abundant peace from heaven, and life, for us and all Israel, to which we say Amen.

May the one who creates harmony on high, bring peace to us and to all Israel.

To which we say Amen.

- 15 -

The Opposite of Resilience Sophie Liebergall, MS2

-7 days She only complained about her pain to the doctors and even then, dispassionately – the disembodied, factual pain of a radiology report My back is on fire whenever I move, she said the words condensing as they passed through her icy lips.

Hydromorphone, doctor said.

-6 days Whoever was up first would roll the potty seat next to her bed and wrap her limbs over their shoulders like the straps of a backpack to hoist her onto the turquoise plastic seat, trying not to pull up her gown but we did sometimes – the muffled yellow flowers giving way to purple bruises like little opalescent oil spills.

-4 days We baked her buttermilk biscuits per her recipe – handwritten in cryptic coils.

We had to guess the oven temp (375) but they came out just fine, layered like golden brown mounds of sandstone.

She broke one in half with shaking fingers, revealing its rare white belly, then placed it back on the plate.

Delicious, she said.

-3 days We went to the used bookstore on Wiley Ave because Anne Marie said she had breathed her own breath twice and it was time to get out of the apartment - 16 -

for a bit.

Laminated wood straining with a collage of paperbacks – lives’ works strung cover to cover into a single twisting tale.

I brought her back a Flannery O’Connor book with a faintly familiar title.

Her thin wrists buckled under its weight.

Oh, I’ll never have time to finish this one, she said.

-2 days the duffels patient by the front door.

We encircled the bed, ogling the body now more grotesque sculpture than her, skin once inflated with cheese grits and lemon pound cake now hanging from a xylophone of ribs, scorpion tail spine primed to snap. ‘allison has school and chris has the regional tournament and gene is going to jacksonville for business – that meeting with the distributor – and carrie is out of sick days and I have to drive allison, but maya will be here to take care of you and we’ll be back next week’ Anne Marie said.

She was still for a moment longer, hair permanently matted flat in the back, until her eyes cracked at the corners and the fury of grief rushed into her limbs.

Tears dribbled from her chin and muscles jerked on the ends of their fibers.

Don’t leave me here alone, she wailed her words rippling with the opposite of resilience.

- 17 -

W E a m e o in n

- 18 -

We decided to solicit submissions for a Failure Echo Board in order to normalize, vocalize, and establish solidarity in failure. Although medicine often focuses solely on successes, each of the following experiences come from our classmates, faculty, and mentors and are ntended to show us that when we fail, we are not alone.

19 -- 19

When I was little, I was skiing with my family and was terrified of a new, very steep run. I cried non-stop at the top, filled with worry, dread, and fear for my life that I would fall. I finally bucked up the courage and started the run. I made one turn before I fell and tumbled down half the hill. I fell for almost a full minute.

My mom raced to get to me, convinced I would be a wreck. When she got to me, however, she was shocked to see a huge smile on my face.

“THAT’S the worst that can happen??” I asked, before jumping up and skiing off. I re-did the run, this time skiing it top to bottom with a huge smile on my face.

I failed 2 classes during Mod 1. When I got the emails saying I had failed I felt a similar dread, fear, sadness. I felt like I had left myself, and everyone who was rooting for me, down. After that, I dug deep. I studied way harder than I had before and I remediated no-sweat. As I finished my first remediation I had that same “THAT’S the worst that can happen??” moment.

Fear of failure is a fear of the unknown. We fear what might happen, what might be the consequences, and that people might view us differently.

It feels like tumbling down a mountain, not sure when you’re going to stop, afraid people will see you as less than, worried about the bumps we are getting as we tumble. But when we get to the bottom of our fall, we realize that we are the same, the people who love us still love us, and all that’s different now is that we took a slightly less enjoyable route to the end goal.

So we pick ourselves up off the ground, dust off the snow, and finish the run. We do it again, this time more confident, more secure in our skiis and the mountain beneath us. Failure is looking into the unknown.

Success is staring into the unknown and asking ourselves “THAT’s the worst that can happen??”

- 20 -

I failed to speak up and vocalize what I thought were the right answers during the anatomy team exam.

Love this! I failed the MOD 2 pulmonary course.

As an MS3, I failed my surgery shelf. Nobody ever talks to you about failing. And I had always read these anonymous posts about failing pre-clinical exams and shrugged them off because until clerkship, I had been lucky. That hubris caught up to me. I have felt the shame.

I have felt the pressure. I’m still here. And I’m still sticking to surgery.

It happens, it’s certainly not ideal, but you will get through it.

During my neurology rotation, our team was taking care of a complicated patient. The attending sent me and the psychiatry intern to interview the patient, and report back to her. Long story short, the psych intern basically convinced me that the patient had this rare diagnosis that I had never heard of before. I presented it to the attending and her first response was: “... really? That’s what you think he has?” And then the intern did not come to my rescue.

The attending then made me do a presentation the next day on that rare diagnosis. Although I don’t think it necessarily impacted my grade, in that moment it felt like a pretty big failure and my self confidence was low for the rest of my time with that attending.

- 21 -

I pronounced naloxone as “nox-ala-lone” repeatedly during a question to an expert on the opioid epidemic in front of my entire class.

As an attending on an inpatient service, a patient complained of a new and significant symptom during the day. We did an examination and decided to monitor the symptom, but did not otherwise work it up. That evening, the night resident called me to let me know that she suspected a severe and emergent diagnosis and that her workup confirmed her findings. As a result of her outstanding clinical judgment and action, the patient had a timely work-up of the medical issue. I was very very glad that she caught this, but at the same time humbled and – to be honest – embarrassed that I did not previously consider the diagnosis that she correctly identified.

Failing wasn’t a fear that had crossed my mind much until clerkships came around. I struggled through my first clerkship, never knowing how to satisfy my superiors’ expectations. When they told me that I failed in the end, my view on life changed. While I had to be confident and strong during the appeal process, I have since had difficulty knowing if I can ever be confident again. I know deep inside now that I will always have to struggle, and then some, in order to succeed in our medical system. The rest of clerkship has been a struggle, and this has been the hardest year of my life. I have a hard time seeing other students act so at ease without thinking, there must be something wrong with me; I’m not cut out for this. What keeps me going is knowing that I don’t need medicine, but I strongly believe that I can bring positive contributions to medicine despite my weaknesses. My weaknesses don’t negate my strengths. Working on my weaknesses is not a requirement, it is a choice I have the power to make. Some skills come easier for me than they do for others. Other skills do not.

But I get to choose to take extra time preparing and practicing those skills for myself rather than for my superiors. Know yourself. You are unique, so take what others say with a grain of salt.

- 22 -

Coming to an institution like Penn for medical school, I knew that my classmates would be stellar, but I didn’t realize just how much everyone seemed to have their shit together compared to me. During our first year, no one seemed to think staying on top of lectures was painful.

No one seemed to think anatomy lab was mind-boggling in terms of the material or emotional burden. No one seemed to be bothered by volunteering in 8 clinics, writing 23 research manuscripts, shadowing 75 hours, and establishing 14 mentors within the first semester of school.

With 0 hours of clinic volunteering, 0 hours of research, 0 shadowing hours, 0 mentors, and many hours spent on studying concepts my peers seemed to pick up on after hearing once (while watching a lecture at 3x the normal speed), I felt inadequate. I was not only failing to live up to the PSOM pillar of “excellence,” with all of its glistening pride and glory, but I was also failing at not comparing myself to others.

We’re told all the time not to get caught up in looking around at what others are doing, but here was something that I was succeeding at!!

Honestly, as an MS2, I’m still succeeding at buying into peers’ perceived or actual ease with which they glide through medical school.

Well, now I’ve failed at writing an essay about failure because I’ve only written about my successes in sabotaging my self-esteem. Maybe I’ve found something I’m better at than my classmates!

-- 23 23 --

I feel like I’m on the precipice of failing every week. I know I’ll get through the next few years one way or another, but the potential of failing continues to scare me. It’s what stopped me from finishing pre-med when I received a B on my first Biology exam in college, an overwhelming time that led me to conclude that it was over. Only after a while did I finally have the courage to return to medicine. While I am here now, the seemingly invincible armors of knowledge and intelligence that my peers wear keep me wondering whether I’ll ever be competent in my field of choice, or whether I will even ultimately have a choice in a specialty if I can’t seemingly retain any information we’ve learned so far.

Since starting medical school, I’ve failed midterms, I’ve failed to take care of myself, I’ve struggled in small group, I’ve failed to take time off to relax, and I’ve failed in living up to promises made to my family and friends, however large or small. While I’m trying to stave off this constant feeling of slipping down a cliff, which is really only a cliff of my own imagination, I’ve been trying to stay content with my own little wins and strengths, while resisting the urge to monitor the average class exam scores in Oasis. What is failure in reality? Often, it’s a feeling borne out of our own messy convoluted constructs and worldview. The feeling of failure often stems from not measuring up to a standard defined by a testing body, an institution, or our own imagination. That feeling shouldn’t be shameful, it shouldn’t have the power to inhibit us from our dreams, but rather it’s a feeling that sometimes happens and is completely normal.

- 24 -

I put a ton of time and effort into trying to honor a clerkship rotation I thought I was very interested in at the time, and came up short.

I desperately wanted to be Cindy Christian’s friend so early on in medical school. I introduced myself and told her that I liked her equation (the social determinants of health one she invented). She said: “Nice to meet you! Do you remember the equation?� I totally forgot the equation and looked like an idiot in front of my hero.

In that moment, I felt like a complete loser/failure/imposter. Luckily, she is as kind as she is impressive, laughed it off, and reminded me that there are lots of things to memorize in medical school :-)

- 25 -

C O V I D

stori the s 26 --- 26

These pieces are part of a series highlighting the unique ways in which COVID-19 has shaped the medical school experience. Some were written by third and fourth year medical students of the Spring 2020 Narrative Medicine course, taught by Dr. Jeffrey Milstein. Two pieces that we particularly wsh to highlight are Sweta Narayan’s essay interviewing Yi Zhou and her work with the Social Needs Response Team and Christopher Fiorina’s poem inspired by a talk with a doula. Both explore ways in which medical students and the community have sought to care for their neighbors.

ies from sidelines - 27 -- 27 -

THE SOCIAL NEEDS RESPONSE T

expanding patient care outside of the h Sweta Narayan, MS1

When the COVID-19 pandemic hit Philadelphia in March, the lives of medical students at Penn were suddenly thrown into turmoil.

Classes went online, clerkships were disrupted, and many students went back to their childhood homes. Without in-person clinical activities, some students felt it hard to inject meaning into their medical education. “I was feeling detached from the real reason why I went into medicine,” said Yi Zhou, an MS2. “[I wanted] to actually help improve lives.”

forced to get creative. Looking for a closer connection to the Philly community, Zhou joined the Social Needs Response Team (SNRT), an interdisciplinary team of medical, nursing, and social work students. Founded in April by Penn Medicine’s Center for Health Equity Advancement in partnership with the Department of Case Management and Social Work, the SNRT has worked to meet the urgent social and financial needs of patients who test positive for COVID-19. “Once diagnosed with COVID-19, many patients lose their income,” said Zhou. “This can lead to downstream consequences, such as being unable to afford housing… or basic [necessities] like utilities or groceries.” While clinicians have focused on the physical manifestations of COVID-19, the immediate social concerns this disease produces for patients are often not addressed.

The pandemic came at an unfortunate time for Zhou and many of her classmates. Though they understood the gravity of the pandemic, these students could not actually help frontline workers battle COVID-19 in the clinical arena. As she worked to respect public health guidelines by staying at home, Zhou felt stuck in limbo. How could she get to know the community she wanted to serve if she could not spend time with patients?

Soon after she joined the SNRT, Zhou got a firsthand glimpse of how COVID-19 can wreak havoc on patients’ lives. During her first shift, Zhou spoke with a contract worker

In the face of this crisis, members of the Penn community were - 28 -

TEAM:

hospital

who had been referred to the SNRT for problems paying his utilities.

Living at home with his father, who had not yet tested positive for COVID-19, the patient was concerned about his family’s welfare. he needed. She helped him access stamps for his letter, found a way for him to apply for utilities support, and connected him with a community health worker for longer-term support. Ultimately, these interventions helped the patient get back on his feet.

As she dug deeper into the case, Zhou realized that a lot of the patient’s issues stemmed from the fact that, after his COVID-19 diagnosis, he was unable to work. As he quarantined at home, the patient worried that he would get fired. Since he had lost his first job earlier in the pandemic, he also worried that he would not be able to get additional workers’ compensation. Though the patient had tried to call the unemployment office multiple times, he was not able to reach them. When Zhou suggested that the patient send a letter to the unemployment office, she realized that he did not have access to a printer or stamps.

Although the SNRT cannot always find immediate, straightforward solutions to patients’ problems, patients often still appreciate being reached out to. “Some of the patients diagnosed with COVID-19 haven’t heard from anyone in a week or two,” said Zhou. “Sometimes a phone call to check in makes a big difference.”

“I just remember [wondering] what it would feel like if there was no way for me to even get money to buy a stamp,” said Zhou. Thinking on her feet, Zhou found creative ways to help the patient find the resources

Through her work with the SNRT, Zhou believes she has been able to find concrete ways to not only improve patients’ lives, but also - 29 -

has helped Zhou develop important professional skills. In addition to the more than 20 medical students who work on the team, there are also a number of students from Penn’s nursing and social work programs.

This collaborative environment has provided a hands-on opportunity to practice interdisciplinary work. “It has been very interesting to see how students from other professions approach the program,” said Zhou. “They help us see problems

her own communication skills. She has found that kindness, genuine empathy, and creative thinking key to successful patient interactions. “I think it takes a lot of trust building before these patients open up to you,” she said. It can take hours and even multiple sessions for patients to start talking about issues in their home and social lives.

Apart from improving her relationship with patients, the SNRT - 30 -

“Resilience” by Noa Cutler, Grade 11

in a different light, and teach us better ways to evaluate patients’ needs.” Through the team’s weekly huddles, Zhou has learned from the experiences of other volunteers and worked with teammates to develop new, creative strategies to address patients’ concerns.

“Even if they are not acutely sick with COVID, a lot of our patients have unmet social needs,” said Zhou. “Our goal is to ultimately make [the SNRT] part of Penn Medicine.” As the SNRT’s Chair for Expansion and Recruitment, Zhou hopes the program can become a more permanent way for healthcare students of all disciplines to address the underlying social needs of patients at Penn.

Though the SNRT currently focuses on patients diagnosed with COVID-19, it would like to expand its services beyond the pandemic.

- 31 -

WHAT I THOUGHT WHEN I STREAMED EASTER MASS Jeanne Farnan, MS3 Standing in my living room I could see Every marbled detail on the open expanse Where usually a crowd would be Save for the deadly circumstance At the far end of St. Peter’s church, stands a man in white, the pope What look he gives the wooden cross!

What once gave death, but now gives hope This year, we see the Easter story Playing out before our eyes, The contagion is the cross of Christ He walks with us, he suffers, dies, But in this darkness, we hold the hope That we, like Him, will also rise

32 --- 32

SOME THOUGHTS Mila Tamminga, MS3

I want to be utterly unknowing, uncertain, showing up with no promises made, recklessly scared and fearsomely vulnerable.

Let the sun come up on the horizon of my unknown, my bleary eyes cracking open onto dawn to find it is here, grapefruit pink even when the world has ended with dusk.

33 --- 33

RE-EVALUATING PRIORITIES Jose Saucedo, MS3

As I’m writing this piece I’m looking out across Lake Michigan from our “fi we named in our new house. It’s snowing right now which is weird… it was ago. My dad is sitting next to me and my dog, Remi, is at our feet.

If there is anything this pandemic has been good for, it’s been that’s it’s evaluate my priorities in life — or at least it has exposed them. I haven’t been a them yet, but at least I know where they stand.

The first few weeks were ones spent in despair as the gyms all closed an self-isolating. I talked to friends who were miles away, but we were on th the first time in our lives, we felt aimless, like ghosts floating by, not touchin leaving a trace of our roaming, no evidence of us even existing.

Several weeks later, I still have these thoughts. I have them multiple t occasionally (and more frequently now), I snap out of it. I look around, see my see the snow falling over Lake Michigan in our new house… these are things These are the silver linings that I should be grateful for. Though this pand many doors — for some, permanently— it has also opened many. I am gra opportunity to train my mind to frame my situation into more favorable co

- 34 -

fish-bowl,� a room sunny 5 minutes

forced me to reable to reorganize

nd friends started he same page: for ng anything‌ not

times a day. But y dad and my dog, s I will remember. demic has closed ateful to have the ontexts.

35 --- 35

W WHITE COAT TOO SHORT Mila Tamminga, MS3 800 people died in New York today, but I soaked beans for chili and watered my plants.

Looked at my hands that are two years too early to help (or maybe I’m just too scared) and put on tea to boil for the third time today.

My white coat is stuffed in my backpack, pockets still with crumpled papers and marking pens and thoughts of my patients while the world ends around me.

Cried three times today, but there’s nothing to grieve except being too early.

White coat too short for mask marks struck across my face.

I say it’s better this way.

I say “I’m a walking fomite, anyways.”

(Or maybe I’m just too scared.)

To be hones floating aro reprieve fro back to wor my excitem quarantine

This has be can’t. I wan that my abi staying at h every day to

How do you behind wha

COVID takes contact… it a ways that’s j

If it’s true th then I’m in t programs (w

If it’s true th which one a my friends a empty.

I look down moment an bring at leas - 36 -

WHAT COVID MEANS TO ME Jose Saucedo, MS3

st, when the idea that we could potentially get time off of clerkship was ound, I was kind of excited. Like a snowday, I thought we might have a short om rotations, get to catch up on projects for a couple of days max and get rk. Not only was I wrong about the time frame, I was also wrong about ment which lasted for a whole 24 hours before I realized the implications of e.

een the most frustrating time of my life for one reason. I want to help and I nt to be in the hospital but I know I can’t. I understand I’m not needed and ility to help, clinically, is limited by my level of schooling, but I feel so useless home while people like my physician father are risking their lives each and o help the sick… to help those that cannot help themselves.

MEANING Jose Saucedo, MS3

u define meaning? I don’t know what “logotherapy” means but I can get at Frankl has to say.

s more than lives; it takes away social interaction, it takes away human also takes away meaning. I know this might sound depressing, but in many just how I feel.

hat working/creating is an avenue through which one arrives at meaning, well trouble. I’m not working in the hospital, I’m not creating workouts or gym which I normally do every week)… what am I working towards? I feel aimless.

hat experiencing something or encountering someone is an avenue through arrives at meaning, well then I’m in trouble. I’m hundreds of miles away from and my girlfriend, starved from true human interaction. I feel aimless. I feel

at the quiche I made for dinner and realize I made something. I smile for a nd acknowledge that creating something as simple as a homemade dish can st some fulfillment. I hope my family likes what I made for them!

- 37 -

AN ADJUSTMENT Christopher Fiorina, MS2 This past summer, I worked with Bridging the Gaps and Together for West Philadelphia as a community connector. My role in the program was to assist community members in accessing resources. In one of our projects, we paired with the Pettaway Pursuit Foundation, a local nonprofit organization that assists new mothers by improving the pregnancy, birth, postpartum, and NICU experiences through education and resources.

We had the opportunity to interview their doulas about their experiences caring for pregnant clients throughout the pandemic. “An Adjustment” is a poem that was inspired by my interview with a doula on the effects of COVID-19 on her work. My first question to her was, “How has COVID-19 affected your experience as a doula?” Her response, after a brief pause and a deep breath, was: “An adjustment.” I was subsequently amazed by how she could continue this valuable work despite all the challenges she faced, and I was struck by the hope that the doula provided her clients. Her main message spoke of the adjustment that everyone needed to make.

38 --- 38

“An adjustment” is what one doula said to how she fulfils her mission.

“An adjustment” for the families who will welcome a new addition.

“An adjustment” to the demands of everyone she serves.

“An adjustment” to the long hours, but she gives what they deserve.

“An adjustment” to be there virtually, whether text, phone, or Zoom.

“An adjustment” to help the families with their baby in the womb.

“An adjustment” to respond at any given hour.

“An adjustment” to support, so families feel their power.

“An adjustment” she says, is needed to deal with the unknown.

“An adjustment” that can help us even over the phone.

“An adjustment” leads to flexibility and from there she went to help the families make their adjustment.

- 39 -

prof

- 40 -

files

- 41 -

Photo by Evie Shaffer

It was February and very cold outside. I wiggled my toes in my new work shoes standing in the halls of HUP. This was my first week ever on an inpatient team, the very beginning of my clerkship year, and I had spent a long time picking shoes for this moment: comfortable but also sleek, so that I could be taken seriously by my team.

As the discussion of rounds got more and more detailed, and slight fatigue began to creep into my legs, I thought about Tadasana, mountain pose in yoga. I drew on my background as a yoga instructor and energized myself to stand straight up.

Mints on my closet shelf

Suddenly, everyone’s pagers went off and they started running down the hall, yelling something about someone on our list and a “rapid.” As the only medical student on the team, with no clear direction, I followed suit and ran behind.

Joia Hordatt Brosco, MS4

We ended up in an MRI imaging suite. A woman I had never seen before was sitting upright on the scanner table at the center of attention, people buzzing all around her. There was a lot of yelling. “EKG is clear,” one person said. Though she was sitting there wide awake, no one was talking - 42 -

to the patient. They were very busy talking to one another. She was on some sort of breathing machine (which I would later learn was a nebulizer treatment), her gown had fallen to her stomach, her breasts were exposed to a room of about 20 people, and her eyes were darting around. She was breathing very fast.

She was clearly scared. I thought back to yoga class, and I walked up to her. I lifted her gown to cover her breasts and I started to rub her shoulder and told her everything was going to be okay. I told her I was going to breathe with her, and I did.

I stayed by her side and took deep breaths.

No one moved me out of the way— maybe it was because of my snazzy shoes?—but I ended up staying there until the end of that nebulizer treatment and then throughout another one. I held her hand while they eventually wheeled her back to the floor from the MRI suite. None of this felt out of the ordinary to me. It seemed like the natural human thing to do for another human. It was only until I left the patient’s room that the team leader of the rapid response approached me and asked who I was. Upon learning I was a secondyear medical student, he praised my “instinct” for “staying attentive to the patient’s socioemotional state” and that “it was key to bringing down her respiratory rate, perhaps more so than any organic cause in this case.”

He warned me not to lose that. I was confused.

“

No one moved me out of the way—maybe it was because of my snazzy shoes?

Fast forward to about nine months later. I was on my very last clerkship for the year, Surgery. I had intentionally ranked the vascular surgery service first because throughout the year I had connected the most with this patient population—“vasculopaths,” as medicine calls them—due to the often vastly complex social and environmental factors interacting with their medical ones. One patient, Ms. M, was a perfect example of this. She had right heart failure, end stage kidney disease and a series of other medical concerns, but was in our care for surgical reversal of an infected AV fistula. I remember when she came down to the OR there were about once again 15 people in the room; she was too sick to undergo general anesthesia, and so a specialized team was there to do a local block.

When we moved her from the transport bed to the OR table, a few breath mints fell out from her hospital gown. Laughter erupted. One of the junior residents was enraged: “She’s supposed to be NPO, someone call up to the SICU. This should be safety netted.”

The vascular surgery fellow was amused: “Where’d you get these mints Ms. M?” As a response she

- 43 -

meekly mumbled that she liked to eat mints. I kept my hand on Ms. M’s shoulder throughout the exchange but otherwise stayed quiet.

A few days later, it was clear Ms. M was not getting better. She had developed an ischemic bowel.

The primary team was trying to facilitate discussions with the family to transfer her care to the palliative team, which was proving difficult, but we on the vascular surgery team weren’t privy to these discussions.

As it stood, Ms. M was stuck in the SICU for the time being.

In the workroom, my fellow sat back in her chair and pondered a bit. She pulled a five-dollar bill out of her bag and told me to go down to the cafeteria and buy some breath mints for Ms. M. When I got to the SICU floor, instead of walking straight up to Ms. M—as I had to the woman I had never met, in the middle of a rapid response, months before—I felt the need to pause. I was cautious now of the medical aspect, because now I knew more. I was cautious of the fact that she was NPO. Of the fact she had a dying bowel.

And so I found her nurse and asked, “May she have these mints?”

The response came back, “No, she’s NPO.” Ms. M died the next day.

and I didn’t. “The nurse stopped me,” I had told my fellow, but in reality, I stopped myself. In that moment of weighing the aspects of her biomedical situation, I overlooked her humanity. At the same time, I didn’t realize Ms. M had hours left to live. No one on the team had ever explicitly said that, discussed her prognosis. I wonder if I would have been more emboldened to act if I did. If she had made the transfer to palliative care and off the intensive care floor, this would not have been such a dilemma; she may have been met in her final moments with more compassion. But when I compare how brazen I was in my first month at HUP with my actions just nine months later, it is a bit shocking. Is this indeed what the mainstream culture of medicine does to us? As the rapid response attending warned me? Do we explore the intellectual exercise of theoretical probabilities of differential diagnoses at the cost of seeing a patient’s humanity?

Or in that moment was I just tired, after a long year as a learner? A long year of trying to maintain my view of humanism while simultaneously dehumanizing the body in the pursuit of understanding its pathology? Might it indeed be possible to treat patients’ disease while holistically attending to their humanity? These are the questions I ask when I see the mints still sitting on my closet shelf today.

I often think I had the power to give her some joy, in those final moments, - 44 -

- 45 -

Photo by Elsa Olofsson

Dr. Amanda Swain: a visionary for the humanities at PSOM

Dr. Amanda Swain is still a little surprised that she’s a physician. Born into a family of creatives in small town Long Island, Dr. Swain herself found a lifelong passion for creative pursuits at a young age. Her journey from a childhood steeped in writing and theater to a career as a medical educator at Penn is unconventional, but Dr. Swain’s unique background has also granted her extraordinary vision.

A champion for medical humanities, she is working to bring about changes in the culture of medicine towards increased compassion, greater interprofessional synergy, and deeper personal fulfillment.

In the course of our conversation, the importance of creative expression emerged as a consistent theme guiding Dr. Swain from her developmental years to today. As a freshman at Brandeis University, she eagerly took to cultural anthropology, imagining a career in the realm of museums, archaeology, and artifacts. But her father’s history of chronic illness had piqued her curiosity about the medical field, and an experience shadowing a gastroenterologist family friend catalyzed the diversion

Carolyn Chow, MS1

- 46 -

of Dr. Swain’s route towards medicine.

She found a means of retaining her creative interests while pursuing a career in medicine when, her sophomore year, she was admitted to a program at Mt. Sinai designed to attract humanities-oriented applicants. Dr. Swain graduated from medical school, completed a family medicine residency at Jefferson, and made her way to Student Health at Penn, drawn by the challenge and fulfillment of caring for the adolescent population.

Several years ago, a friend of Dr. Swain’s invited her to a theater class for health professions students at Jefferson. “We should do this kind of thing at Penn,” she thought.

In search of an avenue to make medical humanities initiatives a reality at PSOM, she connected with Dr. Horace Delisser, who oversees the humanism and professionalism curricula, via Dr. Benoit Dube, then an attending in psychiatry.

Their collaboration has proved more than fruitful. In the years since, Dr. Swain and Dr. Delisser have worked together to develop aspects of the Doctoring course as well as medical humanities electives for Perelman students. Those classes, including Art, Observation, and Empathy and Writing a Life, have given students opportunities to develop faculties for introspection and creative expression both in relation to medicine and beyond it. Here, Dr. Swain has found her niche.

“I enjoy my primary care practice so much, but in terms of where I get my energy from, I don’t enjoy my interactions with medical students as much in that arena as I do in the medical humanities space. It’s so much more fun and so much more satisfying to talk to and teach students about narrative medicine and the visual arts and theater than to be talking about analyzing a urinalysis . . . I want to talk about the things we don’t measure in the office— empathy and communication skills and observation skills . . . I feel very lucky that I’ve found a way to pull that piece of myself into what I’m actually given time and salary to do, and I would love to do more of it,” she says.

Given the role creative arts have played in her own life, Dr. Swain sees medical humanities as a bridge between passion and profession.

“So many of us will spend our careers

- 47 -

as salaried physicians within much larger health organizations. There are good things about that, but you can also start to feel like a very small cog in a very big machine, and that can be very draining if you really want to feel motivated and passionate about what you do. And I definitely think the humanities have a role in that discussion,” she told me.

“From college to medical school and beyond, I felt I had to choose,” Dr. Swain reflected.

“

Dr. Swain went on to expand on how she imagines medical humanities can promote mutual understanding and strengthen interdisciplinary healthcare teams.

“In a time of crisis, where did we go? We didn’t go back to our textbooks. We wanted to engage in ways that could feel creative.

“I would think, ‘there’s a part of you that is so creative and feels so fulfilled by writing and theater, but that’s not something that you really have time for now; that’s not something that you can really make work with your career.’ When you do that you strangle off a little part of yourself; you tie a little tourniquet. And that pressure builds up and I think it ends up for some people probably leading to some kind of burnout.”

For Dr. Swain, a tremendous express herself to-day work in lucky that I’ve

that piece of myself into what I’m actually given time and salary to do.”

“I would hope that finding a way to bridge the creative interests of doctors with some aspect of their clinical experience will ultimately help people feel more fulfilled in their careers over the long haul. It’s a long career—if you go straight through, like I did, you’ve got your MD and you’re 25 years old. You’re going to be practicing medicine for 50 years. You need to maintain energy and focus and enthusiasm.”

though, it has been boon to be able to creatively in her daymedicine: “I feel very found a way to pull

“If you work in a typical medical office, you’re working with people in administrative roles, psychologists, social workers, nurse practitioners, PAs, medical assistants, nurses, students, reception, medical records, referrals, lab techs, and more. How do you manage and unite this group of people? How do you put forward the idea that we’re all in this together in the common goal of providing excellent patient care, but we may be all judged by different metrics, have different responsibilities, and come from very different educational, social, and cultural backgrounds?”

“I think the humanities are a way to do that because you could go in at the monthly staff meeting and go through educational competencies

- 48 -

Photo by Suzy Hazelwood

and run through the fire drill, but that doesn’t bring people together.

But instead, you could sit down and say, ‘we’re going to give you protected time in your schedule and watch this movie or do a visual arts thinking exercise, share our views, have a really meaningful discussion, take something from each other and learn from each other in a way that we wouldn’t have before.’ I think you’re going to get a lot farther in getting everyone working together, on the same page, and motivated than you would in the monthly staff meeting.”

Finally, Dr. Swain credits the COVID-19 pandemic for highlighting an important role for the humanities in a healthcare system and society under significant stress.

She commends Penn Medicine for implementing the COBALT site, a platform for healthcare workers compiling mental health and wellness resources. Besides offering contacts for psychotherapists, resilience coaches, and other support

personnel, COBALT also provides for interpersonal connection and creative exchange including art appreciation.

“In a time of crisis, where did we go?

We didn’t go back to our textbooks.

We wanted to engage in ways that could feel creative. There’s a lot to be said about using the same kinds of resources in non-crisis situations to foster a sense of community and responsibility and relationships in organizations.”

We drew our call to a close so Dr. Swain could make it to a piano lesson. When her son took a break from lessons this past summer, she figured she would resume her own piano journey after a hiatus of several decades, and she’s been loving it.

“You feel like you’re using a different part of your brain, and you are!”

She exclaimed. “Now I’m in, and I’m committed, and I don’t see myself stopping again.”

- 49 -

Holding Hope: facing therapeutic limitations in mental illness

She sat at the table’s head with eyes downcast and black brows furrowed. Her thin body wilted over her knees, her shins creating a shield to protect her vital organs. The corners of her lips sagged unnaturally – as if weights had hung from each end for many months, and now her muscles knew no reprieve. A kind of helpless innocence reflected in her face, yet the receding edge of her hairline and the dark shadows clouding her eyes aged her. It was hard for me to say whether she was 16 or 35. Either way, she had an inviting innocence about her, like that of a hatchling fallen from a nearby nest.

Dr. Lee, the attending physician, introduced each individual at the table: the patient’s father, the psychologist, the resident, myself, and Jenn. “We are all here to talk about what to do, Jenn,” Dr. Lee said. A few moments of silence passed.

Alexis Chaet Lopez, MS4

“Well, I do have a solution,” Jenn said. “I want him to give me a pill so that I can kill myself if I need to,” nodding to her father across the table. Her father sat unmoved, like he had heard these words many times before. His tired eyes looked first to his daughter, then drifted to Dr. Lee across the table.

I couldn’t tell whether he pled silently for help...or for permission.

“Why would we give you something that you could kill 50 --- 50

yourself with?” Dr. Lee asked.

“I am wondering why you need us to give you a pill. You are very astute; I am sure you could find drugs on the street,” said Dr. Lee, challenging Jenn’s logic.

Jenn fingered through her flowered green notebook, as if the pages had her answer.

“

“It’s not that easy,” said Jenn.

“Well, I do have a solution,” Jenn said. “I want him to give me a pill so that I can kill myself if I need to”

Circular conversation continued as we discussed her problems with medication adherence, logistics for delaying her PhD program, and the possibility of starting electroconvulsive therapy (ECT).

Through Dr. Lee’s masterful dance of strategic negotiation, a request for pills was tempered to a promise of cordless headphones. In exchange, the team got something we wanted: a signature from Jenn to rescind her 72-hour notice, which formally announced her intention to leave inpatient psychiatric treatment against medical advice, as well as a promise scrawled on scrap paper that she’d take her morning meds.

“I wouldn’t kill myself. I just need it.” A childlike whine crept into her voice, the evidence of her innocent demeanor contrasting sharply with her bold request. “If you gave it to me,” she pled, “I wouldn’t have to suffer through these horrible thoughts of how I am going to kill myself. I would know I would have the pill if I needed to…” her face contorted and she retreated further into herself, flipping again through her notebook.

Up until then, I had always thought of depression as a chronic illness that many people lived with and died with, but never died from. It’s not that I was oblivious to the number of suicides happening each day; too often, I would wake up to read that another young person had taken their life. I would think about all the terrible happenings in someone’s life that led them to feel that suicide was the only option. And while I knew it was often a person’s circumstances in the context of depression that led to such devastating outcomes, I felt

Jenn started again, hesitantly, as if admitting a great secret. “I think of all these horrible ways to die,” her voice cracked. “And it is torture. It’s like waiting in line to be burned alive.

If you gave me a pill, I wouldn’t have to suffer with these thoughts.”

“You know we can’t do that,” Dr. Lee said.

“Well then, I want to die.”

Silence.

- 51 -

“The darkness under her eyes had improved and her incessant fidgeting had quieted. I sensed hope within her for the first time. She would never admit to it, but I needed to believe, for myself, that this hope would soon take root in her mind.�

52 --- 52

troubled by the thought that if only circumstances had been different, suicide could always be prevented.

At the end of the day, we arrived back to the workroom to finish notes. I opened Jenn’s chart, scrolling to the day’s assessment and plan.

Italics jumped off the page—Major depressive disorder, severe (SAx3; Borderline Personality Disorder; Eating Disorder). She had trialed and failed every treatment for depression in the books: sampling SSRIs, dialectical behavioral therapy, cognitive therapy, second and third-line medications. She had been in and out of the hospital for suicide attempts and severe dips in her depression many times over the last fifteen years, and she now was on month four as an inpatient.

Yet, somehow, in between these hospitalizations, she had managed to get her bachelor’s, then her master’s, hold a job in consulting, and now was deferring a PhD.

straightaways of the E-shaped ward.

I waited for the elevator to rise to Floor 8. “Caution: Patients at risk of elopement!” read the sign inside the elevator. I finally left the building, greeted by a sun that leveled the goosebumps on my arms. The chilled confinement of the psychiatric ward contrasted sharply with the warm, bustling streets. I hopped on my bike to head home.

It was hard for me to imagine that the person curled up in the plastic chair pleading for death pills was this same accomplished woman. I felt medicine was failing her. She had tried the newest plan, ECT, before with temporary success—now it felt like her last hope.

The next day I was greeted by the resident as I stepped into the workroom. “Jenn didn’t go to ECT this morning,” the resident said with an intonation of defeat. “I don’t know what to do with her. She does this every time; it’s self-sabotage.” The resident’s frustration rallied in me a naive optimism. This treatment was her only hope. We called a team meeting.

As I left the unit at the end of the day, I passed Jenn in the hallway. She strode steadily with a determined step, wearing her new green headphones atop her head; she was looking dourly towards the floor as she powered up and down the

After one week of ECT treatments, our team began to celebrate success behind closed doors. In ten years, Jenn had never made it this far in adhering to a treatment plan.

I began noticing a change in her at our morning meetings. The darkness under her eyes had improved and her incessant fidgeting had quieted.

I sensed hope within her for the first time. She would never admit to it, but I needed to believe, for myself, that this hope would soon take root in her mind.

“Well, we can’t keep her forever,” Dr. Lee said. “The truth is, she will probably kill herself one day.” The sac around my heart turned to lead,

- 53 -

dropping into my gut like stone. It was true. Was it true?

I was warned once by a cancer surgeon that doctors should never consider themselves to be Godgifted Healers. “Doctors merely interfere in the patient’s own illness path; they do not determine it,” he said to me. From his perspective, if a patient got better, it was because of the patient, not the doctor. This mindset was critical for sustaining him through the deaths of many of his patients. To him, if a surgeon was a Healer, every patient’s death meant failure on the physician’s part.

I took issue with his view. I worried such a mindset would distance the physician from being fully present with patients. It felt like ambivalence for the sake of self-protection. I reflected on my optimistic medical school admissions essay, “what greater gift than that of healing hands.” To heal others is why I came to medical school in the first place.

Didn’t doctors do more than just interfere in a patient’s illness path?

The full meaning of his warning did not hit me until my experience with Jenn. Was I so naïve to think that after years of psychotherapy with Dr. Lee, my morning conversations with Jenn would result in her turnaround? And if so, was it my own God complex as healer that fed my optimism for her improvement?

Or was it selfless hope for a young person to get better?

That day, we held another family

meeting with Jenn, her father, and Dr. Lee. Behind the scenes, Dr. Lee and I talked through strategies of how we might keep her as an inpatient through one more week of ECT. We debated threatening to take away Jenn’s privilege of outpatient therapy with Dr. Lee. I pushed against this option, remembering a conversation where Jenn relayed to me her fears about being alone and unsupported after leaving the hospital.

“

Doctors merely interfere in the patient’s own illness path; they do not determine it,

Sitting around the table this time, Jenn looked different. She sat upright with her elbows on the counter and her eyes, though not making contact with anyone, resting firmly above shoulder height. Her green notebook sat closed, and she held her fingers interlaced quietly.

I opened the conversation to allow Jenn to share her thoughts and plan.

The conversation quickly nosedived, with Jenn getting upset by the thought of staying inpatient any longer. I stopped. I waited until her gaze hit mine. “Jenn, I care about you,” I said. “We care about you. I am honestly scared that if you go home, you will hurt yourself. I see you doing better here.”

- 54 -

“I know.” Her body softened.

I never thought I’d see her leave the unit, but I did. It was not as joyous as it had been with other patients who had graduated back into free society from the ward. I felt more fear than optimism when Jenn left.

I shook hands with Jenn before she left, a learned professional code in psychiatry, but I wanted to give her a hug.

My relationship with Jenn has made me grapple with the therapeutic role of hope in medicine. I was forced to acknowledge aloud for myself and for Jenn that thoughts of suicide would be there when she went home and may never go away. We brought into the open the unspoken fear: that once she left the safety chamber of the hospital, the possibility of death was real. Yet at the same time, my role as a care provider was to keep alive the possibility of hope in a path towards healing. When I met Jenn, she had refused all possibilities of hope, asking for a pill to end her life.

However, I kept my eyes open to signs of growing hope deep within her. Importantly too, I never lost hope for her recovery or in my ability to impact her life in some positive way. My time with Jenn taught me that finding this hope is critical not only for fostering the possibility of healing for the patient, but also for sustaining a physician’s empathy.

I did not have the ability to cure Jenn of depression. Physicians cannot always stop a cancer from

returning. Suicide is sometimes an unpredictable consequence of mental illness. These truths are hard to stare in the face, yet denying them— as the cancer doctor warned—is to toy with a dangerous God complex.

What sustains me, however, is not this bleak acknowledgement of my limitations, but rather, a recognition that healing can happen without a cure. Physicians have the ability to keep lit a hopeful path for patients when they are too overwhelmed by darkness to remember that it’s there.

In helping patients see paths of hope, and in walking alongside them as they travel into an unknowing future, no ending is a failure and no therapeutic relationship is without meaning.

In order to protect patient anonymity, all names in this story have been changed.

- 55 -

Lightening the Weight of Life Justine Wang, MS1

153. 221. 223. These are the numbers that Bryon MacWilliams recites to me, as instinctively as some people might recall important dates or phone numbers. Except these numbers represent cross-sections at different points in his life, some of the highs and lows in his long journey with his weight. Bryon first recognized a problem with overeating early in his life when he started working in high school. He would buy food and snacks after work, only to binge-eat all of it before he got home. He remembers being relatively healthy at 153 pounds when he graduated from high school, but his struggle with overeating escalated in his early 20’s, especially as he began working as a journalist with a demanding schedule. He describes himself during this period of his life as a “workaholic”, grinding 14-hour days and almost exclusively eating out. By the time Bryon was 30 years old in 1996, he weighed 221 pounds at 5’8”—the heaviest he had been in his life.

Bryon became a member of support groups for eating disorders, including Overeaters Anonymous. At the time, he was one of only a few men in these groups, but the communities were comprised of members of diverse ages and stages of life.

As Bryon met other members who were decades older or settled into marriage and parenthood, he vowed, “I’m going to have this together before I get to that age.”

Today, now 54 years old, Bryon recognizes that his relationship with his weight has been much more complicated than he once believed or, perhaps, hoped.

After a few years of attending Overeaters Anonymous, Bryon decided to leave the group, although he acknowledges that it - 56 -

is helpful for many others.

“In the end, I couldn’t get past—you know, it’s a label. When you have to say ‘I’m Bryon, and I’m a compulsive overeater’ or something like that, it’s like a label. It was maybe good at arresting behavior, but it didn’t feel like it was going to get me closer to the core of whatever was behind the behavior.”

Bryon did not want his struggle with overeating to become an indelible part of his identity, a name assigned to him for the rest of his life. Even more than that, he was beginning to recognize that the overeating might actually be a symptom of a deeper problem, not the problem itself. It was around this time that a history of emotional and sexual abuse within his family that occurred when he was younger finally surfaced. This was a significant period of reflection for Bryon, as he felt that these new stories of past trauma helped solidify the idea that his overeating was not an isolated issue.

“Until that point, I thought everything was my fault, my weakness. I just wasn’t strong enough or working hard enough or brave enough to fix this. And I was very hard on myself… But once the abuse came out, it gave me some legitimacy, like ‘okay, well maybe this isn’t all just me. Maybe I didn’t have to just look toward myself, I could look toward other things.”

Bryon sought private therapy in

his 20’s and found that it gave him the opportunity to see his situation from a new perspective. He echoes a truth that many of us can relate to: it is often very difficult to fully understand the battle that you are in until you step outside of it. Rather than continue to be swept up in a cycle of overeating, self-blame, and self-destruction, therapy became a way for Bryon to pause the process and self-reflect.

Part of Bryon’s self-exploration happened during August 2020, when he was a writer-in-residence at the Millay Colony for the Arts in the Berkshires, New York. This residency is an opportunity for artists and creatives of diverse backgrounds to live and create on a private property secluded by nature.

At Millay, Bryon began to pay more attention to dreaming as a way to learn more about himself and open himself to “receiving information” from his unconscious. He kept a journal during this time to record and reflect on his dreams. In one of these dreams, Bryon envisioned a crawl space in his bedroom ceiling, similar to one that might lead to an attic or a roof. The passageway of the crawl space looked very deep, with an illuminated light beyond it.

Looking back on the dream, he came to understand that the door to the crawl space was a metaphor for how overeating had become a barrier—a way to protect himself from pain and trauma, but also a struggle that has isolated him.

- 57 -

“If you grow up being told and feeling that whatever you do isn’t good enough or that you’re not enough… there might be a lot of reasons to avoid yourself. I remember in the dream, I woke myself up because I was saying out loud in my sleep, ‘Come out, come out’. When I woke up, I wrote it down, and I realized it meant me. I thought it meant me, perhaps, telling myself ‘It’s safe to come out.’”

In addition to his experience at Millay, writing has been a lifelong therapeutic practice in Bryon’s journey with his weight. Bryon is a professional writer and a selfdescribed “crisis journal keeper”. He often journals through the extreme highs and lows in his life. Similar to when he was attending private therapy, Bryon looks back through the journals he kept in the past, now with the distance of time, to gain new perspectives. He finds that the opportunity to step back from himself in this way has been revealing, showing him repeating themes and patterns related to his relationship with himself and overeating.

Bryon continues to see his issues with overeating at a deeper level.

He believes that the core of his experiences lies in an “unconscious place” where his true self is found. He calls this his “mystery”—what others may call their gut, intuition, or soul.

Like many people who have had to overcome struggles, Bryon’s journey

has been dynamic, sometimes involving as many steps forward as backward. At his heaviest point in 1996, he moved to Moscow, Russia where he lived for the next 12 years.

There, he seemed to turn over a new leaf. His daily lifestyle required a lot of walking and he also supplemented his exercise with yoga. Without recalling an exact weight, he remembers being physically fit during that time. Since moving back to his home in New Jersey, Bryon has learned other ways to manage his health. For example, he knows that he needs to mentally prepare what he will eat each day ahead of time and tries to cook his own food as much as he can. He has learned from experience the exact number of calories and the amount of energy and patience it takes for him to lose weight.

While Bryon has made significant progress both in his weight journey and in his relationship with himself, he has experienced incremental gains and losses, the natural “ebb and flow” of dealing with a chronic struggle, over the past 20 years.

Oftentimes, he has felt the weariness of constantly fighting against his body and its drive to push him back toward unhealthy eating behaviors.

Last year in 2019, Bryon’s weight climbed to 223 pounds—two pounds heavier than his heaviest point in 1996. He called it a “pretty big failure” and felt that he had “broken a promise” to himself. Even more, he felt like it had erased all the work

- 58 -

he had put in to not only manage his weight but also develop a better relationship with himself.

“It’s hard to sound like it means anything when, over all these years, I eventually put on all that weight.

There was so much success during those years, but if you measure it according to weight, it’s a lot of failure.”

Yet Bryon does not define resilience by a certain number of pounds or calories. What ultimately motivates Bryon is getting in touch with the “unconscious place”, or “mystery”, within himself that he believes is at the heart of his behavior. To Bryon, resilience is not only learning to listen to and receive that inner wisdom but also “being honest with myself, especially when it’s not something I want to hear or welcome, and addressing it”. In this way, Bryon shows us that resilience is owning failure even when it is hard, and allowing ourselves to fail as we keep getting closer to where we want to be.

Bryon relied on his resilience and past methods once again to return to a healthier state in both his body and mind. Since last year, he has brought his weight down to 191 pounds.

Again, although a number doesn’t necessarily represent success by Bryon’s standards of resilience, he has learned that his personal journey is inextricably linked to his symptoms of overeating.

“I believe that journey is tied to the food and the eating journey. When I’m more distant from myself, when I’m not spending my hours doing what is calling me or being asked of me by the universe, when I’m not taking care of being kind to myself, that’s when I’m more inclined to eat that way…When I’m getting closer to [myself], my eating is better, writing is better, I’m better and kinder to myself. So that’s the place I try to be aware of and stay close to. And every day, I succeed and fail.”

Currently, Bryon’s personal journey has led him to start writing what he calls an “anti-memoir memoir”, a nontraditional approach to an autobiographical memoir that will include a combination of personal truth, secrets, and fiction. As Dr. Atul Gawande writes in Being Mortal, “the chance to shape one’s story is essential to sustaining meaning in life.” For Bryon MacWilliams, writing his memoir carries profound meaning, as it represents a culmination of his experiences thus far to seek his true self and process the issues underlying his struggles with overeating and body image.

“It’s something I have to do before I die, my fear is I’m going to die before I finish this… I’m still, in some ways, trying to get at the core. And I think I never will. I don’t know that anyone ever does, because some of it’s a mystery. There’s always a part of us that’s a mystery.”

- 59 -

Jack was sitting very still in front of his towering bookshelf with notebooks filled with poems and stories he has written as well as various knick-knacks and souvenirs.

His head barely moved an inch throughout our whole conversation.

Jack Ivey Jeemin Kwon, MS2

“When the world starts to tip, I know that I’m starting to tip – it’s not the world.”

Jack spoke so easily about the stroke that destroyed his vestibular system in 2001.

His levity almost masked the gravity of his journey to recovery. He was told that he had to spend the rest of his life in a wheelchair, that he would never be able to go camping and hiking as he once did.

But he refused to let this stroke change his life. Over the course of a year, Jack learned how to stand upright by following the direction of vertical lines on the wall.

He lifted himself off the wheelchair onto a walker. Pushing himself even harder, he slowly transitioned to two canes. And today, he only carries one cane.

Jack grew up in Northwestern Indiana, just off the tip of Lake Michigan. Right out of high school, he worked as a Latin teacher for three years before packing up to travel through Europe and North Africa with his wife in 1973. Almost five decades later, he still vividly remembers everything from this trip, especially being trapped in a campground in Athens when a student uprising overthrew Papadopoulos.

Eventually, Jack returned to America and settled down in Massachusetts, where he got a job as a US defense contractor for Raytheon Subsidiaries. After nearly two decades there, Jack resigned to pursue a new calling: becoming a pastor. While Jack practically grew up in the church, attending - 60 -

Sunday school and services each week, Jack didn’t realize his new calling until a series of serendipitous decisions led to a degree in theology and several pilgrimages. In pursuit of his new dream, he became an ordained pastor in 1994 for the United Church of Christ and moved out to Pennsylvania to serve his new congregation.

Resilience is the inherent Ability to always bounce back When life throws you a curve And tries to beat you down (Excerpt from “Resilience,” by Jack Ivey)

Jack had just started at this congregation when he had the stroke. “You either give up or you keep trying different things until something works. I just keep tackling whatever it is that I can find to do.”

Jack has carried this philosophy since childhood. He grew up in a poor family where everyone was responsible for certain tasks, and if one person fell short, the whole family felt the consequences. Jack’s first job was mowing neighbors’ lawns, and all his earnings went into the family pot.

One afternoon in 2007, Jack was at the church for a general meeting when he felt a searing pain in his back. When the pain persisted for over three weeks, Jack went to his primary care physician, who ordered an MRI and a CT scan; once the results came in, his doctor made an appointment for him with an oncologist. It took awhile for the reality of the diagnosis to sink in.

Multiple myeloma. He initially only felt shock, which quickly morphed into a sense that his world was dissolving around him.

Thus, despite the physical challenges of stroke recovery, Jack dutifully served his congregation for over a decade. Being a pastor is not a light occupation – he was tasked with supporting those going through a hard time, worshipping leadership, writing sermons, teaching confirmation class, working with the youth, and being a unifying presence for the congregation. But the church community and the connection he felt with God gave him the strength to continue working.

After the stroke I had to learn to walk again After the cancer diagnosis my whole life changed I had to learn to live with zero energy I had to learn to live again Jack knows he was dealt a bad hand these past couple of years. He credits his wife and daughter as being his - 61 -

rocks, as well as the constant and grounding presence of God. It meant everything to him that he was not alone in the worst moments of his life.

After thirteen years of chemotherapy infusions, radiation therapy, participation in two clinical trials, and two stem cell transplants, Jack is now in partial remission. “It’s like I’ve been given a chance to play my life as if it were an overtime, like in a sports event. In a way, that’s a gift that cancer has given to me, because I didn’t think that way before.”

become a more standardized portion of the social history.

At the end of our interview, Jack turned around his computer to show me the candle he and his wife light everyday as a reminder of God’s presence.

“Life is a real kick. It would be a real shame to give up on it.”

Though my mother did her best to raise me as a Catholic, at a certain point I became dubious and suspicious of organized religion.

But, hearing Jack speak about his spirituality, I couldn’t help but marvel at the beauty of his faith and the unrelenting strength and optimism it offered.

I asked him if he ever felt angry with God. He shook his head no, saying that he doesn’t expect God to dictate the events in his life – only that the Father would always be by his side.

We learned in our Brain and Behavior block that children who grow to be highly resilient versus children who do not typically differ in one key aspect – having at least one stable and supportive relationship with an adult. Perhaps our concept of supportive relationships should be expanded to include spiritual ones, and that inquiring about spirituality - 62 -

“Life is a real kick.It would be a real shame to give up on it.”

- 63 -

More than a cure Faith Arimoro, MS2

“A cancer survivor and biophysicist shares what his diagnosis taught him about good doctors�

64 --- 64

At age 55, Mark Singer was a successful engineer and a brilliant biophysicist, a happily married man who was generally satisfied with his life. He had recently switched to his dream job: adapting a proton accelerator to attack cancer.

However, a few months later, his world stopped. His job acquired a new relevance – he himself was diagnosed with prostate cancer. Over the next few years, Mr. Singer would be broken down and built up by his diagnosis. Though not something he would like to go through again, coping with his illness allowed him to gain a new perspective on what makes for a good doctor.

beam of protons at a tumor, directly damaging the DNA of tumor cells and, ideally, no other cells. Despite being treated with the proton accelerator instead of radiation, his therapy was still grueling and miserable.

At a routine visit, his family doctor felt a small lump during a digital rectal exam. A specialist may have missed this finding, but his family doctor knew him well enough to know that something was off. A biopsy of the lump revealed a cancer with Gleason score 4N3. What should have been well-organized packed islands of prostate cells were misbehaving, looking more like a Jackson Pollock painting instead of a cross section of a bunch of drinking straws.

Initially, Mr. Singer distracted himself from the reality of his diagnosis by keeping himself busy with work and other responsibilities.

He approached his illness clinically.

Outwardly, he seemed to be doing well. Inwardly, Mr. Singer was terrified out of his mind. It soon became clear that the treatment was taking a toll on him; he would come home and immediately fall asleep, exhausted from treatment and the emotional burden of his illness. His wife encouraged him to join a writing group run by radiation oncology. It was only in this group that Mr. Singer began to process the reality and manage the emotional burden of his diagnosis. Though causality remains to be established, as he learned to deal with the emotional burden, his physical health improved as well. Mr. Singer’s PSA levels declined over the next few months.

Mr. Singer then had his prostate removed and began weighing the benefits of a systemic treatment for his cancer. Forgoing radiation, to the worry of his doctors, Mr. Singer decided to wait until the proton accelerator was available for use in the clinic. The accelerator is more precise than many traditional cancer treatment methods – it aims a

Through the writing group, Mr. Singer learned that the physician’s responsibility is not to cure, but to do what is within their ability to improve their patient’s quality of life. The focus should not just be on beating the disease. This is unrealistic. Though we are trained to cure, at some point, physicians must be able to understand when they

- 65 -

need to provide palliative treatment and support. Making matters worse, we also often view the patient experience as something we are immune to. Mr. Singer recounted an instance at a conference where he was meeting with a group of surgical residents who were discussing their patients as a distant, othered population.

Their conversation struck Mr. Singer as odd. After all, he remarked, all of us will be patients one day.

Mr. Singer encounters these overly solution-oriented attitudes from physicians outside of the clinic’s walls, too. One of his relatives, a neurosurgeon, kept saying that Mr. Singer would fight the disease.

Another relative, an oncologist, was dismissive of the seriousness of his diagnosis. He did not find the overly optimistic views of his relatives particularly helpful. Their words felt hollow, leaving him disappointed and annoyed. From his perspective, the disease did not care if you fought it. Instead of glossing over the uncomfortable reality, Mr. Singer wishes that his physician relatives had just asked him open-ended questions or expressed a desire to learn more.

medicine or good at the humanistic side of the field. Mr. Singer strongly believes that these two skills should not be mutually exclusive. While knowing the technical is important to diagnose and prognosticate, the humanistic side can make or break a patient interaction. He recalls the story of one relative who chose to have a knee replacement done at a community hospital over a highly rated hospital simply because he had a good relationship with the doctor at the community institution. In order to break out of the dichotomous view of medicine we are taught, Mr. Singer offers us what he describes as a controversial and difficult piece of advice: envision being a patient yourself and being out of control. What type of doctor would you want?

Author’s note: I met Mr. Singer near the beginning of my second year of medical school. I am so grateful that Mr. Singer was willing to share his story on resilience with me and hope that his story has meant something to you as well.

Mr. Singer remarks that he had felt supported and listened to at Penn, and advises that all physicians follow a similar lead by striving to make their patients feel the same level of care. At times, physicians hold the view that they must either be good at the technical side of 66---66

“At times, physicians hold the view that they must either be good at the technical side of medicine or good at the humanistic side of the field.�

67 --- 67

Photo by Daian Gan

I may curse and shout at you; please don’t be alarmed Jennifer Wineke, MS3

68 --- 68

One of the many challenges of 2020 has been coming to terms with a loss of control. The future has always been uncertain, it’s true—but a global pandemic has a particular way of bringing that unpredictability to the forefront.

However, for people living with Tourette’s Syndrome (TS), a neurological disorder characterized by involuntary motor and vocal tics, unpredictability is the status quo: living with forces outside of their control is a daily, bodily reality. For them, this year has been even more difficult.

“Stress and Tourette’s are not a good mix,” says Andrew Joannou, a 52-year-old man with TS speaking to me by phone in October from his New Jersey home. “I speak for my fellow sufferers when I say the pandemic has caused a lot of stress, which has caused our symptoms to flare up.” Andrew’s verbal tics are still under control with the help of his medication, but his physical tics— the involuntary twist of his neck, the flinging of an arm—have gotten worse.

When I met Andrew and his wife Amy in 2017, Andrew’s TS symptoms were vastly improved from where they had been just five years before. Andrew and I were introduced through the Longitudinal Experience to Appreciate the Patient’s Perspective (LEAPP) program at the Perelman School of Medicine, which pairs a patient with chronic disease

“

Plants can’t discriminate.

(Andrew) with a medical student eager to learn about chronic disease (me). My first conversation with him was notable more for his humor than his tics, which at that time were limited to jerking movements of his head and occasional spitting. He told me to watch the 2007 documentary Tourette’s on the Job to get a sense of how far his symptoms had come.

Like a dutiful med student, I watched it that evening.

The documentary chronicles Andrew’s journey to find steady employment, from horticulture jobs, which he loved “because plants can’t discriminate,” to “dirty jobs that no one else wanted to do,” to his current position as a mail sorter with the US postal service, where he still works today. Out of the four professionals interviewed in the documentary, Andrew’s symptoms are the most severe; we learn that previous neurologists have dubbed his condition “Super Tourette’s.”

Throughout the program, Andrew is seen hitting himself on the head with a phone (“I need a rubber phone,” he says), slamming his arm into tables, and buckling his knees as he walks down the hall. “I have pretty much everything,” Andrew says in one scene, and he goes on to describe his arm and leg jerks, his echolalia (repetition of phrases), copraxia (obscene gestures), and

- 69 -

coprolalia (obscene language).

Though coprolalia is typically the most salient feature of Tourette’s in pop culture, it is actually rare, present in only about 10-15% of people with TS. In a scene showing Andrew speaking on the phone, he pulls out what sounds like a stock phrase: “I have Tourette’s Syndrome so I may curse and shout at you; please don’t be alarmed, okay?”

Andrew was born and raised in London and shortly after birth exhibited what his doctors called “fits” or “seizures.” As he got older his symptoms waned, but then returned with a vengeance at age six or seven when his tics became louder and more physical. He was sent to boarding school at age eleven and was finally diagnosed at age thirteen. “That’s common with Tourette’s—the late diagnosis,” he says. At the time, there was only one medication to treat TS: haloperidol, an antipsychotic drug developed in the 1950s. “Back in the 1980s, when I got diagnosed, they put you on very high doses of haloperidol, basically to zombify you,” he says. “They didn’t know what to do with Tourette’s or how to treat it.” He spent his adolescence in a medicated stupor, failing many of his classes.

Andrew tried other medications in his 20s and 30s, with dangerous side effects: “All the medications made me suicidal. My neurologist told me the depression was part of Tourette’s. They didn’t understand back then what the deal was. I

decided to stop all the medications cold turkey because I knew there was something more to the depression than just Tourette’s—something told me there was more to it. So I stopped them all, and within a week the depression totally left. And then I went back to my neurologist, and apart from having my head chewed off for doing such a dangerous thing, he understood.”

“

“I’ve met doctors who should never have been doctors,” Andrew says.

“They should have been a butcher, because they treated me like a lump of meat.

But staying unmedicated had its dangers, too. By the time Andrew quit medication altogether, he was living alone in England, and his tics soon became unmanageable. “If I was chopping food, I’d cut myself. If I was cooking a meal, I’d throw the saucepan of food I was preparing at the wall.” He was attacked on public transportation and bullied at work.

He found solace at church and found relief in swimming, cycling, and martial arts, cycling up to 100 miles a day. When he was active, his tics lessened. But he couldn’t stay on his bicycle forever.

One of Andrew’s doctors suggested a lobotomy, an experimental surgery

- 70 -

at the time, and he almost went through with it. “When I was on the list for this so-called surgery, I made an expensive phone call from the UK to the Tourette’s Association of America to get more information.

They sent me the information, and it was basically a study report on 30-something cases, and all the outcomes varied from not working at all to a couple of people being brain damaged. I said, ‘I can’t do this.’” He ended up trying Risperdal, an atypical antipsychotic. “It took away my personality. I was existing, not living. I was like this for six or seven years before I finally went back to my doctor and said, ‘This ain’t working.’” He adjusted the dosage, eventually reaching an unsatisfying middle ground: “I was still having tics, but I wasn’t so dopey that I couldn’t function. But I wasn’t fully alert, either.”

January 2021.

Of course, romance hasn’t been easy. Once, when they were still dating, Andrew bent down to kiss Amy on the bridge of the nose and had one of his biting tics, leading him to chomp down and break her nose. That same evening, he flung a cup of hot tea at her.

“That was my test,” he says with a grin, “to make sure Amy was being genuine, that she was right for me.

She passed the test.”

Once settled in New Jersey with Amy, Andrew continued to search for the right neurologist. “They either weren’t very kind or said that I was too of a severe case for them to deal with,” he says. His tics were so severe at that point that even sitting next to Amy was a risk—his arms would frequently fling out and hit her. “It didn’t bother Amy, but it bothered me.” The chronic pain from his physical tics, due to whiplash in his neck and in his knees, was debilitating.

It was during this time that Andrew met Amy. He came to the US for a Tourette’s Conference in 1991 and stayed in New Jersey with a friend, whom he accompanied to work one day. There he met Amy’s mom, who asked him why he wasn’t dating anyone. “I told her that I had never met anyone who could see past the Tourette’s,” Andrew says. “And she said, ‘Well, you haven’t met my daughter yet.’” After a successful blind date, he returned to England, where he emailed Amy for months before returning to the US to stay with her and her family. The rest, as they say, is history; their twentyyear wedding anniversary will be in

Desperate for a better solution than medication alone, Andrew wrote to a trusted friend, the late neurologist and writer Dr. Oliver Sacks. Throughout his career, Dr. Sacks wrote frequently about TS and spoke about his kinship with those with TS, calling himself an “honorary Touretter.” Andrew had connected with him through the Tourette’s Association of America, and they met in Dr. Sacks’ New York office in - 71 -

2001. “At the end of the visit,” Andrew says, “he said he didn’t want to be my doctor—he wanted to be my friend.

So we exchanged email addresses.”

It was a unique correspondence: Andrew sent Dr. Sacks emails, and Dr. Sacks wrote letters in return. “His handwriting was atrocious,” Andrew once confessed with a laugh.

Andrew had written to Dr. Sacks years before, asking what he thought about Deep Brain Stimulation (DBS), a procedure in which a pair of electrodes are surgically implanted in the brain and attached to a device that emits electrical impulses—a “pacemaker for the brain,” as it’s sometimes called. DBS had been FDA-approved for Parkinson’s Disease, but was, and still is, experimental for severe Tourette’s, though Andrew knew of someone with TS who had undergone the surgery successfully. At the time, Dr. Sacks told him to wait; more research was needed. But years had passed, and this time, Dr. Sacks put him in touch with a neurosurgeon at Mt. Sinai, Dr. Brian Kopell.

When Andrew met with Dr. Kopell, he learned that DBS would help with the physical symptoms but wasn’t likely to improve his verbal tics. Andrew wanted to pursue it anyway, and he started the process to get approval from his insurance company, which was far from a guarantee. In Andrew’s case, approval was swift: “I went to a church prayer meeting and prayed it would happen. I spoke to the medical director and my neurosurgeon on

Monday morning. When I returned to work on Wednesday morning, I got a call from Mt. Sinai, telling me my insurance company approved the surgery. If you know insurance companies, they don’t approve things in three days.” To Andrew, it all seemed heaven-sent. Speaking of Dr. Sacks, Andrew says, “He was my angel. They don’t come like him.”

“Leading up to the surgery, I wasn’t scared or fearful—nothing. I was at total peace about it all. There was a chance I could die, but I felt like if I died, it wasn’t my problem,” he says.

Dr. Kopell and his team performed the series of surgeries in the summer of 2013: two brain surgeries, a month apart—one for each hemisphere— and then another surgery weeks later to place the battery-operated pulse generators in the chest. The surgery was an overwhelming success.

Surprisingly, the first symptoms to disappear were the verbal ones: no more coprolalia. His physical symptoms improved, too, so much so that he was finally able to walk hand-in-hand with Amy without fear of hurting either of them. Since the surgery, his tics have decreased by about 80-90%.

Andrew knows that his challenges are far from over—adjusting his medication regimen and DBS settings, with the help of his neurologists Dr. Andres Deik and Dr. Daniel Kremens, continues to be an ongoing journey. Several years ago, when Andrew’s mother died, the settings on his DBS device had to be

- 72 -

adjusted temporarily to account for the stress-related increase in his tics.

A disruption in his meticulous sleep schedule can wreak havoc, and his sleep apnea, a common comorbidity of TS, can make quality sleep difficult to achieve. Since the onset of the pandemic, he has had to switch from an antipsychotic that he has used for fifteen years, Geodon, to a similar medication, Zyprexa, to keep his tics under control. He still rides his bike, but lately his neck and knee pain have been interfering with his exercise regimen. When he can’t exercise, he reads his Bible or listens to music. “Music calms the savage beast,” he says, “and it definitely calms me.” British ‘80s bands are his favorite: Tears for Fears, WHAM, Ultravox, Thompson Twins. “Do you even know these bands?” he asks, laughing. (Honestly? No. But still the dutiful med student, I looked them up.)

Though research is growing by the day, there isn’t a wealth of data on long-term outcomes for TS patients who have undergone the DBS procedure that proved so transformative for Andrew. He is in uncharted territory—which, in many ways, is where he’s always been. He believes his life’s mission is to share his story with the medical community, particularly with trainees. In addition to participating in the LEAPP program at Perelman, he gives lectures to medical students throughout Philadelphia and New Jersey. He told me once about a lecture in which he turned off his

DBS device for fifteen minutes to show the students how severe his tics are without it. When I asked him if that was a scary thing to do, he shrugged it off.

“I’ve met doctors who should never have been doctors,” Andrew says.

“They should have been a butcher, because they treated me like a lump of meat. I have the right to say ‘I’m never seeing a doctor again,’ but instead, I choose to turn the whole situation around and use the bad experiences I had to educate the new doctors-to-be, to make them better doctors than what I experienced in the past. That’s why I do this. That’s my goal.”

In a year riddled with uncertainty, I can say for certain that getting to know Andrew has made me a better doctor-to-be. Over the past three and a half years, Andrew has given me a first-class education in how to approach a life marked by unpredictability: with resilience, generosity, and an unwavering sense of humor.

Special thanks to Andrew’s neurologist Dr. Andres Deik, who pointed me to the University of Florida’s database of Tourette’s patients who have undergone DBS, which will be used to analyze long-term outcomes and reduce some of the uncertainty for people like Andrew moving forward. And to Andrew, for dealing with my unbridled Oliver Sacks fandom.

- 73 -

LOWER M & HARR HIGH SC

During the fall of 2020, apenndx began hosting School. Organized largely with the help of Mr focused on having apenndx team members involved in the writing fellowship (a peer t magazine, the Dolphin. One of the t encounters was exchanging stori especially during COVID. apenndx s and Harriton English teachers an writing and art pieces focused hope that these pieces h artistic abilities of the a window into “the othe beyond our medical have faced and de periods in life a greate of emp

- 74 -

MERION RITON CHOOL

g events with Lower Merion and Harriton High rs. Diane Shannon, these events were initially s share their best writing tips with students tutoring program) and the school’s literary themes that manifested from these ies of how people manage stress, subsequently invited Lower Merion nd the writing program to submit on resilience for this issue. We highlight the incredible authors and provide a er� - reveal how others, l school community, ealt with stressful e; and, endow er sense pathy.

- 75 -

Artwork by Anni Roenkae

Chocolate & Vanilla Justin Robertson, Grade 12

Artwork by Steven Johnson

76 --- 76

Feels like a dream but I just made it to 17 Got ice cream cake; chocolate and vanilla cream The people in my life are black, white and in between Yea I got culture in my genes bustin thru the seams My RNA comes from close and faraway Where my ancestors came from it’s hard to say It’s cuz they culture was stripped away But now that culture is hip today I’m talkin the hip-hop I grew up on From Kane to Biz, Cool J to BIG, Ye to Jig Back when we would play as kids Music been in my cells, in my veins to live And I got Pittsburgh in my blood Grandpa passed I never met him Know he’s chillin up above I got love and I respect him Sanity never left him Humanity never left him Even when the world was out to get him They said be free black man but never let him White neighbor had told him “nigga get goin” But he stayed, he ain’t run, and that’s why it’s where my Dad come from It’s not subtle I got struggle in my flesh and then some I got skills that’s honed inside my bones Ready for sticks and stones and student loans Unapologetically I’m me Heritage the reason why I’m free Feels like a dream but I just made it to 17 Got ice cream cake; chocolate and vanilla cream The people in my life are black, white and in between Yea I got culture in my genes bustin thru the seams My RNA comes from close and faraway Where my ancestors came from it’s hard to say It’s cuz they culture was stripped away But now that culture is hip today

- 77 -

So many family ties on my mama side You get hypnotized But it’s no surprise You can’t generalize Black is vast so it hurts when they try to stigmatize But I got strength in my core so I’m always on the rise I put my culture on the mantle for guests to see It’s a trophy and it’s lowkey the best of me And the rest of me has roots in NYC Don’t need DNA test to see the recipe I know my grandpa from NIG---ERIA Too much ground to cover, it’s an ongoing highway They say “tell me more,” I say “nice to meet ya But now I’m finishin up like the crust of hawaiian pizza” And yes, I was shipwrecked too Sometimes I-I feel like I got left too It was like my life--it was split in two But I made it thru and never let my face get blue And it Feels like a dream but I just made it to 17 Got ice cream cake; chocolate and vanilla cream The people in my life are black, white and in between Yea I got culture in my genes bustin thru the seams My RNA comes from close and faraway Where my ancestors came from it’s hard to say It’s cuz they culture was stripped away But now that culture is hip today But I got love in my heart Even when it’s torn apart I feel like struggle is an art And issa struggle from the start I got gold in my soul I got cotton in my spirit I make diamonds outta coal This my story hope you hear it 78 --- 78

“Resilience” by Nathan Yu

- 79 -

Stand Tall Pauline Voelkel, Grade 10

Stand tall, Shoulders back, Nerves flat, Never fall.

Head high, Speech clear, No fear, Just try.

But it would be nice to sit, To slump, To limp, And fall into despair’s deep pit.

Oh how good it would feel to cry!

And water feelings with my tears Flooding anxiety to wash away the daunting fears.

But the embarrassment of sorrow will force the river dry.

Society says it’s not okay, People say it is, And when I look both ways Shame is the one who wins Yet every time I’m pulled to my feet By determination’s steady arm That restores my heart’s triumphant beat And reassurance that I’ve done no harm.

Next I feel resilience Lay her hand on my back.

In flows back the wisdom of experience That before all this I lacked.

Finally purpose takes my hand To remind me what I’m doing here. Only he will understand Why I need him so near.

The spirits do not shield, stop, or kill The failure powered knife.

They only keep me still So that I may walk through life.

Like a shark if I stop moving Stop trying, stop improving I’ll fall out of the sky And I will surely die.

80 --- 80

- 81 -

Artwork by Steve Johnson

Photo by Markus Winkler

- 82 -

A Resilience Too Foreign to Me and My Country Claire Sun, Grade 12

In 2000, my parents folded their Beijing apartment into neat little piles, tucked their lives into three striped suitcases, hugged closely what couldn’t be taken, then flew to America. Too wise for dreams of a white-picket fence, they dreamed instead of “better.” They dreamed of America.

In 1966, my parents were born into houses without plumbing, without books, without lights in every room. Eggs and meat were delicacies, reserved for birthdays and holidays. Store-bought clothing was a luxury that rarely met their skin. Summers without air conditioning, winters with a wood stove. My mom’s first dogs were killed for their pelts. My dad’s family couldn’t afford dogs. Simply put, they were farmers trapped decades behind their urban counterparts.

In 1996, my sister was born in Beijing, China. She was allergic to every single brand of baby formula except for the expensive, American brand, which happened to cost four times as much. So expensive, in fact, that my mother’s entire monthly salary was set aside for formula.

In 2002 I was born, in Havertown, PA. At this point, my parents had it all. They were poor immigrants, hard to understand, even harder to respect. I’ve many times by now heard the hushed story, told each time with giggles, about how my parents managed to qualify for more food stamps by listing “me” as a member of the household before I was born. I’ve heard every single variation of “they could not understand my accent.” I remember being a fourth grader, waiting by the post office door, keeping guard as my mom collected coupon circulars from the recycling bins.

My parents now live in a yellow house, windows lovingly adorned with green shutters and lace curtains. They have a shed, a garage, a basketball hoop, and a pool in the back. A white picket fence surrounds the property.

- 83 -

Concert Night Dario Arash Bencardino, Grade 12

“

As I continued to the last line, I realized that my hands had never stopped sweating, that I had been depressing the pedal too sharply, and that the left hand— which is supposed to carry the harmony—had overpowered the right.

84- - -84

Photo by Steve Buissinne

There I was, in front of a matte black grand piano, palms sweating, eyes darting sheepishly about the mass of spectators. From the crowd, my father gave me a look of encouragement, and, in a fleeting boost of confidence, I began to play.

Frédéric Chopin’s Nocturne in E-flat major, Opus 9, Number 2, a nigh-omnipresent piece nearly two centuries old, for some reason gave me particular trouble. What others had done effortlessly gave me major difficulty: the burgeoning ornamentation, the graceful rhythmic changes, the decorative trills. A work so intrinsically associated with piano, and yet, despite my halfdecade of experience, just refused to give, to become second nature the way other pieces would. With discipline, I repeated my regimen time and again until I could run the piece through as smoothly as possible, slowly growing accustomed to the idiosyncrasies of Chopin’s compositions.

Now, sitting at the largest piano I had ever laid eyes upon, I placed my shaky hands onto the cool, delicate keys.

I set off to communicate Chopin’s age-old musical message, a task I had been rehearsing for months.

The quiet melodic line resonated from the piano’s sensitive hammers, as I visibly fought to keep the tempo in lockstep, the pedaling leveled, and the dynamics under control.

Before I realized it, I had flipped the page, then again, then a third time.

Although my performance was far

from innovatory, I was elated to show off, practically floating above my seat in a spur of emotions. I reveled in the simple satisfaction of playing atop a stage, in front of a crowd of onlookers, feeling the adrenaline coursing through my body. My delight quickly became a liability: I waited a few seconds before turning the last page in my bout of inattention. My eyes wandered from the sheet to my hands as I played the last triumphant swell. It’s all smooth sailing from here, I thought to myself smugly. My posture relaxed as my right hand faintly began the closing lines.

The first major error: instead of playing the ornamental flutter, my hands haphazardly garbled out a discordant quaver of a measure, instantly changing the mood. Like a bird shot out of air, the descent was sudden and heavy-handed, starkly dissimilar to the gracefulness with which I had practiced only a few hours earlier. The electricity evaporated fully, replaced by crippling anxiety.

As I continued to the last line, I realized that my hands had never stopped sweating, that I had been depressing the pedal too sharply, and that the left hand—which is supposed to carry the harmony— had overpowered the right.

It’s okay, I reminded myself. A strong conclusion can more than make up for this. The ending is fairly easy, after all. The ending cadence tied up an otherwise muddled last stretch, and the last two chords, despite being

- 85 -

overly loud, were a proper send-off.

Instead of fading out the pedal as directed, I abruptly stood up, turned, and bowed. The audience gave their routine, even-handed applause as I speed walked off stage and sat myself next to my dad.

At first glance, the story doesn’t seem like such a big deal. Almost all musicians have botched a performance before, and most don’t go writing essays about it. However, I did glean a great deal from my failure, and not just about my piano regimen. That night, I spent hours deliberating what exactly led to my tripping up, drawing blank after blank. Now, I realize the error was simple: my mindset. Overconfidence and the lack of a focused, targeted approach were the catalysts for my lacking performance. Having practiced so much, I felt as if I had already crushed the performance before laying my fingers on the keys.

Despite being wrought with stage fright, I somehow simultaneously believed that nothing could possibly go wrong.

others while still maintaining my own convictions, remembering that I still have room to grow. Just like in Chopin’s timeless Nocturne, presence of mind and modulation of mood are paramount to success, and, although there is still much to practice, I am more than up for the challenge now.

The experience I gained continues to influence me today. On test days, I’ve learned to keep my headspace balanced, always coming in prepared and confident, but never arrogantly so. Sometimes, it can be a struggle to keep both restless anxiety and overbearing hubris at bay; despite ostensibly being opposites, I often find myself defaulting to one or the other. In discussions with peers, I remain myself open to the ideas of - 86 -

Facing Page: “Flower of Fire” by Liam Gurevitch, Grade 9

- 87 -

Photo by Aaron Ulsh

- 88 -

Healing Dreams

Lucy Zheng, Grade 9

The regrets locking him in Trapping him in the past The burden sitting on his shoulders Too heavy for him to carry Pushing him to the ground His tears rushing down Forming a violent ocean Waves drowning him Swallowing him whole Never ending pain that lingers in his heart A collection of memories with Wounds that can’t be healed The ambition inside him has vanished Into thin air Facing barriers repeatedly And hitting brick walls Again and again With no sunshine in this ceaseless storm Through time He has lost hope in the darkness Hope Has escaped And is nowhere to be found What is resilience?

He has let go of the past Has escaped the regrets that once hunted him down He lifts his burdens to the sky One by one Taking the weights off his shoulders He swam across the sea of salty tears Overcame the powerful waves of dread And gained new experiences along the journey With care, He lets time treat his wounds And at last, Found the light in his life Shining on him and Illuminating a path He found the hope that will guide him Encourage him And give him the strength To live up to his dreams

89 --- 89

Beneath the Skin Olivia Lee, Grade 10

Humans are intriguing. They are brought into a world of unknowns, yet are capable of learning what seems to be an endless amount. People say, “you get wiser as you grow older� through life lessons and experiences, but no one speaks about the inevitable challenges we face. It is true that people indeed lose and fail; however, by overcoming these hardships with resilience, we can achieve our fullest potential.

On February 1st, 2005, a cry emerged from hospital room 238. A beautiful mother had just given birth to a chocolate brown-eyed girl with a soft round belly. The precious baby looked perfect, sounded perfect, even smelled perfect.

After a couple of days had passed, the mom dressed herself in her thick winter jacket and placed the doll-like baby in a swaddle. The young mother could not wait to bring the bundle of joy home. She Photo by Helena Lopes

- 90 - 90- -

left the hospital with a glowing smile because everything was perfect, at least that’s what she thought.

This thought process dominated her mind until she realized why she was chosen to have this life. She began to tell herself that the staring kids were just curious, the scars were her battle wounds, and she was lucky to be alive. She overcame hatred and the terrible thoughts.

The parents stared at the red, inflamed skin—they knew it was eczema. This led the doctor to prescribe a common ointment to soothe her itchy skin, which soon became useless chemicals. Nothing worked. The fragile, thin baby skin ripped and rebuilt constantly. The severe eczema took over all of their lives and as the girl developed, so did the eczema. Her skin had a mind of its own. Some days scratches bled; other days they would be perfectly healed—each day was a mystery.

She had been to hundreds of doctor appointments, countless hospitals, and dealt with an unbearable number of needles. Seeing the young girl with clear skin was a rare sight.

The girl is me, Olivia Lee. After years of different treatments, doctors, needles, and hospital visits, I sit here writing my story with the best skin I’ve had since I was born. I often wonder to myself after all the pain and tears, “Why haven’t I given up?

There is no cure for this condition.

What am I waiting for?” You see, even after all the difficulties and heartbreaking events that take place in life, we continue to long for another day. Our day may not have been perfect, or even close to alright, but we still fight. We recognize the differences between a bad day and a bad life. With my chronic eczema, I have been beaten down, ridiculed, and pushed to my limits, but every time I have gotten back up to live for another sunrise. Through sorrow and pain, we push to become the best version of ourselves, and that, that is resilience.

Eyes followed everywhere the girl and her family went. Other kids stared, criticized, and excluded her.

It was not hard for her to see what was different about her, but it was hard for her to accept that difference.

When she was not smiling or laughing, she was imagining what it would be like to be “normal”—to not feel like she had all the worst kinds of attention (on her). She felt as though everyone avoided her; they were scared to make eye contact. As time went on and she became a teenager, she believed every part of her was ugly. One cut ruined her night. One stare ruined her day. One scar ruined her year.

- 91 -

SALMON DREAMING Catherine Wan, Grade 11

- 92--92 -

The tide washes, neverending, over rocky shores.

The sun rises without fail.

And again and again, the salmon knows to swim against the current of fast flowing streams.

The effort to swim must be maddening, So inconvenient that evolution has happened this way, So senseless that they must struggle, Red scales in blue water.

Or maybe, it is exhilarating, To break from the current, and clear the rapids.

Maybe each failure is a chance to soar through the air again, And see for a moment another shade of blue, That of the sky.

Do salmon carry heavy fear?

Do they know that failure to breach the flow of the stream means death?

Maybe instinct carries them to that final body of water better than any fickle feelings would. Maybe instinct is bred from the fear of the strong.

Maybe instinct whispers keep going with each jump.

There must be something better to reach for, Somewhere over the thrashing white water, against the current.

So perhaps, salmon hope.

Perhaps they know, as they swim with each other, That they must continue if they want to see something great, Something wonderful.

To keep throwing yourself against the current, against gravity, is some feat.

To persist at all is some miracle.

Whatever drives the salmon every year when the days grow short, drives them well.

The salmon keeps on swimming against rushing currents by the grace of its own being, And dreams of calm waters for delicate eggs. And jumps Again And again And again And then once more, one last time.

- 93 -

Artwork by Steve Johnson

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 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 the lessons we have learned from 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.

To contribute to the magazine or join the team, please see our Submissions page on the website.

For inquiries regarding the arts/humanities course offerings at Penn Med, please contact Dr. Amanda Swain via email at ajswain@upenn.edu.

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:

Issue Design & Artwork

Editors in Chief Catherine Yang Diane Rafizadeh Sonia Wang

Cammille Go

Social Media

Publisher

Prateek Sharma Carina Guerra

Editors

Production & Web Development

Andrew Ahn

Jackson Bowers Likhitha Kolla Susannah Colt

Chris Streiffer Angela Chen

- 94 -