having taken an anatomy course
HannahJohnstonisasecondyearmedicalstudent atDukeUniversitySchoolofMedicine
It can feel almost like you’re two people
One with a scalpel, shears, a saw
One in a forest with the ghosts
How could I describe it to you?
The cataleptic rigidity of hands that won’t open even as you cut deep, searching for palmar muscles and tendons
The wet drip of covering a frozen face and watching the beige fabric stain with a mix of ethanol and human juices
The catching of a saw on bone as you break open a ribcage to view the heart
The quiet ripping sound as you peel back skin
I wonder sometimes if they could watch us if they feel connected to us in the same way we are now so deeply connected to them and other times, I wonder if they’re nothing now but then even in that case, I know they were everything to those who knew them
the message
DanielleLevinsonisafourthyearmedical studentinthePrimaryCareLeadershipTrack atDukeUniversitySchoolofMedicine.
Identifying patient data has been changed to preserve anonymity.
An 89-year-old man with congestive heart failure and interstitial lung disease presents to the emergency department with dyspnea and orthopnea. Over the past few months, his tolerance for activity has decreased and he has had increasing trouble breathing at rest. His diet consists mainly of fast food. Exam reveals bibasilar lung crackles and moderate pitting edema in his lower extremities. His son leaves to get a soda, and suddenly I am alone with the patient, trying to work on my auscultation skills. He starts talking, and I have to remove my stethoscope to make out what he’s saying.
“I’ve been trying to cut back on the salty foods.”
“I know it’s hard.” I’m not even halfway through my second year of medical school, and already I’m so exhausted that empathy feels like a show. I replace the stethoscope on his chest, but he starts speaking again.
“I own a fast food joint. It’s just easier for me to eat there, you know? I live right next door. My parents built the restaurant and the house on the same prop erty, way back in the 50s. I was born in that house.”
My posture stiffens. He reminds me of someone. “That’s a long time to stay in one place.”
“I can’t leave. That’s my community. I get a lot of the same customers and they’re like family.”
“It’s nice to have a community.”
“You bet. My children have all moved away, though. It was too stuffy for them, I guess. My son wants me to move down to Durham, but who will keep the restaurant going?”
I want to comfort him in some way, but I can’t think of anything to say. “Well, it’s good you still have some independence,” I say lamely.
“If you lose your independence, what do you have left? The last thing I want to be is a burden.”
In his stern lip and thick glasses, I see the broad strokes of someone who meant very much to me: another man whose independence verged on stubborn ness, who was still driving around his small town at age 90 with his thick, edema ngers on the wheel, complaining about the rise in traf
“Well, thanks for sharing so much with me,” I say. “Can I listen to your heart?”
My grandfather died on November 6, 2021, the day of my grandmother’s fu neral. I was in Durham at the time, preparing for a test on the gastrointestinal
“You don’t have to go to the funeral,” my mom had said. “Nana would’ve un derstood that you needed to study. You visited her before she died. That mattered
I couldn’t decide whether I was grateful or disappointed to have been absent on that day. According to my mom, Poppy had just returned from the service; ed up the stairs into the house where he’d lived with Nana for years, and then he’d gone straight to the bathroom. He was in there for a while, so my aunt knocked, but there was no response. When her husband broke down the door, they found him unconscious on the oor. Paramedics came and pro nounced him dead onsite. Probably a stroke or a heart attack, they said.
Facts pass through you differently when they happen hundreds of miles away. My grandfather’s death is not a memory, but more like something that I read in a book. I know that it happened and that if I go back to New York and knock on the door of my grandparents’ old red house, I will not recognize the person who answers. Still, I can’t seem to get it into my head that he is really gone. It’s as if I’ve mentally paused the world outside of Duke and Durham. I tell myself that once I fnally be able to take a step back and process every thing that happened in the interim.
For now, reality feels like a snow globe of medical education. I’m stuck in a glycerin labyrinth of hospital hallways and study spaces, slowed by the thick liquid of my own expectations and anxiety. Occasionally, I glance down at the plastic snow that has settled to the foor, a mix of memories and unprocessed facts that I dare not disturb, for fear that they will cloud my vision and impede my progress.
JayJiisarecentalumnusofthe HarrowInternationalSchoolinHong Kongandwillpursuestudiesin philosophyattheuniversitylevel.
The world’s evolved shines too bright, a place where lighting into a movie set, an oxymoronically wastes through too hot. And “rain” past a callous thumb escaping “rain” sprays indifferent before Waxing and waning green garden hose. gathers to rise And water puddles, to fall like actual rain. liquid terminator. a colossal like a fountain,
dialysis in the sunlight
KHHolladaygrewupinTennesseeand recievedherBAinEnglishfromthe UniversityofWisconsin.Afiercedevotee ofpoetry,oldmovies,andtheCarolina coast,shelivedinDurham,NC,formany yearsbeforeherdeathin2016.
Sunlight on green leaves in a high wind outside the dialysis window camaraderie inside but not much with me. Wanting to dance in the sunlight and wind but for now I must remain in hemo to live. Time later to dance in the wind and sun between the dappling yellow and green under the Carolina blue sky.
Time to smell the leafy children of earth feel the sun even to sleep in the unit of blood and later.
Time to savor this sensual life and dance dance dance.
Let me stay
Let me stay for a while longer.
SwethaSriramoju'spiecewasillustratedininkandacrylicpaint andconveystheprocessofhealingandasenseofhope.The useofcolorwasemphasizedtocapturecontrast,dimension, anddepth.
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front cover artwork: Contents of a patient’s pocket and other belongings
Medium: Gouache and ink on paper.
JanelRamkalawanisafourth-yearstudentattheDukeUniversity School of Medicine interested in Pediatrics.
When a patient is brought from the trauma bay to surgery, or from the ED to the foor, their belongings often ft easily into a quart-sized plastic bag. Patients bring so few trappings of their life into the hospital, often only the items carried on their body—a refection of the discrepancy between the day they thought was ahead and the one that ultimately unfolded. When I am not well, I especially desire the comforts of home and the comfort of choice. In a chilly room, stripped of nonessentials and lit by fuorescent bulbs, patients have little of either. Refecting on this reminds me to intentionally center on how the patient across from me may be feeling in this environment, where I woke up and prepared to go today, and where they likely did not.
