Fall 2022 VOICES

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voices about us

Voices is a student-run literary magazine of the Duke University School of Medicine.Wepublishvariedformsofcreativeexpressionfromthemedical co ty,andwelcomesubmissionsfrompatients,students,healthcare - provi ployees,families,andfriends.Ourgoalistopublisharangeofuniquevoic thehealthcaresystem.Wehopethatasyoureadthroughthepiecespubl thisissue,youwillbeinspiredtosubmitsomethingaswell.Formoreinfo pleasevisitsites.duke.edu/voices/submissions.Sendallsubmissions voices@duke.edu.

letter from the editors

Inthespiritofsharingourmostauthenticandtransparentselves,w newvoicesfromourcommunity.Somewillsaythatouranxietiesonlyexist minds,andhwhenlifebecomesunmanageablehthatideamayholdpartial inouranxiousexcesses.Atthesametime,manyoftheseworriesareroote reality.Agingravagesthebodywhilestrippingthesupercial;ourbodie alwaysrespectedasourown;proximityinfectsusevenasisolateddist sanityaway;petsreceiverst-classspatreatmentandurgentcare,whi life-savingvaccinesandproceduresremainstenuous.Fromthesereali themindcanexploreinnitepossibilities.

Whilecontemplatingtheseburdens,weencourageyoutobekindtoyours tobepatientwithyourself,tobehonestwithyourselfandaboutyours issue,ourauthorsexaminedifculttruths.Sometimeshinspite - ofgoodi tionshwecauseharm.Sometimeshinspiteofgoodintentionshweareha theendoftheday,wehopethatthegoodwilloutweighthebadandthat attentiontotheimperfectionswillbetherststepinjustice,inbe selves.

Asalways,wethanktheTrentCenterforBioethics,Humanities&Histor Medicinefortheirunwaveringsupportandvalianteffortstosaveou (ltosaveoursoulsmperourownDr.Baker)beforethedailygrindofhospit whetherasapatientorasaproviderhburnsoutthelight.Wehopeyoue issueandinviteyoutosendusyourthoughts,questions,andnewsubmis voices@duke.edu.PleasealsoinquireaboutjoiningtheVOICESeditingt

Yourco-Editors-in-Chief, LindseyChew,DevonDiPalma, EmilyHathewayMarshall,andLindaLi LAYOUTDESIGN{GRAPHICS:

ucL yZheng

table of contents LetterfromtheEditors2 Takotsubo FlorenceNash 4 Inseparable MarieCheng5 iwishiwasamanbutonlyintheway 6 thatamangetstobeaperson HeavenLee Connections MargaretWeber8 Death Shreya Mishra 10 HandStudyMasterCopy Steven Zeng 11 DoctoringinthePublicHospital FrancisA.Neelon 12 TheDecolonizationofGlobalHealth RachelC.Beglin 13

associate editors Kate Daniel MS2 NathanLuzum MS2 Lucy Zheng MS2 David Ryu MS3

MariamArdehali MS3 FedericaMosti GS3 AustinAyer MS4 S.TammyHsu,MD PGY3 SethFlynnMS4 Undergraduate KiraPanzerMS4 NatalieChou

faculty & staff editors | trent center advisors Karen Jooste MD,MPH Sneha Mantri MD, MS BrianQuaranta MD

JeffreyBaker MD,PhD MarjorieMiller MA NikkiVangsnes

takotsubo No,notlikeanelephantonmychest, Itellthem.Itjsadifferentweight pressingmeontotheexaminingtable asweeavesdroponthesturdy slosh-sloshofmyhiddenheart.

Fromonetoten,theyaskme, thenurseswiththeirkind,busyhands daubingcoldgel,fastening asaggingtangleofwires.

Faster,steeper,sweating,panting, Iwalkandwalkforthem.

Fromonetoten,theyaskagain,

as if there were a calculus for measuring theburnfromwildresofnewfear, the heft of longing for return tosomesafeworldthatmaybeneverwas, thestoneofsorrowinabody grownthisoldalone.

Thedoctorsays,lYouknow, therejsareasonwehavewords likeheartacheandbrokenheart.m

FlorenceNashwasaneditorandresearchanalysta DukeUniversityMedicalCenterandledthepoetr workshopforDukejsOsherLifelongLearningInstitu for16years. ‹¢›‹.fi⁄.fi/fl¤¢‹

inseparable

MarieChengisstudyingcomputerscienceand biologyatDukeUniversity,withhopesofpursuinga careerinbioinformatics.

Thispieceretectsonourunderstandingofhumanemoti anditselusiveorigins.Itunderscoresthetuggingbe thephysiologicalandsocialdimensionsofemotion theirinseparablenature.Twosmallwiresattemp blendintotheorganicshapesservetoquestio emergingstridesofbiomimeticshhowdowerecreatewh we cannot understand? (medium:digitalillustratio

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i wish i was a man but only in the way that a man gets to be a person

contentwarning:men,s*xualharassmentandassault,non-consensualactivity,suicidalideat

thedoctorsaskus,lsomepatientsnot have foronemomentcaniescapewomvaginal, anal and oral sex. what about anhood. to be a woman is agony, is dis you?” tress.ontopofcomplexreproductive sy crazyhowidonjtliketothinkabout tems my thatcompletelychangeourbodi sexual encounters much. when i do, i'mminds,andexperiences,thepotential inevitably faced with the reality - harm of coer committedagainstusbythepeopl cionintosexwithmen,relentless - in weexer love is so high that no woman reaches cisingtheirpoweroverme. adulthood unscathed.itjs disgust they heard me say lmaybe next time,m menareallowedtobelikethat. but wondered why i didnjt seem so into theyfeelentitledtobeinsideof you,t it. asking over and over until no was exert no their power. because thatjs bio more.overandoveruntilitwasnjtright? asking penis enters vagina? because t anymore. over and over, my body be - how we make more humans. thatjs the camearagdoll. standardofnormalcy.itseemsthatpeo perceptions of penetrative sex vary only sousebiologyinthedebateoversocie widely.me,i experienced fear of sex be - constructs when women and gender-nonfore really knowing what sex was.before conformingpeoplehavesomethingtosay ever wanting to kiss someone, i knew the amanipulationof biologyagainstwomen cruel reality thrust upon persons toboxed benetmen.lmenarejustlikethat.t into the category woman. donjt walk testosterone inevitably dictates homealone.watchyourbackforstalking uncontrollable urges.m even in kinde strangers.walkfacingtrafctodeter - ten: kid lwhat do you expect when he wants nappers.yet,statisticallyitprobably to play wonjt with the toy you brought for sho even be a stranger who harms you. itjll andtell?hepullsyourhairtoshowhel be someone you know. someone older, you.m more powerfulh in physicality and - matu their shock is a striking contrast: “what? rity. someone they will believe over youjve you. been on your period for three someone, you would never challenge. months straight due to birth contro you can never be too careful.canjt go plications? to youjre having severe cra thatsleepover;theyhaveolderbrothers. that make you puke and disrupt your - da canjt go to that party. canjt live - ly one function? mo well, isnjt that just w ment without fear of death, mutilation, female body does? staceyjs been on her acidattacks,assault,hurt. periodforFIVEmonthsandshejsnot - com plaining, so why are you slacking off? we payyoutostayhomewatchingtv.m ...my body became wonjt comeandgetyourgrandpas,dads, a rag doll. brothers,andboyfriends.theoneswho wonjttakeno,whodemandmynumber, whocanjtacceptrejection,whocanjt saylhaveanicedaymandthengoabout theirs,whoexpecttobesatisedhthe centerofattention.instead,theysho bekneelingatourfeet. ‹¢›‹.fi⁄.fi/fl¤¢‹

itjs fun walking home alone at night. also choose to be just a person or ju when men inevitably cat call, i can man. dohisgenderisnottiedtohis-perso nothing— or i can tell them off and watch hood,but mine is.so yeah,i wish i was a my back all the way home. ijm always man.but only in the way that a man gets looking for witnesses in case of an am- tobeaperson. bush on the way to work, clearing my sometimes, i get all nihilistic thinking throat in case i need to scream, using a abouthowmuchdestructionmencause phantom number so i donjt have to give and the ease of the world they walk strange men the real one but itjll through. still but then, i think about wh ringif hecallsrightaway.iloveworrying men feel safe enough to cry, when they about men i donjt know,about men i do loveinafearlessway,whentheybecome know, and potential threats to - my physi accomplices in breaking this painful cal safety. because somehow, theyjll cle. ask i remember the men in my life. i -re whatiwaswearinganditjllbeallmymember fault. the times he drove a long way why canjt i just exist as a person. men to drop something off. i remember how get to do it all the time, blend into hetheir kissedmeanditfeltjustrightwh humanity. but me? sex appeal > body > heldmetight.irememberwhatitjslik face>servitude>cookingability->mon love him and to be loved by him.when i ey > everything but my personhood.be - remember,icrackasmile. cause ijve been labeled a woman, not but a it doesnjt matter, because bef person. someone to be detowered, toi can even enjoy the moment, itjs d birthbabies,toraisesaidbabies.

- for stroyed oth bythememories. ers,notformyself. every time you did nothing when your Ifyouorsomeoneyouknowhasbeenaffectedbysex ualviolence,itjsnotyourfault.Youarenotalone.He shitty friend said something disgusting to isavailable24/7throughtheNationalSexualAssault a woman, thrust his hips at her, tried torainn.

Hotline: 80-65473, org.Wecanalsoallhelp puthishandsonher.everytimeyou - nev preventsuicide.TheNationalSuicidePreventionLi providesfree 24/7, andcondentialsupportforpeople er asked and just assumed she lwanted indistress, itmandthatlsheseemedintoit.

- myour dis preventionandcrisisresourcesforyou your lovedones:suicidepreventionlife 80-2735, gusting little friends arenjt good people. line.org youjre not a good person if you contin ue being friends with people you know HeavenLee(they/ have committed terrible acts of violence them)isarecent against the women in their lives. graduate at theofUCIrvine veryleaststoplisteningtochrisand brown? currently teaches highschoolEnglish you didnjt give it a second thought as you went on your merry way. but she LanguageArtsin Chicago. thinksaboutitallthetime,she - has noes cape. itjs not some imaginary ghost un derthebedthathurtsus:itjsyou. i just want to exist as a person, but i have been conned to the prison that is awomanjsbody.therearequestions,but i just want it to stop. remember to wear protection,donjtforgettopeerightafter or ijll get a UTI.donjt forget birth control sohecanhititraw.thisisactuallyruining my life and making me want to die, but atleasthejsgettingsomethingoutof it.i justwanttobeapersoninthewayaman can be both person and man, but can ¥¥fl¤¥. , ¢‹‹fi ,

connections

MargaretWeberisathirdyearMD/PhD studentatDukeUniversitySchoolofMedicine.

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Thispiece,titled"Connections"is , aretection aconversationwithapatientabouthisli relationshipswithbothbiologicalandch family,andhisexperiencenavigatingadouble hipreplacement.Theconversationwas intu encedbytheCOVID-19pandemicandthedeep longing for connection that social distancing created.(medium:oilpaintandwireoncanvas)

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Death Takessomuchawayfromyou.

You move on, Lifetakesanewturn.

You look at the sky, Andhe'smissingit: Thebeautifulway Thatthesunshonetoday.

death

Shreya Mishra is a graduate student in the PrattSchoolofEngineering,andaspirest pursueacareerinstrategyconsult

Howhemissedthismorning, Andthemorningsafterthatg That'sallthattheskytellsyou.

Thesmileonyou Remindsyouofyourbetrayal, ForHappinessshouldhavelost Itswaytoyou.

You moved on, Andyet,notquite.

Thewayhecrinkledh Andwroteyoupoems; Hislaughter,hisan Allreducedtoone . w Memory.

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hisnose,

nger,hisdesiresh word, It'sunfair, Thatalifetimeofdreams,pain, Suffering,joy,laughter Arereducedtojustthat, Oneword.

Weweighourgriefs Beforetakingyourname: Whogetstomournyoutoday, Andwhogetstobetherock.

Theballofblameshiftsfocus, Andyet,noclosure.

You go to his room, Yousmellhisfavoritetee.

Youtryhisphone.

Heisjustnotthere.

No,youdon'tmisshim, Becauseyou'llneverstop Steven Zeng is a third year medical student at Duke University Lookingforhim.

SchoolofMedicinewhoisinterestedinplasticsurgery.

hand study master copy

Thispieceischarcoaldrawingthathighlightshandanatomy.

Itisamastercopyfromanunknownartist.

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doctoring in the public hospital EachdayonroundsIseesorry sullen sick-wracked souls founder it seems in seas without fathom, freightedwithcargoIcannotbear.

Theyturntomelikepilotstothelight.

Buttheymisreadthedepths,they donotreckondistancetotheshore.

IrememberthatIrishmonksofold pushedoffinunrudderedleatherboats, impelledagainsttheopenseaintotheHands ofGod.Whatdidtheytakewiththem?

Loaves?Fishes?Somesea-darkwine?

Anoozyskinhullthrustagainstthepressofsea; anoar;ahabit;aheartliftedbypietyor faithorfoolishhope.

Thatnottheirs buttherough-backedseajswillbedone.

Tobeonewiththehunkeringsprayandgale; thecurdedclouds;thehighthinsun; thepetrelsandshearwaters;theravenous clearwaters;theinnertickoffaithandtime.If landcametomeetthem,itwasasbenison, thetriumphoftrustandluck.

Mypatientssettoseaalone;notInoranyone goeswiththem;theycastoffwithoutchartorcompass, believingthatthemountingcloudsmirroronly yesterdayjssquall.

Theboatrisesandtwists.

Waterlapsthegunwales.Isthatablastoflightning?

Ofthunder?Orjustthemountingriotofthewaves?

FANeelon ‹¢›‹.fi⁄.fi/fl¤¢‹

Dr.NeelonretiredfromDukeUniversityin20after40yearsinthe DepartmentofMedicinejsdivisionsofGeneralInternalMedicine andEndocrinology/Metabolism.

the decolonization of global health

1 Theideaofdecolonization , the dif- were the direct result of colonization and cult process of pulling back the curtain white supremacy. The justication t oncolonialparadigms,isgainingtraction Aryan lives could be saved at the cost in the wake of multiple landmark events, non-whitebodiesiscolonization10. fromthetriumphantprotestsatStanding Whatjs more, much of lwesternm Rock to the murder of George Floyd, asmedicineisstolen,appropriated, - uncr well as thanks to the underlying, ongoing ited learnings from other cultures. work of BIPOC folks who constantly - un simultaneously delegitimizing shamanic, dermine colonization. Every inch of witchour doctor, bruja, curandero,- indi mainstream reality, particularlynous in North medicine as lwoo-woo,m lhippie,m 2 America (aka Turtle Island ) is the result etc., western medicine at the same ti of colonization. That may be hard for steals us from these cultures and reb to grasp,as we are the metaphorical their sh sacred, traditional medicine swimming in water without realizing we pills,tablets,andothermedicineso are,in fact,surrounded by water.Butshelves the originated as plant medic way we view education, gender, religion, before we began to articially synthes law and police, resources, nature, - potent chil medicinal molecules that ex dren, elders, family units, food, work, and innature. morehaveallbeentouchedbycoloniza In retection, we know that much tion, the imposition of a particular of set the healthcare of we receive in modern Anglo-Europeanbeliefs. day is, in fact, thanks to colonization and Healthcareisnoexception. lost lives.That is the foundation of Theremaybepushbacktotheidea medicalproceduresandmedicalcare.So that healthcare could possibly - be how icolo do we decolonize hospitals, -medi nized.j Sure, something like art could cine,be treatment, death, and more? colonized because art leaves so muchOne angle to decolonizing medi room for interpretation. But healthcare? cineandglobalhealthistorst-ackn Medicine? In a culture devout to science edgethatthewhitestraightmalebo and its perceived objectivity, healthcare notabaselineforallbodiesglobally couldnjt possibly be the result of idea biases, that testing our medical - hypo trends,andpopularopinion,right? sesonCaucasianmalebodiesmakesth Wrong. ndings applicable to all people- ever First off, much of our iscienticj where is a myth. There is not one ifood knowledge of human anatomy itself is a pyramidj that makes sense for all hum direct result of colonization. Notbodies just the (we love the hierarchical pyr macro-scale colonization of Christopher mid structure in western society, d Columbus landing on Turtle Island,we? but Very feudal/caste when you look at even the micro-scale colonization of so- it closely). Humans co-evolved with the called doctors experimenting on - and ecosystems; ex somehumanbodiesthatcotractingfromnon-whitebodies.Fromthe evolved in herd cultures have a higher 3 infamous iscienticj experiments of the tolerance for lactose, while other societHolocaustonJewishbodiestothe - Tuske ies have a higher tolerance for red me 4 gee Syphilis experiment to the robbedNoteveryonedigestsalcohol,fruit,or 5 cancer cells of Henrietta much Lacks, of whatweconsidermedicalbreakthroughs ¥¥fl¤¥. , ¢‹‹fi ,

carbs the same way.The white suprema - most dogs and cats in the United States cist idea that the white body,particularly go to the doctor for vaccines and checkthewhitemalebody,anditsmedical - nd upsmorethanmostfolksevergoinsome ings can be copy-and-pasted onto -dis developing countries. While part of t tinctbodiesandculturesisinitself is duebased to their medicinal knowledge and in a colonial, white supremacist mindset. accesstoherbalmedicine,theamount We know that female bodies endure - ra money we spend on pet health in North diation completely differently than maleis concerning considering ho America bodies. These are proven facts butmany arepeoplestilllackaccesstomosqu seldom linked to colonization as the rea- nets, clean drinking water, sanitation and sonforthesediscrepancies. hygiene, and consistent nutrients. Wh Additionally,theveryideathat there dog treats now feature turmeric, there are is a sex binary is a western myth, andpeople its dyingofhunger.Thistellsmetha widespread cultural adoption iswe a direct are more in tune with animal health result of colonization. We know, scientif - than the health of our brothers - an ically, that intersex people exist,ters. thatWhile not care of our non-human kin is every human body is birthed into essential the to global harmony, the ide worldwitheitherXXorXYchromosomes. performing life-saving surgery on a pet Westudytheseianomaliesjinhighschool bunny seems like a grossly misplaced biology as problems to be xed, rather use of resources in a globally connec thanthird,fourth,andfthsexes.Wecanjt ed world. Aside from pets, we still se looktonaturetosupportourquasi- that Chris white bodies are less likely to tianbeliefthatthereareonlymale - chemically andfe toxic areas (think: Flint, - Mic malebodies,either.Frogandturtlegan) eggs and that people of color have- high changesexbasedonwatertemperature; er rates of infant mortality. Food des seahorse imalesj incubate and- ibirthj off Islandcorrelatetocommun onTurtle spring;someshchangesexthroughout of color; in fact, the most accurate wa theirlives.Bacteriaandfungiareto sexless. predict how close someone lives t Self-pollinating towers are lbothmcoal male plant is by looking demographical and female. The idea that everything is atskincolor.Preventabledeaths - an eitheraboyorgirldidnotexist-inall cul ventable illness are occurring bec tures everywhere before European - colo there has not been enough emphasis on nization. For example, many indigenous healingblackandbrownbodies. cultures held special reverence for Two And healing those bodies canno Spirit folk, those who were deemedand towill not look identical to healing white carry both the masculine and feminine bodies,ifwehaveevenmasteredthat.

A spirit within them. Many of theseter Two working with the indigenous Oji Spirit people were highly respected ofand theRedLakeNation,itisapparentt held powerful, spiritual, and ceremonial a hospital offering true healing ser rolesintheircommunities. to the Native population should in Then therejs our prioritization of such practices as regular smudging i white bodies over bodies of color in hospitals, prayer, boughs of dried ceda medicine everywhere, both in preventa - and other medicines, access to saunas tivecareandhealthcare.Infact,Ijd argue or sweatlodges,andtranslators - for therejs a prioritization of pet health over we-speakingelders.Teasandother - med bodiesofcolorinmedicine.Afterliving in icines should be in stock, just as as ruralPanamafortwoyears,Irealizedand that morphineareonhand.Hospitalcafe ‹¢›‹.fi⁄.fi/fl¤¢‹

teria food must include Red Lake walleye, balance.Preciousfewofusareable- toex foraged berries, and other local cuisine ercise, eat well, connect with nature, and that their bodies are accustomed feel to and a sense of community.These are the evolved for. There must be an aspect things of that keep us well. As I once rea culturalawareness,notjustagesture in Redthat Lake, lMedicine isnjt healthc doctors and nurses roll their eyes Food at,is but healthcare.Medicineissickcar a genuine, respected, ongoing practice.

Modern medicine should look upstrea For people to heal, they must feel - wel totreatthecauseofsomanyhealth pr come.TheymustfeelliketheCreatorlems can instead of just pulling the bo visitthem. out downstream. What if the most - pow Whatmedicineshouldnotlooklike erful medical innovation we could make for black and brown bodies is voluntour - is to shorten the U.S. workweek? What ism clinics that ship out to Central if the most and healing thing we could do is South America, Africa, and other lThird lobby for better, more culturally-rele Worldm countries. As a Peace Corps - Vol food access? What if we have been go unteer in Panama,I observed that - volun ing about medicine the wrong wayvthe teers were often called into these clinics wholetime?InruralPanama,fewhavelos tobetranslators.WhileIenjoyedmytime theirlivestoCOVID-Perhaps 19. because inthePeaceCorps,wewerenevertrained they spend so much time outdoors wit orpreparedtollthatkindofrole.As birdsong, the breathing clean air, connec doctorsthemselvesdidnjtspeaked the to local their circadian rhythms, pract language, it is hard to imagine they were subsistence agriculture,consuming w fully equipped to greet and treat folks their of forest-gardens provide. What if rural areas. While I respect the idea should of bestudyingthatinsteadofho what they were trying to do, there must drownanentirepopulationinprozac? be increased preparation for trips like Healthcare is not inherently these such that there is local knowledge The idea of healing bodies is beauti beingacknowledged,used,andrespect - and noble. But we must acknowledge ed. Professional translators must that be on like other aspects of our cultu these trips, and thorough research steeped must incolonization,fromthewayw beconductedbeforewhitesaviorsmade touch medical discoveries to the way we down in rural areas with low access and continue to treat human beings, all high poverty rates to pat themselves dependent on on their skin color, weig the back. At least in countries - like ethnicity, Pan gender, etc. Medicine is no ama, there is high respect for authority; one-size-ts-all. The more we acknowl having this cultural knowledge, doctors edge and respect traditional medi may know that their clients are unlikely distinct bodies and stories, disti to question them based solely ongions their andbeliefs,andthevalueand di white coat, and can alter their care to nity of a human life,the more people we leave more space for questions and - can debringtohealing. cliningunwantedcare. s. at the very least stop la Rachel C.Beglin isareturned PeaceCorpsVolunteer Thereisalsoanoteworthyaspect of farmmanager inLongmont,Colorado. preventativemedicineversus-thecapital Toaccess thefootnotesforthisarticle,pleasegoto istic,colonial,parasiticwaythat - our health tinyurl.com/fall22decolonization care system currently seems to work— createtheillnesstoprotoffthecure.Weeat sopoorlyinthiscountry.Welivesooutof ¥¥fl¤¥. , ¢‹‹fi ,

voices join VOICES sites.duke.edu/voices voices@duke.edu

front cover artwork: Anxiety HannaVargaisaPhDcandidateinEnvironmentalEngineeringat DukeUniversity,withapassionforrenewableenergy, sustainability,andproblemsolving.

Millionsofpeoplesufferthedebilitatingeffectsofanxiety-related disorderseveryday.Thispiececommemoratestheimmensepower onejsmindcanhaveovertheirlives,andthebattlingthoughtsthat maypreventtheindividualfromsimpleactssuchasspeakingup. (medium:ink&permanentmarkeronpaper)

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