Black Diamonds 2019

2019

AN ARTS & LITERARY MAGAZINE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE VOLUME 6 | 2019

Cover Image Svalbard, Norway | May 2017 William Zehring, PhD | Professor of Biochemistry, Department of Medical Education

Black Diamonds is an arts and literary magazine of Geisinger Commonwealth School of Medicine. All content is the property of each respective author/artist. No part of this magazine may be reproduced without the permission of the author/artist of each submission.

F

or thousands of people living in northeastern Pennsylvania (NEPA) during the 19th and 20th centuries, coal was precious. It was the black diamond they mined and the substance that supported their

lives. Formed in ancient times under the massive pressure of the sediment above it, coal became the foundation of an entire economy in NEPA. That economy has all but vanished from this part of the country, but today, NEPA is witnessing the formation of a new and valuable resource. Created under the pressure of a great need for future physicians, Geisinger Commonwealth School of Medicine now exists. New students are coming in to NEPA every year to begin the process of being transformed into physicians through the steady, constant pressures of medical school. And like the rich veins of coal that extended through the region, these future physicians are now stretched across counties in northeastern and central Pennsylvania. For many of these students and their teachers, the arts are an important part of life outside of medicine. Our hope is that this journal can serve as a showcase for their expression and be an inspiration to those who read it.

Zachary Wolfe, MD MD Class of 2015

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Geisinger Commonwealth School of Medicine is committed to non-discrimination in all employment and educational opportunities.

table of contents Editor’s Piece Transitions in trust // black diamond trail the view from between the divide arches Life Beyond the diagnosis waterfall nescopeck state park the arrhythmias translucence untitled 1 who is behind the stethoscope?

A day in the life: residency

06 08 10 11 12 13 15 16 19 20 21 22

25 26 27 28 29 30 33 34 35 36 38

untitled 2 Earth, water, air: New Orleans earth, water, air: leesburg earth, water, air: seattle LeaF railway // glimmer of gold essay A Patient in need // empathy untitled 3 prattler making routines meaningful glow

05

Editor’s Piece | OLApeju simoyan, md, mph, bds, faafp Program Director, Geisinger Marworth Addiction Medicine Fellowship | associate professor Art and science inform each other. From the earliest drawings of neurons by Santiago Ramón y Cajal to Rosalind Franklin’s X-ray diffraction images giving us the first glimpse of DNA, creative expression has been an important

As I was preparing to write this piece, I spent some

a straight path. If only we could experience smooth,

time reflecting on the interesting names of two of our

uninterrupted sailing through each phase of life!

student performing arts groups — The Arrhythmias

means of disseminating

and FlatLine. I thought about how these could relate to

scientific knowledge.

the concept of transitions, the theme of this issue of

These pioneering

Black Diamonds. These names reflect the heartbeat,

endeavors deepen our

the essence of human life. Arrhythmias are irregular

knowledge and enhance our lives. We need your support to continue the pursuit of beauty and

rhythms, some of which are “innocent” and transient while others are life-threatening. At the other extreme, a “flatline” is observed on the cardiac monitor when

However, the reality is that life is hardly ever a straight path or a “flatline” from point A to point B. Real life is usually filled with unexpected twists and turns, interruptions to our “regular rhythms,” in essence, “arrhythmias.” Life’s challenges may include the loss of a loved one, academic problems, divorce or having a family member who is addicted to drugs or alcohol, to name a few. While we cannot completely avoid life’s difficul-

truth. Please consider

the heart stops beating. The ideal situation is some-

a charitable gift to fund

where in between — when the heart beats at a normal

the annual publication of

rate and with a regular rhythm. Although the flatline

Black Diamonds.

in this context symbolizes the absence of life, for the

Consider the concept of improvisation as it relates to

purposes of this discussion, let’s assume it represents

music. Improvisation in music allows musicians to

ekg pattern from vecteezy.com

06

Tra n s itions : Improvising through the arrhythmias of life

ties and challenges, we can exert some control over how we respond to them.

deal with the unexpected, to deal with mistakes so that they are

This issue features the three winning essays from the Glimmers of

not recognized as such, and to keep playing. Similarly, our ability to

Gold essay competition which was organized by GCSOM’s chapter of

accept and deal with life’s challenges, adapting to new situations while

the Gold Humanism Honor Society. These heartfelt stories put a hu-

accepting our limitations can be viewed as a form of improvisation.

man face on illness and remind us of the importance of compassion

A jazz musician improvises, playing what hasn’t been rehearsed and

in the delivery of healthcare.

responding to cues in the moment. By learning to adapt to change and prepare for the unexpected, we can “improvise” our way through life’s transitions — the unexpected arrhythmias.

I hope that you will enjoy this is-

As a novice on the saxophone, I have found that this instrument lends

sue of Black

itself very well to improvisation, which is a good thing because learn-

Diamonds

ing to play a new instrument can be stressful! With time and regular

and be

practice, it becomes less stressful and more enjoyable. Ideally, play-

inspired to

ing a musical instrument is one of many activities that can serve to

do what

mitigate the stress we experience in daily life. For many, in addition to

it takes to

hobbies, our faith, family and friends play a significant role in helping

maintain

us maintain balance in our lives.

balance in

In this issue, third-year medical student Amelia Mackarey writes about her experience transitioning to her clerkship years in her essay, Transitions in Trust. Drew Cornwell, DO, a second-year anesthesiology resident, gives us a glimpse into his daily routine as he helps patients to transition between the realms of unconsciousness and wakefulness.

your life, especially during times of transition.

Transitions in trust

the medical student’s journey

Amelia Mackarey MD class of 2020

G

o ahead. Make the first incision.”

My attending offers me the scalpel,

the corners of his eyes crinkling with encouragement.

“Oh, no. I couldn’t,” I sputter and gesture defeat with my hands. “I’m not ready,” I admit.

I am a just a medical student: I have so much more to learn.

But even in my brief exposure to medical education and medicine, I’ve rec-

Waterfall ognized that these fields are built on a Andres Rodriguez foundation of comprehensive underClass of 2021standing, steadfast integrity and, most 08

importantly, profound trust. Throughout the course

is not that placed in you by your peers, preceptors or

of my education, I’ve noticed that this trust has

your patients. Rather, it is the trust that you place in

become more internally focused. During our first two

yourself, something that is personal, yet so power-

years of training, we trust that the material we are

ful. It is the trust that emanates from within you and

being taught is relevant and applicable. We believe

characterizes each interaction and encounter you

that if we devote ourselves to learning countless

have with your patients. It is the trust that inspires

details and endless facts, we will one day be able to

you to provide the best care possible; it is reassuring

treat, to comfort and to serve our patients with poise

to your patients. It is the trust that gives you both the

and grace.

confidence to answer a question and the strength to know when you should be asking one instead. It is

As we transition to our clinical clerkships, the desire

the trust that allows you to scrub in for one opera-

to help our patients is what solidifies the founda-

tion with pride but to step back from another with

tion of trust in our education, our instructors and

humility. In reflecting on my education and each of

ultimately, ourselves. We accept the guidance of-

the transitions and changes throughout, I am grate-

fered by peers, residents and attending physicians

ful for the greatest skillset with which it has befitted

because we have confidence in them. We push

me: the trust it has fostered in me.

ourselves, working long hours in order to glean the most from each experience. We challenge ourselves

I am a medical student: I have learned so much, and

to watch educational videos, read medical literature

I trust in myself to learn so much more.

and spend extra hours rounding, charting, observing and practicing, trusting that these exercises will help

“OK,” I exhale. “Scalpel,” I say, as I accept the instru-

us become better physicians.

ment from my attending’s outstretched hand.

However, the hours of studying and shadowing

“Incision,” I announce. I trust myself as I calmly etch

are not what define us, nor the reason our patients

a small, steady cut in my patient’s reciprocally trust-

have faith in us. Through all my educational experi-

ing flesh.

ences, I have learned that the most important trust

the hours of studying and shadowing are not what define us, nor the reason our patients have faith in us.

Photo:: Black diamond trail William Zehring, PhD 09

My world fell silent.

Staring, wondering what next

the heartbreak I feel with them.

I’m not unaware.

Blank thoughts, words swirling As I say the words, The questions, endless How would I tell my family?

As I shatter their whole world, I listen, quiet.

The answers, hopeless A new grandmother, What this really meant, The doctor knew so little.

A friend, brother, pet owner, You are a human.

What my dreams are, crushed.

I am with you now, Shattered by the words

a partner in this journey.

I try to find the courage

“We will do our best.”

“I will try my best.”

-Anonymous 10

If only they knew,

Arches Alayna Craig-Lucas MD Class of 2021 11

Glimmers of Gold essay contest winner 12

li f e b e yond the diagnosis Kristin Hare MD Class of 2020 I was only 16 years old when my mom was

remember taking her to doctors’ appointments,

diagnosed with multiple sclerosis (MS). At first,

my tiny weightless body pushing her wheelchair

I did not really think much of it, as I knew a lot

in and out of old buildings that were anything but

of people in my community who suffered from

handicap friendly. As we began to realize the se-

this disease. I saw them continue to work, raise

verity of her condition, fear struck my family over

families, enjoy outings and evenings with friends.

both her state of health and our financial strug-

What I did not know was that within a few

gles to support her. I grew more and more angry

months, my entire perception of illness would

over the years as her condition not only weighed

forever be challenged.

heavily on her, but on everyone who loved her too.

I watched as my mom gradually lost control over

I recall taking her to the neurologist one day. The

her body; first her legs became weak and numb,

physician asked all of the typical medical ques-

and then her arms and hands. Within just two

tions related to her condition, but never once

years, she was already bound to a wheelchair. I

asked how she was doing mentally and emo-

tionally. How was she coping with her new state of normal? How was she getting around at home?

How was she handling the transition from being a working woman for 30 years to now being wheelchair bound in her own home? I thought he would want to know these things. At a very young age, my mom’s illness gave me insight into the fact that health goes way beyond the physical. I watched as my mom’s memory started to decline and her muscles began to atrophy and there was no longer any medical solution. Then what? I wanted so desperately for her physicians to ask me how I was doing, or how our family was functioning as a unit. In reality, none of us were doing well. I struggled with this constant guilt of feeling down over my mom’s condition, but being too scared to speak up, since my mother was the one who was actually sick. She struggled over being a burden to all of us.

As I transitioned into my late teen years I began to watch how growing up in turn took a toll on my mom. She was extremely upset about being unable to help me with shopping for college, decorating and moving into my dorm room. She was heartbroken that she couldn’t come visit me at school when I was sick or stressed because she was now dependent on a caretaker and had lost most of her

Waterfall Andres Rodriguez MD Class of 2021 13

health goes way beyond the physical freedom. Again, illness goes beyond the physical, but this is often un-

physician’s office. Her illness had progressed beyond a clinical presen-

recognized in the healthcare setting. I empathize with physicians who

tation; it had become a new way of life.

want to provide the best patient care, as it can be extremely challenging. Working diligently to properly assess and diagnose patients while

If there is one thing that I have learned over the past few years, it is

formulating treatment plans can be a daunting task, especially when

that no one illness is routine. Not every person with the same diagno-

one physician is assigned a dozen or more patients at a time. Howev-

sis presents the same way clinically nor do they respond to treatment

er, in order to provide the best patient care, one must truly understand

the same way. We are taught what different diseases are according

the patient’s concerns beyond the medical diagnosis.

to textbook definitions and clinical presentations. While being able to identify medical conditions is critically important, being able to identify

My mom was diagnosed with severe depression within a year of

how those conditions change patients’ lives is just as important. No

her MS diagnosis. Physicians kept telling us that she was so down

single physician will ever be able to understand all that patients go

because of her disease. It seemed like they could understand why

through, but taking extra time to ask patients and their loved ones

someone with MS would be depressed, but it did not feel like anybody

about their concerns outside of the hospital setting shows that we as

understood that an illness involves so much more than just the course

healthcare professionals care more than just about a patient’s imme-

of the disease. She was not just depressed because she had MS. She

diate medical needs. It is important for physicians to recognize that an

was depressed because she was missing out on shopping for prom

illness is more than just a physical change. It is a change in a person’s

dresses with her daughter and being able to ambulate to volunteer

future plans, family decisions and perception of who they are in life.

in the community and go to work. She was missing out on making family dinners and cooking our favorite family dishes for the holidays.

Her life was missing the moments that one cannot see in a hospital or

14

Nescopeck State Park William Zehring, phD 15

The arrhythmias Elizabeth Zygmunt Director of Media and Public Relations

Most of us would say that inventing meaning while letting loose is the essence and promise of jazz. – Robert Christgau, music journalist

B

eing successful in medical school is difficult and requires great discipline. Most students

find the need to adopt punishing study schedules that offer little respite from the sane, orderly, uncompromising mindset of the sciences. Yet every Sunday afternoon, GCSOM’s fourth-floor student lounge erupts in joyous sound that veers from gospel to blues and everywhere in between in a burst of music that is anything but sane, orderly or uncompromising.

16

Meet “The Arrhythmias,” a jazz group founded

if we were feeling stressed — we didn’t want to

by first-year students Emily Christie and Jessie

put anyone in the position where they felt they

De Angelis, both of whom play alto sax.

had to come. We have enough stress.”

“Jessie and I met during orientation and

Perhaps unsurprisingly, given the emotive and

bonded over the fact that we both play saxo-

freeing form of jazz, the students who gath-

phone,” Emily said. “We talked about how we

ered to “informally jam” found great release

would love to put together a group that would

in the sessions. “In the jazz environment, you

meet and jam informally. When discussing the

create insanity — but it’s beautiful,” said Emily.

group, we agreed that we didn’t have to meet

“Sometimes, especially if it’s a test week, I

17

start out playing timidly, but then, as the practice goes on, I let loose and as the sound comes together, it’s thrilling. We all love our group now. No one misses it.”

Jessie said that, in addition to emotional release, playing jazz indulges the musician’s creative energy — something she feels is crucial for students who hope to become caring and empathetic practitioners. “Jazz allows improvisation,” she said.

“You play what you feel. That taps into your creative side. There’s a lot of teamwork in a jazz band, too. Those things are important in medicine.”

Emily agreed, adding, “Playing jazz is very useful for personal interactions — it opens you up to adversity and struggle, even if it’s only in songs. I think it’s better to be open with people. Drawing from creative processes helps you develop better ways to approach patients.”

18

“Drawing

The Arrhythmias have been playing together for several months and have a vocalist, a keyboard player and a violin, in addition to

from creative

the saxophones. They also have a playlist

processes

and Bess,” to the gospel sound of “Mercy,

helps you

of songs ranging from “Summertime,” the bluesy aria from George Gershwin’s “Porgy Mercy, Mercy.”

Now, Emily and Jessie think it’s time to take their joyful noise on the road. They are currently talking to volunteer groups,

develop

senior centers and nursing homes, where

better ways

might enjoy a break from routine. As Emily

to approach

in any environment.”

patients”

they hope to spread a bit of their group’s “beautiful insanity” to others who could said, “One thing I’ve learned about jazz is that, with it, you can find joy and happiness

Translucence Alayna Craig-Lucas MD Class of 2021 19

untitled 1 Janis Williams staff 20

Asawer Nihal MBS class of 2019

Grab your stethoscope

Ask them to talk slow

Sure enough you solve their medical concern

Press it against their heart

Let them know all your time

And put them at ease

Hear it beat fast

Is theirs

Smile

Take a second and reflect

But not before you realize

Reassure them they are alive

On everything they’ve shared

To them you are thankful

Listen to their lungs

Assure them you will try your best

For confiding in you

You know how the melody goes

Tell them to lay down and rest their head

Gratitude you feel

On the hospital bed

Because you comforted them to heal

Look them in their eyes

The smile you can’t conceal

Ask them how they feel

Examine them the way you’ve been taught

Helps you approach your next patient

Listen to their words

For over six years

With stethoscope in hand.

But don’t forget emotions can also show fear

Be confident in your ability

Assess their body language

And treat them with humility

21

a day in the life

Drew Cornwell, DO second-year Anesthesiology resident

induce emerge repeat 22

Induce, emerge, repeat. Isn’t that the usual

[5:28 AM] Out the door. Apple in hand. I’ll

anesthesiologist’s day? The routine may be

eat more during my AM break. I’ve never

similar day to day, but no anesthetic is the

been able to eat much this early. I love that

same. Each case in the OR has a myriad

my door-to-door walk to the hospital is 12

of variables influenced by a patient’s type

minutes.

of surgery, medical comorbidities and how my attending and I plan to deliver the

[5:45 AM] “Hey man, how was your night?”

anesthesia.

I say to the senior on night float as I walk in the workroom. “AAA rupture, it was wild.”

[5:05 AM] Why is my alarm going so early?

Scrubs are on, stethoscope utility belt is

Where’s my phone? Today is...Monday...no,

on, “Batman?” Head down to OR 17 to start

Tuesday? Shoot, Tuesday. I’m giving the

my room setup.

morning report lecture at 6 AM.

[6:05 AM] Lecture begins. I teach 15 min-

[7:30 AM] Attending has come by and met

properly against the vocal cords to monitor

utes on noninvasive versus invasive blood

the patient. We’re ready to head to the OR.

the recurrent laryngeal nerve. After three

pressure monitoring. Man, I wish I could

Patient is still nervous; 2 mg IV midazolam

months in the OR, intubation has become

throw an arterial line in everyone. The chief

will help. “I call this the ‘I don’t care juice.’”

much easier.

residents fire off some questions and we

She laughs.

wrap up.

[8:08 AM] Tube is taped, the ventilator [7:43 AM] In the room, monitors are set up

switched on, and patient positioned. Sur-

[6:45 AM] Went by pharmacy, picked up

and attached to the patient. My attending

geon asks for a timeout. Incision.

drug bag, drew up my syringes. Fentanyl,

arrives. “How do you want to induce, Drew?”

lidocaine, propofol and rocuronium.

[8:45 AM] Blood pressure has been trend[7:47 AM] Patient is asleep and apneic.

ing down. I started phenylephrine infusion.

[7:05 AM] Seated bedside in pre-op, talking

Turn on the sevoflurane and squeeze the

Should be good rest of the case, but I’ll

to my first patient. A routine physical by

bag a few times. Still strange to think I’m

titrate it as needed.

PCP found a large nodule in the thyroid. A

doing 100% of her ventilation.

biopsy was concerning for cancer. She’s

[9:28 AM] Attending gives me a 15-minute

anxious. I need to remind myself that this is

[7:48 AM] Paralytic pushed: time to intu-

an everyday occurrence for me, but not her.

bate. We use a video laryngoscope since

I have 10 minutes to earn her trust.

the specialized breathing tube needs to seat

break. Where’d my protein bar end up?

[10:40 AM] Pathologist calls with report:

23

benign adenoma. Surgeon says that it’s 10

can get the room turned over and ready.

minutes until closing. Time to get to work to prepare for wake-up.

reading for my cases tomorrow and hopefully get some other general studying. 45-60

[12:32 PM] Second case started smoothly

minutes/day is my goal.

and I’m getting a lunch break from a senior [10:56 AM] Patient is at 0.3 MAC and

resident. I run into my buddy who is a sur-

[9:45 PM] Wife and I relax watching old

breathing spontaneously. I’ll need a smooth

gery resident and we catch up over lunch.

episodes of The Office. I made a s’more for

extubation without coughing. My attending

dessert. Can’t beat that.

has talked me through his method. Smooth

[3:25 PM] Time to get to an afternoon lec-

as silk, out comes the breathing tube. Eyes

ture, third case is just wrapping up, but all

[10:25 PM] I need to go to bed, 7:15 AM

open as I quietly say, “You’re all done.”

has gone well.

case start tomorrow. Five minutes into starting a podcast, I’ve passed out.

[11:01 AM] Recovery room is ready. I get

[4:48 PM] Pharmacology lecture is done.

the patient to shoot me a “thumbs-up” as

I’ll prep my cases for tomorrow and call my

Induce, emerge, repeat. In the book of daily

the ENT resident and I push the bed to

attending during my walk home.

life as an anesthesiology resident these are

recovery.

merely chapter headings as I escort my [5:32 PM] “Daddy!” I might be tired, but

patient into the realm of unconsciousness,

[11:14 AM] Sign-out given. Patient is still

nothing brightens a day like coming home

assume control of their physiology and

groggy but talking to me. I write orders for

to family.

smoothly return them to their original state

post-op pain and nausea management.

24

of awareness. It’s a book that is hard to

Time for the case, a partial parathyroidec-

[7:20 PM] Two kids can be a zoo to get

tomy. I start my stopwatch to see how fast I

to bed. I track down a textbook and start

put down.

Untitled 2 Janis Williams staff 25

Earth, Water, Air: New Orleans Heather M. Davis Director of Marketing and Communications 26

Earth, Water, Air: Leesburg Heather M. Davis Director of Marketing and Communications 27

Earth, Water, Air: seattle Heather M. Davis Director of Marketing and Communications 28

leaf Miriam Eagleson MD Class of 2021 29

Glimmers essay contest winner vanessa thiel MD class of 2020 “What are some symptoms of hyperthyroidism?” The instructor asks. It is now our turn to eagerly recite the facts imprinted in our minds.

“Diaphoresis, tachycardia” Ah, yes. I nod my head, as I recall the feeling of my heart racing, trying to escape the confines of my chest. What is happening? I would wonder. I remember walking across my college campus, making my way from one class to the next; but boy, it felt as if I had just run a marathon. I remember climbing a flight of stairs, feeling astonishingly winded after minimal exertion. Now, I know I’m not the most athletic person in the world, but wow!

Was I out of shape or what?! Even as I sat at my desk five minutes after the start of class, I could not seem to catch my breath! Also, was it hot in

Endrailway of Season Danjustin Sylvestre collins md class staffof 2021 34

here or was it just me? I felt flushed, uncomfortable and slightly concerned at my lack of fitness.

s of Gold “Weight loss, excess hunger”

“Tremors”

it worse, the embarrassment of seeming

Oh yes. I remember that as well. I recall

Oh, the tremors. This was by far one of the

nervous, made me nervous! The shaking

sitting at the library with my close friend,

most concerning things I remember. As I

increased, my confusion and frustration

studying for yet another midterm exam.

sat in my molecular biology lab, I remem-

growing stronger. My embarrassment

We had just eaten dinner not too long ago.

ber grabbing the pipette and attempting

peaked when my lab instructor began to

Two hours, maybe. Yet I could already feel

to transfer my samples. My hand hovered

notice my apparent incompetence. What

the stir of my stomach, the familiar feeling

over the tubes, tightly grasping the pipette,

the heck is wrong with me?!

of hunger I had become accustomed to

attempting to stop the shaking. For some

recently. I pulled out some snacks, acknowl-

reason I could not seem to aim correctly. I

“Exophthalmos”

edging the confused look on my friend’s

used my left hand to steady the right, only

Hearing this symptom, I shift uncomfort-

face. “I don’t know, I’m just so hungry lately!”

slightly improving the process. I looked

ably in my chair. I look around and wonder:

It was almost convenient — I mean, who

sheepishly at my lab partner, embarrassed.

does everyone notice?

doesn’t love food? And happily, I ate away

She chuckled a little, slightly confused as

without gaining a single pound. I even lost a

to why I seemed so nervous. But that’s the

I was diagnosed with Graves’ disease

few pounds, to my own pleasant surprise!

thing — I wasn’t nervous. Or was I? To make

in May 2015. After lab tests, radioactive

31

As medical students, we often rattle off a list of symptom without even considering the consequences to the patient.

32

iodine uptake scans, and antibody testing, I ran home

being the healthy 21-year-old I was prior to this diagno-

to look up the symptoms and complications. Alas,

sis. It was similar to having a cold and a stuffy nose —

everything I felt in the past few months made sense! I

you never really appreciate the feeling of a clear nostril

could breathe a sigh of relief — I finally had an answer!

until you can no longer breathe. Before this experience,

I wasn’t out of shape or nervous in lab. It was all a

I never appreciated being healthy. Now, I had a chronic

product of this disease! I felt vindicated.

condition that required close monitoring and follow-up.

I had to consider treatment options, schedule appoint-

I also remember hearing about protrusion or “bulg-

ments and remember to take my medication twice a

ing” of the eyes. I found pictures online, pictures that

day.

depicted worst case scenarios — severe bulging, with some individuals even requiring surgery. I remember

As medical students, we often rattle off a list of symp-

no longer feeling vindicated. I remember feeling fright-

toms without even considering the consequences to

ened.

the patient. These words are no longer products of thought but rather reflexes: lists now imprinted on our

My thoughts raced. How did my eyes look? Were they

minds after endless hours of study. As we go through

bulging? Would they get worse? Would I need surgery?

these lists, let us remember that these symptoms are

Do I look abnormal? For weeks I would lie in my bed

more than just that; they are experiences, memories,

unable to fall asleep, constantly anxious and worried

emotions felt by the patient. Symptoms are not just

about my eyes and what this disease could potentially

tremors, palpitations or weight loss. They include

do. I also worried about the treatment — possible radia-

confusion, frustration and fear. They are moments in

tion, possible surgery? I worried about the complica-

time that may stick in a person’s mind forever. Simi-

tions — thyroid storm? Arrhythmia?

larly, a disease is more than just a diagnosis — it is an event, and often a realization of one’s own vulnerability.

I felt overwhelmed and frightened. I was in over my

Remembering this can help us to understand, connect

head. The possibilities introduced by this new diagno-

and to truly empathize with our patients.

sis made it feel as if my whole world had been turned upside down. I wanted nothing more but to go back to

Patient presents with chief complaint of…

Help me, I scream Chronic pain?

Something stronger?

Addiction

Chronic pain A little bit longer?

I’m sorry, there is nothing more we can do

Terminal Am I not a healer?

Can you not wave your magic wand and make this disappear?

What is my prognosis?

Statistics How long ’til I heal?

Uncertainty No, No

Can I not wave my magic wand and make this disappear?

What is my prognosis?

Statistics How long ’til I heal?

Uncertainty You see,

You see, The coats we don,

vanessa thiel MD class of 2020

a patient in need

Terminal Illness?

empathy

I come to you for answers

The coat you don, The tools you carry Suggest an answer to my questions A solution to my pain Why do you turn your back?

The tools we carry, We are supposed to be healers We are supposed to have answers Even when there are no solutions, We cannot turn our backs

Treetoes Linda Bradley Guest artist 33

untitled 3 janis williams staff 34

prattler

Eshiemomoh Osilama MBS class of 2019 A holy intention,

just over-zealously,

a whole-hearted attempt.

as my closed eyes blunder

The words and worlds amalgamate

off,

affixed by and to

innocently,

a selfless and divinely trusting

from chasing

egotism.

chasteness to

They fly up from my heart

a dreamy otherworld –

and flitter for a moment on my tongue –

my knees sore and still soaked in

but only syllables slip,

syllables.

well-meaning, yet unrepresentative, only syllables drip

But an air always comes,

from my lips and

atoning

puddle around my knees.

and torrid, to evaporate the puddle

Piffling, prattling,

up, up, and away –

feigning a commitment to piety,

to decode and transpose

a commitment to prayerful sobriety.

each time I fall asleep,

My hands keep crossed intently, devoutly,

each time my spirit is willing,

with my head bowed

and, each time my flesh is weak.

35

Glimmers of Gold essay contest winner 36

Making Routines

Meaningful Esther good MD class of 2020

O

ne of the most profound moments in my clinical

putting on a patient’s socks and shoes is not usually part of a physician’s job description. She could have put on her own socks and shoes, although not without some difficulty. The physician had other patients waiting to be seen and could have hurried out as soon as he had

finished examining her. Was it really fair to make other patients wait while he did something she could have done by herself?

rotations occurred on a busy day in the clinic. My

preceptor had patients scheduled until late in the evening

It seems that there are always other patients waiting. The

and was already behind schedule with his morning pa-

mismatch of supply and demand in healthcare is appar-

tients. We were with an elderly patient who had wounds

ent in most of my rotations. There simply aren’t enough

on her foot and he knelt down in front of her to examine

providers to meet the needs of all the patients who seek

it. He removed her sock and shoe so that he could prop-

their care — at least not in a timely fashion. Physicians

erly assess the wounds’ healing while he asked her about

and other healthcare professionals are faced with the

her pain and the different medications she had tried.

dilemma of whether to provide care to as many patients

Afterward, while holding her foot in his hand, he gently

as possible, but sacrifice the amount of time and level of

pulled the sock back onto her foot and slipped her shoe

attention they can afford to give each patient, or to offer

on over it.

thorough, high-quality care to fewer patients, leaving others without any services at all. The healthcare systems

“Thank you, Doctor!” the patient said, again and again.

they work for often appear to be driven by profit margins

Her face was filled with gratitude and surprise. After all,

rather than by concern for patients.

I don’t believe there is an easy solution to this problem, and

acknowledge a patient’s pain during a procedure or anxiety

I don’t expect the physician shortage in the U.S. and across

over a new diagnosis. During such times, I look around for

the world to be rectified any time soon. There will always be more patients. There will always be more need. Physicians

I think

who work too hard to meet unrealistic demands, either out of a sense of obligation or due to the requirements of the healthcare systems they work for, risk burning out and jeopardizing their own mental and physical health. In this environment where there is always more to do, how can we serve our patients well? How can we see the humanity in patients rather than seeing them as statistics and numbers?

responses that I can emulate: the nurse who reaches out and holds the patient’s hand, or the physician who takes an extra few minutes to explain the next steps to a patient.

of my preceptor, kneeling

And of course, I think of my preceptor, kneeling in front of a patient, putting on her socks and shoes. Could he have put those 60 seconds to better use? The impact that the lost time had on his other patients was likely negligible at best.

But it was incredibly meaningful to that patient. By helping her with such a simple, personal task, he showed her that she was valuable and worthy of his time. He demonstrated that he saw her as a person, beyond the clinical presenta-

In his New York Times article “Doctor Talk to Me,” Anatole Broyard says, “To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life.

I would feel better if I had a doctor who at least perceived this incongruity.”1. Perhaps it is too much to expect physicians to appreciate the full depth of how illness affects each of their patients, but maybe a starting point, as Mr.

in front of a patient, putting on

Broyard suggests, is simply acknowledging this incongruity. We can begin by keeping at the forefront of our minds that our routines are not our patients’ routines. With that in mind, we can push ourselves to offer the extra word of support, helping hand, or listening ear whenever possible. It’s easy for even seasoned healthcare professionals to get so busy with the task at hand that they forget to

tion of the wound he was examining.

I hope to carry that lesson with me throughout my future career as a physician, especially on the days when I am caught up in a crazy schedule, and I am tempted to view my patients as a list of tasks that need to be marked off before I can go home. I want to make those small gestures that acknowledge my patients’ humanity as part of my

her socks

routine so that I never forget that my role as a physician is in service to them.

and shoes 1. Broyard, A. (1990, August 26). “Doctor Talk to Me.” New York Times, p. 1.

Retrieved from http://www.nytimes.com

37

glow dan sylvestre MD class of 2021

Even after so many passes,

Winter chomping at the bit,

The poignance of The Fall still feels novel,

to tug you out-into the abyss,

Like all the moods of Man were held captive in

Like the undertow of Summer’s shoreline lapping,

oaks and maples,

Just as unforgiving,

suspended specks of dust in golden rays,

but without the salt and glow,

Tiny galloping spirits of change,

Spring now seeming but young, naïve,

liberated by brisk breezes,

Gradually...

To sail on yellow wings,

then all at once.

Then orange-red, Then brown,

Gradual indeed,

Then flightless.

But look enough and one soon sees,

Waning warmth, waxing shadow,

A different glow in ice and snow,

Whirls enraptured in remembering,

Friends that warm the darkest months,

Gradually... then all at once.

A deeper whirl, a river flow, Gradually... then all at once.

38

COMMITTEE

Olapeju Simoyan, MD, MPH, BDS, FAAFP Editor in chief Vanessa Thiel Managing Editor Miriam Eagleson Layout Designer Heather M Davis, MFA Production Manager Amelia Mackarey Student Editorial Assistant Alysha Nicholls, MSHE STAFF Editorial Assistant