Spring 2020: The Health Humanities Journal of UNC-CH

The Health Humanities Journal the university of north carolina at chapel hill SPRING 2020 | exploring illness, caregiving, and medicine

MISSION STATEMENT The Health Humanities Journal of UNC-CH aims to inspire and facilitate interdisciplinary thinking and collaborative work while developing and embodying a variety of ideas that explore the interface between arts and healing. This publication allows for dialogue, meaning-making, and multiple representations of the human body, medicine, and illness.

To learn more about the publication or to submit, visit http://hhj.web.unc.edu.

DISCL AIMER The Health Humanities Journal of UNC-CH adheres to legal and ethical guidelines set forth by the academic and health communities. All submitters maintain patient privacy and confidentially according to the Health Insurance Portability and Accountability Act (HIPAA). The University of North Carolina at Chapel Hill and The Health Humanities Journal of UNC-CH do not endorse or sponsor any of the viewpoints presented in this journal. The opinions presented in this journal are those of the corresponding authors.

SPONSORS

The Carolina Parents Council

The Health Humanities Journal of The University of North Carolina at Chapel Hill SPRING 2020

Editorial Team Elizabeth Coletti Editor-in-Chief Majors: Chemistry; English Class of 2021 Maia Sichitiu Design and Layout Editor Major: English Class of 2023 Jillian Nguyen Marketing Director Major: Media and Journalism Class of 2020 Alice Peng Art Director Major: Economics Class of 2021 Malik Tiedt Treasurer Major: Medical Anthropology Class of 2023 Jane F. Thrailkill, Ph.D. Faculty Adviser Co-Director, HHIVE Lab Department of English and Comparative Literature

Shraya Changela Editor Majors: Chemistry; Excercise and Sport Science Class of 2020 Rabab Husain Graduate Editorial Adviser M.A. Candidate in Literature, Medicine, and Culture Jillian Shiba Editor Major: Anthropology Class of 2020 Olivia Delborne Editor Major: Psychology Class of 2022 Anna Covington Editor Major: Neuroscience Class of 2021 Kristina Alton Graduate Editorial Adviser Medical Student

Table of Contents Elizabeth Coletti

Editor’s Note

4

Dr. Jane Thrailkill

Adviser’s Note

6

Katie Danis

Dissecting Your Dad

8

Vennela Avula

a conversation with a farmworker

10

Hazel Milla

Resin

11

Lucas Thornton

Scenes from a County Health Department

12

Grace Sword

I Wish She’d Stop Pacing The Hallway; She Makes Me Anxious

16

Mickey Menzel

Gorgeous

17

Abraham Rudnick, Lara Hazelton

An Annual Creative Writing Competition in Mental Health Humanities for Students in Canada

18

Harika Kottakota

NICU

22

Katherine Collamore

Unidentified

23

Diepreye Amanah

Flatline

27

Rachel Carney

Attempting to Manage Mental Illness

28

Mary Glenn Krause

Cultural Burial as a Human Rights Consideration within the Ebola Response and Beyond

30

Clare Landis

Thank You

34

Katie Regittko

Learning to Forget

36

Ben Ashby

Wrinkles

38

Rachel Carney

Susan Myers, Room 211

40

-Cover art by Alice Peng.-

4

Editor’s Note

Dear Readers, Being a part of the Editorial Staff of The Health Humanities Journal is a fasttrack to getting thrown headlong into discussions of narrative medicine, poetic structure’s relation to message, and more perspectives on hospitals than we sometimes know what to do with. As with past semesters, I have greatly enjoyed the process of creating this edition of the HHJ, but the end of this school year has also seen the relevance and consequence of the journal’s themes demonstrated in an unavoidable way. As I write this, COVID-19 has become a global pandemic, affecting well over a hundred countries and disrupting travel and normal operations even at UNC. Although none of the pieces in this issue of the journal touch on the coronavirus itself, as they were all written much earlier in the semester, we believe they still offer a reflection on the sometimes unsettling shared omnipresence of health.

We are all individual, creative in our own right, and more separate than we often wish to be. But experiencing illness, grappling with our own health, and contending with what it means to live in a body in this ever more connected world reveal a greater universality, which many of these poems and essays tap into. In this issue, we are proud to include the journal’s first international publication, seeing our work in the health humanities reflected in the common themes and topics of a Canadian creative writing competition. Another poem explores the way we talk about health, literally, across a language barrier and cultural divide, questions that are echoed in another essay that explores the implications of global public health on cultural burial practices and demonstrates how health dovetails with religion and governance, inextricable from the daily exercise of our lives.

In these works, a character in a short story on the diagnosis of an STD grapples with responsibility and blame, an undiagnosed disease refuses to release its hold on a frustrated student, and poets desperately attempt metaphors to convey the experience of mental illness or of watching someone else in pain. We cannot escape our own encounters and trials with health. It sways everything from the world at large down to the smallest infant in the NICU. Yet for as many myriad experiences of illness and medicine as we live through, there are just as many ways of expressing them through the humanities: through poetry, through fiction, through personal narrative and research and art, all of which we hope to showcase in this journal.

5 My enduring gratitude goes out to the many people who have helped to make this edition of the Health Humanities Journal a reality. Thank you to Dr. Jane Thrailkill for your support and guidance. Thank you to our generous sponsors who allow us to print copies of the journal to spread conversation in the health humanities across the campus of UNC and beyond. Special thanks goes to Dr. Vincent Kopp for funding the new annual Walker Percy Prize, which each year will be awarded to one of the pieces published in the journal by a UNC student author that best exemplifies the spirit of Walker Percy in its ability to surprise and entertain the reader while offering a new perspective on health experiences. Thank you to the board of judges and to everyone else in the English department who helped on the long road to making this prize a reality.

I must also thank the Editorial Staff for their dedication and investment of hard work and creative talent throughout this year. I have been impressed, proud, and grateful for each of you in turn as we have brought this journal to life. It truly is a monster of Frankenstein’s creation that we must piece together and resurrect each semester, and it’s been a pleasure to undertake that work at your side. Finally and perhaps most importantly, although I don’t like to play favorites, thank you to our authors who have offered up their skillful writing and personal accounts of living and talking through health. Without you, this journal would be empty and we would all be worse off.

The Editorial Staff and I are proud to present the Spring 2020 issue of The Health Humanities Journal of UNC-Chapel Hill. We hope that it can serve as a small sampling of not only the vast, interconnected ways that humanity deals with illness and medical systems, but also how those very experiences are used as inspiration, source material, and catalysts for meaning-making and creativity.

All my best, Elizabeth Coletti Editor-in-Chief

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Adviser’s Note Dear Readers,

Already the beginning of spring break seems a world away, though as I write it’s been a scant two weeks since the last day of real-time, in-person instruction at UNC. Each day’s headlines herald an exponential increase in (known) COVID-19 cases as the virus spreads to new locations. We hear daily about more closed borders, stranded Americans, stock market declines, and shortages of clinical essentials. Writing about life as it changes under plague conditions is like “seizing a spinning top to catch its motion,” to use a phrase from philosopher William James.

Now I am a week into home quarantine. What plunged my family into this strange hiatus felt like an action movie, fast-paced and dramatic.

Spurred by the ease of international travel, my husband and I squeezed a trip to southern Spain into a brief spring break. Two remarkable Saturdays bookended our journey: the first, a languid immersion in the pleasures of southern Spain; the second, a mad dash for the border.

Arriving on Saturday, March 7, we wandered the streets of Seville, marveling at the packed tapas bars, convivial cafes, and pre-Easter church pageants. Liturgical incense mixed with the heady fragrance of orange blossoms; congregants carried a life-sized effigy of Jesus in solemn procession; families ambled with children and babies late into the evening.

Apparently COVID-19 had not tampered with the rich cavalcade of Spanish culture! My literature-professor superego worried: were we in a modern version of Edgar Allan Poe’s “The Masque of the Red Death”? In that story, oblivious revelers party on, while a deadly plague lurks among them.

On Wednesday, March 11, we had a jolt: the U.S. president announced a ban on travelers from Europe, beginning two days hence. The news arrived in the middle of the night. Groggy and disoriented, we searched online for immediate flights home, finding crazy itineraries (four stops! through Dubai!) for a price equal to a year of UNC tuition. Swiftly, we learned U.S. citizens were exempt: we could fly home from Seville as planned.

On Saturday, March 13 the axe fell: the Spanish president declared a state of emergency. All shops, bars, and restaurants had to close, now. People had to stay inside. Dazed by this news, we learned that our flight home was canceled. The borders were closing; Spain was a hot spot. Traffic on the internet made rebooking impossible and the airlines weren’t answering their phones. We were stranded. By then the sun was setting in Seville, and everything was shut down. In the U.S., however, it was early afternoon. My husband called his brother in New York, a wizard at planning travel. Minutes

7 later we were booked on a flight home. The rub: the plane departed from Lisbon. We had to find our own way across the Spanish-Portuguese border.

As night fell we rushed to Plaza de Armas, Seville’s bus station.

Minutes before the kiosk closed we purchased tickets on the midnight bus to Portugal. We joined a couple dozen scared travelers, waiting. Most wore surgical masks—an item absent from the bustling streets and cafés mere hours before. It took six hours to arrive in Lisbon. From there, we caught our flight, landing outside of New York City. (No North Carolina airports could take travelers from Europe.) Afterward, we learned that Spain closed its borders to land travel hours after our departure. In a week, Seville had become a ghost town.

Now, in the bubble of quarantine, our mad dash is already a memory.

We are in the zone of uncanny domesticity. For us time is suspended. Yet the clock ticks ominously as healthcare workers, first responders, grocery staff, and local governments prepare for an exponential increase in people suffering from COVID-19 and the respiratory distress it can bring. The longer our state of uncertainty continues, the more the precarious among us will hurt, from lost income, social isolation, and the myriad sorrows that plague living brings with it.

The health humanities favors the individual story, affirming that biomedicine and science-based healthcare alone cannot speak to the human experience of illness and mortality. Yet, because our human imaginations can flag when faced with the scale and pace of a pandemic, we need to listen to the epidemiologists, computer modelers, and tireless public health experts as they strive to help us comprehend what is to come. The “flattening the curve” graph, with its elegance and clarity, may save thousands of lives.

Handwashing may be the great technology that keeps us safer.

Now more than ever, we also need humanists, poets, and artists to give voice to individual experiences, so that the quiet suffering—as well as moments of courage and beauty—isn’t submerged in the onslaught of cases and mournful statistics. And crucially, we need good government, because without the healthcare system, transportation network, and infrastructure that supports our vast democracy, we would surely be lost.

Please think of this adviser note, written in what may now seem the distant past, as my message in a bottle. The speed of change can be daunting, even paralyzing. I invite you to share your own stories about living in a pandemic, and if you are willing, to send them to the editors of the HHJ. My hope is that you and the wider community continue to expand our understanding and to practice compassion as we all adapt to life now.

Jane F. Thrailkill

8

Dissecting Your Dad Katie Danis

Prologue You don’t know him for the first five years. The kitchen door creaks at 3 a.m., a formaldehyde fog, a shadow. Years later, you’ll swear you heard him humming Backstreet Boys one night. He will deny it.

Chapter 1 You will need: forceps, funhouse mirror At the county fair, you find him in the Hall of Mirrors.

Your green eyes, ski-slope nose, piano hands, all stretched upward like a beanstalk.

You call him the Jolly Green Giant when he wears his lime scrubs.

He laughs and still makes you eat your beans.

Chapter 2 You will need: bonesaw, biology textbooks from 1994 You find him in the margins.

College anatomy textbooks, months-old volumes of The American Journal of Gastroenterology, covered in the same cramped scrawl as the notes in your lunchbox.

You creep downstairs at 2 a.m. and find him combing through patient files in surgical lamplight.

You count twenty streaks of silver hair for twenty years of practice, Twenty years of you stitching him together, Making Frankendad, Saturdays in your car seat wondering about the man clinging to Mom in a parking lot.

This is how you come to know your dad through dissection.

The scalpel becomes an extension of your arm.

You reach for him with knife hands, Cover yourself in papercuts searching for him.

Chapter 3 You will need: scissors, New York Times Sunday paper You carve every conversation, every half-done crossword, every coffee mug

with the handle pointed to the left.

You gather scraps, hoard pieces no patient or pager can take away from you.

You have a 100 in math but still ask him for help with your homework.

9

Chapter 4 You will need: scalpel, surgical tape Are you selfish for wanting a surgeon to heal something as trivial as your loneliness?

Are you naïve to think you need him more than anyone else?

His illegible scrawl is etched into your genes, on your face, in every eyebrow tug and neck jerk.

You stitch together scraps of the man in the mirror, Waiting for a pair of lime green scrubs that you can wrap your arms around like an ace bandage.

Before some hospital comes for another part of him Say, “I’m sorry I need so much of you When you already gave me your eyes Your nose Your hands.

You carve yourself up for public consumption, and I thought I could ration the pieces you gave me, but I am not as selfless as you.

I am not cut out to be a surgeon.”

Epilogue Intestines squirm through your fingers like cold ramen. Fetal pig strapped supine, chest open to the morning fog.

As you pause cutting, passing the scalpel to your lab partner, a familiar scrawl creeps in.

Rhomboid, trapezius, latissimus, names colonize the husk between your latex fingers.

Anatomy flashcards loop like the chorus to a Backstreet Boys song. Or the Green Giant jingle.

As your partner peels back the chest muscles, a familiar scent catches you.

“I’ve always liked the smell of formaldehyde.”

“You would.” He holds the scalpel out to you. “It’s in your blood.”

-Katie Danis is a sophomore from Greensboro, NC, pursuing a major in Global Studies and a minor in Chemistry.-

10

a conversation with a farmworker Vennela Avula

in the waiting room, you sit across from me your weary eyes take in a new environment bright lights shine on your sunburnt skin we speak the language of silent h’s i ask how you like it here you reply demasiado trabajo y muy poca comida, viajamos desde lejos y no hablamos el idioma this hospital, they think we don’t comprehend but it is they who don’t understand every time, they tell us to take the prescription as if it can fix the effects of a decade of working in the fields a lifetime of injustice the doctors say our health is determined i worry for my daughter how do i stop the cycle from continuing how do i protect her from the circumstances of our life -Vennela Avula is a third-year undergraduate student from Raleigh, NC, pursuing a major in Environmental Health in the Gillings School of Global Public Health and a minor in Spanish for the Health Professions.-

Resin

11

Hazel Milla

I wonder how you feel as you lie there, a tumor pressing on your frontal lobe.

I sit beside you with a little jar and resin-wrapped moss inside pain pressing on the inside of my head, held guarded in my cells, captured with now hardened glue: your pain, I like to think, pain I could pick up and roll around in my fingers like moss-fibers, until it disintegrates in the oils of my skin.

I wonder if I could preserve your mind and soul in a jar of resin.

I like to think and wish; I like to revel in this false permanence I’ve created and try to forget the tumor in your head.

I wish I could pull it apart or that I could take it from you and put it in my head so that I could feel your pain, and you wouldn’t have to.

-Hazel Milla is a junior from Chapel Hill, NC, pursuing a major in Neuroscience and a minor in Creative Writing.-

12

Scenes From a County Health Department Lucas Thornton

Scene I: Five-Star Review

This room is designed to torture me. On the wall, there is a chart that

rates every type of contraception on a scale of one to five stars. The coveted five stars of infallible infertility belongs to vasectomies and tube-tying. Two stars, my level, is home to condoms. Admittedly, it’s a step above the one-star pull-out method, but according to this chart, fifteen out of one-hundred women still become pregnant with condoms. On top of possibly having chlamydia, I might be a father. I wonder if chlamydia can transfer from mother to child. If so, poor kid.

Scene II: The Test

The waiting is the worst part. The test isn’t even that bad. It only

hurts for a moment. The doctor, a middle-aged woman, has obviously seen this before, since she was speedy in shoving a dry Q-tip down my urethra.

Somehow my shirt, which I was holding up, found its way into my mouth and

13

between my teeth. I felt a prickling sensation. My eyes wobbled between the gloved hands of the doctor grabbing my penis and the embarrassed nurse holding a clipboard over her mouth as she observed the process.

Scene III: Easy Reading

You know, I didn’t think I had HIV prior to coming here, but after

reading a few pamphlets on it, I think I may be infected. The writers of these pamphlets—they’re very sure of themselves. Sex without a condom, or a “rubber” as the pamphlet parenthesizes, must lead to disease. A lingering cough or a cold you can’t shake are some of the earliest signs of HIV. Get Tested Now! Had I made a mistake by declining the doctor’s suggestion that I get an HIV test? It was free like everything else. All it required was a simple blood test, much easier than a urethral swab. According to the doctor, I would know my fate in forty minutes flat.

Scene IV: Anxiousness

I walk the floor. I pace from one end of the room to the other. I live

in a box. My chest is being overtaken by butterflies and a tight feeling of imminent explosion. Chlamydia or no chlamydia, I will combust when the doctor walks in to announce my fate.

Scene V: Silent Assassin

“I’m not diseased,” I say to myself over and over again.

“But that’s the rub of chlamydia,” I think, “most males don’t

experience any symptoms. Something unseen could’ve been nibbling away at me for weeks.”

14 Scene VI: The Wrath of God

My old Sunday School teacher called AIDS a righteous plague

sent down by God. Chlamydia can’t be too different. Of course, the pain of its yoke isn’t as severe as AIDS, but it still captures the same aspect of retribution: I sinned and disease will punish me. I must pray.

Scene VII: Our Father

“Dear Lord, I’m gonna be honest. I have sinned and I need

forgiveness. Yes, spiritual forgiveness would be nice, but right now in this room, I need physical forgiveness. I need Your healing hand to reach out and wipe away any sickness I may have gotten from my last immoral encounter. If I am not sick, then good. You work in mysterious ways after all. Thank You. In Jesus’ name we pray, amen.”

Scene VIII: Confession

I am a sick man . . . I am a selfish man. I only pray when I’m in

trouble. I do not give thanks unto God; I just beseech Him. I deserve nothing from Him. He should let me suffer. Instead of praying, I will distract myself with Temple Run.

Scene IX: The Big Reveal

“So, you tested positive.”

Silence

“I’ve prescribed you some azithromycin. You’re going to need to take

that for about four days.”

Silence

“Take the pills after meals. You’ll want some food in your stomach

when you take these. This is strong stuff.”

15

Silence

“Now, I’m going to give you some condoms. Use them next time. Do

you know how to use them?”

I did not explode. I am still here.

Scene X: Aftermath

Turns out, there is some pain afterwards. After the test, I mean. I’m

standing over the toilet bowl. I have my pants unbuckled. My head is craned toward the ceiling. Everything goes well until a burning sensation scorches my penis. I look down immediately. No blood, just a smoldering pain within me. I guess this is the consequence of having a dry Q-tip penetrate your urethra. I live in fear of my next pee.

Finale: A Certain Body Part in a Certain Area Due South of My Nose

There’s this Russian short story I like. It’s by a guy named Gogol, and

it’s about a nose. I think it’s supposed to be some sort of social satire, but I don’t really care for that part. I just like it for its absurdity. A man loses his nose, finds his nose walking around, talks to his nose, and the nose returns to its rightful place. You don’t need to know anything about this story, except for the fact that it exists and I’ve been thinking about it lately. I’m thinking about it because I like the idea that the story implies: a human body part can have a separate life from its owner. This is a comforting idea. It relieves you of responsibility for actions supposedly performed by yourself. “My nose did it, it wasn’t me!” Yeah, unfortunately this is fiction, absurdity.

-Lucas Thornton is a sophomore from Teachey, NC, pursuing a major in English.-

16

I Wish She’d Stop Pacing the Hallway; She Makes Me Anxious Grace Sword

Violet shirts clash Against seafoam green pants Against orange socks Stained with spilled (albeit hurled) milk And tears.

I ask myself, “Why can’t I look good while I’m in here?”

In here: Where the TVs are caged And buildings and mountains are drawn, with dull crayons, on paper Stuck on windowless walls that do not let any sun in So the fluorescent lights will have to do.

I could ask for another blanket, but I decided it was better to feel cold then nothing at all.

-Grace Sword is a sophomore from Marion, NC, pursuing majors in Dramatic Arts and English and a minor in Anthropology.-

Gorgeous Mickey Menzel the surgeon calls me “gorgeous” as he gleefully beams admiring his recent handiwork that was meant to refurbish, fix the outside of my body, my home. but he wasn’t there at 3 a.m. in the hospital hallway when I was screaming, trying to swallow the pain and my father begged the nurses who walked by with their eyes averted and their ears turned off while I was on the stretcher in the hall, neglected for hours and hours. months later my haunted house body is tied up with a bow; these scars are only visible to a trained or spying eye inside a relentless fire whips around there are no hinges, bolts, screws and the grisly howling picks up especially at night.

I am full of ghastly ghosts and trembling bones which have been ripped off and thrust around the remnants of tissue that once were body parts are strewn on the floor, singed at the edges black and sooty big holes of missing pieces chewed away by myself or silently stolen at the hand of a medical professional; I did not consent for them to take my flesh. the cold cold rain drips from the ceiling of my bones I quake and think of that fire inside me it is merely ebbing, not extinguished and the surgeon says Gorgeous -Mickey Menzel is a graduate student from Ann Arbor, MI, pursuing a master’s in Teaching English to Speakers of Other Languages (TESOL) from Pepperdine University.-

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18

An Annual Creative Writing Competition in Mental Health Humanities for Students in Canada: A Descriptive Report and Thematic Analysis Abraham Rudnick and Lara Hazelton

Abstract: The Department of Psychiatry at Dalhousie University has conducted an annual creative writing competition for undergraduate and postgraduate students among Canadian medical schools since 2010.

This report briefly describes the process and thematically analyzes some output of this competition during its first decade. Both undergraduate and postgraduate students from most medical schools in Canada have applied and won recognitions for poetry, short fiction, and graphic prose works. The winning pieces commonly incorporated themes of sadness, loneliness, and death. Expansion of such an endeavor to other disciplines and countries may be beneficial.

Introduction

Health humanities, which is interdisciplinary scholarship and

creativity in the humanities and arts as it relates to health, has grown in recent decades, expanding to involve non-medical disciplines as well as lived experiences of people with health challenges and their families.1 At many universities, learners are involved in health humanities initiatives, such as The Health Humanities Journal.2 Another example is the Dalhousie Department of Psychiatry Annual Student Writing Contest (ASWC),3 which is part of this department’s Medical Humanities program that is separate from but complementary to the HEAL program, Dalhousie Medical School’s Medical Humanities program (one of the first in North America).4 This creative writing competition focuses on mental health and related topics, due to the host department’s scope and faculty expertise.5 The establishment of the competition was described previously by Lara Hazelton and Nicholas Delva.6 In this report, we provide a brief overview and a thematic analysis (without quotations, so as not to identify particular authors’ themes) of the

19 competition and its winning entries during the first decade of its existence.

The data analyzed in this report is in the public domain with continued approval of all concerned and involved.

Brief Overview

The writing competition was introduced in the year 2010 and

has continued annually. All undergraduate and postgraduate (residency and fellowship) students at the seventeen medical schools in Canada are invited to submit entries a few months before the deadline, which occurs each spring. The creative work submitted typically consists of poetry, short fiction, graphic prose, and essays. Additionally, confidentiality is required for anyone mentioned in the work, excluding the author. Adjudication has involved semi-structured reviews by faculty psychiatrists who were advised by a creative writing expert. Winning submissions are posted on the host department’s website, and their authors receive formal recognition and $100 CAD.3

In each of the first two years of the competition, only one submission

won first place; since then, one or two undergraduate submissions and one or two postgraduate submissions have won first place each year. In addition, two to three honorable mention submissions were awarded in the first six years. Approximately half of the winning entries in the writing competition were poetry while half appear to be short fiction, although some may in fact be reflective personal essays. A handful of graphic prose works have also won first place. The distribution of poetry and prose was similar across the years and across winning entries.

Thematic Analysis

A thematic analysis of the winning entries identified three themes

that predominate: sadness, isolation, and mortality. These frequently cooccurred in the same work. The theme of sadness and its variants (e.g., depression, desperation, and grief), were the most common among winning

20 entries. The second and third most popular themes found were solitude (e.g., loneliness, social isolation, and withdrawal) and mortality (e.g., suicide, dying, and witnessing death), respectively.

The following themes with negative valence were found at a lower

rate than the aforementioned: losing control, feeling insane, ignoring suffering, and experiencing guilt. Further, there were themes with positive associations (i.e., expressing compassion and appreciating beauty in a painting or colors of nature), but they had low prevalence. Among the evaluated pieces, many authors acknowledged the perspectives of both students and patients, thereby providing an overarching theme of students mirroring patients’ and their families’ experiences.

Discussion

These findings suggest that medical (undergraduate and

postgraduate) students who creatively write effectively about mental health and related matters may be preoccupied with negative experiences and their impact. On the other hand, it could be that these winning submissions were judged as more effective by the faculty adjudicators than submissions involving humor or focusing on more upbeat topics. It is encouraging that the authors were able to empathize with patients and their families. These findings pose educational implications, such as focusing attention towards supporting learners as they process negative or otherwise distressing clinical experiences.

Important limitations of this report are that it addresses only

Canadian medical (undergraduate and postgraduate) students and that its thematic analysis addresses only winning entries of the competition.

Opening up the competition to other disciplines and learners from other countries may be beneficial. There are also opportunities to involve patients in adjudication. In addition, starting in the year 2020, experts in creative writing will adjudicate submissions alongside psychiatrists.

21 Conclusion

The past decade has shown that it is possible to have a sustainable

creative writing competition that offers medical learners a chance to explore themes with depth and complexity. We anticipate future collaborations with other institutions interested in sponsoring related creative writing competitions, as we believe it is a worthwhile endeavor for all involved, enriching psychiatry practice, education, and research with emerging contributions of health humanities.

References 1. Karin Eli and Rosie Kay. Choreographing lived experience: dance, feelings and the storytelling body. Medical Humanities 41, no. 1 (2015): 63–68, http:// dx.doi.org/10.1136/medhum-2014-010602.

2. The Health Humanities Journal of UNC-CH, http://hhj.web.unc.edu/.

3. “Annual Student Writing Competition,” accessed February 2020, https:// medicine.dal.ca/departments/department-sites/psychiatry/education/ medical-humanities/writing-competition.html.

4. Thomas J Murray. Development of a medical humanities program at Dalhousie University Faculty of Medicine, Nova Scotia, Canada, 1992–2003.

Academic Medicine 78, no. 10 (2003): 1020–1030.

5. Abraham Rudnick, ed. Recovery from Mental Illness: Philosophical and Related Perspectives (Oxford: Oxford University Press, 2012).

6. Lara Hazelton and Nicholas Delva. Exploring the Intersection of Mental Health and Humanities: The Dalhousie Psychiatry Student Writing Competition. Academic Psychiatry 40, no. 2 (2016): 337–338.

-Abraham Rudnick, MD, PhD, is a professor and the current Medical Humanities Coordinator in the Department of Psychiatry at Dalhousie University, Canada.-Lara Hazelton, MD, is an associate professor and the founding Medical Humanities Coordinator in the Department of Psychiatry at Dalhousie University, Canada.-

22

NICU Harika Kottakota

There is something sinister about the tubes twisting around you like hibernating serpents Silver fangs propelling clear liquids straight into your chest An unsustainable capillary action A heartbeat that may never be your own My eyes play the most insidious games as they reconnect the electrode patches in every formation Fingers trace the neon green spikes desperate for clues The amniotic fluid has bleached you inside and out But I still imagine the lucifer blue swallowing you whole Your breath barely warm enough to fog the glass between us

-Harika Kottakota is a fourth-year undergraduate student from Burbank, CA, pursuing a major in Biology, minors in Human Rights and Africans Studies, and Interdisciplinary Honors in Science, Technology, and Society at Stanford University.-

Unidentified

23

Katherine Collamore

“I don’t know.”

My heart plummets into my abdomen as I hear these words come

from the lips of yet another physician. As my hope fades into emptiness, I stare despondently at the white tile floor of the neurologist’s exam room.

Another inconclusive test, puzzled doctor, and week wasted. I walked

around school with electrodes glued to my head for no reason. I didn’t shower for seven days, only to discover the limits of deodorant and dry shampoo. I slept completely still so that I did not alter the location of the EEG cables, to learn nothing. Today, just as yesterday, I am the girl who faints.

One, two, three . . . twenty-seven, twenty-eight, twenty-nine. I count

the Q-tips in the cabinets as Dr. Ross offers recommendations for further testing and new specialists. I have lost interest in running more tests. I’m tired of hearing the same bewilderments from professionals who can allegedly help me. Instead, it seems they have no ability or desire to discover what might be causing my unusual symptoms. Every doctor we see gives up after running his or her routine, diagnostic test and failing to find an answer.

He has one hand on my electronic chart and one hand on the door

knob—ready to move on to the next patient. Dr. Ross’s voice is indescribably dry and monotone, and his face is completely unengaged. “Have you ever considered seeing a psychiatrist? Some people faint when they are anxious.”

I try not to roll my eyes and shoot a snarky answer back. He shifts his

glance back and forth between my mother and me. Just like all the physicians we have consulted, he decides that the most plausible answer is to assume it’s all in my head. However, we’ve heard this suggestion countless times before and pursued the theory to no avail.

In an effort to remain civil, my mom responds, “Yes, she sees Dr. Lee

at Georgetown once a week.”

This satisfies him. Believing that he made a meaningful contribution

to my case, he leaves saying, “Oh good! Keep doing that. You don’t need to come back here again. I’ll transfer all your files over to Psychiatry.”

24

After this visit, I never saw nor heard from Dr. Ross again. He

probably believes I was magically cured or I fell off the face of the earth.

Either way, me and my confusing array of symptoms weren’t his problem anymore.

That’s my identity: a problem. Someone who gets in the way, who

disturbs the flow of everyday life—like a person standing still in the middle of a crowded New York City street during rush hour. Everyone shoves her out of the way, groaning at the inconvenience, mumbling insults under their breath.

When my mom and I get into the car to drive back to school, I stare

out the window. The grey clouds looming over the small neurology practice gave me the feeling that medicine was failing me. As rain drops begin falling on the windshield of my mother’s blue Suburban, my eyes well up. My mom sees the tears and says, “This is good news. Be happy that nothing is seriously wrong with your brain.”

I know I should feel relieved and at peace. But I don’t. I feel a dark

shadow closing in on a deep, hollow hole sitting in my gut. Of course, I’m glad I don’t have a brain tumor or epilepsy or narcolepsy, but I have something—and I want to know what that something is. My symptoms don’t cease simply because I don’t have a diagnosis. I don’t just suddenly stop fainting or miraculously have the energy to get through the day without three naps. I can’t stand up without getting dizzy now or stay up past 9:30 p.m. It’s all still there. It just doesn’t have a name. It’s unidentified. I’m unidentified. The most debilitating part is that you can’t fix something when you don’t know what’s wrong.

I sigh as we pull into the school drop-off lane. “I don’t want to go in.”

I don’t want to faint in the middle of class again and make everyone

stop what they are doing to try to help me. I don’t want to get transported to the nurse’s office via wheelchair for the whole campus to see. I just want to go home and fall asleep. My mom answers, “I know.”

Nevertheless, we both get out of the car and walk toward the front

door to sign in. I grab the rusted metal door handle and lean back with all my

25 weight to open the front door. I used to be a world-class runner, now it takes all my might to open a door. The halls echo with high-pitched voices and laughter coming from the cafeteria.

The bell startles me as it blares through the overhead speakers,

signaling the end of lunch. A stampede of my classmates shove me to the side as they run to class. My friend Emma and I start walking up the four flights of stairs to English after the noise and rush calms down. After just six stairs, my quads burn and my knees buckle beneath me. I try to push forward without drawing any extra attention to myself.

When we reach the end of the first set of stairs, my arms begin

to throb as my lungs expand and push against my ribs to signal they have nothing left to give. I turn to Emma and say, “You go ahead. I’ll be along in a few minutes.”

I don’t want to make her late again because I can’t walk up the stairs

without a break. After she turns the corner of the next stairwell, I walk over to the water fountain for a drink. Once I take a few sips of water, my legs begin to stabilize and my vision becomes clear again. Feeling energized, I climb the remaining stairs to class. I walk in last—the whole class is already there. I sit down, and the bell rings. Ms. Avery pulls out her copy of Anna Karenina and begins a discussion about character development and theme.

One of my classmates comments on Anna’s feelings of isolation

and her search for true happiness. I try to raise my hand to contribute my thoughts, but this sudden, simple movement sends my body into fight or flight mode. I feel tingling in my face and coldness in my ankles while my calves begin turning a dark shade of purple. My breathing quickens, and I can feel my heartbeat in the tips of my fingers, my toes, and my temples.

I turn my head to signal to Emma that something is wrong, but as I do, everything around me becomes blurred and I feel like I’m staring at the world without my glasses on ------

My eyes shake as they open. There is still a dark vignette filling the

corners of my vision.

26

“I am so sorry.”

The apology forms from behind the dryness of my tongue,

immediately, as I surface from what feels like a gentle sleep. My eyes flutter in response to the bright light. I cannot remember the exact moment before my body slid to the ground, but I know that I have fainted . . . again. I cannot move. I am completely helpless. The back of my head rests on the floor as I become aware of my surroundings. Just as I start to feel as if I have regained partial consciousness, my eyes roll back and my face droops ------

I open my eyes and see the school nurse leaning over me. All my

classmates and Ms. Avery look on. I notice the blood pressure cuff around my arm and read my heart rate on the screen: 106 beats per minute. I’m tachycardic, as usual. The machine screams and squeezes my arm to the point where my fingers begin swelling. Abruptly, it stops. The blood pressure reader beeps red and green with warning messages. Inconclusive reading.

Unidentified.

Ms. Avery comes forward and asks the nurse, “What do we do?” I hear

the nurse respond, “I don’t know,” right before my vision flutters, my eyes roll back again, and -------

-Katherine Collamore is a sophomore from Chevy Chase, MD, pursuing a major in Psychology and a minor in Health and Society.-

Flatline Diepreye Amanah After his tiny lips and soles turned blue, and his warm cotton breath ran cold, they shut the curtains and bolted the doors as if light would prevent him from appearing when they moaned his name. Then they took down the curtains, tinted the windows, painted the walls orange, repainted them beige, then gray.

They burned his clothes and toys with the furniture, held hands, blamed each other, wore matching black.

They tried to have another baby.

They sold the house and moved away.

Soon they smiled again, then suddenly stopped talking.

The therapist said they would be okay.

He packed his bags and slammed the door.

She shaved her head, tossed her Bible, stared into the dark.

She was found today cold, blue, still, but free.

-Diepreye Amanah is a sophomore from Charlotte, NC, pursuing majors in Nutrition and English and a minor in Chemistry.-

27

28

Attempting to Manage Mental Illness Rachel Carney

1. i don’t want to be sitting in this office that is meant to be comfortable but is clearly still a doctor’s office, surrounded by these pointless knickknacks that are supposed to be calming or interesting or distracting enough to take my mind off of where i really am. i do like this little plushy basketball and so i grab it and spin it over in my hands until i get bored and then grab the neon fidget spinner. it gives my fingers more to do, so i flick it for the next sixty minutes until i get to leave.

2.

The blue pill filled my head with cotton balls, slipped in through the ear canal. White space, thick and full, replaced all the words caught at the back of the tongue, stuck stubborn to tonsils.

Peeled from the palate, a parapet.

Manifest a croak to pass as an answer to a question that can’t seem to bypass the cotton to my brain.

The lady with the glasses in the chair across from me cocks my head with one hand & with the other begins tweezing the cotton out, through my mouth, ears, & nose.

29

White strands multiply on the table in front of me until my head slowly feels less full & the words come back to me.

3.

Wake up, breakfast, brush teeth, get dressed, class, lunch, homework, gym, shower, therapy, dinner, study, blue pill, green & orange pill, white pill, sleep repeat indefinitely.

-Rachel Carney is a junior from Mooresville, NC, pursuing a major in Exercise and Sports Science and a minor in Creative Writing.-

30

Cultural Burial as a Human Rights Consideration Within the Ebola Response and Beyond Mary Glenn Krause

Humans should have the right to practice cultural burial or similar

body deposition (CBOSBD) using mortuary rituals (including last rights, mourning rites, preparation of the body, and final disposition) that are connected to one’s religion, belief system, and/or sociocultural community.

However, there are circumstances where public health responsibilities to the living conflict with certain mortuary practices. When mourners are denied the ability to dispose of their dead in accordance with their mortuary rituals due to public health concerns such as the spread of infectious diseases, it can lead to unintentional psychological and physical health consequences.

The pressing need for a CBOSBD right is best exemplified in the

Ebola virus (Zaire ebolavirus or EVD) epidemic within the Democratic Republic of the Congo (DRC). Transmission of EVD occurs through direct contact with infected bodily fluids or fomites.1 Therefore, the physically intimate funerary or burial practices that more than two hundred cultural groups practice in the DRC put mourners at high risk for infection from the EVD victim’s body. Risky aspects of these traditions include cleaning and decorating the cadaver, transporting the body to the deceased’s home village for internment, and holding large public funerals with the body present.

These customs put not only the next of kin but also the wider community at risk for infection.2 Furthermore, the virus remains viable for up to seven days, and its RNA remains detectable in body fluids for ten weeks.3 This longevity creates a notably extended period for potential infection.

In a national environment already plagued by systematic inequality

and low institutional trust, critical standard containment protocols for EVD increase tensions between affected communities and response workers.4 Only about 7% of the DRC’s population have internet access, making it difficult for many citizens to make informed decisions.5,6 As a result, misinformation

31 can be easily spread through rumors. In past EVD epidemics, these tensions built upon misinformation, and communal distrust of authorities peaked regarding patient burials. Because communities were unable to observe the body after death, claims were made that body parts and tissues were harvested from the dead and used in witchcraft or otherwise trafficked.2,7 Even an in-person demonstration of response workers taking saliva samples for testing from a person who may have died from EVD led to protests that the workers were trying to extract organs from the mouth.7

The use of body bags in patient burials specifically created unease

in the DRC’s EVD response.2 Rumors occurred claiming that the cadavers were stolen and that the opaque body bags used to quarantine the body were filled with rubble to deceive the community.8 Some people voiced religious concerns about the body bag’s inability to rot, which in turn would prevent the deceased’s spirit from ascending into the afterlife.9 These types of rumors led to reports of stolen bodies and coffins from treatment centers and gravesites for secret burials.10 In order to prevent further infection and mistrust, the International Coalition of the Red Cross (ICRC), the Red Cross Movement, and the British government switched from opaque body bags to transparent body bags in order to allow families and communities to confirm their loved ones’ identity and observe the condition of the body.10

Academics, public health officials, governments, and emergency

health responders are beginning to recognize the widespread need for a safe compromise between standard containment protocol and CBOSBD within the EVD response. Dialogue with community leaders has increased. Families are now permitted to don personal protective equipment and participate in the preparation and burial of the body.11 The ICRC and UNICEF-affiliated Social Science in Humanitarian Action program both seek continual feedback from these communities.11 ICRC volunteers routinely go door-to-door to collect comments and concerns about safe and dignified patient burial protocol as well as other EVD-related response efforts, and they publish their findings in routine reports.9,12

32

However, the conversations and subsequent actions need to go

beyond the EVD response within at-risk countries. Respectful, sensitive, and educational dialogue on death and mortuary ritual needs to be mandatory for all healthcare professionals in all countries. We need to set up protocols that allow for sensitive mortuary rituals that also prevent infectious disease transmission. These conversations need to involve the recognized nextof-kin in order to curb the negative psychosocial impact that can occur when mortuary rituals are not conducted. By recognizing CBOSBD as a fundamental human right, conversations about death can be brought to greater attention within the international organizations responsible for protecting human rights and global health.

References 1. Suresh Rewar and Dashrath Mirdha. Transmission of Ebola Virus Disease: An Overview. Annals of Global Health 80, no. 6 (2014): 444–451, http://doi. org/10.1016/j.aogh.2015.02.005.

2. Juliet Bedford. Key considerations: burial, funeral and mourning practices in Équateur Province, DRC. Social Science in Humanitarian Action, June 5, 2018, https:// reliefweb.int/sites/reliefweb.int/files/resources/SSHAP_burial_funeral_and_ mourning_practices.pdf.

3. Joseph Prescott, Trenton Bushmaker, Robert Fischer, Kerri Miazgowicz, Seth Judson, Vincent J Munster. Postmortem Stability of Ebola Virus. Dispatch 21, no. 5 (May 2015), https://doi.org/10.3201/eid2105.150041.

4. Patrick Vinck, Phuong N Pham, Kenedy K Bindu, Juliet Bedford, Eric J Nilles.

Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. The Lancet 19, no. 11 (2019): 529–536, https://doi.org/10.1016/S1473-3099(19)30063-5.

5. Sally Hayden. “How Misinformation Is Making It Almost Impossible to Contain the Ebola Outbreak in DRC,” Time, June 20, 2019, https://time.com/5609718/rumorsspread-ebola-drc/.

33 6. Laura Spinney. “Fighting Ebola is hard. In Congo, fake news makes it harder,” Science, January 14, 2019, https://www.sciencemag.org/news/2019/01/fightingebola-hard-congo-fake-news-makes-it-harder.

7. Laura A Bagnetto. “Stealing tongues: miscommunication in the time of Ebola in DR Congo,” Radio France Internationale, April 11, 2019, http://www.rfi.fr/en/ africa/20191031-stealing-tongues-miscommunication-time-ebola-dr-congo-drc-northkivu-kinande.

8. Alex Carle. “‘Ebola is fake’: how do you fight a disease people don’t believe in?” Thomson Reuters Foundation News, June 21, 2019, https://news.trust.org/ item/20190620142457-zkby8/.

9. Kevin Bardosh, Ingrid Gercama, Juliet Bedford. Social Science and Behavioural Data Compilation, DRC Ebola Outbreak, November 2018–February 2019. Social Science in Humanitarian Action, March 5, 2019, https://reliefweb.int/sites/reliefweb. int/files/resources/SSHAP_burial_funeral_and_mourning_practices.pdf.

10. James Landale. “Ebola in DR Congo: The body bag that saves lives,” BBC, July 9, 2019, https://www.bbc.com/news/av/world-africa-48915618/ebola-in-dr-congothe-body-bag-that-saves-lives.

11. “Ebola: 1 Year On, Virus Continues to Rage in DR Congo,” American Red Cross, July 13, 2019, https://www.redcross.org/about-us/news-and-events/news/2019/Ebola1-Year-On-Virus-Continues-to-Rage-in-DR-Congo.html.

12. Anna Teehan. “Inside the response to provide safe and dignified burials in the face of epidemics,” Canadian Red Cross, March 20, 2019, https://www.redcross.ca/ blog/2019/3/inside-the-response-to-provide-safe-and-dignified-burials-in-the-faceof-epidemics.

-Mary Glenn Krause is a senior from Raleigh, NC, pursuing majors in Anthropology and Archaeology and a minor in Public Policy.-

34

Thank You Clare Landis

It was nighttime, but there were so many fluorescent lights on in

the hospital room that it felt like it was noon. Amidst all the chaos, I stared blankly ahead at a whiteboard.

“Clare,” she said for the second time. My eyes traced the letters in

faded blue marker spelling out “fall risk.” I hugged my knees to my chest.

“Honey,” she pleaded, “you have to drink this.” I closed my eyes and

shook my head.

“I don’t let my patient’s blood sugar get this low. Your organs are

going to fail.”

I shook my head again as tears started to form.

“Come on, you can do this. You have to do this, you don’t have a

choice here.” She tried handing me the juice again. I took it this time, drank it all in one big sip and started to cry.

“You did good. You’re okay.” I turned away and buried my head in the

thin hospital pillow.

The next day, they put a tube in my nose that followed down to my

stomach. It felt as if they had prodded a giant knife into my sinuses and throat. Because it kept sliding out of my nostril, I had to jab this dagger deeper and deeper into my body. The nurse who gave me the juice the night before saw how much it hurt me and carefully taped the tube to my face so that it wouldn’t move. “When you’ve been a nurse as long as I have, you learn how to do these things.” She winked at me. “You call me if there’s anything else you need. I’m here all night.”

I was excited to see her the following night when I was more stable—

we were able to talk a little bit about life. She showed me pictures of her granddaughter, and we laughed. I gave her a long hug when I left a week later. She told me that she was so proud of me and that I had to keep fighting because I could win.

Although that nurse only knew me for one week, she had cared about

me so deeply. I had been battling anorexia for almost half of my life, and she

35 became my ally at the time when it got the closest to winning. She was the person who helped me survive.

Today, it has been over a year since I met her, yet I see her

everywhere, and every time I want to say thank you. I see her in my friends staying up late studying to be pharmacists and PAs. I see her in my boyfriend working hard to fulfill his pre-med requirements. I see her whenever I walk past someone crying in the library over a failed organic chemistry exam, and I see her in my dad when he comes home from a long day of seeing patients.

I know that a career in medicine is demanding, hard, exhausting

work, and I know patients are difficult because I have been an exceedingly difficult patient myself. But what I really want to say is thank you. These current and future healthcare providers serve a greater purpose than they know. They save people who need encouragement, those who need a helping hand or just a sugary cup of medicine—they save me.

-Clare Landis is a sophomore from Charlotte, NC, pursuing a major in Business and a minor in Cognitive Science.-

36

Learning to Forget Katie Regittko How do I learn how to forget The past ten years of my life?

10.

I see trauma and fear Not playgrounds and friends Hands around my neck Instead of linked arms and four square.

11.

I see calorie charts and Scrapbooks full of emaciated girls Not middle school and newfound hobbies.

Who needs a hobby when you’re Flying so close to the sun?

Icarus did too.

12.

I see hours spent in the bathroom and Dictionaries full of excuses Not school dances and field trips.

I spent my first kisses With death, Not people.

13, 14, 15, 16, 17.

I can hardly remember my high school classes, But I can tell you how long you can spend In the bathroom after lunch before Your teachers get mad.

Instead of attending homecoming, I’m coming home to run three miles Or binge and purge Or stare at the ceiling while my stomach growls.

18, 19.

I see treatment centers and Ensures Not sororities and college basketball.

My heart beats out of my chest because of malnourishment,

Not because of watching scary movies with friends.

Running on more coffees than hours of sleep On more laxatives than assignments piling up I know every bathroom on campus like the back of my hand But I haven’t made a single friend.

37

Now I’m left with nothing but Bad habits, Regret.

Because instead of learning How to play guitar, I learned how to hide how little I ate.

Instead of learning to speak Spanish or French, I learned the language of doctor’s offices And the DSM-V.

And even when I want to, I can’t seem to unlearn these lessons.

Yesterday I ate a snack with a friend and Had to go to the bathroom.

I found myself hunched over The toilet, seat up, Because I was full.

Sometimes I have to will myself to swallow.

More often, I have to will myself To get the food in my mouth In the first place.

I’m teaching myself, like an infant I am teaching my body to need I am teaching my brain to want I am teaching my heart to forgive I spent the last ten years teaching myself How to exist on nothing.

I am teaching myself now to forget.

-Katie Regittko is a sophomore from Garner, NC, pursuing majors in Sociology and Psychology.-

38

Wrinkles Ben Ashby

For a bit over a year now, I’ve had the privilege of being in love.

It’s ridiculous to say, but every moment of every day is made more colorful because she’s in my life, though we spend most of those moments apart. I can’t stop dreaming about the future, wondering what it might be like to spend bits of every day with her, full of long walks and babies falling out of clouds. In one of those moments, I wrote Timber a poem: I think I’d like to see your wrinkles To watch crinkles at the corner of your eye become folds in the sun celebrating the giant forehead creases you’ll get from laughing too much.

To grow old and crooked together pretending to be grumpy when our grandkids aren’t around knowing you so closely that I discover your wrinkles before anyone else.

I think your wrinkles will be beautiful.

This was what I envisioned love to be like; two people becoming entirely familiar with each other, with beauty and quirks giving way to poor eyesight and early dinners over the course of decades. It’s a touching description of love, but through my time in the hospital, I’m realizing it may not paint the full picture. Here’s a bit of what I mean:

I met Adonis in the pediatric ICU. He was diagnosed with neuroblastoma at three months. His parents hadn’t finished decorating his room in their new rental home before he was whisked back to the hospital, maybe to never come home again. They prayed that his cancer, a type known for granting miracles, would wish itself away, but there was a fear that it would kill him.

I met Mary, a 40-year-old woman with metastatic cervical cancer.

She’d gotten married the year before, two years after her diagnosis. She and her husband knew full well at the wedding that she was going to die. Their marriage revolved around her day-by-day decline in health. She’d been so sick for the last three months that they’d not even gotten to share a kiss.

I met Josh, a man who has had fifteen abdominal surgeries since 2000. He lived with a bladder bag and a bowel bag. He was morbidly obese, his hair was greasy and thin, and he was too tired to speak in full sentences.

He fell in love in 1995: five good years, followed by nineteen where his wife

39 drained his urine three times a day, paying fractions of their bills with his disability stipend. Her dancing partner is gone. She doesn’t travel anymore.

They haven’t got any kids.

I met Alfonzo, a man who would lose his right arm. He was married in 1999. In 2002, his wife had a cerebral aneurysm rupture. She has no shortterm memory, so she asks him the same questions every day. She needs help using the restroom and dressing herself. He fell in love with her for her cooking. He had left his job to care for her and wondered what would happen now, without two good hands.

Love can be a promise to celebrate each other, enjoying life in the company of someone you care about. Sometimes you do get to grow old with the people you love, but it is rarely like you imagined. Love comes with a cost.

The hospital is a place where many discover this cost for the first time. The introduction of unexpected suffering can be debilitating for the patient and their loved ones. As I watched dozens of families come to grips with new and disappointing realities, I felt some of this fear well up in myself. Love can be a commitment to suffer someone else’s death before your own. How could I keep a promise like that?

It was in my second interaction with Alfonzo that I found an answer.

I visited him after his fasciotomy, before they were forced to amputate his hand. He was recovering well, anxious to return home to his wife. I reassured him that his wife was safe in the care of home health nurses. Tentatively, as if asking for a friend, I then mentioned the caregiver’s burden and asked where he found hope. Alfonzo pursed his lips, eyes following the lines in the ceiling tile, and said, “I can’t imagine doing anything else.”

It seemed I had been asking myself the wrong question. Caring for a loved one as they face unexpected, life-limiting illness may be a great burden, but it would be a much greater burden to leave them alone. Say I were to run from this second-hand suffering: Who would fill my place? Could I move on, knowing that the woman, or the parent, or the child I loved might be alone?

This was a much easier question to answer.

When her wrinkles come early, I can’t imagine being anywhere but by her side.

-Ben Ashby is a fourth-year medical student at the UNC School of Medicine from Omaha, NE.-

40

Susan Myers, Room 211 Rachel Carney

She placed her hands on my face and stroked my skin like I was a porcelain doll. Her hands moved to my hair, running each strand through her crooked fingers like she was spinning thread.

So beautiful.

Her eyes were sunken deep into her skull, clouds floated in front of her blue irises. I could tell they had once been stunning like a clear river or the sky in February. They darted from my chin, to my cheeks, then to my nose, and finally rested on my eyes.

Don’t let me die. I’m so talented. I paint landscapes.

Thin lips were agape as she waited for words to emerge from mine. Her hands were grasped around my wrists like she was trying to drink in my own youth, as if it was something I could give away.

My family loves me. They’re coming to see me next week.

Her hands shook violently and her skin sagged from her bones. Deep wrinkles etched into every part of her body. Some invisible force that had once held her together was now gone, and she was unraveling.

Don’t let me die.

All I could muster was that I wouldn’t, as if God himself afforded me the authority to do so.

She was carried out in a body bag three days later.

-Rachel Carney is a junior from Mooresville, NC, pursuing a major in Exercise and Sports Science and a minor in Creative Writing.-