Celebrating Humanities & Arts (ChArt) Journal

Celebrating the Humanities & Arts (ChArt)

The Journal of the Phoenix Biomedical Campus

ChArt (Celebrating the Humanities & Arts) The Journal of the Phoenix Biomedical Campus

ChArt (Celebrating Humanities & Art) The Humanities Journal of the Phoenix Biomedical Campus Volume 6 ŠCopyright, All Rights Reserved

Celebrating Humanities & Art is an interprofessional, peer-reviewed/juried journal devoted to sharing the insights and experiences of the Phoenix biomedical community (students, staff, faculty and patients) through original works of personal expression, including original art, essays, motion media, photography, poetry and prose.

The journal is supported by: The Program for Narrative Medicine, Department of Bioethics and Medical Humanism The University of Arizona College of Medicine-Phoenix 435 N 5 St. Phoenix, Arizona 85004 th

Contact: PBC-Journal@email.arizona.edu Website: phxbiomedhumanities.wordpress.com Available for purchase: Amazon.com

CONTENTS 1.

Forward, Jen Hartmark-Hill

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2. Occiput and C Spine , Megan Cadigan

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3. Hope, Dr. Lisa Shah-Patel

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4. Connected Hearts, Merrion Dawson

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5. Letter to my Mother, Meher Rakkar

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6. And Then There Were Two…, Thomas L. Kelly

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7. Through My Eyes, Gary Stanzak

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8. Her Shades and Mine, Dr. May Mohty

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9. Mrs., Elizabeth Borden

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10. Poetic Remembrance, Mohammad Khan

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11. Study of Feet for ‘Donor’, Dara Farhadi

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12. You, Sokena Zaidi

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13. Circles of Life, Dr. Cheryl O’Malley

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14. To Touch or Not To Touch, Dr. Robert E. Kravets

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15. Time is what time is, David Beyda

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16. Lofoten, Amanda Hendricks

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17. Symphony of Medicine, Melissa Gordon

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18. “Core Clerkships”, Madalyn Nelson

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19. transgenesis, mary catherine lockmiller

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20. Ebb and Flow, Dr. Steve Lieberman

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21. The Test, Charles Smith

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22. Old Man Storr, Amanda Hendricks

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23. NUMBERS…How do they define us?, Dr. Lisa Shah-Patel

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24. Deck of Cards, Dr. Lisa Shah-Patel

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25. a blue rose burns, mary catherine lockmiller

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26. fourteen ways of looking in a mirror, mary catherine lockmiller

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27. The ceiling of the basement, Dr. Steve Lieberman

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28. Untitled, Lorrie Pena

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29. “Tsé Biiʼ Ndzisgaii”, Bibi Eghtedari

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30. Work in Progress, Tanner Ellsworth

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31. Saying Hello, Dr. Lisa Yanez-Fox

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32. Winner of First –Year Medical Student Reflective Writing Essay,

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Jenna Koblinski 33. Bubbles, Dr. Steve Lieberman

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34. Index

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Dear Phoenix Biomedical Community, Greetings! We are pleased to present our sixth annual humanities and arts journal. Our mission is to celebrate the diversity of perspectives, ideas and experiences of our campus with you and present both the familiar and extraordinary moments in human experiences. Representative pieces are drawn from the genres of prose, poetry, photography, painting and motion media. They showcase the many creative and artistic talents of our community.

This print edition is a selection of editor favorites, carefully woven together for your enjoyment. We hope that you feel inspired by the unique perspectives of the authors and artists presented. May these works lead you to a renewed level of commitment to self-expression and artistic exploration, and may your own endeavors create harmony, balance and joy in your life.

On behalf of the editorial board – enjoy!

Jennifer R. Hartmark-Hill, MD, FAAFP Editor-in-Chief Student Editors Tanner Ellsworth Dara Farhadi Sara Pousti Meher Rakkar Aishan Shi Resident Editor Herbert Rosenbaum

Faculty/Staff Editors Jennifer Hartmark-Hill Tom Kelly Catherine Lockmiller Tabitha Mosier Adolpho Navarro Kristen Wagner

Corazón Del Desierto Amber Perry 2012 Special Acknowledgements Dr. Jacqueline Chadwick – With appreciation for support for the founding of this journal Dr. David Beyda, Department of Bioethics & Medical Humanism Chair — With appreciation for ongoing support, and providing our publication a home Megan Cadigan– Cover Art Denise Moynihan & Rita Ellsworth –Print Collaboration Dr. Paul Blackburn– Keynote speaker - 2019 celebration gallery event

Title: Occiput and C Spine (7x7 in print, colored pencil on colored paper ) The cervical spine represents a location of vulnerability in the human body. Important arteries, veins, and nerves run through delicate canals while vertebrae smaller than your wrist support the all-important area of higher functioning: the brain. While learning about this part of anatomy, I couldn’t help but remember our patient panel with those affected by a spinal cord injury and how this anatomy would one day help someone whose life changed in a traumatic instant. I am grateful the donors allowed us to explore and learn in such a vulnerable state just as I am grateful that I was able to see, firsthand, one of the most vulnerable parts of our own bodies alongside the impact on life when its function is altered.

_______________________________________________ MEGAN CADIGAN is a first year medical student at the University of Arizona College of Medicine - Phoenix. She was born and raised in Albuquerque, New Mexico and graduated from Arizona State University with a degree in Neurobiology and a minor in Studio Art. Her combined interest in medicine and the arts has been and continues to be one of her passions. On Saturdays, she can usually be found at the Phoenix Art Museum admiring James Turrell’s installations and intermittently worrying if her cat, Olive, is tearing up the couch while she’s out.

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Title: Hope This poem was written by my mother-in-law, Minaxi Patel, as she was going through chemotherapy for ovarian cancer. Mom fought a long and hard battle over the last two years, took every challenge and every bump one day at a time, but succumbed to this disease on 12/7/18. Having published several books in her native language, mom’s poetry always expressed her values and love of life. This photograph was taken by my husband, Dr. Rutvik Patel, during mom’s last month and represents the love and emotion she showed. In the end, she left her four beautiful grandchildren (youngest granddaughter, Neela, pictured here) with wonderful memories and the strength and passion to make each day amazing. _______________________________

DR. LISA SHAH-PATEL is the Director of Career and Professional Advising for the University of Arizona College of Medicine-Phoenix. She works as an independent contractor reading screening and diagnostic mammograms, and performs ultrasound-guided procedures and stereotacticguided biopsies. She completed a seven-year combined Biomedical Sciences/Doctor of Medicine program at the UCLA School of Medicine where she received her MD degree and completed her fellowship in Breast Imaging at the Mayo Clinic in Arizona. In her free time, she enjoys spending time with her family, going to the beach, skiing, and traveling.

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Hope By: Minaxi Patel 8/13/2018

My friends at the infusion center Happy to see you Happy to meet you Happy to wish you Laughing and giggling Talking and sharing Sitting on chemo chairs With a person or alone Chemotherapy or hydration Easy or difficult Painful as well as hopeful Port, needles, and pouches Caring saline or medicine That people call poison But hope of life for us Very friendly nurses and staff To be here means alive To be here means one extra day To be here is celebration Of life, of existence, And one more day for prayers

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Title: Connected Hearts (Watercolors and ink , 9 x 12 in) I just wanted to say thank you to my anatomy lab donor, but I’m not very eloquent with my words.

This artwork was done on watercolor paper, using watercolors I received when I was 12 years old, and a Micron pen. I was able to create this during my winter break, and it made me feel at ease. It also reminded me that I can use my brain for more than just medicine. _______________________________

MERRION DAWSON is a first year medical student in the Class of 2020.

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Title: Letter to My Mother This piece was written for and about my mother, who has been my crutch in recognizing and taking control of my depression. It was my sophomore year of college at the University of Arizona and things had been coming to a boil for months. Her arrival in Tucson was precedented only by a text message asking when I would be out of classes for the day. I was expecting a fight; I wasn't expecting the outpouring of love, support, and sadness that followed my announcement. I hold the conversation we had that day close to my heart and find myself returning to it whenever I need to remind myself to be grateful. But despite all this, there was a very real chance that it may not have happened at all.

My mom recently mentioned to me that she was considering not making the trip because she didn’t think it would be worth it. It is for that reason that I want to use this space to urge whoever might be reading this to make the effort to confide in the people you care about, and who you know to care about you. You never know what difference it could make! _______________________________________________

MEHER RAKKAR has been interested in the intersection between Humanities and Science throughout her educational career and is excited to be able to explore it in more detail through her interactions in medicine and her mentorships working with underprivileged children to address childhood trauma through exposure to the arts and intentional experiences with the humanities.

She believes strongly in the healing power of creative expression through the spoken and written word and hopes to continue to follow her curiosity surrounding the interactions between trauma, healing, and metaphor through continuing to write, teach, and witness the effects of poetry. For more poetry by Meher Rakkar, please visit www.thoreaubredtravels.wordpress.com/

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You gave me life before I knew what life was meant to be.

On the other side of the country, You brought me into the world you had just begun to build.

Then, 20 years later, You gave me life again.

That day in the Jiffy Lube parking lot On the cracked gray seats Of the car we'd known for over a decade, You let me melt into a puddle of gasoline And hand you my last box of matches.

You let me pour myself into the dark wells of your brown eyes Until I saw them drown and spill me over sharp cheek bones Down the contours of smile lines, long since used, Into hands That even our sisters can't tell apart.

2,300 miles from where you first relieved yourself of me You let me fill you again with my emptiness.

That day in the Jiffy Lube parking lot I saw how deeply you loved me To be able to put so much of yourself away That you could soak me up, Drop for drop, And wring me out into the fuel engine of a space probe Destined for a world you didn't understand, But were determined to explore if it meant Finding me again.

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But we are no longer tethered to one another by the cord You once used to sustain me With the same nutrients you nourish your own body with.

I worry if you stray too far from our ship, You may not find your way back.

I know if you could You would shrink yourself down to the size of my pride And crawl into my brain to rewire the parts of me That I've snipped away, Even if it meant shorting yourself out.

But even that day in the Jiffy Lube, Surrounded by tools and technicians, You wouldn't have been able to.

You can't be my electrician.

But you can be my mother, And I need you to know that that's enough.

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Title: And Then There Were Two… Last year, I wrote a letter to my newborn son Liam. It was meant to provide him some perspective on the exciting journey to come. Flash forward a year and I find myself now a father of two. Though it was never really planned that way, it was a blessing. I could not imagine my life without my two sons. Knowing that I had given Liam that gift, I felt it was only appropriate to do the same for Finn.

This letter, addressed to both, is written in the hopes that it will also be there for them as a source of inspiration and guidance. _______________________________________________ THOMAS L. KELLY and his wife Jessica are the proud parents of two sons—Liam and Finnegan, who were born in September of 2017 and 2018, respectively—as well as two crazy bulldogs—Yoda and Geno. Thomas works as a web editor in the Department of Marketing and Communications at the University of Arizona College of Medicine – Phoenix. He holds a bachelor of arts degree from Miami University and a master’s in education from Arizona State University. He has also written three full-length novels. The first, Masterless Warrior, is available through all eBook formats. He is currently pitching his next novel, A Thief’s Bounty, to literary agents.

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To Liam and Finn, Life is hard to define; one descriptor could never do it justice. Difficult as it may be to peg down, I will give it my best.

To begin, life can be funny. Just a over a year ago, I was holding you, Liam, in my arms, awestruck by the fact that I’d become a father. Then, just one year later, you arrived, Finn. The feeling was different the second time around. No less impactful, just different. I struggled with the notion that perhaps it was too much for me—that I wouldn’t be able to find an acceptable balance. As you will see, that is part of the journey. No one is exempt from self-doubt. It is what you learn from your reservations that truly defines your character.

Life can move fast—the two of you serve as primary examples of that—but as you grow up, don’t rush along with it. It isn’t a race, after all. There is no medal for finishing first. I encourage you both to take your time to explore what interests you—to dedicate yourselves to the things you are passionate about and never waver from them.

Life can be trying, even puzzling, forcing you to adapt to overcome the bitter sting of disappointment. It is in those trials that you will discover the inspiration to become the best versions of yourselves.

Life can be unjust. Too often, you will be confronted with the fact that some people seem to exist solely to bully, demean, and belittle. It can hurt. I know. Yet enabling them to dictate who you are and what you enjoy only further emboldens their behavior. Ignore them. People remember the positive forces in their lives far more than the negative, so stand up for yourselves and for others. I once encouraged you, Liam, to be a beacon, a force of optimism. As the eldest, I hope you will set that example for Finn.

Life can be wonderous. It excites me to imagine the things you two will do—the places you will travel and what you will see. Never set restrictions or give in to uncertainty. Those enable the nefarious agents of fear and doubt to rear their ugly heads. You both can accomplish whatever you set your minds to. That doesn’t necessarily mean it will come easy—nothing worth doing ever does—but trust in yourselves enough to believe that you are capable of achieving anything. The only true limit is the scope of your imagination.

Lastly, life can be lonely. If needed, I will always be there in the instances that you struggle. It warms my heart and fills me with a great sense of pride, though, to also know that you will have each other.

Remember, of the many words we have used to describe life, they all share one bond: Life is a challenge.

Embrace it.

Love always, Dad

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Title: Through My Eyes

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I was first inspired to meet and photograph Larry Miller after seeing a post from a friend on social media. After learning that Mr. Miller was one of the first Emergency Medical Technicians in the country, I knew I had to hear his story. We met at his home, and he began to talk to me about his experiences being an EMT, recounting the history of pre-hospital emergency care as it was evolving in the 1960s and 1970s. I learned that Mr. Miller had many endeavors in his life—from being a leather craftsman making belts and holsters, to his time serving as a Chief of Police. It was a pleasure to have him share his narrative while allowing me to candidly take his photograph ____________________________ GARY STANZAK has been a valley Firefighter/Paramedic for the last 30 years. His passion for photography started soon after his wife bought him a professional camera as a wedding gift. Gary enjoys shooting many subject matters, including firefighter photography, family portraits, food photography, and, of course, his grandchildren.

Facebook/stanzak photography

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Title: Her Shades and Mine I wrote this poem after my encounter with a patient who recently lost her best friend, her husband, of 59 years. It is a reminder that we always need to delve into the real reason a patient seeks help and that addressing the psychosocial determinants of health is a must in each and every encounter. The sorrow, depression and loneliness can easily be hidden behind “sunglasses” and it is our job to take them off. _______________________________________________ DR. MAY MOHTY is board certified in Pediatrics and Urgent Care medicine. She attended medical school at the American University of Beirut, Pediatric residency at the University of Maryland Medical system. Dr Mohty is a Clinical Associate professor at the University of Arizona College of Medicine-Phoenix, where she serves as Doctoring and Capstones Course faculty. She enjoys spending time with her husband and four sons, gardening and travel.

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What was I looking at?

Yes, I like brand names like the Dior inscription on the side of her sunglasses But No, I was trying to see what is under the shades Was trying to get a glimpse into the reason she kept hers on Arizona’s sun is definitely very bright She was indoors, in a room without windows No need for the shades? Right?

My staring made her say something Wanted to keep them on after my eye injection You know…the wet type of something called macular degeneration Voice trailed off No, it is not the reason why I could tell There was that deep sorrow, that choking sound in her voice I could tell The real reason is not physical She held my hand Doctor, My husband of 59 years He loved my eyes, I loved his I cover them now, I cover my sorrow I could tell The real reason is one I could never heal I wish I had my shades on I was lying when I said everything will be fine Yes, it was a lie I need my shades to hide my lies To hide the tears welling up in my eyes How I wish the reason was a physical one…

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Title: Mrs. This image is a painting that I did as a thank-you to the donor that I worked with in anatomy. The dichotomy of the right and left is to show how she was in life and how I have known her in her death. The flowers are to show the lasting impact that her gift will have on myself and the other students that have had the opportunity to work with her. I believe that the knowledge that we have gained and the empathy that we have learned through this experience will make us better doctors and better people in the future _______________________________

ELIZABETH BORDEN graduated from Seattle Pacific University with a major in Chemistry.

She is currently a 1st year MD/PhD student and hopes to pursue a career in pediatric oncology.

In her free time she enjoys doing art, cooking, and spending time with her husband and dog.

“I do not consider myself an artist, but I love to use art as a way to process and express emotions for which I cannot find the words.”

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Title: Poetic Remembrance Experiences that began as far off dreams, given birth by our hands. In the remembrance of their echoes, delight and strife follow. For their synthesis gives rise to the new fate that we will chase.

Events of the first year…

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MOHAMMAD KHAN is a Scottsdale born and raised Arizonan. He is a second year medical student, with an interest in poetry and expression. He believes that the words we choose can bring meaning to those things we appreciate. His specialty interests include family medicine, pediatrics, and immunology, and he hopes to serve as a teacher to the patients he will someday meet.

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Intro to Medicine Bright eyes, bold hearts entered into the year The fires and fury of the Phoenix outside and within us, lighting our passion Introductions to medicine imbibed us with knowledge, for we saw to drink at that font Yet the rush and throes of that information were intense, and in challenges, we were tested Molecular bases to build upon, bones and groans served to be our skeletons Carving knowledge from the bodies of science, we were blessed with donated wisdom and opportunities Honored and humbled, the body of our work required training and study to be understood As the months fall, temperatures cool, and these things we can learn touch our nerves, Facts and problems, cases and people as our knowledge deepens lead to new problems Working, studying, laughing, studying, running, serving, breathing, and occasionally sleeping The days turn and turn, until our eventual break.

Though a powerful reminder in an officer’s tale of survival of the power of the physician to abide the patient Cerebral thoughts color the mind, filling in the power of thinking and the weight of our coat Planning, struggling, fighting to keep up with the body of knowledge we need to learn The brain’s many trials and tricks needed be brought to bear Thought through tough fight, we come to the heart of medicine, A spirit of kindness and caring, and a sanguine demeanor, joy of those little heartbeats.

To bring our eyes to focus on a person, and give them the gift of time, they will grow A garden needs love and patience, as does a physician provide for the community In our final days of the year, we take a deep breath and brace for the wave of knowledge And in so doing, in the power of healing with love, we find inspiration.

Thank you, to all who helped shape this dream 29

Fourth of July cookout Prior to the beginning of the year, a flashy festival, with food and swim galore!

A chance for new friends to meet, and relax, comfortable in the field we will come to adore!

Many, many dogs were eaten, many more were left over to hit the hay Though the laughs and smiles of friends, made the day Summer retreat Friends, forests, frolic exploration, medicine bright horizons shine Dominican Retreat A first chapter, recorded; labors of work and study rewarded Across the sea, we fly, a crew with new insight as problems and cases diversify Roiling heat, dusty breaths sustain us; the work calls and they need us Rooms made from tools we could find; problems and words complex placed us in a bind For people in need, seeking help and guidance; we laid down our hands, and listened in silence Cases, studies in intimate details of life; cures for pain and strife A one legged man in pain, our eyes saw his discomfort and strain Yet, he never stopped smiling, as our diagnoses were compiling His hands were pained, his wrists were strained; however, in healing himself, he was trained.

For the patient, good things come in time, though this path is long and full of pantomime, The radiant smiles of those in pain, when life turns shocking; for them, this path is worth walking .

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Title: Study of feet for ‘Donor' This was inspired by a piece by Albert Tucker called, “Study of feet for ‘Cadaver.’” The view of two bare feet resting with toes pointed up (sometimes with a tag) is a common symbol that portrays a representation of donors and cadavers. My goal, while creating this piece, was to reflect on why this has become such a universal symbol and consider my thoughts and appreciation for our donors’ contributions.

Our feet, more specifically the bottom of our feet, are typically hidden—tucked away in bed sheets, living in socks and shoes, and cushioning our weight as we roam. They are the furthest from our brains and yet one of the most vulnerable parts of our bodies. (Anatomically, they’re also one of the most underappreciated aspects of the human body). I cannot say why the feet, viewed from this unique perspective, have become the symbol it has become. Perhaps to the uninitiated, it is a quick way to deduce an impersonal connection that exposed, inactive feet suggests the person attached has passed.

My hope for this piece is to remind myself that behind the portrayal of this ubiquitous symbol are people who have lived lives as unique as each of our feet. The sight of two feet passively resting does not have to indicate that the value of a life has ended. The physical impressions of the footsteps we create may eventually fade away, yet our actions have the power to live in eternity. ____________________________ DARA FARHADI is a member of The University of Arizona College of Medicine – Phoenix, Class of 2022. He graduated from The University of Arizona in 2016 with a degree in Neuroscience and Cognitive Science and then received a master’s degree in Science Journalism from Boston University.

He enjoys playing tennis and video games.

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Title: You This piece is a tribute to the woman who, after her passing, became the donor for my Anatomy course. I learned an incredible amount of information throughout the class, but was hesitant and conflicted throughout most of it. Only upon completion of the class did I really come to terms with the magnitude of her decision to serve as our cadaver. I am by no means an artist or writer, but I felt I had to offer some acknowledgement of her sacrifice, and this letter is just that. ____________________________________ SOKENA ZAIDI is a California native and a first year medical student at the University of Arizona-COMPHX. After receiving her Bachelors degree from the University of California, Davis in 2016, she spent a year in Washington D.C. as a research fellow at the National Institutes of Health. She enjoys hiking, cooking and watching the Phoenix sunsets.

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Dear You, You scared me the first day we met. I knew I should feel thankful for meeting you, for having this opportunity that I had worked so much of my life for – and yet I couldn’t look at you. “This is for my future patients,” I told myself every morning I made the walk to school. But I struggled to disconnect the clinical from the emotional. As the cold of the anatomy lab set in and the formaldehyde overpowered the perfume I desperately searched for on my neck, my mind wandered; how many cups of coffee were sipped by those cold purple lips I saw last week? Who did you kiss goodbye in the mornings before starting out the day? Who were you?

After a few weeks, it became easy to focus on the clinical. You were the teacher, and I the student, thirsty to learn in the short time we had together. You taught us the delicate balance of forces that move life-giving blood up and down our body. You showed us how our muscles contract every second of every day to let us breathe, laugh, cry and so much, much more. Nerve fibers and roots carved out paths that we tenderly, then more aggressively once we were comfortable, traced piece by piece.

The trepidation and apprehension soon turned to true excitement as you taught us more structures. I burst with pride while examining your heart, which was deemed healthy and hardy, especially considering all the years you spent on this planet. Moving the chambers around in my hand I tried to calculate how many times this precious heart beat during your life. What made it flutter with joy and did anything or anyone ever break your heart? Did it pound when you received your diagnosis of cancer?

I don’t know the struggles and triumphs you had in your life, and I never will.

But I know the heart that stopped pumping as death shrouded you. I know the lungs that filled when you took your last breath. I know the muscles that tensed as your spirit left this world. I know the eyes that looked one last time at the sky before closing forever. I know the structures that let you speak your last words, but I will never know the songs you may have sung to children your womb gave rise to.

I hope you left this world content with the time you had here. Life, death and medicine are inescapably connected, and you taught me this lesson in the gentlest way. Thank you for placing your trust in me and in my classmates. Your gift will remain in my memories forever, and I, as well as my future patients, owe you an immense debt of gratitude for any good that comes from my hands.

I thank you, I thank you, Sokena Zaidi

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Title: Circles of Life Our lives are integrated collages of the domains of work, community, family and personal. Within our complex days, these domains overlap in meaningful ways and at other times they require distinct with boundaries to be able to protect and grow. The art piece with circles reflects the diversity of each of the domains of our lives and this aspect of overlap and distinction. ____________________________

DR. CHERYL O’MALLEY is a strong leader in undergraduate and graduate medical education, and has served in many local and national leadership positions. She has used art and reflection throughout her career to maintain her own heart in medicine while inspiring, teaching and leading others.

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 Title: To Touch or Not to Touch – That is the Question

_______________________________________________ DR. ROBERT E. KRAVETZ is a Clinical Professor in both the Departments of Internal Medicine and Bioethics. He is a medical historian and collector of medical antiques, many of which are on display at the campus. He hopes that they will highlight the history of medicine and make students and physicians more aware of their medical heritage.

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With the advent of medical technology, there have been great strides in diagnosis and treatment. Physicians relying solely on cold, hard, hightech machinery, end up distancing themselves from their patients and practicing a more impersonal art of healing. Unfortunately, physicians often allow scientific precision to usurp the necessity of touching and knowing the patient. The healing properties of touch, a simple form of patient communication, are often overlooked and under-utilized in our everyday practice.

In many cases, physicians are spending less time communicating verbally and through touch with their patients. Sometimes doctors diagnose and prescribe therapy without having any physical contact with the patient. “Although imaging can provide us with the most intimate secrets of the body, it does not improve how patients feel or tell us how much they suffer.”

Physicians dating back to the ancient civilizations of Egypt, India, China, Greece and Rome employed touch as an adjunct to providing humanistic care. The laying on of hands is not only a diagnostic but also a therapeutic tool that in today’s environment is a “touchy” subject. Touching a patient and listening for certain sounds is a critical to making an accurate diagnosis -- a skill necessary to become a respected physician. Lewis Thomas correctly stated that “touching (is our) real professional secret…the oldest and most effective act of doctors.”

Caring as Well as Curing

Early medical diagnostic techniques were restricted to what doctors could learn with their senses and the“ laying on of hands.” Therapeutics was limited to a few effective treatments administered with close personal attention. Physicians could often only offer care but not cure. As our knowledge for cure has increased, in many cases our capacity for care has diminished significantly.

The thorough physical examination of the past now is often hurried, cursory, incomplete and sometimes non-existent. “When you are sick, you want more than treatment, you want healing.”

Ill patients feel as if they are in a foreign country suffering from culture shock. Touch can do much to allay the anxiety that patients feel. It lets them know that they are not alone – that we care!! One of the most frequently cited quotations, when discussing humanistic medicine, is from Doctor and Patient written in 1928 by the Harvard trained physician Francis W. Peabody. He concludes this slim volume, which I urge all physicians to read, with the following quotation. “One of the essential qualities of the clinician is interest in humanity, for the secret in caring for the patient is in the care of the patient.”

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Benefits of Touch

The skin, the body’s largest organ, is the conduit for facilitating communication by touch between two or more individuals. Touch can convey recognition, empathy and caring. It provides a sense of security that can alleviate stress, concern, and fear. Fortunately, just the simple, time-honored physical examination of the heart, lungs, and abdomen will provide patients with reassurance and has healing power. A warm hand gently laid upon a patient’s wrist to take the pulse, or an arm around a patient’s shoulder at the close of a visit to convey caring will help him/her assimilate treatment suggestions. Physical contact is reassuring and can help amplify or help explain a doctor’s meaning while forging a personal bond with a patient. When a physician touches a patient, both parties have the feeling that something is being done. This practice could and should be carried out with every patient encounter, whether in the office or in the hospital.

Improving the Physician-Patient Relationship

Physician burnout, so widespread today, is due to a multitude of factors. The primary reasons for the dissatisfaction is the lack of control in one’s life and being forced to practice in ways that are contrary to one’s core values. Individuals who develop the capacity for compassion, understanding, and an awareness of the humanistic aspects of medical care are less prone to the burnout that sadly extinguishes a meaningful career prematurely. “The reward (in practice) is to be found in the personal bond that forms (and is) the greatest satisfaction in the practice of medicine.

Touch is one of the hallmarks of humanistic care and can bolster physicians in the battle against burnout.

Touch, common in the past, brought comfort and reassurance to patients at a time when medicine had much less to offer them. All cultures have endowed the hands of their healers with power.

Priests, medicine men, and seers, have for centuries, used the mysterious energy that is mediated in their touch and transferred to the sick. “Physicians do possess a little bit of magic” and they themselves are therapeutic when they deal with patients like the shamans of bygone days. It is essential that we teach future generations of physicians that hand holding is just as important as all of the tests that they prescribe.

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Title: Time is what time is I came to a point where time was more of a foe than a friend. Despite my best efforts to bring time into my circle of life, time always seemed to stay on outside of the circle: taunting me, wanting me to chase it and needing it. Soon, I gave up the chase and let time lead the way, knowing that all I could do was follow. _______________________________________________ DR. DAVID BEYDA is Chair and Professor of Bioethics and Medical Humanism. He is a published author with three books, a national essay award and multiple essay publications. His interest in the narrative aspects of medicine stem from his preference in setting a picture using the written word.

He writes in a “stream of consciousness” style, letting the words find their own way on paper.

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Somehow, there is never enough time. Trying to make up for lost minutes is nothing but a fool’s errand. Life comes with a set amount of time, some of which is given and some of which is taken. We never know how much. To say that we enjoy this time of our life is superficial at best. So, how do we manage? How do we cope with all that is needed to live, to make life worthwhile, to make the best of everything when time is quick to come and quick to leave?

I really don’t know. But what I can tell you is that time is elusive, is hard to find, hard to catch and even harder to make up. So why bother? There must be a reason to the madness. To chase it, to find it, to give it meaning, leaves little time left. So we waste time trying to find time. People talk about time past, time in the future and how time in the present is a “present.” Really? Time in the present is fleeting. It comes for a split second and is gone, now becoming time past and time future is right behind. So where’s the “present,” the gift that some talk about?

Time is never borrowed or lent. It is personal and restricted to that one person to whom it belongs. The person who is using the time. Have you ever been asked “May I have a minute of your time?” or “Do you have a moment?” Yes, I do, but it is mine, and I can’t afford to give it away unless you have one to give me back. Time is quick to pass and out of sight. I’ve asked many times “Where did the time go?”

There is a special experience, in a special place, that time is noted. It is the last breath taken, the last laughter, the last cry, the last words, the last moments on this earth. We cherish those times, not because we know that they are the last times, but because we are focused on the time. The minutes towards an execution, and the minutes to the passing from this world to the next. What would we do with those minutes if we really knew that they would be the last ones we have? Would we be frightened, happy, confused or anxious? Would we wish for more time to enjoy an experience or less time so as to get whatever we are facing over with? It is hard to know. Time is time. Time is the owner of our lives, controlling all that we do whether we like it or not.

Time is the boss, the ruler, the undisputed god of our lives. There is no arguing, negotiating, or bartering with time. Time does not listen, does not care, does not wait for anyone. Time runs on its own time. Time moves forward and backwards at its own pace and location. Central mountain time, pacific time, eastern standard time, Asia time, Africa time, in short hemisphere time. It dictates our lives.

Even now, time is taking up my time. Writing this has taken time that could be used for something else, but time has chosen to do this, not me. I wait for time to give me time. I ask time for time. And when I least expect it, time gives me more time without me even asking for it.

We count the hours of sleep as time, We count the hours of the day as time. We count the years of our lives as time. I have lived 35,215,200 minutes so far, give or take a minute or two. How about in seconds? Well, there are too many to count. The bigger question is how many more minutes, how much more time, do I have left?

How many was I given in the first place?

So how about you? You more than likely wasted some of your precious time reading this. You’ll never get those minutes of time back. So sorry about that, but you chose to do so. You chose to use your minutes of time to read this rather than using your minutes of time for something more productive and more useful. Tic toc.

Another moment of time is gone. Time is what time is.

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Title: Lofoten Taken from a boat while travelling in Norway. This is a mountain scene between the towns of Lekenes and Gravdal in the Lofoten archipelago. ____________________________ AMANDA HENDRICKS is currently a faculty coordinator at the College of Medicine – Phoenix.

She has worked with COM-P for over a year. She received her bachelor’s degree in English and her master’s in Education/Curriculum and Instruction. She loves to travel whenever she can find the time and money. While many places have been crossed off her list, Amanda continues to find new places to explore. Her other hobbies include photography, reading, baking and hiking.

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Title: Symphony of Medicine  This piece was inspired by my time in the hospital setting, specifically observing patients in the ICU. I noted that for a majority of a patient's stay, there were vastly more machines instead of people in their rooms. This allowed me to envision what they would be hearing and sensing in that situation. _______________________________________________

MELISSA GORDON is a medical student in the Class of 2019 at the University of Arizona College of Medicine - Phoenix. She graduated from The University of Arizona in 2015 with a Bachelor of Science in physiology and psychology. Melissa enjoys writing in her spare time.

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It’s a symphony that surrounds me, enveloping me, becoming the only thing that exists I cannot remember when it started, only that it has always been present and quite possibly could continue forever

It felt intrusive at first, but just like a foul smell in a small room, I began to tolerate, then acclimate, and finally accept it until it became a permanent fixture

I wish to know this symphony, to understand its deep intricacies that are somehow foreign yet familiar. I slowly begin to pinpoint each sound, identifying its role in the orchestra that is my life

I am now the conductor, defining the pace, counting the beats The staccato notes that is my heartbeat begin the overture, a steady rhythm that seem to mimic a military march

The legato notes, my breaths soon follow with the ventilator attempting to infinitely lengthen the notes. They are meant to be the flutes, designed to provide a melody, the background that is always enriched with complexity, but so often overlooked. They slur from one to the next seeming to enjoy contradicting the tone that the heart is attempting to set.

An accompaniment of machines now join in. Their names, I do not know, though they feel like old friends. Just as Brutus was a friend to Caesar, perhaps their presence represents a danger. They are the brass, powerful, yet at times abrasive, as they present their simplistic set of notes.

And now, the time has come to move from the Adagio to the Allegro. The tempo begins to quicken as the rhythm transfers from quarter notes to eighths and this is where the piece truly begins.

The drip from the IV is the metronome, maintaining the peace amongst the cacophony of noises. Each instrument has a part to play, yet they all demand to be heard.

The respirations begin to crescendo, and those once delicate slurs begin to trill finally beginning to overtake the machines.

The audience is captivated by this symphony and how could they not be? It is unlike anything they have ever seen or heard before.

It is utter perfection, my greatest work, but it is time for the piece to wind down.

There is only one way to end such an opus, and that is with an eternal final beat.

It rings so loudly that solitary ending note that is strong and weak at the same time. Then silence.

But wait … more sounds, a standing ovation? A crash of cymbals a flash of light reigniting an encore performance and life goes on.

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Title: “Core Clerkships” These 4.5 x 4.5 inch pieces were intended to represent each of the 6 core clerkships completed during the third year of medical school. Each piece was created with the clerkship in mind and as a reflection of my experiences throughout the particular rotation. It may be interesting for the viewer to guess which piece reflects each rotation, as our experiences influence our own interpretation of the pieces.

1/6 – surgery, 2/6 – internal medicine, 3/6 – pediatrics, 4/6 – psychiatry, 5/6 – obstetrics & gynecology, 6/6 – family medicine _______________________________________________ MADALYN NELSON is a fourth-year medical student at The University of Arizona College of Medicine – Phoenix. She is an Arizona native, and she graduated from Xavier University in Cincinnati, Ohio with a degree in biology. Madalyn has a passion for traveling and global health. She plans to go into Family Medicine in the military.

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Title: transgenesis I am deeply interested in body modification as a subversive art form. Our bodies are held to extreme expectations by our culture, especially if we identify as women. Everyone can agree: we live in a world obsessed with rigid beauty standards, a world that wants us to adhere to those standards, and a world that shames us when we don't. But when we ink, pierce, and rearrange our own bodies, we fight back just a little bit, and take control over our own narratives. This poem is part of a series that speaks to that fight for control to decolonize, deconstruct, and reconstruct our bodies as we see fit while recognizing the complexities and problematic nature of body modding (tattooing in particular), its ability to be grotesque and sublime both at once, its history of representing enormous swathes of people, its problematic connections with slavery and imprisonment, and its deeply personal connection with the lives of transgender folx. Â ___________________________ mary catherine lockmiller really likes writing. especially poetry. and non-poetry. which is basically all literature. she's a health science librarian. so she gets to be around a lot more nonpoetry than poetry. thankfully she's around other people who also want more poetry in their medicine. yay poetry and medicine.

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i am at the edge open up close and watching for the carve-whistle buzz of the flat the sudden pierce and retract slip in where was i not there not where the skin inside her bubbles speckled flesh but not the bone there was blood probably It was just below the film there was an edge it was cut a suppuration an itch surely she was sick i can’t tell i am at a point where i was the point is i’m here a trifle of scar a word

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Title: Ebb and flow On an inlet to a marina in Cozumel, this rock formation filled and drained with each passing wave. A neutral density filter allowed a long exposure to capture the flow of water back into the sea, distorting time in addition to space (the formation is less than 2 feet in diameter). ____________________________

DR. STEVE LIEBERMAN is an amateur photographer who enjoys shooting landscapes, architecture, and wildlife. He likes to challenge viewers’ sense of scale, orientation, and perspective.

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Title: The Test This poem was inspired from 2nd year of medical school during one of the most stressful times of my entire educational journey. With our first board exam coming up many of my classmates and I were extremely stressed. It became really easy to lose track of the reasons we were spending 12 hours a day studying. I believe this poem helps maintain a proper perspective by contrasting the stress of a medical student studying for their board exams with a patient awaiting the results of a life alerting test. _______________________________ CHARLES SMITH is a fourth year medical student at the University of Arizona College of Medicine-Phoenix going into Family Medicine. He received his B.S. in biology from the liberal arts college, Southern Virginia University, where he discovered his passion for writing and the humanities. This passion has continued through his Master's of Arts in Biomedical Science through Midwestern University-Glendale and now as a co-editor for his Medical School's student run newspaper. Outside of medicine he enjoys spending time with family and friends, sports, music, and the outdoors.

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It’s a test.

It’s only a test.

On which tomorrow rests.

Nevertheless, my breath fails to fill my chest as I try to choose the answer that works best.

Board exams are a burden, an unwelcomed guest.

It’s about patients, not a contest.

It’s a test.

It’s only a test.

On which tomorrow rests.

Nevertheless, their breath fails to fill their chest as they prepare for hopefully the best.

Cancer will always be an unwelcomed guest.

It’s about living, not a contest.

It’s a test.

It’s only a test.

On which tomorrow rests.

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Title: Old Man Storr Taken from the a hiking trail in Scotland along the Trotternish Ridge on the Isle of Skye. The famous rocks are known as the Old Man of Storr. _______________________________________________

AMANDA HENDRICKS is currently a faculty coordinator at the College of Medicine – Phoenix.

She has worked with COM-P for over a year. She received her bachelor’s degree in English and her master’s in Education/Curriculum and Instruction. She loves to travel whenever she can find the time and money. While many places have been crossed off her list, Amanda continues to find new places to explore. Her other hobbies include photography, reading, baking and hiking.

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Title: NUMBERS…How do they define us? _______________________________

DR. LISA SHAH-PATEL is the Director of Career and Professional Advising for the University of Arizona College of Medicine-Phoenix. She works as an independent contractor reading screening and diagnostic mammograms, and performs ultrasound-guided procedures and stereotactic-guided biopsies. She completed a seven-year combined Biomedical Sciences/Doctor of Medicine program at the UCLA School of Medicine where she received her MD degree and completed her fellowship in Breast Imaging at the Mayo Clinic in Arizona. In her free time, she enjoys spending time with her family, going to the beach, skiing, and traveling.

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You are born on a certain date.

You weighed a certain amount and showed your presence at a certain week.

This defined you as term or premature.

You were followed with growth charts and percentages…

More NUMBERS. You were allowed to enter kindergarten when you turned 5.

You were considered a teenager at the age of 13 and were driving at 16.

You took the SATs and all those other standardized exams…were your NUMBERS good enough to get you into your dream college?

You were an adult at 18 and could have your first drink at 21.

You studied hard in college and got a certain GPA…more NUMBERS. You were applying to medical school and had to take the MCAT…more NUMBERS. You got into medical school and now you were going to be a doctor…but wait, another exam—the USMLE—more NUMBERS. These NUMBERS, you thought, determined your residency specialty and defined who you were, but wait…

30 years later, married with grown children, you sit in the doctor’s office—not as the doctor, but now as a patient— More NUMBERS…your labs are back and numbers show that you are sick.

The NUMBERS which will follow you for the rest of time as you get treated with surgery and chemotherapy…

Only to hear that the NUMBERS are not going in the right direction. You say…what, you say…why?

These NUMBERS that have followed you since you were born are now determining your destiny. Is this fair? Does this define who you are and who you will be?

No, I say!

These numbers are what helps guide us and what helps us become categorized, but in all reality, we are who we are. We are the sons and daughters, brothers and sisters, colleagues and friends, who each have a story. We often allow these numbers to take a hold of us…to control us…to lead us towards a certain direction. But we must remember that these are merely NUMBERS. We are who we are for the reasons we want to be. We are loving, honest, helpful, enthusiastic, and dedicated individuals of a society in which we can make such a difference. Don’t let a NUMBER define you but let you define yourself!

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Titles: Deck of Cards The Deck of Cards truly personifies the experiences a person goes through, whether they were experiences created by yourself or those which you were dealt. There are so many times in life we feel that we have been dealt a raw hand, but we must remember that it is not the hand we are dealt, but what we do with it. Started by my husband prior to our marriage, and finished by me afterwards, this drawing reflects how sometimes we make the most of what we are given, even an unfinished drawing. I challenge each and every person to remember that you will be given a variety of cards and will come across all different types of suits, but stay true to yourself, and you will always “win.” _______________________________________________ DR. LISA SHAH-PATEL is the Director of Career and Professional Advising for the University of Arizona College of Medicine-Phoenix. She works as an independent contractor reading screening and diagnostic mammograms, and performs ultrasound-guided procedures and stereotactic-guided biopsies. She completed a seven-year combined Biomedical Sciences/Doctor of Medicine program at the UCLA School of Medicine where she received her MD degree and completed her fellowship in Breast Imaging at the Mayo Clinic in Arizona. In her free time, she enjoys spending time with her family, going to the beach, skiing, and traveling.

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You are given a deck.

You may feel it is a wreck.

You may want to fold But you stay strong and hold.

You smile, you cry And make a humble sigh.

You look at your hand, shy away and fold Only to know you should have placed a hold.

All in all, your hand was an ace.

You were a success in finding your place.

You wanted to bet But only if all was set.

You knew the importance of being bold But were wary and felt the need to fold.

You were given a hand.

Allow it to land.

Stay collected and calm Always think of the sayings from you mom.

No need to run.

Know you have won.

One shuffle, one bridge.

Let the cards create the ridge.

Don’t focus on the suit.

Let it all be a hoot.

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Title: a blue rose burning I am deeply interested in body modification as a subversive art form. Our bodies are held to extreme expectations by our culture, especially if we identify as women. Everyone can agree: we live in a world obsessed with rigid beauty standards, a world that wants us to adhere to those standards, and a world that shames us when we don't. But when we ink, pierce, and rearrange our own bodies, we fight back just a little bit, and take control over our own narratives. This poem is part of a series that speaks to that fight for control to decolonize, deconstruct, and reconstruct our bodies as we see fit while recognizing the complexities and problematic nature of body modding (tattooing in particular), its ability to be grotesque and sublime both at once, its history of representing enormous swathes of people, its problematic connections with slavery and imprisonment, and its deeply personal connection with the lives of transgender folx. __________________________________________

mary catherine lockmiller really likes writing. especially poetry. and non-poetry. which is basically all literature. she's a health science librarian. so she gets to be around a lot more nonpoetry than poetry. thankfully she's around other people who also want more poetry in their medicine. yay poetry and medicine.Â

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NOTE: In tattoo culture, one debate involves knowing how tattoos are affected when epidermal skin is burnt away but leaves the dermis intact. In 2018, an image of a burnt tattoo was posted on Reddit, and went viral. This poem refers to that image. so there it was a good two inches of charred skin curled black like a burned Ziploc unsealed the under layer electric neon blue like birds in the tropics like ice that hasn’t seen the sun in a thousand years a blue rose where the fire scarred grows breaks the surface of the hand stripping itself of age tearing itself away the new flesh the old pattern alive in the microphage matrix this was nothing new this was the body knowing the image carved into every single cell of the hand and wrist the arm the rose is the arm the skin the blue-bright open there is no close

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Title: Fourteen ways of looking in a mirror I am deeply interested in body modification as a subversive art form. Our bodies are held to extreme expectations by our culture, especially if we identify as women. Everyone can agree: we live in a world obsessed with rigid beauty standards, a world that wants us to adhere to those standards, and a world that shames us when we don't. But when we ink, pierce, and rearrange our own bodies, we fight back just a little bit, and take control over our own narratives. This poem is part of a series that speaks to that fight for control to decolonize, deconstruct, and reconstruct our bodies as we see fit while recognizing the complexities and problematic nature of body modding (tattooing in particular), its ability to be grotesque and sublime both at once, its history of representing enormous swathes of people, its problematic connections with slavery and imprisonment, and its deeply personal connection with the lives of transgender folx. _______________________________________________

mary catherine lockmiller really likes writing. especially poetry. and non-poetry. which is basically all literature. she's a health science librarian. so she gets to be around a lot more nonpoetry than poetry. thankfully she's around other people who also want more poetry in their medicine. yay poetry and medicine.

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Some women have described their body art as a way to rebel against male dominance and to ‘reclaim’ power over their own bodies. In creating scarred, branded, pierced, and heavily tattooed bodies, they aim to reject the pressures of beauty norms and roles of ‘proper’ femininity.

— Victoria Pitts, In the Flesh: The Cultural Politics of Body Modification

I

one eye half asleep grime at the seams

II Crawl up your skin crusted toothpaste blots your naked frame your edges III swivel see your sawtooth neck and spine swivel see your overbite IV the other eye drags you down never blinks literally yanks at your face V three red roses and a black leaf crown clinging to their bony passage the skin that seals your gut VI turn again three swords carving at the heart of the matter at the nape of your own neck VII In tarot three swords mean survival in real life, three swords mean you’re fucked

VIII you are the wreckage of a hairless animal rouging yourself up with a fancy syringe that clothes your skin with IX color (which is lame you’re still an animal) X you cover yourself with petals feathers fire and birds XI a flock of faddish watercolors crawling calling no sound no voice only noise XII (it’s okay bodies need images more than words) XIII the eyes can hear it and they understand the body understands the world is here broken XIV in the mirror language of its skin nestling birds and roses

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Title: The ceiling of the basement The columns and arches in the basement of Antoni Gaudí's Palau Güell in Barcelona seem as unbalanced as M.C. Escher's distorted depictions of physical spaces. _______________________________________________

DR. STEVE LIEBERMAN is an amateur photographer who enjoys shooting landscapes, architecture, and wildlife. He likes to challenge viewers’ sense of scale, orientation, and perspective.

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Title: Untitled This double haiku was inspired by a ruptured ectopic pregnancy that nearly ended my life in October 2012. I am ever thankful for my quick-thinking colleagues who called 911 and the surgical team that saved my life. I often reflect on the missed milestones and what my life would be like if I were to have been able to give birth. Time passes and the pain dulls, but the memory of what was and what could have been lingers on. What I find so striking about pregnancy loss is how common it is and how little it is talked about. Once one person shares their experience, it seems to empower others to share their story. _______________________________________________

LORRIE PENA is the Manager of the PreClerkship curriculum at the University of Arizona College of Medicine - Phoenix. She holds a Master’s in Educational Psychology (Human Relations) and a Master’s Certificate in Educational Technology both from NAU. She earned a Bachelor’s Degree in Management and Organization from Penn State and a Certificate in Baking and Patisserie from Le Cordon Bleu. She is an avid baker and adventurous crafter.

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October begins Dying leaves float through the air The day I lost you It’s May Seventeenth The Spring breeze stirs in the air Celebration mourned

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Title: “Tsé Biiʼ Ndzisgaii” In October of 2018, I got the opportunity to visit Monument Valley, or Tsé Biiʼ Ndzisgaii in Navajo, which translates to “Valley of the Rocks.” On the drive up, we raced the sun and managed to get to our viewpoint right before sunset. Exiting the car, we were awe struck by the expansive beauty of the valley. It was truly breathtaking. Looking beyond the buttes into the horizon, I felt that I had been transported into a different place and time, getting a small glimpse into the rich and sacred Navajo culture that had been shared with us that day… and what a privilege it truly was. _______________________________________________

BIBI EGHTEDARI is a third year medical student from Los Angeles, California. She attended UCLA for undergrad where she majored in Psychobiology and minored in Biomedical Research. She plans on pursuing Internal Medicine. In her free time she enjoys traveling and photography.

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Title: Work in Progress These three sketches highlight perhaps the three biggest experiences that led me to medicine: my father’s cancer, my brother’s addictions, and my daughter’s birth. Each snapshot represents a pivotal moment that helped define my future, medical or otherwise. _______________________________________________

TANNER ELLSWORTH is a member of the class of 2021. He graduated from Brigham Young University with a major in English and a minor in Japanese. He enjoys all things cello, movies that don’t have happy endings, baking shows, filing taxes, and his wife and daughter.

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May 2003 Baseball is my least favorite sport, probably because of the dirt. Even if I come home after practice and shampoo twice, I can still smell the sand stamped into my hair and rubbed into my skin. Today is my final game, and then I can quit forever.

I blame my father for my lack of athleticism, but blame implies resentment, which there is none. We just are not the type to play catch or watch sports.

Instead, I sit on my couch, holding a book closely in my right hand and a baseball glove hesitantly in my left, trying not to inhale the dirt caked into its cracks.

“Your father has cancer.” The words float in, settle like dust—ignored, avoided.

All I can think is, “Do not strike out.” If I can only avoid striking out, I can finish the season without crying after the game. But I am clueless in how to make contact between bat and ball. No amount of focus can help me avoid this failure.

That summer, we pass back and forth many things not spherical. We stay up late reading books when the steroids keep him awake. He explains PET scans and chemotherapy and cells gone rogue. I ask a million questions, as usual, and gain a collection of medical heroes: non-athletes like me.

May 2008 My favorite jeans in high school are also my brother’s. In a way only siblings understand, we are not certain who bought them or who owns them, but I am certain that we both feel entitled to an argument when they aren’t available right when we want them.

I am wearing these jeans as I sit at the computer using all of my research skills to find the identity of the pill that was in the front pocket.

It is white. Surely, it’s just Tylenol or Aleve; I have nothing to fear.

It is diamond-shaped. Have I ever seen a pill like this?

The imprinted letters and numbers form a final clue and confirm what I already knew.

I have no idea what to do. Each option holds benefits, consequences that must be weighed. Which is worth more: our relationship or his life?

So, I repeat the words too familiar, “Dad, I think you should know something.”

That night, I just lie there, promising better grades and higher achievements, vowing to undo the tears I see in my mother’s eyes, committing to myself that no amount of pain—no surgery or sadness—demands these opiates I never want to touch.

May 2016 I am coming up on twenty minutes trying to get the car seat just right in the backseat. I am sweaty and frustrated, but just one hundred feet and a few walls away sleeps my new daughter, which makes it all worth it.

Before today, the car seat sat for weeks in our living room. We purchased carefully, reading each review, weighing each pro and con, selecting with clueless expertise. This car seat—pristine in its black, unstained newness—will hold our whole world.

The straps click and tighten. Arms and hands, tiny in their newness, fold unnaturally into their embrace, too loose.

The cushions protect a brain, a personality that I cannot comprehend in that moment.

Love will form so naturally, so fully in the months to come. But for now, I can only cluelessly stare at my daughter —fearlessly strong, intelligent, loving, tirelessly active, calm, perceptive, endlessly curious, silly, stubborn—failing to see these traits that will later define her.

For now, I can only focus on her unsupported head, her unpracticed breathing, and her unadjusted eyes blinded by the light, eyes that stare back, begging for fewer prods, warmer blankets, and softer arms.

No matter how tight, the straps feel unsafe, uncomfortable.

Just two minutes after the on-ramp, we pull over in panic to check breathing. Love is a double-edged sword: 73 fulfilling, yet exhausting.

Title: Saying Hello After my son, Michael, passed away I was in such a dark place emotionally. Sometimes, the only peace I found was going out into nature with my husband, Mikel, and our youngest dog, Luna. On our hikes, I would have these conversations in my head with Michael – telling him how much I missed him and wishing he was here to enjoy the day and talk about everything and nothing. On this day, I was brave enough to ask Michael for a sign that he was listening. As we were hiking up this steep trail, I asked Mikel to step out of the frame, so I could get a photo of just Luna. I snapped the photo and we continued our hike. Later in the afternoon, I was looking at the photos we had taken, and I was surprised to see how this image turned out. I silently cried to myself, and I said to Michael, “Thank you for letting me know you were with me.” To some, it may be just a sun beam shining down on a dog, but to me, it is my son saying hello. _______________________________________________

DR. LISA YANEZ-FOX currently serves at the Assistant Director for Curricular Integration and Review and is an Assistant Professor in the Internal Medicine Department at the University of Arizona, College of Medicine – Phoenix. Dr. Yañez-Fox also teaches on-line in the Doctor of Education program at Arizona State University. Dr. Yañez-Fox received her Doctorate from Arizona State University in 2017 in Educational Leadership and Innovation. She received her master’s degree in business administration from Roosevelt University in Chicago, IL. Dr. YañezFox has been serving in higher education since 1998. Her passions include traveling with her husband (Mikel), spending time with loved ones, and hiking.

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Title: Winner of First –Year Medical Student Reflective Writing Essay _______________________________________________ JENNA KOBLINSKI is a medical student in the Class of 2021 at the

University of Arizona College of Medicine-Phoenix. She is from Gilbert, Arizona and graduated from the University of Arizona as a physiology major and psychology minor. She has a strong passion for medicine and writing and feels very fortunate for all of the opportunities to combine the two.

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Anxiety was bubbling up inside of me as I felt hot water streaming down my face. “It doesn’t count as crying if you’re in the shower,” I repeated to myself, as if that would make it true. It was only the first week of medical school; I should not be feeling this way, but knowing that was not stopping the slow drip of tears from glands I was still months from being able to name. The tears mixed with the water from the shower and circled invisibly down the drain.

Slight panic was stuck in my throat as I thought of the day and the numerous charts shown by the learning specialists.

They were medical school “report cards” from previous students that I too would one day receive. Colors were bad. Red, my favorite color, meant they had failed the block; orange meant passed with a retake and yellow meant passed, but with a score that did not correlate well with STEP. Red, orange and yellow kept flashing through my mind like the one sunset I did not want to see. I can’t even remember if they had shown us any student charts without these colors. This was all intimidating, but what had spoken to me most was hearing people say that what worked in undergrad would not work here and that undergrad success did not equate to medical school success. I felt as though I would fall into that pile of students and as someone who has wanted to be a physician her whole life, I did not know what I would do if I could not succeed in medical school.

After a good night’s rest, I was able to calm down and build myself back up. Being able to talk to second years helped, as they reassured my class that we would be okay. My excitement about medical school was again allowed to be my main focus.

This was only increased by finding out that when we were shadowing third and fourth years on rotation I would be seeing a surgery.

I could not wait to finally be in an operating room as an actual medical student. Although I had to be there at 4:30 am, this was a trade-off I easily would make.

I consider myself a “middle-of-the-day person,” but that morning you would have thought I lived for the mornings. I was out of bed as easily as if I had a day at Disneyland ahead of me. Realizing I had gotten ready too quickly, I forced myself to sit on my bed for ten minutes; I did not want the third year to think I was too eager. I finally began my short drive to Banner.

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The sky was black, as the sun was still hours from rising. Dancing and singing along to “Shape of You” by Ed Sheeran, I felt so excited for the day in front of me—so carefree. My car was almost out of the way when I realized the black SUV speeding down the road perpendicular to mine was not going to stop at their respective stop sign. I tried to speed-up myself and I pounded on my horn as hard as I could to try to alert them I was there (and had no stop sign of my own). However, this was hopeless and the car crashed hard into the back right side of my poor Elantra, spinning me around a full 180 degrees (to the point where the cops initially thought I had been heading back from the hospital and not to it). By the time I was able to get out of my car, the SUV was long gone. I was able to make out a sole Cardinals decal, but not even one license plate number. Because I fortunately was unhurt, it took quite a while for the police to come to me and during this time, I had plenty to think about. My mind began racing—almost as fast as that car’s speed—and although I would not consider myself a superstitious person, how could this not be a sign? My first time visiting a hospital in medical school and not only am I hit by a car, the car doesn’t even stop to check on me or exchange insurance? Worrying this was going to set the tone for the rest of my first year, I finally was able to talk to the police (there was nothing they could do) and almost went home and called it a day (after checking in with the school). However, I felt a hardness come over me and thought I would be damned if I let this stop my surgery experience.

Taking it easy on my car that, at least to me, appeared drivable even in its poor, dented condition, I made it to the hospital. I met with the third year and after seeing the end of rounds, headed to the operating room. I had shadowed colorectal surgeries in undergrad, but this was a thyroidectomy—uncharted territory. The third year went to talk to someone and with a huge grin on his face told me, “we’re scrubbing in.” I was in shock. The most I knew about scrubbing in was how to help someone else pull their tag off of their gown (and that you had to walk with your elbows bent and hands up in the air). I mimicked the third year’s technique as we scrubbed down our fingers and scooped our hands under the water—making sure to avoid water dripping from our elbows back to our hands.

In the OR, I was able to actually stand right-up against the patient and see everything first-hand. The car accident at this point was not even a flutter in my mind. I was amazed I was getting to experience this life opportunity at all, especially as just a second-week medical student. The surgeon was remarkable, both at her work and how she taught her residents and students.

As someone who knew nothing about the thyroid, she explained everything to me, only enamoring me more with what I was getting to witness. Nearing the end of the surgery she called me over and said, “put your finger here,” pointing to the patient’s neck.

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Clearly this was a joke, so I didn’t move. It was not until I saw the third year give me a nod in that direction that I realized, this was no joke. I came over and she took my hand and placed it over a smooth, pulsating tube. “That’s the common carotid artery,” she said so casually as if it weren’t my first time placing my hands on someone’s internal anatomy. In reality, I must not have stayed there for very long, but to me the only indication that time hadn’t completely stopped was the constant rhythm of her blood moving through the vessel. I was amazed—what an experience. I was overcome with gratitude for the patient, the surgeon and the medical student for affording me such an opportunity. Medicine was truly the path for me. In that moment, a car crash seemed so arbitrary.

After that, medical school really took full effect and; while I definitely struggled, I loved it and felt I could do it. If there were a difficult week, I could turn to an endless supply of resources for help. My clinical knowledge and skills were growing.

Doctoring and my community clinical experience (CCE) may have felt uncomfortable or awkward at times, but throughout the year, I had changed so much and actually felt confident to talk to patients alone. My first doctoring video could now just be a cringeworthy joke to look at, rather than the reality of my capabilities. While I knew I still had a long, long way to go in all aspects of my medical school training and I was far from a person who did not make mistakes, I felt as though I was on the right path and had the tools necessary at hand.

The year had its ups and downs, but to me, truly culminated in my last CCE session of first year. The day went the same as every other CCE: I went and talked to patients by myself, came back to my preceptor and delivered my oral presentation.

However, there was a lull in the day where my preceptor sent me to go shadow a resident with a patient. I was not given any background on this patient, all I knew was that she was Spanish speaking and her daughter was with her.

The chief complaint became clear that the patient was out of her opioids and wanted a prescription refill. I (shamefully) immediately thought about the opioid epidemic and all of the talks where we were told that physicians need to prescribe them less. To me, they did not seem appropriate. Why not any of the alternatives we were taught? This colored the encounter with a slight judgement. It was not until the resident told her that her already huge osteosarcoma had grown in size and was now compressing her nerves even further that I felt the color drain from my face. This woman was in pain. Real pain. Emotional and physical pain. Pain that I had luckily never known.

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I immediately felt overcome with guilt about the hypercritical thoughts that had flitted through my mind. I thought learning that opioids do serve a very real, necessary purpose when prescribed correctly was going to be my lesson of the day Standing up and sitting down, shifting her weight from the cancerous leg to the other, it was apparent this woman was in pain, but she was one of the nicest patients I had ever encountered. She was answering every question so positively—her appetite was fine, she was doing well, she was happy. At these responses, her concerned daughter in the corner burst into tears announcing that her mother was lying to the resident—she was not fine, not even a little. This was all very overwhelming for me, but the resident remained calm, cool, collected and above all, empathetic. The resident refilled the meds and then told the patient she was about to move to another state to become an attending. It was only at this news—not her worsening prognosis —that the patient herself began to cry and hug the resident goodbye. A real goodbye. A forever goodbye. We left the room and only after exiting, did I see tears well-up in the resident’s eyes.

We discussed the encounter with the attending; I was given details about osteosarcomas and then I was sent home and they went to lunch. Leaving my last day of CCE, I realized I had so much learning to do. I had no idea how to react in those situations or treat a patient when a cure is no longer an option. Driving home, I suddenly had the compelling urge to shower. It doesn’t count as crying if you’re in the shower.

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Title: Bubbles The reflections on the surface of a hot spring in Yellowstone National Park distort the viewer's sense of orientation. _______________________________________________

DR. STEVE LIEBERMAN is an amateur photographer who enjoys shooting landscapes, architecture, and wildlife. He likes to challenge viewers’ sense of scale, orientation, and perspective.

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AUTHOR/ARTIST INDEX Beyda, David

40

Borden, Elizabeth

24

Cadigan, Megan

8

Dawson, Merrion

12

Eghtedari, Bibi

68

Ellsworth, Tanner

70

Farhadi, Dara

30

Gordon, Melissa

44

Hendricks, Amanda

42, 54

Kelly, Thomas L.

18

Khan, Mohammad

26

Koblinski, Jenna

74

Kravetz, Robert E.

36

Lieberman, Steve

50, 64, 80

lockmiller, mary catherine

48, 60, 62

Mohty, May

22

Nelson, Madalyn

46

O’Malley, Cheryl

34

Pena, Lorrie

66

Rakkar, Meher

14

Shah-Patel, Lisa

10, 56, 58

Smith, Charles

52

Stanzak, Gary

20

Yanez-Fox, Lisa

72

Zaidi, Sokena

32