ChArt Journal 2020

Celebrating the Humanities & Arts (ChArt)

The Humanities Journal of the Phoenix Biomedical Campus th 7

Edition

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

Volume 7, 2019-2020 ŠCopyright, All Rights Reserved

Celebrating the Humanities & Arts 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

Email: PBC-Journal@email.arizona.edu E-Journal: www.tinyurl.com/pbc-journal2020 Website: www.narrativemedphx.com Print Copy: www.Amazon.com

Dear Phoenix Biomedical Community, Greetings! We are pleased to present our seventh 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 selfexpression and artistic exploration, and may your own endeavors create harmony, balance and joy in your life.

On behalf of the editorial board – please enjoy!

Jennifer R. Hartmark-Hill, MD, FAAFP Editor-in-Chief

Student Editors Tanner Ellsworth Dara Farhadi Sara Pousti Meher Rakkar Tiffany Harmanian 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 Denise Moynihan & Ricky Bergeron –Print Collaboration Dr. Cynthia Ivy, OT, OTD, M.Ed., CHT– Cover Art Dr. Rosemarie Dombrowski– Keynote speaker - 2020 Celebration & Gallery Event

Title: Gratitude This blockprint was inspired by personal reflection of gratitude to those who donated their bodies so that we could teach and learn from them in the gross anatomy lab. The carvings contain stylized hearts to symbolize generosity and warmth, and flowers to denote the circle of life along with connectedness of all living things. The accompanying cross section of the proximal forearm characterizes the predictable yet individually unique 3-D relationships within the human body that we discover with each dissection.

_______________________________________________ CYNTHIA IVY is an associate clinical professor of Occupational Therapy (OT) at Northern Arizona University, Phoenix Biomedical campus. She is the director of the anatomy course for the OT students and teaches anatomy as a table instructor in the University of Arizona medical school. She continues to work occasionally as a certified hand therapist at Mayo Clinic. In addition to teaching, research and occupational therapy Cindy enjoys spending time with her four children and close friends, frequently centered around creating or enjoying various forms of the arts.

Title: First Poem of the Decade

Like many artists, I write poems in reaction to what I encounter in everyday life. I also reflect a good deal about quality-of-life issues, our political climate and how we as a species interact with the rest of life on earth. “First Poem of the Decade” is a poem I wrote shortly after midnight on January 1st, 2020. Hearing the fireworks reminded me of a conversation I overheard recently between a bus driver and another passenger about both animal and homeless shelters’ search for volunteers to keep those in their charge calm during the New Year’s Eve firework displays. Although I knew the overlap between veterans who suffer from PTSD and homelessness, I never thought about how they would react to fireworks, which I, similar to the rest of the public, tend to associate with festive occasions.

I hear laughter in the distance And bombs giving off delightful sparks For millions but the kennel prisoners And those trapped in PTSD-bandaged heads The bus driver said the shelters wanted volunteers That she loved going to city hall to lay on the grass For wide-open viewing of man-made meteor showers But the housed homeless who lost everything On government assignments went crazy And ran around like animals in cages So the fireworks were moved elsewhere For the thousands who left their innocent selves In fields we can’t imagine no longer conscripted They volunteered they had a choice we can Recite in a ritual for comfort Then go back to let those bursts sparkle In our eyes thinking hope is free

_______________________________________________ IMOGEN ARATE is a Phoenix-based Poet and the Executive Producer and Host of Poets and Muses, a weekly poetry podcast where she chats with poets about their inspirations.

Since its inception in December 2018, Imogen has interviewed over 60 poets, from diverse social-economic backgrounds both in the United States and abroad. As a poet, she has written in verse since her tween years, in four languages and published in two (English and French). While Imogen has always utilized poetry as a vehicle for self expression, she has also found it to be an effective therapeutic tool in coping with a recent trauma. Currently, Imogen is working with the Narrative Medicine & Health Humanities Program at the University of Arizona College of Medicine (Phoenix), Phoenix Youth Poet Laureate program and Oh My Ears through Poets and Muses as a collaborative partner.

Title: Blast Zone

This shot was taken at midnight on January 1, 2020. In that moment, we shed the weight of an old decade, and burst into the light of a new one. Strangers, friends, family: none of us knew what would happen between now and December 31, 2029. We didn't know what would happen in the next few hours. All we knew was the chaos, the smell of firework smoke, and the brilliant color-blasts ringing in our ears.

_____________________________________________ CATHERINE LOCKMILLER is a health science librarian. The best parts of her work involve researching and writing about critical theory in information science, and how it can build a resistance politics rooted in transformative justice.

Title: The Narratives of Veterinary Medicine

Training in narrative medicine has the potential to bring significant benefits to veterinary education and to the veterinary profession as a whole. This piece is an introduction to the narratives of veterinary medicine, with the objectives of generating interest in narrative medicine within the veterinary profession, and encouraging animal owners to share their own narratives with their veterinarians.

I. Lena stood quietly as I lifted her eyelid, observing her bright yellow sclera in stark contrast to her coal black face. The icterus was consistent with the significant increase in her serum GGT that I received back on her blood chemistry a short while later. I wheeled the ultrasound machine close to her abdomen, and the diagnosis came quickly: cholelithiasis.

Unlike humans and many other animals, horses do not have gallbladders. Bile stones form in ducts within the liver, and the underlying cause is typically unknown. Surgery is rarely attempted and not often successful when it is, so we try a combination of medical treatments to reduce inflammation, eliminate infection and dissolve existing stones. Some horses improve with this empiric therapy. Others, like Lena, continue to deteriorate. In the ensuing weeks she experienced severe diarrhea, a prolapsed rectum, hepatic encephalopathy, and intermittent epistaxis. Her liver function was rapidly failing, and with each new problem I communicated to her owners that if she was a human she would be on the transplant list, and we don’t do liver transplants in horses. Each time they refused permission for euthanasia, telling me to treat her symptomatically or they would take her from the hospital and find someone else who was willing to help her. They claimed to love her as a member of their family, but it was me that had to watch this sweet mare die a violent, heartbreaking death one Sunday afternoon. On post mortem, a dozen stones were found in her liver, the largest the size of a golf ball.

II. The old broodmare was buckling as she walked into the clinic, her pain refractory to the analgesics we rapidly administered. It was difficult to tell how much of the swelling in her abdomen was due to the near-term foal she was carrying, and how much was bloating from whatever problem was going on inside her gastrointestinal tract. We recommended immediate exploratory abdominal surgery and a C-section as the best option to save both the mare and the foal. The owner instead elected a terminal C-section, a procedure in which the mare would be euthanized under anesthesia after removal of the foal. The mare was anesthetized and dropped to the floor of a padded stall, and the surgeons deftly removed the foal. Physical examination showed no signs of prematurity or dysmaturity in the foal, a large filly. She was very alert and was soon attempting to stand. I began explaining to the owner that the foal would need plasma to replace the immunoglobulins she would have received from her dam’s colostrum, and that we would provide him with a feeding schedule for mare’s milk replacer based upon the filly’s weight. He told me brusquely that he was in a hurry and had to leave, picked up the filly, and began walking out to the parking lot. Pleas to allow us to administer at least a single liter of plasma to the filly fell on deaf ears, her owner insisting that she would “make it or not”. He crossed the parking lot to his vehicle, dropped the filly onto the dirty, dusty floor of a stock trailer, and drove off. That was the last we ever heard from him. This baby had not a chance for survival.

III. As veterinarians we practice within the limits of a triad composed of ourselves, our animal patients, and their human owners. In an ideal encounter, the veterinarian and owner have similar views on the value of animal life, the veterinarian possesses the knowledge and skills to help the patient, and a fiscally responsible owner has planned for a veterinary emergency. In times when a patient’s condition is beyond what veterinary medicine has to offer, we are fortunate to have the option of euthanasia. The word “euthanasia” means “good

death”, and when suffering is great with little chance for a positive outcome this is a blessing for our patients.

Discord can arise when there is disparity between the views of the veterinarian and the owner regarding the intrinsic value of the patient’s life, the role of euthanasia in veterinary practice, or the monetary value of veterinary services. In these instances, significant turmoil may result, for example, for a veterinarian who must euthanize an animal that could be treated successfully for a nominal investment from the owner, or an owner who feels pressured to run up a large veterinary bill when other financial obligations are paramount.

Attitudes towards animals and the veterinary care they require may be influenced by cultural and socioeconomic factors, and can be associated with strong emotions. But a social history of the owner is not a prescribed component of the veterinary examination. Communication focuses primarily on obtaining the medical facts of the animal’s illness and providing information about diagnostic and treatment options, and the owner’s narrative, which is inextricably linked to the course and outcome of the animal’s illness, remains buried.

In veterinary medicine, the narrative of illness belongs to the animal patient, and this narrative matters. The patient communicates things such as signs of pain and changes in quality of life to the owner and to the veterinarian with behaviors that are both speciesspecific and peculiar to that individual. But this communication is not spoken in words, it is passive, and they must choose to “listen”. Thus the patient has no direct input into decisions made regarding veterinary care. As seen clearly in the two cases above, both of which occurred very early in my veterinary career, the course of the patient narrative is dictated by human decisions, which are necessarily influenced by human narratives. In neither of these cases did I have great insight into the owners’ personal stories, but perhaps if I had, my ability to communicate with them would have been better and the patients’ narratives would have ended differently.

As a veterinarian with an undergraduate education in the humanities, my first exposure to narrative medicine was a coming home of sorts. The value of this training for veterinarians and veterinary students was immediately clear to me. Narrative medicine can bring a new dimension to the triad, resulting in better care to our patients, more compassionate service to their owners, enhanced understanding of the specific nature of the bond between a particular patient and owner, and insight into our own narratives and the perspectives and biases we are bringing to the table. As veterinarians we often debate the question “To whom is your greatest loyalty, the patient or the owner?” There is no single right answer to this question, but training in narrative medicine might help us achieve a better balance of service to both.

At this time, narrative medicine has made virtually no inroads into veterinary education, and it is my goal to change this. I’m currently enrolled in the Certificate in Narrative Medicine program through Columbia University, and seeking ways to incorporate these practices into the veterinary profession.

_____________________________________________ DR. MARGARET BROSNAHAN is an Assistant Professor of Equine Medicine at Midwestern University's College of Veterinary Medicine in Glendale, AZ, and is currently a student in the Certificate in Narrative Medicine Program through Columbia University. She received her undergraduate education in the humanities at Bates College in Lewiston, ME, and she is committed to integrating the concepts of Narrative Medicine and Medical Humanities into the veterinary profession

Title: sun dial and other poems

These are poems that I wrote while I was traveling through a very bleak period of depression.

They explore a mental space and a world in which it appears that life is drained of it's animating factor, and merely filled with material forms. While the tone is somewhat nihilistic, I hope that they convey a sense of being on the verge of piercing through the caul of inertia and despair. And that through the distinct absence of the narrator's spiritual identity or sense of purpose, they hint at it's burgeoning presence.

sun dial i remember those days when i swore that movement meant progress circling around and around. my shadow burned a bit darker each day, blackening into a deep well of ink each day became a quiet tell of time on my face, like a scar that peoples eyes would pass over quickly before looking away and in empty conversations, words flossed through my teeth as i spoke of time, and change and growth yet so much simply stayed the same. the numbers signifying important dates rolled around a little wheel, like the disc on a rotary phone

i was calling obsoletion and the line kept ringing, so i waited listening to the sound of my own breathing. everything sounded a bit flat, voices stretched thin over the line the ringing in my ears slowly turned into inching forward it was in those moments i could hear myself think; hear the clock in my chest ticking out my numbered minutes moving the river through me, as i sat still. my shadow was a dog chasing it's tail around and around.

_____________________________________________ ISARAE KOVAL is a writer and visual artist residing in Mesa, Arizona. Her writing has appeared in Sky Island Journal, Artspace QuARTerly, Poets and Muses Podcast and Phoenix New Times. Her writing often explores themes of anomie, alienation, and the personal and collective shadow. She is currently at work on her first collection of poetry, The Valleys of the Dead.

Title: HEARING IS A SENSE / LISTENING IS AN ART Quality communication is perhaps nowhere more important than when dealing with people who are ill and vulnerable. Hearing, an effective form of communication, is different from listening; the former implies perceiving sound, and the latter adds heeding and empathy. It is a privilege for a physician to hear patients speak of their emotional pain and talk about their innermost feelings. They suffer fears, regrets, anxieties and concerns and are anxious to be heard by an empathetic ear. Many patients complain that physicians are rushed, do not answer all of their questions and often listen with a “deaf” ear.

Physicians must carefully choose their words because language can be vey powerful. The imagination tends to run wild when the patient is ill and susceptible. Medical terminology or jargon must be avoided because it may not be understood. Seemingly innocent expressions, common medical parlance, can have a vey powerful negative effect on the listener. As the patient-physician encounter can be limited, each word can assume monumental importance. Properly chosen words can fall upon patient’s ears like gentle dew, the wrong ones like a chilling rain.

Most physicians are certainly not lacking in communication skills for they talk with peers, present cases at conferences or lecture clearly. When it comes to patients, however, it is almost as thought communication was taking place in a foreign language. Physicians will rarely admit this as they think they are effectively communicating despite evidence that patients often fail to understand or remember what is said.

For effective listening it is necessary to spend a little extra time in order not to appear rushed. Being attentive signifies interest and concern conveying the message that the patient is being heard, listened to and understood. Without appearing judgmental or directive but rather being serene, the physician will elicit an outpouring of the patient’s feelings. Sometimes silence will provide the best listening ear; not interrupting indicates respect. Friendly body gestures that express concern and interest are simple ways that the physician can communicate effectively. A simple touch of the hand, yet carefully observing professional boundaries, will convey empathy. “If not now, when?”

____________________________________________

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.

Title: Night Calls The shrill ring of the telephone awakens me from a much-needed sleep. I roll over and look at the clock “2:00 AM. ” Picking up the phone, I answer “Dr Kravetz.” On the other end the voice says “this is the answering service and we have a request for a house call, let me give you the information.”

It is mid-January,1960. I am in an Internal Residency program at the Brooklyn VA Hospital for a two-year period. Although there is a “marginally” acceptable salary, I have to moon light to make the extra money to make ends meet. All of the residents did this at that time in their training.

I get dressed, step out into the cold air and a street covered with snow. In this cold weather, the car does not start up that easily. My drive takes about 30 minutes. Arriving at the address for the house call, I enter the apartment and introduce myself as the doctor. A question I always ask is “why did you call in the middle of the night.” The answer is “I just was not getting better after a few days, or, worst yet, “I was out and just got home.” No consideration for calling in the middle of the night.

Most of the house calls are routine minor illnesses. Sometimes, however, there can be an acute problem such as a suspected heart attack or some impending abdominal catastrophe. All I have is my little black back with some basic medications and my clinical acumen. There is no emergency room backup, laboratory, or x-ray available to make the correct diagnosis.

One learns to become very proficient at making a diagnosis, whether this is a serious problem requiring immediate hospitalization or just something that can be handled with some practical advice and a few prescriptions. One had to become quite use to doing a skilled history and physical examination and coming to the correct diagnosis.

House calls “rarely” are made today. Everyone goes to the emergency room where they have a plethora of test, many unnecessary, and receive a diagnosis and a huge bill. I emphasize to the students that I teach at the College of Medicine the importance of doing a detailed and knowledgeable history and physical. I tell them that some days, even in the hospital, the computer system may be down and they have to rely on their clinical skills.

What do I receive for my house call? Up until midnight, my fee is $5.00 and after midnight, $7.00. I was thrilled to make $50 on a weekend. My, how times have changed. Now a house call is about $125, if one is even made. In retrospect it was excellent experience. As a side note, Nancy never would wake up when I left for these night calls or had to go to the Emergency Room. She slept through my absence. I never minded, as I was glad to see her get a good night’s sleep. ____________________________________________ 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.

Title: Locked In

I recently spent some time in the ICU shadowing at Banner Good Sam, and I came across a man that had been there for days. Things didn't look good. I observed him motionless on the bed as his healthcare team bustled around him. His eyes were open and staring at a bright fluorescent light on the ceiling. It was late. I felt tired and I wondered "what is he feeling?"

Deep breath in. Hold it.

Bright lights, beeping. Muted sounds.

“I’m here!” Deep breath out.

_______________________________________________

KRISTINA YANCEY is part of the Class of 2022 at the University of Arizona College of Medicine Phoenix. She graduated from The City University of New York-Staten Island in 2008 with a dual Bachelor of Science degree in Biochemistry & Chemistry, earned a master’s degree in Educational Leadership from Arizona State University in 2017 and completed a Graduate Certificate in Health Sciences through the Pathway Scholars Program at The University of Arizona College of Medicine – Phoenix in 2018. She enjoys research, community activism, singing Karaoke, dancing, and writing.

Most of all, she enjoys spending quality time with her husband and daughter.

Winner of The Annual First –Year Medical Student Reflective Writing Essay Contest

Dust swirled around my car and a dense brown cloud approached on the horizon. The high-pitched pinging of my phone’s alarm pierced the silence: Warning: Haboob approaching. Pull aside, Stay alive. I pulled to the side of the road following the line of cars in front of me as the dust stormed past my car.

It was the first day of the MBLD block in medical school. As a new Phoenix resident, I was just beginning to adjust to the desert landscape and arid 110-degree July desert heat. “Toto, we’re not in Kansas anymore,” I thought as I peered out the window. Of course my first day of official medical school classes would start with a giant dust storm. We had just finished a series of lectures from professors, learning specialists, and career advisors about what to expect throughout the next year. I was still wrapping my mind around all of the acronyms thrown at us: PRAB, PBL, GIMDO, CBI, SP, PAL block; it was like an alphabet soup of letters jumbled in my mind. The period of my life that I had been dreaming of was finally here, but was I ready?

Feelings of doubt swirled around in my brain every night before I went to bed: am I capable or smart enough for this? Will I succeed? As the dust roared around me, I sat back and settled in my seat. It seemed like the apocalypse was approaching. I guess all I could do was wait out the storm.

--------During my first few weeks of medical school, my white coat was still, well, white. It had been hanging up in my closet for the beginning of the year while I was spending time in the classroom. Putting it on, I still felt like I was my five-year-old self playing dress up in my miniature sized lab coat, using my toy stethoscope to treat my 5-year-old cousin’s myriad of made-up conditions. Donning my new attire, I entered into my first shadowing opportunity as a medical student following a Family Medicine doctor for half a day. The morning was spent seeing patients in need of diabetes management or chronic back pain issues, until another doctor interrupted us excitedly: “This next patient needs a pap smear, you should come watch!”

I entered the room following the attending, the resident, and a 3rd year medical student: like a trail of ducklings dutifully following the mother, careful not to be left behind. The patient was sitting on the examination chair, wrapped in a hoodie. I saw a backpack in the corner of the room. As the doctor started making small talk and preparing the room, we found out the patient was a third-year pharmacy student. “This is going to be a routine pap smear,” the doctor said as she explained the steps of the procedure to the patient. As it began, we all huddled closer to observe the procedure. The exam appeared to be perfectly normal until she saw a pink mass obstructing the view of the cervix. The physician consulted the attending doctor who agreed that it would be best to biopsy the obstruction. “What’s wrong?” the patient asked with concern in her voice. The doctor explained that there was a visible mass and she wanted to take a biopsy of it to learn further information.

This was supposed to be a routine exam. Even though this happened a year ago, I still remember this encounter.

She was so young; she was a professional student like me. Honestly, it could have been me. I never ended up finding out what the results of the biopsy were. I pray that they were normal.

I still think about that girl; I still feel the worry in her voice. I still dread the thought that something could be wrong, or that her health could be taken away from her in a second. When I am tired of the constant studying, the lists of drugs I still need to memorize, the jealousy I experience of friends who are on lavish vacations while I am stuck at my desk, I think about her. Studying in medical school began to feel different than it did in undergrad.

There are some of the same concerns: Should I go to lectures or watch them from home? Should I take notes from hand or use flashcards? Yet, the lists of diseases that I cram in my head are connected to future patients. My own feelings of inadequacy are a driving force to keep going, pushing, and striving for the best for my future patients.

This feeling motivated me through the rest of the year. When I met my donor in Anatomy class, the humanity of medicine was evident. I could not help but reflect on the pathways in life that brought them here and all the health care professionals they encountered through their journey: Who was the doctor that delivered them when they were born? Did the doctors perform physical tests to check the physiological functioning of their body while I lamented at the pathological processes that deteriorated it? While I traced every vein up my donor’s leg, I wondered where they had taken them in life. My donor was my first ever patient, yet, they were the one that cared for me. They allowed me to learn, grow, ponder, wonder, and marvel. When I got to scrub into my first surgery after Anatomy class ended, I knew I only had the privilege and knowledge of what I was about to experience thanks to them.

As the year progressed, I learned to give myself grace. During the physical exam in my Doctoring class, I accidentally dropped a dozen ear pieces on the floor; they all splattered across the floor, bouncing off of each other like marbles. I fumbled with needles as I attempted to practice giving shots on my fellow classmates. I wondered if there was a limit to the number of times I could cry in a day from feeling so overwhelmed. I stood there motionless like a statue when our simulation man started coding during a practice simulation during CBI. I was stretched thin, pushed to my limits, and began questioning myself and my inadequacies.

Despite this, I cannot forget the new experiences that allowed me to grow, connect with patients, and reaffirm why I wanted to be a doctor in the first place. I listened to the story of a former heroin addict and her struggle to try to reconnect with her family during her rehabilitation. I traveled to Chicago for the American Medical Association and represented my school as we voted on health policy that affects medical schools throughout the country. I attended my CCE and listened as a teenager talked about wanting to throw herself in front of a car to escape the turmoil in her family. I learned to trust my voice as I answered Attending’s questions during shadowing. With the looming test date of Step 1 next year, I know that I have many more challenges ahead of me. Self-doubt will still pervade my thoughts. However, I am still proud with how far I have come and know that I can carry that with me throughout the remaining years of medical school.

-------I reclined my seat and stared up at the skylight in my car above me, but all I could see was a thick brown cloud.

Before I knew it, the dust storm had finished as quickly as it had started and rain began pouring down, creating a thunderous din. I stared out the window, watching the raindrops fall from above, as my mind wandered and reflected on the first patient panel we had a week ago during the Introduction to Medicine block on breast cancer.

I closed my eyes and I could see each of their faces on the panel, one by one, down the row, until my mom’s face popped into my head.

My mom passed away from breast cancer when I was 16. I couldn’t believe that the first week of medical school featured a disease that largely shaped my motivation and reasoning for becoming a doctor. I remember the clumps of her hair falling out in the bathroom, going to visit her in the hospital after softball practice, and helping her walk with the assistance of a walker from the bedroom to the bathroom. I also remember how her eyes squint when she was laughing so hard, how she spent hours working with me on my tennis serve and hearing her stories of working at NBC when “Friends” was the hit TV show. She had breast cancer, but that was just a small part of who she was. The patients on the panel had breast cancer, but that was just a small part of their journeys as well. I wondered what each of those women felt when they first heard that they had cancer and if it had shaken their families’ worlds like it did to mine. I wanted to say to them: I see you, I am here for you, and I am listening.

The line of cars in front of me began to move, jolting me from my reverie. As I started moving forward, I hit shuffle on my Spotify for my drive home. “Let it Be” from the Beatles came on the stereo. It seemed like serendipity. As someone who worships John, Paul, George, and Ringo, I knew that the song was inspired by Paul’s mother, Mary, who died from cancer when he was 14. When the Beatles were gaining popularity and the chaos of Beatlemania was at its height, she came to Paul in a dream and told him that everything was going to be alright and to just let it be. I knew all the lyrics, of course, but really listened this time. Paul sang:

When I find myself in times of trouble, Mother Mary comes to me, Speaking words of wisdom, let it be.

And in my hour of darkness she is standing right in front of me, Speaking words of wisdom, let it be.

The storm passed, like they always do. I got out of the car and, for the first time all summer, felt a cool breeze on my skin; a welcome relief and a gentle embrace. I started to feel like I was home. Despite the uncertainty the next four years of my life would bring, I was ready. It was time to embrace the unknown, conquer my fears, and settle in. I was letting it be.

____________________________________________ KELLY HABIB is a second-year medical student at the University of Arizona College of Medicine – Phoenix.

She was awarded The 2019 University of Arizona College of Medicine – Phoenix First Year Medical Student Growth and Self-Reflection Writing Award. This award was founded by Dr. Elaine Niggemann, and is presented after the first year of medical school to one student annually by the Program for Narrative Medicine & Health Humanities, in the Department of Bioethics & Medical Humanism.

Title: The Unrevealed

I was asked to do a workshop on body mapping to honor the donor for the anatomy lab. This poem was inspired by my memory of having the opportunity not only to meet one donor but also to TA Anatomy at Creighton Medical school . I believe that the human body is the ultimate creation from God.

_______________________________________________ DR. GRACE A. HAYNES is a highly regarded Family Medicine physician with a distinctively integrated approach to healing through medicine, art, and ministry and genuinely compassionate patient care. A graduate of Creighton University School of Medicine and University of California, Davis, Dr. Haynes has served patients in private practice, as Medical Director for Verve Wellness Center, and as Department Chair of Family Medicine at Thomas Davis Medical Center. She is the founder of Grace’s Song HMAM, a Phoenix-based non-profit. She has served as a medical missionary in Gambia, Liberia, and Malawi.

Title: PHQ-2

I wrote this piece during a Narrative Medicine and Health Humanities event led by Rosemarie Dombrowski and students of her Medical Poetry class as ASU. As a member of Street Medicine Phoenix, I often work with homeless patients and this poem was an opportunity to explore the first time I saw a patient I'd worked with in the clinic out on the streets. The man I'd worked with had only the week prior disclosed to me that he was contemplating suicide, and I was able to navigate him to more helpful resources; it was no small victory to me that he left the clinic more hopeful than he had arrived. But, as relieved as I was to know that he was still around, seeing him in such a vulnerable position that day was difficult to reconcile. It was a moment that brought me face-to-face with the reality that we really have no control over what happens after a patient leaves our care, and ultimately how important it is to strive to make the most of what time we do have to make a difference.

_____________________________________________ MEHER RAKKAR is the intern for the Program for Narrative Medicine and Health Humanities, and a member of Street Medicine Phoenix. She is currently in her gap year before starting medical school this July and is so excited to finally start her journey in the field she loves!

Originally Published by Stories-In-Medicine https://storiesinmedicine.wixsite.com/uaphoenix

Title: The Impact of a Single Handshake Pockets of pus in his belly, legs edematous, completely exposed and vulnerable.

Intubated and sedated, left with an open abdomen.

Doctors talking about him instead of to him.

Changing his dressing, he grabs my hand; squeezing it, whispers a gratuitous, “thank you.”

This was a patient I encountered while on my very first surgery rotation. He had been admitted to the VA SICU for a portal vein thrombosis, and during his hospital course, he acutely worsened with an uptrending white count and mental status changes. My first time meeting him was as he was rushed to an emergency exploratory laparotomy. We opened him up, and my resident tells me that it’s my job to “keep his shoes clean” since we knew the patient would lose a lot of blood. As I mentioned, his abdomen was full of these walled off abscesses. We cleaned him up the best we could and left him with an open abdomen and a wound vac. He subsequently required 3 more surgeries to wash out the belly and finally close his fascia.

The experience I decided to write about was when I went to change his wound vac one Saturday while I was on service. It was my first time changing one by myself, and I was still early on in my third year, so I felt awkward, nervous, and would periodically become lost in the hospital, feelings that are all too familiar during clinical rotations. I wanted to do a good job for this patient, so I asked the nurses to help me set up the procedure and gather my supplies while we gave the patient more pain medication to make it more bearable. As stated, he was intubated and somewhat sedated, but he was awake enough to acknowledge me and understand that I was going to do a dressing change. I was nervous and didn’t want to mess it up, and I knew he must be in pain; I made it a point to talk to him and let him know what was going to happen and that I would do my best to make it as painless as possible. Once the dressing change was finished and I was about to leave, he grabbed my hand. He smiled and let out a whisper letting me know that I had done a good job.

I followed this patient throughout his hospital course and subsequent wound vac changes, and I watched him regain his strength and personality. By the end of my time at the VA, he was being discharged home, and I was grateful to have provided him with some comfort during his stay in the hospital. I will forever treasure that moment when he grabbed my hand because it reminded me of the humanity behind all of our patients, something that can easily be forgotten when they are in the ICU (more machine than person) or in surgery (literally their insides on the outside). They have their stories to tell, and I really enjoy hearing them. It makes my work feel more meaningful and that I am actually changing someone’s life rather than just fixing their diagnosis.

MEGAN BURKE is a fourth year medical student at the University of Arizona College of Medicine Phoenix. She was born and raised in Phoenix, attended Xavier College Preparatory for high school, and received her BS in Biology from Loyola Marymount University. She is pursuing a career in pediatrics and is specifically interested in childhood exercise, nutrition, and mental health. In her free time, she enjoys anything active (yoga, spin, and running) and spending time with her family here in the Valley.

Title: October 2019

This painting is an abstract expressionist piece that explores my fall of last year. Many mediums, colors, and textures jockey with each other on the canvas. Bright and bold, yet contained to a 20 x 20 neutral space, it examines a tempestuous period of time.

_____________________________________________

ELLEN CYRIER is Senior Coordinator of Undergraduate Recruitment at the University of Arizona.

Before moving to the Grand Canyon state, Ellen obtained her undergraduate degree in Fine Art from The University of Iowa. Since graduation, she has continued her artistic efforts, creating her own art business and website, while also pursuing her interest in higher education. Now with a Master's degree complete, and much more free time to be had, she is amplifying her creative pursuits and making even more art. Ellen enjoys exploring all mediums, with special attention focused on texture and light in each piece. When not clicking through her film camera, Ellen can be found on the tennis court, or enjoying the beautiful Arizona weather.

Title: The Surgeon That Accepted Me

The summer before my freshman year of college I decided to reach out to a bunch of different surgeons and doctors to shadow in Phoenix. A kind cardio-thoracic surgeon at Mayo Clinic, known as Dr. Jaroszewski, accepted me as a shadowing student during the summer. I was turned down multiple times, but the acceptance of this surgeon showed me the importance of putting yourself out there as a pre - med and understanding that as a future doctor, I strive to be accepting to students just like her. My favorite memory during this experience was that the she noticed that I was short, and asked someone to get me a stool so that I can see the heart. The experience of watching this surgery and seeing the beating heart for the first time was indescribable. I will forever hold this experience close to my heart (pun - intended).

I called to see if they would accept me I would have never thought they would I just graduated high school But to them, who am I? 2 weeks later standing on a stool Wonderfully astonished No words to describe The beating heart that was two feet away And the kind surgeon that Accepted me ______________________________________________

TIFFANY HARMANIAN is currently a First-Year Student studying Medical Studies at Arizona State University in the Barrett Honors College. Her interests are writing poetry, science fiction, and studying at hipster coffee shops in Downtown Phoenix. She is currently in the works of establishing a Medical Humanities Club at ASU to promote the importance humanities-based involvement as pre-health students.

Title: A Study in Scarlet

I wrote this case story after a patient encounter I had with catatonia. I watched a woman struggling to make herself heard be restored to nearly her full faculties with an Ativan Challenge. We learned a lot about her in the coming days and it was a good experience to see her recover to the woman she used to be. The most striking feature of her presentation was her simply repeating the word "red," over and over again.

During our medical school training, we try to disentangle the Gordian Knot of the human body, and stand in awe of such a task - so many different pathways, and all missteps lead to illness. As we walked through our last Steps of pre-clinicals, we prepared for the transition into the wards.

Starting my first day, I was excited, and anxious. I could imagine the beating of my heart, and I awaited the stories that would be etched in.

Red red.

The first day in the hospital was straightforward - an orientation to what will come. Lectures and expectations aimed ever higher. Walking through the hospital, the physical tolls on the patients were apparent. There were people in wheelchairs, people with altered gaits, and some who wore their diagnosis on their face. Shuffling, shifting, the patients stumble through the hospital. For some, the rhythm of their feet and coughs is drowned out by the moans and anguish of those who suffer. The crack of the cough, heard a thousand times, underscores the background noise. Red alarms can begin to lose their meaning. The patients’ stories are written into how they move, or in the psych ward, into their very minds. However, it is so easy to conflate the person and the disease.

One patient, whom I saw and later admitted to our unit, underscored the importance of remembering every patient as their own person.

Red red. Red red!

These words galloped their way out of a small, frail woman. She was exhausted in her hospital bed, her sister at her side. As we walked into the room, this small woman barely turned her head to look at us. She was profoundly diaphoretic, her hair slicked back and body glistening from her frenetic pace. Frail arms, worn down by time, appeared trapped at her side - flexed but immobile. Her body appeared to not obey her will, and her arms had this waxy flexibility. As my resident introduced us to the patient and her sister, he bade me to try to take her history. I meekly introduced myself and asked how she felt. I then received a hail of red.

Red red. Red red. Red red.

My resident took over, asking the sister for the patient’s history and what happened. As we discussed the patient, she would look at us, and I stood there trying to understand the magnitude of what has happened to her. Her legs were still, hidden under a cover; no motion or activity. She peppered the red rainfall with the occasionally stated “yes.” She once said the word helicopter.

Looking out the window, we could see the Banner helipad with its barnhouse colors. Her sister had purchased a small cardinal red bear from the hospital gift shop in a desperate attempt to give the patient something to hold onto. The patient cradled the small bear, when her arms had the strength to hold it, but sometimes it was too much. She had an erythematous lesion along her left lateral arm which she tried to keep away from probing hands. As she lay in her bed, she was exasperated, her mouth belting out reds and consuming the remnants of her energy. Her head could barely rotate, and her body was stiff and noncompliant. At one point she saw my name and interrupted her streak to repeat it. I handed her my badge and she fumbled with the little thing. She wanted to say something, but it was drowning in the red sea. Her eyes hid a gleam of understanding, the tiniest spark of soul; however, they appeared clouded and unfocused. Her soul was held back by forces her mind could not conquer. As I try to untangle what was happening, my resident readies two syringes. One, a half a milligram of lorazepam, the other a saline flush. A gentle push of the syringes into the patient, and the miracle happened.

Red …. Red ….

She slowed down. Her galloping pace became a cantor, and something was stirring behind her eyes. As her verbigeration slowed down over the next 30 seconds, she began to look around more thoughtfully. She studied us in more detail, the alarm in her words subsided. Over two magical minutes, this woman who before appeared obtunded and trapped in her own world was able to reach out to us. She took my hand, and told me her name and how she was feeling. She introduced herself and her sister - tired but happy. Over the next 15 minutes, her control of her body returned, and for the first time in two weeks, was she able to carry on a conversation. She asked me about my name and who I was. I told her, and it was a great meeting. It feels so strange to meet the same person twice within the span of 10 minutes. She began to laugh and ask for things she needed, and asked us to be careful of her sore arm. Her eyes now danced across the room, absorbing the scene and opening wide with wonder. Beautiful eyes that shone bright, like the soul blazing behind them.

Mohammad?

I saw her again after the weekend. I was able to gather her history and really speak to her about what drives her and who she was. She was a woman born into a foster care system, who grew up through high school struggling with bipolar I disorder. She lamented the hardships of her youth, and channeled her pain into care for newer generations. She would put her all into something some days, and not others. She was not dumb, and told me she would sometimes try to get an A+ just to spite her detractors. In fact, the reason she chose the word red in her catatonic state was because she knew “code red” would symbolize emergency, and she was trying to communicate this with us. She felt anxiety and irritation at her inability to communicate, so she tried to sound the alarm. However, the marks of her condition followed her through life, as she struggled with coming to terms with herself and who she wanted to become. She chased life and sought out the love of a military man, but would be hounded by the shadows at the back of her mind. She would fight to become the most loving and caring woman she could be, and sometimes in the war of life, you lose a battle. She would occasionally lapse and require psychiatric assistance, but she always got up. She is the loving great grandmother to multiple children and wants to shower them with love. She dreams of seeing Hawaii once more with her husband to relive her happy memories. She loves to read history, and was a big fan of Muhammad Ali’s boxing career, which was why she reacted to my name when I originally saw her.

A patient is a story, and we read but a chapter in their life’s journey. She is not merely a patient, but a teacher of life’s many lessons. To care for her, helping play a small part in her care and being able to attend the patient’s needs is a reminder of the blessings that come with the practice of medicine. We work so that the soul can heal, the mind can grow, and the heart can love. No amount of reading could have prepared me for my study in scarlet.

_______________________________________________ MOHAMMAD KHAN is an MSIII and home-grown. He enjoys archery, poetry, tea and having no idea what specialty he is interested in! He loves to dabble and experience as much as he can, and he hopes he brought that to this work.

Title: Blue

The practice of veterinary medicine consists of three narratives, those of the veterinarian and animal owner, along with the wordless narrative of the patient. Making the decision to perform euthanasia is a difficult one, even when made with the patient's best interests at heart. For me, the geriatric horses that have willingly given their lives to fulfill the sometimes selfish desires of humans are the hardest. We don't want them to endure true suffering for even a day, but we don't want them to miss one glorious day of this life we have all been given. We watch them day by day for silent indications, never being quite sure if the time we chose was too soon, or too late.

Separating your life from this world is a burden of ambivalence.

We read the gloomy prose of your slow rise,

your angular form, the crimped lines of your feet.

We waver at the punctuation marks, a deep gaze from familiar brown eyes, your warm breath, the softest touch of your nose.

Today was a bad day.

Perhaps tomorrow will be better.

Perhaps not.

Perhaps it’s time.

Cerulean liquid flows from my hand to your heart.

Curious liquid!

One moment before, an anxious glance, a nervous dance.

Trust born of time brings calm.

One moment after, a life story sinks to its knees.

Ragged breath for us both.

Deliverance or betrayal?

That question, remanded to my heart for eternity. _____________________________________________ DR. MARGARET BROSNAHAN is an Assistant Professor of Equine Medicine at Midwestern University's College of Veterinary Medicine in Glendale, AZ, and is currently a student in the Certificate in Narrative Medicine Program through Columbia University. She received her undergraduate education in the humanities at Bates College in Lewiston, ME, and she is committed to integrating the concepts of Narrative Medicine and Medical Humanities into the veterinary profession

Title: Unfinished Lace I was much younger than I am now when my aunt was diagnosed and then died from complications of Alzheimer's Disease. The experience of death in a family seems to either strengthen or weaken bonds between those who remain living. I continue to reflect upon events and different people's perceptions of those events when I recall what happened when various family members, particularly my aunt, died.

I was in my 20s and a busy college student when my Aunt Jane was diagnosed with Alzheimer's Disease. It’s not exactly a disease, the way I think of other diseases. There's heart disease, where people sometimes need a surgery and must modify their behaviors. Kidney disease, which can lead to thrice-weekly trips to a clinic for dialysis, being kept alive by filtering apparatus only to continue life wearing baggy tops, with no opportunities to jump rope or ever swim in the sea again. But Alzheimer’s Disease is a quiet shadow of a disease, showing up gradually.

First, she was frequently lost. While driving. In parking lots, she did not recall where she parked.

Then, in her own backyard, forgetting which way to walk back up to the house - in a yard she'd lived with for 60 years. Then Aunt Jane left the oven on. Lost her keys. Not that unusual for someone in their late 70s. This is the aunt who babysat me when I was a kid. The one beam of light in some long, dreary weeks. She taught me to hand sew and tat (that’s lace-making with a little metal shuttle, and I wished we’d completed more of our projects). She also taught me to melt butter and chocolate and to make all kinds of desserts.

Aunt Jane had a whimsy about her, a joy that was all her own. When these memory lapses began, even she did not recognize them for the enemy that they were. "I'm gettin' old," she'd sing, and sip her tea or light up a skinny clove cigarette and laugh. Her hugs smelled of Final Net hairspray and spice, maybe from the kitchen, maybe from her smoking. But she'd hug you, then look you in the eye and say, "I'm happy to see you!" And she meant it. You just knew. Her house always had treats, not just melted-into-the-wrapper hard candies or stale crackers, but baked goods. Ginger cookies that somehow remained soft for days after baking. Tiny shortbread squares lined up in a tall glass container with a lid. And homemade cheese crisps. She didn't even have a recipe for that one, but they always tasted cheddar-y and like they belonged alongside a salad in a swanky restaurant.

I went home from college only when I could a get ride. The campus was two hours from my folks' house. Aunt Jane had babysat me all the time when I was a kid, so any visit to my own parents included a visit to her as well. When I learned about the Alzheimer's, I almost didn’t believe it. I thought maybe the new doctor didn’t know about her whimsy, her attempts to patch anything and everything - jeans, book bags (what we used in the 1970s when backpacks were only for hikers), and broken hearts. I thought maybe she finally got so full of everybody else’s tears and secrets that she started to leak, and they just thought it was Alzheimer's, but it wasn’t.

I kept going to see her when I could, and gradually the conversation shifted to be mostly me talking and her just nodding and smiling. The treat jars began to be filled with pretty rocks and shells or dried flowers from her garden. The shuttle she used to tat with sat still on her little side table, and even the TV remote, which had been a trusty friend to her, rested under a layer of dust. Once on a visit, she poured us tea, which she'd always done, but gave me one of the tiny cups from a child's tea set rather than the regular sized cup and saucer she was using. I smiled and just drank more slowly. Then there were days when she forgot to put on underpants. Or any pants. And days when she’d put up a fight when asked to brush her hair or else pull it up in a tie.

And then later, there were times when she was mean. Not grouchy or sharp-tongued, but actually mean, complaining about the mailman or a neighbor, making me wonder if she’d been having those dark thoughts about us all the whole time, and maybe Alzheimer's was what happened when your brain just could not process any more kindness and it had to sit quietly or else pour out evil thoughts and words.

No, that's not what the MRI said, though. It had been many months and batches of cookies ago when she was last truly in control of her own thoughts, hands, and hugs. Finally, the Alzheimer's Disease became her constant companion, and it put her to sleep most of the time. She stopped laughing, and then stopped smiling, and then stopped even opening her eyes.

"Mom, I'm home!" I got a ride from Columbus to Perrysburg with a friend for the fall break from school. The house smelled like October - fresh apples in a bowl on the table, coffee kind of burning still in the pot from a long day, and the cool air from open windows, probably the last weekend the windows would be open that year.

"Oh, good, let's go see your Aunt Jane," my mom spoke without meeting my eyes. She pulled on a long sweater-coat and grabbed her keys. She hugged me in a dismissive way, in passing, as I dropped my bag on the floor, pulled one little box from its side pouch, and followed her out to the car. "It's been a long day, I'm glad you're here," she said again without looking at me. "The doctors don't know how much longer Jane will last. She's hardly been eating at all, she just sleeps. Now, don't be upset, but she probably won't recognize you."

Tears were collecting in my mom's eyes and she sniffed one of those ferocious, child-like sniffs.

Jane was her oldest sister, the one who also babysat her when she was a girl. Their adult lives did not have many parallels - my mom always worked outside of the home, and Jane did almost everything you could inside of a house - cooking, sewing, building furniture for doll houses, playhouses, and then little tables for her own things. Mom married one man and stayed with him for decades, while Jane had married several and loved more. But Jane found it easy to love people and to laugh. As girls, the two had winced and shuddered under the same angry hands of their father; had run and hid from anxious farmhands; and said the same prayers for their mother. But as they matured, their lives took different turns, two very different flowers in the same, large field.

Hey, Aunt Jane," I whispered as we entered the house. My cousins had been taking turns sitting with her, and a nurse from the Hospice facility was there almost all the time now.

"She can't hear you. She's like ... gone," my cousin Mary got up from the chair beside my aunt's bed.

"How about I do some dishes?" my mom suggested, as she busied herself almost immediately in the kitchen, which was in disarray. The counter looked like it had weeks' worth of dishes and paper plates, pizza boxes and candy wrappers left beside what appeared to be unopened mail.

I sat down and slinked out of my coat. I warmed my hands a bit by blowing on them, then got the box out of my pocket. It had my shuttle we'd used for tatting, and a single clove cigarette. I'd stolen that cigarette from Aunt Jane when I was a few years younger. I'd kept it in a jewelry box in my dresser, and even took it took it with me to college, kind of a good luck charm, I guess. Though I loved them, I'd never planned to smoke it because then it would be gone.

I gently reached for Aunt Jane's hand. "Hey, it's Jennifer. I brought you something." She squeezed my hand and my heart swelled in my chest. I forced her fingers open and slid the shuttle into them.

She cupped her hand around it, then fidgeted a little. I think she knew what it was. Her hand did, anyway. Then the cigarette, I slid it back and forth against the skin under her nose, rubbed it a little on her upper lip. She opened her eyes; she grinned a thin smile as she looked me.

The obituary said she died in December. I could not go to the funeral because I had finals that week and no ride home, anyway. To me, she died the last time we were together. To me, she's still with me, in the tiny box with the shuttle and the clove cigarette. _____________________________________________ JENNIFER PRIEST MITCHELL is a native of Ohio, and has worked at the University of Arizona College of Medicine-Phoenix since 2016. She worked for the Oregon Health and Science University for 10 years before moving to Phoenix, and for the Ohio Attorney General's Office prior to that. She is a graduate of Capital University in Columbus, Ohio and is currently pursuing a master's degree at Arizona State University. Jennifer enjoys hiking, baking, and writing for a variety of audiences. She is a wife, mother, and human companion to two rumbly, tumbly rescue dogs.

Title: sun dial and other poems

These are poems that I wrote while I was traveling through a very bleak period of depression.

They explore a mental space and a world in which it appears that life is drained of it's animating factor, and merely filled with material forms. While the tone is somewhat nihilistic, I hope that they convey a sense of being on the verge of piercing through the caul of inertia and despair. And that through the distinct absence of the narrator's spiritual identity or sense of purpose, they hint at it's burgeoning presence.

at 2 am the world ends. but the din lives on, spiraling through my ears

neighbors noisily clank up a metal stair, laughing as cars roll drunkenly to wherever home is tonight. we all stumble through our last days knowing nothing

it's all we can bare really. everything else is too painful. the last shot is swallowed with a grimace as the lights come on. no one is as pristine as when they walked in.

speaking in babbles and incoherent slurs about the most meaningless things.

_____________________________________________ ISARAE KOVAL is a writer and visual artist residing in Mesa, Arizona. Her writing has appeared in Sky Island Journal, Artspace QuARTerly, Poets and Muses Podcast and Phoenix New Times. Her writing often explores themes of anomie, alienation, and the personal and collective shadow. She is currently at work on her first collection of poetry, The Valleys of the Dead.

Title: Adventure the Land

This piece was inspired by my seven-year old daughter who said that she wanted to “adventure the land” as we were planning a family trip. It truly allowed me think from a child’s perspective how wonderful and exciting the world is and how easily we as adults forget and lose that feeling as we get enwrapped in our daily activities. Take in the beauty around you and remember that beauty does not have to be from a foreign land or famous building, but can merely be from looking into your child’s eyes or hearing your patient’s sigh in comfort. This photo was taken by me when we were on a trip to Seattle to "adventure the land".

You said you want to adventure the land I will provide you with a hand.

The world is full I want to show you without any rule.

The world has so much to offer Please look at all just a bit softer.

I want to show you it all Each and every crevice and wall.

Smile and take it all in

It will all look so different with just a spin.

You said you want to adventure the land And I want you to see every mountain and sand.

Please keep that same awe And never become so raw.

Care till the very end Stay curious for every bend.

Stay safe and smile

And always remember each and every mile.

I want to show you it all Remember to stand proud and tall. _____________________________________________

DR. LISA SHAH-PATEL is the Director of Career and Professional Advising at the University of Arizona College of Medicine-Phoenix. She completed a seven year combined Biomedical Sciences/Doctor of Medicine program and received her medical degree from UCLA School of Medicine followed by Radiology Residency at St. Luke’s Roosevelt Hospital in New York City. She completed a fellowship in Breast Imaging at Mayo Clinic in Arizona and currently works as an independent contractor reading screening and diagnostic mammograms and performing ultrasound guided procedures and stereotactic guided biopsies. In her free time, she enjoys spending time with her family, going to the beach, skiing, and traveling.

Originally Published by Stories-In-Medicine https://storiesinmedicine.wixsite.com/uaphoenix

Title: My First Rotation of Third Year Medical school is scary.

Intimidating.

Daunting.

Sometimes I wonder how I am standing here, Already in third year, Still thinking they made a mistake by letting me in.

I was born and raised in Mexico and only spoke Spanish until I was about 15 years old. I moved to the US in high school and struggled because of the language barrier to the point that I lost my confidence. I got into medical school, it wasn't until I was 26 years of age, and because of my MCAT score it was through a bridge program. The reading section on the MCAT, especially, was not good enough. Somehow, I managed to make it through my school classes and eventually finished second year. Then, Step 1 happened. I do not believe I have ever felt so inadequate like I felt during this time. I studied passionately for 12-16 hours every day for 5-6 weeks. Only to find that I ran out of time during each block in my exam, because my English reading proficiency will never be like a native speaker. My comprehension will always take me a little longer. Even before getting my score back, I felt like a failure since I knew I could not perform to my potential and that took a toll on my confidence.

Somehow I started rotations and the nervousness combined with excitement kept me going for the first couple of weeks of my rotation, yet that feeling of failure followed me. I had to relearn another language of OB/GYN acronyms and was daunted with all the things I did not know and the responsibilities I felt like I could not accomplish. Then, a doctor forced me to present about a patient who I was not supposed to present and demolished me in the middle of rounds with other students, residents, and nurses to witness. A lot of what he said is a blur, but somewhere I remember he said he could not understand what I was saying because of my Spanish accent. That is when I realized I should not be here. Immigrants are not supposed to go to medical school, they are supposed to find a stable job, have a family and give their children an opportunity to grow up in this nation and live the “American dream,” right?

What am I doing here?

Should I even be here?

The medical student impostor syndrome had never been stronger or more discouraging. I was so afraid about faculty finding out about me and dropping me from the program. The impostor syndrome I was experiencing was extremely debilitating and at some point it handicapped my performance in my rotation. I doubted even the way I walked; I constantly looked at my badge to make sure it said Ana Meza-Rochin and not someone else’s name. I lied about my medical knowledge sometimes when doctors asked me questions so that they did not have any expectations of me, or so I would not have to take the risk of failing by giving the wrong answer. I even told some doctors that I would rather shadow and observe instead of seeing a patient on my own because I felt so afraid and incapable of doing so, whereas a few months back I would have fought to be given that responsibility and opportunity to show them what I can do. I was not that brave girl who fought until she reached her dreams anymore. I was a different person.

Thankfully, I had great preceptors who taught me with patience and made me feel comfortable doing simple tasks such as finding a baby’s heartbeat with Doppler ultrasound, measuring fundal height or asking simple OB questions. Later, I was sent to see a new OB patient by myself. She had a Hispanic last name and her mother accompanied her. When I walked into the room the patient spoke to me in English and I followed along. I did the typical questions and physical exam and then the midwife came to see the patient.

As the midwife asked the patient about information in the chart, the patient’s mother who had been carefully observing me and looking at my badge whispered to me, “do you speak Spanish?”

I moved closer to her and away from the other conversation and whispered back, “yes.”

Smiling she asked, “are you from Puerto Peñasco?” a small town in Mexico, and confusedly I said, “yes”. Before I could ask her anything else, she asked, “Is your mother Dr. Rochin?”

I stood quiet for a couple of seconds in denial echoing that faintly familiar name in my head, kind of like trying to recall a dream. “Yes,” I answered.

“Your mother was my doctor in Mexico and she delivered my children including her,” as she pointed to the patient. “It is amazing to see the daughter of my doctor taking care of my daughter and her child.” She said that with the biggest smile and with tears in her eyes.

Speechless, I walked out of that room and sobbed. Something happened to me in that moment. First, by reminding me who my mother was, I was reminded of who I was, which I feel like I had forgotten. Second, I was reminded of the why. The why… it was like something fell from my eyes that allowed me to see further than my own frustration, fear and feelings of worthlessness.

I understood where I was coming from, what it meant for me to be standing there regardless if I felt competent or not and where I was going. The “what am I doing here?” question due to feelings of inadequacy became more like a “WHAT AM I DOING HERE?” out of excitement for doing the impossible.

Immigrants often do not get the chance to stand on the top of mountains of opportunities, of distinguished careers, of success, of believing they can do anything they can dream of not only for their children, but also for themselves. I realized I had been focusing on all the things I did not know, on all the ways I felt awkward, not ready, not worthy, helpless instead of focusing on how far I have made it, the great privilege I have to be training to be a doctor, all the lessons hidden in each day’s struggles, and the new adventures awaiting for me tomorrow. That just blew my mind.

Third year is a fun, hands-on year but also a very challenging one. Challenge comes in different forms and directions for each student and sometimes it feels that we are the only ones going through adversity. I believe it is important to focus on the why, on the good, and yes, always look forward but also look back. Looking back is an essential reminder of the great obstacles that we have overcome, all the growth we have endured and all the things we now know. It is hard to realize those things when we are only surrounded by great physicians who constantly challenge us to think more critically and ask more of us each time to make us better doctors. Looking back reminded me of why I am devoted to where I am going and thankful for the challenges that have brought me to where I am.

_____________________________________________ ANA MEZA-ROCHIN is a fourth-year medical student at the University of Arizona College of Medicine-Phoenix. She is an immigrant from Mexico who moved to the US in high school. She obtained her B.S. in Health Sciences from Arizona State University. She is interested in Surgery with a specific interest in Plastic and Reconstructive Surgery with an emphasis in Global Health. In her free time, she enjoys traveling and spending time with family.

Title: Jynx From “Four Poems from Otherworld,” these poems speak to the gross disservice that both speculative and historical narratives do to Black people, specifically in popular representations of Black womxn, mxn, and Black death.

go Jynx ! lovely kiss the streets to sleep / wild Jynx ! telepathic voodoo queen dark skin / darker than an asphalt pit / pink lips / puckered like a fall tulip two hills / on your chest like twin kingdoms / swang hips / shake up cities like branches yo Jynx ! you deserve to win pageants / you’re pretty / powerful and the baddest / the people who are petty and jealous also chase your cool / they’re cruel and callous everyone wants to avoid / attack and acquire you / nobody openly admires you / obsessed over outsider / objectified and ridiculed / you’re hunted like rare minerals for instance / a baby Jynx was taken from the care of her three older sisters / nearby was a town where Jynx and her twins suspected the kidnappers had fled with polar breath the trio exhaled bright blizzards that replaced sunlit skies / fountains froze over like winter and every resident hid from their vindictive glacier Team Rocket / the criminals who stole their baby sister / attempted to flee via aircraft / but their hot air balloon was suspended mid-takeoff by the psychic minds of the triplets see / I know three women who’re like Jynx / they will storm and sweep to save their seeds / nothing from our world can slow them down / my Mom and her sisters hold it down that’s why my blackass is still around / because when I couldn’t be found / family made sure I was safe and sound / so yes / I’m upset Jynx isn’t brown instead she was blacker than a bruise until they gave her a purple hue / as if that’s less of an insult / in Pokémon / racist stereotypes can be caught we are not mammys / mandingos / sambos / or jezebels / we survive and excel / we prevail and reveal / we fill voids of missing motherlands with song and dance in a land that never gave us a chance / who are you to misdraw our bodies / when you don’t even know our stories ? take your minstrels out of my media go Jynx ! lovely kiss the streets to sleep / wild Jynx ! telepathic voodoo queen / dark skin / darker than an asphalt pit / pink lips / puckered like a fall tulip / two hills / on your chest like twin kingdoms / swang hips / shake up cities like branches black women are not magical negros / but if they were / their magic would belong to them and them alone

_______________________________________________

SEAN AVERY (pronouns he/they) is a rapper, poet, and teaching artist from Avondale, Arizona. Their work integrates Hip-Hop music, poetry, and theatre to explore how Black masculinity is projected onto their body. They strive for an authentic performance of self, hoping to inspire others to examine their own identities. Avery’s work has been featured on Afropunk, Blavity, the 2015-2016 Wisconsin Film Festival, and the 2018-2019 Chicago Hip-Hop Theater Festival. They’ve shared the stage with performers such as Saul Williams, Lemon Anderson, and J. Ivy. They’re also an alum of the University of Wisconsin-Madison with a B.A. in English Creative Writing, where they received the nation's only full-tuition Hip-Hop & Spoken Word scholarship, First Wave. Currently, Avery teaches throughout the Phoenix valley at schools and nonprofits while performing their Hip-Hop play and album “skinnyblk” both regionally and nationwide. “skinnyblk” the album is available now on all streaming platforms.

Title: On the rail between two countries Reflections from a train window while passing from Austria into Czechia.

blue hour middling-i slip from skin to skin, an unseen border

_____________________________________________ CATHERINE LOCKMILLER is a health science librarian. The best parts of her work involve researching and writing about critical theory in information science, and how it can build a resistance politics rooted in transformative justice.

Title: Angry Trump Wallpaper

This piece was inspired by a 1974 work by Andy Warhol. Warhol screen printed a line drawing of Mao Zedong, then chairman of the Communist Party of China, onto usable wallpaper, a statement in and of itself. After seeing this work recreated in person, I was inspired to create a modern version of a 2020 leader who, like Mao, has proven quite controversial. This work catches President Donald Trump in an unfortunately common pose, yelling to those on his left. He is then copied and patterned into a wallpaper print. I hope this piece has viewers take a closer look at our President, potentially draw comparisons and illuminate differences between the two leaders, gives a laugh, and most importantly, sparks conversation as we sit on the precipice of the 2020 election.

_____________________________________________

ELLEN CYRIER is Senior Coordinator of Undergraduate Recruitment at the University of Arizona. Before moving to the Grand Canyon state, Ellen obtained her undergraduate degree in Fine Art from The University of Iowa. Since graduation, she has continued her artistic efforts, creating her own art business and website, while also pursuing her interest in higher education. Now with a Master's degree complete, and much more free time to be had, she is amplifying her creative pursuits and making even more art. Ellen enjoys exploring all mediums, with special attention focused on texture and light in each piece. When not clicking through her film camera, Ellen can be found on the tennis court, or enjoying the beautiful Arizona weather.

Title: Mr. Popo

From “Four Poems from Otherworld,” these poems speak to the gross disservice that both speculative and historical narratives do to Black people, specifically in popular representations of Black womxn, mxn, and Black death. oh Mr. Popo / black as Soul Glo / once swallowed Kamehameha whole / helped heroes and their children get swole / but they did him so dirty / nobody knows that really he’s a deity / looking out for Earth / assisting the great fighters who protect our world / yet they drew him pitch black / riding on a magic carpet / watermelon red lips / smiling negro servant when Bulma saw him on the lookout she did the whitegirl freakout / like she was witnessing a monster shadow rise / blocking the sun out / but it was just his skin and size that shocked her like electric-volts / her fear used him as a conductor / i must’ve mistook his black for rubber / but nothing insulates the hatred of other oh Mr. Popo ! black as charcoal is garden-tending all you do ? and care for men lighter than you ? and bow to aliens who humans still treat more human than you ? growing up i tried to never see you but you lingered like a lead balloon / creature creeping through the room of my mind when white people pass by / double conscious mirror / reflecting your eyes instead of mine when childhood heroes are super when they’re blonde / and their sidekick in the back is blacker than tar / children are sent a message about who they are / i’m sure the average fan doesn’t dwell on Dragonball / but there are things i believe no one can ignore like Mr. Popo / genie sambo / giddy grinning when he’s shown / his face / an old Disney cartoon / no one else is drawn like him in the show / and i’m supposed to let that go ? they say his power level is unknown / i bet when he’s free / he’ll let us all know _____________________________________________

SEAN AVERY (pronouns he/they) is a rapper, poet, and teaching artist from Avondale, Arizona. Their work integrates Hip-Hop music, poetry, and theatre to explore how Black masculinity is projected onto their body. They strive for an authentic performance of self, hoping to inspire others to examine their own identities. Avery’s work has been featured on Afropunk, Blavity, the 2015-2016 Wisconsin Film Festival, and the 2018-2019 Chicago HipHop Theater Festival. They’ve shared the stage with performers such as Saul Williams, Lemon Anderson, and J. Ivy. They’re also an alum of the University of Wisconsin-Madison with a B.A. in English Creative Writing, where they received the nation's only full-tuition Hip-Hop & Spoken Word scholarship, First Wave. Currently, Avery teaches throughout the Phoenix valley at schools and nonprofits while performing their Hip-Hop play and album “skinnyblk” both regionally and nationwide. “skinnyblk” the album is available now on all streaming platforms.

Title: Clef

Clef is a shot from the base of a spire in The Church of the Assumption of Our Lady and Saint John the Baptist in Kutna Hora, Czechia. i've seen enough gothic cathedrals at this point that i am rarely surprised at their beauty. This one, however, was different. It was the most sparing work of gothic architecture i've ever seen, with ample free space that allowed the architecture the room to speak for itself. It was an austere beauty, partially because sections of the building were wiped out by the Hussites in the 15th century.

This image of the spiral staircase is my attempt to get at the richness of this church's history, the way that the architecture folds up into the ancient hymns and chants which have reverberated across its walls, through the transepts and into the hidden niches where the bones of the long dead ordained are buried, sharing substance with the brick and mortar, melding with music, paint, blood, and writing. It isn't just a building. It's a world unto itself, layer upon layer compressed into a single note.

___________________________________________

CATHERINE LOCKMILLER is a health science librarian. The best parts of her work involve researching and writing about critical theory in information science, and how it can build a resistance politics rooted in transformative justice.

Title: Hurricane (Storm gives a lecture on the Middle Passage)

From “Four Poems from Otherworld,” these poems speak to the gross disservice that both speculative and historical narratives do to Black people, specifically in popular representations of Black womxn, mxn, and Black death.

Mutant comes from the latin word mutare, meaning to change. In this way, all living things are mutants: seeds change into trees, infants change into adults, bodies change into compost. What makes superhuman mutants different is that we are aware we are mutants. Therefore we change much more than ourselves.

My alter ego is Ororo Munroe. Maybe in another timeline my hero name was Rain Daughter or Flower Mother, maybe Water Bearer or Desert Savior, but in this timeline my mutation changed into something destructive by definition, a natural act of violence and sudden chaos. I wonder if this sort of alchemy has a trigger.

Perhaps some Africans lost in the ocean were mutants, and upon descending into the depths, they mutated into something not mutant nor human. Perhaps having been from my birth-coast, their initial powers were weather phenomena—maybe just a few of them, or maybe most of them.

These West African mutants could be the eyes fixing wind and water on our drylands and cities, mournful, vindictive ghosts, spinning storm after storm like spin tops that crash into whatever

unsunken earth lies along the path they escaped; phantoms spitting ancestral pain like sky gods spit thunder and twisters.

Perhaps these prematurely escaped enslaved folks even adapted to their new world without air, becoming like Namor and his Atlanteans, but dark as cooled lava, and the crowns of toothed orca whales. Who’s to say these Mer-Africans don’t live deeper than golden Atlantis or military submarines, deeper than any human, mutant, alien or cosmic entity can descend. Imagine living on our blue planet, yet far away from our empires and borders, completely free from human tyranny and gluttony that rots even superhumans right here on the surface.

_______________________________________________ SEAN AVERY (pronouns he/they) is a rapper, poet, and teaching artist from Avondale, Arizona. Their work integrates Hip-Hop music, poetry, and theatre to explore how Black masculinity is projected onto their body.

They strive for an authentic performance of self, hoping to inspire others to examine their own identities. Avery’s work has been featured on Afropunk, Blavity, the 2015-2016 Wisconsin Film Festival, and the 2018-2019 Chicago Hip-Hop Theater Festival. They’ve shared the stage with performers such as Saul Williams, Lemon Anderson, and J. Ivy. They’re also an alum of the University of Wisconsin-Madison with a B.A. in English Creative Writing, where they received the nation's only full-tuition Hip-Hop & Spoken Word scholarship, First Wave. Currently, Avery teaches throughout the Phoenix valley at schools and nonprofits while performing their Hip-Hop play and album “skinnyblk” both regionally and nationwide. “skinnyblk” the album is available now on all streaming platforms.

Title: —and you, the ocean between them

I had a lot of time to think in my first year of college, and one of the things I often thought about was the strange no-man's-land I stood in as an Asian-American. The prevailing assumption is that being at such an intersection of cultures is, somehow, inherently a bridging of the two. That assumption isn't entirely inaccurate; but in my first year away from home and the Asian-American communities of my home state, I realized that it isn't entirely accurate either. This poem is my take on what that bridge actually looks like.

--Danielle Du

— and you, the ocean between them

还 、海 《 hai 》

【零】 This is how it feels: a foot in both doors, so the saying goes— but no one never warned you and never did you imagine that these doors stand as shorelines on opposite ends of the very earth you walk (poles in their own right: north, south no; east, west) —and you, the ocean between them: a paradox inherent, only ever close enough to touch either shore, (a body of water by grace only) churning with the runoff tears of both.

What are you then? impossible

【一】

through that east pole door, this is the world you glimpse: graveyards, tombstones filling the spaces between these arcing highways and skyscraping towers—

death, between every breath life takes past, between every step present makes and neither, neither feel like yours It feels wrong: the ocean turns.

“Pay your respects,” your parents insist, “Say hello to your great-grandparents.”

But you do not know them, never knew them, never will know them and these headstones gleam too smooth; so you refuse, and watch as your parents bow in front of this one tomb in a forest of tombs. (a world of blood and lives and family you have never, never known) “Just try it,” they say, standing now, one final beseeching lifeline: “there’s nothing to be scared of.

It’s just three bows, then you’re done.”

But there is more than one kind of fear that scorches this ocean floor— you turn away, fix your eyes to the sky instead; only half wondering if your great-grandparents (and their grandparents, and their parents, and theirs, and theirs and theirs and theirs)

This is how it feels: The first time you step

can see you,

this paradox child of two shores torn.

still.) 【五】

【二】 This is how it feels: How deeply you mourn that now, enough to quench the heedless flames that once roared through your own heart.

You know now, now you would kowtow a thousand times to seize this lifeline that, at least, means one shore is willing to claim you as its own. the ocean, the ocean, ah how it cries, longing for just one land to call home

【三】

This is how it feels: Even the sight of a clothes tag makes you hear the voices of your ancestors’ ghosts whispering at the edges of your jacket, snagging winter branches for hands unerringly certain in their own inquiry, nonetheless afraid of your answer: Did you forget us?

In the end, this is how it feels:

Two shores, rising on opposite ends of the very earth you walk (poles in their own right) and you, the glittering surging ocean between them, somehow holding shorelines both: a bridge inherent (between two ends of this earth you walk, poles in their own right: east, west, east, west) ever turning, yearning, astorm, aflame ever calming, settling, stilling at last paradoxical perhaps impossible perhaps This is how it feels:

still nonetheless standing (still, still) between it all.

Don’t forget to remember us, now (“made in _________,” after all)

Endnotes:

•What on earth are you doing with the subtitle there? Without the accent marks, hai can refer to multiple Mandarin characters by the Pinyin system (which is used to romanize Mandarin Chinese and as a system for learning/typing the language). In this case, I picked two: 还 (hái) and 海 (hǎi). The first character, 还, is an adverb that translates to “still,” or “yet,” or “also/too.” The second character, 海, refers to the ocean. However, it should be noted that these two characters are not exact homonyms in their pronunciation: Mandarin, being a tonal language, has four distinct tones and these two characters are spoken with very different tones; hence the accent marks.

•What does it mean put together then? Essentially, “still: the ocean.”

•So, just to be sure — are the random divider thingies in Mandarin too? Definitely. They’re just numbers; the very first brackets contain the Mandarin character for “zero,” and the next goes to “one,” then “two,” so on and so forth.

Fun fact! The major turn in the poem occurs at 四 (four, sì), which traditionally is associated with bad luck due to the fact that it sounds like the character for death, 死 (sǐ). Interpret that as you please!

Title: Good-bye Death is a word that many people do not like to use. I found this to be true, and painful, as our family lost both my father and my father-in-law recently. I often found that by using alternate phrases or terms, as opposed to "death" or "dying," people were more comfortable speaking about things like Power of Attorney, funeral arrangements, and other necessary, though difficult issues related to death. The economy of words offered in the haiku form of poetry also seemed to include the brevity preferred by many when discussing death.

Final promotion Biggest change of address yet Some choose to say, “Death.�

_____________________________________________ JENNIFER PRIEST MITCHELL is a native of Ohio, and has worked at the University of Arizona College of Medicine-Phoenix since 2016. She worked for the Oregon Health and Science University for 10 years before moving to Phoenix, and for the Ohio Attorney General's Office prior to that. She is a graduate of Capital University in Columbus, Ohio and is currently pursuing a master's degree at Arizona State University. Jennifer enjoys hiking, baking, and writing for a variety of audiences. She is a wife, mother, and human companion to two rumbly, tumbly rescue dogs.

Title: Zoom Out

This came about in a rare moment of inspiration during a long period of creative lethargy. It was my most difficult year of high school and after submitting my college applications, I was in no mood to write more. Yet somehow, I knew this slump was exactly that: a slump, a temporary valley of my own even as others might be surmounting peaks. So this became an expression of that sentiment, and a reminder to myself not to forget wonder.

--Danielle Du

A single moment of time: fleeting, impossibly strung along with the rest to make up a moment — a nanosecond, a microsecond (in which stars flared to life for the first time and a breath left lips for the last time) - zoom out A single second of time: tangible, lavishly brief in its lingering shadow as it sweeps overhead — a heartbeat (in which the last passenger pigeon dodged the swipe of the cat's paw, little knowing it was the only one remaining) - zoom out A single hour of time: arching, demandingly pressed as it meanders down the riverbed, soaking in its wake (in which suns died and towers burned, even as rain clouds swirled over deserts the first of its kind to pass still-heavy in centuries)

A single eon, a few billion years (in which worlds began and ended in that final aching darkness, while creatures once ruling fell to earthworms and dust, as flickering skies marked the last beseeching flares of stars, and on the universe went and turned, onward, onward heedless of these lives that burned) - zoom out Time may no longer be kept, perhaps but still it trickles on: nothing may last forever, it seems but still lives toil on: but perhaps it seems the bright stillness lies within the moment itself — - zoom out -

— for never again will we stand here the same.

So now:

- zoom out -

- zoom in -

A single day, a single night: waning, cautiously turned (in which lovers met and whales crossed seas, while diamonds were forged and snow graced peaks, and a first word is spoken by a one-year-old)

for somewhere, somewhere there is always a moment momentous — if only one might take the care to

- zoom out -

- zoom out -

A single week, a month, a year (in which lagoons were mapped and armies onward fought, while geese navigated stars and innocence was lost, as vows were sworn and lichens ground soil from rocks, and mortality is grappled with in a fifth-floor apartment overlooking bay fog) - zoom out – A single decade, a score, a century (in which empires rose from drifting ashes and jellyfish began glowing where light never reached, while gold veins pulsed through riverbeds and vines grew over a sleeping city that will never again wake, as infants and grandparents the alike aged and a sea once dead brims back to life drop by drop by drop) - zoom out -

Title: sand texture

One of my favorite things about being immersed in nature is enjoying the small things. Damp sand beneath your feet, cool breeze on your face. This photo was taken at Torrey Pines State Beach - a location with beautiful cliffs, big waves, and miles of views. Ever prone to discovering and depicting different and new representations of things we pass by everyday, I thought this bit of sand was a real macrocosm of life: light, dark, mysterious, recognizable, fun and contemplative at the same time. A reminder to take in the large picture, but not forget the beauty in what's right under your toes.

____________________________

ELLEN CYRIER is Senior Coordinator of Undergraduate Recruitment at the University of Arizona.

Before moving to the Grand Canyon state, Ellen obtained her undergraduate degree in Fine Art from The University of Iowa. Since graduation, she has continued her artistic efforts, creating her own art business and website, while also pursuing her interest in higher education. Now with a Master's degree complete, and much more free time to be had, she is amplifying her creative pursuits and making even more art. Ellen enjoys exploring all mediums, with special attention focused on texture and light in each piece. When not clicking through her film camera, Ellen can be found on the tennis court, or enjoying the beautiful Arizona weather.

Title: Triumph

I was inspired by this contest to create this piece. I have been facing some interesting realities as of late, but no matter the struggle we must strive to survive! Perseverance will pay.

Strive even when low.

Know a feeling will fleet.

Sweet is victory!

_____________________________________________ CALVIN COOKE is a student of life, striving to do it all right.

Title: Bullet in binary

1-800-273-8255. Talk To Someone Now. If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States

What if your brain is a shell And you an emptied bullet And your mind a gap What if you scattered present with past with What comes may come won’t become because a blast Blew apart the calendar, every time and hour and all your Boiling, oozing, bursting thoughts.

What if the bang of the gunshot Was not enough and the ring Of your nerves was all you heard.

What if your veins shivered In the skein of your want for undoing.

What if they clung to the blood And the bone and the weight wouldn’t let go.

What if you were alive And unsheathed and your skin Never came open never unopened Not letting the bullet break out nor letting air rush in.

What if what you almost did Splattered what you are and were into a single Wound that never almost emerged What if it stuck And you were shot in the mid-unstruck Waiting for a hole for clarity for the light-breach-sound-span-galaxy-abyss.

_____________________________________________

CATHERINE LOCKMILLER is a health science librarian. The best parts of her work involve researching and writing about critical theory in information science, and how it can build a resistance politics rooted in transformative justice.

Title: sun dial and other poems

These are poems that I wrote while I was traveling through a very bleak period of depression. They explore a mental space and a world in which it appears that life is drained of it's animating factor, and merely filled with material forms. While the tone is somewhat nihilistic, I hope that they convey a sense of being on the verge of piercing through the caul of inertia and despair. And that through the distinct absence of the narrator's spiritual identity or sense of purpose, they hint at it's burgeoning presence.

form & void take a look around. now look harder. everything is what it is. just as real, just as flawed just as impermanent as the things you've merely imagined to be. your body is just a body. not something abstract like lines or shadows or shapes.

things are only what they are. perhaps as meaningless as letters and words were before sound pronounced them out.

this world is a language you do not speak fluently and no one truly knows, just the few key phrases we are each a foreigner to reality, dumb tourists miming with our hands speaking exaggeratedly in loud voices, trying desperately to disrupt a calm that is long and ancient and knowing in it's silence, like words read quietly off of a page and kept to yourself.

_____________________________________________ ISARAE KOVAL is a writer and visual artist residing in Mesa, Arizona. Her writing has appeared in Sky Island Journal, Artspace QuARTerly, Poets and Muses Podcast and Phoenix New Times. Her writing often explores themes of anomie, alienation, and the personal and collective shadow. She is currently at work on her first collection of poetry, The Valleys of the Dead.

Title: Miracle Baby

This story is about a case of twin-twin transfusion syndrome. Twin A was much larger than twin B and twin B was not supposed to be viable. I had the privilege of taking part in this mother’s cesarean section. The parents were prepared and expecting to be handed twin B and grieve his loss. Miraculously, twin B came out kicking and breathing— a miracle baby.

One would live.

One would die.

This was the reality their mother faced.

In one room, in one morning, in one memory.

One new life.

One untimely death.

There was a baby shower for two, there were cribs for two, there were matching onesies for two.

So two would live.

Because two had to live.

_____________________________________________

KRISTIN TAYLOR is an MS3 at UACOMP from Sacramento, California.

Title: seven

"seven" is a piece exploring the seven deadly sins and the relation to nature through haiku. nature does not sin by paints the picture of consequence of human wrong doing to self and other. in nature we find peace and harmony needed to heal and be happy, it is the ultimate antidote for the soul.

the need in your want is just desire suffering dawn snow melts in sun i have taken you in with touch of eyes mouth ears nose larvae loses skin the arrows shall point toward only me supreme my thirst dries the land ephemeral stars fell off incurious eyes forgotten sunrise wading troubles thick with teeth grinding importance spring bloom neglected reincarnation live all the lives denied birds that swim mid flight if for my eyes exist as my fishing line is cast indian summer

_____________________________________________ GERMAN DARIO resides in Tempe, Arizona with his wife, two sons, two dogs and sometimes a fish. Recently published in Good Works Review, Into The Void, The Friday Influence, Right Hand Pointing, The New Verse News, The Acentos Review, and The American Journal of Poetry. Poets and Muses podcast - https://soundcloud.com/poetsandmuses/imogen-arate-with-germanpiedrahita

Title: One little bite

They say medical school is like eating an elephant and the only way to do it is one bite at a time. During my first year, I got really good at eating that elephant, but I struggled to find the balance between school and enjoying life. I didn't draw at all first year until winter break because picking up a pen just felt like too much work. This year I participated in Inktober, and found myself being able to enjoy drawing again. I just drew something small everyday and learned to chew on my elephant and my art. I'd say it's been a pretty good year and I have really learned to take things one little bite at a time.

_______________________________________________ MERRION DAWSON is a second year medical student interested in family medicine. She studied public health during her undergraduate degree in Tucson.

While she does not consider herself much of an artist, she certainly loves to draw!

Title: Considering Finality during Winter Solstice

Like many artists, I write poems in reaction to what I encounter in everyday life. I also reflect a good deal about quality-of-life issues, our political climate and how we as a species interact with the rest of life on earth. “Considering Finality during Winter Solstice� was written after reading a number of news articles about people dying unexpectedly young or being killed over hatred or prejudice at around winter solstice.

Death swung its scythe like an unbridled teenager And wheat in golden hue alight from their rooted shoots The sky furrows befuddled with its forehead of gray Has someone gone on a year-end bender?

Did shivers from cold require reactive calisthenics?

The questions hang like foggy breath on cold dusk air Congeal as blood shrinking from mournful news Some ends arrive though we wish time would break Others crawl sloth paced While anguish induces prayers for haste Still the dark angel cloaks its purpose Or regresses in tantrums befitting this age We haven't the clearance required for clarity The declassification is left to those more privileged Our fate relegates to divining through potions Stirring pots bubbling over with insecurities The assured finality the only guarantee Though still off-putting weighted against Minuscule odds for enormous gains

_______________________________________________ IMOGEN ARATE is a Phoenix-based Poet and the Executive Producer and Host of Poets and Muses, a weekly poetry podcast where she chats with poets about their inspirations. Since its inception in December 2018, Imogen has interviewed over 60 poets, from diverse social-economic backgrounds both in the United States and abroad. As a poet, she has written in verse since her tween years, in four languages and published in two (English and French). While Imogen has always utilized poetry as a vehicle for self expression, she has also found it to be an effective therapeutic tool in coping with a recent trauma. Currently, Imogen is working with the Narrative Medicine & Health Humanities Program at the University of Arizona College of Medicine (Phoenix), Phoenix Youth Poet Laureate program and Oh My Ears through Poets and Muses as a collaborative partner.

Title: The Worry

The inspiration of this piece stems from what we feel when we have family members who are ill or undergoing a tough time. Not only is it trying for the individual going through the pain and/or suffering but also for those around them. Questioning, worrying, wishing, and hoping encompass the gamut of emotions we feel during these times.

Sleepless and thoughtless Why, how, when, what will it be Sadness and dreadful.

_____________________________________________

DR. LISA SHAH-PATEL is the Director of Career and Professional Advising at the University of Arizona College of Medicine-Phoenix. She completed a seven year combined Biomedical Sciences/Doctor of Medicine program and received her medical degree from UCLA School of Medicine followed by Radiology Residency at St. Luke’s Roosevelt Hospital in New York City. She completed a fellowship in Breast Imaging at Mayo Clinic in Arizona and currently works as an independent contractor reading screening and diagnostic mammograms and performing ultrasound guided procedures and stereotactic guided biopsies. In her free time, she enjoys spending time with her family, going to the beach, skiing, and traveling.

Title: Don Quixote Abroad

This picture is of a sculpture in Spain commemorating Don Quixote. I still vividly remember reading that book when I was younger, and becoming completely infatuated with the line “The lance never blunted the pen, nor the pen the lance.” I think I understand it even more now that I’m in the medical world. Sometimes health care can feel like war, but it will always coexist with a sort of beauty. Art can be found in even the most unlikely places.

_______________________________________________ KATELYN RALSTON is a junior at University of Arizona. As she nears her final years there, she plans to ace her classes and continue into medical school at the end of her senior year. In her free time she does work with WIMS and Iskashitaa, a local refugee group in Tucson. She hopes to one day become a neurologist.

Title: Genius

From “Four Poems from Otherworld,” these poems speak to the gross disservice that both speculative and historical narratives do to Black people, specifically in popular representations of Black womxn, mxn, and Black death.

No limit to what you can do - Yasiin Bey f.k.a Mos Def like calculate the distance between a gas giant & one of its moons like sow & embroider the flag of a nation built on your servitude like lead a party for self-defense against the county’s counter intelligence like raising your own children & their children & sold children or family was sold children shanties full as a blood-moon like running enslaved people past marshlands of gunmen & swamplands of hungry dogs by mapping out constellations like working a fourth of the week & still taking loans from the bank & using your own savings to ensure your daughter gets a college diploma & if you never reared a child or saved a life or saved a home you would still be glorious alive as your feet when your song plays daily you invent a way to smile despite this calloused white world you are the breeze on summer days good green grass & brown sugar sunlight _____________________________________________ SEAN AVERY (pronouns he/they) is a rapper, poet, and teaching artist from Avondale, Arizona. Their work integrates Hip-Hop music, poetry, and theatre to explore how Black masculinity is projected onto their body.

They strive for an authentic performance of self, hoping to inspire others to examine their own identities.

Avery’s work has been featured on Afropunk, Blavity, the 2015-2016 Wisconsin Film Festival, and the 2018-2019 Chicago Hip-Hop Theater Festival. They’ve shared the stage with performers such as Saul Williams, Lemon Anderson, and J. Ivy. They’re also an alum of the University of Wisconsin-Madison with a B.A. in English Creative Writing, where they received the nation's only full-tuition Hip-Hop & Spoken Word scholarship, First Wave. Currently, Avery teaches throughout the Phoenix valley at schools and nonprofits while performing their Hip-Hop play and album “skinnyblk” both regionally and nationwide. “skinnyblk” the album is available now on all streaming platforms.

Originally Published by the Grey Matter Poetry Blog https://www.narrativemedphx.com/grey-matter-blog

Title: A 55-Word Story --The False Negative

I met this patient on labor and delivery for the birth of her third child, which was unplanned. She had an IUD when her pregnancy test came back positive. While taking her history she told me that she had a cousin with corpus callosum agenesis and that she was extremely concerned that her baby would have chromosomal abnormalities or be born with similar developmental defects. She had appropriate obstetrical care prior to the birth of her baby, including a negative quad screen. However, Julia was born with several characteristics of a Down Syndrome baby. Her parents were very angry and distraught. In hindsight, her OB could've offered her a cell free DNA test, which would have been more sensitive for Down Syndrome than the quad screen. But this was not the case. I thought this was a very valuable lesson in knowing what tests are available for my patients in order to appropriately address their concerns, but to also consent my patients in knowing that these screening tests are not 100% sensitive or specific.

Kind woman, face smiling through the contractions.

An unexpected pregnancy to parents weary of chromosomal abnormalities,

their cousins afflicted by such.

Now culminating in the birth of a child, both loved and wanted.

Baby Julia is born.

Cleft lip, simian crease, flattened nasal bridge, hypotonia, microtia.

Julia's mother sobs; her quad screen had been negative.

_____________________________________________

CAYMAN MARTIN is a fourth year medical student at the University of Arizona College of Medicine-Phoenix. She is a graduate of ASU Barrett Honor College, with a degree in Psychology. She plans to be a Family Medicine physician, and will graduate in May with an MD and a Certificate of Distinction in Service Learning.

Title: Message in a Million This braided essay came into fruition after many other short essays written in an independent study and creative nonfiction class. There was a common theme in the previous essays about finding some type of meaning in the artifacts of my life, so I wanted to write a piece that would encourage readers to do the same in their lives: to find some meaning in all the small, everyday things because life is more than just feeling happy and sad. I think it should be about finding meaning in every thread to make life worthwhile.

I sit on the bedroom floor with the rough, peppered, brown-beige carpet making imprints on the sides of my legs. There are cards - birthday cards, graduation cards, holiday cards - scattered about my bookshelf. Some sit on top of my Harry Potter series, some are wedged in between Charles Dickens and Fyodor Dostoevsky. Some are housed in bright pink envelopes and some are in plain white.

--Organizing things has always been calming to me. It simplifies life because one category of things goes here, another category there. There has been meaning brought to the disarray of objects. A visual representation of a simple, efficient, organized life.

--A bookshelf is an interesting thing. The one in my room, housing the amalgamation of cards, is made of birchcolored wood resting on the usual arrangements of parallel and perpendicular slabs of more birch-colored wood. What a simple way to organize the prism-shaped objects that render entire worlds within thin slices of wood-derivative.

--There are so many ways to organize things. If the things are books, they can be organized alphabetically or by the Dewey Decimal System or even by the color of the spine. My bookshelf is organized in a way that it shows age.

The bottom shelf has fantasy worlds from my elementary school years where the good guys always win, save the world, then go home. With the middle shelf, the line between good and bad is blurred with the likes of Pip on his own journey. The top shelf is even less focused on saving the world. It focuses on living in it, and maybe, thriving in it someday.

--Towards the end of any of my therapeutic organization sprees, there is usually that one box, corner, drawer, stack of miscellaneous things. That is how my neon, green Nike shoebox of cards came to be. I never knew what to do with the folded-up pieces of paper of varying quality and content. A birthday or holiday card comes once a year. A graduation card comes not that often. I would open the card, smile at the picture and, sometimes, the message, then place it on the bookshelf where the books could keep the cards company and prevent them from being bent out of shape.

--A house is just another thing. It is a big thing that organizes other things. To the cards, the envelope is a house. To the pieces of paper, the book is a house. To the books, the bookshelf is a house. To a tree, the soil underneath is a house. Funny thing is, paper had once been part of wood, which was part of a tree, which made its home in the earth, but is now living in between the covers of more wood. Humans also force other things into a new home.

When I was younger, I had crickets housed in an old, plastic fish tank housed in a house.

--The shoebox houses a stack of cards that is surprisingly tall, about three inches of cardstock and envelopes balanced on top of each other. I open the envelopes and pull out some of the cards. A hand drawn card, although it is more of a manila piece of craft paper, with a picture of a rabbit is signed in a smudged pen by a person whom I have a bit of trouble remembering from back in middle school. Another card has a picture of a dachshund dressed as a hotdog wishing me happy birthday. There is a spoon drawn inside as the contents of the message. The card, bent around the corners and slightly wrinkled, is signed by my best friend. The inside joke about this particular utensil we shared in elementary school still makes me smile, although not from the hilarity of the joke, but from the memories we still share.

--There is a tiny corner of the world that can be called home. It sits eleven stories up in a towering stone structure. A tiny, two-bedroom apartment inhabits this structure high above the streets of Shanghai. Its four-by-four, faded yellow tiles, pockmarked with black flecks, give way to a hallway with wooden floors at the end of a five-foot entrance way. They creak and groan. I would show my mother’s mother all the particular spots where a foot could land and make a symphony out of the cacophony. I made mental patterns out of the seemingly random patterns etched in the wood. But that is not why I was so interested in one of the many oddities of the home. The wood rose exactly one inch above those yellow tiles. The first piece of wood lay completely perpendicular to the tiles on its side, and the next piece was level to its top edge, somewhat like a mini stair step. Any visitor who set foot into the house would stroll in easily by walking over the smooth, yellow tiles, but quickly receive a word of caution about this silly, little, potentially dangerous step before crossing the threshold into the heart of the house. The hardest part is always acknowledging this strange attribute to a visitor.

--There is a type of cricket that possess a dark, elongated abdomen, much like a grasshopper, but its antennae are much longer, thin as silk, and sit more gracefully on the head like a crown, rather than a set of horns. My grandfather had bought this cricket for me from a man on a bicycle who wandered the streets selling an assortment of these critters housed in small, bamboo cages. We gave it a new home and set it outside on the balcony ledge. Each night, a solo performance entered softly into the house from the balcony. It was a peaceful, lonely sound from a solitary arthropod. The milky texture of the melody lulled the residents of the house to a restful sleep. The stair step in the house never bothered it. I do not know what bothered it so much as to jump from the eleventh floor one day. I wonder if I could have known what it was truly singing about had I listened more closely.

--There is another type of cricket, the common backyard cricket. Dirt-colored and almost transparent, they are much smaller and have formless black flecks across their backs. In a desert, the cacophony of crickets screams through the house. The chaotic voices tear out of the two plastic boxes that hold five or six of them at a time and clatter off of the tiles in the kitchen downstairs. Here, a lesson was learned in dominance and the survival. The normally melodic chorus might as well have been a symphony of death. The crickets would fight one another for space and potential mates during the night. In the morning, the macabre performance would offer its results.

White fuzz would grow out of headless corpses while sightless, beady eyes searched for meaning beyond the visible world.

--I wonder if some of those who did not stay in my life knew of the fact and were trying to make up for that fact by sending crisper, thicker, nicer cards, so at least I can remember them fondly via cardstock. But I never received any cards from the residents of my grandmother’s house - the stair step, the cricket, my grandmother - and I remember these things the most.

--It has been said that crickets sing. Or that they chirp, but this would imply that there are vocal functions at work within this insect. Instead of “singing”, or “chirping”, “winging” and “legging” would be more accurate for seemingly-vocal act called “stridulating”. Stridulating is the action of producing a noise by rubbing certain parts of the body together. Crickets stridulate by rubbing their wings and legs together. Their actions speak louder than their words; their “words”, in turn, play a melody of hidden meanings.

--When closed, their visage presents a message; when open, their message is clouded with words; when closed again, meaning has been added to their message. A book or a card presents a wonderfully easy message to find meaning in. Just read.

--But what about the crickets? Is it only when the passersby hears them that they exist? Is it only when their archaic melody is heard that they are meaningful? Who is to say that the unintelligible melody must be out of happiness and who is to say that it must be beautiful? Who knows how the sky appears from beneath the blades of grass, beneath the grains of sand, to one pair of eyes?

--With neither a true home nor origin, it remains to be found by those clamoring for it. In an ocean of unknowns and mysteries, it floats like a vacated exoskeleton. Once found, it sinks like an anchor and grounds the message. Pay attention, it says. Pay attention to the message in a million seemingly insignificant things.

_____________________________________________ EMILIE LU was born in Mesa, Arizona and began her undergraduate degree in Medical Studies at Arizona State University at the Downtown Phoenix Campus in 2017. Her freshman year English class and teacher spurred her to take other creative writing classes. Writing was the perfect way to take a break from the science classes she loves by doing something else she also loves. Since then, she has dabbled in poetry and how it relates to medicine in its healing components, read her writing at the Third Annual Virginia G. Piper Undergraduate Writers Showcase, and will be attending the Desert Nights, Rising Stars Writers Conference this February as a 2020 Humanities Scholar.

Title: 55-Word Story

I decided to write this story because it was one of the most memorable cases during my interventional radiology elective. During most days on IR we are consulted by various services to place drains, lines, and to access areas of the body that these services would be unable to. Usually these are non-emergent cases and the day the atmosphere is very relaxed unlike many of the other surgical subspecialties. However on this day we received a call from the trauma team that there was a woman actively bleeding and on the brink of death. They needed us to save her life. We were called up the OR where we virtual strangers and required to lead the life saving therapy for this woman. We were able to save her life with an incision that was no bigger than the tip of a pen. It was life changing. I saw her the next day and the only reason I was able to see the site that we had operated on was because it was marked with a band aid. Being able to reflect on this experience writing this piece really allowed me to see how impactful my time and experience with IR was. I fell in love with medicine again during my IR rotation and writing this only deepened that feeling of passion. This short story is how I would describe IR to someone because it embodies the simplicity but effectiveness of the service. I also really enjoyed the 55 word method and will continue to use it moving forward.

"No woman should die from post-partum hemorrhage."

A stranger in the OR becomes the leader Needle. Wire. Sheath.

Water and wires mix with blood Screen lights up. A contrast roadmap of her hemorrhage.

A 3ml cc syringe saves her life, a band-aid souvenir is all she'll leave with.

Strangers’ job is done until next time.

_____________________________________________

KRICHELLE WHITE is a first generation medical student in the class of 2021 at the University of Arizona College of Medicine Phoenix. She attended Arizona State University and graduated with a BS in Genetics, Cell and Developmental Biology in 2012. She intends to pursue a career in interventional radiology and hopes to continue to serve her community and practice in Arizona.

She enjoys spending time with rescue dogs, soccer, stand up comedy, bad TV shows, and spending time with her fiancee as well as friends and family.

Title: Time Stamp

This poem was inspired by my first interaction with a critical care patient. As a scribe I was in charge of recording a timeline of care, which was very interesting for me as the scene was pretty chaotic but at the same time, completely under control. I wanted to try to capture that feeling of anticipation and fear that seemed to permeate the room, and the immense relief when the patient pulled through and everybody could go back to normal.

A race to zero Chest compressions Time stamp

Nitroglycerin Time stamp No time for heroics Time stamp Everybody falls into synchrony Time stamp A breath a moment a fluttering hope A hushed room caught between life and death

Between success and what else could we have done And then just like that He sits up Time stamp Critical care logged Patient is back in the step of time and so are weTimeline Complete.

_______________________________________________ KATELYN RALSTON is a junior at University of Arizona. As she nears her final years there, she plans to ace her classes and continue into medical school at the end of her senior year. In her free time she does work with WIMS and Iskashitaa, a local refugee group in Tucson. She hopes to one day become a neurologist.

Title: Bodies

This haiku was written as the message of a personal essay I wrote two years ago. With this piece, I wanted to deliver the same message, but in a pithy way. The message is to recognize how our own bodies are our homes because of the phrase “home is where the heart is�. We are confined ourselves.

Whether or not we like the exterior, it is the interior-our personalities, ambitions, values-that can be refurbished once we recognize this.

Walls that bend and bleed To fit into my own skin Home, where the heart is

____________________________________________ EMILIE LU was born in Mesa, Arizona and began her undergraduate degree in Medical Studies at Arizona State University at the Downtown Phoenix Campus in 2017. Her freshman year English class and teacher spurred her to take other creative writing classes. Writing was the perfect way to take a break from the science classes she loves by doing something else she also loves. Since then, she has dabbled in poetry and how it relates to medicine in its healing components, read her writing at the Third Annual Virginia G. Piper Undergraduate Writers Showcase, and will be attending the Desert Nights, Rising Stars Writers Conference this February as a 2020 Humanities Scholar.

Title: Body in Bloom As a kid whenever I would walk the beaches of South Carolina, I would notice how the granules of sand were like the cells of the beach. As I continued to learn more about medicine I realized how all around me I would see the elements of human anatomy in nature. This piece of art is inspired by the fact human body is a representation of nature as nature is a representation of the human body.

_____________________________________________

NISHA REHMAN is an MS1 student at the UA College of Medicine-Phoenix. She was born in North Dakota, grew up in South Carolina, and moved to Arizona during high school. Her favorite medium of art is henna which I began to learn when I was 7. Her passion for henna inspired her to form a nonprofit named Hands for Henna, which sells henna tattoos and uses the proceeds to host educational classes for refugee youth.