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VA N D E R B I LT U N I V E R S I T Y J O U R N A L O F M E D I C A L H U M A N I T I E S
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VOLUME VII
2013
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7"/%&3#*-5 6/*7&34*5: +063/"- 0' .&%*$"- )6."/*5*&4 Tabula Rasa, Latin for “blank slate,” is Vanderbilt School of Medicine’s journal for medical humanities. Tabula Rasa is dedicated to the idea that the mediums of pixels, paint, pen, and paper lend individuals the means with which to explore the nature of humanity and enhance their medical experience. The journal is published annually, and we invite submissions of original short stories, poetry, essays, interviews, artwork, and photographs from medical students, residents, faculty members, alumni, patients, and members of the Nashville community.
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Front cover artwork by Ali Hanson 8"*5*/(
from the editor
4UVEFOU QBUJFOU EPDUPS GBNJMZ NFNCFS ǽ XIP BNPOH VT IBTOhU TUBSFE BU B DMPDL BOE XBUDIFE UIF TFDPOE IBOE NBSDI JOFWJUBCMZ POXBSE The concept of time is one that can never be ignored in medicine. Universally, we experience time to heal, time spent in a waiting room, time of birth, and time of death. In this issue, Tabula Rasa: Vanderbilt Journal of Medical Humanities explores our relationship with the clock and how we, from our various perspectives, perceive the passage of time.
This year, funding cuts across the medical campus made it impossible for the medical school to fund our printing as in previous years. In true Vanderbilt spirit, our contributors and editorial board refused to accept this news. The book you hold in your hands is thanks to the outpouring of support we received from you, the Vanderbilt and Nashville community. In an uncertain economic environment, I am grateful to each of you who makes this journal a priority. Tabula Rasa continues to provide a medium for us to share and appreciate stories across medicine that otherwise would go untold. I encourage anyone with an interest in medical humanities to submit their work to future editions of our journal. My sincerest thanks to our hard-working editorial board, who did a fantastic job soliciting submissions over the past year. I would also like to give a special mention to our production editors, who were flexible in working on the journal as it transitioned from print, to online, and back to print once more. I am so proud of everyone in our Tabula Rasa community who made this publication possible. Meredith Rogers Editor-in-Chief
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COMMUNITY
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ick.
Tick ,3*45* ("--*("/ My breath hitched as I held it. I waited carefully. Tick.
I exhaled. Tick. My shoulders lifted as I held my breath again. I exhaled before the next tick of the clock. It wasn’t working. Nothing I could do could block the offensiveness of that loathsome clock counting out time. Tick. Pause. Tick. Pause. Tick. It was relentless. It wouldn’t stop. I could hear the ticks reverberate through my brain. Tick. Long pause. Ah, it was stopping. Tick. No. It wasn’t. The nurse came into the stillness of my room, her busy form and her connection with life upsetting my existence. “How are you today?” She checked my IVs. “What is going to happen?” She clucked her tongue at me. “I don’t know. We are waiting.” I discovered hospitals were all about waiting. Waiting on test results, waiting on doctors, waiting on social workers, waiting on surgery openings. Waiting. Tick. Waiting. Tick. “Ah.” I looked at her directly for the first time. She had been nice enough not to turn on the lights. I hated the intrusiveness of lights like I hated the offensiveness of time. Her shadow was thrown into stark relief from the brightness of the ICU hallway. Out there, life was happening. In here, I was trying to stop it. Tick. Life kept passing. Tick. “How close was I? It’s important. How close?” I gripped the bed rail, hoping she would answer. The other nurses had refused. They just looked away from me and found another task outside of my room. “Ten minutes.” The words swirled and flew across my hospital room and landed, only to settle and imprint on my soul. She left. Tick. Ten minutes. I breathed deeply. Ten minutes between life and death. I closed my eyes, seeing myself the night before as I swallowed pill after pill after pill. Swallow a pill, sip some wine, put the wine glass down. Click. Swallow a pill, sip some wine, put the wine glass down. Click. Then, it had gotten fuzzy. Shapes and time became indistinct until I woke up here in a room of black and beeping machines and a clock that wouldn’t stop counting time no matter how much I cursed it and begged it to stop. Tick. I opened my eyes. Tick. Ten minutes. It was a lifetime. It was a flash in a pan. Ten minutes. It was the difference between me being on Earth and me disappearing from Earth. I had all the time in the world now. Tick.
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I had no idea what to do. Tick. Why wouldn’t time stop? Tick. Wait. I had a future. Tick. Decisions. Tick. I loved time.
Kristi is a graduate student at Belmont University studying to receive her master’s in English. She has two wonderful children and teaches full time.
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COMMUNITY
On Turning a Dark Corner
Beating Death
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One who is faint of hope, yet with resolve endures Deep trenchered wounds of rabid, blind ravenous chancre And the pain which gnaws upon the shrinking self; One who constantly takes in the endless anguish For an interminable, slow-dragging course of time May imperceptibly improve, and come to find Some comfort in a deep autumnal melancholy, An umbrageous solace that will cloak The wounds and griefs of grievous suffering. He might then vaguely sense a distant promise For a future time of healing and, Beyond healing, of something better yet, Glimpsing thence a distant gate which beckons, Opening onto the gentle, broad up-lands Of a new, serene, sunlit life. Born in Nashville, Norman Randolph Parks gained a B.A. and MAs in English and Art History at Vanderbilt, followed by doctoral work at Harvard and the University of Michigan (A.B.D).
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H
er head bobbed with each breath in syncopation with the monitor, beeping in rhythm with the second hand of the clock. I examined her face, emaciated. That word…even the sound of it, like skin glued to bone. Her eyes were glazed half-moons, and her waning eyelids drooped ever closer to her end, her last breath. I watched her, heaving respirations, each rise and fall of her chest like a swimmer trying to pull toward the surface, but being dragged toward darkness. Or maybe like a mother trying to situate her child more comfortably in her arms. The effort stole her whole body. That was her life now. Chest heaving, head bobbing, eyelids drooping, and the monitor’s devoted beep. It would stop only when she did. It would not leave her side until her final breath. Beep… Beep… Beep… I touched the bone under her sweater, what used to be her arm. I watched her, headbobbing as she heaved each shallow breath. Beep… Beep… Beep… I rushed over to see her when I heard she had one night left. I thought of things to say. The perfect words. I rehearsed them in my head. They were ripped away by the labor of her breath. Beep… Beep… Beep… I found some words, but they were barricaded in my throat. I would have to force them through. They were not like the constant, even sound of the beep. They were jarring, unnatural in that place. I had to force them out with a deep breath. Beep… Beep… Beep… “I’ll have to wait to teach you how to belly dance,” I said, holding back the laugh, a sound that didn’t belong with the monitor’s monotone. “Maybe in heaven.” I choked as the laugh disintegrated. In response, her body continued disintegrating. It was clear that she would soon have no breath. Beep… Beep… Beep… I must have been in there for hours. The clocks were lying to me. I passed her loved ones, friends. I watched as they talked to while away her time. As I walked down the hall toward the front door, the beep faded. I knew that there would be no more beep. No more breath. She would be clean and new, as white as her name. She would be Ivory. I smiled, and took a deep breath. Beep… Beep… … Her breath was gone.
Emily Siami is a graduate student at Belmont University studying Writing. When not writing, she works as a middle school English teacher in Madison, TN.
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COMMUNITY
When and How
Ceaseless Trance
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The body keeps as mum as running streams below earth’s skin, a mime not unlike our planet’s face, indicating this or that, pointing through a story told in eyes, a hiccoughed footstep, a hand searching the core for miscreants hidden near the heat of inward matter. Time of course will tell more than time, more than elaborate pokes and jibes we coax a mime with, to laugh, to cry, reveal its human state. It’s hid in makeup, a Peter Pan dragging along his shadow, fearful of growing up, and old, and what his rivers know that he does not. Time flexes, recoils. We draw it out long and pack it up to keep, like treasure, glad at last it doesn’t speak, holds quiet its route. The clock on every wall counts every tick, confirms us, when to feed, to rest, to toil. It’s just a foil: staving off a time that can’t be measured, from the star-boom of our birth, to the long sustain of sun that is a youth like the greening of the planet’s earth rich with destiny fulfilled by waiting. Yet time compresses toward the western edge, we find it short from dawn to darkening, think some revelation is at hand from courses deep beneath the wrinkled land. Still it’s only the suspension of a vital knowing that keeps us, keeps us going.
Georganne Harmon, a Vanderbilt graduate, grew up in Nashville, where she now makes her home. Her poems have appeared in various journals, including POEM, Pearl, Slant, New Millennium Writings, Maypop, and others.
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Emily grew up on a small farm in Tennessee and studied Journalism and Art at MTSU. She currently works as a media specialist for the Section of Surgical Sciences at Vanderbilt.
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COMMUNITY
There’s an Old Woman, Slowly Eats Me Alive
Remember
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There’s an old woman, slowly eats me alive, From head to foot; methodically imbibes the firm flesh of my youth; My cheeks apples; breasts, buttocks, Overcoming their natural tension, by her teeth’s tensile pull; Her toxic saliva tinting my fingernails yellow, and thickening them Like an overcooked gravy, in the unyielding skillet of her intention, Her continuous cooking fires smoking my hair, the same color as soot and ashes. My hands beginning to shake too, with the palsy, of her unholy desires That every day be her mealtime again, and that she gets to begin all over again This daily eating of my flesh, like her own privately observed communion, Which will continue unabated, until she reaches the inner sanctum Of my plenum, and parts there the ruby curtains.
Sometimes I wonder when the Earth will decide it’s my turn to line up underneath it, next to other bone-ridden boxes. Or will I be ashes freed from some loved ones hand, writhing with the wind, fighting to mix in with the dirt and waters, a final vow to be part of it all even in death? If I write my will, will that further prepare me? Will the tangible things I leave behind mean more than the risks I was willing to take? And what would my sister choose to remember me by? This piano I’ll leave her, or the songs we used to sing?
Revealed then is that holy grail of my being, palpitating there; Veins still smooth, uncollapsed, pink and healthy; And with just a simple touch of her withered hand, it becomes Another rotten apple, just like all the ones before it, In a sort of imitation, of the witch bestowing the poisoned apple, To the princess of the realm, who is still unrecognized, and in hiding; Almost as if it were the same apple offered to Eve, That has been secreted also, inside our bodies, Like a time bomb waiting there, until the garden should arrive At it’s winter season; and the fruit, so long over ripe since the harvest, Begins to cave in, with inner liquefaction; The face to sag, and the mouth to hang open, The eyes losing their focus; the ears, their hearing. Because all of the knowing contained of the apple Was in the end only death; it’s only inheritance, For death was the one thing lacking, in that first Garden, And because we are all of us, her children Descending from that first sin and falling out, So that even now, we all look alike, shortly before death; All we siblings, of Eve’s children, with the sunken apples in our cheeks, As it is the very core of our being; that is rotting from the inside out, And it is bitter- very bitter indeed, to watch our body’s last fruit go to waste.
Patti Masterman grew up as an only child which probably made her much more introspective than she would have been. Writing is more like something she wants to be doing every day, rather than something saved up just for a special occasion.
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Ashley Mintz is a painter and songwriter. She has had music used in a play, and indie film and a short film. She is currently a student studying Music Technology and General Technology.
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COMMUNITY
Zendoodle
Sun
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3&#&$$" 304& .00%: The sun rose low that day. No larger than a palm, It held in the sky, heavy In its course. Meanwhile, they dressed you in a hospital gown. Light blue, it crinkled in your lap as you sat. Hands folded, you were the priest before mass. You were birds in a rain, held close in a tree. If I had word enough, or prayer, I would see each black hair turned grey, Each grey white, until, hoary and wise, You are Aeschylus, pacing out your days. But I have only this. So hold, dear sun. Catch in the sky like a seed.
Virginia Fleming is 9 years old and loves art. Her parents Amy and Geoffrey Fleming are faculty in the Department of Pediatrics. She decided to create this ZenDoodle of the seasons to show her view of how time passes.
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Rebecca Rose Moody, nĂŠe Mooradian, is a wife, French teacher, and poet currently living in Nashville, TN in a creaky old Victorian house. She enjoys hiking, writing and playing music with her husband, and playing with her kitten.
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COMMUNITY
Confusion
Every Second is of Infinite Value
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Confusion, Like an endless maze. Stuck at a which way Confused. Which way to go, I try to decide. I stop thinking, I just go one way, Dead end, I go back to the which way, I go the other way, It leads to a another Which way I go one way Again.
Jackson Rehm is an 8 year old student in the 2nd grade at the Ensworth School in Nashville, TN. He enjoys drawing, writing, and playing with his 3 brothers in his free time.
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Emily Stegeman is from Dayton, OH, and is attending the Doctor of Physical Therapy Program at Tennessee State University. She is a second year student in the program and wants to become a pediatric physical therapist.
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COMMUNITY
Pat and Viola #"33: " /0-"/%
Originally from Cairo IL, Barry A. Noland is a professional art and commercial photographer. He is currently working in the Office for Diversity at the Vanderbilt University School of Medicine.
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MEDICAL
T
The Other Side of a Minute
Going Home
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hey silently mourn with those left behind. Behind the sympathetic hugs and their warm eyes, the tears remain discreetly veiled most of the time. There is too much to do to fall apart on the job. The day started like any other day. She rounded, peering at charts, keeping track of those critically ill or injured. One new patient, a young man, age 40-something, a freak accident months ago. On a Saturday in April, the damage announced itself and life changed in that minute. The light began to dim. His body was warm and the monitors beeped regularly. Eyes closed, he appeared to be sleeping peacefully. She held his hand for a moment and wondered about it all. How did this happen? He seemed just fine yesterday. All the tests came back with the same result: he would not recover; this would be his last day. There was absolutely no possibility, no hope. The damage would not be undone. Still, the machines keeping him alive beeped, the only sound in the room. What happens now? she wondered. Is his spirit here, with us, in this room? Can he see us, hear us? A flurry of papers and the chance for another life to be saved, and another, and another. No hesitation, it is what he would have wanted. Upstairs, there was another young man. His heart had broken with grief and pain. So much loss, so much pain. No hope. Despair became his uninvited constant companion. He decided it was time to leave and tried his best to make it so, with the help of a weapon. However, it was not to be. NO? NO. It was not the time to go. So he stayed, his body broken on the inside and now also on the outside. There were other close calls and the code team arrived to offer support and stability. Still he remained here, alive, in this place, in this city. It was not the time to go. The irony of this really struck a chord and she went home and cried for all of them that day. Tears for the one, having a normal day, being rudely interrupted by pain and by darkness. Tears for the miracle of a chance at another life. Healthy kidneys, a new heart, new lungs. These would be received that evening by others living on borrowed time. One telephone call and the other side of a minute meant hope and life and a second chance. The other with the broken heart and broken body, who tried so desperately to leave only to learn that the answer to his plea was to stay, to live. I feel that there is a mystery surrounding birth and death. One minute later or earlier, we are in another place, somewhere physically unknown to those who live and breathe on this earth. Every day, when I look out the window and up to the tall hospital towers, I remember the other side of a minute. That people here are transformed by those 60 seconds. A baby is born, a new heart arrives, spirits leave and go elsewhere, we cry for those we miss. Our husbands, our daughters, our sons, friends, parents, our elders, our wise ones. Those of us in the practice of healing are ever mindful of the frailties of life. It is both a blessing to be fully aware and also very painful at the same time. We see the joy and the hope up close and also the sorrow and the sadness and the loss. We each have so many choices every day. In one minute, we can forgive, we can laugh, we can offer a kind word, a genuine smile. We can leave someone feeling a bit better than they perhaps did, in the minute before. And that, for me, will always be a reason to get up in the morning. We each have the gift of those infinite possibilities, to make a difference. Especially here, where joy and sorrow live side by side, we can create a silent legacy of kindness.
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This place I once called home is a wax museum. The pictures on the wall, moments poached from a distant past, whisper to one another of the change in me. I intrude upon the intimacy of sepia-toned memories of the girl I once was. Everything is hushed and slower here, somehow. Not mine, but an archaeologist’s hands fondle the relics and treasures, surprised to find that the fossilized footprint of childhood is still warm to the touch.
Kelly is a second year medical student who started her literary career by scribbling on her bedroom walls in pencil (sorry, Mom!) and never stopped writing since. She would run away tomorrow to be a concrete poet in Brazil if she didn't love medicine so much!
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MEDICAL
Father Time
T
45&7&/ #64#:
ime has changed health care in ways that none of us could really anticipate. Over my 28 years of health care provision, I am still in awe with how far we’ve come diagnostically……and how far we have slipped from the personal attention and commitment to patients that were standard fare in former days. It is called “progress.” Progress requires documentation on reams of paper or multiple gigabytes of memory. However, it seems to include less in the way of personal contact with patients. I was one of the fortunate ones. A new nurse practitioner, having completed intense training yet now facing the real world of healthcare where quality of care is valued, but seemingly, never as much as quantity. I was educated in the era of evidence-based practice. You had to find the correct treatment, for the correctly diagnosed condition. There was always a new medication, better than the last, which would surely cure the patient’s ills. It’s about volume; treating the masses with things that research says “on average”, work. One thing people asked me while I was interviewing for jobs was, “How many patients can you see in a day?” I had no idea. I had been a paramedic and an ICU nurse for years. But arriving at diagnoses, and making treatment plans rather than carrying them out, was a whole new challenge. None-the-less, the correct question really should have been; “How many patients can you see in a day…well?” They called him “Dr. Buddy.” I simply knew him as “Doc.” His name was actually Dr. O.D. Mitchum. I was so blessed to have begun my nurse practitioner career with him. I spent the last clinical rotation of my training with him and he offered me a job. He started his practice in that small town the year I was born. He had a still and quiet mannerism. He had the most piercing, yet calm-inducing eyes I have ever seen. Regardless of the situation, patients and families just seemed to calm down when he entered the room. There was something about him that transcended his ability to merely diagnose and treat; something genuine…something real. He spent time with them. Being a professional partner to this community pillar was no small task. I was the new kid in town and he was the older, experienced, much-loved care-giver. I knew all the latest treatments, yet many patients wouldn’t even see me when I first started practicing with him. That was until Dr. Buddy told them I was “OK.” My first inkling that his methods were different than what I had experienced in my training occurred when I found one of his patient notes that had been completed nearly forty years before. It said, “Earache; Red TM, Amoxil, $3.00.” No one had to be convinced the care was good through voluminous writing. He took time to care. I’m not sure we can do that to the same degree today. His was a different time. You did not just treat patients, you got to know them and cared for them. Not “cared” in the sterile, treatment-provision sense so much as the “truly concern yourself with” sense of care. You did not use diagnostics to diagnose, but rather to confirm what you suspected through wise use of time, keen senses and a hands-on approach. He never did use anything other than an old low-power “one-eyed” (monocular) microscope from the 1950s. Yet, he didn’t deny my request for a high-power binocular microscope for my own use. He simply looked at me and said with a smile, “High power, low intelligence.” I was talking to him about a new treatment that I felt we should offer to our patients. It was after all, the latest and greatest. He apparently did not agree. But rather than just a quick, “no”, he said, “you know, sometimes it is better to know when NOT to do something. Most
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patients get better despite us, not because of us.” It’s something I’ve never forgotten and now commonly pass on to my own students. It wasn’t just me. He said things to patients that I would never have dreamed of saying. He could do that…he had put in the time with them. When talking to people about things, he would commonly sit on the edge of the bed, put his arm around them, look them in the eye, and then brilliantly inject some humor. Let me give you some examples: One particular lady couldn’t understand how she was gaining weight, while supposedly eating nothing but “salads.” He said to her, “Well, cows get fat on grass.” Another lady when asked if she got any regular exercise, responded, “Well, I like to ride horses”, to which Doc replied without missing a beat, “Well get off and tote the horse for a while.” He always followed these little quips with important education. Lessons calmly conveyed with a sense of touch, caring and yes, humor that are mostly absent today. I suspect that there are few providers these days that have the kind of credibility through time investment that would allow them to be this honest and straight-forward, yet without the patient perceiving any insult whatsoever. He cared about them, and they knew it. What is it that providers have lost? Is it human compassion? Maybe it’s human touch. Maybe it is what we currently try to describe to students as “authentic presence.” Maybe it is, at least partially, as simple as time spent. Funny how this doctor who eventually served his community for more than 50 years until his recent death, already knew something that we now feel obligated to include in medical and nursing curriculum. Not only has the passage of time changed our approach to real people in need of care in some positive ways, “progress” has also cost us time spent with patients face to face in a way that conveys concern, fosters honesty, and allows the development of a true caring relationship. I am not so blinded by nostalgia that I believe that we can ignore time; we can’t, ever again. But I will never forget Dr. Buddy, or the impact that this small town doctor had on my approach to patients, even now…even more so, after all this time. Dedicated to the memory of Dr. O.D. Mitchum
Dr. Busby is an Assistant Professor of Nursing at Vanderbilt University and teaches in the Family Nurse Practitioner and doctoral nursing programs. He has worked in health care for 28 years as a paramedic, RN, and as a FNP. He has been a nursing educator for 10 years.
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MEDICAL
Half a Miracle
a case presentation in five poems #3&/%" #65," JUNIOR’S FIRST SOLILOQUY in which he considers his father’s sudden death, resuscitation, and coma He was a piece of work, my dad was. Always running after something, wanting something new. Drove a truck, twenty-four cans of beer every twenty-four hours, always going someplace leaving us kids behind. And women—talk about women! Must’ve been a hundred women between his mama and Darlene. Married eight of them. Like that movie star, Liz Taylor. Don’t think he ever married Darlene, though. I thought it was a miracle, the hand of God reaching down to rearrange things so when my daddy died at the Waffle House up the road, so when my daddy died that doctor, a man who spent his life watching the image of God, was sitting at the counter eating breakfast, ready to bring my daddy back to life. It was a miracle, but what kind of miracle is this always needing another miracle to come along and clean up the mess? Always wanted more, not less. Junior, he said (it was a TV show about taking care of old folks), Junior, the game’s over when it’s over. You ship me out to a warehouse like that, I’ll get you in your dreams. Lie there like a big dumb baby, some nurse powdering my butt—unh-huh.
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Just strap me up in the driver’s seat, put a brick on the accelerator, point me at the river, and accelerate me right on out of here, to the next place, wherever that is. That was my dad, not miracle man over there. But, you know, he still looks like daddy, looks like he’s sleeping, just sick with bad dreams. Can you kill a man’s already died once? Miracle worked only part-way, and he never wanted nothing only part-way? JUNIOR’S SECOND SOLILOQUY in which his grandmother insists on tube-feeding Dead is one thing, but I reckon for her, hungry is another. She can’t talk about dead, so she has to talk about hungry, wiping her hands on her apron. Lot of women I know like their bottle babies best, singing “mama’s little baby loves shortning bread”, “pattycake, pattycake, baker’s man”, and rocking, rocking. Baby’s not so cute, shirttail out, saying no, he won’t comb his hair, pick up his room, move that old crankcase off the porch. Made no nevermind, she cooked anyway. Meatloaf, scallop potatoes. They used to make crank ice cream, he told me once, in July, hamburgers and Polish hotdogs. Peanut butter and jelly, eggs, over easy sliced tomatoes. Lot of food between them two. Lot of dirty dishes, too.
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MEDICAL It’s a bad thing for a grown-up man, but how he looked when he’s a bottle-baby, round, and clean, and tickled about everything, maybe a mama can’t get it out of her mind. He’s going to go, but he don’t have to go hungry. JUNIOR’S THIRD SOLILOQUY in which the family decides to withdraw life support We want to stop everything and let him go. Will he know? Will he get hungry? Want a glass of rain? Smother with no oxygen? Want the window down again? Will he hunt for a map, since he’s going off his usual run, to a place he’s never been? They all say no. They say to stop and let him go. He was a piece of work, always running after something. He always wanted to stop ev__erything and go. Do we stop real sudden, or stop real slow? JUNIOR’S LAST SOLILOQUY in which he realizes that life does not necessarily go on Daddy, Mandy, and me. We were almost like a family for a while. Darlene too. He made an old barrel into a barbecue. We sat under the catawba tree, had a beer or two, watched lightning bugs like skipping ghosts. Mandy ironed his uniforms. Smelled like a kitchen, like toast. He’d get the garden hose, wash her car,
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tease her about maintaining her machinery. She’d sock him on the arm. Seemed like home. Now the trailer’s empty, Daddy’s gone. Just that old catawba tree, and Mandy and me. Something’s fallen between us. Every day’s a slow walk in a dense fog, thick fog has settled in the hollow between us. Can’t seem to see, can’t seem to touch. Seems like we could talk, Mandy and me, but there doesn’t seem much to say. POSTSCRIPT: MR. MARTIN TRANSFERS TO THE VA thanks to T. Day, LPN Dobhoff tube feeding of ¾ strength Jevity at 95 cc hr, residual 0 cc. Foley to bedside bag draining 300 cc tea color urine. 1 mod soft brown stool incont. Skin care and a.m. care given. Turned q 2 hr with pillows placed for support. Transport per ambulance with attend. to Veterans Home. 28% face mask in place. Occ patient will moan. No verbal response. Personal belongings bagged and sent with patient.
Brenda Butka practices pulmonary medicine at Vanderbilt Hospital.
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MEDICAL
Girl at Tamale Teaching Hospital
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Frances Cheng is an MD/PhD student at Vanderbilt, currently in the graduate phase of training. She enjoys traveling, photography, and international health.
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I
went to see a movie with my granddaughter once. She had been begging to see…oh, what was the name of it? You know, that funny actor? Alicia had said it would be funny anyway. She kept looking at me with her beautiful brown eyes and saying “You’ll have fun, Grandma; it’s going to be hilarious.” Alicia had just learned that word and was using it every ten minutes. I hadn’t been to a theater in fifteen years, and kept thinking I would get into some social snafu in front of everyone, but she looked at me with those brown eyes, Harold’s eyes… So of course I said yes. We went on an afternoon when school had been canceled due to ice, but the afternoon had been so beautiful there were nothing left but puddles scattered across the street. Alicia took my hand as we went into the theater and said, “Cotton candy, Grandma?” I bought the biggest cotton candy stick I had ever seen and a huge coke which I carefully carried as she skipped ahead of me. The movie actually wasn’t that funny. That’s why I remember this day so well. All except the movie’s name, anyway. It was about this man who starts using some sort of special remote and fast-forwarding through parts of his life. And then every time after that, his life would fast-forward through those same parts, whether he wanted it or not. I remember sitting there thinking, “This is my life.” Then Alicia spilled her soda on herself and we went to the bathroom to clean her up. By the time we got back, the movie was done. It wasn’t until we were in the car on the way home that Alicia looked up and said, “Why are you crying, Grandma?” People are always saying they feel like life is passing them by. But for me, life has passed me by. All the nights I can’t sleep, when it’s hard to breathe or the pain gets too bad, I stay up thinking of all the things I should have done differently. In the end, it always comes back to the same answer. I was afraid to live. Now I’m afraid to die. I feel as though I left my life on auto-pilot, going through the day based on halfconsidered principals and a misguided sense of duty. For a while, during the nights when Harold’s snoring kept me up, I would grab a journal and a cup of coffee and move to the couch to write. I would examine my life and ask the questions I was too afraid to ask the rest of the time. One time I felt asleep with the book open across the coffee table. That morning at breakfast, Harold asked me quietly what was so wrong with the life we had. I didn’t write in the journal again. Part of me never believed I had a choice. I felt bound by a sense of God’s will or my family’s expectations that rendered me frozen; I couldn’t make a wrong decision or it would ruin my entire life. I could never come back to the same path. I now realize that this fear was a decision in and of itself. I left others to decide for me. Then I could blame them when something went wrong. I loved Harold deeply. Most days I feel like nothing in the world could persuade me that our decision to marry at seventeen was wrong. But when I see the youth nowadays, their freedom of pursuits, their ambitions and travels and enthusiasm for life, I wonder… But I cannot pursue these thoughts further. I always envisioned myself facing death with peace and confidence. A knowledge that I made no wrong decision and that the path I followed had been laid straight before me. These thoughts cause me too much pain.
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MEDICAL Every time I see Alicia, though, I am able to cling on, for a few minutes, to the hope that my life was right. Yesterday, when she came by after school, she started talking about getting her ears pierced in a couple months when she turns sixteen. Then she switched to doing proofs in her geometry class and the amount of homework they have. She turned thoughtful for a moment, looking at the floor, and spoke, “So there’s these girls at school, and they’re picking on another girl during lunch, and I’m trying to figure out what I should do. What do you think...� She looked up. “Why are you crying, Grandma?� Through the tears, everything seemed to click into focus.
April Christensen is a fourth year medical student from Parker, South Dakota, who completed her English degree at the University of Nebraska.
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Unit Time at Children’s #3*"/ 8 $)3*45."/ After he said that Meg’s heart had stopped And a team of doctors was trying to bring her back Time got waxy Like the candles we used to pinch, after cupping them at the end of church. And I was afraid to walk the hall to call Dad Afraid I wouldn’t be there when they came out. And I knew that Meg wouldn’t want me to keep the doctors waiting In case they needed to speak briefly and get back to the clinic Where kids were waiting and playing and crying, Just hoping to get home before the cartoons started. Waiting adults would suddenly point their chins at newcomers Who could have been doctors, but were not, and refused to answer unvoiced questions. And the clock was broken, at least for me.
Brian Christman grew up in Tulsa, OK. He is a member of Vanderbilt faculty where he has enjoys teaching, research, and patient care. In his spare time he tries to make furniture and writes a bit of poetry.
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MEDICAL
Daredevil
Perfect Timing
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aiting is a universal experience. Enduring the empty passage of time can feel cruel, especially in the 10N Trauma waiting rooms. You see, on this floor, timing is everything. You observe the trauma team scurrying to the next trauma alert to save a life and you see trauma families painstakingly endure waiting for news on their loved ones. On any given day on the Trauma floor, time is actively referenced as the “Golden Hour,� when “life hangs in the balance� or “time is of the essence� and when referencing a survivor’s recovery outcome you hear, “This is a marathon, not a sprint,� “Time will tell,� “Wait and see,� and “Slow is good, fast does not last.� Oh time, we have such a love-hate relationship with you; you’re either on our side or you’re not. This is evident given that our Level 1 Trauma Center treats more than 3,000 catastrophically injured patients a year. Basically, we obsess around the clock with each of these 3,000 patients every year; which is to say, we’ve got timing down to an art. As for my part with the trauma team, I comfort those who wait: those waiting for their loved one to open their eyes, waiting for them to turn the corner and improve, or waiting to go to rehab and home. Ironically, I even help families plan their time by providing recovery resources and support, and encouragement through peer visits by volunteers from the Trauma Survivors Network at Vanderbilt. In the midst of this fragile and dire time tending to the trauma families in waiting, I noticed something magical as it unfolded in our waiting rooms. Complete strangers who live near and far from various walks of life relinquished their defenses to form unity among other strangers in waiting. Boredom? Far from it. This phenomenon of strangers bonding during a crisis was so compelling that I studied it for three years (that’s a lot of time) to write my doctorate dissertation on the matter. What did I find? Sorry, you’ll have to wait until it is published. But I’ll give you a snippet. I found that time is mysterious, especially when shared. In the moment of crisis, we pray, hope, suffer, endure, cope, empathize, equalize, and interestingly, we bond. Thus, it helps us come to grips with Trauma truisms: “The Golden Hour,� “Life hangs in the balance,� “Time is of the essence�, “This is a marathon, not a sprint,� “Time will tell,� “Wait and see� and “Slow is good, fast does not last.� On 10N Trauma, timing is everything.
Dr. AndrĂŠ L. Churchwell is Associate Dean for Diversity at VUSM. Churchwell was born and raised in Nashville. He now lives in Brentwood and is married to Doreatha Henderson Churchwell. They have two children.
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Susan M. Sutton Clawson, PhD, MPH manages the Trauma Survivors Network at Vanderbilt. Susan’s passion for writing and working in trauma began at age 7 when she won the Young Author’s Conference for a story about a mama bear who suffers a burn injury and is hospitalized.
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MEDICAL
The Harvest "-* )"/40/ Time is of the essence At a time like this My pager summons Run! How exciting To be flying On a private jet! I feel so important Like them Looking down from Above Not much talking On this ride Nervous laughter Idle banter Phones ringing Fathers explaining Why They won’t be home for dinner Or at the soccer game “Time is of the essence” They say Every second wasted diminishes Life Faster We must go faster Why is the ambulance not here? Don’t they know we are important? Don’t they know time is of the essence? Life Is being wasted A moment of silence? We don’t have time for moments! Quick! Cut, cauterize, clip Snip, snip You take this I’ll take that Wait, I need more vena cava
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For my liver My organ cannot fail You’ve already taken nearly all of the pulmonary veins I mean, don’t be selfish Alright, I’ve harvested my organs Thanks for your time But time is of the essence So I must jet Good luck and God speed You all got what you need? The coolers are packed? The blood has been drained? Hooray! Sew up the corpse, Students We’ve done it! We’ve beaten Time! We’ve doled out more Life! Ripped from the body Of a mere mortal Gun shot wound to the head Lucky for us His young, healthy heart was still beating When He Was pronounced Brain Dead
Ali Hanson is nearing the end of her MD/PhD training at Vanderbilt and has just begun exploring how she might incorporate her lifelong passion for the arts into her future career.
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MEDICAL
Can’t Stop the Clock %06( )&45&3 With crisp scrubs I slip into OR 20 Just used The mops are gone but the wet tiles still glisten To prepare tonight’s theater. The props must be perfect for our protagonist Laryngoscope Mac 4 blade Tube Stylette Check Etomidate Succinylcholine Atropine Epi Check Central line Arterial line Fluids Check Oxygen Ambu Bougie Machine Check Check Check Check Ready for the drama that I hope never comes. The hands turn slowly But the room is ready I am ready I whisper to myself They can hurt me but they can’t stop the clock.
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Minutes turn to hours with not much to report PACU patients perused Dinner was delivered Pre-ops prepared for tomorrow. The hands still turn But the room is ready I am ready We joke over tacos They can hurt us but they can’t stop the clock.
Midnight comes The curtains rise Trauma to OR 20 I rush Remember Rehearse Ready for my role As the spotlight finds the protagonist Bloody face Crush injury Sucking chest wound C-collar The hands turn But the room was ready I was ready I hear myself saying They can hurt me but they can’t stop the clock. But we all know how it ends. Tube placed/through pink bubbles and orphaned teeth IJ slammed in As blue drapes cover me A-line appears My attending is useful tonight A wake of blood chases the scalpel down the abdomen Pours over the sides of the table Splatters on the sugeon’s shoes. The hands turn quickly But the room was ready I was ready But we all know how it ends He rises Falls Rises
Along with our hopes Until they reach the IVC Sheared from the heart Out of blood Out of time Out of hope. The curtains fall As monitors fail And finally The narrator asks for the time.
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MEDICAL
Morning Rounds The EKGs twist Twirl Tumble Slowly snake into steady-state lines. The hands turn quickly But the room was ready I was ready Dawn comes The sunlight signals a start for most But for me And him An end. My truck pauses at each red-light They last a little bit longer this commute Echoes follow me They can hurt us, but they can’t stop the clock. But we all know how it ends I am ready.
(3"$& )0 Dear Attending, I recognize your love for patients, Your calm, your poise, your ruminations While handling their complications And addressing their expectations. Your love for teaching is also clear, You grant us knowledge without a sneer, You reference papers with ample cheer, To further help each student’s career. But really, have the years fixed your feet, Buttressed your back - your knees with concrete? Is our pain and misery so sweet That rounding must be a four hour feat? Perhaps to you, rounds pass in a blink, Filled with questions that force us to think. But for us, time on rounds seems to slink To the point where we require a drink. So please keep our mental health in mind (And our feet, our backs, our knees in kind), When tomorrow brings the daily grind And shorten rounds if thus inclined. Love, Student Disclaimer: the contents of this poem may or may not reflect the author’s views
Doug Hester is an Assistant Professor of Anesthesiology who writes poetry as a way to cope with stresses of the operating room. "Can't Stop the Clock" is about the transience of both medical practice and also life.
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Grace Ho is a third year medical student from Virginia Beach, Virginia, who completed her undergraduate education at the University of Notre Dame (Go Irish!). In addition to medicine, she enjoys good coffee, crossword puzzles, and FoxTrot comic strips.
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MEDICAL
Past, Present, Future
Eleven Liters
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Med student going on rounds, What wonders of medicine abound. Peeking around the corner with anticipation, Treading with trepidation. Yet each floor, each hall, Horrors and sorrow await, like a bird call. Patients, some young, some old Lives in the balance, relationships both warm and cold. Inside, under sterile lights and paper gowns, the IV drips, Outside, unbridled except by a tree, the frosty air nips. The sky blushes, the clouds change, the wind blows Setting sun, bird chirps – all impermanent, as the world grows. Student, nurse, doctor, student-doctor, Patient, Mere titles, momentary, themselves transient In the room, a beautiful bouquet, a rose one day, Garbage the next day, that’s the way From rubbish pile one day, turns to dust And from the dust, a sprout! Dirt becomes a must Have no fear, from the ground a flower peeks A blossom next week. Things arise out of causes and conditions Things disappear due to causes and conditions, Every cause, an effect Life, too many actions to dissect With past life, the present life is possible With present life, the future life is possible Love, the greatest wealth With it, no fear will death be dealt Those who understand the rose in a garbage bin, Will always win The ultimate bliss Hope, a gentle kiss
Emory Hsu cannot quite believe how fast time goes by and that he will be graduating from medical school in May. This short poem takes its roots from the two different styles of Zen by Buddhist monks Master Hsing Yun and Thich Nhat Hanh.
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T
hey always take eleven liters, she said. That’s impossible, we said. Every two weeks, she said. They always say listen to your patients. We found eleven bottles. Eleven liters, we whispered. Eleven liters. 3:00, the darkest hour of the night. The mid-night news babbled on. Her husband slept in the corner, his head on his chest. Under her gown we saw raised red marks from previous paracenteses. Every two weeks, she whispered. Every two weeks. The fluid flowed from her side. One liter, two liters, three liters. Drip, drop. Tick, tock. The weather report repeated itself. Her husband breathed deeply. Four liters, five liters. Drip, drop. Tick tock. 4:00, even her fluorescently lit windowless room felt darker than dark. We talked about cats and family, sleep patterns and circadian rhythms. The traffic report repeated itself. Her husband shifted in his chair, looked up, went back to sleep. Six liters, seven liters. Drip, drop. Tick, tock. 5:00, eleven liters, we whispered. Eight liters, nine liters, ten liters. Drip, drop. Tick, tock. We talked about eleven liters. Five and a half big bottles of soda. Eleven liters! Every two weeks, she repeated. Every two weeks. Morning came and brought with it a new newscaster and an endless series of traffic reports. The eleventh liter. One day, there will come a one hundred and eleventh liter. Each liter exactly the same as the liter before. Drip, drop becomes a mantra, an endless cycle. The insomniac narrator of Marcel Proust’s In Search of Lost Time complains that the great problem of human existence is the “anesthetizing effect of habit.” We see and we hear and we feel without seeing or feeling or hearing anything at all – because we have seen and heard and felt the same before. My fear is that Proust is right, that the hypnotically insistent drip, drop becomes an anesthetic. That I forget what I am doing and to whom I am doing it. I found the solution to Proust’s problem in Thornton Wilder’s play Our Town, in which the voice of the dead laments, “Do any human beings ever realize life while they live it? – every, every minute?” Habit may anesthetize – but only if I allow it to. One day, as I look into the face of my one hundred eleventh patient, I want to see. Really see. I want to remember what I am doing and to whom I am doing it. I want to remember, as Wilder’s dead remind their audience, that we don’t have a “million years” to waste. Most of all, I want to remember that every drip and every drop and every tick and every tock is a once in a lifetime gift.
Lucy Boyce Kennedy is a second year medical student from Kensington, Maryland. She thanks her parents for teaching her not to end every sentence with a preposition; her siblings for being her partners in crime; and her dog for keeping her bed warm when she is out of town.
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MEDICAL
Veterans’ Affairs
Changing Seasons
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“’68 was a rough year,” he smiles weakly to his nurse. that year he met Jack Daniels after all those children went up in screams and flames. he came home and they thanked him for his service. men in DC, on TV, said he’d saved the commies from themselves. his liver’s been slow-burning ever since. now men in white coats come in, prod his belly under veterans’ pajamas that say PROPERTY OF THE UNITED STATES GOVERNMENT. thank you for your service, they say. he burns slowly, wonders who he served. a drink would put the fire out, but government hospitals don’t serve alcohol.
Irène Mathieu is a third-year medical student with interests in global public health, activist medicine, and primary care. Irène has been writing ever since she was able to talk. In 2011, she was nominated for the Pushcart Prize.
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Lauren Mioton is currently a Vanderbilt Medical Scholar working on clinical outcomes research.
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MEDICAL
Ode to a Candle
Denial is Universal
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The putrid darkness of a windowless room pins my skull with iron hands. Yet just beyond reach relief lies dormant on a coffee table. The tall cold walls rise to curved lipsmy sparks invade the stillness, leasing life. On cue a golden heartbeat sings in the chest of a woman dancing in her own spilled blood
I should not have missed the change. Your wife knows best. She said you were different. I noticed your tremor. But I thought it was a medication reaction. Really I just didn’t want you to be sicker. I was willing you well. I knew I couldn’t change the weeds that overtook you. But I willed your kidneys to work. I let my hope blind me. When we cleared those toxins from your body, everyone said you were a satisfied customer. I didn’t deserve your gratefulness.
Warm breath erupts from her molten body; without pain, she surrenders her apricot and mango perfume. She shields my room from the unbending black but I just watch her flickering away the days until her own dark death.
David is a fourth-year Vanderbilt medical student from Indiana pursuing a career in Urologic Surgery.
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Sharmeela is currently a Nephrology Fellow at Vanderbilt. Sharmeela believes writing to be an extraordinary outlet to help cope with the emotional trials of being a physician, and she plans on continuing to write poetry and fiction.
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MEDICAL
Watching Clouds
Here’s to Looking at You
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I sit on the stone steps of a thousand-year-old trail, Facing south. Machhapuchhre rising behind Sacred solitude untouched by human feet. The valley in front fills silently with thick, white, rolling clouds, Coming closer, smothering the hillsides. A glance away then back catches the imperceptible forward movement of shrouding white. This, my task: To watch the valley losing itself to the clouds. My singular task. I watch the clouds. I walk the well-worn steps. I eat. I rest. I memorize the Himalayan mountains before me. Singular tasks. Time and space to devote my whole self to that which I see and hear and feel. In the moment. Modern education frowns on singularity. Achievement despises it. A gift. And a curse. Telephone while driving. Eat while typing. Email while the floors slip by in the elevator. Gain achievement, accolades, awards, success. And satisfaction? I return to the clouds. They require all my attention, all my focus, all my love, all my gifts. Singleness of purpose. Singleness of focus. Inner satisfaction. Inner peace.
Beth Ann Sastre is an assistant professor in the Division of General Internal Medicine at Vanderbilt University Medical Center.
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There’s nothing tentative In the unveiled face Or in the blue-black focus of her gaze Marks of nobility, a proud bearing Indigo robes, tasteful pairing Hail a woman A daughter, a mother, a wife The golden sands could not slip her by Seizing every shred every patch of time With artist’s fingers and a winsome smile Never lost in the far or unknown Reigning in the here and now Meals cooked, bills paid Chores tackled, skirts tailored, beds made Countless hours by our side, always present, always mine A tough business-woman, crystal in her goals Choosing a husband, planting a garden, making a home Inspiring success in her circle and more Graceful in all times, never ill at ease A wiser counsel we could not seek His beautiful bride, our sweet mother The bounty of our harvest to her we owe Age cannot diminish, nor seasons fade Exhilaration of a time well spent A life lived jubilantly!
Monita Soni MD is a pathologist, author, poet and artist. She has published many poems and essays in newspapers and journals. Her recently published book of poetry is, “My Light Reflections.” You can listen to her podcasts on the Sundial Writers Corner on NPR.
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MEDICAL
A Moment of Light
Time Never Sleeps
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In medicine, it is easy to get overwhelmed by the sadness, disease, and death around you. To me, this photograph reflects the possibility of having the juxtaposition of joy and grief, hope and despondence, darkness and light. Indeed, I have had some of the most uplifting encounters with some of the sickest patients and have seen patients inspired by their illness. Of course, the moment of sun in the photograph was transient, just like the moments of hope in a hospital sometimes are, but it is important to remember that these moments exist, so that we can get cope with the more difficult moments without losing direction.
Eszter is a first-year medical student who grew up in Shreveport, LA. She completed her undergraduate degree in Molecular and Cellular Biology and French at Vanderbilt University.
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Voranaddha “Bim� Vacharathit is a third year medical student from Bangkok, Thailand. Her hobbies include sculpting and creating medical animations.
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PATIENTS
I
Waiting for Truth
It Won’t Be Long (Tim’s Song)
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t’s the secret-keeping that intensifies the anguish of waiting. I’d prefer truth, flinging the medical closet door open without hesitation in the same way that I came out as a lesbian. I’d like to name my illnesses as easily as if I were revealing a case of the flu. If I were recovering from brain surgery, heart disease, or breast cancer, I wouldn’t go out of my way to hide it from anyone. Maybe people would offer to bring meals or run a marathon in my honor. But I’ve learned from experience that what I have – complex post-traumatic stress disorder, major depression, and bipolar II – are more likely to make people stare, stutter, and squirm. They may blurt inappropriate comments. They may disappear from my life. I simply don’t have the emotional fortitude to risk disclosure unless I am certain of a positive reaction. For the sake of my mental health, I conceal my mental health. When I went on medical leave, I thought I’d be better in a few weeks. I’d return to work, offering a vague reason for my absence, no elaboration necessary. But weeks turned into months. Sick leave turned into short-term disability, then long-term. Years later, I’m still not back to work. I am still waiting for specialist appointments, for new medications to take effect, for symptoms to pass. I am still waiting to find out the lifespan of a secret. It becomes more awkward to keep as time passes. Close friends at work who know my situation reiterate my request for privacy when colleagues speculate or press for information. I’m loath to make new acquaintances; they always ask what I do for a living. Naming my profession is easy, but then come questions about my current projects (none) or exclamations about the coincidence that I work with their friend (who inevitably has been hired after I became ill and thus we’ve never met). If I try to circumvent these responses by appending my job title with a casual, “I’m on medical leave right now,” the door is open to ask how long I’ve been away, when I’ll be returning, or what kind of illness I have. And sometimes, a few months – or years – later, I hear, “You’ve been away from work ever since I’ve known you. Are you ever going back?” Right now, I’m waiting to get better, to live fuller life, to resurrect my stalled career. But I know that once I’m well, I will wait again: to hear the questions I will be faced with about my long absence, to learn whether – if the truth comes out – the repercussions will be as negative for me as they have been in the past, to see whether I am ever able to risk talking openly about my illnesses, and to watch how – and whether – our society combats stigma in the realm of mental health. When the waiting is over, it seems, the waiting will have just begun.
Even though It hurts to let you go I know it’s time for you to fly You got your wings And I’d give anything If I could leave here for your side But I’m just glad to have known All the love that you have shown I know you’d like to stay But hey ... life goes on And it won’t be long We’ll be together Soon we’ll look back And laugh at these tears It won’t be long But it seems like forever Could be tomorrow Or it could be years But it won’t be long
And it won’t be long We’ll be together Soon we’ll look back And laugh at these tears It won’t be long But it seems like forever Could be tomorrow Or it could be years But it won’t be long It won’t be long... No, it won’t be long...
Time is short And that’s both good and bad You’re here one day And then you’re gone So I’ll try Not to be so sad Cuz I know it won’t be long Til I’m looking in your eyes And we’re both so much alive Just some other place Some other time... Above are lyrics to a song. You can listen to It Won’t Be Long at: https://medschool.vanderbilt.edu/tabularasa
Anonymous lives in Canada with her wife and their feline companion. She is grateful to be surrounded by a web of loving friends.
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Robert Charles Burns moved to Nashville in 1984 to pursue music and play the role of “Hoss” on WSIX before going public with AIDS in 1995. He is a Nashville Cares volunteer, speaking publicly to help educate youth while continuing his music dreams.
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PATIENTS
Self – Reflection: Is it Kindness or OCD?
Time Not Foretold
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onfess, wash, wash more, repeat, repeat, check, repeat…It was 1996 when I took a huge risk and told a psychiatrist of my thoughts and fears; I was so terrified of judgments. The actual result however was an accurate diagnosis of OCD (Obsessive Compulsive Disorder). WHEW! What a relief! I learned I was not alone, that what I was experiencing was not my fault and it was treatable. My diagnosis came at a time when OCD was considered a “popular disorder”. As more research was conducted and information became available, OCD became a media darling. Those with the most visible symptoms (whose suffering was palpable) were featured on television, radio and in print, labeled as people with “bizarre” behaviors. I ran, not walked, to treatment, willing to do anything to heal. Medicine, individual therapy, group therapy, support groups, volunteer researcher and voracious reader of everything OCD became my life’s work. Catching my attention was a rarely discussed part of OCD; scrupulosity. Scrupulosity is a symptom of OCD in which an individual acquires an “overdeveloped” sense of religion or morality. My moral battles became my albatross. Believing I was stealing if I found a penny in a parking lot and didn’t turn it in to the owner, I fought never-ending battles between myself and obsessions. It has been easier to be kinder to others than to myself. I have sent people I know multitudes of informational emails under the guise of “protecting them”, later realizing it was what I thought they had to have. I feared that without sending them information, I would be negligent in helping them be safe. OCD is about attempting to manage my world, trying to be in control, because so often I have felt out of control and tried to put everything in a safe box. If I don’t disclose to you the absolute whole truth, I think I have been deceitful and must tell you EVERYTHING which of course is TMI. The obsession tries to make my world safe and the ritual or compulsion is to serve the obsession. With confidence in myself, the support of a loving husband, family and friends, a wonderful psychiatric service dog and an effective therapeutic team at Vanderbilt, I am learning how to let go, to embrace my OCD and the willingness to live a life of uncertainty. I believe all of these help in healing my OCD.
Lorre Mendelson is a human rights activist, educator, and freelance writer working to end human trafficking and slavery. She identifies as a woman with OCD and lives in Nashville with her husband, Ross, and psychiatric service dog, Sunshine.
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W
hen I was growing up, I held a secret certainty that I would be dead by the time I was 24. This wasn’t a faulty gift of prophesy, nor was it based upon medical knowledge. My doctors, who had treated me for juvenileonset rheumatoid arthritis since I was eight, had told my parents that I would likely be in a nursing home by the time I was 40. So I was supposed to live for at least that long. No, my belief in my own early demise came from a lack of hopeful imagination; given my health through childhood and adolescence, the thought of surviving far into my twenties was not just untenable, it was dismal to picture. On a daily basis, I needed help with bathing, getting dressed, and at times even with brushing my teeth and going to the bathroom. Often a new medication would improve my situation, but at the most for several months; then it, like the previous meds, would lose its efficacy. I did not see my condition getting better with time, and I couldn’t imagine coping with life as an independent adult. In my young mind’s logic, not being able to foresee a positive future for myself equalled seeing no future at all, and it seemed preferable to believe I would have a shortened life than one even harder than the one I was living. Of course, it was a rather romantic notion, too: an image of myself as a too-soonlost girl rather than as a long-lived burden and invalid. The seemingly arbitrary age of 24 for my demise came from reading about one of my favorite composers, Lili Boulanger, who had succumbed to the effects of what is now known as Crohn’s disease at that age. While I didn’t consciously think on a daily basis about having—perhaps wanting—a short life, my belief in it infused my life in some ways; I pushed myself hard in those aspects of life where I could thrive and excel, such as music and academics, and envisioned myself as a bright, fast-burning candle. I followed my doctors’ prescribed health regimen of exercises and medication, but otherwise used my body the way a gambler might go through her winnings. I was not an accumulator. I ignored my physicians’ concerns about my plans to go away to college, or to enter a demanding grad-school program. It was not until I was past the age of 25 that I realized that what made longevity seem impossible to me had far more to do with how I lived my life than with the disease itself. As a child, I wish I could’ve imagined what I have now, at 44; advances in technology and treatment mean my life is much easier and my quality of life in many ways better than what I had while growing up. I think of returning to my child-self and granting true foresight; but then a part of me realizes that somewhere in me, there was, if not accurate prophetic vision, at least faith in something better - something that kept me yearning striving to live life fully.
Alyson Knop has been living with juvenile rheumatoid arthritis since age 8. For that and related conditions, she received extensive and excellent care through the Vanderbilt University Medical Center while living in Nashville.
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PATIENTS
On My Therapist Moving Away
Animal Time
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For eight years you sat; Three times a week, you listened To my history. Now you have abandoned me; Will my history go too? Where does it belong? In my memory or yours? Does it change with time, Shifting with each new insight, Each thought reinterpreted?
That night, some 4.5 billion years in, she drifted unmoored— a wanderer, a wayward raft, a darkness she could never speak, as he cracked her open, pried her in two, plunged himself down between her breasts, through her skin-and-rib-fluted shell, to scoop with his surgical hands the flesh of her dying heart, his scalpel carving rescue as she lay stretched across his table, his fingers threading new pathways that would (if she were lucky) pull her back to shore.
Susie Margaret Ross is a writer and poet. She is not sure that she has a theory of writing, but if she does, it is that what the reader brings to a poem is equally as important as what the writer brings.
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And in the sheen of her heart’s surface, he saw his own reflection, the overhead lights, the bestial sky, and listened as her ribs groaned open and the stars of her sighed release, contracting systole— pushing diastole—
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PATIENTS one last time into his ears, over a city asleep, over her own bed waiting empty, and around the body of her lover awake just rooms away as she rocked in spite of her now-stopped heart in the arms of a machine—
Invisible (Parrot) 7*$503*" #00/&
oxygenated blood in, deoxygenated blood out; oxygenated blood in, deoxygenated blood out— the forced sacrifice of animals keeping her alive, holding her safe, the flow of blood whispering a lineage of creatures in their endless loops, unfurling mud, sinking to the bottom, rising up once again as his hands on her heart danced the struggles of stardust. Nothing miraculous or otherworldly: the two of them simply bodies, simply remnants, simply humans in animal time.
When she was 38 years old, Lori Anne ParkerDanley suffered a rare, life-threatening event when two of her coronary arteries spontaneously dissected. “Animal Time” is about that experience.
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Victoria Boone’s painting “Clouds” has been chosen to be in the Permanent Art Collection in the new Music City Center. Victoria started BOONE VISUAL ARTS (BVA) in May 1997.
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PATIENTS
Einstein and Me
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EDITOR-IN-CHIEF Meredith Rogers, VMS II
am absolutely positive this is my last chemo treatment,” I protested, breathless. Slumped in my wheelchair, I peered at the nurse as she efficiently removed the IV from my port. My hairless, pale face was pained. “The doctor told me three more rounds of chemo after my HCG fell below 5. It fell below 5 on November 1. Today is Dec 6 and I’m done.” Ignoring my concern, she argued, “You’re mistaken. My records show four more weeks.” She paused, “Hmmm, wait. Well, at least two more, to be safe.” It wasn’t safe. I felt like I was dying. Not from the cancer, but from the chemo. I not only was hairless, but my fingernails were turning black, and I was a walking skeleton, cheekbones protruding. I felt death lurking in my ravaged body, and I knew: Time was up. I knew because when you have cancer, time is no longer measured in minutes and weeks, but in rounds and blood markers. Time becomes elastic, flexible, relative. Einstein knew all about time’s relativity. So did I. The nurse did not. In August, when the doctor pronounced, “It’s cancer,” time halted. My heartbeat slowed and grew louder, my breath hollowed and, joining the silence in the room, roared in my ears. Jumping time, I stepped outside of my body and watched myself sitting in his office, being practical and asking the right questions. Soon, however, there wasn’t enough time as it hurtled along under the procession of tests, surgeries, and the careful rearrangement of every detail of my life. I frequently found myself looking for lost time, wondering where it had gone and what I would do if I had more of it. Once chemotherapy began, time adjusted tempo to a steady but agonizing march, in rhythm with the alternating weeks of my bi-weekly treatments. My “wicked chemo” would end only when my cancer, or my life, did. There would be no pause in the assault; my cancer had a winner-takes-all prognosis. With no end in sight, time trudged on, measured in rounds of treatments, monitored by weekly blood tests. And then, one day, my HCG blood count read below 5. Miraculously, time inhaled and began to breathe again. “Three more rounds of chemo, six more weeks” the doctor declared. With those words as my mantra and hope as my teacher, I followed time, breathed, and began to mark the days and the weeks remaining. So, voice shaking, I summoned all of my courage. “I’m sure,” I pronounced. “Three rounds. Six weeks. Please check again.” The nurse sighed, irritated. “Okaayyy.” She huffed. “Wait a minute. I’ll be right back.” A minute? Sure. I could wait a minute. It was only time.
MANAGING EDITORS Brian Cash, VMS II Matthew Taussig, VMS II
“I
Cathy Kelly obtained her B.S. degree in Finance from Brigham Young University. After several years in the business world, a diagnosis of uterine and lung cancer in 2011 inspired Cathy to pursue her love of literature and writing.
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PRODUCTION EDITORS James Lee, VMS I Alejandro Perez, VMS II EDITORIAL BOARD Community Eleonor Leger, VMS I Chelsea Samson, VMS II Eszter Szentirmai, VMS I Voranaddha (Bim) Vacharathit, VMS III Medical Anna J Ahn, VMS III Caitlin Bell, VMS I Monica Bhutani, VMS I Hillary Drexler, VMS II Neil Issar, VMS III Patients Lillian Johnson, VMS II Zain Gowani, VMS II Samaiya Mushtaq, VMS II Rishi Naik, VMS IV ADVISORS Joyce Johnson, MD Scott Pearson, MD Gregory Plemmons, MD ACKNOWLEDGEMENTS Scott Rodgers, MD Bonnie Miller, MD Jeff Balser, MD PhD Terence Dermody, MD
A doctor possessed of the writer’s art will be the better consoler to anyone rolling in agony; conversely, a writer who understands the life of the body; its powers and pains, its fluids and functions, its blessings and banes, has a great advantage over him who knows nothing of such things. THOMAS MANN, 1939
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