2020 VUSM Tabula Rasa

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VOLUME XII: 2019-2020

VANDERBILT UNIVERSITY SCHOOL OF MEDICINE


Cover Art: “Aurora Borealis� - Ray Zhou full prints appear on page 35

The works published in this journal were selected by medical and nursing students at Vanderbilt University based on artistic and literary merit. They do not reflect the personal views of Vanderbilt University or Vanderbilt University Medical Center. To contact the editorial staff or submit your creative work, email postcallanthology@gmail.com To access complete versions of excerpts, visit https://studentorg.vanderbilt.edu/literatureartsandmedicine/tabula-rasa/


VANDERBILT UNIVERSITY JOURNAL OF MEDICAL HUMANITIES 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.


EDITOR’S NOTE This year was one of tragedy for myself and many of those around me. A death in the family uprooted everything I knew and caused me to have to dramatically shift how I viewed the world to persist. The coronavirus pandemic brought a different sort of isolation and loss which altered society permanently and profoundly. A devastating tornado tore through neighborhoods of Nashville that those I love call home. We received chilling reminders that police brutality and racial violence continue to take the lives of innocent black folks. Unexpectedly, a large part of my healing has occurred by immersing myself in the creativity of others. As pieces began to trickle into the journal, I felt a sense of connectedness with the Vanderbilt community. I lost myself in the personal reflections and struggles shared by the journal’s writers and saw the world through the lens of its photographers and artists. Thank you to all who have contributed to this journal for sharing your vulnerability and talent. Though I have not met most of you, I will not forget your words and art. Thank you also to Drs. Daniel Birchmore, Brian Christman, and Ann Price as well as all others who have made this publication possible. As you sift through these pages, I hope you, too, find refuge in its voices. Sincerely,

Manasa Bhatta Editor-in-Chief, Tabula Rasa Vol XII


2019-2020 EDITORIAL STAFF Editor-in-Chief Manasa Bhatta, VMS3 Poetry Editors Elizabeth Cosby, VMS1 Jaclyn Lee, VMS3 Eve Rodenmeyer, VSN2

Prose Editors Lex Erath, VMS3 Jessa Fogel, VMS2 Design Editor Arulita Gupta, VMS2

Art Editors Tara Duffie, VSN2 Joyce Huang, VMS3 Alice Liao, VMS2

Managing Editor Sarah Pourali, VMS3 Raymond Zhou, VMS3

with special thanks to Daniel Birchmore, MD, Brian Christman, MD, Ann Price, MD, the Vanderbilt Medical School Alumni Association, and the Vanderbilt Medical School Administration for their continued and dedicated support of the medical humanities


In Loving Memory of Dr. William J. Stone, MD 8/1/1936 - 5/11/2020 “Address patient problems with intelligence Attack your daily tasks with due diligence Rare cases do us enthrall But remember most of all To treat each soul with awesome reverence� -Dr. William Stone, Medical Limericks

Dr. Stone was a beloved member of Vanderbilt faculty. In addition to being a renowned nephrologist, he was an esteemed poet, educator, and friend. His charming limericks brought joy to learners across the world and inspired an appreciation for the whimsy of medicine. He will be missed by all.


TABLE OF CONTENTS Featured Pieces editor’s picks for top written and visual arts pieces PROSE

PHOTOGRAPHY

“But if you don’t even know that what color shirt and tie you wear is important, why would you even bother to ask?” “Medical School Interview circa 2005” -William Yi, pp. 24

POETRY

VISUAL ARTS

“What I look for ahead is not simple, but only more compressed.” “Edge of Day” -Trent Rosenbloom, pp. 31

“Living Will” -Bruce Jennings, pp. 23

“Sara’s Dream” -Amany Alshibli, pp. 23

Part I: Tabula Rasa 11 12 12

“When Facing Pandemic” - Cosby Stone

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“Anatomy” - Daniel Lev Family DNA” - Daniel Lev

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“My Serious Child” - Heather Jordan “Portrait of the Author by her Daughter” -Carolina Jordan

“Living Will” - Bruce Jennings

20 21 22 23 24

“Confetti” - Eszter Szentirmai “Stars and Stripes” - Eszter Szentirmai “Sara’s Dream” - Amany Alshibli “Taking a Sexual History” - Natalie Hibshman, Jaclyn Lee, Maggie McBride “The Renters” - Xavier Bledsoe “Fall River Scene” - Frank Gee “The Next Generation” - Frank Gee


TABLE OF CONTENTS Part I: Tabula Rasa 26 27 29

“Painting the Sky” - Delany Fleming

30 31 33 34

“Three AM” - Jean Anderson

35 36

“Aurora Borealis” - Ray Zhou

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“Winter Lightning” - Quentin Eichbaum “Wave” - Quentin Eichbaum

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“A Mid-Femur Knight’s Dream” - Aaron Azose, Mandy Azose, Bekka DePew, Grace Harrison, Clark Stallings, Alex Tinianow

42 43

“Twenty-One Weeks” - Daniel Pereira

“Aging is Not a Disease - Jacob Parnell

46 47

“Non-‘Complications - None’” - Lealani Mae Acosta

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“Dry Eyes: Evolution of Awareness” Catherine Fuchs

49 53 54

“Are You There?” - Yulia Lee

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“Hulling the Heart” - Lori Anne Parker Danley

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“On an Angel’s Wings” - Teresa Turnbo

60 62 66 67 68 69

“A Cat Named Carmen” - Federica Angel

“Survival Skills” - Manasa Bhatta “First Day” - Eve Rodenmeyer “To The Young Woman who Donated her Body” - Scott Pearson

“Medical School Interview Circa 2005” William Yi

“Close” - Barry Noland “Truth, Lies, and Presidential Bones” - Roy Meals

“The Emergency Room” Arthur Yu

“Tunnel Vision” - Barrington Hwang “Mechanical” - Jaclyn Lee “Wind + Ice” - Jaclyn Lee

“Ah, You’re The Doctor?” - Denise Raynor “Lavender” - Anivarya Kumar “Anatomy Study Date” - Alice Liao “Red Dream” - Frank Gee “Negative Study” - William Yi


TABLE OF CONTENTS Part II: Post-Call Anthology 71

“Rose” - Karl Misulis

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“Letting Go” - Rolf Meinhold

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“Bird Calls in Autumn” - Brian Christman

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“Where Am I Now” - Nanette Bahlinger

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“Sunset at Davenport Pier” - Ashwin Inala

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“Flowers in Spring” - Daniel Lev “Flowers Underwater” - Daniel Lev

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“Mabs” - Kelly Sopko

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“Me Am Hulk” - Andre Churchwell “My Spirit Toddler” - Kia Quinlan

“Dusk’s Revenge” - Ashwin Inala

91 92

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“Love Time for Jane” - Richard Hutson

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“Paper Wasps” - Janice Savage

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“I Can’t” - Jessa Fogel

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“Black Hole” - Jean Anderson

84

“Rio Grande River at Twilight and in the

96 97

“Kaieteur Falls” - Peter Bryant

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“Shrinking” - Allie Yan

Morning” - Joyce Huang

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“Heart Yourself” - Regina Russel

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“Sonoran Desert” - Samuel Rosenbloom “Edge of Day” - Samuel Rosenbloom

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“The Sleepwalker, the Insomniac, and the Windmills” - Anita Louie

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“The Baltic Shore” - Emily Mace

“Unremarkable” - Henry Quach

“Alligator” - Tara Duffie “Coast Scene” - Tara Duffie


PART I: TABULA RASA “Wherever the art of medicine is loved, there is also a love of humanity.” - Hippocrates


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WHEN FACING PANDEMIC Cosby Allen Stone, MD, MPH The world will seem frightening, alarming, and strange but the sun will keep shining the rain will still rain and this dichotomous schism will cause you some strain because a stress that’s mixed with normal is very hard on our brains. Remember that viruses don’t infect you by grudges they don’t care about your politics they’re impartial judges. To infect you, they all have certain rules they must follow To protect you, our methods can be good but tough to swallow. First, listen to experts and do what they ask the goal is avoiding all the worst that could pass

Use hand-washing and distance as your tools to protect all the vulnerable among us whom we must not neglect. Next, don’t give in to panic fear makes fools of us all and when making a decision don’t ignore love’s higher call. Don’t cause harm to one another while you care for yourself. You will not find your security by emptying shelves. Because pandemics only show us what was there all along; all the kindness, all the fractures all the noble, all the wrong. It’s our countless small decisions that are notes in greater songs. And to combat pandemic viruses “Love your neighbor” is never wrong.

Cosby Stone, Jr. is an Instructor in Allergy/Immunology at Vanderbilt University Medical Center, performing research in risk-stratified management of medication allergies. He has four published volumes of poetry, called Becoming a Physician, Nature and Faith, Remembering Residency, and First Time Parents, with a fifth anticipated for 2020.


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MY SERIOUS CHILD Heather Jordan, MPH Once, when she was three, my daughter looked out at the winter sky and the barren trees and made the realization that trees look like people. She held up her own arm and hand and spread her fingers before her. Their branches are like arms, she said, and the little branches are like fingers. This is a thought that had occurred to me only as a teenager, in art class, when someone else pointed it out.

“Portrait of the Author by Her Daughter" - Carolina Jordan

She was a serious child. She never cried over small things. When she was learning to walk, I forbid anyone (mostly my mother) from gasping when she inevitably fell. She would stumble and fall, maybe hit her chin or knock her head - I would look to her to inform my response. If she wasn’t crying, I wasn’t crying. If she was crying, it would dig deeply into my heart because I knew she meant it. She never cried out to me, “Mama!” when she was in pain. But I had never really seen her in pain. A previously health 5-year-old girl presents to the emergency department with a chief complaint of persistent left-sided neck swelling with new-onset headache, odynophagia, and pupillary asymmetry [1].

New Year’s Eve of her fifth year, I was buckling her into her car seat for the long ride from our hometown of Tallahassee back to Nashville. “My neck hurts,” she says. “Do you have a sore throat?” I ask, closing her door and moving to the driver’s seat. “Is that what you mean?” “No. My neck hurts.” What five year old has neck pain? I scoffed to my husband. I’m the one with pain, I thought, adjusting the pillow that padded my seat, getting ready for the drive.


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We spent the evening in Atlanta with friends-with-children, low expectations for a raucous start to the New Year. At nine pm we lit sparklers outside. She is tired, she says. Her neck hurts. We put her to bed on a large air mattress in the nursery next to our friends’ already sleeping baby. The adults have wine and try to stay awake until midnight. I am pregnant again, we tell them. We cheers. We hear her on the baby monitor - she is crying, not the baby. The pathophysiology of pseudoaneurysm development after infection is not completely understood, but it is thought to be caused by the introduction of infection from pharyngeal, tonsillar, peritonsillar, or lymphatic channels. A few days later we took her to the emergency room. They diagnosed her with an infected lymph node on the left side and prescribed antibiotics. A week later, when she is still waking up at night, crying out in pain, we take her to her pediatrician, back to the hospital, to an ear, nose, and throat doctor. No one is quite sure what could be wrong. She is tested for an ear infection, influenza, mononucleosis, meningitis, tuberculosis. Ultrasounds show growth or shrinkage of the infected lymph node. Increasingly, nighttime is interrupted by crying, at first waking up from pain, but eventually sleeping through it and crying in her sleep, talking out loud, pain creeping into her dreams and turning them sour. Looking back, it went on for too long. Between bouts of crying or pain, she had normal days. She went to school, though I was called to pick her up more than just once or twice. Have you been to the doctor? her teachers asked. She really doesn’t seem like herself. I wanted so much for everything to be normal, I may have been reluctant to admit she was as sick as she really was. But then, within one month she had seven different consultations, so perhaps I am being hard on myself. We tried so hard to figure it out. Patients with ICA pseudoaneurysm require urgent management because they are at risk for rapid decompensation secondary to hemorrhage, airway compromise, and stroke. One bleak Saturday morning in late January, my husband was out, and she was very, very sad. I had suggested earlier that we walk down the street and have waffles at a nearby coffee shop. She liked this idea, but after battling with her to get her shoes and coat on, she did not actually look up to it. “We don’t have to go,” I said. But the disappointment of not doing a simple thing that had been planned weighed so heavily on her mood that her eyes welled up and overflowed. I don’t think she even wanted to eat waffles. She just wanted to feel well


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enough to eat them. “We don’t have to walk,” I said, stroking her hair. “We can drive if you’re too tired to walk.” “She doesn’t look like she feels well,” said the man behind the counter. “We’ll get waffles to go,” I said. “No! I want to eat here,” she insisted. But as she wept into her plate of butter and waffles, pressing her left hand to the side of her neck, I knew it was time to go. I gathered all the syrup containers and the to-go boxes in one arm and lifted her onto my hip with the other. She was so light; her bones were so sharp. Back at the house, she lay on the couch while I sat on a chair across from her, trying to figure out what to do. What was wrong with her? Why couldn’t anyone figure it out? Her face was tilted to the side, her hands clasped under her head against a pillow. She was so lovely, but so pale and sad. And her eyes, constantly evolving shades of blue since birth, looked strange. From afar, it looked as though they were two distinct shades - one the color of the winter sky, the other the deep blue sea. Your eyes, I whispered. I knelt down beside her. They were not different colors. It was that the pupil of her right eye was as big as the moon, and the pupil of her left the point of a pin. She was admitted into the hospital a few hours later. I wint to the hosptl. I got a IV. IVs hrt. IVs are win thay tac your blud. I wint to the emrgise. That is wer I got my IV [2]. She spent ten days in the intensive care unit and two more nights in observation. The infection in her lymph node had caused a pseudoaneurysm to balloon out of the carotid artery on the left side of her neck, putting pressure on the optical nerve. It never affected her eyesight, but the change in her eyes served as an alarm signal to something much worse. After a CT scan, an MRI, an infectious disease panel, she was scheduled for surgery to have a microscopic platinum stent placed in her neck, to cut off the balloon’s source of blood. Won niet I wus not cumftrbl. Nowt to self the secont flor is wer all of the ice crem is. When she tells the story, she was only afraid that first night. After that, all she remembers is the attention showered upon her by the nurses - the hair braiding, the ice cream, and wagon rides around the PICU, her father trailing behind, pulling her IV stand on wheels. The PICU rooms are open to the hallway, so we could see into the rooms of the other children. She was


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concerned about the very small babies and whispered prayers for them at nighttime. Her teacher had her classmates trace their hands on an oversized get well card. She loved reading their names out loud, spreading out her fingers and placing her hand over theirs. Mi mom cam to help. I did not wak up that night. There were family sleep rooms we were told, but neither my husband nor I wanted to be apart from her, or from each other. We shared a single pull out bed, somehow making room for my five months pregnant belly. Sometimes one of us fell asleep next to her bed, singing lullabies, holding her hand, sitting upright as we were not allowed to sleep in the bed with her. Even though she doesn’t remember it, the first few nights she often cried out in pain during the night. The nurses would wake her up every hour to shine a light in her eyes, to gauge any changes in her pupils. They would take her vital signs, sometimes they would take blood. She was indignant about the probing. “No!” she would yell with a subtext of “How dare you?” Sometimes she would get worked up and cry out “Mama! Mama!” even though I was standing right beside her, holding her hand. “I’m here, I’m here, it’s going to be alright, you are so brave,” “Mama! Mah-ma!” She would look past me so intensely that I was compelled to turn around to see who might be standing behind me. But there was never anyone else there. It gave me chills. I had the sense that she wasn’t calling out for me at all, but for some archetypal mama, the one we all seek when we are in pain. The only time I fell apart was walking her down to surgery. I began to wonder if we had never moved to Nashville, would this have happened? The doctors said the situation was so rare they would never again see a case like hers in the whole future of their careers. They would even publish a paper on it. So what if we had never moved here and she had never been exposed to whatever contagion it was that started it all? But then, what if this had happened anyway and we were still living in Florida and not so close to a hospital that just happens to employ experts in rare infections and pediatric stents? The technology needed to perform the surgery was so advanced that if we were living one hundred years ago, she would surely have died. I shuddered. Fifty, twenty, even ten years ago and she may have died. I shuddered again. It hit me how close she was to dying and I couldn’t stop shuddering, my mind winding in circles of disbelief. My husband held me, around the corner, hiding from her. We didn’t want her to know we were afraid.


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My favi port wus the donut scan [CT scan]. The ein. It was after we returned home, out of the bubble of the hospital, that we realized how bad it had been. Because it was immediately so much better. She put on weight, she slept through the night, the nightmares never came back. Her pupils have not returned to equal size, but the difference may be noticeable only to us that know to look. She returned to school. She pretended to draw blood from her stuffed animals, or to carefully perform surgery on them. As she learned to write, it became a frequent topic, often with accompanying illustrations. She processed it in her own way, created her own memories that were exciting, rather than traumatizing. Her little brother was born around three months later. The day we brought him home from the hospital she actually climbed the walls with excitement, running from one end of our small house to the other. She didn’t know where to put her energy and it bubbled up and overflowed frequently. We had never seen her so silly. The shadow of illness lifted and drifted out of our house. References: [1] William McEachern, MD, Alice Walz, MD, Keerti Dantuluri, MD, Daniel Dulek, MD, Kristina Betters, MD. Anisocoria in a 5-year old Girl. Pediatrics in Review. July 2019. [2] Carolina Jordan. First Grade Writing Journal. Fall 2019.

Heather Jordan is a Program Manager at the Vanderbilt Institute for Global Health. She has a BA in Spanish Literature and an MPH in International Health and Development. She enjoys writing fiction and essays. Her daughter, Carolina Jordan, is now seven years old and in the first grade. Her son, Tiago, will soon be two.


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ANATOMY | FAMILY DNA Daniel Lev, MD

While Daniel Lev had no formal art school training, both of his parents were artists. He began painting during a three-year sabbatical (1975-77) while raising bison in Colorado. After a 28year hiatus, he resumed painting following retirement from his glaucoma practice.


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LIVING WILL Bruce Jennings, MA “If I can, I shall keep my death from saying anything that my life has not already said.” -Michel de Montaigne, “That No Man Should be Called Happy Until After his Death” He and his daughter mulled it over. His remaining life would pass with decency and dignity, weather permitting. In a style modest and optimistic. He smiled.

I see. Icons without iconology, exuberance under the breath.

No, she said, optimism is a proposition. The word hovered between them, they watched it leave. Hope then, he said, which is a posture.

The sound the smooth curve of a railing makes as the hand slides along it, but you can’t quite hear.

In a style humble and hopeful, a Shaker style for the furniture of mind and heart aging in smaller quarters. He smiled again. Your mind is too ornate, she said, would the simplicity suit you? I hope to outlive that opposition. What I look for ahead is not simple, but only more compressed:

Now you’re catching on. Attention that deserves payment without calling attention to itself.

The shaping of space between parallel slats in a door or as a design element decorative, but not too much. A natural wood stain, reveals the gift of grain, its lines showing something pure, but not pristine. Hygiene? Another posture? She smiled.


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No, I’d say such shapes were sturdy geometries of consolation to their makers, offered to celebrate a creation, but not their own. And is not ours. Shapes sufficient, she said, unto the day, he answered. Handles and knobs that do not menace or repel invite the embrace of human flesh; chairs not so comfortable as to let you sit too long or neglect your chores; just enough glass in doors to reveal something within, but not too much.

Bruce Jennings is a bioethicist and a faculty member at Vanderbilt School of Medicine in the Department of Health Policy and the Center for Biomedical Ethics and Society. “Living Will” imagines a man whose idea of a good dying (and a good aging) challenges us with depth and nuance, an idea that must be finely understood before it can be honored.


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CONFETTI | STARS AND STRIPES Eszter Szentirmai, MD

Eszter Szentirmai is a graduate of Vanderbilt University (BA '12) and Vanderbilt School of Medicine (MD '16) and is currently a PGY-4 pathology resident (Vandy for life). She thinks pathology is the perfect mix of art and science and loves the unexpectedly beautiful appearance of the tissues of the human body.Â


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SARA’S DREAM Amany Alshibli

This is part of a series of prints inspired by a segment of the documentary titled “Children of Aleppo,” in which 5-year-old Sara describes a dream where she is chased by airplanes and snipers. These works depict the unsettling imagery that she describes; beyond mere representations, the pieces intend to evoke discomfort in the viewer and serve as a memorial to the loss of innocence suffered by children exposed to war and conflict.

Amany Alshibli is a second-year medical student. In undergraduate, she developed a new passion for printmaking, taking classes to learn techniques in lithography and intaglio. While she finds herself without access to a print shop in Nashville, she tries to keep up with this hobby with painting and linocuts. Much of her work is influenced by her Syrian background.


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TAKING A SEXUAL HISTORY Natalie Hibshman, Jaclyn Lee, Maggie McBride An awkward student now I don my coat To ask the question that fills me with dread To aid the task, and later write a note I’ve brought with me some paper and a pen “So tell me sir, do you like boys or girls?” Oh gosh, I think I might have asked it wrong I blush and listen as your tale unfurls My mind now taken for a ride along The images you paint are far too much In shock, my poker face now a crumble You’re even starting to describe her touch I have the answer, despite my stumble “Thank you for sharing all of this with me You’ll need a dose of penicillin G”

Natalie Hibshman and Jaclyn Lee are third-year medical students at Vanderbilt University School of Medicine. Maggie McBride is an MD/PhD student in her first year of her PhD program. This piece was their submission for the annual VMS College Cup sonnet competition on behalf of Batson College.


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THE RENTERS Xavier Bledsoe Other creatures live here, inside all of us tiny, furtive stowaways we call bacteria

When it moved into a host they found they shared a goal. Symbiosis did its work and parts became a whole.

Some would try and kill me, some I’d die without, somehow they’re a part of me of this I have no doubt

Now it’s just an organelle a part of human life even though in ages past it entered from outside.

Of all the cells within me, most are not my own. How should I engage the fact that I’m a living home?

Biology will tell a tale of body, bone, and blood identity and meaning though these facts know nothing of.

Maybe drop the paradigm of other versus self. As with mitochondria it doesn’t truly help.

A human never simply is the sum of all their parts. Something more than synergy a concept far apart.

The dynamo, the powerhouse of every living cell began as a prokaryote that lived all by itself.

A heart is made of muscle cells, aortic valves and nodes, but cardiology is blind to love and crippling woes.


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The organ spoken of above, comprised of beating flesh, does not define how I respond when family’s laid to rest. Neither does this human form with all its foreign friends define the soul or circumscribe our spiritual ends.

Xavier Bledsoe is a second-year medical student from St. Louis Missouri with interests in internal medicine and psychiatry. In his spare time, he enjoys ceramic pottery, political philosophy, singing, and theology.


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FALL RIVER SCENE | THE NEXT GENERATION Frank Gee

Frank Gee is a Nashville-based artist and Vanderbilt patient. He draws inspiration from the world of nature for his art, especially water and aquatic life. His work has been featured in numerous national periodicals and magazines and used by conservancies across the nation for fundraising. To purchase and view more of his work, visit frankgee.com


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PAINTING THE SKY Delaney Fleming

Delaney Grace Fleming is 14 years old and is an 8th-grade student at J.T. Moore Middle School. She loves painting (especially watercolor), making miniature dioramas, crafting, singing, and dancing. Recently she has been sewing cloth masks to donate at the Monroe Carell Jr. Children’s Hospital at Vanderbilt where she has been a patient since the age of two.


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AGING IS NOT A DISEASE Jacob Parnell, MD It's a sunny and hot day in south Georgia. Pretty normal for August. The gnats swarm thick, thicker than anyone from north of Macon can possibly understand. My grandmother is watering flowers and plants around the yard. My grandfather is seated in the shade on the porch, petting the dog. This kind of scene happens every day. But something is suddenly different today. As if hit by an unseen assailant, my grandmother loses her balance and falls straight backwards, hitting the concrete patio. He sees her and runs to help. The back of her head is bleeding profusely and her hips and hand are hurt badly. He cannot pull hard enough to stand her up. He goes inside to call for help, but he cannot remember how to use the phone. He tries to get her a washcloth to stop the bleeding, but he cannot remember where the washcloths are. Eventually, he brings her the cell phone. She calls for help, and both of them recover from the ordeal. Scared, but otherwise okay. In my grandparents, you can see two very different forms that aging may take. His body is still healthy and moving forward. In his whole life, he has never had to take medications for blood pressure, blood sugar, anything else you might think of. He can walk, lift, and even climb into a deer stand with a little help. He will push through brush and limbs to take you to pick figs and blueberries down in woods as if he were a much younger man. Yet, his mind is slowly failing him. A man who could once direct you to every farm in Southwest Georgia via dirt roads that you didn't know existed now can barely drive around his home town without getting lost. He was once a master story teller, regaling children, grandchildren, friends, and strangers with tales from 1940s farming in Georgia, travels in the Pacific with the Navy, fifty years of small business experience repairing tractor tires, and interactions with travelers stopping in his service station. And of course hunting stories, so many you could go years without hearing the same one. Today, his list of stories is much narrower, down to the few that he remembers. Occasionally, a glimmer or spark will bring out a story we have not heard before, but mostly, those riveting and detailed stories have faded from his memory, only living on in ours. On the other extreme, she has a mind that works well – much better than people half her age and even younger. She can explain chemistry calculations that she taught decades before I was born; I cannot remember any of the chemistry I learned just a few years ago. She cooks every meal,


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every day without a recipe. And she can sit for hours telling the who, what, when, and where of hundreds of photographs, many black and white, from our family's history. Yet her body fails her from time to time. She is a strong survivor of breast cancer and lymphoma. She has had hip and knee replacements and suffers from pain in her legs, back, and jaw. And she falls. One fall is scary, but she falls all too regularly for our family to handle. Between the instability of her muscles, painful and unsure joints, vision problems, and dizziness from medications, she is at hazard to fall even just walking across a flat room. She is encouraged to use a walker, or at least a cane, but her mind moves her to work and get things done around the house as she has done for many years. We are talking about a woman who, to provide for her working father and brothers after her mother passed, would catch, kill, pluck, and cook chickens for dinner when she was only ten years of age. She does not, probably cannot, slow down to use a walker. But she continues to fall, each fall scarier than the previous. Despite the sadness that these stories might evoke, there is certain happiness here too. He is always there to support her. His arm is her solid hold every step in life. Over uneven grass, down the stairs, or out of a car, he is her stability and her support, as he has been for over 60 years now. As well, she is his guide and his mind. When he cannot remember or cannot solve the problem, she is there to remind him and to explain what he is trying to do. When he cannot remember the details of a story, she is his story-teller, filling in the gaps for him. When he cannot remember where to go, she is his navigator. As each of them age, we see more and more disappear in terms of their physical and mental abilities. But at the same time, as they age we see more and more of their love for one another. They stand in to replace the losses in each other. Whatever one lacks, the other provides. This love is something that our family recognizes more now and something that holds us all together in a way I cannot describe. So is aging a disease? I am not sure. When I see my grandparents separately and think about their medical problems, I certainly think aging must be considered a disease. But then again, when I see my family all together, sitting in my grandparents’ den, my grandparents at the center of it all, it's hard to believe aging is a disease. Aging certainly takes away, but I can see that it gives too. It gives in ways that I could not have ever imagined. Jacob Parnell is from Perry, Georgia. He studied at the University of Georgia before attending medical school at Emory University School of Medicine. After marrying his wife, Amanda, in 2013, he moved to Nashville for internal medicine residency at Vanderbilt. He is now completing a fellowship in geriatrics at Vanderbilt.


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NON-“COMPLICATIONS - NONE” Lealani Acosta, MD, MPH Routine rewiring: central line slipped onto guide, then threaded through. I'd done it once, no problems. Confidence and gloves were donned, erasing doubts of being intern dunce. The threading wasn't smooth: a kink? The wire withdrawn. I'd -- no, "we'd" -- lost his central line, Sedation gone, his vomit spiraled out his mouth. The fault was solely mine. The drugs shot up as O2 sats had plunged, now aspiration pneumo was to blame. Four nurses and two doctors who had lunged in order to restrain his bucking frame stepped back, surveying damage done. It was my first non-“complications: none.”

Lealani Mae (Leah) Acosta is an Assistant Professor of Neurology specializing in neurodegenerative memory disorders, focusing on creativity, stemming in part from her interests in poetry, drawing, and calligraphy. Thankfully, her procedural skills have vastly improved from intern year, and she relishes doing lumbar punctures without complications.


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THREE AM Jean Anderson, MD Torn from the warm darkness and some sweet dream An incessant something pulls me urgently Through lightening circles of consciousness. A lamb bleating Becomes a bird squawking Becomes a baby crying And I break the surface, now fully awake I answer the phone that stridently rings at my bedside, Am told to “Come now. 7 cm”. Stumbling hurriedly into my clothes, I bequeath the darkness to my lover, who dreams on, and rush into the cold, bright with stars. On my way, I sing with Rosanne Cash ”It was a black Cadillac that took him away…” and she accompanies me to a nightless place, bulging with light.

A conjuror of magic and miracles. Anxious eyes search mine and I smile confidently, my voice calm and reassuring. Oz—like I hide behind mysteries, never showing my own doubts and fears. I am in time. Fully dilated, +2 station. The fetal monitor hums, the mother screams with her contraction and I chant “Push! Push!”. Ever so slowly the head descends and small circle of dark hair crowns. “Push again” I whisper, “one more time”. And then in the strange alchemy in which blood and water become flesh, I bear witness, carefully as any priest , and deliver this new life into the light. Torn from the warm darkness and some sweet dream.

I walk thru the door and become someone elseJean Anderson (MD '79, HS '83) is Professor of Gynecology and Obstetrics at Johns Hopkins University. Her career has focused on caring for women living with HIV. In 1988 she founded and continues to direct the Johns Hopkins HIV Women's Health Program, which has provided care for over 8000 women.


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SURVIVAL SKILLS Manasa Bhatta Sometimes in the hospital, I have glorified death. Last year, I opened the chart of a patient I met with lung cancer to find that he had passed away at home. I felt a pang of sadness, maybe even shed a few tears, but that kind of sadness is beautiful and does not leave you feeling broken and small. It is a gentle crashing wave rather than a tsunami enveloping you whole. It inspires you to write poems about why you went into medicine. It drives you to pursue the field of oncology to provide life-prolonging measures to patients who remind you of him in the future. The grief from your patient passing as a medical student is the most peaceful kind – our obligation was minimal, every interaction pure and voluntary, and there is no feeling of guilt or missed opportunity. We reproduce it in stories, and it produces a soft reflectiveness rather than a crushing pressure bearing down on your chest. It is completely different when it is your own father. This kind of grief is not graceful or linear; it has ragged edges and missing pieces. While sifting through pictures on an old camera, I came across a picture of my dad. I skipped past it hastily and then paused on a picture of trees. My fingers backtracked. My dad appeared in front of the trees, holding his grandson on our patio. I studied the curves of his cheeks and his wrinkles and wondered when he had gotten old and why I had not noticed. My prior romantic fascination with mortality, riddled with platitudes like “end-of-life care” and “support for grieving families” began to seem meaningless. Since I was young, there was nothing I’ve loved more than a good story. I had come to see patients this way – equating them to a story which blended biology and soul. All of a sudden, being in the hospital felt different. I began to see my father in the patients I met. Sometimes, I would see family members and wonder how they were coping and how they would cope if their loved one passed away. Often, I wanted to hug daughters waiting in the room with their parents tightly, to cry with them. Instead I would ask how they were doing, with an empathetic smile, politely and professionally. Sometimes, my perceptions would be tinged with jealousy. How can a person with a less healthy lifestyle than him live to be so much older, I would find myself wondering. Or the opposite – at least my father was able to live as long as he did, I would think when I met sick


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patients younger than him. It is easy to forget that a life extends beyond paper, medical records, and a hospital room. It’s easy to forget that death is neither poetic nor educational. I am unsure now as to whether it is a privilege or a burden to witness and deliver life-changing news, to get the full story about a patient’s past trauma, to learn exactly how one thing led to another leading to devastating illness. But I know now what it means to fall down, how to get swept up by the waves, and how to help those around you get back up and dry off. Rather than narrative elements, I now see these as what they truly are – survival skills.

Manasa Bhatta is a third-year medical student at Vanderbilt originally from Johns Creek, GA. She is applying to residency in internal medicine with an interest in hematology-oncology. Writing is her preferred means of making sense of the world.


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FIRST DAY Eve Rodenmeyer The morning is pink like eosin As you dash stethoscope in hand Still glazed with the night’s rest Clutching a clipboard tightly like compression socks Nudging yourself towards the breakroom, the assignment, The mishaps, the anxiety, the learning moments, The god-awful smells, the patience. The practice. As the morning grows into day, you Find yourself swirled like a centrifuge Pulled in unimaginable directions Mitotically splitting to complete every task Trying not to feel like a hangnail By the time night falls, you feel More like a person than a pathogen As the work finally ebbs You realize you haven’t had a sip of water The whole shift.

Eve Rodenmeyer is a first-year nursing student from Jackson, MS. She has a background in English literature, psychology, and creative writing. She loves traveling, reading, and writing poetry about the human condition, and she is above average at hula hooping.


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TO THE YOUNG WOMAN THAT DONATED HER BODY Scott Pearson, MD I do not want to tell you thank you. I hope you already know that. I simply want to tell you this, You are beautiful. We saw how you hurt. We saw the scars. How the surgeons bore into your body hoping to remove the tumor that no longer could be removed. Yet through it all, you saw beyond the weeks, the months of pain, worry. Your loved ones sick with it.Â

You gave to us long before we knew of your gift. You were waiting to meet us when we needed you most. What the world can no longer see lives on, your beauty, every time we see the hurt in others, you are there, reminding us exactly where to look.

Scott Pearson is a cancer surgeon and medical educator. A Professor of Surgery at Vanderbilt University School of Medicine, he teaches anatomy and the importance of the patient’s narrative in giving care. A former Fellow at The Robert Penn Warren Center for the Humanities, Pearson is the author of the novels Rupture and Public Anatomy.


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AURORA BOREALIS Raymond Zhou

Raymond Zhou is a third-year medical student from Gaithersburg, Maryland. He is very proud to lead VUSM’s Medical Photography evening elective and the Literature, Arts, and Medicine student organization. In his free time, he enjoys walking his cat, Booger.


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MEDICAL SCHOOL INTERVIEW CIRCA 2005 William Yi, MD Flipping through the old binder of photos, I come across a captured moment from prom. But instead of prom, my mind flickers back to a memory of how I became a physician. The room is cold, perhaps purposefully so. The chair I’m sitting in is elegantly painted black with gold trim. Inlaid with the institution’s seal on the back, it pervades a regalia befitting its environment. Four others and I are nervously waiting to be called in, one-by-one, by the chairman of the surgery department here at X University. It’s been a grueling month of traveling from one city to the next. I’ve been sleeping in motels, occasionally brushing my teeth in airport bathrooms and changing into a suit in public bathrooms. Despite my attempts to save as much money as possible, my credit card balance for the month is already more than what my parents would earn in a month. I can’t help but notice the crispness of the suits and the perfectly fitted skirts of the other interviewees around me. There’s a bit of envy running through me. I know that they’re no different from me. They, too, have spent the last four years studying molecules, physical principles, and memorizing research techniques in the hopes of being accepted into medical school. I can’t help but feel different, though. It feels like I’m a child in a room filled with adults. Their shirts are tailored with golden cufflinks. My suit overhangs in all the wrong places. The shoulders of my jacket waterfall over the edges and the legs of my pants accordion into fussy bunches. It’s the same suit I wore to my high school prom. I breathe slowly, trying to calm the racing of my heart. I’ve done this process so many times over the last few weeks, but every time I sit here, waiting to be called into my interview, my palms grow damp and I occasionally forget to take the next breath. One…two...three, one… two…three. I’m counting out the length of my breaths, but I’ve forgotten to do this silently. “You ok?” the girl in the navy pencil skirt sitting next to me asks. “Yeah, I always get nervous, even though I tell myself the whole time leading up to this moment not to,” I whisper back in embarrassment. “I keep telling myself to act professional and


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strong, like I’ve done this before and I belong here. But I always break down and get on edge.” Damn it. In my anxiety, I’ve gone ahead and just revealed myself to my competition. If it comes down to her or me getting a spot here, clearly, we know now who that spot is going to. She chuckles and pats me on the shoulder. I’m a child. “You’ll be fine,” she whispers back, sensitive at least to the fact that I want to keep our conversation a secret from the others. Thankfully, she’s the next one to be called in and I can hide back in the solitude of my own mind. The others in the room seem at ease, carelessly looking around the room or primping their ties. Occasionally, they get up to get a cup of water from the cooler, or to examine the pictures on the walls of graduated medical students from the years before. The secretary carries on with her duties from behind her desk. From time to time, she answers a phone call on her headset, her hands and face moving as if she were actually speaking to someone in front of her. She makes no attempt to lower her voice. She doesn’t care that we are in her office anxiously waiting the next ten minutes that might determine our futures. She’s seen hundreds of people like us come through this office year after year. It’s just another day to her. Thankfully, focusing on what’s going on around me must have made the time fly by, because the office door to the adjacent room opens and the girl in the pencil skirt strides out. She’s smiling, exuding a glow like she’s just had the best sex of her life. My hands are sweating again. “William Yi, the chairman will see you now,” the secretary bellows. I nervously fumble to grasp the folder I’ve brought with me. I read online somewhere that when you go on an interview that you should bring an attaché or leather binder with you. It makes you look more professional. I couldn’t really justify the expense though. Instead, I bought a black plastic folder at the drugstore and filled it with some loose paper. In the next office, the chairman is sitting behind his massive desk. He looks like one of those Greek aristocrats, except instead of a white toga, he’s wearing a tailored suit. His hair is grey with streaks of white, and it’s perfectly coifed back in silky tendrils. I shake his hand, and the cufflinks of his shirt jump out at me. They’re golden links in the


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shape of a pancreas. “Please, sit down,” he says, as he nestles back into his massive leather chair. And then there’s a nervous pause. He’s got a quizzical look on his face, and I can feel his eyes searching me. The interrogation has begun and not a word has been said yet. “Are you going on a date?” he asks, smiling at the corners of his mouth. “What do you mean?” I sheepishly respond back. I don’t know what he’s quite getting at. I’m completely thrown off already. Is this a test? I know that interviewers sometimes do this just to jostle you, but I have no clue what this is about. “That’s a great shirt and tie combination,” he goes on. “Forget the corsage?” I can sense the underhanded sarcasm in his voice. I still don’t know what he’s getting at, though. I look down at the blood-red shirt and tie I’m wearing, and I can’t find any stains or loose buttons. Everything looks to be in place. I look back up, and I can tell that he can tell that I don’t have the slightest idea what he’s talking about. “Well, anyway,” he goes on, clearly disappointed that we’re not on the same page. “I see here that you’re from Los Angeles. Tell me a little bit about why you want to come all the way across the country to X University for medical school.” The rest of the conversation is pretty benign. Standard questions about why I want to come here, what made me want to become a doctor, and where I see myself in ten years. I give the same answers I’ve been giving at all my interviews. The whole time though, I’m still befuddled by what the beginning of the interview was all about. When the interview ends, he shakes my hand and walks me to the door. I figure from how we got off that I’m clearly not coming to X University for medical school. What’s the harm in questioning this guy for what transpired ten minutes ago? But I hold my tongue. The polite, non-confrontational Asian manners in me take hold, and I walk out without a word. The weeks after that experience were filled with more interviews. Eventually, I got into medical school and became a surgeon. But that interaction with that pompous white physician still stuck and clung on, like a bad smell that couldn’t be bleached away. Staring at the picture of myself from prom, wearing the same suit I wore to that interview, it finally hits me: shiny red tie on blood-red shirt. What was I thinking? How ridiculous I must have looked finally dawns on me. Surrounded by all these young


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professionals in their manicured skirts and power suits, I was wearing an outfit perfect for Valentine’s Day. But I didn’t really know that then. No one had taught me appropriate shirt and tie selection for an interview. I want to blame myself for not looking this information up on the internet. I try to make excuses for myself: "Was all this information readily available on the internet in 2004?" (It probably was). Alternatively, I could have sought someone out to help me make clothing decisions. But if you don’t even know that the color of your shirt and tie is important, why would you even bother to ask? And I start to blame my heritage. I blame being an immigrant’s son. I blame my parents. Had my parents not been immigrants, had they known the culture, I would have known. They would have instructed me. The reality though, is that I'm shifting the blame even as I'm trying to find someone to blame, because really, the blame lies on me. How many countless other Asian immigrants had gone through this process and researched how to ace the interview? I'm sure there was something in that research that detailed what appropriate dress was. Nevertheless, as I'm mulling this over, I wonder why it even matters what someone is wearing at an interview if they have demonstrated their abilities clearly on their record. Then it dawns on me that the whole purpose of the interview is to determine whether the person in question is just some loony-toon, or one who can interact in a stable manner with another human being. The interview is designed to filter out those people that look good on paper, but in person may rankle or offend. My search for someone to blame has circuitously led back to me. Yes, if someone came into an interview for a job I had posted and they were wearing an outfit suited for a high school prom, or if they were wearing a boutonniere, I probably would have crossed them off my list of potentials as well. Damn it! I hate it when my ruminations cause me to see myself in a negative light. Wanting to really test this theory though, I promise myself that on my next Tinder or Bumble date, I will show up wearing a red shirt, red tie, and a boutonniere on my lapel. If I don't feel like the date is going well, I'll say something like, "Don't judge me on my outfit, it's not 2004." William Yi is a general surgeon and graduate of Vanderbilt School of Medicine class of 2009.


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WINTER LIGHTING | WAVE Quentin Eichbaum, MD, PhD, MPH, MFA, MMHC, JD, FCAP, FASCP

Quentin Eichbaum was born and raised in Africa where the vast landscapes, animal life, and cultures inspired him to take up watercolor painting. He attended Harvard Medical School and completed residency/fellowship at MGH. At Vanderbilt, he is Professor of Pathology and of Medical Education. His work has been exhibited in the US, Europe, and Africa.


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A MID-FEMUR KNIGHT’S DREAM Aaron Azose, Mandy Azose, Bekka DePew, Grace Harrison, Clark Stallings, Alex Tinianow 'Twas five am in B-pod sad and grey. The man appeared - affliction of the knee. Complained of pain and fever all the day. He shed a tear and spoke a desp'rate plea. Internal med says, "we’ve no beds today! To heal this knee with meds? 'Tis but a dream!" “No fracture here,” the orthopod did say, “and thus we cannot take him on our team.” "But soft! What light through yonder femur breaks! You twats just want to turf this man to us." "'Tis true, our team has plans to dine on steaks. Just take this man and pray; don't cause a fuss." Amidst this joust the nurse exclaimed with ire, "You hapless fools! Your patient did expire!"

Aaron Azose, Mandy Azose, Bekka DePew, Grace Harrison, Clark Stallings, and Alex Tinianow are current and former Vanderbilt medical students. This piece was their submission for the annual VMS College Cup sonnet competition on behalf of Gabbe College.


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CLOSE Barry Noland

Barry A. Noland is a native of Cairo, IL and a neo-native of Nashville, TN. He is a photographer and former artist’s model. His photographic journey began with figure and fashion work and gradually expanded. Barry's work has been recognized, published, and awarded regionally, nationally, and internationally. To see more of his work, visit barrynoland.com


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TRUTH, LIES, AND PRESIDENTIAL BONES Roy Meals, MD I, along with some others, take Presidents Day as an opportunity to celebrate the lives and contributions of all US presidents. Amid the praise, however, perhaps I alone feel compelled to describe their skeletal maladies. I have gleaned the following information from several websites and books that carefully detail the reported injuries, diseases, bad habits, and addictions experienced by US chief executives throughout their lives, starting with George Washington’s birth in 1732. The list may not be complete and accurate for at least three reasons. X-rays were not discovered until 1895, so a “fracture” before that time, unless the bone ends were seen emerging through the skin, might have been a dislocated joint or a bad sprain. Secondly, diagnostic terms such as gout, lumbago, and rheumatism have been tossed about without strict and uniform definitions over the nearly 300-year span of this survey. And early on, there were no confirmatory laboratory tests for such diagnoses. Finally, there have been multiple instances where a president wanted to keep his ailment(s) secret because of their implication of weakness or vulnerability; nevertheless, the truth escaped. It is possible, however, that there are other presidential ails that never became publicly known. Efforts at secrecy led to at least one other problem: it may have precluded some presidents from receiving the best care available, because for the sake of covertness, they shunned the most eminent (and most visible) doctors and hospitals. Another possible problem is that trying to maintain secrecy usually entailed lying. Jimmy Carter is the longest living president--presently 94 and counting. Who was the healthiest president? Likely it was Millard Fillmore. He neither drank nor smoked and was conscientious about maintaining his wellbeing. He had no known medical problems until he suffered a stroke at age 74. A second stroke later the same year killed him. Conversely, John Tyler was in ill health throughout his life. His maladies included arthritis and general achiness, particularly in his post-presidential years. Nonetheless, he managed to father eight children with one wife before he was President and seven more with a second wife after his term. His last child was born when Tyler was 70. Tyler died two years later. Imagine


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his productivity had he been spry. People will undoubtedly speculate forever about Lincoln’s skeletal condition. There is some agreement that he inherited it from his mother, since they shared many skeletal features. A reporter once described Lincoln as over six feet tall, lanky, with long drooping arms “terminating in hands of extraordinary dimensions, which, however were far exceeded in proportion by his feet." Lincoln, whatever his skeletal peculiarities, did not apparently have any noteworthy bony problems other than having a piece of his jaw extracted along with a tooth. Many of his fellow presidents were not so lucky. Jefferson, Kennedy and George W. Bush all had severe back pain. Jefferson’s life predated the discovery of general anesthesia, so elective back surgery during his time was unimaginable. JFK had one operation, Bush had two. Gerald Ford sustained multiple injuries playing high school and college football, which led in later life to bilateral total knee replacements. These restored his ability to play golf and tennis. In 1893, during his second presidential term, Grover Cleveland surreptitiously had surgery to remove a cancer from his mouth (on his cigar-chewing side) along with part of his upper jaw and hard palate. The surgery was performed entirely through his mouth, so there was no external evidence of the procedure, and his bushy moustache likely concealed the swelling and bruising. The clandestine operation took place aboard a private yacht cruising Long Island Sound. His five-day absence went entirely unexplained, and Cleveland allegedly said to those involved that he lied more about this event than he did during the whole rest of his life. Twenty-five years later, the truth emerged. Here is a list of presidential fractures sorted from head to toe. Taft fell from a wagon at age nine and sustained a “minor” skull fracture, which by some accounts left him with a life-long and visible indentation in his scalp. Both Truman and Carter broke their collar bones, the former from falling out of a chair in childhood and the latter from skiing in adulthood. Both had additional fractures later in life. Truman fell and broke several ribs, and Carter broke his hip as he was leaving home to go turkey hunting. Far more dramatic were Jackson’s rib fractures, which resulted from a duel. Later, in an out-and-out gunfight, a bullet shattered Jackson’s shoulder. The first gunshot wound continued to drain and stink for the rest of Jackson's life. Jefferson broke his wrist two months after becoming Minister to France. This occurred either


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while jumping a fence during a tour of Paris with a married woman (Jefferson’s wife had died three years before), while he was jumping over a kettle, or while he was walking with a friend. Here is a list of presidential fractures sorted from head to toe: Taft fell from a wagon at age nine and sustained a “minor” skull fracture, which by some accounts left him with a life-long and visible indentation in his scalp. Both Truman and Carter broke their collarbones, the former from falling out of a chair in childhood and the latter from skiing in adulthood. Both had additional fractures later in life. Truman fell and broke several ribs, and Carter broke his hip as he was leaving home to go turkey hunting. Far more dramatic were Jackson’s rib fractures, which resulted from a duel. Later, in an out-and-out gunfight, a bullet shattered Jackson’s shoulder. The first gunshot wound continued to drain and stink for the rest of Jackson's life. Jefferson broke his wrist two months after becoming Minister to France. This occurred either while jumping a fence during a tour of Paris with a married woman (Jefferson’s wife had died three years before), while he was jumping over a kettle, or while he was walking with a friend. Was somebody lying? Regardless, this injury nagged him for the rest of his life and further disabled him when, at age 78, he fell from a broken step at home and fractured his opposite wrist. Reagan fell from a horse and broke his femur when he was 38. At age 90, well after retiring from public view, he broke his hip, which was successfully pinned, and he survived another two years. Regarding non-fatal gun shots, yet harrowing glimpses of death, but without apparent skeletal injuries, the award goes to Rutherford B. Hayes. He sustained Civil War battle wounds on four separate occasions and had horses shot from under him an equal number of times. Even though Washington as a child blurted “I cannot tell a lie,” and Lincoln was known as Honest Abe, the prize for bold truth-telling goes to Eisenhower. A White House visitor noticed him wearing a leather wrist brace and inquired. Ike responded that it was mild arthritis. The visitor said he was glad it wasn’t serious. Eisenhower exclaimed, “I should say it’s serious. I can’t play golf.” Roy Meals (MD ’71) is a Clinical Professor of Orthopedic Surgery at UCLA. He has been Editor-in-Chief of The Journal of Hand Surgery and president of the American Society for Surgery of the Hand. His love of teaching has inspired his blog, aboutbone.com, and his two books. A third book, Bones, Inside and Out, is scheduled for publication in October 2020.


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TWENTY-ONE WEEKS Daniel Pereira Premie proclaiming excellencies With still outstretched hands For breath barely out of reach. Bustle decoding the beat of life With blood brimming with epi Epi the nectar of life Bringing life to a lifeless body Beating brightness to blood, bones, and brain. Beaming eyes begging for baby to live Until suddenly a beat A brow lifts, a belly rises. The bustle abandons baby to live To breathe, to bathe, to beep and boop Premie with outstretched hands Proclaiming excellencies

Daniel Pereira is a third-year medical student at Vanderbilt. He immigrated with his family to the United States when he was seven years old and quickly learned to love and to wield English to convey powerful meaning and emotion. He intends to match into Orthopedic Surgery and incorporate ethics, education, and policy into his future career.


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THE EMERGENCY ROOM Arthur Yu in the incandescent lights of the emergency department night is irrelevant. bays of glass line the walls with curtains hiding their secrets. each room holds a different life Illness does not discriminate. souls in the building are branded by IVs or by scrubs. patients patiently lie in waiting hoping. doctors read, interrogate, think translating. the emergency room is the last stop for hope where doctors are science’s pope. no patients’ pain are equivalent yet they all share a similar sentiment.

Arthur Yu is a first-year undergraduate student from Alpharetta, Georgia, double majoring in Medicine, Health, and Society and Human and Organizational Development. He is looking towards a career in medicine. His poem draws inspiration from his experience and perspectives while shadowing in the emergency room of a hospital.


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DRY EYES: EVOLUTION OF AWARENESS Catherine Fuchs, MD Gently creeping through natures sheath, Blink to ignore an itch, Gentle breeze stirring patterns in the sand. Transient intruder of conscious awareness Nagging the senses. Pulsing waves alter sensory cadence. Familiar blink met with raspy confusion Itch creeps to prickle. Incessant grit as dominance rearranged. Brine vexing once protected orb Lacrimal shield frayed. Intrusion outside the bounds of logic.

Catherine Fuchs is a 1982 graduate of Vanderbilt Medical School. She completed residency in psychiatry and fellowship in child and adolescent psychiatry at Vanderbilt and joined the faculty in 1987. Her clinical focus is consultation liaison child psychiatry with a clinical research focus on pediatric delirium.


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ARE YOU THERE? Yulia Lee Ding dong. My mom stood by the door and I stood beside her, holding her hand. Then I paced back and forth in anticipation, and I ran my hands across the bright red jjajangmyeon delivery stickers concealing much of the door and the crumpled fliers for the upcoming Seoul provincial elections flaring from every crack. In my other hand, I held on to my middle school diploma, my most prized possession at the time. Was the bell always this quiet? The familiar, light footsteps got closer and closer. My grandma swung open the door and beamed, radiating her comforting presence. She gave both my mom and me her signature side hug, rubbing her face so hard that it left the scent of cherry blossoms on my left cheekbone. “Come in, come in! It’s been so long. Sweetie, you’ve lost weight. Are you sure you are eating well? Your mother’s food is not nearly as good as grandma’s food, huh? I already have the jjigae cooking, I hope you have an appetite!” I took off my shoes and meandered through my childhood home. My grandma’s brown leather recliner, the cream-colored walls with the 16x20 family portrait, and the plethora of dracaena plants hadn’t changed over the years. But it wasn’t the same. In my room, the lead streaks across the white wall that used to read 2003, 2004, 2005, and 2006, each line higher and higher, now read 20, 200, 20, 2, like a broken code. The windowsill, which had housed my orange and green plastic telescope, had been taken over by several dust bunnies. The kitchen sink was overflowing with dishes I didn’t recognize and black plastic bags of reeking trash lined the veranda. Naturally, my eyes were drawn to the back of my grandmother’s head. The roots of her hair were starting to split from lack of washing and I could see patches of white growing behind her ears. Her floral blouse hung too loosely around newly pronounced collarbones and sharp shoulders. Her white pants fit around her stilt legs like a pair of hand-me-downs. Her toenails


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curled at the ends from not having been cut and the back of her heels had begun to crack. The destruction of the disease could too easily be seen. “Shoot, the jjigae! I hope it’s not burnt. Come sit around the table, let’s eat.” At the dinner table, I displayed my diploma to her. In my head, I had already rehearsed the exact lines I would say to her describing my graduation and my plans for high school. “You’ve already graduated, sweetie? Why is this in English? I thought you went to school just down the street from here.” The disease had already conquered some of her memories. “Grandma, we moved to India three years ago, remember? We don’t live in Korea anymore; we live in India, remember?” She nodded her head and pretended to remember. I quietly lowered my diploma back to my side. Like always, we reminisced about the time we went on the family trip to Guam and how shocked my grandma was by all of the coconut bras and straw skirts, the time my grandma pulled out my tooth using a piece of caramel and I swallowed both the caramel and my tooth, and the time my grandma taught me how to swim without floaties by throwing all of my favorite Hot Wheels in the deep end. After each anecdote I brought up, my grandma smiled emptily and nodded. These memories were no longer ones we could share. They were like broken codes to her. Memories that only I had access to: unanswered, esoteric, broken memories. If she couldn’t recall any of the memories that we shared, if she had lost our entire history, who was I to my grandma? If she had no memory of her own life, who was my grandma? I wanted to open up her head and wake her up, shake her brain, knock on it, ring a bell. Ding dong. My mom stood with a bag of pastries from Napoleon, my grandmother’s favorite bakery from the corner of her block. As I lifted my heels up and down in anticipation, I ran my hands over the laminated nametag smack in the middle of an uncomfortably bright, white sliding door to my grandmother’s room. In my other hand, I held on to my Vanderbilt acceptance letter.


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Why is the doorbell so high-pitched? It’s annoying. The slow, dragging footsteps got closer and closer. The door slid open and the nurse gave us the okay to enter the room. My grandmother looked up as my mom and I walked in, then sank her head back into her pillow. Her bed was raised at 30 degrees and a table rested just above her knees with a lunch tray of rice, kimchi, seaweed stew, sausages, and fried anchovies that had gone cold. At the end of the bed was her nametag and to the side of her bed was a drainage bag for her urine. On the windowsill sat a couple bouquets of flowers and cards, infiltrated by dust bunnies. My mom walked over to the bed and brushed her hand through my grandmother’s hair. “Ma, we’re here. Your daughter is here to see you.” My grandmother slowly opened her eyes and stared up at my mom. She didn’t say a word. She had lost most of her hair and her figure was half of what it used to be. Forget the memories —she didn’t even know how to eat, walk, or shower on her own. As time engraved wrinkles around my grandmother’s eyes, it also worked backwards, slowly snatching back each memory, skill, and word she had ever learned. “Ma, do you remember me? Soo Yong, your daughter. I’m here with Seo Yeon, your sonyeo. We brought your favorite red bean pastry from Napoleon.” My mom patted her palm on her chest over and over again, but my grandmother did not reciprocate any of my mom’s signals. “Ma, who is this?” My mom pointed at me. I was still standing frozen by the door. My mom signaled for me to come closer to my grandmother. I lifted my heavy heels from the floor and inched closer to her bed. I scratched my elbow nervously in the heavy silence as my grandmother stared deeply into my eyes. “Neopjeoki. I know you. You used to look just like your father. How could I forget my own granddaughter? I am terrible. I need to die. It’s time for me to die.” Neopjeoki, which means little pancake, was what my grandma used to call me as a baby. Even now, my grandma has moments where she snaps back into her old self. For a few minutes at most; then she leaves again. I know that as time progresses, my grandma’s state is only going to worsen. There is no cure for Alzheimer’s disease. Each time I fly back home to Korea to see


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her, she will be worse than the visit before. Every time I ring her doorbell, she will have lost a little more of herself: her thoughts, her memories, her words, her emotions. My childhood memories can no longer be shared, and I am no more than a stranger to my grandma. I will never be more than a stranger to my grandma. Whatever I do, whatever I say, it will all be erased from my grandma’s memory within a couple of minutes. Nothing I do will ever matter to her. I swing open the wooden door to my grandma’s room in the hospice and skip over to her bedside. Although she doesn’t remember that she loves sunflowers, I bring her one every time just to see her smile as she holds it in her hands. Like my grandma did for me when I was a baby, I give her a bath and comb her hair, which is now completely white. I rub her back so that she can digest her stew and cover her with hugs and kisses. I show her unconditional love, love that will not be answered. Just as my grandma showed me how to love entirely without needing to be loved back, I do the same. My grandma tells me that I am her favorite grandchild because I am the only one she can remember right now, and we laugh. Five minutes later, she tells me the same joke again and we laugh just as hard as we did the first time. Throughout the visit, my grandma tells me the joke twenty more times, and each time we laugh like it’s the first.

Yulia Lee is a senior at Vanderbilt University studying neuroscience and psychology. At Vanderbilt, she is actively involved with the Asian American Students Association, Alpha Epsilon Delta, and VSVS. When she is not studying in the Eskind Biomedical Library or working in her lab, she likes to play lacrosse, eat at new restaurants, and hang out with her friends.


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TUNNEL VISION Barrington Hwang, MD

Barrington Hwang is a first-year general psychiatry resident at Vanderbilt University Medical Center. He is the media and podcast editor of the AJP Resident Journal and a member of the AACAP Alliance for Learning and Innovation committee. Areas of interest include immigrant and refugee populations, integrating the humanities into the field of medicine, and ethics.


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MECHANICAL | WIND + ICE Jaclyn Lee

With formative experiences in China, Massachusetts, and California before landing in Nashville, Jackie Lee is a third-year medical student, loving the study of health and disease amidst learning about life.Â


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HULLING THE HEART Lori Anne Parker-Danley, PhD When I was 38, I suffered a SCAD (spontaneous coronary artery dissection) that travelled the length of two coronary arteries. I’m lucky to be here, and thank my surgeon, who realized what he was seeing when he looked at my angiogram (too often, doctors don’t even know what a SCAD is). My SCAD caused two major heart attacks and led to an emergency triple bypass, which was necessary to save my life. This story, “Hulling the Heart,” is based on this experience. At the time, I was working at a museum and had recently fallen in love with and given lectures on Hyman Bloom’s painting The Hull, which is central to the story. Finally, in the early morning, the hospital room is quiet. She is thankful for this time when everything is still, and she is simply allowed to be. Relieved by the silence instead of the breezy hellos of nurses coming to check her blood pressure, give her medicine, ask if she’s still nauseous, or if there’s anything else she needs. And though she is afraid the way she is every time she wakes up here—since with each waking comes remembering, regathering, noticing the deep, new ache along her sternum—she tells herself she won’t call out to her husband who sleeps across from her on the couch, tells herself she won’t call out to him this time, because he needs to rest, tells herself just listen to the heart monitor, just listen to its rhythm, just listen; you’ll be OK. She is on the eighth floor. It is the fifth day. One wall of the room is almost entirely made of windows. Through the glass, she sees the city, the sky, the first bits of summer light. But she is a stranger here. Nothing is familiar. Not the buildings, not the signs, not even her own hands resting on her chest. There’s nothing familiar at all except for the giant body she notices drifting up again in the clouds. It was the one she had dreamt of, the one who was there yesterday and the day before—the dead one with the cut-open torso, the woman from the painting. ~~~~ Created in 1952, The Hull was one of Hyman Bloom’s corpse paintings. But a later one and different from the first bodies he’d gathered into pigment during the years before. Not at all like the large canvases of the 40s, in which the bodies were stationary, flat, lying on their backs or their stomachs, and seen by the viewer as if from above, the figures pressed up against the front


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of the picture’s surface and surrounded or covered in dark, gestural, distancing swaths of cloth. Though the early corpse paintings were unexpected and raw, at the same time, she would suggest to the crowd who’d come for the lecture, they were stiffer, less bold, and perhaps even tentative in comparison to The Hull. They were paintings that were easier to look at, images that allowed the viewer more distance. You could stay on the surface without being pulled in. Bloom was painting them from the exterior; depictions of decay and putrefaction were simply renderings of decomposition already present on the skins of the bodies themselves. These early corpses were Bloom’s first stories of the dead. But as the years passed, Bloom’s relationship to his subject would change: his responses to their deaths, their shapes, his need— for it was a need wasn’t it?— to paint them in their left-behind form would shift. By 1952, his representations were deeper, more insistent. By the time of The Hull, Bloom was cutting his corpses open. ~~~~ The woman’s body continues to drift on the other side of the window. She watches it move across the horizon, the body pushing through a cluster of bruised clouds. For a moment there is only a leg, part of an arm, a sliver of white rib over the city before she emerges again on the other side. (She had decided the corpse was a woman: there were the small knees, the slightness of the arms, and the curve of the thighs as the legs splayed open and down the sides of the autopsist’s table.) The body then lingers for a moment—an undulating palimpsest over the city. It is a landscape covered in a dream. But why just a dream? she asks silently to no one, why not believe there is an actual body floating there? for it seems just as likely, the chances of it happening just as great, as probable to her as the place she inhabits now—this strange world on the bed, connected to an IV, with oxygen tubes in her nose, where she is caught in a body turned heavy, almost-dead weight, as it sinks under itself and threatens to pull her down. She is nothing but body, she thinks, nothing but one physical process coiling around another, hunkered down inside its own rhythms as it moves in and out of sleep, in and out of pain, in and out of a medicated haze, in and out of wondering, did this really happen to me? Later, it will occur to her one afternoon as she sits on the couch at home, how grave it was, how sick she’d felt, how close she’d come, and just how terrible it had been, and she will write


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in her notebook, This might just be the worst thing I have ever been through ... It will be a moment of emergence, an awareness of her near-calamity as she inches closer to the other side of shock, though she holds the event in abeyance, at that moment still only willing to commit to the phrase “might be.” Through the window, on the sides of the buildings and over the roofs, she follows a memory of colors—oranges, greens, purples, reds, bright white in wide, fast, slippery brushstrokes— drifting for a moment before receding into the skyline. The painting of piled up flesh, a woman’s body turned inside-out, moves slowly across the sky and around the corner of a building. The corpse is floating over the now-unfamiliar landscape. Five days have passed, only five days, and yet the world on the other side of the window, the stone and concrete structures thrusting themselves into the sky beyond the hospital grounds, the trees, the telephone poles, the billboards past the interstate, are unknown to her now. Downtown is to the left (or is it to the right?) and home is to the right (or is it to the left?). She isn’t sure, can no longer say. She felt, she’d whispered to him the night before that she was traveling in a distant land. Yes, this is how she feels exactly, as she walks slowly, still unstable, step by slow, precarious step, down the hall each morning past the nurses’ station, past women older than her smiling, encouraging her, saying “Look at you; look how good you’re doing!” as small, infirm shuffles became major accomplishments, when just last week she had no reason to notice her steps at all. It’s as if she were traveling in some far off place where the faces you think you recognize are ones you don’t know, the clothes you wear are familiar but ill fitting, and you never walk far because you realize how quickly, how easily, you could simply lose your way. A bird flies past the window, its black wings nearly grazing the surface of the glass before gliding through the woman’s shoulder. The body disappears around a corner. She closes her eyes again. ~~~~ In the gallery, standing to the side of The Hull so as not to block their view, she faced the group who’d come for the talk. She spoke of the sensation she’d had when she’d spent time in front of the work, which was the uneasiness of realizing that this too would someday be her, but


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rather than turning away, she asked them, might the painting offer the possibility to grab mortality by the collar and stare it in the face? This is what Bloom was offering, she suggested— to his viewers, to himself—a meditation on death that didn’t stay on the surface, but peeled back the layers of everyday living, of people going about their business, their plans, their hopes, and their wants, straight down to the biological honesty teeming beneath. The woman in the black jacket nodded, understanding, and when she asked them about the painting’s beauty, there wasn’t anyone in the group who disagreed. Yes, it was split-in-two body before them; yes, it was a woman cut from stem to stern become a painted mass of dead, collapsing flesh; and yes, the corpse was a map of last wounds, but it was beautiful, striking, even in its grotesqueness, for, of course, a few of them did see the body that way. But grotesque or not, the colors of it, the iridescence of it, the rhythms of its brushstrokes, revealed a figure—a life—still vibrating in its echoes. Unexpectedly, the more she studied the painting, the more she noticed that the corpse was more alive to her than the autopsist’s hands. The gloved hands were firm and unwavering on the left side of the painting; and though the right hand held a knife that became one of the strongest vertical lines in the work, its intent was almost laughable to her one night after she had stared at it for almost an hour, almost laughable in the midst of the woman’s quivering flesh, since the hand, too, was nothing more than part of someone who would eventually succumb to the same fate. It was the corpse, she realized, not the hands, even as the left fingers clung to the ribs the autopsist had excised out of the body, that commanded all the attention. The hands functioned as counterweights, arrows really, that had the effect of pushing the viewer’s gaze back into the body’s wound. ~~~~

continued online

Lori Anne Parker-Danley is a visual artist and sometimes writer with a Ph.D. in philosophy. By day, she’s the director of the patient education department at VUMC. In 2009, Lori Anne had a SCAD (spontaneous coronary artery dissection) that caused two major heart attacks and required a triple bypass to save her life. “Hulling the Heart,” is based on that experience.


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ON AN ANGEL’S WINGS Teresa Turnbo, CCRP Written in honor of the Neonatal Transport Program at VCH. I hear her coming from a distance Through the fog of early morning I chase the tears- quickly wiping them away For when an Angel sings- I cry. Why should this happen When an Angel brings hope I search my heart for answers as to why When an Angel sings- I cry. The early morning sea of metal quickly parts right and left Bowing silently as royalty passes by A tiny prince or princess inside the massive carriage Finally, understanding why, as an Angel singsI softly cry.

Teresa Turnbo works in the Department of Anesthesiology. She won her first poetry award while a sophomore at Hickman County High School. One morning, while stuck in traffic, she heard an Angel coming in the fog. She watched as the cars moved left and right to make way for the ambulance, and a work in progress was finally complete.


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A CAT NAMED CARMEN Federica Angel, MD What are we going to do about Carmen? I met the woman—a cat with nine lives—during the hospital stay that would be her last. Her collapse was caused by septic emboli to the brain from an inoperable clot of bacteria in her heart. And although she arrived altered overnight, she was pleasant the following day after the administration of IV antibiotics and steroids. That day, she seemed calm and ready to confront her illness. The initial diagnosis had not been clear, but by the second hospital day, we were certain – this was serious. Deadly, even for a cat. My resident knew her from past admissions. “She leaves AMA all the time and has had serious infections before. Once, she left with an empyema.” He proceeded to tell me that Carmen had not dialyzed in one month and was reportedly out shopping whenever renal dialysis nurses would call. “Does she have a family?” I asked. “Oh, she has a family. Had to call the police on them last time. Apparently, they are known to Metro,” he said. “We know this family.” “But she does have children,” I half questioned, half stated. “Seven of them,” replied my resident. “Various fathers. Living with various family members. We offered to do a tubal during her last admit and she declined.” We exchanged glances. As we entered Carmen’s room to discuss our devastating news, she was alone and sleeping. We worked to arouse her, but she seemed disinterested in another gathering of white coats. My intern began…. And I stood at the foot of her bed, watching her face twist with a torrid panic. “Am I gonna die?” she cried. “Am I dying?” Sorrow. Weeping. And white coats telling this woman of her grave prognosis. I had only known her five minutes. “Oh, my baby, my babies! I want to see my baby!” Then she was done with us and curled up in a ball as we asked, offered, planned – but she couldn’t hear it. “It’s too much. Too much,” she concluded. After a brief time, she shared that she shouldn’t have done it- shouldn’t have taken that last


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hit of cocaine. “He made me,” she said through the tears. “I came to the hospital. ‘I hope you die, b*tch!’ he said.” As she cried, I tried to reassure her, to tell her that no one should speak to her like that. Who could we call to be with her? “No one. I have no one. It’s just me.” My resident stayed behind with her while we went on with rounds, yet I remained haunted by this bedside conversation. Carmen was a million miles away from me, on an endless bridge, and I was standing on the other side. How could I reach her? Minutes into a conversation with a stranger, speaking of her impending death, I felt like I had failed her. But the practice of medicine is not always about how much science we know; it is more often about how well we know humanity. How could I understand her suffering? What do I know about suffering? Suddenly, it occurred to me that in some of her last words, hidden among reflections of her pain, were ones remembering her joy and love – words referring to her children. At the beginning of our lives, we all start out the same: vulnerable, tender, unbiased, trusting, and needing. The first provider intertwined in all those beautiful emotions is the mother. I then understood Carmen, more than I thought I could, as my mind drifted to thoughts of my own son. I wondered if the experience of bringing life into the world, as hers slowly melted away, may have been Carmen’s only opportunity to really know love. She decompensated quickly after that. I checked on her in the Medical ICU the following day, hoping to give her company and ease her burden by asking about her children, hoping to redeem myself as a practitioner of a “healing art,” but it was too late. She was already lost in a purgatory of pharmaceuticals and critical illness. No contacts could be reached because all the numbers in her chart were disconnected. The nurses reported that no family members had been by to visit her. Later, I was told that there was a family meeting with a concerned aunt, her boyfriend, and one young son, among others. She would not survive this hospitalization and the plan was to let her pass peacefully in our Palliative Care Unit. She died three days after I left the teaching service, before the bed transfer could take place. She had been on her ninth life. She was 33 years old. Federica B. Angel is in her twelfth year of clinical practice. She completed residency at Vanderbilt in 2008 and then moved to Nashville where she met her husband and started a family. Federica wrote this piece to reflect the stresses of practicing medicine under time constraints while valuing the humanity, candor, and humility of the profession.


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AH, YOU’RE THE DOCTOR? Denise Raynor, MD, MPH The year is 1982. I’m a second-year medical student, one of three Black medical students in my class and one of ten in a medical school of about 400. “215 needs these labs drawn. I’ll leave the chart here.” I am vaguely aware of a resident physician talking as I root through my patient’s chart trying to get a handle on his history and chief complaint. “Did you hear me? I need you to order these labs.” Somewhat dazed, I look up quizzically. “Excuse me,” I say, genuinely confused. “Are you talking to me? Oh... Oh,” I say with my voice rising. “I don’t work here. I’m a medical student. You need to find the ward clerk.” I mean, I’m dressed in the coded uniform of a Vanderbilt medical student: short white coat, pockets brimming with cards, handbooks, tourniquets, stethoscope, reflex hammer. Surely, all this stuff should indicate that I’m somewhere on the medical professional spectrum. Maybe he didn’t see them, you’re thinking. Well, he’d been standing over me for several minutes. Maybe he was distracted? No. He saw my brown skin and just assumed. This was not the first or the last time that the Vanderbilt medical community seemed incredulous about my presence. This incident was only the first of hundreds, maybe thousands of times during my 40-year career that I was mistaken for a clerk. For those unfamiliar with the job, the ward clerk was the person who transcribed doctor’s orders for medications and labs onto paper forms and scheduled diagnostic tests. In those days, the position required only a high school diploma. Residents, other students, faculty, and colleagues continued to misidentify me as a clerk until the position was eliminated by computerized medical systems in the late 90s. By then, I was attending faculty at Emory University and later, the Ob/Gyn Department Residency Program Director. Whether I was in Philadelphia or Florida, New Jersey or Nashville, the mistake reoccurred. Even now in my retirement, very little has changed.


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These incidents are examples of what are now known as microaggressions, the newest term applied to interpersonal interactions involving misconceptions based on racial stereotypes. Unfortunately, most Caucasians have been slow to acknowledge microaggressions. When I mentioned this incident to two former women residents, they quickly responded that it happens to them. They‘re still being confused for nurses well into their medical careers. My predicament is something different. Mis-identification of the two women at least assumed that they’re medical professionals; a ward clerk was just the hired help, one step above janitor. The assumption that I am hired help is embedded in the stereotypical myth of low Black intellectual capacity. Too harsh, you say. Black people will immediately concur; when you live in brown skin, you battle stereotypical assumptions of inferiority daily. In the white, oh-you-must-be-a-nurse scenario, it’s not an assumption about intellectual capacity but a tacit recognition of the lack of opportunity for women to become physicians. The rationale for that misconception was based historically in the myth of female frailty. Women were considered incapable of withstanding the rigors of medical training. And there was (and is) the notion of female emotionality (formerly called hysteria) and their uncontrollable menstrual-driven variations in mood. One of the two former residents is Asian, but the same assumptions about African American don’t hold for her. Current stereotypes of Asians identify them as super intelligent. At the same time, Asians are just as likely to harbor stereotypes about African Americans. After all, if they grew up in this country, they’ve been bombarded with the same racial stereotypes as everyone else. If they grew up abroad, American values have been exported through current events, US troops, literature, and the arts. Historically, the world has understood the circumstances of African Americans; the Nazis and North Vietnamese used it as propaganda among Black GIs. My experience is not unique nor, sadly, a thing of the past. In the past five years, I knew a Black male resident who was repeatedly mistaken for an orderly throughout his training. Another resident recounts that some white patients complained to her team that they never saw a doctor even after she had rounded on them and introduced herself as a team physician. Her words, dress and demeanor were futile against the patient’s natural prejudices. It just didn’t compute. The same resident also tells a story about updating a patient’s family during a surgery. After some complications develop, she is asked to drop out of the surgery and go talk with the


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family. Dressed in her scrubs, white coat, surgical hat, and shoe covers, she introduces herself as a physician on the surgical team each time as she visits the family in the patient’s room. She sacrificed her surgical experience to comfort the family. With the surgery complete, an irate family confronts them, miffed that no one has bothered to talk with them. “You all just kept sending the housekeeper.” In 2006, it was unfathomable for this family to conceive that a Black woman, dressed like all the other physicians, could be one of them [1]. How is that possible, you ask? I doubt that this family thinks of itself as racist or that they meant any harm. But their intention has nothing to do with their actions. The family completely ignored all the normal cues that indicate someone is a physician. Why would a housekeeper be dressed like the other surgeons? And they ignored not just her clothing but her words. She said she was a surgeon. How would a housekeeper know anything about surgical complications? One other thing, she didn't say if any of her team spoke up about it. Her silence suggests that they didn't and she was left to quietly swallow the insult. While discussions about race are extraordinarily difficult, not acknowledging the racial dimensions at the core of many situations simply reinforces and condones racial stereotyping for all participants and observers. And it leaves the Black physician dangling from a limb. One more story that relays the collusion of white colleagues and the isolation of minority medical professionals. A medical student of Ghanaian descent is rotating through an outpatient clinic when his preceptor asks the white patient if he objects to having a medical student participate. And the patient responds, “As long as he doesn’t shoot me!” Pause for a moment to take that in. With the student dressed in his white coat and tie, the patient felt comfortable enough to joke about Black thuggery with a perceived ally, the white preceptor. In return, the preceptor joined in laughing in a moment of white male bonding. Stunned, the student took a deep breath or two and proceeded to conduct a professional interview and exam. The incident brings Step’n Fetchit to mind. He gaily swallowed every racist insult with a smile, warming the hearts of white audiences everywhere. Black audiences laughed too, but they saw in him the passive resistance they employed daily because Step’n Fetchit was always successful at a classic racist trope: avoiding work at all costs. The student reflected on his reaction this way: “I was primarily angry. I was angry that, despite my best efforts to look the part of a medical professional, this patient could not see


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beyond the color of my skin to stereotype me as a thug. I was angry that my preceptor did nothing to stand up for me. I was angry that I did not know what to say in order to stick up for myself. I was angry that I had allowed someone else’s prejudice to cause me to doubt whether I belonged in the space that I had worked so hard to enter” [1]. His words reflect a mix of emotions, humiliation, the puncturing of his self-esteem, his doubt about his accomplishments, the betrayal by his preceptor and importantly, a sense of powerlessness to control his personal image in the world. Emotionally, these interactions take a heavy toll on minority medical personnel and particularly on trainees. How did I and other African Americans in medicine feel about the racial environment? Importantly, we knew these burdens were ours to bear. At Vanderbilt, there was no one else in the medical center with whom I could share my feelings except the nine others like me. Tales about my ward clerk job simply joined the repertoire of comedy material shared with them. It was part of our bonding rituals. My recurring misidentification wasn’t a complaint I could take to an all-white faculty and advisors then or even now. Even now, as with my former residents, the first reaction is denial: “you’re making too much of this” or “they didn’t mean anything by it,” as if my emotional pain is less important than a defense of some other white person they don’t even know. That denial will soon morph into blaming me for accusing someone of prejudice, tacitly soliciting me to apologize. Trust me, I’ve been through it over and over again.

continued online References: [1] “Bias in Obstetrician-Gynecologists’ Workplaces” , a clinical commentary piece in Obstetrics & Gynecology, 2019 which details resident stories.

A Professor Emerita in the Emory Department of Gyn/Ob, Denise Raynor (MD ’84) has dedicated her career to the reproductive health of minority women. As a veteran of the civil rights and political left movements of the turbulent 70s, she served as residency program director while seeing the patients that added to the 10,000 babies she's delivered.


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LAVENDER Anivarya Kumar I was never one for roses Petals always welting, thorns always prodding One shot to take him and my hopeless romantic becomes Hopeless But today a new kaboom to my heart Today I marry with lavenders, their violet spikes violent a little less A purple royalty, a mask for your politique Gathered in clusters and your aim? To make America great. Again, my love is muffled by the past that triggers me so I control myself easy, much harder for you though In the name of protection you hold onto your 2nd amendment In the name of love I beg my 2nd vow till death do us part a 2nd time As you search for your ammunition to counter me, you are my silencer and today I am silent My lavenders have pistils and soon they will multiply One times twenty-five thousand five hundred and twelve, do you even know how to count that high? So I toss the lavender bunch over my shoulder And I wonder Who’s next?

Anivarya Kumar is a junior majoring in Medicine, Health, and Society with minors in Neuroscience and South Asian Studies. With a passion for medicine and literature, she hopes to integrate patient narrative into clinical care and mitigate health disparities as a physician-author. This poem is an excerpt from her upcoming third novel, Unfold.


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ANATOMY STUDY DATE Alice Liao

Alice Liao is a Chinese-Canadian from Toronto and medical student at Vanderbilt. She began taking photos of her surroundings when she studied abroad in England during college, so that she could share the fun things she encountered with her friends at home.Â


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RED DREAM Frank Gee

I was having a colonoscopy at Vanderbilt. The anesthesiologist didn’t want to weaken my heart, so he gave me half of a drug to put me to sleep. All of the sudden I blacked out and went into a black tunnel and came out on the other side of that tunnel - it was the most beautiful place with red poppies, birds singing, deers running, butterflies, wonderful music. I thought I had died and this was my journey to heaven, but all of a sudden I heard voices from my doctors, talking about places to eat - and then back to reality, I heard voices behind me and saw 18 students looking at my ass. Vanderbilt is a teaching hospital! So here is my short trip to heaven!

Frank Gee is a Nashville-based artist and Vanderbilt patient. He draws inspiration from the world of nature for his art, especially water and aquatic life. His work has been featured in numerous national periodicals and magazines and used by conservancies across the nation for fundraising. To purchase and view more of his work, visit frankgee.com


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NEGATIVE STUDY William Yi, MD

William Yi is a general surgeon and graduate of Vanderbilt School of Medicine class of 2009.


PART II: POST CALL “For human beings, life is meaningful because it is a story.” - Atul Gawande


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ROSE Karl Misulis, MD, PhD Rose awoke to the smell of pancakes. Mom was making the usual Saturday morning treat, blueberry pancakes with pure Vermont maple syrup. On special occasions, she would accompany the regular fare with patties of breakfast sausage, but she did not smell that sweet and spicy scent. No, just pancakes this morning. Who would she play with today, Jenny? No Rose remembered that something had happened to Jenny. Something bad. Was she sick? Was she hurt? She could not, for the life of her, remember what happened. Okay then, she would play with the boys across the street, they were lunatics but fun. But then she remembered that the boys were away. Were they off at camp? Again, the details escaped her. Nevertheless, she would enjoy this summer morning. Rose’s eyes opened and she looked around the room. Panic briefly filled her. Where was she? But then she remembered, this was the guest bedroom at her daughter’s house. That’s right, she was visiting her daughter for a couple of weeks. She would not play with Jenny or the boys today, those were foggy memories from long ago. She was visiting her daughter. What was her name? Violet. That’s right. Or was it Lily? She had two daughters, and she wasn’t sure whose house she was in. Rose sat up in bed, swung her feet onto the floor, and prepared to start the day. Her bones creaked and groaned under protest, but followed her commands, as they had done for these eighty-some years. How many years was it? She had lost track. “Good morning, Mom!” chimed a cheery voice which accompanied the opening of the bedroom door. “Happy Birthday, Mom!” A tall, thin woman with short red hair entered the room and strode to the bed. She bent down to embrace Rose, gave a kiss on the cheek, then stood upright, turning to adjust the vertical blinds. With a quick twist of her wrist, the direct rays of sunlight were out of Rose's eyes. “Is that better?” “Yes, thanks,” said Rose. Rose looked at the woman and was frightened that she forgot which of her daughters this was. She thought she would cover up her lack of memory by not saying her name. It would come to her eventually, like many other times when she would fight


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for a memory and it would finally come to her a few moments later. The woman extended a hand with long slender fingers. Rose extended her own hand and they grasped. For a moment, Rose stared at the joined hands, one smooth and graceful and one wrinkled and gnarled. Had she not been on the opposite side of this exchange a number of years ago? She remembered how she had helped her mother in her long illness so many years ago and how frail she looked. The young hand tightened its grip on hers and pulled. This was not social contact, this was help for her to rise from the low bed. Rose had been taller in her youth when her spine was straighter, but her legs were still long. She had liked being tall most of her life, but now getting in and out of low-slung cars and chairs and beds was a challenge. As Rose stood, she noticed the name-tag on the woman's shirt. It said 'Lily' and below was 'Customer Service'. Ah! She was relieved, the guilt of not remembering could be left behind. “Thank you Lily,� Rose said. Rose’s memory was failing. The nice doctor told her she had Alzheimer's disease. At least he seemed nice. He was totally professional and polite. Rose remembered that, at least. She had been irritated that he had spoken more to her daughter than to her, but then, she would not have remembered the details, anyway. She had also been irritated by all of the questions. She did not mind testing strength, reflexes, and coordination and listening to her heart. She had been an athlete in her younger years and she was proud of her body. No, the endless questions which formed the memory tests were particularly frustrating. Remembering three things then having to repeat them after a seeming eternity. No one would remember those. Who is the Vice President? Who cares? The Vice President is just a highly paid understudy, waiting for the President to not be President anymore. The doctor had given her some pills to take. One little pill every morning. Rose did remember that the pill was to try to improve her memory. Had it worked? It did seem like she could remember a little better. The two walked out of the bedroom and down a short hall, hand-in-hand. At the end of the hall was a family room complete with kitchen area, dinette, and comfortable seating area. On the perimeter of the room were a television and accompanying stand with accessories, desk with


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computer monitor, and another small incidental table filled with papers and envelopes. Lily led Rose to the kitchen and guided her to the dinette. “I think I'll sit at the bar, dear,” said Rose. They continued to low-backed bar chairs facing the kitchen area. “What do you want to do today, Mom? This is your day!” Lily said. Rose was puzzled, “I thought you have to go to work?” Lily smiled, “I just got off work, I'm home for the day. I don't have to go in until tomorrow night.” Rose noticed Lily manipulate her pin, remove it, and deposit it on the counter. Meanwhile, Rose picked up her handful of pills, dropped them into her mouth, and forced them down with a half-glass of water. She shuddered with the terrible taste. Why can't doctors come up with better flavor on those pills? Pills with an M&M candy coating? Now there's an idea. Rose asked, “What do YOU want to do?” Lily deflected the question, “This is your special day, you choose. Whatever you want...within reason.” “So, I guess Alaska is out of the question,” she said with a smile. Lily returned the smile but said nothing. Rose asked, “Can Violet come over? Can we all have lunch together?” Lily winced, “No, Mom. Violet can't come over today.” Rose asked, “Maybe on the weekend? What day is today?” “It's Saturday,” answered Lily. She bustled around the kitchen, preparing their usual fare, cereal, yogurt, coffee, and juice. Not hearty but healthy and satisfying. The pancakes she had smelled when she woke up had been a distant memory, part of one of her dreams. While Rose had always been a dreamer, her dreams had become particularly vivid this past few years. The nice doctor had said this was normal with Alzheimer’s disease.


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Lily continued, “Maybe you would like to go to the botanical garden?” “Yes, that would be lovely,” said Rose. Why had she not thought of that herself? She loved the botanical garden, and so did her girls. Rose used to know all the names of the plants, and she would still remember many. Older memories were better preserved than newer ones. Rose's heart skipped a beat. A memory. A thought. An emotion. She asked, “Why can't Violet come with us?” Lily did not answer. Rose asked again, “Please tell me. What happened?” Lily looked down at her hands and stopped her bustling, “Mom, Violet passed away. She...” but Lily did not finish. She shook her head and turned away. Rose was sure Lily was crying now, and the emotion was contagious. She was sorry she asked. She now remembered what happened. “Oh my God,” Rose started crying, “my Violet!” Her beautiful sweet Violet, once full of life and laughter, withered away to a skeletal being ,wracked by pain caused by ovarian cancer. This memory was horrible. “Was it recent? I forgot when it happened,” Rose said, her tears now beginning to dry up. “Yes Mom. Just a week ago. We buried her last Saturday.” Lily turned around, her normally bright cheeks flushed and her eyes red. Makeup had been streaked by her tears. “I'm sorry, Mom.” Rose touched Lily's hand. “I'm sorry I keep forgetting. I made you sad again.”

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Karl Misulis (MD ’82) is a neurohospitalist at VUH. After completing medical school, residency, and fellowship here, he returned to Vanderbilt in 2018 to start the neurohospitalist program. Along the way he has published 20 medical texts, taught medicine around the world, and played keyboard in several rock bands.


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LETTING GO Rolf Meinhold, MD

Swirling, Whirling, Twirling Each leaf quivers and hangs for a moment; As its grip slips, it releases, and, letting go, is committed to the fall. Every drifting dance is different and sacred and beautiful. Until it comes to rest on the Ground of all Being. Two fall seasons ago, I was walking my dogs and noticed at the beginning of the season how the leaves would fall in their own special manner from tree to ground. I was dealing not only with end of life issues on an ongoing basis with my patients, but had recently lost my mother. As I thought about that last transitional moment, the metaphor revealed itself to me. I think the falling of the leaves is one of those events we tend to miss in our hectic lives half conscious. It has not been the same for me since.

Rolf Meinhold (MD ’84) has been happily practicing family medicine for the past 33 years in different practice formats. He is still in solo practice but has partnered with MDVIP over the past 7 years in a concierge model. In the last year and a half, he has become certified through the Chopra Center in Ayurvedic approach to health and wellness.


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BIRD CALLS IN AUTUMN Brian Christman, MD One hundred blackbirds adjust by Braille as the chill permeates One hundred blackbirds, aligned on a wire, meditate on fading sunlight and cast shadows on the chaff When sleet sets siege, some tuck into emerald magnolia tree mansions for the winter Others hide beneath the snow and ice All birds becomes somber so near the earth And there is much to discuss. I knew a man whose sun-roasted skin twinned the backs of crocodiles in summer When they lay parallel in the shallow muddy and reflect on violence preordained. He could foretell phone calls and restore sight to hounds blinded by raccoons. While the weak sun lasts, the leather men gather outside the courthouse in a perfect arc To whittle double reed duck calls and reflect on distant victories. Their hoarse stuttering engenders the respect age is due For there is much to discuss. A fluttering of tanagers filled the aspens near school this morning One bird’s heart burst with the excitement, and he fell. The quiet raven-haired girl with a white eye and the gift of snow palmed the warm feathery corpse back to class Soon, just before his peers took flight, She blew airy frost over the beak, restoring its breath This is the only time the story has been told.

Brian Christman was raised in Tulsa, Oklahoma. He is Chief of Medicine at VA TN Valley HCS, Vice-Chair for Clinical Affairs/Vanderbilt Medicine, and a part-time woodworker and poet. His pieces have appeared in Annals of Internal Medicine and The Pharos.


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WHERE I AM NOW Nanette Bahlinger, MTS With thanks to Wanda and Brenda, the donors and their families, wherever they are. Disclaimer: The information included in the introduction is subjective. The observations of ADP records reflect my biases, interests, and moods, and the recording of those observations was made without the use of any formal tracking system. Early in 2014, the three staff members in the Office for Continuous Professional Development relocated from the basement of the Sony Building to the fourth floor of Light Hall. One of the rooms we moved into had been the office for the Anatomical Donation Program (ADP) for about ten years. Since 1925, the ADP had processed records for hundreds and hundreds of donors, most on paper and many of them in this room. As new occupants of an old office, we inherited and were tasked with purging those records. We dutifully began by consolidating the original files and then divided the volume so that each of us assumed responsibility for four drawers. Our job was to locate the essential paperwork: to clip together the body form, donor card, death certificate, next of kin form, and final disposition form for each donor. Everything else was to be shredded, and the salvaged papers were to be scanned and electronically saved before they too, were shredded. It was apparent from the beginning that our task would be physical – there were odors to contend with, staples (and more staples!) to be removed, fragile papers to be gingerly handled – as well as emotional. The tale of the scrivener came to mind – Ah Bartleby! Ah humanity! – and lingered throughout. The records we worked with were arranged chronologically in army-green hanging folders. Some folders contained records for a single year, others for multiple years; some bulged with paperwork, while others were slim with fewer documents. But all of the records were carefully ordered, filed, and maintained, and revealed quite a bit about the women who were responsible for them. ~~~~


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Brenda Lair worked in the ADP during the 1960s, 70s, and 80s and had a buoyant, outgoing personality. She was inclined to establish relationships with donors and their families, and her records were full of cheery, carbon-copied correspondence. (In one of her letters, she commented on the new interstate system and how easy it made travel.) Disassembling Brenda’s files could be a challenge because she stapled with abandon – her files were easily identified by the sheer quantity of staples attached. Sometimes the staples looked like a game of pickup-sticks, scattered and piled one atop one another. Wanda Pope succeeded Brenda. She worked in ADP longer than any other staff member and was much more conservative than her predecessor. Her correspondence was standardized with rarely a personal comment and her papers were stapled with similar restraint. (They could also be a challenge to remove because she often stapled between sheets of paper, making it difficult to find and figure out which staple to remove first.) Use of the telephone became more common during her tenure, so her files contained fewer letters and more notes from conversations with donors and their families. These, too, were transcribed in the same measured tone, even when the comments directed at her turned accusatory or emotional. She was the model of professionalism. Despite their different styles, however, it was obvious that both women valued their work and the people they dealt with. The first was evidenced by the content of the files which included every detail, both relevant and seemingly irrelevant, and the second by the letters of appreciation sprinkled throughout. Over and over again, donors and their families took the time to thank the two women for their “kindness and compassion,” the same words repeated through the decades. Few other things were as constant as those words, however. The majority of the files I reviewed were dated 1957 – 1976 and oh, the societal changes and donor differences they revealed! ~~~~ The most noticeable changes were to the format, method, and content of documentation- that is, the actual paperwork in the files. Early donor records – those dating from the 1950s – rarely contained more than a death certificate or, in the case of fetal donations, a tag labeled “Baby Smith.” For others, there was only a piece of paper with the four-digit donor number written on it, often in pencil. Correspondence to Vanderbilt changed too. Telegrams were common in the earlier files, especially for those whose family members had died at Clover Bottom (a facility for mentally


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disabled people). Other correspondence was written on everything from personalized stationery to sheets torn from notebooks. The earlier letters were handwritten, often in an elegant script with an air of formality, and frequently directed to a male (Dear Sir) or males (Dear Gentlemen). By the 1970s, slanted script had given way to upright, boxy handwriting with bubble-dots over the i’s and a more casual tone. Later records contained letters written on typewriters and occasionally a computer. In addition to funeral service programs for donors, obituaries were sometimes saved. Newspaper articles describing the well-lived lives of prominent donors were included, as were articles detailing the more unusual circumstances of donors’ deaths: the escape, pursuit, and killing of the Brushy Mountain prisoner and the forlorn college student who committed suicide in the hallway of the downtown Metro Nashville Police Station, among them. Personal artifacts from donors could be found in the records, too, including poems. One was penned by a teacher who fancied herself a literary figure; on her death certificate her husband had lovingly described her occupation as “Teacher/Poet.” The second was a schizophrenic whose daughter wrote a note asking authorities to question whether her mother’s death by drowning had truly been an accident. Handwritten notes by Brenda, Wanda, and other ADP staff were also scattered throughout the files, scribbled on the backs of used sheets of paper, computer punch cards, scraps, bits of cardboard, and once, on a familiar, folded brown paper towel. ~~~~ Birth dates for adult donors ranged from the late 1800s to the mid-1900s. The earlier files documented a handful of immigrants, including men and women from the British Isles, Scandinavia, and Germany. This was consistent with the general characteristics of donors who were overwhelmingly white and of European descent. The single donor of Middle Eastern descent specified that he wanted the poetry of Rumi to be included in his service, and the funeral program in his file indicated that it was. A greater number of the earlier donors born in the U.S. were non-Tennessee natives. Of these, the Northeasterners and Midwesterners tended to be better educated, making up the majority of professionals, including teachers, professors, engineers, and scientists. Native Tennesseans tended to be farmers, laborers, service-industry workers – cashiers, waitresses, a parking lot attendant, a golf course groundskeeper, a bartender, and a cemeterian


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among them – or those in commerce, including sales people, small business owners, and corporate retail managers. The three most common occupations listed on death certificates were teacher/professor, minister/clergy, and housewife. From the medical profession, two or three doctors donated their bodies and perhaps triple that number of nurses. Lawyers were scant and politicians absent. Of the 23-year old who died of MD-related causes, his parents listed his occupation as “Sports Fan.” Not surprisingly for Nashville, donors included those in the music industry. The ashes for one musician were sent by the ADP to a friend of the musician who subsequently left them in a repossessed trailer. An employee of the trailer leasing company gave the ashes to an- other person who held onto them for several years before his wife contacted Vanderbilt asking for “any information on this abandoned person.” Veterans and victims of the two World Wars also donated. From the First World War were the 100-year-old veteran whose list of illnesses included “possible exposure to mustard gas,” a Belgian native deported by the Germans, and another veteran who carefully detailed with palsied hand that he had served from “April 29th 1918 to June 15th 1919.” From the Second World War were the Jewish man who had spent three years in a concentration camp and a veteran whose list of past illnesses included “frozen feet in the trenches.” Another veteran had been a gunner on an aircraft carrier where the kickback caused by the massive weapon resulted in kidney problems later in his life. Husbands and wives often donated together and regularly asked to be buried together. Single women far outnumbered single men and were often identified as teachers. Overall, however, male donors were more numerous than female donors.

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Nanette Bahlinger received a BFA from LSU and an MTS from Vanderbilt University. She has worked at VUMC for more than twenty years.


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SUNSET AT DAVENPORT PIER | DUSK’S REVENGE Ashwin Inala

Ashwin Inala is a third-year undergraduate student at Vanderbilt University from Morrisville, NC. He is a neuroscience major and hopes to pursue a career in medicine after graduation. Outside of school, he enjoys captaining Vanderbilt’s Table Tennis team, spending time with his dog, and capturing nature photos.


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LOVE TIME FOR JANE Richard Hutson, MD “Sweet Spring is your time is my time is our time for springtime is love time and viva sweet love”. -E.E. Cummings Loving her today is not sufficient, I thought. And so: Having loved her yesterday, And so dry much today…. I suggested, very reasonably I thought, Loving you tomorrow and tomorrow. Further, should some Eternal One be observing Who could grant my request I would choose: Loving you along the streams, Beneath all the Sycamores and Pines, And into all the Nights of Forever. “Earth’s the right place for love. I don’t know where it’s likely to go better”. -Robert Frost

Richard M. (Dick) Hutson was born in Murray, KY in the Jackson Purchase area of western Kentucky. He was a member of the Vanderbilt Medical School Class of 1966. After completing residency in family practice, he returned to Kentucky, practicing in Paducah. Since retiring in 2000, Dick and wife Jane have lived in their second home on Kentucky Lake.


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I CAN’T Jessa Fogel I can’t write a poem anymore So don’t bother, don’t beg or implore Please don’t ask me for rhymes That expound on the times Or ideas at humankind’s core

Now my river of thoughts is all dried Uninspired, went out with the tide My brain reels and surges But no poem emerges I can’t, and you can’t make me try

I used to write day after day Just thinking and scribbling away With a pen in my hand And my head in the sand Unaware I had nothing to say

My thoughts cannot gain enough traction To kick my poor pen into action Every word that I drag From my cortical lag Feels as natural as dental extraction

My mind was so young and frenetic Filled with thoughts that were wild and poetic ‘Til my higher degrees Rid my mind of disease Purged my soul with creative emetic

I assure you, I simply cannot Write a thing, after all I’ve been taught Of the brain, lungs, and heart But my soul still needs art So I guess I could give it a shot

Jessa Fogel is a second-year medical student at Vanderbilt University School of Medicine. In 2017, she graduated from Dartmouth College with a Bachelor of Arts in biology with a minor in international studies. She enjoys running, reading, and painting in her free time. In the future, Jessa would like to pursue a career in general surgery or orthopedic surgery.


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RIO GRANDE RIVER AT TWILIGHT AND IN THE MORNING Joyce Huang, PhD

Born in Qingdao, China, Joyce Huang is a third-year medical student at Vanderbilt. Having grown up next to the sea and in close proximity to the mountains, she is fascinated by how the world is represented through colors, patterns, and textures. Through travel, she explores the artistic exchange between land and the photographer.


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HEART YOURSELF Regina Russel, PhD, MA, MEd

San Francisco sidewalk February 2019 National Suicide Prevention Lifeline: 1-800-273-8255

Regina Russell was raised by free spirits in the Ozark Mountains of Arkansas. Her art is built on the exploration of ordinary experiences, embellished by findings from a lifetime of extraordinary adventures. She captures photographs and creates music with her husband in Nashville, Tennessee.


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SONORAN DESERT | EDGE OF DAY Samuel T. Rosenbloom, MD, MPH, FACMI

Trent Rosenbloom is the Vice Chair for Faculty Affairs and an Associate Professor of Biomedical Informatics. He is a board certified internist and pediatrician who completed his fellowship in Biomedical Informatics and an MPH all at Vanderbilt. Dr. Rosenbloom is the Director for My Health at Vanderbilt, one of the nation’s oldest and best adopted patient portals.


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THE SLEEPWALKER, THE INSOMNIAC, AND THE WINDMILLS Anita Louie Based on Johan Barthold Jongkind’s “Moonlight on the Canal” Los molinos, in the distance, Spread across the starry sky like crosses. Ah, yo entiendo, yo entiendo I do see why he thought they were giants. Their canvas sails flap serenely in the breeze Creaking softly, patiently above the canal Caressed by gauzes of moonlight, and the diaphanous haze of fog. Suddenly, out of the tangled tresses of trees, sonámbulo, a lone sleepwalker. I squint to see if the silhouette is a mirage of the night, Or perhaps of my own exhaustion, But she breathes in the night air with confidence. The moon touches her wrinkled face, And guides her to the water’s edge Where the windmills flutter a welcome And she smiles blindly back with familiarity.

I continue to stare in disbelief, wondering What she remembers in the morning, if anything at all, Or if she questions why the edge of her nightgown Is laced with ferns and poppyseed and dew. Her arms are now raised above her head in silent triumph For she has found her way back, somehow And she embraces the absurdity of how each step carries her Back to this oasis of tranquility every night. She breaks into an uproar at this farce, This permutation of chance and moonlight, Laughing and laughing into the night Alone, save for the stoic company Of me, and the windmills.

Anita Louie is a first-year medical student at Vanderbilt. She enjoys writing plays and journaling in her spare time.


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FLOWERS IN SPRING | FLOWERS UNDERWATER Daniel Lev, MD

Daniel Lev (MD ’61) is a retired ophthalmologist and painter. He likes painting feelings and perceptual structures: a momentary unfocused glimpse of red birds darting about on a forest floor or his surprise at peering into a clear stream and seeing flowers.


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MABS Kelly Sopko, MD

Kelly Sopko grew up in a home that valued both medicine and art; her father is a physician and mother an artist. She has practiced hospital medicine at VUMC for over 12 years. She views art as an outlet for expression and renewal. Her inspiration frequently arises from the natural world and, of course, her cats, Bastet and Maboroshi.


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ME AM HULK Andre Churchwell, MD

Raised in Nashville, Andre Churchwell currently serves as Chief Diversity Officer for VUMC and Senior Associate Dean for Diversity Affairs at VUSM. Influenced by his father’s passion for the arts, particularly when he would draw his favorite cartoon characters, he began drawing and studying art of all genres. His drawings have been published and exhibited regionally.


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MY SPIRIT TODDLER Kia Quinlan

Kia Quinlan is a third-year medical student in the MD track at VUSM. She was born in Houston, TX and grew up in Atlanta, GA. She completed her B.S. in psychology at Yale University. She plans to pursue pediatrics. Kia loves to dance hip hop with VMS Dance and her favorite place in the world is St. Kitts in the Caribbean.


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THE BALTIC SHORE Emily Mace

Emily Mace is a Nashville native and current Vanderbilt medical student. While an undergraduate at the University of Virginia, she majored in biology and studio art. She has continued to paint intermittently through medical school, with pieces ranging from abstracts to landscapes inspired by her own travel experiences. Â


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PAPER WASPS Janice Savage “There is a time for everything, and a season for every activity under heaven…a time to tear down and a time to build.” Ecclesiastes 3:1-3 NIV The birds are back now and all the fields gone green garden gloves are warmed awake by my hands. Along the edges of the garden, the devastated marigolds lie crushed and gray, bent by the pounding work of winter. It is time to heap up debris and compost the past. I turn first toward the house Last year’s bird nests must be cleared from under the eaves. And then, my Rite of Spring, removal of the nests of paper wasps. I lift my broom to flick the hulls from their hiding places, gray chambered clumps, abandoned paper castles, the once busy nursery now empty bassinets. How I hate the ones that hatch, the way they weave and dodge the swatter dragging their useless legs through summer’s heavy air like menacing punks cruising the night, looking for trouble. But the nests, more majestic than pyramids, formed from cellulose spit, such simple symmetry, each a masterpiece. I flick them to the ground to be gathered heaped with all the other miracles. Janice Savage lives with her husband Carl in Nashville and works at Vanderbilt Medical Center as an administrative assistant. Her work has appeared in various publications over the years such as the Vanderbilt Review, Tabula Rasa, House Organ, and Old Red Kimono. She has a grown son, daughter-in-law and two grandchildren.


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BLACK HOLE Jean Anderson, MD Day after day I wait for news of you, As if looking for a brightly colored package from some faraway country, bound in twine and covered with many stamps. I stand on the shore and watch cotton candy foam scud along the sand, with shooting spray and wheeling gulls joy-riding the wind. They laugh at me while they careen madly, now close to the surface, lost momentarily behind a wave, now rising as if catapulted into the sky. I look out to sea, sheltering my eyes from the glare, But you are not there. I search for you in the hot hazy days of summer in land-locked Tennessee, where the tall pecan trees thrash about in ecstasy, their pale leaves shivering in the dance, while the bruised sky darkens

and the earth becomes silent and still, so that even the wind holds its breath. When I was small you would hush me and say “There’s the rain crow! Listen!” and I listen now, until the first hesitant drops crescendo into torrents of rain and drown out its voiceand yoursAnd you are not there. The catbird that sang sweet songs outside your window has flown south, leaving its nest forlorn in the holly tree full of red berries. but the crows have returned to roost in our old oak trees, noisily flocking in the gathering winter, calling in the darkness, and the white-throated sparrow has returned with its reedy quavering voice that pensively wakes me in the morning. I listen for your voice at dusk and dawn But you are not there. She has become a star, I am told.


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So I look for you wandering among the Pleiades or sitting in Cassiopeia’s throne or hanging from Orion’s belt, perhaps hiding in the cup of the Big Dipper. But the constellations you showed me in the night skies of childhood seem cold and distant now. And you are not there.

And then I found you. You turned towards me in the water, Your face radiant, your arms open, As if to say I have been here all along.

I think perhaps you have fallen into A black hole, Where time and matter go to die Collapsing in a mass so dense that nothing can escape, not even light. Like grief. I fell asleep last night, wanting only to rest, suspended in time and unconsciousness, forlorn from searching. I dreamt. I walked in a meadow towards a lake in silence, no longer looking and listening.

Jean Anderson (MD '79, HS '83) is Professor of Gynecology and Obstetrics at Johns Hopkins University. Her career has focused on caring for women living with HIV; in 1988 she founded and continues to direct the Johns Hopkins HIV Women's Health Program, which has provided care for over 8000 women.


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KAIETEUR FALLS Peter Bryant

Peter Bryant is a third-year medical student at Vanderbilt going into Emergency Medicine. This year, he had the opportunity to participate in a global health elective in Guyana with a group of emergency medicine physicians. While there, he worked in the ED of a public hospital in Georgetown, while also getting a chance to take in the country’s natural sights.


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UNREMARKABLE Henry Quach That man is unremarkable. He has a normal face. He is wearing a plain shirt, plain jeans, and plain shoes. He is waiting for the bus after a long day of work. Perhaps he will buy dinner and watch television tonight. Either way, he is unremarkable. I would not be able to pick him from a crowd. But I saw him. I noticed him. I remarked on him. As it turns out, he is remarkable.

Henry Quach is currently a fourth-year medical student at Vanderbilt pursuing a career in dermatology. He has enjoyed serving as a leader of the Literature, Arts, and Medicine student organization. He believes that medicine and humanities can only support and strengthen each other.


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SHRINKING Allie Yan In the hush of autumn, under the waning moon, I was born, small, into this world. In a little hut, in a rural village, deep, in Southern China, There was little food, little money, little things. Quick-witted, smart, high marks in schools That in the end, I could not afford. New China was a disease of this land, our land, And everything within it seemed to shrink. I am in the wards. Rushing, speeding, People are always sick. A little boy at the end of the hall, Is weakening, his blood is shrinking, There is no one willing to give, In the quiet of the night, out of sound, out of sight I take from myself, and I give, I give, I give, and I shrink. My firstborn, grows inside me, my beautiful girl, my pearl, the winter comes, the cold, the cough, She shrinks, and shrinks, and shrinks.

Two children to feed, there is nothing The money, the food, the work, All of my scraps, I give to them, To grow and grow and grow. I am sick, I am fine, I work, I must go, There is money to earn, food to get, People who are sick and shrinking, I still have two children to grow, I am tired, weak, my kidneys they speak, They scream, they fail, and they go Across an ocean, a deep blue sea, A new land, new earth to be Everything is strange, unfamiliar, Yet everything here, there is. Food, things, money, family, Here, everything, there is. Another two little ones, running about, Happy, big, and growing, They leave food on their plates, And play games and fight, But I am happy they do not yet know, Just grow, and grow, and grow All of my days are spent in the house, cleaning, cooking, telling the children to eat,


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Outside in the backyard, In the clean-cut green, I make a bed for myself to sleep, I grow winter melons, tomatoes, green beans, and peas Crops from the land that I know, In the hush of autumn, before the cold, I make meals from the earth that I grow. The oldest leaves the house first, She has grown. Like the sky is watching, My body knows, And my insides open their mouths, And once more, they scream on silent haunches in the morning fog, comes to stay, again, the disease. The machines they hum in the cold white rooms, Warm hands touch my old skin, Every bone aches, my back, my pain, The small body I have lived in, It shrinks. My voice does not speak, it shrinks My tongue cannot make the right sounds, To make the heads around me turn, and listen,

Oh, how small I’ve become. The needle slides in, Cold and sharp, disappearing into my skin the red it flows out, I give and I give, I shrink and I shrink and I shrink. My daughter spends summer Saturdays Tending the bed that I made, She grows the soil that I can no longer, She makes me eat and eat, She takes me to see the machines on Saturdays, Mondays, and Wednesdays too, I have lived in her home for years and years, She gives and she gives and she gives The years they’ve walked, and ran and stilled, I sit and stare out the window, Now, how I wish time would slow, to see the earth I’ve sowed, grow The little ones are just getting big, For them, life is just beginning, All my life I’ve been shrinking, giving, Still, I want to see it grow.

Allie Yan is a fourth-year Vanderbilt undergraduate student who will be matriculating in medical school in the fall. During her senior year, she took a course on Narrative Medicine taught by Dr. Scott Pearson, where she was inspired to write this poem about her grandmother’s personal and patient experiences.


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ALLIGATOR | COAST SCENE Tara Duffie, MA

Tara Duffie is a psychiatric mental health nurse practitioner student at Vanderbilt University School of Nursing. She worked for almost a decade as a psychometrist for Vanderbilt University Medical Center and received a Master’s in Clinical Psychology/Neuropsychology from Middle Tennessee State University.


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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