Tensegrity Volume 1: New Beginnings

Tensegrity

Literary and Arts Magazine

Submissions byMichigan State University Health Professional Colleges

Presented by the Students ofMichigan State University College of Osteopathic Medicine

Volume 1: New Beginnings

TENSEGRITY

A Literary and Art Magazine by and for the Michigan State University Health Professional Colleges:

Michigan State University College of Human Medicine

Michigan State University College of Nursing

Michigan State University College of Osteopathic Medicine

Michigan State University College of Veterinary Medicine

Editor-In-Chief

Melissa Chavarria, OMS-II

Faculty Advisors

Dr. Jessica Heselschwerdt, M.D.

Dr. Edward Rosick, D.O.

Editorial & Design Team

Trevor Evans, OMS-II

Salina Halliday, OMS-II

Naveen Kakaraparthi, OMS-II

Matthew Mayeda, OMS-II

Kelsey Sharples, OMS-II

Jordan Walker, OMS-I

Fundraising Team

Esther Funez Castro, OMS-II

SHORT ESSAYS

OTHER VISUAL ART

Human beings are remarkable amalgamations--unique stories, experiences, and personalities all melded into a single body of distinct physical characteristics. Yet, when learning about medicine, the hard rules and facts of science often seem too mechanistic and impersonal. We lose the individual perspectives that shape our humanity. Our humanity, however, instinctively challenges us to seek otherwise--a universal tension drawing us together to better offer meaning to the world within its objective and detached confines This literary magazine, named Tensegrity, is a small window to share these reflections.

Tensegrity is a concept that, while inherent to the practice of osteopathic medicine, applies to medicine as a whole. In a biological context, tensegrity speaks to our body’s reliance on the synergistic tension between each piece of our musculoskeletal system to grant integrity to our structure--we are at our strongest when we work as one. This literary and art magazine provides a focal point of creativity and expression for a collective, interprofessional effort to expand upon the humanism within medicine. Physicians, both allopathic and osteopathic, nurses, and veterinarians all contributed their voices to this first edition of Tensegrity to create a publication that speaks to all of us about how the sum of the components of who we are--minds, bodies, spirits, careers, passions--come together in mutual tension and support to illuminate what it is to be human within the role of health professional.

Fitting the inaguaral nature of publication, the theme of this first edition of Tensegrity is ‘New Beginnings’. As you read this magazine, we encourage the reader to seek out the connecting ties of beginnings within each entry. From the literal beginning of a human life in ‘New Life’ to the start of the pursuit of medical education in ‘First Autumn in Michigan’, each submission finds a unique view on a simple question: what does it mean to begin?

The making of Tensegrity has been a rewarding creative outlet during the transformative years of medical school. We recognize how practicing and appreciating art serves as a judgement-free canvas for tapping into new perspectives that can help unlock the many mysteries left in medicine, as well as fuel our ever shifting understanding of life overall.

Thank you to everyone who contributed to this inaugural edition of Tensegrity. We are humbled to have taken part in something that we hope will encourage health professionals to express their artistic inspirations for years to come.

- The Editors

Letter from the Faculty Advisor

We ask, “What does writing have to do with medicine?”

Mrs. A sits across from me in the exam room, a smile on her lips but missing from the rest of her face. “I have stomach pain,” she says through the interpreter. “I feel like I can’t swallow, and my ears are always plugged. I’m tired all the time. My heart races.” We’ve had this conversation before. Mrs. A is perfectly healthy. Several panels of labs and images have revealed no abnormalities, yet here she is, not even weeks after the last appointment wherein I assured her that she is well. If you looked at her medical chart, you might understand Mrs. A to be a somaticizer. A hypochondriac. A pan-positive-review-of-systems-pain-inthe---

But if you asked me who Mrs. A is, I would tell you something else. Mrs. A came to the United States 5 years ago with her family. She has a strong faith and supportive community. She hates the Michigan winter (who doesn’t?) She loves music and reading with her two young children. Her husband, also my patient, died from metastatic cancer two months ago. This is her story. Her clinic notes do a quite poor job of telling it.

So much of medicine is about stories. The stories our patients share with us remind us that they are people with rich lives outside the walls of the hospital, not just collections of symptoms and disease states. We carry their narratives with us to remind us why we do what we do, and to bring the light back when we feel burnt out. Writing, therefore, is not a diversion from but rather a natural extension of the storytelling so critical to our professional lives.

It is with this in mind that I am very pleased to serve as a faculty advisor for the inaugural edition of MSU COM’s literary magazine, Tensegrity. We are honored to bring you works of written and visual art from across the health colleges, representing a diversity of experiences. We hope that Tensegrity helps inspire you to discover and tell stories of your own.

- Jessica Heselschwerdt, MD

BUT HOW DOES IT END?

On my way to work before dawn, the unwrinkled snow was spread out over the fields like parchment and the full moon was writing a poem.

There were some good lines about trees, and I was quite eager to read all of it. But, as the sun shouldered itself into the sky, the moon’s delicate pen ran out of ink.

The Office Visit

Knock, knock

A stone skips over the clear water

I can see myself sitting on the dock

I open the door to somebody’s daughter

What brings you in today?

A waterfall thunders in it’s glory

unfolding before me is ever changing spray this is her time to tell her story

aches and pains

pulverizing anguish and trauma

weight losses and gains all explained with barely a comma

her words dance like rain

ripples of concentric circles radiate her pattern anything but plain a unique story to appreciate

labs ordered questions addressed plans for how to go forward perhaps she is a bit less stressed

the door opens with a click her waterfall fades in my mind over is my break from my own personal creek I hate to leave her behind

But, another door beckons amazing what can be just 900 seconds.

- Dr. Steve Williams, MD, MPH

7 feet from the moon Deanna Ingrassia, OMS-II, MSUCOM

- Chelsea Rawe, OMS-II, MSUCOM

November

The season of gray beaches: when sepia driftwood angels and seaweed krakens wash ashore, and gulls hang like clothespins on the sky; when fishbones lay sown into sand, and thunderheads drag their tentacles across the horizon as though they have always been there and as though may never leave.

- Ryan Skowronek, OMS-II, MSUCOM

Lake Michigan Infinity Stumps Deanna Ingrassia, OMS-II, MSUCOM

Time Lacks Discretion

Time lacks discretion for those that come and go we weep, we fear, we embrace yet the jagged edges of the mind stand barren amidst the blaze of our hearts

So take a moment to breath to engage to disrupt the dullness of cardboard monotony

Upend the structure and venture unbounded into the grace of possibility

Let the curves of your heart carry you through the liquid fluctuation of your soul where the edges are sanded and change is a continuum of unending connection

Blooming on an Inlet Dune

The mouth of Two Hearted River- a place which inspired Ernest Hemingway to write a narrative recognizing the regenerative powers of nature. Kelsey Sharples, OMS-II, MSUCOM

-Salina Halliday, OMS-II, MSUCOM

Homecoming

I once heard a story about a young man who had returned home from a business trip, walking through the airport to retrieve his luggage. A huge crowd gathering on the tarmac caught his eye through one of the glass windows lining the walkway. He paused, as he saw the stairs of a private plane unfurl and descended to kiss a plush red carpet covering the ground. Through the window, he spotted people playing musical instruments, waving flags, cheering and holding their hands out in hopes of a handshake. An older gentleman emerged from the plane and descended the stairs, smiling and waving at the crowd that had gathered to greet him. Shaking hands with the select individuals who bordered the carpet, he made his way to the car that awaited to take him to the next part of his journey.

The man staring out of the airport window made a plea to God, equal parts anger and awe, “Is that ever going to happen for me? To be that special that people stop their lives to welcome me home?” The man felt God answer him, “My child, you are not home yet.”

An illuminated open door leads to an underground salsa club, a space for creative and musical expression.

Industria 8

Ania Pathak, OMS-II, MSUCOM

Human Windmill

Deanna Ingrassia, OMS-II, MSUCOM

I had assumed that “home” in the story meant heaven, and as I had no plans of becoming a politician, movie star, or other such famous persons, I thought the same would be true for me; that I would not have that kind of welcoming until I had finished my journey on earth.

A few years passed, and I had made the trek from California to Michigan to attend medical school. On the first day of orientation, I approached the front stairs of Fee Hall, and the faint echo of applause floated to my ear through the humid June air. My head shot up as I remembered the story of the man at the airport from years before. Tears sprung into my eyes as I ascended the stairway and saw that both sides of the hall were lined with people, students and administrators, clapping and congratulating each member of our class as we arrived. Until that moment, I hadn’t known how much it would mean to have people who had been through the journey before me acknowledge and appreciate the work it had taken to be standing in this hallway. Although I had thought I would have to wait my whole life to experience this feeling, I was wrong. I had been welcomed home.

- Nicole Matouk, OMS-I, MSUCOM

First Autumn in Michigan

During a short walk on campus between classes, I ran across an unfamiliar trail. Stepping off of the sidewalk and onto the less traveled but more beautiful path, I felt a kinship with the surrounding trees as we both prepared to let go of the old things that no longer served us. Although it would be hard to see the glory of Autumn fade, my sadness waned as I imagined the new pathways and possibilities that would reveal themselves throughout the seasons of this journey.

- Nicole Matouk, OMS-I, MSUCOM

A CHOICE OF VENUES

It was one of those mornings when unhappiness came down like a heavy curtain closing off the lights of the stage. After spending far too much time staring toward my feet, I looked up through the window.

The clouds grazing the air like a passing herd of bison were heading off to wherever.

And I definitely felt better just knowing that.

Sunlight

To think We heal or cure another, Is to take credit for growing a plant.

We are here to prune leaves

Water cut stems

Repot what has been unearthed, Uprooted, and brought inside.

But it never will or could be Us that extend and unfurl Leaves off of fresh shoots That live with us in parallel.

Let’s not rotate terra cotta pots in well-illuminated windows And start calling ourselves The sun.

- Ania Pathak, OMS-II, MSUCOM

Littermate Companionship Kelsey Sharples, OMS-II, MSUCOM

Nesting Cindy Zhang, OMS-I, MSUCOM

- Dr. Steve Williams, MD, MPH

MEDICINE: Eight Effective Habits to Prevent Burnout and Promote Health and Wellness

Burnout has become easier than ever to experience in medicine. Pervasive at all levels, including in medical students, residents, and physicians, burnout has a negative effect on one’s career, one’s ability to work with others, and most critically, the delivery of excellent patient care. What is the best way to counter impending burnout? I have found it helpful to have an easily remembered mnemonic. Eight effective habits to cope with burnout and promote health and wellness can be arranged into the word MEDICINE: mood, exercise, diet, interpersonal relationships, community, introspection, narrative medicine, and engagement. These eight habits cost no money to implement and can have a substantial impact on your mental health and outlook. Taking care of yourself using these methods will make a difference in your life and in the lives of the patients you care for, ultimately helping you continue to provide the most compassionate and patient-centered care on a regular basis.

As stated, the “M” in “MEDICINE” stands for mood. This refers to mood swings, which include impatience and irritability. These not only affect a person’s own health but also can affect patient health because it lowers the quality of patient care. It is important to be able to identify when a mood swing is occurring and how to prevent or minimize their pattern in the future. Some basic methods for controlling mood swings are to get proper sleep, engage in therapy, and track past mood swings in a journal to understand them better. Exercise is an important way to manage overall burnout and this is why it is second in the “MEDICINE” mnemonic. There are many ways to participate in exercise, even when on the job. For example, taking the stairs instead of the elevator, doing core-strengthening exercises while seated, stretches to restore energy, and deep breathing to promote calmness. While the physical benefits of exercise are well known, the mental benefits are often overlooked. Inactivity can lead to depression or anxiety, so exercise helps relieve these conditions. The “D” in the “MEDICINE” mnemonic

stands for diet. It is essential to make healthy decisions at the cafeteria and when using vending machines. There are also foods that help one gain long-term energy, preventing fatigue during a shift. A healthy diet is important for many reasons, but achieving a healthy lifestyle greatly reduces burnout. Planning healthy, quick meals or using meal prep techniques are great ways to ensure that you stay well-nourished during a long shift. Understanding this aspect of health will also enable medical professionals to use personal experience when educating patients on proper nutrition. Developing relationships is key to avoiding burnout. Interpersonal relationships represent the next step in ensuring that once a relationship is developed, it stays healthy. The level of job satisfaction physicians experience heavily relies on their ability to build relationships with patients. It is important to understand both verbal and non-verbal communication techniques that can be used to foster these relationships. For example, non-verbal communication cues, such as head nodding, not being buried in notes or on the computer, and leaning forward when interacting with a patient, encourage a positive attitude in a patient towards a health care provider.

Community is the next piece of the mnemonic. It is important to take advantage of teamwork among hospital employees. This can result in improved patient care and a more cohesive work environment. When everyone is working together to share the workload, physician burnout is significantly reduced. A plan involving cooperation among nurses, physicians, and ancillary staff will reduce burnout across the board and improve patient safety as well as benefit patient care. To encourage transparency among team members, brainstorming and discussing problems as a team can lead to solutions that benefit everybody. Introspection is a personal element vital to reducing burnout, by helping one to realize when burnout is about to occur so that self-care can be implemented. Meditation is a wonderful way to reduce anxi-

ety and depression, which will calm feelings of potential burnout. There are many free smartphone applications available that offer meditation, and these can put someone in a healthy state of mind during a break from a long shift or even while driving on your way to work.

The “N” in “MEDICINE” stands for narrative medicine. Physicians experiencing burnout can become irritable, resulting in a lack of compassion and empathy. The word “narrative” will remind medical students, residents, and physicians about narrative medicine, allowing them to recall that each patient has a unique set of life experiences and a unique story. Being empathetic and compassionate, as well as giving patients enough time to tell their entire story, helps build a deeper, more personal relationship with patients. It is easy to get caught up in one’s own knowledge, but listening to the patient is important for both relationship reasons and in looking for signs of unusual medical complications.

The final letter in the “MEDICINE” mnemonic is “E”. This stands for engagement. Patients who engage in personal health goals receive better care, and the provider experiences a higher job satisfaction rate, which reduces burnout. There are many ways to engage patients, including education, presentation of multiple treatment options, and checking or clarifying a patient’s understanding of their options by using the teach-back technique.

New Life

Deanna

Ingrassia, OMS-II, MSUCOM

- Fawaz Habba, OMS-III, MSUCOM

After the Storm

Across the silvered water drifts wolffia in vast swathes, clumping, separating, and reforming—here, there— appearing not unlike continents hastened through the sea of time.

Standing alone upon the rain-slicked dock comes the scent of the post-storm earth, of the pond, of stirring life and of life in its becoming. And in the warmth and stillness of the air, you feel unburdened.

Two river dwellers find tranquility in the flow of early spring. Kelsey

- Ryan Skowronek, OMS-II MSUCOM

Espy

Sharples, OMS-II MSUCOM

“Wherever

Medicine, at its best and truest, grows out of a love of humanity. I fear though, that sometimes medicine flirts with a dangerous hubris that corrodes its very purpose. In overvaluing

sterility

standardization

systematization

status,

medicine can neglect and lose the same humanity it lacks its fundamental purpose without. Overzealous and rampant medicalization in medicine, is self-defeating. It can sterilize the life out of more than just microbes, but also the messy experiential nature of being fully human, and being seen and connected with as fully human—the stuff of life.

Sterility, standardization, systematization, and status, should come second to the subjective stuff of life, stability, sustainability, and service. Doing so takes medicine from study to practice.

Practicing medicine in service holds sincere space for others, and for their healing. Service is both humbling and powerful because of its capacity to catalyze change, not control and coerce it. Servitude births that power; power owes its life to servitude— because both exist only between people. Intersubjectivity and its necessary interdependence explains their consanguinity. No power exists without, and is always secondary to, service. Think of Teachers

Politicians Lawyers Doctors.

And when our actions cease to be in servitude, when self-importance trickles in and we sterilize the humanity out of our patients, we start to rank our status over their human existence. Then we physicians become little more than an act, a vacuous and false pretense—a tremendously dangerous thing to be, when we nurse and tend the very root of human experience and life—health and disease. To remove service, is to exsanguinate power, and leave it empty and expired. A farce. We render ourselves inefficacious in the sphere where we claim to work. And we leave our patients as objects, instead of the full human subjects they are. We’ve taken the fullness of medicine out of us and the fullness of life out of them.

the art of medicine is loved, there is also a love of humanity.”

– Hippocrates

Remain sensitive to shifts from a system that serves others, to one that serves itself, undermining itself and its own worth. Power lives between people, not over people. To disempower, is to dehumanize—to sterilize.

Standardization and systematization without sustainability and stability are equally vacuous.

Remain sensitive to shifts from a system that serves others, to one that serves itself, undermining itself and its own worth. Power lives between people, not over people. To disempower, is to dehumanize—to sterilize.

Unchecked,

Standardization and systematization without sustainability and stability are equally vacuous.

Sterility extinguishes life, not prolongs it.

Unchecked,

Standardization limits breadth, variety of experience, and individualization intentionally.

Sterility extinguishes life, not prolongs it.

Systematization devalues everything that falls outside its scheme and can limit possibility.

Standardization limits breadth, variety of experience, and individualization intentionally.

Status extinguishes the humility from which medicine’s depth of meaning takes root:

Systematization devalues everything that falls outside its scheme and can limit possibility.

to be in service to, seamless with, humanity. To practice medicine is to live it out through our common humanity, not study it. We should be asking:

Status extinguishes the humility from which medicine’s depth of meaning takes root:

Who is this bringing power and control to?

Are we disempowering, or empowering?

to be in service to, seamless with, humanity. To practice medicine is to live it out through our common humanity, not study it. We should be asking:

Are we giving someone their agency back?

Who is this bringing power and control to?

Their humanity back?

Are we disempowering, or empowering?

Their lives and wholeness back?

Are we giving someone their agency back?

Their humanity back?

These, these are the important questions.

Their lives and wholeness back?

Because it was never about us. It was and is and will always be about our common humanity.

These, these are the important questions.

- Ania Pathak, OMS-II, MSUCOM

Because it was never about us. It was and is and will always be about our common humanity.

- Ania Pathak, OMS-II, MSUCOM

Crusty Bread

Growing up, baking cakes and cookies was part of how I relaxed and took time for myself. Baking has now become an enjoyable hobby for me and recently I have begun challenging myself with new recipes. One baked item that I have wanted to master is a simple crusty bread. These pictures represent the process of making that bread, first the dough and the finished product. Making this bread was so enjoyable and turned out well for my first try! It has given me confidence to continue to hone my bread-making and baking skills!

- Brook Centofanti, OMS-II, MSUCOM

Burnout

No matter how hard things may seem or how tired you are, always remember that tomorrow is your chance for a fresh start.

- Megan Carrillo, OMS-II, MSUCOM Acrylic on Foam Board

Wabi-sabi: Embracing transcience and imperfection

Due to its lack of true roots and a vascular system, moss must frequently start anew. However, with sufficient time and a supportive environment, moss can flourish to provide the tranquility and diverse textures frequently experienced in Japanese Gardenss. Matthew Mayeda, OMS-II, MSUCOM

Bearing Witness

Though sought at any price and clutched by hands frantic to safeguard its scarce remains hope continuously slips away

A relentless exodus like dry grains of sand streaming between fingers dissipating

Like the last tendrils of bonfire smoke folded invisibly into a willing breeze

fading

Like the parting glimmer of a good dream that vanishes forever upon return of the waking state

The last remnants of hope seemingly evaporate leaving not a trace for those so desperately seeking what logic refutes

- Suzanne G. Wilson, MSN, RN

In the White Room

I.

In the white, fluorescent hallways, A maze of tiles reeking of ammonia and latex gloves, she sleeps in denial of tomorrow, unaware of today. She lays covered in white sheets three times her size, a hand-me-down white comforter pulled across her chest, exposing her callused, blistered feet. Her memory fading, vanishing like water droplets evaporating into the air above.

II.

Like a ritual, I would come every week, staying at her bedside for hours. I introduce myself. She calls me a different name: I reintroduce myself.

III.

My ears ringing, throbbing with her pain, nurses swiftly Force feed her jello that is reflecting her stark face in geometric green cubes, they ignore her rejection of the food. She begs for the Snickers bar she saw on TV insisting the nurses hid them from her. She cries.

Behind the Woman in the Wind, Lower Antelope Slot Canyon

A single trickle of water running across sandstone begins the erosion that creates these thin and deep, winding and breathtaking underground slot canyon formations. Ania

Pathak, OMS-II MSUCOM

IV.

She’s punching numbers, no pattern, I watch, supervising.

She’s rambling on about her two missing daughters, a voice is responding on the other line, I listen intently. She hangs up the phone absentmindedly. It rings again—

A panicked voice asks to speak to the doctor, explaining that she must call 911 about two lost children.

She sits innocently on her bed, glowing white from the walls, she asks who was on the phone. She says she didn’t call anyone.

V.

I sense the empathy in her voice today— her room brighter than usual, her wan face wrinkling as she forms a coy smile. She clinches my hand and tells me she hopes for a Snickers bar for dinner, tonight.

Walls

of New Life

A bustling street amidst a maternity hospital, a delicate place where many are fortunate to witness the first breath of new life.

Kelsey Sharples, OMS-II, MSUCOM

- Angelina Cerimele, OMS-I MSUCOM

Edifice

Ania Pathak, OMS-II, MSUCOM

Normalcy is Illusionary

Pretending to be normal is exhausting; Is there any point in trying to physically and mentally adhere To a construct that is strictly theoretical?

I gave up on seeking perfection a long time ago As there is more harm than benefit in aspirations of reaching for a limit that does not exist. In class, it can be so difficult to pay attention learning about monovalent cations So I go on virtual tours of Greece, Italy, and Croatia Mentally dancing in the azure water and lolling in the sand. Transfer me to somewhere warm and sunny Where my only responsibility is to avoid sunburn

Even if it’s only for a fleeting minute and based off of satellite pictures from yester-year. Michigan can be such an icy tundra and these four brick walls in which I am trapped for hours On end (strictly by choice!) seem stifling and repressive But I must remind myself, again and again, that this is not “the real world” At least not really.

Basophilic Trevor Evans, OMS-II, MSUCOM

Within these four walls, in this lecture hall, where my seat is too hard and I sit in the back so when I fidget, I don’t distract the others I am safe

There are no angry clients, no fractious cats, no employees ready to quit. My only job is to answer questions To the best of my ability And stay afloat amongst the seemingly never-ending projects and exams. C’s get degrees is what they say And even though we all smile and nod at this old adage, We keep reaching for the 4.0 In hopes that our efforts will match our expectations And the fear of failure is kept at bay. One day, we will all look back on our accomplishments and smile. Why can’t that day be today?

- Kristy Herman, DVM Class of 2021 MSU College of Veterinary Medicine

ANCESTRY

What matters most is more than ghostsit’s how we came to be

- Dr. Steve Williams, M.D., M.P.H.

Ode to Pathoma Trevor Evans, OMS-II, MSUCOM

Honoring the Human Experience

As medical students it is critical we zoom in and understand the science of medicine. It is critical we understand cellular processes, the mechanics of our body, and the chemical and physiological impacts our treatments have on a person.

It is critical we achieve a deep understanding and respect for those things that make us tick and those changes and injuries that can make us sick.

This deep-dive makes it all the more crucial for me to remind myself to zoom out, recognize and honor the human experience. This system can feel like it pulls you away from those very things that inspired you to become a physician. At times it can feel like those things that keep you rooted in serving your community are the things that drain you the most. Yet, what we chose to build our framework and what we choose to build our career from cannot be forgotten as we dig deep and study for the exams we must take.

I just ended a two-week rotation on Palliative Care and I am grateful for the experience. This was the rotation I was the most afraid of experiencing because I was not sure what it would surface for me. John Thompson always reminds me to reflect and to process so that I can move forward and continue working hard. I am writing so that my heart and mind have clarity; I am writing so that I honor my own journey and my intimate relationship with illness, death and dying.

Over the span of my shifts, I witnessed nurses and physicians care for their patients while gently affirming the needs and contributions of the caregivers. I watched as the spouse of a dying man grappled the reality of his prognosis and the limitations to what she could do for him. I watched as he (the patient) assured her that she had done enough for him and that his decision to go to a hospice facility would give them the opportunity to spend much needed quality time.

It makes me think of the daily absence my father must feel and the life that has to be rebuilt for anyone that has lost a loved one.

I drank coffee with a different patient and his wife while they reported the events over the weekend to the nurse overseeing his care. I was reminded about the daily updates Barhaza Franco would give me about my mother and my constant need to know the play-by-play when I was not able to visit her. Its a reminder that I was raised by fierce brown women. Its a reminder of the strength and patience we as a family tried to maintain as each of us had our waves of burnout.

In our weekly group debriefing, we talked through the many ways pain is felt and experienced as well as the different methods of managing them. We learned about the differences between palliative versus hospice care and the sensitivity needed to talk through these options as a person becomes terminally ill.

There is so much trust that is given to physicians; there is so much trust that needs to be earned. We have to recognize that we see people in their most vulnerable states.

We will deliver devastating news more than once and there will be moments where we will have to walk patients and their families through unbearable life-changing decisions. The best advice I can give myself is to treat each person and family with the same respect, patience and attention that I gave my mother.

Power and love to any person that has witnessed the death of a loved one

Power and love to any person that was not able to say goodbye

Power and love to any person that has had to make a life ending decision for a loved one

Power and love to any person that has been a caregiver

Power and love to anyone that walks around each day missing a loved one they have lost

Power and love to any person that has held space for a grieving friend or family member

Power and love for anyone that has felt guilty for feeling burned out

Power and love to the illness narratives that have never been heard

#queeringmedicine #powerandlove #honoryourjourney #medstudentsofcolor

- Mauricio “Jimmy” Franco, MS-II, MSU College of Human Medicine

8pm

Ania Pathak, OMS-II, MSUCOM

Into the Hinterlands

Ryan Skowronek, OMS-II MSUCOM

WORTH SAVING

The cloud-free sky is blue, the still air cold. Fourteen degrees Fahrenheit cold, at this moment. Out back, where the scrubby yellow grass is still recuperating from its knockdown by the ice storm two days ago, I am surprised to see a large piece of white canvas, flattened out. It appears to be a little under the weather itself.

The tattered willows that line its southern edge have absolutely no use for it. And neither do I right now, since the canvas seems so strangely out of place. But this becomes another state of matter soon.

All it will take is a steady southern breeze to melt the snow and ice that winter leaves behind. Miraculously, the canvas then becomes a mirror, a lens, a living thing responsive to the wind and helpful to its neighbors. The willows judge their look in green.

Clouds check different shapes as they float overhead. Even sandhills sneak a peek, when they rattle by. On the edges, fat beetles prowl the shallows, bold red wings cling to rushes, and lean water striders glide across the top.

Beneath the surface, weaving through filaments, bass and bluegill seek a meal where resilient pond grass grows.

Appreciating its fine reflections of good neighbors and the marvelous new window it also provides, who would have thought that a nearly discarded frozen tarp could prove to be so useful? Good thing we kept it after all.

- Dr. Steve Williams, M.D., M.P.H.

Sea Foam Lamina

Trevor Evans, OMS-II MSUCOM

On

Each individual begins at a different ‘baseline’ of interpersonal emotional intelligence, as with any other inborn character trait, but we are presented opportunities throughout our lives to glean and integrate what we have learned from challenges. The direct route of empathy maturation is listening to individuals share their insecurities and hardships, but what we more commonly experience is, in essence, the indirect route, which pertains to intuition and inference based on the behaviors, actions, and reactions of others. This is recognizing the subtle changes in facial expression or body language, such as one who has been irrevocably hurt by some flippant remark and instead feigns laughter to project an unperturbed air.

The indirect route relies more heavily on Theory of Mind processes, mentalization, intentional stance, etc.,which may take place in areas of the brain required for language interpretation and the inference of meaning1. The cognitive development of language has given rise to modern capabilities of abstract thinking, foresight, symbolic culture (e.g., art, ornamentation), and empathy. Language and complex speech have persisted in part due to their ability to evoke empathy and thereby strengthen bonds between individuals and groups. Yet, besides the direct and indirect routes, there is the route of the aesthetically induced, a particularly subjective experience.

The default mode network (DMN) is comprised of interacting brain regions associated with inward contemplation and self-assessment. When viewing an image an observer deems aesthetically moving, the tonic inhibition is removed from the DMN2. Studies indicate the intertwined nature of empathy and art, and its possible role in the undoubtedly broader physiology of the former: that

which we find emotionally moving, regardless of the emotion elicited, can induce the introspection, perspective-shifting, and inference of meaning necessary for the maturation of empathy. And it is through self-reflection—the appraisal of our own morality, of transgressions against us and ours against others, of our values and beliefs, of our past experiences and behaviors—that we can better understand others.

Plato’s Allegory of the Cave advocates for the active scrutiny of information and of meaning inference, rather than a passive intake and acceptance of either. Whatever meaning you synthesize is far more enduring than anything another person could tell you. My convoluted study mnemonics are more memorable than someone else’s straightforward memory aids because mine have been infused with personal semantic context and the significance of actively participating in their creation and encoding. Similarly, that which allows you to draw your own conclusions affords this same result (e.g., abstract painting; c.f., Marcel Duchamp’s personal art coefficient). Critical thinking is compulsory when an answer is not provided. And dramatization can serve as a conduit to the unconscious, for arrangement of disparate images and nuanced symbols into a meaningful product. It allows us to feel the significance, rather than being told cause and effect. It’s the difference between being told that the color violet corresponds to the wavelength range of 380-450 nanometers and actually seeing the color yourself. In The Recognitions, William Gaddis wrote, “Everybody has that feeling when they look at a work of art and it’s right, that sudden familiarity, a sort of… recognition, as though they were creating it themselves, as though it were being created through them while they look at it or lis-

1 Ferstl EC, Neumann J, Bogler C, von Cramon DY. The Extended Language Network: A Meta-Analysis of Neuroimaging Studies on Text Comprehension. Human Brain Mapp. 2008; 29(5): 581-593.

2 Vessel EA, Starr GG, Rubin N. The brain on art: intense aesthetic experience activates the default mode network. Front Hum Neurosci. 2012; 6(66): 1-17.

Art & Empathy

Man is an animal suspended in webs of significance he himself has spun.

Clifford Geertz

ten to it…” This is why filmmakers Stanley Kubrick and David Lynch avoid elucidating symbols in interviews. And it is why when asked to explain the meaning of his piece of music, composer Robert Schumann sat down at the piano and played the piece again. A lack of resolution keeps us ruminating on the unfulfilled, consciously reentrant or not. And our eventual synthesis of meaning can result in a “Eureka!” moment. In Carl Jung’s Man and His Symbols, he writes,

“There are certain events of which we have not consciously taken note; they have remained, so to speak, below the threshold of consciousness. They have happened, but they have been absorbed subliminally, without our conscious knowledge. We can become aware of such happenings only in a moment of intuition or by a process of profoundthoughtthatleadstoalaterrealizationthattheymusthavehappened;and though we may have originally ignored their emotional and vital importance, it later wells up from the unconscious as a sort of afterthought.”

Interpreting aesthetically moving art and stories featuring minimal exposition can stimulate DMN neurons so that we look within ourselves for meaning.

The aforementioned routes of empathy maturation come together in literature, film, music, and artwork, which afford us valuable supplemental opportunities to understand the world in ways we would not have had the chance to otherwise. They externalize one individual’s wisdom and biases and anxiety and regret and love and fear and hope and doubt and desire, allowing for the transmission of these lessons, emotions, and perspectives. There is ubiquity in one’s unique experiences. In art, there is a striving towards some elusive underlying truth, towards something undeniably ‘real’ (which you might imagine the quintessential starving artist belaboring), for in the development of empathy did incubate the capacity for both deception and self-deception. The world is complex.

Misunderstandings will inevitably make mountains out of molehills. People construct false outward selves for fear of rejection of their true selves, of their vulnerabilities and insecurities, becoming mere reflexes of what we perceive others want us to be. The true intentions and agendas of strangers and even friends and family may be beyond reckoning. When we extricate ourselves from the world while examining art or in periods of solitude, we rediscover our own true feelings, beliefs, and needs. Perhaps this is why we find beauty in that which is immutably real and true to its nature, for example: in verdigris and the ruins of civilizations, in autumn, in one’s sloughing of pretense in exchange for admissions of self-consciousness and faults and failures, in hushed confessions of petty automatic thoughts driven beyond the pale—these ossuaries of pride and hopes and creation now serving memento mori.

In his Philosophy of Composition, Edgar Allan Poe wrote, “Beauty of whatever kind in its supreme development invariably excites the sensitive soul to tears. Melancholy is thus the most legitimate of all the poetical tones.” Likewise, sorrowful films may feel more ‘real’ than others, more aesthetically moving. In most films, you never see someone struggling to find how to articulate themselves; yet, that very inability to satisfactorily express your emotions communicates such a powerfully human message in and of itself: an alexithymic phenomenon born not of some incomprehension of emotions, but rather from experiencing those emotions too intensely to quantify. For sometimes what is not or cannot be said is far more meaningful than what is. Sorrow seems intrinsically linked to earnestness, for only that which is perceived as sincere can be emotionally registered. And there has been a gradual shift towards an amalgamation of sincerity and cleverness, whereas the latter had often been employed to circumnavigate the former, with poignant examples including David Foster Wallace’s Infinite Jest and Charlie Kaufman’s Synecdoche, New York. And we can reform our own morality in observing the actions of nuanced, morally ambiguous characters, such as those in

David Milch’s Deadwood and the latter seasons of Damon Lindelof’s The Leftovers.

One may find tranquility in music, another in reading. One may be moved by Caravaggio’s The Calling of Saint Matthew as a whole, another the chiaroscuro and symbolism, and another still the delicate brushstrokes that comprise it. And upon the viewing of subjective aesthetically moving stimuli, regions of the brain that are concomitant-

ly involved in empathy formation are activated, thereby triggering self-reflection. So whatever artistic medium you choose, therein lies the potential to inspire a more empathetic version of yourself into being—a moment of solitude for a deeper connection with humanity.

- Ryan Skowronek, OMS-II MSUCOM

Swans

Each spring migrating waterfowl return to nest at the lake. These mute swans will remain until the end of the season to raise their family of cygnets.

Laryssa Kaufman, M.D.

Walking In A Snowstorm

Earth was hidden a blanket of snow a white canvas untouched and waiting cast dewy golden by the eastward rising sun

I hardly noticed those first few miles fascinated by the birds and the wind

The beautiful mountain I stood at its base in awe, in privilege

The slope picked up but I knew it would I knew what to do

Step, step, step, step One foot then the other is all it takes to climb a mountain

That’s what she said The mountaineer I look sharply; up the mountain It’s intimidating from here but she’s sitting at the peak beckoning me to join her

Step, step, step, step I hear no more birds The snow weighs down heavy on these frozen feet

Step, step The wind blew cold burning glass against my face Perhaps, I should lie down

Perhaps it would blow over The clouds beyond looked ominous No, if I lie down I won’t get up

Step, step, step, step, step, step Crystals formed about my ruby nose and blackened lips my once hot breath turned suffocating me

Step, step, step Come on Come on The mountaineer called down

Step, step Perhaps I should just lie down No

Step Perhaps I should just lie down

p

Perhaps I should just lie down.

- Anonymous, A Second Year Medical Student 6 months before the Step One Exam

Untitled

Lynn Shaw, R.N.

Physician

To be the keepers of human physicality And its organic process Of rise and fall, live and decay

Chemical cascading Electric narrative Physics and her Natural laws of gravitation Forces, movement, balance Circuits, magnetism, ions Gait and thought

The universe folded in on herself, into awareness, an organic and experiencing sentience. And experiencing herself, human Nestled with and in a sea of her own kind As her keepers

Whorled into meaning

Whorled into personhood Whorled into a life sustaining And life taking, self-perpetuating Milieu

Of life in time and space.

- Ania Pathak, OMS-II MSUCOM

Violet Trabeculae

Trevor Evans, OMS-II, MSUCOM

Polymorphic 1

Trevor Evans, OMS-II MSUCOM

Polymorphic 1I

Trevor Evans, OMS-II MSUCOM

Copyright © 2019 Student Osteopathic Medical Association

Works produced in this issue of Tensegrity are used with the permission of the original authors/creators. The original authors/creators retain all rights to their respective works.

This publication would not have been possible without the time and efforts of individuals committed to the representation and inclusion of the humnaities in medicine. A special thank you to:

Dr. J. Heselschwerdt, M.D.

Dr. E. Rosick, D.O.

Dr. J. Taylor, Psy.D.

Dr. K. Ruger, Ed.D.

Dr. R. Sina, D.O., PhD

Dr. M. Schlinger, D.O.

Mrs. Beth Courey, Director of Student Org. and Special Programs

Ms. Alissa Berry, Administrative Assistant, Wellness & Counseling

Julie Taylor, Publishing Services Coordinator, MSU Libraries

Cover Art by: Salina Halliday, OMS-II, MSU College of Osteopathic Medicine

Are you a student or faculty member of the MSU Health Professional Colleges (COM, CVM, CHM, CON) and are interested in submiting your writing and/or visual art to be considered for the next edition of Tensegrity?

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