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

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.

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- 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,

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.

“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

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.