Tensegrity Vol 2: Balance in the era of covid-19

Michigan State University College of Osteopathic Medicine Students Present 2021

Michigan State University College of Human Medicine College of Nursing

College of Osteopathic Medicine College of Veterinary Medicine

Vol. 2: Balance In The Era Of Covid-19

TENSEGRITY

Literary and Arts Magazine

Michigan State University Health Professional Colleges

“Breathing life into the science of medicine.”

Be present. Take a moment to quiet your mind and bring your surroundings to a silence. Focus on the body’s center: the heart. Release overflowing emotions, fears, memories, stress. Embrace the emptiness, a heart that is ready to heal, feel love, and be at peace.

Cover art

Lauren Bonilla, OMS-II, MSUCOM, ‘Open Your Heart’ (ballpoint black pen, watercolor)

Copyright @ 2021 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.

Tensegrity

A Literary and Arts Magazine by and for the Michigan State University Health Professional Colleges: College of Human Medicine

College of Nursing

College of Osteopathic Medicine

College of Veterinary Medicine

Editor-In-Chief

Melissa Anderson-Chavarria, G3, DO-PhD program, MSUCOM

Faculty Advisor

Dr. Jessica Heselschwerdt, M.D.

Editorial & Design Team

Maya Braden, OMS-II, MSUCOM

Dimitri Joseph, G1, DO-PhD program, MSUCOM

Naveen Kakaraparthi, OMS-III, MSUCOM

Serena Soleimani, OMS-II, MSUCOM

Jordan Walker, OMS-III, MSUCOM

Cindy Zhang, OMS-III, MSUCOM

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"Obsession,

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"Curious

"Learning

We, the editorial board, are honored to bring this second volume of Tensegrity Literary and Arts Magazine to life. Tensegrity is a principle in osteopathic medicine that refers to the synergistic tension among the internal components within the human body that lends integrity to its structure. These components may be interpreted as both anatomical (tension within the musculoskeletal system) and as mutual tensions and connections between the mind, body, and spirit. Inherent within the concept of tensegrity is the necessity of balancing these tensions to create the optimal meeting of forces. And so, in acknowledgment of this, the editors have selected ‘balance’ as the theme of this volume. We strove to provide a way for members of the MSU health professional colleges community to use creative writing, photography, and visual art to express how they juggle the rigors of service in the health professions and their personal responsibilities, hobbies, and passions outside of their work.

Not long after issuing the first call for submissions for this volume, the COVID-19 pandemic began, and life took a radical turn. In response to this, the editorial board adapted the theme of this journal to reflect the times—Balance in the Era of COVID-19. The creative pieces you are about to enjoy were produced at different time points throughout this dramatic period, and revealed shifting perspectives that might be all too familiar and relatable. Moreover, we discovered that sometimes, not every piece was fully complete, fully realized, and yet…that felt appropriate. What each person has experienced in this last one and a half years cannot be fully encapsulated into words or art. Like the masks that we now don everywhere, obscuring much of the face behind it – some things will be hidden, ineffable. And that is okay.

It is our hope that Tensegrity: Volume 2 will offer a snapshot into how members of our MSU health professional colleges community have sought balance during this tumultuous and historic time. These creative pieces convey the highs, the lows, and everything in between within the era of COVID-19. There is both joy and sorrow reflected in these pages, capturing the wild and at-times overwhelming twists and turns of the lives of health professionals in a time of global health crisis. It has been a privilege to provide a creative outlet and platform for our community during this time. We thank these writers, photographers, and artists as we present to you, Tensegrity Volume 2: Balance in the Era of COVID-19.

- The Editors

“I don’t know, Dr. H. I just have so many worries about it.”

Marie, age 62, was meant to be seeing me about knee pain. After a quick exam, some reassurance, and a PT prescription, I should have been on to the next patient on my busy Friday schedule. But I asked Marie if she’d gotten the COVID vaccine yet, and she had some questions for me. What if it causes cancer? I heard it wasn’t tested for very long. Will it give me COVID? What if it’s worse than COVID? My husband says I should get it, but I don’t know. I’m scared. What do you think?

40 minutes into her 15 minute appointment, Marie still wasn’t so sure. As she walked toward check-out: “I just don’t think it’s for me. But thank you for taking the time to talk about it.” I left that appointment feeling unmoored and off-balance- not simply because I was now running behind schedule, but moreso because the weight of this pandemic seemed crushing, and I felt helpless to change it. Life, both in the clinic and in the classroom, looks very different now than it did before words like “coronavirus” and “social distancing” entered our national vocabulary over a year ago. I now view my patients from behind foggy goggles, or through a computer screen. I leave clinic with deep indentations on the bridge of my nose. I teach via Zoom, doctor via Zoom, attend book club via Zoom, celebrate birthdays via Zoom. I feel deeply afraid when I see a maskless face in public. I feel deeply angry when I see people spread false vaccine information. I have witnessed more tragedy this year than I ever have before.

But I have also witnessed resilience. I have seen patients who have sewn masks for their entire neighborhood. I have seen students who had their medical school experience turned upside down, yet persisted in tireless pursuit of their education. I’ve seen patients proudly waving their vaccine cards. I’ve seen students channel their energy into helping others, volunteering virtually even when they couldn’t in person. And I’ve also seen them create art.

You’ll find some of that art here, in Tensegrity’s second edition. I’m enormously proud of the efforts our students have made over these long, difficult months to collect these pieces. And I’m thankful for the students, faculty, and staff of our allied health colleges who have chosen to share their work so that we may share it with you. You may find some of your own emotions reflected here in these pages- isolation, frustration, despair-- but also, hope.

Today, things are still far from normal, but there is some hope on the horizon as vaccination rates rise. I am confident that whatever comes next, our students and our patients will continue to adapt and find their balance as we enter each new phase of this changed world. The Monday after Marie’s appointment, I logged onto the electronic health record. Among the messages that had come in over the weekend was one from Marie: “I just wanted to let you know I got my vaccine on Saturday!”

And just like that, my own sense of balance was, if just for a moment, restored.

- Dr. Jessica Heselschwerdt, MD

Polarized

-medium: mixed media collage

The world we once knew has rapidly transformed through COVID and this can send the mind into a spiral. This collage highlights how the mind polarizes things but when remembering the raw nature of being human —we are body, mind and spirit —the mind can loosen it’s grip.

- Alexa Magsoudi, OMS-II, MSUCOM

Be Still

Balance is a concept we frequently recommend to patients but, often, struggle with inside our own lives. Just as the tenets of osteopathy call us to, I strive to balance my body, mind, and spirit. This way, no matter which season of life I am in, I always have my priorities straight, a sense of fulfillment, and a strong foundation to stand on.

- Medium: acrylic Izabela Birsanescu, OMS-II, MSUCOM

Seven years ago I took a hot yoga class in a packed studio. A R&B playlist bumped loudly overhead, as the woman next to me sporadically sang along with the music. Afterwards she smiled at me and said, “It was nice to practice with you!” I was new to yoga so this was the first time I considered yoga to be a practice, a word signifying a skill performed repeatedly in order to improve proficiency. I reflected on those words; “A practice, by nature, is an acknowledgement that we are not perfect – but we are working on it.”

Many perceive yoga as a practice of flexibility – but in fact, it is a practice of balance. The practice of balancing sthira and sukha, Sanskrit words loosely translating to strength and softness, effort and ease. The practice of balancing breath, matching each intentional inhale with each measured exhale. The practice of balancing our bodies, physically balancing on one foot or both hands, and mentally balancing our resistance with acceptance. As a recently graduated fourth year medical student and brand new resident physician, I delight in the way both yoga and medicine are considered a practice, an acknowledgement of imperfection. I practiced and taught yoga throughout medical school and found the physical and mental aspects of yoga to be a steady force that helped me maintain balance over the past four years. And now, facing the start of my career as a physician, I cannot imagine one practice without the other.

The first year of medical school reminds me of child’s pose, a common way to begin a yoga class. Newlyminted medical students are fresh and eager sponges ready to absorb information. As we start small and settle into our practice, we accumulate knowledge but are unable to do anything with it yet. Sometimes we wonder if we are doing enough, moving enough, learning enough. We try to be patient, settling into steady breath, allowing this early part of our journey to set the tone for the years to come.

Second year is like sun salutations. We start to work our way through routine movement, create physical and mental heat, and work our way through familiar patterns. We become eager and excited to progress in our practice as we cultivate muscle memory. We begin to move with tempo, inhaling and expanding, exhaling and contracting. As we grow more comfortable with our role, we gain knowledge and confidence. The practice starts to feel good.

Our third year resembles the practice of including a peak pose, where one sequences a class to prepare for a specific difficult posture. Movements become intentional, similar to how professionally we orient our energy toward determining a future specialty. We rotate through clerkships, shifting through various poses, searching for that ideal balance of effort and ease – of strength and softness. We learn to sit with discomfort, to continue to breathe through the parts that don’t fit right. We hope we have learned enough, seen enough, prepared enough that when we finally reach the peak pose, we will be ready.

Finally, fourth year brings us to corpse pose, savasana, our practice of stillness – the time to soak in all of the physical and mental work we have done as we prepare to start anew. Often the most challenging part of practice is that it necessitates full relaxation and quiet – and we as humans are quite skilled at finding distractions to prevent us from being fully present with ourselves. When we finally allow ourselves the chance to rest, we close our eyes and see how far we have come.

Sometimes, however, the distraction is too big to ignore. This year, savasana was thrown off course by coronavirus, and my graduating classmates and I will begin as interns in the midst of COVID-19. Instead of festive graduation celebrations and traveling abroad, we are participating in virtual ceremonies and baking banana bread at home. We proudly watch healthcare providers put their own lives at risk each day, knowing that we will soon follow in their footsteps. We endure the inevitable instability that accompanies uncertainty, and bravely remember that we chose a life of service.

I lean on my yoga practice, both physical and mental, to keep me grounded and balanced as my colleagues and I dive headfirst into a global pandemic.

Yoga teaches me the importance of being fully present. Whether it is moving on my yoga mat or giving a patient my undivided attention, yoga is where I learned to cultivate the breath to both keep me steady in a challenging posture and to keep me focused under a sterile gown in a hot operating room. Yoga emphasizes observation without judgment-- to notice my own body’s flexibility and to learn about a new patient. Through instability, doubt, insecurity, and fear, I return to my practice to find balance. In yoga and medicine: I am an expert in neither, but I am practicing both.

- Caitlin McCarthy, MD, MSUCHM Class of 2020

Haiku about my cat, ru

Bewildered Ms. RU

As innocent as she looks The pieces will fall.

- Dr. Katherine Ruger, Ed.D. Associate Dean of Admissions & Student Life, MSUCOM

A Different Perspective: My Valentine’s Gift

I wrote a poem just for you, Even though I knew you knew. That my love grows bolder each day, Whether we’re together or far away.

As we wait for our little gift, We prepare, we move, we thrift. I’ll never forget the scary ER trip; That one-sided pain made me lose my grip. I cried and cried and prayed the whole way. After 4 hours, the providers saved the day. I saw our baby as I held my breath; That little heart beating dissolved what worry was left. Then we resumed our daily routine, Mainly indoors due to quarantine.

I watch you and my brother, George, laughing aloud, Creating memories of you horse-playing about. Not upset over the ruined pillows and broken dishes, Your friendly bond answered many of my wishes.

I am grateful he has a brother at last, The 6 foot 14-year-old who grew up too fast. Just yesterday I carried him in my arms, Won over by giggles and toddler charms. Who I once ran with on my shoulders, Now I’m the boss giving him orders. How to adult, and cook, and scrub a pan, Watching George grow into a fine man. With different routines we go about our day, Ready to help each other along the way. Enjoying the sleep we’ll surely miss, Madly in love after Baby’s first kiss. For now there’s so much to be done, By grace, complaining there is none. No rest for the weary, but that’s fine, Every effort will be worth it in time. The crib still needs setting up, Still board studying, I can’t give up.

I get tired and overwhelmed; You come over and as I am held, I am reminded God brought us together. We can withstand the trials and weather. A tale of love as old as time.

Another year I ask, will you be my Valentine?

This poem shows an individual student’s perspective. It is superficial and lighthearted without many of the deeper concerns that you are about to read. I believe it is important to share our stories in order to help others and to normalize challenges faced by different student populations. Anybody can face a unique situation: minority, majority, traditional, or non-traditional students. It is a humanizing experience for us when we attempt to relate and learn from one another.

Student parents and student guardians are a minority group that is underrepresented, especially in literature. Pregnancy in school is often regarded as something to avoid at all costs as the ultimate undesirable event. For me, choosing to have a child was an empowering and much awaited decision. However, that’s not my whole story. Yes. My pregnancy is celebrated and significant. However, it remains a rather minor part of my story as a medical student. Baby or not, my other priorities are still there. I am an osteopathic student trying to keep up with my OMM skills; I am board studying; I have just joined a research study; and I am highly involved with my family. My husband and I shoulder our school responsibilities while managing our own health issues, the illnesses of our aging parents, and while raising my teenage brother. Can’t quite imagine being in my shoes? A few years ago, neither could I. I am writing this story to encourage others facing complex or unique situations. We have a voice. We are capable and we are resilient. We are able to accomplish extraordinary things; not due to having some special ability, but because we find ourselves in the position where it is our only option.

This is my real-life experience of planning to get pregnant as a married medical student while caring for a minor. Pregnancy had been on my mind since I got married over 5 years ago. I spoke with others in the field who are at varied stages of their training and read numerous blogs on the topic. The advice I received surprised me. Many parent physicians admitted that while medical school isn’t easy, it can be the least complicated and most flexible time to have a baby. After considering all the advice and praying about our decision and circumstance, we decided to start trying. After a year, we succeeded in getting pregnant. We still had many unanswered questions. How do we raise a child and go to class? Would I have to put medical school on hold? With finances stretched thin as it is, would we have to take out $20-30K in loans to hire a full-time nanny? Ultimately, the answers would come with time and research. For the moment, we were overjoyed and thankful. We decided to tackle each issue with preparation and remembering that we were not alone. Since we both face very rigorous academic obligations, we realized that we would need to build a village of support. I met with SPOM (the student parent organization on campus), academic advising, and spoke with family about our situation. Finally, our new issues started to feel more manageable. The more tools, scholarships, and resources we add now to our support group, the better prepared we will be when the time comes.

Ultimately, my daily focus is still that of any other student. Like my classmates, I study and do my best to clean, cook, and stay active. We are all facing a pandemic, caring for our mental health, and striving to drink from the knowledge firehose. Recalling my first day of medical school, I realize our different backgrounds are one more attribute that can help us in our shared vision. Each unique perspective can strengthen the healthcare team by allowing us to connect with patients facing their own unique challenges and realities.

- Izabela Birsanescu, OMS-II, MSUCOM

Balance from Within, Unity

-medium: acrylic paint

Returning to balance is not a finite state because life’s dualities keep emerging and when welcoming all dimensions of each experience or state, we remember the wholeness within that is untouched by these changes. COVID-19 has exemplified the nature of balance, as the outside world is full of chaos and it feels like we have to choose 'a side' and yet it’s all co-existing, which this piece depicts with the yin and yang united by an infinity symbol.

- Alexa Magsoudi, OMS-II, MSUCOM

- Medium: Digital Art

An altogether common experience in both medical school and life mid-pandemic. Feeling disconnected and lost, as if you’re losing any semblance of who you once were. You fall, and you think you’ve reached the bottom, but then you fall some more.

- Vera Nattler, MS-II, MSUCHM

One of us had to do it. It was my turn to accept the assignment – cover the nursery, as we say in pediatrics, and take call from anxious parents whose nice children had caught some naughty diseases at the wrong time. It would mean that the dogs and I would be alone and the party would be elsewhere. There was no way to drive from there to the hospital and back in time, and the calls – at all hours of the night – would be a gift of interrupted sleep that no one wished for.

It could have been worse. Usually there’s snow in this season of year and sometimes ice that makes driving very dicey, but it was in the forties almost every day. So, a car with sturdy tires replaced my riding in a sleigh. At first the call was brutal – the phone kept ringing, concerns stacked up upon my desk, and, somehow, a trip to the nursery still had to be worked in. For sure, there were a few moments of doubt. But calls slacked off, and I made it safely to the hospital, where every room of newborn joy filled ready hearts before I turned to travel home.

As the conversations with parents continued through the day, something else occurred. A mutual sense of gratitude emerged, because I was there to help them and the lines between us blurred. A kindred spirit joined each chat as they and I conferred. The questions in the nursery and the answers I supplied had relieved the sense of doubt, and my advice for parents in their homes helped spread a welcome calm. I gave them confidence. They gave me meaning. Face to face and on the phone, we were no more alone.

This Christmas had its sadness, the first one by myself, but, my children called and the grandchildren even thanked me for my cards and gifts! Added to the care I offered there was a fine balance to the day. And, I saw firsthand what matters most - the heartfelt gift that eases pain, and points to joy, unwraps a blessing for the host.

- Hiram Stephen Williams, M.D., M.P.H. Professor of Pediatrics Emeritus, MSUCOM

Fresh Eggs

- Ania Pathak, G3 DO-PhD Program, MSUCOM

There’s this word in the medical field that’s said often: balance. The balance between work life and home life. Things you love and things you want. Time for friends and time for yourself. These were all topics of discussion I had with fellow medical students as well as other healthcare practitioners, and there was always an invisible scale in the midst of these discussions. Making enough money at work for my family on one side of the scale, and spending quality time with my family on the other. A career that pays well enough to chip away at my student loans, and a career that I truly enjoy. The invisible scale of balance that stuck out the most to me though revolved around patient care.

As future doctors, we’re taught to do more than what is asked for the patient. To advocate. To fight. To do what’s right. What’s taught far less are the counterposing rules, restrictions, and downsides. We want to educate patients regarding the nuances of all of their conditions to provide the most individualized care; emphasize to patients the necessity of follow-up appointments; explore every necessary lab, screening, or imaging modality to provide the most accurate diagnosis and health status even if cost-prohibitive; convince insurance to cover expensive but efficacious treatment options; and engage in outreach to better improve the health of the community at large. Yet, all of these goals take time. It could mean seeing one less patient that receives treatment, one less patient for whom the hospital (and you) could bill, one additional hour at work meaning one less hour spent with loved ones, or one less hour of free time or sleep. All of this accumulates over time. And time is truly money.

How do we balance the scale? How do you balance the scale for the patients you see? For the hospital you work in?

How do you balance the scale for your own life? These are the questions that I ask myself, the questions that I’m sure all of my friends and colleagues ask themselves. I hope that we will all find that answer, that balance.

OPTIMISM

Upon departing, a leaf unseals the promise of the twig

- Hiram Stephen Williams, M.D., M.P.H. Professor of Pediatrics Emeritus, MSUCOM

- Megan Carrillo, OMS-IV, MSUCOM

A Healer Stands

centuries later, a novel pandemic strikes. All is different except the sacrifice of our providers as they rise to the challenge of battling the disease at hand. The unamed healer stands day and night in the hospital, street, and nursing home, ready to face the unknown to provide aid and to comfort. When one healer leaves for the day, another takes their place; thus, alwaysa healer stands.

- Izabela Birsanescu, OMS-II, MSUCOM

An Isolated Consciousness of Hopelessness

Thoughts swirl in mind on spinning stool, Sitting still here is hard to do.

In a world full of phones of intelligence, With a remarkably virtual presence, There’s no shortage of things to think about here, But also, not a whole lot for me to do. Social media notifications, emails galore, Bing, ding, a ring, and a ring, lighting up a phone they sing.

There’s an inundation of instant gratification, But an emptiness remains, what is going on in my brain?

Loneliness may be soothed with a song or a verse, A depressed kind of feeling with a memory of mirth. Friends are not just on Facebook but in a real world around you,

Struggles hidden behind posts when help is needed the most.

Pictures posted, likes and loves, scrolling and scrolling, This life still goes on whether you’re moving or not . There were places to go, and so much to be done, BUT suddenly, a virus puts a stop to things… Things were remote, but now somehow, they’re remoter.

Things were virtually remarkable, And now, they’re remarkably virtual. Zoom here, Zoom there, You can Zoom most anywhere.

But you’re still in your pajamas, And your hair looks bananas.

That’s okay, I’m muted and unseen. Attending a meeting here, a friend get-together there, All from one seat, all from one station, Without even using my imagination. When virtual presences and meetings are over. I sit again with my thoughts and mull them over. Thoughts come like bubbles, They inflate, then they float, And if not caught for a single instant, They might just pop and sprinkle some soap. Sometimes they race, sometimes they’re slow, But they’re always coming, always going. Finding home within the brain, They spring into ideas. A lightbulb flashes, then crashes; New ideas are born from its ashes. Shifting and drifting, constantly sifting, Ideas emerge, as do solutions. They are sown in trial and grow in challenges unseen, Through a whole lot of trouble grows one magic bean. A magic bean grows high into the clouds, Climbing through the atmosphere, high above. It rises above the pandemic pandemonium, It rises above our collective isolations and fears.

It might be encapsulated in a prayer, then a plan; But whatever it is, great ideas emerge from times such as this,

And the future we hope for is one not to be missed.

- Samuel Schotten, OMS-IV, MSUCOM

I will not let medicine destroy my life.

I feel guilty for even saying it. I have dreamed and prayed about going to medical school and becoming a doctor for my entire life but now that I am here, I have an evolving perspective on things.

There are many things that make a fulfilling life - friends, family, traveling, and experiencing new things. This does not mean a life without the stressors of scholarly activities. In fact, a fulfilling life includes writing about your passions, networking at conferences, and volunteering in the community. Writing encourages reflection, networking creates a community of like-minded friends with similar passions and goals, and community service give you purpose and allows you to meet new people. These activities coupled with support from family and friends give me purpose. This is a life worth living for.

Striking the delicate balance of life and medicine is the key to having the best life in medicine possible. The rigors of medical school can impede your ability to lead your life the way you want to. It’s easier to let medicine control you than it is for you to find a way to take control. Having long hospital time commitments, studying the days and nights away, and living in a constant state of stress and worry can dominate your life. The lack of sleep you get becomes intimidating at times because it is not just a one day problem, it is a chronic problem that will follow you the rest of your medical career. You need to set healthy, realistic boundaries with yourself. You can love both parts of your life but feel discouraged at times. You are allowed to feel this way.

Developing balance has never meant more to me than it does right now. I value all parts of my life: my blooming medical career, my other personal life, and my scholarly endeavors. I have never strived harder for balance in my life than at this moment. The transition from classroom to bedside has been an incredible experience but also very wearing and worrisome. I have a reinterpreted concept of balance that is ever-evolving from this transition period.

The challenges of transitioning from books to bedside actually competes with the unbelievable dilemmas that are faced with the coronavirus pandemic. I didn’t think COVID-19 changes could really compete with anything, but this does. It is challenging to learn to flow with and love the punches life throws us but it is in our journey of success and failure that allows us to become the best version of ourselves possible. I have always believed “It is the journey, not the destination that makes a story great” and nothing has reigned more true at this moment. If you spend your 4 years of medical school and many additional years of residency focused entirely on medicine and become neglectful of everything else, you have created a serious problem for yourself. You have created an unfulfilling life.

I will not let medicine put a pause on all the things that make up a great life. I’m taking control.

I am creating balance.

- Brittany Ladson, OMS-III, MSUCOM

Covid-19 Reflection

You want to look away from the television screen, but you feel as though you can’t. Treading the fine line, it’s about maintaining the balance between staying informed and staying hopeful how do you do it?

- Megan Carrillo OMS-IV, MSUCOM

Obsession, Depression, Appearance, and Balance

For many medical students, the COVID-19 pandemic has brought nothing but disorder, heartbreak, anxiety, and an overall feeling of uneasiness since its arrival in the Spring of 2020. Medical school is challenging enough, with its high levels of expectation from faculty to exams nearly every week. Stress essentially surrounds the medical student during his or her four years of training. To survive medical school, it takes dedication, persistence, hard work, but – most importantly – it takes balance. With the addition of the impact of the COVID-19 pandemic on medical education, finding this balance in medical school is an undeniably daunting task. While I still have a way to go, my time spent at MSUCOM has been the nidus for me to change how I perceive myself, my career, and the world around me. In other words, medical school is helping me find balance, and the COVID-19 pandemic has provided me the time to reflect on how it has so.

Before beginning medical school, I had lost all balance in my life. Ever since I could remember, I wanted to be a professional athlete and play in the National Football League (NFL). When I was about thirteen, I started training every summer (and eventually winter and spring too) with professional football players themselves. As I started training with them – shedding sweat, tears, and blood – I realized very quickly that getting to the NFL was going to take an insane amount of hard work and perseverance.

What is harsh about the NFL, unfortunately, is that there are certain physical markers that an athlete must meet just to earn a chance at getting a workout with one of the thirty-two teams. I was big and strong…but never big enough, or strong enough, or fast enough to have gained that shot. Like so many other aspiring athletes, I didn't have the physical attributes needed to play on Sunday. It simply was not meant to be, no matter how hard I tried. This drive I had to prove myself otherwise had pushed me to a mental, physical, and emotional breaking point over time, losing my sense of balance. Instead of having joy in my center, my heart – hate, anger, and disgust began to take over.

Even though I was a heavier kid when I was younger, I was never 'morbidly obese' …just stocky, like a tree trunk. While this really helped me as an interior defensive lineman in high school and college, my drive to change my body – to make it 'NFL material'– made me feel disgusted with the way I looked. When I should have been accepting of my body for what it was, I overanalyzed every component of my physical self (thinking, would a high school…a college…a NFL coach be impressed by my physical condition?) This rage I felt inside towards my physical appearance slowly grew; I became obsessed with it.

Personally, I believe obsession can be a powerful tool in any one person’s pursuit towards self-achievement. Being able to refocus on a thought or ideal is essential while facing adversity, and the path towards success requires us as individuals to overcome difficulties. Challenges such as financial, physical, the COVID-19 pandemic, etc., are all-around us, regardless of the career- or life-paths we choose. Overcoming adversity is simply part of living a normal life. Where balance becomes important, however, is not letting adversity become the focal point of one’s obsession. My drive to work out and diet my way towards achieving an NFL body consumed me. Instead of pursuing the NFL for the love I had for football, I began pursuing the NFL for the fame and fortune it would provide. I focused on proving all the 'nay-sayers' – football personnel who never believed I could do it – wrong, instead of trying to enjoy the ride, proving myself and my supporters right.

After playing my last snap in 2017, the reality hit me that I had played my last snap forever. My body was physically beaten and broken down to the point where it felt like if I took one devastating hit, I would disintegrate and turn into dust. The reality finally set in that my body was not 'NFL material'; it was not good enough to cut it, even after a decade’s worth of training. Instead of taking a pause to celebrate all the good my body was able to provide me (i.e., a successful high school and college football career), I became obsessed with how to lose all of the weight and muscle I took years to achieve.

From November 2017 to May 2018 (one month before beginning medical school at MSUCOM), I exercised roughly three-hours every day and cut my daily caloric intake from 6300 calories to approximately 1600. I had lost over one-hundred pounds during that time span. Even though I physically felt rejuvenated, I was still unhappy with how I looked and who I was. Deep down, I could never shake the fact that I was in medical school and not on an NFL team somewhere. Although I struggled with suicidal ideation throughout high school and college, these thoughts intensified when I started medical school. I felt guilty for letting down my family and those who supported me during football. After one of my first exams in medical school, I found myself standing on the edge of a downtown Detroit building, ready to jump. Looking down at the patrons below, I finally realized that I needed to make a change with how I saw myself and the world around me. I needed to change how I wanted to live my life moving forward.

This battle with suicidality, body dysmorphic thoughts, and bulimic behaviorism haunted me for years. After stepping backwards from the balcony, I decided to seek counseling provided by MSUCOM faculty. Two years later, I am blessed to say that I have

not had a suicidal thought or issue with my body appearance since. Balance does not mean that you should not work hard to achieve your dreams. Balance comes from an inner peace you find when your dreams and your reality begin to synchronize. I never found this synchronicity with football. My obsession with my body and the NFL began to deteriorate not only the relationship I had with myself, but the relationships I had with my loved ones, too. Nothing in this world is worth ending one’s life over; it simply is never the answer.

Balance, as I have learned to appreciate, is never letting any one thing become the only thing. Adversity will always exist: the COVID-19 pandemic is just another challenge. Medicine may be difficult, but anything that is meaningful requires hard work and dedication. However, do not allow medicine to be the only dedication one has. As medical students and professionals, we must continue to dedicate time towards the relationships we have with ourselves and our loved ones. That is the balance by which we ought to pursue and to live our lives.

Three Seasons, Pandemic

Spring, Isolation

Retreat within self: watch, bake, read, run, run, repeat. Clenched jaw and drawn blinds.

Spring, Uncertainty

Headlines: lungs failing. Birthdays passed in living room. Do you drink alone?

Summer, Unrest

Gasping for a change-

“I can’t breathe” rings through the night. Face masks flood the streets.

Summer, Guilt

In splashing waters, laughter and release held back by proximity.

Fall, Adrift

Rain muffles footsteps, six deer paw the path and starea moment shared. Gone.

Fall, Apprehension

Frost blurs my windshieldmore menacing than before. A long winter looms.

- Casey Paul Schukow, OMS-III, MSUCOM

- Eren Sipahi, MS-II, MSUCHM

Faces of the Frontline

- Courtney Merlo, OMS-II, MSUCOM

When People You Don't See, Disappear

I have owed Matt an apology, about the bike, for a decade. On the day I met him, he was sitting on a bench, outside a grocery store. His sister had bought him a black and white Schwinn, but at the time, I didn’t know about his sister, or why she bought him bicycles. I just saw an intoxicated, homeless man. We waited outside the ambulance, while a police officer ran the serial number, because I was in no hurry to sit with Matt in a small, enclosed space. People stared as they came and went from the store. When the bike didn’t turn up stolen, to make amends, I agreed to transport it in my ambulance – a bike, a walker, sometimes a wheelchair, are as important to a homeless person as a car is to a commuter.

Over the years, Matt and I got to know each other. It turned out that I started and ended my shifts at the corners where he stood with a sign. I had seen him day after day, shift after shift, without noticing –look ahead, don’t make eye contact, wait for the light to change. For two summers we rode together, me commuting to work on a twenty-dollar bike I bought at a yard sale, and him on the Schwinn purchased by his sister. My shift started at 9:30 am and I would see him trundling down the railroad tracks, from his campsite, as I rode to work. Twelve hours later, summer twilight settled toward dark, as I pedaled home and he rode back to camp, with five-gallon water jugs hanging from each handlebar – “enough for the guys.” Our snippets of conversation, riding beside each other or through the window of my ambulance, while I waited for a light to change, strung together into a disjointed tapestry. On cold days I encouraged him to stay warm and he told me that, after years living in Southeast Asia, he liked the cold better than the heat. On hot days, he would say, “At least I’m not working construction,” which had been his profession. When it rained and I told him that I hoped he’d stay dry, he’d remind me, “Rain is good for my sister’s garden.”

When I started working part-time, so that I could attend medical school, I saw less of Matt. The COVID-19 pandemic highlighted the shifting value of my life. As a medical student, I arrived at a clinical site and was assigned to a care provider who did not have COVID-19 patients. I worked with residents and physicians, seeing a patient for a few

minutes and then retreating to a relatively safe space, to discuss diagnoses and treatments, in preparation for rounds. I followed nurses and spent the morning with patients – stand-pivot-adjust – ordered them breakfast, sometimes fed them breakfast, if a tech wasn’t available, while the nurse hurried to distribute morning medications, before rounds. Then I picked up a shift on an ambulance and listened to dispatchers repeat warnings – Priority 1, cardiac, COVID positive, airborne precautions – 3 on a fall, COVID positive, airborne precautions – Priority 1 on a diff-breather, airborne precautions. Local hospitals diverted the most severe cases, forcing us to spend thirty or forty minutes, in a confined space, with COVID-19 positive patients who were breathing forty times a minute. During the first wave, in West Michigan, call volumes dropped to almost nothing, as people avoided hospitals, for fear of contracting the disease. During the second or third wave, whichever this was, the number of infected patients grew at an exponential rate. As hospitals transferred patients to subacute rehabilitation facilities, ambulance services were inundated, first with transfers to the facilities and then, if the patient’s health declined, emergency calls for readmission.

For the last six months, I haven’t seen Matt. I look for him at the start and end of each shift, when I pass the corners that he used to frequent. In emergency medicine, we see people on bad days. Some people we see more than others and for some, the frequency increases until you stop seeing them. If they die on your shift, you know, but if not, no one calls, no one hangs banners on buildings or takes out ads on billboards or even writes an obituary. You just keep looking at the houses or the street corners where you picked them up, hoping that you’ll see them. The day I met Matt, I made him sit outside the grocery store, while people stared and a policeman confirmed that his bicycle was not stolen, because I didn’t want to smell him. Ten years ago, the thought of putting on an N-95 didn’t occur to me and I’m sure that Matt would have been offended, if I had. Now, I wear a mask and walk into the street, rather than pass someone on the sidewalk. COVID-19 has changed many things, but the pandemic has not shifted the bedrock of our deepest biases. We protect ourselves with masks and face shields, but still look away, don’t make eye contact, wait for the light to change, as the disease spreads through

so called susceptible populations – recent immigrants, minorities, homeless men, who sit on benches, outside grocery stores.

The terror of this pandemic is not the R-naught or the mortality rate, or even the lack of herd-immunity, but rather that anyone can catch the disease. I rode to work with a desperately ill man, chatted with him through the open window of my ambulance, without fearing that I would contract his addiction. I drove past Matt for years, without noticing and still would – look ahead, don’t make eye contact, wait for the light to change – if I hadn’t met him. During a pandemic it makes sense to limit exposure –doctors shouldn’t spend more time in patient’s rooms because nurses and techs have to. Smaller hospitals divert critical patients, forcing paramedics to endure extended exposures and as you step out of your truck, sweating beneath layers of PPE, you are likely to see people strolling by on the sidewalk, with no masks. As

health care providers, we are trained to limit exposure, but as a society, we have trained ourselves to ignore a litany of pandemics. We look away from addiction, don’t make eye contact with the mentally ill, and wait for the homeless to change. Now, we find ourselves confronted by a pandemic that we cannot ignore, because we are all susceptible. A cough, a sneeze, a breath, but rather than waking with a sore throat or malaise that passes in a few days, it is as though we suddenly risk waking to find ourselves sitting outside a grocery store, homeless, intoxicated, and trying to convince a paramedic that we didn’t steal a bicycle. As a society, if we do not force ourselves to turn, make eye contact and change the trajectory of the COVID-19 pandemic, by wearing masks, socially distancing, and getting vaccinated, we will owe far more than an apology to the millions who have suffered, died, lost loved ones or friends.

- Jacob Guiser, MS-II, MSUCHM

Illuminated Haze

Ania Pathak, G3, DO-PhD Program, MSUCOM

Tranquility Among Chaos (2020)

- Medium: Acrylic on Canvas

As clinicians, we must find balance. Specifically, we must find tranquility among the chaos in order to provide the best possible patient care.

- Jenna Bernson, MS4, MSUCHM

Middle Clinical Experiences

I spent the last days before lockdown in a rustic Wilderness State Park cabin, on the wintery tip of the Lower Peninsula, surrounded by close friends and their respiratory droplets. During the trip I developed a cold and I gargled salt water and blew my nose as we joked that I must have that Coronavirus going around. We laughed, and shared the small cabin’s oxygen, unfamiliar with terms like 'social distancing'.

I didn’t have Covid then, but it was an omen of those first few months at home. I shared in our collective low-grade yet constant paranoia that every itchy throat or headache or sneeze was the start of the Real Deal, the Big One. I took my temperature with a meat thermometer, and made toilet paper shortage contingency plans. A human mind deprived of stimulation will begin to spiral into surprising directions. They say that’s what drove an isolated prisoner in 1700’s France to invent Solitaire. After only two months of not seeing friends, and going to medical school via Zoom, my brain began to desperately hunt for spare crumbs of serotonin. I baked bread, watched movies, ran 24 miles a week and hated it, turned off screen time warnings on my devices, and drank beers alone in my apartment with my friends via webcam. To this day, I cannot remember what I used to spend my time doing before the pandemic started.

Even though most of my days are still spent on Zoom, we still have clinical shifts sometimes, interviewing patients while wearing masks and face shields that make us look like low budget astronauts. One patient in the ER burst out laughing as soon as she saw me. I crinkled my eyes as hard as I could under the helmet to show her I completely agreed that I looked ridiculous.

Every student I know is grateful for these clinical opportunities, a chance to step away from a shared screen and breakout rooms. The clinic is where we see what we learn in the classroom take on life. For example, I do not think that I will remember nephritic syndrome, blood and protein in the urine, by thinking of effaced podocytes in a glomerular basement membrane. I will remember it by the patient that told us “Doc, my piss looks like a pint of Killian’s Red Ale.”

A year ago, my friend asked me how much longer I thought the pandemic would last. Neither of us could be sure, but we agreed that surely August was the outer limit. I cannot cite any pertinent public health research we based our estimation on, but somehow it was still disappointing when August came and went. Now spring is here, and the universe seems rich with obvious metaphors about rebirth and renewal, emerging from the worst pits of the pandemic. I do not feel as if the world around me has changed dramatically since a year ago though, only that I myself am new. Some of the wounds of isolation and loneliness closed by primary intention, leaving behind neat lines where they used to be, others left to heal by themselves with thick fibrous skin left behind. After a quiet year of introspection, it seems natural to think about how the world is different now, and what the next year will bring, but instead I think about Wilderness State Park. With no light pollution there, on clear nights you can see galaxies, and the glow from the Mackinac bridge. You can stare at the lake and the sky for a long time before you worry about what comes next.

- NiCo Pigg, MS-II, MSUCHM

Pieces of Home Ania Pathak, G3, DO-PhD Program, MSUCOM

There were no almonds in our lives, but there was the watermelon we loved to share, you at your house, me at mine, after the vendedora de patilla dropped off a slice for each of us as she passed by. And there was the blue smoke of the jacaranda rising from our patios that we burned

as conversation, because your father never let us meet. We pledged that not even the roar of the jaguar could keep us from each other’s arms. And it did not, though the macaw hatched fifty broods before our promise was Fulfilled.

Poetry:

Hiram Stephen Williams, M.D., M.P.H. Professor of Pediatrics Emeritus, MSUCOM

Visual Art: Blurred Beats

-Salina Halliday, OMS-IV, MSUCOM

“It was inevitable: the scent of bitter almonds always reminded him of the fate of unrequited love.”

- GABRIEL GARCIA MARQUEZ

We must accept our mood swings as they are

Mood Swings

- Lauren Bonilla, OMS-II, MSUCOM

Whether human or feline, we have to be especially kind to ourselves in times of struggle.

Emotions do not define us, they are only a temporary state of being.

HANGING ON BY A THREAD

Sparkling between the backlit leaves of morning, gossamers sway in the breeze like bejeweled necklaces that are worthy of a missing princess or shimmering high wires waiting for acrobats even though their circus is nowhere to be found. But, on closer inspection, we just see eight-legged sailors throwing silk from the deck of the sinking ship of summer. So we shiver and look for our lifeboats as well.

- Hiram Stephen Williams, M.D., M.P.H. Professor of Pediatrics Emeritus, MSUCOM

'Silly' 'Tied-Up' 'reflective'

Ansel

- Ania Pathak, G3, DO-PhD Program, MSUCOM

Curious Colors

We seek precision in medical research and practice, but life often refuses to be contained by lines.

- Salina Halliday, OMS-IV, MSUCOM

Bite Size

“Don’t let my first suture be on someone’s face” I think to myself as I walk into my EM shift, going over the motions in my head to drive a needle and tie a knot. I feel confident I can do it, but god I hope it’s not on someone’s face. If the attending decides the laceration is an appropriate size for a second-year medical student, no problem. If the attending asks if I can do it, I won’t look timid just in case they can smell fear-- which they can. I practice asking where the laceration is in a manner that sounds inquisitive and not fearful; “I’m game for that laceration, but where is it?” On the way to the exam room, I will wonder if it is technically lying to say that I’ve done this before. I hope the patient doesn’t ask specifically if I have done this before on a real living human. “At least it’s not on your face,” I’ll joke-- unless it is.

The patient we see does not need stitches on her face, but she needs many stitches on her index finger- she nearly cut it clean off with an industrial saw. She is sitting upright in the bed with her finger splayed open, taking up more space than any index finger should, and she’s awake, watching it all. Meanwhile, her boyfriend is sitting in a chair with his head bowed, keeping his gaze anywhere but on her finger. He tries to make small talk and she teases him about his queasiness. Unfazed, she wants to get back to work. I relate more to the boyfriend, especially as the room starts to close in on me. The resident works to put her finger back together, like some sort of grotesque skin puzzle, and I lean against the wall. When that starts to feel like a stepping stone to the ground, I stand up. I get closer to the patient’s bed and then I step away, pacing forward and back. I ask if they know of Tommy Caldwell, the professional rock climber who lost his finger to a table saw but remained the best climber in the world somehow. Immediately I regret telling a story about someone who lost their finger, and I wonder if my poor storytelling judgement is due to my queasiness. Passing out right there doesn’t feel like it would be good for anyone present, so I sneak out to the nourishment room without a word.

In April, I wrote an essay saying that the lockdown-- then in its infancy-- was going to be good for me. I was just coming off a tough first year in medical school and I felt like some time alone, and more sleep, exercise, and homemade food would be beneficial. I planned to use the lockdown to care for myself, and when the time came, I would jump back in. When I wrote that, I could not have imagined being isolated for this long. I did not foresee the speed at which time alone transforms from a luxury into a powerful altering force on my well-being. Or that nearly a full year later, the COVID-19 pandemic would be running with more steam than ever. I didn’t foresee skipping Thanksgiving at my grandma’s house or feeling like I should seriously consider cutting back on drinking. I didn’t imagine having to wait several more months to see my girlfriend in Boston. Or feeling like a virus had the potential to ruin our relationship. I never thought I would have to remind my parents not to get too close to me, suddenly understanding how they must feel when they try to convince my grandmother that she should no longer drive. I didn’t imagine my first suture to be through a blurry face shield.

But the surprises have not all been bad. I didn’t expect to return from the nourishment room-- still queasy-- to successfully suture for the first time. I was surprised to find myself volunteering to go first. I was also surprised and relieved that the resident was supportive and instructive, and the patient was unbelievably relaxed, given both her injury and that two medical students would be performing their first ever suture on her finger. I was surprised to learn that a finger repair made me feel sick, but then I also was surprised when I pulled myself together (if only for just long enough).

This year has been a reminder of the countless challenges to come, for which I can never truly be prepared. There was no way to be prepared for this pandemic. Most of us could not even fathom something like this happening. On a smaller scale, I prepared to suture-- I read about suture technique and practiced several times on gel-- but nothing could prepare me for the real thing. The current world, and our career choice, seem ripe to produce more surprises. The only option may be to face challenges with what we are equipped with. From now on, when I encounter an unexpected finger injury, a new procedure, or even another pandemic, I’ll accept that I am as prepared as I can be, and with that realization I will find a new strength.

- Eren Sipahi, MS-II, MSUCHM

Learning to Redefine

- Pastel, charcoal

Sometimes it is okay to go outside the lines, deconstruct, re-build, and explore something new.

- Lauren Bonilla, OMS-II,

MSUCOM

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