Aenigma Medicorum (Volume 1 - 2013)

Aenigma Medicorum The Puzzle of Doctors An Annual MUSOM Review of Literature, Photography, Art & Music

Pictured (from left to right): Scott Studeny, Hilary Hott, Ally Roy, Stephen Roy, Matt Christiansen, Joanie Garratt

Aenigma Medicorum Founder.................................................................................................................................Bi Mo Executive Editor.................................................................................................Matt Christiansen Design Editor...........................................................................................................Joanie Garratt Submissions Editor....................................................................................................Scott Studeny Copy Editor...................................................................................................................Hilary Hott Selection Committee..............................Ally Roy, Stephen Roy, Blake Epling, Gordon McLemore Faculty Advisor.......................................................................................Thomas C Rushton, M.D. Faculty Advisor............................................................................................Stephen Petrany, M.D. Faculty Advisor.......................................................................................Guada Lopez Marti, M.D. Our heartfelt appreciation for the funding provided by the Multicultural Advisory Council.

Letter from the Editors We would like to welcome you to this inaugural edition of Aenigma Medicorum, the annual literary and art review of the Joan C. Edwards School of Medicine!

We know that medicine is as much an art as it is a science. Woven into the day-to-day practice of medicine are stories of sickness and accidents, birth and family, struggle and prosperity. These experiences inform health care providers as much as their patients: while patients look to medical professionals to manage their health issues, we learn from them as well, forming a partnership toward mutual wellness. This physician-patient understanding is crucial in our quest to improve the human condition through medicine and find a niche that best serves our community and loved ones.

The practice of medicine is therefore a puzzle with many solutions leading towards the same end; each experience is directed by our own unique encounters, life stories, cultures, and backgrounds.

The name Aenigma Medicorum translates

roughly to the Puzzle of Doctors, an acknowledgment that the most important aspects of medicine go far beyond interpreting lab results, reading an image on a screen, or a making a diagnosis.

With this publication we hope to contribute a piece of this puzzle by featuring creative works that reflect the experiences of our community. Our submissions reflect a broad spectrum of professional experience, from medical students just entering the field to researchers and physicians who have practiced for years. This board is honored to present Aenigma Medicorum and reaffirm our commitment to fostering a culture that emphasizes humanism and clinical excellence in medical education at the Joan C. Edwards Marshall University School of Medicine.

Contents 7

Sunflowers.......................................................................................Yasser Etman

7

Fall Colors.......................................................................................Yasser Etman

8

Old Tailor Shop...............................................................................Yasser Etman

9

A Dying Secret....................................................................Rezwan Ahmed, M.D.

10

Unlocking The Cell..............................................................Rezwan Ahmed, M.D.

11

Dislocated..................................................................................Warren C. Doyle

12

The Adventures of Mothman & Larva Boy............................................Ryan Clagg

13

Where the Heart Meets the Sky........................................................Joanie Garratt

13

The Sentinel...................................................................................Joanie Garratt

14

A Tranquil Stroll.............................................................................Joanie Garratt

15

A Young Woman.............................................................................Stephen Clark

15

Study of a Man..............................................................................Stephen Clark

16

Mug and Napkin............................................................................Stephen Clark

17

Tiger Swallowtail.........................................................Aaron M. McGuffin, M.D.

18

Remembering him on Vacation.......................................Aaron M. McGuffin, M.D.

18

Rhinorrhea...................................................................Aaron M. McGuffin, M.D.

19

Untitled..........................................................................................Scott Studeny

19

We Are...........................................................................................Scott Studeny

20

High Light.....................................................................................Scott Studeny

21

Untitled............................................................................Kimberly Becher, M.D.

23

Only true kingz do these thingz.....................................Thomas C. Rushton, M.D.

24

Civilization’s compass...................................................Thomas C. Rushton, M.D.

25

Hyacinth Batik...................................................................................Gina Guzzo

26

Ostrich Feather Skirt, Cowl Back Top...................................................Gina Guzzo

26

Wine Bottle Chandelier........................................................................Gina Guzzo

Contents [Continued] 27

Rhino Bug...........................................................................................Kate Steele

27

Dog, Honduras....................................................................................Kate Steele

28

Ignorance Gains Access........................................................................Kate Steele

29

Wink.............................................................................................Matthew Boyer

30

Bones............................................................................................Matthew Boyer

30

Untitled Desertscape......................................................................Matthew Boyer

31

Minions........................................................................................Dilip Nair, M.D.

33

Who Are You, Really?....................................................................Dilip Nair, M.D.

34

Stairway to Nowhere....................................................................Dilip Nair, M.D.

35

Man selling dates at a souk in Kuwait City, Kuwait..........................Shaun Stanley

36

On Shadowing a Case of Clostridium Difficile............................Michael Hardman

37

Portrait of Harris Hawk..............................................................Zachary Sanford

37

Portrait of Cheetah.....................................................................Zachary Sanford

38

A Matter of Perspective................................................................Zachary Sanford

39

Stained Glass................................................................................Sarah Johnson

40

Thinking Place..............................................................................Sarah Johnson

40

Clown Dash..................................................................................Sarah Johnson

41

Rose...........................................................................................Daniel Roberson

41

Mile 1........................................................................................Daniel Roberson

42

Sugarwood................................................................................Daniel Roberson

43

View from the Top: Rainstorm.....................................................Neha Goyal, M.D.

44

Elaborate Dining Room.............................................................Neha Goyal, M.D.

45

Where Dreams Come True..................................................................Kate Proffitt

46

Love Birds.........................................................................................Kate Proffitt

46

Somewhere Over the Rainbow............................................................Kate Proffitt

Contents [Continued] 47

Ohio River...................................................................................Mats Lemberger

47

Ode to Joy...................................................................................Mats Lemberger

48

L’Enfant Plaza Subway Station..........................................................Kyle Burner

49

Trees.........................................................................................Matt Christiansen

50

Animals....................................................................................Matt Christiansen

51

Men anpil, chay pa lou: Many hands make the load lighter...........Nafreeza Hussain

51

Ritchie.......................................................................................Nafreeza Hussain

52

Nan Lakou la: In the backyard...................................................Nafreeza Hussain

53

Dil to pagal hai......................................................................Meaghan Tranovich

53

Kabhi khushi kabhie gham.....................................................Meaghan Tranovich

54

Kuch kuch hota hai.................................................................Meaghan Tranovich

55

Wayfaring Stranger...........................................................................Shane Cook

55

Wagon Wheel....................................................................................Shane Cook

55

Carolina in the Pines..........................................................................Shane Cook

56

Dusk in Laguna Niguel.................................................Guada Lopez Marti, M.D.

58

Theatre..............................................................................................Shayne Gue

59

MAY...............................................................................................Sarah Slocum

59

Power Down...................................................................................Sarah Slocum

60

REX...............................................................................................Sarah Slocum

61

Untitled.............................................................................................Jason Locke

62

Cruiser 2......................................................................................Darlene Cordle

63

Indigent?..............................................................................Shirley Neitch, M.D.

Sunflowers

Since I was a child I had a passion towards art. I have always wanted to be a physician and thought I can do both in the same time. After starting medical school I found myself forced to sacrifice making art to be able to succeed in the medical career. After I had completed my medical training I was able to rediscover my talent in making art and to self educate myself to be able to satisfy my life long desire to make good art.

Fall Colors â“Şâ‘Ś

Old Tailor Shop I am a pulmonary medicine fellow at Marshall University Joan C. Edwards School of Medicine and plan to pursue training in critical care medicine. I will continue to do my best to save lives and make art at the same time.

Yasser Etman

⓪⑧

I am a first-year Internal

A Dying Secret

Medicine resident at Marshall University, Joan C. Edwards School of Medicine. The

9 minutes till expiration....

I stare into her eyes, unknowing that my words Will be reverberated for all of time

unique interactions that health care professionals have with their patients gave me the inspiration to write “A Dying Secret” and “Unlocking

the Cell.” I have always

However simple, however profound They are my last, encapsulated

wondered how life would seem if experienced as someone else. If we could re-

A mere montage in time

experience our lives in

reverse, knowing that we had less than 10 minutes left, what

Hitherto, the script was evolving

would we tell to the one who is

Now an Ellipsis has been placed

by our side at that moment?

Into the story - one that's never-ending

“A Dying Secret” poses that question. “Unlocking the Cell” is a poem about a

The zephyr from my breasts slowly Seem to be overcast and alarmed An urge takes a hold of my being

medical student who was unexpectedly afflicted with a stroke in her pons, leaving her forever debilitated. Her story is one of denial and anger,

emotions I have seen

Almost exasperated, I tenderly utter

expressed by many patients.

My sympathy goes out to those

What my youthful lips

afflicted with unforeseen

In much despondence shamefully compels

circumstances, hoping that their hardships can one day

be provided with a greater purpose and meaning.

"Please forgive....

Rezwan Ahmed, M.D.

⓪⑨

Unlocking The Cell Urgently transported, awaiting bed I stare at the victim, bewildered.

Frozen in time, our eyes collide...

As I take a leap inside her blinks

"Why, why me?"

Agony echoes through the cap, Piercing my heart, yet I start blankly, Unable to show my daggered outrage

One moment in time that forever Paralyzes her goals, deafens her beauty.

An infarct within her pons that Mutes her daily experience

I wonder how her patience is tested Herself, a future medic.

Serving graciously, Not reliant on the system in which she is now involved

It silences my thought during this brief exchange Knowing that the expression of "help," a "blink," Will not provide assurance for This eternal state of lifelessness

①⓪

I wrote this poem originally as part of a hip hop song I made with a friend in college.

It was written in 2007 after I suffered an elbow dislocation that was really painful and difficult for me. I was depressed that I couldn't play, and writing this poem/song helped me put this unpleasant incident behind me. The care I received as I was having my arm reset and the interactions I had with my doctor as I was recovering have long been a motivation for why I wanted to pursue a career in medicine. My doctors helped me deal with my pain and get my strength back, and they did it with an empathy and deftness of emotional intelligence that continues to inspire me. I hope to be able to help others in the future as I was helped by the physicians who fixed my arm.

I am a first-year medical student at Marshall University, Joan C. Edwards School of Medicine. I love outdoor activities, traveling and playing sports (especially soccer!). I'm so thrilled to be here at Marshall and on my way to a career in medicine.

Dislocated I lie inside that ambulance, left arm mangled, Head swirling, eyes blurring, choking and strangled, By the tears and the fears and the shock and the pain, And an anger that I hope I'll never feel again.

I was a senior in college, it was early in fall, It was my last soccer season, and soccer meant it all.

I was fit, I was hungry to guide my teammates and team, I had just been named captain, I was living in my dream.

I had worked hard to get there, trained and sprinted for weeks, I'd run miles and miles, and come home sweating in streaks.

I wrote emails, made phone calls, to my teammates and coach, To get them pumped for the season, so we'd be ready to go.

And then the first game came, I was starving to play, It was warm and beautiful, it was a bright, cloudless day.

But then the brutal moment that I'll never forget, My elbow snapped in a tackle that I'll always regret.

And then reality came, and then the pain came too, And not the pain from my arm, the pain that soccer was through.

See this game was not a game, it was a part of my name, It was a part of my heart. I'd never feel the same.

Soccer was my identity, it had always felt fated, And now my arm and my spirits were dislocated.

I was broken, I was crushed, I felt lost and depressed, I would cry in my room after games that I missed.

It was a really hard year, but during that year I grew, And I'm a better person now, for that bad card I drew.

Because I had to learn lessons from those cards I was dealt, And I had to learn strength from that pain that I felt.

And while I still sometimes grieve for that season long gone, I learned to change, to adapt, and I learned to move on.

Warren C. Doyle

â‘ â‘

The Adventures of Mothman & Larva Boy The Mothman Prophecies film came out when I was 13. My friends and I would joke about Mothman being a classic superhero like in a comic book. Naturally he needed a sidekick, so I came up with Larva Boy, a physically inept but highly intelligent partner. In describing this creature, I would push up my glasses, uncomfortably flick my tongue a few times and shout “Larva Boy” in a Jerry Lewis-inspired squeal.

Cut to 10 years later. I was waiting for a response from Marshall but was convinced that I wouldn’t be accepted. Out of desperation, I started looking for a job as an illustrator. I got the Adobe Illustrator program and a drawing tablet to start building my portfolio. Striving to think of something original, I remembered my middle school joke and imagined what it would be like if Mothman and Larva Boy had their own comic book. This drawing would be the cover to the first issue. Hopefully in the future, I can pick up where I left off and make the rest of it.

I am a first-year medical student at Marshall University, Joan C. Edwards School of Medicine.

Ryan Clagg

①②

Where the Heart Meets the Sky A view of the Basilique du Sacré Cœur on the summit of Montmartre in Paris, France. Known as the “Basilica of the Sacred Heart of Paris,” this church is located at the highest point in Paris. As this photo captures the Basilica of the Sacred Heart against a beautiful sky in the highest point in Paris, it is only fitting to name the photo “Where the Heart Meets the Sky.”

The Sentinel A photograph taken from the Chimera Gallery atop the Notre Dame in Paris, France. Enraptured by the power of the church, this chimera of Notre Dame, once considered a demon, has been converted. It is now believed to be a guardian that watches over and protects the parish. I tried to capture the chimera as a guardian overlooking the city of Paris.

①③

A Tranquil Stroll A photograph of a quiet canal in the sestieri of Castello in Venice, Italy. In such a popular destination as Venice, it is difficult to find solace from crowds. I was surprised to encounter such a beautiful area of the city that had yet to be discovered by tourists. I hoped to capture the serenity of Venice that lies beyond the tourist attractions.

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine. With interests ranging from woodworking to drawing, I have always considered myself to be an artist. However, my true artistic passion remains with photography. I am particularly enthusiastic about travel photography. I enjoy capturing my unique perspective of all the world’s beauty and sharing it with others.

Joanie Garratt

①④

A Young Woman

Study of a Man

①⑤

Morning Tea I am a second-year medical student at Marshall University, Joan C. Edwards School of Medicine. Having taken a year off from school due to health reasons, a former teacher and a family friend (a retired physician) both suggested that I spend time learning to draw, paint and sculpt throughout the year. Having very little background in art, it took some time to begin to learn the techniques and skills needed, but I found myself enjoying the creativity of it. This creative process helped to take my mind off of my health and changed the way I look at even ordinary objects in the world. As I have returned to my studies this year, I have continued to pursue art when I have had time, and although I am still very much a beginner, I hope to continue to improve upon my artistic ability. I highly recommend anyone who is interested in art of any form to try it. The pieces pictured - Mug and Napkin, A Young Woman, and Study of a Man - are some of my early works.

Stephen Clark

â‘ â‘Ľ

Tiger Swallowtail Poised upon the side of a dirt road is a butterfly whose arrival was announced by an exotic display of fitting grace. The black and yellow wings signaling wildly in aerodynamic Morse code..--.. untranslatable beauty.

The stillness of its stance uncharacteristic, nearly motionless upon the ground, save the slow mechanical upbeat of its hind wings, mesmerizing and golden.

In its pause, there is the background of poverty. The wingspan of debris stretched from a discarded crush of rusted can to soil soaked paper, refuse routed in a serpiginous flush by a trail of liquid feces. The froth and foam forming a delta in the nearby ditch, where the dogs lie, counting their ribs with parched tongues, licking themselves clean off the bone.

Such is the system of waste in Honduras.

From the doorway of an adobe a family is staged, a shirtless father and his shoeless sons, cocooned within a roof of tropical leaves. Their browned skin metamorphic with the beaten paths that lead up to their beaten bodies. In one of their hands is a machete, humidly swinging, back and forth, hypnotizing another generation of blackened pupils into overgrown fields.

They are neither eating nor drinking when the sun comes up. The cultural silk that binds them unbroken.

And so they remain, at the doorway, unchanged, as the fleeting path of a Papilio glaucas goes unseen, its wings lifting to the higher leaves of a nearby tulip tree. It is here where the yellow-green eggs are laid and the caterpillar emerges, free to spin itself into new life. ①⑦

I have written poetry since my mother, Rosemary McGuffin, exposed me as a young child to monthly poetry meetings held by the Marshall University English Department. Mom was an English teacher and was a wonderful writer. My first publication was at age 12 in the “Laurel Review”. Since then I have written much, but submitted little. I have had three poems published in the “Pharos” and one in the “Archives of Pediatric and Adolescent Medicine”.

My tendency is to write about what I know best, which is medicine, and how health and illness affect those around me. “Tiger Swallowtail” was written based on an experience in Honduras where I observed a butterfly in the middle of a destitute village. Its beauty in contrast to the surrounding scene prompted the poem. “Remembering Him on Vacation” is a poem that compares my experience hugging a dolphin during vacation with that of not hugging a patient with cancer. It speaks to a paradox for physicians that at times we hug things we normally wouldn’t and don’t hug when we probably should.

“Rhinorrhea” is a shape poem, addressing a common symptom, that of a runny nose, from the perspective of the drainage winding its way down the face. The “drop” personifies, perhaps, a person contemplating suicide. Poetry for me is a form of expression that uniquely and safely helps me reflect on how I experience the world around me.

I am the Senior Associate Dean for Medical Education at Marshall University Joan C. Edwards School of Medicine.

Aaron M. McGuffin, M.D.

Remembering him on Vacation

Rhinorrhea

I did not really know a dolphin

When

until I hugged one fully,

it is cold

ventrally exposed and raised

on the inside

above salted water on the playful

I want to run violently, downhill;

cue of a trainer’s whistle.

a flashflood, discharged unnoticed,

The weight and understanding

with movements too quick to be wiped away.

of his mammalian burden

The emotional torrent takes me to the edge of

fully captured, wet and firm

a cliff,

upon my overwhelmed chest.

a quivered lip, where I prepare to jump, after

Like I did not really know you

a final pause to remember why I do not care

sufficiently touched, but unhugged,

anymore and confirm I am not worthy

ventrally exposed in hospital gown,

of my salt. I wait for the last time

lying parallel with the grave,

for a slow build-up of hydrostatic

and taking medicine, tasteless,

courage to end it all as a drip

swallowed without benefit.

that drops to a pendant splatter

The serious and rueful silence

concentrically warming

before an intercommed code blue

the outside ground

the weight and confusion of

below.

your cancerous burden uncontrolled, diaphoretic and wasted, hundreds of miles separating our hearts.

These three poems will be published in May 2013 in a collection entitled “Common Illness: Poems Written For a Love of Medicine”.

①⑧

Untitled I took this picture on top of a West Virginia hill in Ona. I really just couldn't pass up the opportunity to capture the colors that had been painted across the sky on that evening.

We Are...

This picture was taken at a family trip to the Greenbrier river. Growing up in Huntington, I have always been a Marshall fan. This was just a fun way of showing our support to the Herd. It's amazing what you can do with some sparklers and a slow shutter speed!

①⑨

High Light This is actually one of the first pictures I took with my camera. I knew once I took the photo that this picture was going to really give direction to the type of photos I would take throughout my journey as a photographer. For some reason, the close-up shot of the highlighters really caught my eye. The picture really captures my daily routine at the time: studying and drinking coffee. I received the camera as a gift, a way to just help relieve stress and escape the clutches of the textbooks.

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine. I am excited to pursue a career in Pediatrics, and can't wait to see where the medical career is going to take me.

Scott Studeny

â‘Ąâ“Ş

I am a second-year Family Medicine resident at Marshall University Joan C. Edwards School of Medicine.

Kimberly Becher, M.D.

â‘Ąâ‘

I am currently exploring gender issues and "Civilization's compass" is one image from the series.

How do gender roles influence and shape a culture and society? Is this an absolute? In other words, does visual imagery find common ground, or are the symbols interpretable only within the boundaries of a particular worldview? The image captured without a lens lends itself to helpful ambiguity. Beauty is strength and strength is beauty. The second image, "Only true kingz do these thingz," is part of the "beauty and the beast" series. The element of science fiction, one of my favorite literary genres, suggests a future dystopia. There is masculine posturing and feminine posing. Is the future that much different than the present after all? We perceive the strength of "true kingz" and hear their plea to be noticed and respected, but it is not to be. She will enchant us. We will gaze upon the beauty, after all, and not the beast. What about a subset of the world, medicine in America? Medicine looks different today. This is not merely technological but rather a dramatic shift in demographics. So the art and science of medicine, its practice and modes of delivery, are palpably shifting. For example, I have found that I must adjust my teaching style depending on the gender of the student to maximize effectiveness.

My ideas for exploring "gender" go back to my childhood in this way or that. Somewhat confusedly and certainly ignorantly, I grew up with both a twin and younger sister. They will tell you that I was the best brother they ever had (and the only one). They had friends. This was a potent soup of fear and curiosity; and it was frequently scalding. It was like a bad Billy Joel song. But I couldn't resist.

I finally married one, Catherine, who is a forensic science faculty member here at Marshall. My daughter, my oldest, explained to me one day how she was a woman and women know fashion. I picked out my clothes that day. She is getting better at it as of late. Still, it seems that genders have tendencies that suggest hard-wired proclivities. I see the desire and incomprehension in my son's eyes. I suppose one could attempt to articulate them (Turgenev did: "beware the love of women, the ecstasy, the slow poison"), but I prefer to use a camera in some form or fashion. Do I believe Stieglitz and his "equivalents?"

It would seem an important and timeless question worthy of further

exploration. I neither went to the Brooks Institute of Photography nor became an astronaut, but I did go to medical school. I still shoot film and read books made out of paper. I could give up food to have more books and film, but find it hard to do when there is a good bottle of wine at hand. Or chocolate. I will work for chocolate except if the Dean is reading this; if so, I work for a paycheck; Adam Smith and all.

Thomas C. Rushton, M.D.

â‘Ąâ‘Ą

Only true kingz do these thingz

4X5 inch format color slide, Epson flat bed scanner.

Model: A Wren (Blanton)

⑥③

Civilization’s compass

Lensless camera, 4X5 inch format, printed on Rives BFK paper using "new" cyanotype process.

Model: Beth Funfstuck

I am a Professor of Medicine and Chief Section of Infectious Diseases for the Department of Medicine at Marshall University Joan C. Edwards School of Medicine.

Thomas C. Rushton, M.D.

②④

Hyacinth Batik I have many creative outlets. Sewing, painting, cooking, gardening, and remodeling are just a few. All these works represent different facets of my life. Despite the different types of work, most stem from a general theme: I enjoy nice things, and I enjoy the sense of pride and accomplishment that comes from making them yourself. The batik represents original artwork, which I made to decorate my home. It was based off a lakeside photograph of hyacinths blooming and butterflies flying. The clothing and the chandelier were inspired from designer pieces, though I morphed each to fit my personal style.

②⑤

Ostrich Feather Skirt Cowl Back Top Sewn by Artist.

Wine Bottle Chandelier Made by Artist.

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine.

Gina Guzzo

②⑥

Rhino Bug During a medical mission trip in Central America, this insect created quite the commotion with its unique rhinoceros features.

Dog, Honduras This pup stole my heart as I stayed overnight in a farmhouse on a coffee plantation in Copan, in the western region of Honduras. She made her way into the outdoor kitchen during each meal looking for scraps and was promptly shoo'd away by the cook.

As we helped clean up, however, we found ways to slyly pass her leftover empanadas and platanos.

I am a fourth-year medical student at Marshall University, Joan C. Edwards School of Medicine.

Kate Steele

â‘Ąâ‘Ś

Ignorance Gains Access President Guebuza was coming to town, so of course I wanted in on the action. This was about 2 months into my stint as a Peace Corps volunteer in Mozambique and I wanted to experience as much culture as I could possibly imagine.

When my roommate and I arrived at the city center where he was to speak, there was such a massive crowd that we were overwhelmed by just exactly where the president was going to be. As we stood contemplating how to navigate the mass of people, we watched as a group of mostly children, with some adults, would run from something or someone, stop and regroup, then begin running again. Intrigued, we went closer to find out what was happening and as we approached, the crowd made way for the "mzungus" to see. I saw this group of men in such elaborate costume and was blown away by the amount of "African culture" I was seeing and immediately went to photograph. I was encouraged to go as close as possible to get the best angle, and I did not hesitate to step right up.

As my two years there went by, I learned quickly that that would be the one and only time I would get that close to the Nyau. I learned more about this secret society and its practices and the rumors that surround it. Even though this is a UNESCO World Heritage group and they are a great attraction during public festivals, they are also well known for their violent and possibly hallucinogenic-provoked raids on the community, terrorizing those who live in the area.

When not in chicken feathers and large masks dancing to the rhythm of the hand drum, they are in the mountains having secret meetings and show up in the village, scantily clad, bodies covered in dried mud with their faces covered under burlap. When the Nyau are out, a hush quickly spreads over the village because no one dares to step foot outside.

Whether the rumors are folklore or truth, we may never know. However, from the instances I came in contact with this group, such as fleeing the dirt road from the market with a woman to hide on a neighbor’s front porch as a Nyau covered in mud came screaming out of the bush and somewhat after us, I developed quite a healthy fear.

Unfortunately, I rarely had the chance again to get as close to this amazing piece of culture as I did the day the president came, before I became aware of who they were.

⑥⑧

Wink This little guy is a chameleon. His eyes move independently of each other. I was living and working in Botswana before the start of medical school and got to see some fantastic wildlife in the region. Photo taken June 2012 in South Africa.

I am a first-year student at Marshall University Joan C. Edwards School of Medicine.

Matthew Boyer

⑥⑨

Bones Untitled Desertscape The Arabian Desert is a mysterious place with many spectacular views. I took these photos while on a road trip from Riyadh to Manama.

Pictured here are camel bones and a sand formation in the shape of a sine wave. Photos taken December 2008 in Saudi Arabia.

③⓪

Minions Memorandum To: Health Care Administrator, Novice From: Health Care Administrator, Mentor RE: Minions My assignment as your mentor arrived via e-mail last week, hence this message to you. I had not been able to get to it earlier due to my responsibilities in the Department of Obfuscation. We have new Policies and Procedures that are to be released soon and I had to proofread them to eliminate any clear and straightforward language. Please note that I may be using such language in this memo, so treat it confidentially.

You need to know that you are embarking on a grand and promising career. You will hear some of our critics sneer that we are recent interlopers in a previously sacrosanct relationship between doctor and patient. Do not let this self-righteous mockery bother you, it comes from sheer envy.

We have taken up a role for which no one anticipated the need but whose absence no one can now imagine: “Regulation of Physician Behavior.” In the weeks ahead, I will give you detailed tips regarding this task. (They will give you an advantage over the other administrators, especially if you do not share them with anyone.) For now it is sufficient to paint you the big picture.

The core secret to regulating physicians’ behavior is to keep them continually off-balance. As long as this is achieved, doctors’ behavior is like putty in our hands. The most successful strategy to this end has been to overwhelm them with an avalanche of detailed tasks that have nothing to do with what they thought being a physician was about. We have had three major allies in this endeavor: 1. Medicare (officially, CMS), the government payer for doctor’s services 2. The architects and vendors of the Electronic Health Record (EHR) and 3. The purveyors of Evidence-Based Clinical Practice Guidelines A fourth is OSHA (Occupational Safety Health Administration), but it is the mere threat of their involvement that sends doctors’ organizations scurrying to put bridles on their members of their own accord. It is, of course, no surprise that these entities are so helpful; we have thoroughly infiltrated them already. In fact, we were involved in their establishment.

You may have heard that doctors are self-impressed, egotistical types who are accustomed to having their own way. All true, I assure you. How then have they been so successfully cowed?

Well, first let me point out that just because their behavior has been regulated doesn’t mean that their hearts have been conquered. There is still a fair bit of whining and even snarling as they comply with our Rules and Regulations and follow our Policies and Procedures. Our job is not for the faint of heart or the thin-skinned. “How then,” you ask, “have our strategies worked?” Well, we have another, most important ally: the physicians themselves!

③①

Indeed, some physicians have joined our ranks as administrators, and so have some nurses. While these individuals have particular influence with doctors, bi-cultural as they are, they are not who I have in mind when I speak of our physician allies. No, it is the regular, rank-and-file doctor of whom I am speaking. This creature has two essential tendencies that play right into our laps: a craving for comfort and an expectation of entitlement. If these traits did not run so profoundly, so pervasively and so powerfully, we would not be half as successful as we have been.

To be sure, there are a few physicians out there who seem not to be as susceptible to our methods. They tend to be generalists (specialists are, on the whole, more intelligent and pragmatic). They are mavericks who insist on staying in solo or small group single-specialty practice clinging to their autonomy, running their practices as they wish. These sorts are also often willing to make less money and work longer hours than their more compliant counterparts. Some even tend to be skeptical about the universal applicability of evidence-based practice guidelines and seem to actually take seriously the guidelines’ disclaimers about the need to apply clinical judgment in the specific individual patient’s context! However disturbing these misguided troublemakers may be, there is every reason to be hopeful.

For one thing, these outliers are few in number and will get fewer still since we have successfully begun running medical education as well. For another, under our guiding hand, hospitals have become the dominant giants on the medical landscape. Patients need hospitals and even these miscreant doctors need patients, so we have them. They cannot simply use hospitals for the care of their patients as they were able to in the past. They must become servants of the hospital as it dispenses services to its customers. (Incidentally, this is why sub-specialists are our dream. They are able to perform rare, exorbitantly expensive tasks with highly sophisticated technology that we can easily convince the public they need. If a sub-specialist behaves like a temperamental primadonna, humor him. It is worth it!) Finally, the government will soon put a stop to any foolish notions of individuality or independent practices among physicians.

So you see, you have chosen well by throwing your lot in with us. Live long and prosper!

P.S. You would be wise to destroy this memo after you have committed it to memory. Be prepared to deny any and all of its contents if the need should arise. Reacting with offended indignation would also be a good idea.

Dilip Nair, M.D.

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I, a family physician, am

Who Are You, Really?

a professor in the department of family

The words above the pocket of your white coat

and community health. I

Curl and loop in elegant flourish

came to Marshall over

Declaring who you are in most professional tones

20 years ago to begin

You are a physician, so it would seem

residency training in family medicine. I have

But, who are you really...?

stayed ever since. I am passionate about family

Are you a merchant plying your trade?

Selling goods and services most sophisticated and technical To men, women and children most desperate and needy For beneficence, commerce and at a fair price Considering the demand, the labor and the third party payer Or are you someone else?

medicine and am eager to cast a vision for its reformation and renewal. Laurie, my wife and partner of almost 25 years, and I live in

A mentor, friend and confidante

Huntington. For the last

A shrewd and skilled advisor

6 years we have been

A tearful and tender neighbor

deeply engaged in educating our two

You are a physician, so it would seem

children at home.

But, who are you, really...?

Dilip Nair, M.D.

All three of these pieces - Minions, Stairway to Nowhere, and Who Are You, Really? - are born out of my profound sadness and distress over the shape and trajectory of both the practice of medicine and medical education. In these pieces I seek to awaken our consciousness and sensibilities to what is being lost and to the detrimental and even pernicious aspects of modern-day trends in medicine and medical education. If my work is biting it is not out of malice as much as an attempt to arouse us from self-perpetuating complacency.

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Stairway to Nowhere “A Center of Excellence we have become,” shrieks the billboard, Parading ranks of stern-faced surgeons, physicians poised for action.

Policies and Procedures, covering every contingency in every way, Slice sharp edges that cleave the Excellent from the Mediocre, Those pitiable competitors, plodding on, unaided by Protocols, Graphs and Charts Oblivious of the beans left uncounted.

Professors of excellence fumble for the approval of chairs and deans, Propitiating peer reviewers, grant-givers, guardians of PC, Attacking exam room keyboards for offerings to gods of Productivity, Warily negotiating with students eyeing their popularity ratings, Yearning to hear an insatiable master proclaim, “Well done, good and faithful servant. Come into the Halls of Excellence.”

Societies of Mutual Admiration bestow students with honors, one to another, Fueling clamor to play the game, jumping hoops, talking the talk, Painfully filling every point of Competency on every painstaking scale For all the Right reasons, by all the Right metrics.

To be noticed as more Excellent than the next or the last.

“Come with me, my friend” said one Excellent to another, Scales falling in the light of Epiphany, “Let me show you the Stairway of Excellence¹; It is a Stairway to Nowhere².”

¹ I am indebted to Charles McCormick, M.D. for this phrase. ² I am indebted to David Powlison, Ph.D. for this phrase, an adaptation of his “ladders to nowhere.”

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Man selling dates at a souk in Kuwait City, Kuwait I was fortunate enough to encounter this wonderful scene of hanging lights and dates while at the souk (market) in Kuwait City, Kuwait in 2003.

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine.

Shaun Stanley

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On Shadowing a Case of Clostridium Difficile....

Upon opening the doors, the air smelled sour, I had been shadowing the floor for nearly an hour.

But something was not right when we entered the hall, The omen stung my olfactory like a bee set to maul.

We walked down the path; the smell grew stronger of course, I knew in my heart we would be reaching the source.

As if my legs resisted movement, they produced a stumble to my gait Masks, gowns, and gloves so we would not share the same fate.

“How are you feeling today?” the physician inquired.

“My bum hurts,” she said. “It is less than desired.”

She told us then of a most horrific story without any forewarning One of copious blood, water and toilets “and that’s just since this morning.”

My head shook, eyes watered, and stomach turned and tossed I feared for the party that my lunch would soon be lost.

“Well, we’ll get the colonoscopy soon,” and the patient grimaced in pain “Don’t worry,” he said, “the procedure is rather mundane.”

As we left the room the fresh air felt like bliss He said to me, “This is not a colonoscopy that you should be prone to miss.”

My body recovering from hypoxia, my nostrils felt singed in defeat, “I think perhaps not; for my shadowing hours are complete.”

Dear Reader: In the time it took you to read this poem, 0.64 Americans were diagnosed with a case of Clostridium difficile colitis. It is a serious condition that currently has many treatment options, and I believe that it needs more awareness. I would like to challenge the reader to this responsibility: Please tell three people about the serious epidemic that has spread like a mudslide across the United States. It is my hope that someday these bacteria may never grow again. I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine.

Michael Hardman

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Portrait of Harris Hawk

Academy of Natural Sciences, Philadelphia, PA

Portrait of Cheetah

Philadelphia Zoo, Philadelphia, PA

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A Matter of Perspective

Eastern State Penitentiary, Philadelphia, PA

Photography has always been a passion of mine since the very first time my aunt introduced me to her old manual exposure camera. From the intricacies of dark room development to the meticulous nature of framing the perfect shot to encompass an entire moment in one single image, the photographer is constantly challenged.

These works represent some of the sights of my adopted home of Philadelphia, where I was able to complete a Masters in Medical Sciences at Drexel University College of Medicine. Since the completion of my degree I have moved here to Huntington where I am currently completing my Medical Degree at the Joan C. Edwards School of Medicine at Marshall University. Although my time is at a premium, I hope to continue finding opportunities to place myself behind the camera and encapsulate future moments on film.

I am a first-year medical student at the Joan C. Edwards School of Medicine at Marshall University and plan to pursue a career in surgery. I am an avid traveler and amateur wildlife photographer.

Zachary Sanford

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Stained Glass I started painting in high school, following an assignment that I really enjoyed. It's not a frequent hobby; I do it when I feel something that needs to be put down in a concrete form. Most of my paintings are bold, brightly colored, and abstract, like these. I believe that sticking with images that already have connotations would limit what the art can express, and art that elicits unique thoughts in each viewer often promotes a connection to the piece, which is my goal.

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Thinking Place

I am a secondyear student at Marshall University Joan C. Edwards School of Medicine.

Sarah Johnson

Clown Dash â‘Łâ“Ş

Rose Mile 1

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I am a first-year student at Marshall University Joan C. Edwards School of Medicine. I like to look at life and the things in it from a different angle. So much of how people live is based on perception and it's always fun to change one's perception of things from time to time. I like to take pictures of everyday things that are fun to look at. The only piece that "means" something is the Mile 1 piece. John Heywood said, "A hard beginning maketh a good ending," and I believe he is correct. Medical school is difficult and is not an easy road on which to travel. I took the photo on the road to Huntington before officially starting my medical education, so it seemed appropriate. I am most passionate about people and I like to spend my time around others. I have a habit of noticing things that most normally wouldn't. For example, I might notice little things like why inhabitable and habitable are both words yet they mean the same thing. I have been given many blessings and I like to take time to be thankful and give back when I can. It's an honor to think other people might like the pictures I've taken.

Daniel Roberson

Sugarwood

â‘Łâ‘Ą

View from the Top: Rainstorm

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Elaborate Dining Room

The ever changing aspect of nature as well as human imagination is what I aim to depict in these pictures. I am a secondyear Internal Medicine resident at Marshall University Joan C. Edwards School of Medicine.

Neha Goyal, M.D.

â‘Łâ‘Ł

Where Dreams Come True ④⑤

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine. The beauty of nature has always fascinated me. I enjoy capturing the beauty of a rainbow, a sunset, a flower or an animal.

The rainbow photo was serendipitous. It had been pouring down rain all day in Washington DC. As our day came to an end, we began to walk to the Botanic

Love Birds

Gardens. Suddenly, out of nowhere, the beautiful rainbow appeared. It is a memory that I will never forget. The cross

Somewhere Over the Rainbow

stitch is a hobby that I have enjoyed for many years. I particularly like the cross stitch of Mickey Mouse walking along with Walt Disney in front of the Magic Kingdom castle. It shows Walt and the realization of his dreams with Mickey and the backdrop of Cinderella's castle.

Kate Proffitt

â‘Łâ‘Ľ

Ohio River

Ode to Joy Please visit the

I am a first-year medical student at Marshall University's School of Medicine. I was inspired to pursue a career in medicine after volunteering in McDowell County, West Virginia as an undergraduate.

Over the years music has been an irrepressible source of hope and wonder for me. I came up with this arrangement of Beethoven's "Ode To Joy" in 2010 during my postbac premed year while I was living in Haverford, Pennsylvania.

Walking beside the Ohio River last year, I was struck by the expansiveness and the composition of the scene. I snapped a photo;"Ohio River" is the result.

Mats Lemberger

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Aenigma Medicorum website at

http://musom.marshall.edu/ students/aenigmamedicorum

to listen to the audio file of Mats’ composition.

L’Enfant Plaza Subway Station This photograph, for me, captures one of those moments when you open your eyes to the beauty that exists all around, be it in nature or man made. Taking this picture was a matter of luck for me. I was just fortunate to have a camera on me as I was waiting for the subway. I have very little experience when it comes to art, but the way the train was blocking the light and how this affected the ceiling struck me as truly amazing.

I am a Huntington native. I received my undergraduate degree in Biotechnology from Marshall where I was a Yeager Scholar. I am a first-year student at Marshall University Joan C. Edwards School of Medicine. I am also a 2nd Lieutenant in the Army and have an interest in anesthesia.

Kyle Burner

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Trees

Thinly sawed firewood, stained and shellacked.

I have always been fascinated with the natural world and the interactions between humans and the outdoor environment. After receiving a BS in Conservation Biology in college, I spread my wings (or fins) and worked as a Fisheries Biologist in Yellowstone National Park and then in the Bering Sea, Alaska. I found that the fish weren't as grateful as I had hoped and I turned to human medicine to satiate my curiosity. During my transition to human medicine, I became even more fascinated by the effects of our environment on our health. With the increasing prevalence of lifestyle diseases that affect Appalachia so profoundly, we see that our mastery of the world around us is not quite so thorough as we thought. How well we are able to mediate these interactions with our environment, whether it is tobacco smoking or pollutants or choosing what to eat for dinner, will determine the success of the health care field in the years to come. I hope these pieces serve as a commentary on the effects we have on our surrounding environment and, conversely, the effects that it has on us.

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Animals

Sheep hide, Deer hide, Alum tanned, stretched and lightly bleached.

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine.

Matt Christiansen

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Men anpil, chay pa lou: Many hands make the load lighter Ritchie

Photography and public health have been separate passions of mine. In my travels not only to Haiti, but other countries, I realized I can bring my two passions together. In the future, I hope any of my international medicine endeavors will further allow me to combine public health and photography.

I am a first-year student at Marshall University Joan C. Edwards School of Medicine.

Nafeeza Hussain

⑤â‘

Nan Lakou la: In the backyard ⑤②

Dil to pagal hai

the heart is crazy

Kabhi khushi kabhie gham

sometimes happiness, sometimes sadness

⑤③

Kuch kuch hota hai

something something happens

Since a young age, I have loved dance and been fascinated by movement of the human body. Although I am most familiar with classical ballet, I am always interested in learning about new forms of dance. My classmate Madhvi Shah is trained in Raas, a traditional Indian folk dance. She was generous enough to teach me about it and I enjoyed the challenge of trying to capture the motion in a photograph.

I am a second-year student at Marshall University Joan C. Edwards School of Medicine. I am considering a career in Physical Medicine and Rehabilitation.

Meaghan Tranovich

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Wayfaring Stranger

Please visit the Aenigma Medicorum website at

Bert Wood: Lead vocal, rhythm guitar, dobro Wendle Cook: Bass

http://musom.marshall.edu/ students/aenigmamedicorum

Shane Cook: Harmony vocal, mandolin, banjo

to listen to the audio files of Shane’s compositions.

Wagon Wheel Shane Cook: Lead vocal, rhythm guitar Bert Wood: Tenor vocal, dobro Wendle Cook: Bass

I am a second-year student at Marshall University Joan C.

Carolina in the Pines

Edwards School of Medicine.

Bert Wood: Lead vocal, tenor vocal, rhythm guitar, dobro

Shane Cook

Wendle Cook: Bass Shane Cook: Harmony vocal, banjo

Growing up in a small town in southern WV, I was fortunate to have excellent role models and an amazing family that helped me to establish good morals and values, as well as my faith in God. I come from a talented musical family on both my mother and father’s side and was privileged to have an excellent music teacher and family friend, Bert Wood. My mother’s father, Meredith Kirk, opened a recording studio (Gearl’s Recording) in 2000 in Hewett, a small town in southern WV. The musicians that came though and produced records inspired me. With the help of my grandfather’s best friend, Bert Wood, I began playing the banjo at age 14. As I progressed from the banjo to the mandolin, dobro, and later the guitar, I started playing in church and at funeral services with my grandfather and Bert Wood’s bluegrass gospel band, the Hewett Gospel Boys. After the loss of our bass player, my father, Wendle Cook, quickly picked up the bass and joined us. Our group spent a lot of time playing in churches and funeral services in our town and the surrounding communities. However, after the very unfortunate and devastating loss of my grandfather in 2005, the number of services we played drastically decreased and the album we were working on at the time was never completed.

About a year ago, Bert Wood, my father and I decided to finish our old album and make a new bluegrass gospel and traditional bluegrass album. The songs submitted here are our unmastered takes on songs from the two albums. Wayfaring Stranger is a gospel hymn that I first heard A’capella style by my great grandmother, Nina Barker. The song has since become a favorite of my father and I. It was also one of the first songs I learned and recorded with my grandfather. Wayfaring Stranger really captures the great aspects of bluegrass gospel music—the high, lonesome, mountain sound with the good message.

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Dusk in Laguna Niguel I am originally from Argentina and love to travel the world. This past summer we spent some time in California, driving the nearby Los Angeles seaside towns. Laguna Niguel caught my eye, with its colors at sundown and the wide blue Pacific Ocean waving good bye. I joined the Pediatric faculty at Marshall in 2010, specializing in Pediatric Infectious Diseases. I love the family-centered community of Huntington and enjoy swimming at the YMCA, practicing yoga, traveling and taking pictures of my surroundings. My other passions include my 3 year-old daughter, Mia, and my husband, Damian.

Guada Lopez Marti, M.D.

⑤⑼

I am a Magna Cum Laude graduate of the Biomedical Sciences program and Honors College at Marshall University, and am now a second-year medical student at Marshall University’s Joan C. Edwards School of Medicine.

My stage credits include over 50 productions, including such roles as Amahl in Amahl and the Night Visitors, Scarecrow in The Wizard of Oz, Orin Scrivello, DDS in Little Shop of Horrors, The Rum Tum Tugger in CATS and many, many more. My professional performance work began in the summer of 2010 as an Entertainer and Diver at The Mayan Adventure in Sandy, Utah. I most recently starred as Princeton and Rod in the regional premier of Avenue Q produced by CUP. I also has an extensive Show Choir background serving as the founder and director for the ARTS All-Star Show Choir, where I served as director from 2007-2010. Under my direction, the AllStars received numerous awards, including the Fame Award, Best Male Soloist, Best Show Concept, Best Costumes, Best Instrumental Ensemble, Best Vocal Sound, Best Choreography, Divisional Grand Champions, and Overall Grand Champions.

I currently serve as the President of Curtains Up Players, Huntington’s premier theatre company. I will be actively involved in 6 full-scale productions over the next 12 months (all while studying for Step 1 at some point). Additionally, I serve as the choreographer for the 8-time State Champion Hurricane High School Red Hot Show Choir.

Throughout my life, I have been afforded countless opportunities to share my God-given talents with others. From coast to coast, I have had numerous “gigs” working with hundreds of the most talented professionals in the business today. Moreover, through Curtains Up Players, we are committed to a mission of spreading art education and theatre for social change to students throughout the Mountain State and the surrounding Tri-State area. I have never been so passionate about a cause as I am about this, and I’m committed to doing whatever is necessary to make it successful. I have been called “crazy” on at least a thousand occasions, mainly concerning my decision to take on such a large role in CUP and pursuing a medical degree at the same time – and maybe I am – but I wouldn’t have it any other way. I keep busy, but I’ve enjoyed much success with each and I have the best support system anyone can ask for.

There may not seem to be a clear correlation between Theatre and Medicine in the foreground, but theatre has had a tremendous impact on my life and, most certainly, on my future career as a physician.

Because of theatre, I have confidence. I possess the skills to effectively

communicate with others and work as part of a team. I possess creativity and good judgment. I can think abstractly. But perhaps most importantly, the arts have made me a better, more empathetic person – a trait I plan to utilize in caring for each of my patients.

Shayne Gue

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⑤⑧

MAY I bought a carton of raspberries at the market. Every time I drop one in my mouth I can’t resist rolling it around

Power Down

my tongue. The fuzziness sparse, exquisite roughness, your stubbled cheek against mine while you hug my worries away.

The way they crunch when chewed.

Reminder - they’ve seen days of sun and won’t give up so easy.

There’s a stain on my favorite old sweatshirt to prove it.

West Virginia’s starting to smell of honeysuckle. Delicious.

I roll down all the windows,

I was one of those kids that loved hanging out in libraries so I could smell the old pages of books. I began writing poetry when I was eleven while living on 250 acres of West Virginia wilderness, and started taking pictures soon afterward. "Power Down" was taken on an Engineer's Tour of NASA's Vehicle Assembly Building, where I was fascinated by the stories of the men and women who made America's shuttle program a success. We often forget how many behind-the-scenes actions go into such a program, and I found the testaments to their work mesmerizing. Everyone who has spent time in West Virginia should recognize "MAY". Those first, early days of summer when heat radiates from the ground, carrying whiffs of wildflowers and cricket songs. They are second in my book only to the first morning when I can smell autumn. In late June, 2012, we adopted our first dog, albeit while my husband was out of town. Later that day, I was walking him when the wind picked up out of nowhere and trees started sighing and cracking. We rushed home to hide from the storm and lost power for three days. I had promised Rex air conditioning when I adopted him. My bad.

I am a second-year medical student at Marshall University School of Medicine, who grew up in Charleston, WV. Someday, I plan to have my husband build us a house with a library, and adopt a lot more puppies.

stick my head out like the coonhound in that battered pickup. Inhale until lightheaded I’m delirious with smiles.

Sarah Slocum

⑤⑨

⑥⓪

I am a fourth-year student at Marshall University Joan C. Edwards School of Medicine.

Jason Locke

â‘Ľâ‘

Cruiser 2 Darlene Cordle

⑥②

Indigent?

Indignant taxpayers, we Glancing at the early morning waiting room Spot three.

Two Medicaids, say the murmurers, and one good one.

Don't get me started on Medicaid, they say.

That one's a frequent flyer. That new woman...just look at her- dressed to the nines and coming in here on Medicaid.

They oughta have to get jobs, buy insurance like we have to instead of buying Xanax and beer and tattoos and clothes like that.

You're new here doc, so let me tell you, the murmurers say.

That first one, he gets his Xanax every month right on schedule, never a day late.

H-hello d-doctor. I'm d-doing OK I guess. I'm st-still t-taking care of my Grandpa, and I th-think I'm good at it. I th-thought I might g-get a job at the nursing home, even with st-st-stuttering like I do b-but with my skin, this s-s-psoriasis. He rolls up his sleeves...

On to the next room. New patient. "Found a lump in her neck," it says.

Lovely young lady, scared to death. Squeaky clean, no make-up. I'm behind her to check her neck, the tag of that dress to the nines sticks out, brand name obliterated and "second" stamped there. Thrift store stuff, that fancy dress -threadbare at the collar and fading. I hope and pray I don't have cancer, doctor. We can't get any insurance since my husband had his cancer when he was a teenager. My kids....

Praying these patients didn't hear the murmurers. Praying I wasn't murmuring too.

Dignified patients, they.

Never having written poetry before, I was driven to this topic by the increasingly ugly talk of this political season. I used this as a way to express my feeling that in the labeling of people as “not taking personal responsibility for their lives”, when in fact one knows nothing of the lives of the labeled ones, these persons’ humanity is forgotten and their struggles are reduced to scorn. As I have always had a certain fascination with words themselves, I started with the “indignant taxpayers” idea, and the interrelationships of Indignant/dignified/indigent soon followed, and thus this piece.

Shirley Neitch, M.D.

⑥③