Obliterants Spring 2016

obliterants

Journal of the Humanities & Social Sciences in Medicine and Public Health

UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE ISSUE 7 - SPRING 2016

Motivation 1

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Lulu Wong

OBLITERANTS Journal of the Humanities and Social Sciences in Medicine and Public Health

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mo路ti路va路tion noun the reason or reasons one has for acting or behaving in a particular way.

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Letter fom the Editor

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elcome to the Spring 2016 issue of the Obliterants. In this issue we would like to underscore and highlight the fuel that energizes and nourishes our daily actions. What is the impetus that drives us from waking up before dawn, getting out of bed everyday and burning through the midnight oil?

We can create these positive feedback loops and find meaningful connections with humanity through art, compassion, and knowing what serves to catalyze our well-being.

We hope as you flip through the colorful pages of our Spring issue that we can actively participate in providing you refreshment, invigoration, and to ignite your innate motivation. Thank you to each and every one of the contributing writers, poets, artists and photographers for your innovative creations.

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EDITORIAL ADVISOR Gauri Agarwal, MD EDITOR IN CHIEF Mary Lan EDITORS Emeka Albert Stephen Allegra Misha Armstrong Cathy Chicon Jo Duara Ariel Eber Olivia Gardner Francisco Halil Jeffery Lin Angela Zhu FRONT COVER Laura Bloom

ABOUT OBLITERANTS Obliterants is a journal published by students, residents, alumni, faculty, and staff of the University of Miami Miller School of Medicine.

Its mission is to publish writings and artwork that promote the humanities and social sciences in medicine and public health.

Obliterants is not an official publication of the University of Miami School of Medicine.

Expressed written opinions are solely those of the authors and artists and do not necessarily represent those of the University of Miami, the School of Medicine, or the Department of Epidemiology and Public Health.

Submissions Obliterants is published annually. Faculty, staff,

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BACK COVER

residents and students are invited to e-mail

Mary Lan

their submissions to obliterants@gmail.com

Laura Bloom

TABLE OF CONTENTS 6 Rose Ceremony Tribute Photos by Eric Weiss

10 Mae Tao Clinic Photo by Myra Aquino MD, MPH

11 A Feature Of Matthew Ciminero’s Photography

By Matthew Ciminero

15 Mud, Math, And Water Poem by Gauri Agarwal, MD

17 Time Capsule Article by Benjamin Vipler, MD

24 Loud Soundless Battle Poem by Sandy Jiang

26 Reflection On My Motives Article by Jack Strutner

28 Every Moment Is An Opportunity to Live Painting by Michelle Shnayder

30 The Art of Listening Revisted Article by Sandy Jiang

34 Writing His Own Story, 1992 Article by Daniel Lichtstein, MD

37 Paintings Walking trail, Farming, CT by Robert Kozol, MD Painting by Ekaterina Kostioukhina, MD

38 Third Year Painting by Jennifer Shiroky

39 Empathy Poem By Paige Finkelstein

42 Cannot Be Changed Poem by Sandy Jiang

46 Mi During The Cardio Module: An Etiology Poem by Hillary Goldstein

50 The Things They Carried Poem by Julien Thomas

52 To A Future Medical Professional Poem by Sarah Ring

54 Better Than Average Article by Ashita Klein

56 Motivation Photo by John Lee

58 Contributor Bios

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8 Eric Weiss

Eric Weiss

Eric Weiss

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mae tao clnic taken by myra aquino MD, MPH This is a picture of the Mae Tao Clinic in Mae Sot, northern Thailand, near the Burmese border.

The clinic is a health service provider and training center that promotes quality health care for displaced Burmese and ethnic people along the Thai-Burma border. I was here for a month in February 2014, spending up to a week in every ward to observe and assist the staff and their patients. Needless to say, it was incredibly eye-opening, and I observed conditions I rarely-- if ever saw-- in the United States, including thalassemia and severe malnutrition.

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matthew ciminero It was refreshing to be able to spend some time with nature again after completing 14 continuous weeks on tiring Orthopedic Surgery rotations that begin long before the rooster’s crow and end long after your friend’s have finished happy hour. The days were filled with unbelievable weather, slightly unusual for Fall in the Pacific Northwest from what I gather.

The air was cool and crisp, not a cloud in the sky. There was never a moment devoid of magnificent wilderness, whether relaxing next to a babbling brook at the base of a beautiful waterfall -- the sound of the water flowing against mossy rocks and fallen logs was tranquil; hiking through a lush Fir forest -- the scent of Ponderosa pines permeated the atmosphere while sun rays pierced through the forest’s leaves and branches and warmed my skin; or taking a stroll on a west coast beach -- not a single worry in the world.

This carefree notion lasted into the evenings. As I stood under the night sky and let my eyes adjust, the black veil above me became freckled with bright stars. Soon the entire universe was before me. A cloudy band of stars shot upwards from the southern skies and arched above my head. I realized how insignificant my worries were relative to the universe’s unfolding.

There was something calming about this notion of insignificance, reminding me to live in the moment, to breathe in the fresh air and be at peace with oneself.

Hopefully my pictures can display a fraction of the beauty I was fortunate enough to witness while on this vacation. Trips like this help to put things into perspective and provide a haven from what you’ve been working very hard for over the entirety of your academic careers. They serve to recharge your batteries and return to your goals with newfound insight and motivation.

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12 Matthew Ciminero

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Lulu Wong

15 Lulu Wong

16 Matthew Ciminero

mud, math and water

by gauri agarwal, MD I rinse my young son’s hair in a Mumbai hotel tub The dirt of our splendid day melting into the marble My eyes wander to the window to the slums at dusk As a toddler walks naked on corrugated cardboard A gaunt dog slowly saunters by him as the clouds open My husband and I debate vigorously in the States About the value return of a private school education A girl of nine in East St. Louis works on an equation As a bullet ravages the glass of her window And ends the days, degrees, and daughters to come I worry about my children and their ability to swim Should they fall, their arms stretching for a beloved ball As a Syrian boy is released from his mother’s arms The unsatiated waters of the Mediterranean engulf him His body floats to the sand, his face caressed by the froth The world weeps and forgets, Aware that mud gives and takes life That dreams are only for some That water can cleanse or drown

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time capsule

By Benjamin Vipler, M.D.

In 5th grade I was given the assignment of creating a time capsule. As with most time capsules, the goal was to include as many things that were of interest at that time, to discover at a later date, and hopefully be surprised with the change that had occurred. When time came to open my capsule, I was able to share a chuckle with my close friends while I flipped through the Star Wars cards, wrestling figurines, and the Muggsy Bogues Jersey. I never did turn out to be one of the shortest players in the National Basketball Association, as my idol at the time was. Shortly after our laughter was had, these inconsequential memoirs were tucked in a drawer somewhere and forgotten for good.

Who was I going to invite to the “Sock Hop?” Was I going to be picked to play soccer at recess by the kids wearing the Adidas Sambas?

Should I go with Oregon or Kentucky for my state report?

These were the important questions and decisions that I had to deal with in 5th grade. This brings me to the question, what if I did a time capsule at a more important time in my life. What if I created a time capsule in medical school and opened it after residency? Would I have predicted that I would go into internal medicine when I wanted to be a psychiatrist going into medical school? Would I have ever guessed that I would be chief resident of the flagship hospital in the Military Health System? Would I have known that I would go on to marry a girl who I met on the bus down from our small Boca Raton regional medical campus to the welcome barbecue at the University President’s house in Coral Gables? Would I have guessed she would go on to be chief resident the hospital down the street from mine?

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What mementos would I have saved?

At the beginning of medical school, we were introduced to journaling. Some weeks this became an administrative task that had to be completed by midnight on Sunday. Other weeks this was an avenue to vent. Others still, it was a way to reflect on the interesting diagnoses and unfortunately sick patients I would see at their most vulnerable. I remember after one of our examinations, one of our administrative assistants asked for our signature to “release” our journal entries. I assumed this would be used for undergraduate medical education research so gladly signed. To my surprise, shortly before medical school graduation, I was presented with a bound compilation of all the entries I created throughout my four years. I still periodically open this journal, which offers an opportunity to laugh, cry, think, or dream. It sometimes offers the motivation that may be lacking on those late nights at work, when I know I have to trudge through some snow on the way to the train back to my one-bedroom apartment. I would have saved this memento in my

AS FOREIGNERS, WE CAN PREACH THE “RIGHT” WAY TO CONTAIN I had the privilege of attending medical school at what used to be the UMMSM regional campus EBOLAWhileALL WANT, BUT at Florida Atlantic University.

I canWE see that “The U” still has a THIS significant presence in Palm Beach County, my exact program is noONE longer available to current WILL DO NO SERVICE IF medical IT ISschool applicants. On a weeknight during my second year, I recall receiving a text message from one of my classmates NOT ACCEPTED BY THE PEOPLE. at 9PM which read, time capsule.

“Read your email… tomorrow is going to be interesting.”

When I read my email, I learned that there was a news article published that day stating that Florida Atlantic University was opening their own medical school, and that many of our faculty and deans who interviewed, taught, and mentored us would be potentially leaving us. I remember the next day when an impromptu meeting was called by our core faculty to dispel any rumors. I recall 48 students peppering our devoted UM faculty with questions about the legitimacy of their potential degrees. I recollect a few students who were parents or

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homeowners furiously inquiring about school districts, and referencing the current “buyer’s market.” Most importantly, though, I am still impressed with the poise that our UM faculty handled these questions. I am still amazed at how our devoted educators worked with each and every student to make sure their transition to the “New Regional Campus” was seamless. My sub-internships in both medicine and surgery in Palm Beach County were some of the most valuable clinical experiences I had as a medical student, all while maintaining the lifestyle that I had grown accustomed to. I am blown away by the motivation our UM faculty had to NOT throw in the towel and call the few years building the UM presence in PBC a “failed experiment,” but rather continue to build UM in PBC into one of the most competitive regional campus programs in the country. I would have put one of those newspaper clippings about FAU’s new medical school into my time capsule, and once again remember the struggles, but also the prevail of our class and our school.

What if I created a time capsule now? What would I include?

Interesting patient vignettes, wedding keepsakes, military awards, and football game tickets would probably make the list. As I approach the start of my fourth decade of life, I find that I have a better idea of what is important and what is not. Maybe football tickets are on the same level as wrestling figurines, but those are the types of mementos that need a time capsule to remember – The patients, mentors, teachers, and other experiences in my life that have made me the person I am today will always be with me. &

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Eric Weiss

Eric Weiss 21

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Eric EricWeiss Weiss

Lulu Wong

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Loud soundless battle by sandy jiang

A compliment brushes it off but it comes back and still stays.

There is much fear and unrest in the world these days.

Loudness everywhere despite no sound: I see the uncertainty, loneliness in your face as I walk around.

Much defiance and dividedness and not enough solidarity, Too many façades enacted and rehearsed and not enough sincerity.

You shout over you, you over me, and I over me, There is too much blindness even though everyone can see.

We all look over our shoulders each doubting and conspiring, A game that doesn’t exist but yet so seductively inspiring.

To be up one against your neighbor and friends, There is no compromise or backing down—it never ends.

Chaos, sounds, violence, colors, anger, passion in the air, It’s in the music, the art, children, food, a poison infiltrating everywhere.

Quick it’s time! Carry your weapons of choice, You’ve insulted my blood, my life, my mind—now hear my reasonless voice!

It is a never ending battle of the ones who want and the ones who settle, We carry the wrong warfare, argument, mentality, and equipment into this loud soundless battle.

Divided by crossfire of unrequited, longing, inadequacy, and the need to be heard.

There is much shouting, pointing, and screaming but no one has really said a word.

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And the world keeps dividing, new groups forming, all in blinding anger, The world on fire, every man’s word sparks with fear and danger.

No one listens to one another the tensions start to boil and fester, I watch in the distance, a world covered in so much hurt, thorns—a crying soul covered in blister Not enough love and listening and too much sorrow, I try my best each today that is always gone tomorrow.

Nothing can happen again twice and we cannot rehearse, Error is written and fate may have thought it has us under its curse.

But I know we wake up each morning with something to live for, In this loud but silent battle we still have time to make this into something more.

This battle should have been over but it clearly goes on, People must still care enough for lines to still be drawn.

It’s time we break the boundaries and erase the past that instilled so much bitter and fear.

We cannot cover our ears any longer, there is no more time—the future is here.

It will be difficult to stare straight into my eyes and tell me what is true, It will be hard for me to accept who you are, and to accept your view.

But whatever motivation that drove you into such silent and smoldering hate, I know we can redesign the world’s future and rewrite its seemingly disastrous fate.

Whatever love is buried and below can still be undug and blended into something new, I believe in the last glimmer in light in me is the same glimmer of light I believe in you.

Mary Lan

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Mary Lan

reflection on my motives by jack strutner

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single mother in Port-au-Prince, Haiti was struggling to raise a son and make ends meet. One day she became sick and had to be hospitalized. In the hospital the mother asked her son to go and purchase dinner nearby.

Little did he know that after running this errand his life would be changed forever. When he returned he was informed that his mother had passed

away. Devastated, the boy attended his mother’s funeral days later. After the service, the boy stood alone, watching as all of his relatives left one by one. With no one else to turn to he

then hiked his way through the crowded and chaotic city of Port-au-Prince to an orphanage named the Maison de Lumiere, or The Lighthouse.

It has been over four years since I worked at The Lighthouse. During my stay there I had the privilege of getting to know this boy and his story which has been burned into the back of my mind. I have often thought of the doctors who treated the boy’s mother. I wondered if they knew that one day of work for them would drastically impact this boy’s entire life.

This past month I found myself in the shoes of those doctors as I was involved in the care of an ill patient. He underwent a procedure and experienced multiple complications during the surgery. The next morning during rounds our team heard the code and ran to his room.

As I was performing chest compressions I began to feel the weight of the situation and his life hanging in the balance. Despite our best efforts the patient still passed. What family and friends were in the waiting room anticipating the news? How would their lives be forever changed?

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In the days after my patient passed I began to reflect on both experiences. Being on both sides of the story of caring for a dying patient and seeing the effects on their family left me with a great sense of duty to work hard to become a competent and compassionate doctor.

For in our profession the stakes are high, we deal with life and death. What a privilege, honor, and tremendous responsibility that entails. For with every patient encounter we have the opportunity to drastically affect their lives and the lives of those close to them forever. %

Lulu Wong

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Michelle Shnayder

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Sometimes life can get in the way of living. We must remind ourselves of the infinite possibilities that we have each moment on this earth.

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by Michelle Shnayder

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the art of listening revisted by sandy jiang

It’s easy to be stuck in a world where terrible diseases freeze as still images on powerpoint slides, patients are reduced to case studies, and symptoms are quickly simplified to statistics and algorithms memorized from lists and exams. However, it is important to realize that patients are people, and when they leave the clinic, like you and I do at the end of a day, they are shaped by families, lives, habits, personal battles, and complexities that are taught only through human experience. We still get very black and white responses as we scroll through the list of questions we must ask in a personal history; we do not get to observe, smell, feel, and in a sense “hear” their full holistic history. This is especially the case in a city as diverse as Miami, where cultural diversity really impacts how we “listen to our patients.” In some cultures, people are taught to “listen” to the doctor and never give information. We also live in a city deep seeded in poverty and we, as clinicians, may not be familiar with the daily challenges families go through just to put a meal on their table. There are so many unheard voices even though we are technically listening in the clinics. The “Art” of listening is being lost, and I think it is time we revisit it.

Why are concerts and movies universally enjoyed by all, but art galleries only seem to cater to a select few? As an artist, I find it strange that I do not enjoy sterile white walls and paintings.

To me, art should really appeal to the 5 senses, and it makes sense as to why experiences that involve taste (drinks/cheese/popcorn), sight (the art itself), hearing (orchestra, sound effects), feel (velvet seats, costumes), and smell (odors, market scents, perfumes) were more appealing to a universal audience, while galleries that involved only 1 sense appealed to those who were more sight orientated. When I paint or draw, I have the most bizarre genres of music, random snacks,

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Matthew Ciminero

feel and smell the blend of mediums as they roll onto paper. What if that is what is going on in the healthcare system? We listen but we do not hear, we see but we do not truly comprehend? And I believe, truly understanding our patients requires more than a clinical visit in which our patient becomes a sterile painting on a wall; alive to some but a dead experience to others.

To truly understand the art of listening, we must realize that everyone listens in a different way.

Some people listen visually, others by smell, and others by hearing. I started going out to Parks and Recreation sites for my capstone experience to design a nutrition curriculum for juvenile delinquent and at risk youths. Sitting at my desk writing out models that had been tested by top tiered institutions should gear me to write a truly comprehensive curriculum, right? I found it was more complex than that. As I visited the youths in the community, I realized I wasn’t seeing the stubborn streaks that kept our nation from combatting obesity, the family traditions that prevented youths from exercising and acculturating into American scientific standards, and

We see the clinical problems, but we do not really see the community shades of colors, voices, tastes, and sensations that make our patients complex people.

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adolescent behaviors that made nutritional educational activities hard to implement. All of this made me realize how complex the patient-physician interaction truly was, how complex it was to create protocols and models without the help of various stakeholders in the community, and how crucial it was that medical education emphasized field work.

By being out in the field, I see parent child interactions, child-child interactions, environmental surroundings, habits, quirks, and idiosyncracies in the community that explain so much of the nation’s trends towards obesity. Healthcare leaders are very aware of the issue with malnutrition and obesity, but implementing change has been difficult. When the community talks to me, they tell me misrepresentations and impressions they have about the healthcare system, healthcare professionals, and medical knowledge. Without this dialogue with community members outside of the clinic, I would not have been able to truly “see” the complexities in our healthcare system. Every week, I sit with a board of community members including doctorates, school super attendants, juvenile services, parks and recreation staff, law enforcement, and physicians, and I realize we, as healthcare providers, cannot tackle many of the health issues without a comprehensive group of people to help us. We see the clinical problems, but we do not really see the community shades of colors, voices, tastes, and sensations that make our patients complex people. We teach biochemistry, clinical vignettes, case studies, and basic sciences, but we do not truly teach nutrition and preventive health. Most medical schools cover 20 hours of nutrition, often sprinkled in between organ modules.

If medical education in nutrition and wellness is not being treated seriously, then physicians will not take the area as seriously, and there will be less future advocacy for our patients. We “see” our patients and their problems, but we do not truly “see” their life stories, health habits, nutrition, physical activity, and other lifestyle factors. Our complete “patient history” is truly not that holistic, and I think it is important that physicians go out into the community to understand healthcare in preventive terms. Now when I see patients, I not only listen to their histories, but I also try to hear, smell, and feel what they describe from my experiences in the field. I think my being out in the

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community has really helped me put a more, but not perfect, construction of the person in front of me.

I think back to the exercise that as first years, MD MPH students underwent, in the Frost Museum to learn the “Art of Listening.” For some, the exercise was enjoyable, as they were truly visual individuals. For some, it was a frustrating experience, and I think part of that stems from the fact we do not have the cultural or knowledge background behind some of the works. Without that knowledge of sight, smell, taste, hearing, and sensation, we make assumptions and “see” things but do not “comprehend.” I think anyone can benefit from the art of listening, but we must realize there are many ways of “listening”, and that it encompasses all our senses. O

Sandy Jiang

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writing his own story, 1992 by daniel lichtstein, MD

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first met my future father-in-law during my sophomore year in college in 1968. He had been widowed thirteen years earlier, and had raised three children on his own.

Leonard was the most down-to-earth, humble man I had ever met, and we “clicked” right away.

As I spent more time with him and got to know him, I realized that although he didn’t easily talk about his life, he had lived a remarkable one.

Laura Bloom

the US. They slept in the forest, ate whatever they could, and amazingly made it to their destination after four months. Leonard arrived in Flint, Michigan not knowing a word of English and having to help his family survive.

He went on to the University of Michigan and subsequently law school, after which he ran a successful family business.

Like so many, Leonard’s life was interrupted

by WWII. He was in the Army and stationed in France. His unit came under fire on numerous occasions. On one very memorable day Leonard was instructed by his officers to stay behind, alone on watch in a farmhouse in France, while the remaining members of his unit went out on a mission. Leonard soon realized that a German patrol unit was approaching and he had no way of communicating with his commanding officer.

Leonard was born in Russia in 1911 and at the

He crawled under a bed while the Germans

age of eleven, he and his family walked almost

searched the farmhouse, and was a cough

four- hundred miles in an attempt to board a

or sneeze away from being captured or killed.

ship first headed for England and then on to

Fortunately, he made it through that day and

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the rest of the war to return to Michigan to his wife and family.

My relationship with Leonard was one of mutual respect and from my perspective, extreme admiration. He didn’t have an arrogant cell in his body, and he never wanted anyone to feel sorry for him. I admired him greatly not just for what he had survived and subsequently accomplished in his life, but for the way he led his life. His needs were simple and he was an outstanding father and role model to his three children. I like to think that I helped bring out his sense of humor, which was not obvious to many who knew him.

My wife and I left Michigan in 1970 so that I could begin medical school in NY. Leonard was a wonderful grandfather to his five grandchildren. Unfortunately, in his 70’s, Leonard had his first heart attack. He did well for years, but in 1992 had another MI resulting in severe heart failure.

When my wife and I arrived in Michigan, Leonard was intubated in the CCU. He was being cared for by a team of physicians, and I met the intensivist in charge. Being the only family member with a medical background, I communicated with the physicians daily and it was clear that Leonard’s prognosis for meaningful recovery was very poor. I did the best I could to transmit the information to everyone in the family. Leonard was awake during this time and able to communicate only by writing. It became clear to me that what he wanted was to have the tube removed and be allowed to have a cup of coffee, and maybe a little soup. On his third hospital day, I was alone with him in the CCU, leaned as close as I could to his good ear and asked him if he wanted the doctors to remove the tube. He nodded yes. I asked him if he realized that if the tube was removed, he may not be able to maintain an adequate level of oxygen to survive.

He nodded again. I repeated the question a number of times, and each time, Leonard nodded affirmatively and with conviction. I shared this with the family, and then spoke with the intensivist.

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The intensivist reiterated that he did not feel Leonard would live very long after the tube was removed, but he was willing to remove the tube if that was what Leonard wished.

A few hours later, the tube was removed, and Leonard was permitted to have some broth and a cup of black coffee. Everyone in his family spent time with him over the next several hours before kissing him goodnight. Leonard died peacefully at about 12:30am that night In Atul Gawande’s book, “Being Mortal: Medicine and What Matters in the End”¹, the author talks about allowing patients to “write their own story” and openly and frankly talks about how he helped his own father do so at the end of his life. Decades before in East Lansing, Michigan, a very special man was allowed to write his own story at the end of his life, and have a cup of coffee and a few sips of soup. ^

1. Gawande, A. Being Mortal: Medicine and What Matters in the End. Metropolitan Books.

Henry Holt and Company. 2014.

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Walking trail, Farmington, CT

by Robert Kozol, MD

by Ekaterina Kostioukhina, MD

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City Park

third year by Jennifer Shiroky

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I created this piece for an assignment we received during the first semester of third year. The deans requested that we bring in a piece of art made or found that expressed how we were currently feeling at this point in our careers. This piece is about leaving the classroom, entering the healthcare system and being involved in patient care for this first time. It’s about balancing developing clinical skills and understanding, grasping what my responsibilities are as a student, building knowledge, appreciating the fine details and work up of a patient, while maintaining awareness of the patient as an individual with a full life outside of our hospital interaction and their illness.

Matthew Ciminero

empathy

by Paige Finkelstein

When you are hurting, I am hurting When I deliver the news that your beloved has passed My tears flow like your tears, albeit on the inside When you feel pain, I feel pain When I prick your arm with the needle I cringe with your reflexes withdrawing, albeit on the inside When you are frustrated, I am frustrated When I tell you I am not sure what the answer is I have so many questions too, albeit on the inside When you are worried, I am worried When you see your child has fallen ill I am frightened like you are frightened, albeit on the inside When you are fighting, I am fighting That daunting diagnosis I persist as you persist, albeit on the inside When you feel relief, I feel relief When I tell you it’s benign I cry out with joy like you, albeit on the inside When you are my patient I feel what you feel

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Mary Lan 41

cannot be changed By sandy jiang

It was a dream! A gaudy opening illumination of a ray of choice, to put what had been in books into hearing it in life and voice, holding the letter of invitation to a chance to impose, my ideas on far lands and exquisite people contained only in prose, and yet they whispered, a culture cannot be changed.

A paradise of colors and culture so unlike my own, two worlds lived in the same geography I jabbered excitedly into phones, one shrouded in books, theories, ties, numbers, literature, and instruments, another drenched in color, grime, smells, charms, language, and temperaments, and yet they whispered, a culture cannot be changed.

Sands of time crept by despite no change in rains and heat, It began to feel as if though moments and seconds were always put in repeat.

One world continued in its machine of data, steel, graphs, and meetings, Another continued brash, broken, gaudy, yellings, and beatings, and yet they whispered, a culture cannot be changed.

Holding white tediously planned pristine papers of maps, proofs, and authority, I look at the scene- unmatched in description and meshed with uncertainty, and yet the experts in their white luxury say to go on and change and better, despite the invisible forces that bind these people’s lives like a fetter, and they continued to whisper, a culture cannot be changed.

And the worlds began to blur but yet grow farther apart, Travels back and forth only make me question however will I ever start?

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One world growing whiter and blacker in barcode in ideals and theories Another still in messy color, unwavering, unforgiving, drenched in song and stories, and it began to creep on me, a culture cannot be changed.

Sunrises each day making my familiar surroundings more foreign, A nightmare brews-- The theories make no sense meshing two systems- a distortion, A war ensues, newspapers decry infamy and inequality, One culture defiantly refuses and another proclaiming superiority, And they raged, a culture cannot be changed.

A world of white pristine castles not a person ever experiencing wear and tear, trying to patronize or help peoples coming from lands of war and fear, monies, lives, and time are wasted and squandered, As all efforts to make theories into real life practice are now floundered, And so it is, a culture cannot be changed.

But the proofs and these studies, the leaders said! They must be right, We must impose them and teach them and put up a fight, What we believe from luxury and perspective to make this world what we deem good, Nevermind culture differences- they do as we say they should, But the natives seethed, a culture cannot be changed.

A race to pack and leave before there is an uprising, I pack my bags haunted by the first day of my anthropological teaching, Quick quick hurry up and finish this task and put it onto a resume or paper, There’s nothing you can change, they howled as I wake from my dream drifting away in vapor, and I remembered and know now, a culture cannot be changed.

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45 Matthew Ciminero

MI During the Cardio Module: An Etiology

by Hillary Goldstein

You were a boy at school in Brooklyn when your father died, and you told us that during that day you'd heard him calling your name.

My mother called me at school when you died during the Cardio module.

She told me you'd had a heart attack.

And after I hung up the phone I looked back at a slide: Pathophysiology of Unstable Angina I realized you had been calling my name for weeks When I read your medical records, I would learn that you had described your condition to me fairly accurately.

There was a blockage in a major artery in your leg.

The doctor had put in a stent, which had then blocked up again.

You wanted so badly to see my cousin graduate That you let us encourage you to walk, even though it hurt terribly and you worried it was no use trying

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I had learned that the mortality rate For men of your age and comorbidities with severe atherlosclerotic claudication was so high.

When my mother called to tell me, I was horrified to find that I was sad, but not surprised.

I felt I knew too much and not enough to comfort my grandmother.

Insert empathetic statement here.

That's how you get educated You used to say when I complained that school was too hard.

When I wait for the train in the morning, I remember How you rode the bus to work for two hours, both ways, every day so that your children could live in the suburbs, and imagine a different kind of life.

Matthew Ciminero 47

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the things they carried By julien thomas

Matthew Ciminero

They carried MRC pens and Calder library penlights, water bottles, Advil, gum, green tea mints, car keys, house keys and a rarely used key for home.

They carried paper tape, surgical scissors, tweezers and gauze, Pestana’s Notes, Surgical Recall, and the fear of spreading clostridium difficile.

They carried Pocket Medicine and a Moleskine handbook, an IPAD and an extra charger. They carried a mortgage on their education.

They each carried a Littman Cardiology stethoscope.

They carried badges for Veteran’s Affairs, JFK, Holy Cross and UM. Each of them wore a long, heavy white coat with pins from their societies. Everywhere they went they carried the oath of Hippocrates and the appearance of a physician.

They carried the most vulnerable secrets of their patients and those locked within their patients’ bodies. They carried the agony of mothers, and daughters, and sisters; of people who elicited their deepest sympathies while also inciting a struggle to understand the choices those patients made.

They carried crackles and wheezes pulses, murmurs, heaves and thrills, they carried the music of each patients life. With each patient that surveyed rows of watchful eyes over surgical masks silhouetted by operating room lights, they carried the fear of oblivion.

They carried the wails of terror and grief pleading for help that echoed from rooms as they walked purposefully down ward halls.

They carried the daily decisions that will determine the physicians they will become. They carried the regret having to choose between their patients, their studies and themselves.

They carried the expectations and pride of their families and friends.

They carried each other.

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51 Emma Crichton

To a Future Medical Professional

by Sarah Ring

He who has an ear, let him hear The subtle cries Of a patient in distress, The pleas for healthcare Amongst those who have less, The need for hope When one’s future is a guess, The secrets of past One’s presentation may confess.

He who has an ear, let him hear The pounding of his heart Before an upcoming test, The blinking of his eyes From many nights without rest, The insecurity he reveals Disguised by words of jest, The acceptance of himself When he did not do his best.

He who has an ear, let him hear The uniqueness of his background By which he is blessed, The views of his peers Which cannot be repressed, The differences in perspectives Sources to be acquiesced, The changes in his understanding Beyond what he may have guessed.

He who has an ear, let him hear.

No. He who has an ear, let him listen.

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Better Than Average By ashira klein

Matthew Ciminero53

better bythan average ashita klein Beginning at birth

, people judge others based on their

measurable success. Has your baby rolled over yet? Will I see you at the straight-A ceremony this week? Why didn’t you go to graduate school this year like you planned? What grade did you get on that exam? Did you do better than the average?

Better than the average. I find that ridiculous. On one hand, it is sometimes, in rare instances, helpful to know. If the entire class failed and the average was a 54%, maybe your 50% doesn’t look so bad. For myself, I find comparing my success to the average distressing. If I am happy with my grade but earned less than the average, I stop feeling as proud of my grade. Though some use it for motivation, as society trained us to do, imagine if everyone was solely motivated based on their expectations for themselves. If I am happy with my score and find it is above average, I am extra happy. But then I think about what that means. It means I am happy I did better than my classmates; happy that others didn’t do as well? That idea is definitely not something I want to perpetuate.

I understand that I am in control of whether or not I choose to look at the average, but sometimes I think we would be better off not knowing the average. Think about it. We are in medical school.

We are in school to become doctors—to save lives, to make a difference, to choose medications and give treatment options for patients. Does it really matter how well we did compared to the average? What should matter is how well we know the material before we are given the tremendous responsibility of translating it into patient care. If I happen to not do well on an exam because I was stressed or had a personal emergency or just a bad day, but actually think I know the material, isn’t that technically what matters?

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On the other hand, in order to be doctors in certain fields, good grades play a part; possibly a large part. But I also know other slices of our medical school careers do also. Research.

Standardized tests. Extracurriculars. Leadership. Kindness. Compassion. Empathy. There is a reason an interview goes along with both the residency and medical school application processes. If grades and scores were the only parts of our applications residency programs really care about, they would never need to meet us; they could read all about it on a resume or transcripts. I am not saying I will not study hard to earn a high grade on exams, but imagine if we could move to a mentality where we want to do well for our patients, instead of for numbers on future residency applications. Imagine what that would do for our motivation and mental health.

Why is success so exclusively measured by grades and bank accounts? I know plenty of excellent parents; when was the last time someone congratulated them on unconditionally loving and supporting their kids in all endeavors? When was the last time society placed as much approval and acceptance on a painter or musician as when a parent says “my child is going to be a doctor?” Comparing ourselves to the average just perpetuates the idea that doing numerically better than others is somehow our goal in life. Numbers exclusively don’t measure knowledge; they definitely don’t measure how it will translate into patent care. Learn as you see fit. You may need to ‘play the game’ to a certain extent, but don’t let it rule your life. Your score (or even pay check) may be more or less than the average, but when your end goal is to help people because you simply want to make a difference, you are always better than average. a

We are in school to become doctors—to save lives, to make a difference 55

Aspiring to be a cardiologist, John J. Lee, a second year internal medicine resident at the University of Miami, Holy Cross Hospital program, motivates himself to push his limits in all facets of life.

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Salman Farsi, MD

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STAFF + CONTRIBUTORS Laura Bloom MS Genomic Medicine, MD, MBA Class of 2018 Laura has had a unique and exciting path through life. An artist and world-traveler at heart, Laura seeks to find beauty and humanity in every experience. Here are several photographs she has taken throughout medical school that were inspired by the ideas of motivation and perseverance.

Lulu Wong MD Class of 2018 I am a second year medical student who moved to Miami from California for medical school.

I have a lot of hobbies, some of which include reading, snowboarding, yoga, painting, and horseback riding. I love animals and nature, and I feel my art tends to reflect that. I hope you enjoy my paintings!

2nd Lt. Eric Weiss MD Class of 2016 I am a Miami Hurricane down to my base pairs, and am proud to soon be serving my country as an officer in the USAF. I developed a passion for photography and love to capture the world around me!

Myra Aquino MD, MPH Class of 2015, Writer, Film Director (rap music video director) Guam- and Philippines- born and raised, Seattle-college’d, UM medical school graduate.

Based in San Francisco rediscovering life and having countless breakdowns while extracting knowledge from the tech and gaming industries, and writing and shooting films for health agencies and hip hop artists.

Matt Ciminero MD Class of 2016 Everything around us has beauty; it may simply require a change in perspective to find it. I enjoy photographing just about anything, especially nature. I’m rather fond of sports, movies, writing, and being a nerd. Netflix and I have a love/hate relationship.

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STAFF + CONTRIBUTORS Gauri Agarwal, MD Associate Regional Dean for Medical Curriculum Dr. Agarwal lives in Boca Raton, FL with her husband and four children.

Ben Vipler, MD Chief Resident, Internal Medicine, Walter Reed National Military Medical Center, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences, UM Class of 2008, Miller School of Medicine Class of 2012 Ben grew up in Upstate New York. He is an avid skier, who spent 5 days per week on the snow during the winter of his senior year of high school -- a factor that ironically led to his choice in college. Ben currently lives in Washington, D.C. with his wife - a fellow UMMSM grad - and they spend most of their time away from the hospital trying all of the new restaurants the city has to offer.

Sandy Jiang MD, MPH Class of 2018 Sandy is a tea connoisseur who turns her travel time on buses, trains, and planes into knitted scarves. She enjoys going to restaurants and art shows to steal recipes or art pieces for herself to replicate. She enjoys her public health work with Parks and Rec Miami, and hopes to work with adolescent health and wellness.

Jack Strutner MD, MPH Class of 2017 My name is Jack Strutner and I grew up in Monterey, California. I am currently a MD/MPH student with a particular interest in global health. I have worked with various organizations in Haiti including the University of Notre Dame Haiti Program, Sustainable Organic Integrated Livelihoods, and Child Hope International orphanage.

Michelle Schnayder MD, MPH Class of 2018 Michelle graduated from Brown University in 2014 with a BSc in Neuroscience and Science and Society. Prior to entering medical school she had been a captain of the Division 1 Brown Gymnastics Team and researched the effects of meditation on the brain. Michelle is currently the MD/MPH Curriculum Representative of the 2018 graduating class and a co-founder of the Mindful Med Student Interest Group at the Miami Miller School of Medicine.

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STAFF + CONTRIBUTORS Daniel Lichtstein, MD Professor of Medicine, Regional Dean for Medical Education Received his BS from Michigan State University (Honors College) 1970, and MD from State University of New York, Downstate Medical Center, 1974. Internship, residency and chief medical residency in internal medicine at Jackson Memorial Hospital 1974-78. Private practice, West Palm Beach, Florida 1978-1996. UMMSM faculty since 1996.

Robert Kozol, MD Professor of Surgery Dr. Kozol was born and educated in Syracuse NY. He formerly served as Chairman of the Department of Surgery at the University of Connecticut. He currently serves as Program Director of the Surgery Residency on our regional campus. He resides in Lake Worth with his wife Jill.

Ekaterina Kostioukhina, MD PGY2 Internal Medicine at UMMSM Regional Campus Art is a way of creating a world of wonders, a manifestation of the magic within. Through rhyming sounds that resonate and sing our feelings, we can share the unique experiences that medicine lets us see.

Jennifer Shiroky MD, MPH Class of 2017 I grew up as an artist in a medical family. As I continue to experience more within the world of medicine, my experiences within the world of art have developed into a guide and my pieces into fusions of the two.

Paige Finkelstein MD, MPH Class of 2018 Graduated from MIT in 2014 with a double major in chemical engineering and biology and double minor in chemistry and science, technology, & society. Academic interests include trauma, surgery, and novel drug development. Hobbies include photography, baking, and glass blowing.

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STAFF + CONTRIBUTORS Hillary Goldstein MD, MPH Class of 2018 Hillary grew up in New Jersey and is pleased to have found warmer waters here at the University of Miami. She hopes to practice Family Medicine. When she is not wreaking havoc on the Medical campus, she can usually be found jogging around Brickell or napping.

Julien Thomas MD, MPH Class of 2017 As Ethics Representative for the RMC I’ve had the opportunity to explore the many ethical questions we are exposed to as medical students. I enjoy ethics because of the deep discussions each case sparks and the sometimes surprising solutions that can arise with a little creativity.

Emma Crichton MD, MPH Class of 2017 I grew up in Jamaica and learned to love Caribbean art. I explored this love during college pursuing a Studio Art Minor, more for the chance to learn various types of craft rather than for the addition to my degree. During med school I try to continue this hobby as often as possible!

Sarah Ring MD Class of 2019 Sarah comes from the best undergraduate institution in Florida (Go Gators). When she’s not in Calder Library, you’ll most likely see her trying to convince future MDs that she can still exercise on a broken foot, harassing people to come out to Mindful Tuesdays (irony is great), or suboptimally dancing...anywhere, really. Now you have the opportunity to read her just-as-suboptimal poetry.

Ashira Klein MD Class of 2019 A South Florida native who uses her blog to remind herself, as well as her readers, that there is more to life than grades and school. Besides living the life of a med student, she loves spending her free time working with kids or relaxing at the beach.

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STAFF + CONTRIBUTORS John J. Lee, MD PGY-2, Internal Medicine, Holy Cross Hospital Aficionado of California love (Go Bears!). Survivor of Chicago winters. Excited to see what the Sunshine state is all about.

Salman Farsi, MD, MPH PGY-1, Internal Medicine, Holy Cross Hospital Grew up in Valdosta, Ga. BS undergraduate degree at College Valdosta State University. MPH degree at Drexel University. Medical School at Florida International University c/o 2015.

Mary Lan MD, MPH Class of 2016 Mary is fascinated by the intersection between art and medicine. She enjoys learning about different cultures and how they express themselves. She is excited to travel the world and to serve her country in the Army.

Emeka Albert Egbebike MD, MPH Class of 2017 Emeka was born in New York City and raised in the suburbs of New Jersey. He completed his undergraduate education at the University of Central Florida where he studied Biology and Creative Writing. His interests are in global health, health disparities, and emergency medicine.

Stephen Allegra MD, MPH Class of 2018 A native New Jerseyan, born & raised about an hour west of NYC. Went to college in Ithaca, NY - majored in Human Development and minored in Global Health. I have a deep respect of the outdoors and love to travel. My favorite annual trip is to visit my relatives in South Texas.

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STAFF + CONTRIBUTORS Misha Armstrong MD, MPH Class of 2019 I grew up in Jacksonville, Florida and graduated from the University of North Florida. I am interested in social justice issues, ethics, and humanistic medicine.I enjoy writing and I am always looking for a good book to read.

Cathy Cichon MD, MPH Class of 2018 Graduated from the University of Notre Dame in 2014, current member of the MD/MPH Class of 2018. Loves global health, art, and avocados.

Jo Duara MD, MPH Class of 2016 Jo is a full time medical and public health student and a sometimes writer. She hopes that this sometimes will increase to many times over her career. She is going into a residency in pediatrics and one day would like to write a book about the heart and soul of medical education.

Ariel Eber MD Class of 2017 Born and raised in Miami. Painting and drawing since childhood. Took up photography and art history in college. Deeply inspired by the culture, music, food, and art of new cities. Currently anticipating the next adventure in life!

Olivia Gardner MD, PhD Program, MS1 Olivia has an undergraduate degree in Biochemistry from the University of Southern California.

She is currently a first year student in the University of Miami’s MD/PhD program and intends to pursue her PhD in the Department of Human Genetics and Genomics, specifically studying the genetics of neurodegenerative diseases.

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STAFF + CONTRIBUTORS Francisco Halili MD Class of 2018 Reinterpreting Lewis Carroll’s creation, Alice in Wonderland, the camera for me is quite literally a “looking-glass.” It is a mechanical apparatus of glass and optics through which I see the world as well as the mirror through which I discover myself. What one sees through the lens is a blend of what is physically present interacting with what the photographer sees with an eye of anticipation.

Jeffrey Lin MD, MPH, Class of 2017 I’m always restless but learning to focus in my old age and I have to admit, I am really enjoying the process. From art to medicine and back, life is always a pleasure.

Angela Zhu MD Class of 2019 Although I have degrees in biological engineering and medical sciences, I really love literature, the fine arts, and music. I am a classically trained violinist (started playing 12 years ago!) and have a proclivity for disappearing to Europe to take in the museums and great food.

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Laura Bloom