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JOURNAL OF THE HUMANITIES AND SOCIAL SCIENCES IN MEDICINE AND PUBLIC HEALTH

GLOBALIZATION

BIG PLANET, SMALL WORLD

UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE ISSUE 6 - WINTER 2015 1


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JOURNAL OF THE HUMANITIES AND SOCIAL SCIENCES IN MEDICINE AND PUBLIC HEALTH

EDITORIAL ADVISOR

EDITOR-IN-CHIEF

GAURI AGARWAL, MD MARY LAN

MANAGING EDITOR

EMEKA ALBERT

DESIGN DIRECTOR

JEFFREY LIN

ART DIRECTOR

FRANCISCO HALILI

JO DUARA ARIEL EBER ALEXANDRA LEVITT GERARD SMITH

SUBMISSIONS EDITORS

COPY EDITOR

FRONT AND BACK COVER

INSIDE FRONT COVER

STEPHEN ALLEGRA PRIYANKA MEHROTRA SANDY JIANG

Welcome to the Winter 2015 issue of Obliterants, published by medical students from the University of Miami Miller School of Medicine. In this issue, we would like to explore and delve deeper into our theme: Globalization. As humans, we inhabit this one planet in the solar system (as far as we know) which sometimes can seem far reaching and spread apart, and on the other hand, our world is actually an ever-shrinking one contracting upon itself, and we are getting closer and closer. Globalization doesn’t have to be about how many miles or over how many oceans one has travelled, but rather that an idea travels from one individual to another. Our planet may seem incredibly large and infinitely vast, however we are progressively uniting, overlapping and our world actually may seem smaller than it actually appears. How many times have you heard the phrase “What a small world we live in?”, well this issue would like to remind us how deeply connected we are to the world and not just to where we are geographically located. We will travel together to Tanzania, a clinic in Nigeria, explore the Ebola outbreak in West Africa, witness the strikes in Paris and experience different cultures through song and dance. Obliterants has always been a place for anyone to express themselves freely through any medium of art. This edition compiles the work of faculty, staff and students who have put aside everything they are doing for a moment to reflect. We would like to thank each and every one of the contributing writers, poets, artists and photographers for sharing their experiences with the Obliterants. Sincerely, Obliterants Team 3


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6 WANDERINGS IN TANZANIA

42 A SLOW DEATH

10 WORKING WITH WEST AFRICA TO CONTAIN EBOLA ARTICLE BY MALLORY MONDA

44 NNO

12 JE SUIS CHARLIE

POEM BY PRIYANKA MEHROTRA

PHOTOS BY DIXON YANG

PHOTOS BY FRANCISCO HALILI

14 FOOD, MEDICINE AND CULTURE ESSAY BY SANDY JIANG

16 THE CABARET

ESSAY BY RAMMY ASSAF

18 STILL LEARNING

POEM BY MICHELLE SHNAYDER

POEM BY GAURI AGARWAL, MD ESSAY BY EMEKA ALBERT

46 DEAR AVA

48 DOCTOR YET?

ARTICLE BY JO DUARA

50 CONTRIBUTOR BIOS 54 10 TIPS FOR DATING YOUR NON-MED-SCHOOL SIGNIFICANT OTHER ARTICLE BY JENNIFER TIBANGIN

20 LIFE AND DEATH IN ANATOMY POEM BY DAN BALDOR

21 RAISING THE BAR

ESSAY BY DANIEL LICHTSTEIN, MD

22 INDOOR TANNING LEGISLATION AND ADOLESCENT ACCESS

ARTICLE BY BRIAN BISHOP AND GAURAV SINGH

24 A WALK AT NIGHT

PAINTING BY SHELLY BIRCH

25 THE HUNGRY GAMES COMIC BY LOUIE CAI

26 #WHITECOATSFORBLACKLIVES PHOTOS BY ERIC WEISS

28 WHAT IS THE COLOR OF YOUR REVOLUTION? ARTICLE BY JEFFREY LIN

35 FLOWERS FOR DAISY

PAINTING BY FLETA BRAY

36 THE DOCTOR AND THE DYING PATIENT

POEM BY EKATERINA KOSTIOUKHINA, MD

38 REPRISE

POEM BY EMILY RYON

39 A FEATURE OF MATTHEW CIMINERO’S PHOTOGRAPHY BY MATTHEW CIMINERO

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WANDERINGS IN TANZANIA BY DIXON YANG

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Toddlers get together for their daily yogurt time in Neema House, an orphanage located in Arusha, Tanzania. The orphans are often left by parents who cannot afford to raise them. Orphanage directors set goals to have each child adopted by age three.

The two men are breaking the shell of cocoa beans at a coffee plantation near Mt. Kilimanjaro. They are chanting “twanga, twanga, twanga kunywe kahawa” meaning “hit, hit, hit to drink coffee”. We later sat down together to share a pot of freshly brewed black coffee.

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The children ride around Stone Town, Zanzibar during their quiet weekend afternoon shortly before call to prayer which can be hear throughout the town. These close buildings and narrow alleys are characteristic of Zanzibar where the people are predominantly Muslim.

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“

These photos were taken during my summer clinical volunteering in Arusha, Tanzania. Several Masai tribesmen would visit the local clinics, but it was especially difficult to treat them because they could rarely afford medication and a large cultural barrier prevented effective understanding of modern medicine. On our way to the Serengeti for a weekend excursion, some other volunteers and I stopped at a village and had the opportunity to learn more of their way of life which is spiritually intertwined with nature and centered on family units.

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WORKING WITH

WEST AFRICA TO CONTAIN EBOLA UNDERSTANDING THE RESISTANCE TO FOREIGN IMPOSED CONTAINMENT

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t is hard to truly grasp the tragedy that Ebola wreaks on an individual. It is hard to imagine a relative dying suddenly and having strangers in full Personal Protective Equipment (PPE) cart them off, maybe to a mass grave. If Ebola was in a house, many belongings get burned, even mattresses. It is hard to imagine losing everything and not having the means to replace it. Everything else is bleached with chlorine; leaving a residue and smell that guarantees the day will not soon be forgotten. There is so much misinformation out there. Some say Ebola is not real; some say Ebola was brought by whites to control blacks.

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BY MALLORY MONDA

Traditional healers say one thing and foreign aid workers, another. Who do you believe? Trusted friends or strangers? Ebola educators say the disease came from bats. This can be hard to believe since nobody died from eating bats before. They prohibit the washing of dead bodies. But traditions do not die overnight. Why should they, since nobody died from washing bodies before? Ebola came at a time when individuals were not doing anything different. Naturally, many wondered, what was the cause? In fact, some perceived the cause to be the presence of foreign aid workers. There hadn’t been any workers there before, and then all the sudden they showed up when people began to die. Between June and July of 2014 I worked on the Ebola response team in Sierra Leone. Yet, even with this experience the suffering associated with this type of tragedy. I am not accustomed to a history of colonialism or the misinformation and confusion that can accompany well meaning international health campaigns in Africa. My education, ideology, and career path align with the westernized medical and public health tactics employed in the outbreak response. But what happens when you do not understand or agree with the western way? Do you resist the intrusion? Resistance was an enormous deterrent to early containment efforts. We remember that educators and health workers died from violent community resistance to Ebola education and containment. Many escaped treatment centers, likely infecting others in the process. Educators were stoned and pharmacies, ambulances burned. Yes, these were


criminal acts and I am not suggesting we condone them. The many deaths are a true tragedy and should not be forgotten. However, these acts did not transpire out of malice or even “stupidity” as I have heard some say. Although, it would be easy to label this behavior as such. By labeling the behavior as something we have no power to influence, we strip ourselves of any responsibility for the actions. But it is not that easy for us. Foreign aid response has a responsibility to act as partners when entering any stranger’s territory. So when our efforts are met with resistance, it is our responsibility to ask why, to find middle ground, and assist with technical support and man-power in a manner that is accepted within the existing system of the community. It is not as easy as writing off resistors as criminals. But maybe understanding the resistance to Ebola education, treatment, and containment is easier than we think. Firstly, people create causative relationships from perceived patterns. Is it unreasonable that people in Ebola affected regions perceived a connection between the foreign aid and health workers entering their communities and the escalating death toll? Is it unreasonable that this is whom they blame? In fact there is a relationship between the two, it is just not one of causation. We know this, but we take for granted that people with diverse histories, belief systems, educational opportunities, and worldviews should take our word for it. People see their friends enter treatment centers alive and leave in body bags. If people truly believe that health workers are intentionally spreading Ebola, can we blame them for resisting? Whether you think so or not, it is still our job to bridge the gap in understanding. For, without the trust and blessing of the community you work within, your success will always be limited. Secondly, everyone wants autonomy. If a foreigner came into my house and imposed rules, I might resist. It probably would not matter if those rules were in my “best interest.” I might even wonder how this stranger thought they knew what was in my best interest. This is how some people felt in Sierra Leone. Compounded by their fear, confusion, and grief, strangers regulated many aspects of daily life. If you do not believe Ebola is real, why would you follow burdensome containment rules? This is why we need to find creative ways to make Ebola containment guidelines work within the diverse framework of people’s daily lives and belief systems. This means straying from the unilateral mode of westernized imposed guidelines, and not just with the Ebola outbreak. An Ebola expert told me a

story that put the resistance into perspective. In a previous outbreak, his team entered villages fully dressed in PPE to claim bodies. They were threatened and feared they would be stoned. Finally, someone asked the community why they were resisting. The community thought the aid workers were ghosts in their white suits; so they fought back. A compromise was made and the workers began their PPE adornment while the community watched. No more threats of stoning occurred. It was a simple misunderstanding. As western aid workers, it is difficult to understand when people resist our help. Aid workers selflessly fight against Ebola and it can feel like a slap in the face when our advice is intentionally ignored and practices continued that perpetuate the outbreak. But humans are logical beings. Behind what we may interpret as irrational resistance lies logical thought processes that dictate what is believed to be appropriate behavior based upon their personal knowledge and experience. As foreigners, we can preach the “right” way to contain Ebola all we want. But this will do no one service if the people do not accept it. We can be more effective in future outbreaks. But first we need to see the people of West Africa as partners. They are experts in a different area of Ebola. The people of West Africa are now experts in personal experience, suffering, and catastrophe brought about by Ebola. It does not need to be us telling them to follow our rules for their safety. We need real partnerships. The goals are the same for us as they are for them when it comes to containing Ebola. So let us take the time to work with the people, to adapt our strategies and listen. This mentality is not Ebola specific. Any healthcare encounter or public health intervention, especially in a global context, shares the risk for provider domination. So whether treating an epidemic in a foreign country or engaging in everyday American medical practice, I hope we can remember to form partnerships. I hope we can remember that even if we have the cure, if it does not fit for the patient it is not a true cure at all. I hope we can remember that even as experts, we do not always have the answers.S

AS FOREIGNERS, WE CAN PREACH THE “RIGHT” WAY TO CONTAIN EBOLA ALL WE WANT, BUT THIS WILL DO NO ONE SERVICE IF IT IS NOT ACCEPTED BY THE PEOPLE. 11


What is freedom? To whom and by whom is it given? In God we trust our Liberté Égalité Fraternité If gerrymandering our own definition is out of the question. How so that just governments must. But with freedom of speech what will we choose to say? Black and White but Red all over We give our words life Traveling and speaking for themselves far beyond the bounds Often outliving their authors out of context vs. original intent To provoke a lion with a pen screaming satires, only words all lowercase Remembering all too well there exist lions on both sides. And lions are beasts make no mistake. Their teeth are as real as their roar There is no reasoning with a lion. The pen is mightier than the sword. But both can draw blood.

- Je suis Charlie

PHOTOS AND POEM BY FRANCISCO HALILI JR. ADDITIONAL PHOTOS BY ALEJANDRO ARBOLEDA 12


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FOOD, MEDICINE AND CULTURE

SANDY JIANG

BY SANDY JIANG

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ood, medicine, and poisons exist in an equilibrium that mankind has taken pains to sort and record throughout history. Medicines and poisons exist on a fine equilibrium: foxglove, taken in the right amount can help with atrial fibrillation, but too much is lethal. There is also an equilibrium between food and medicine. Functional foods, are foods that are consumed because they are healthy: we know that we eating many fruits and vegetables is great for

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our health. Medicinal foods, however, are foods targeted to very specific illnesses. The easiest example is taking ginger for nausea and orange juice for vitamin C. But what about some of these: people taking garlic for hypertension, bittermelon (L. momoridica spp.) can help with diabetes, saw palmetto for prostate problems, and star anise for colds? Here we transgress into the world of ethnomedicine: how people use plants for medicinal benefits. It is a field that is little known, but gaining ground quickly, but unfortunately


a little too late. It is important for global and public health professionals to be aware of some important issues that pertain to medicine, pharmaceutical companies, and patient cultural backgrounds. Ethnomedicine has existed for thousands of years. The oldest cures came from herbs, plants, and even animal parts. They were recorded in ancient texts that can be found in Egyptian, Chinese, Latin and Sanskrit writings. Many of these cures still carry on to current medicinal usage, but many are being discarded or forgotten. Unfortunately, as each generation uses less and less of older cures, fewer individuals retain the knowledge of more complicated and potentially valuable brews and combinations. There is no better example than China, where a complete revival is impossible after the Cultural Revolution wiped out many older Chinese physicians and destroyed traditional texts.

medical knowledge die with the elderly. With this loss, the pharmaceutical knowledge of the modern world is ironically now at a disadvantage. Ancient cultures spent thousands of years determining and recording what is medicine, poison, or food. Disregarding or disposing of this knowledge spells a loss of valuable knowledge, time, and potential cures to newer generations. The average American probably cannot identify the trees in his or her backyard, and would be much astonished that oak (Quercus spp.) has acorns high in tannins that can reduce diarrhea, that aspirin comes from the bark of the willow tree (Salix spp.), and that compounds from local Miami papaya trees are used as meat tenderizers. Finally, we cannot underestimate the importance of conservation. Conserving a whole land, preserving the original species, and asking cultures to record and transmit their information can aid health professionals in the future. Destroying or wiping out a species of plants could destroy the next taxol (discovered in Pacific and English yew).Plant compounds are beautifully complex; nature has designed them well, and is often highly inefficient to synthesize these compounds from scratch. These medicinal foods can provide a starting block to build on or provide the intact compound to help millions in this world of illnesses. Thus, I believe that public and global health should examine environmental concerns that tie in with cultural preservation. Botanicals are widely used by the societies that we seek to study and we brush them over without realizing that food, medicines, and poisons are a huge identity to these cultures. Without studying medicines and plants, we are doing a great disservice towards global health. z

Pharmaceutical companies spend millions every year to test, research, and find new compounds to solve diseases. A lot of that valuable information is actually hidden in cultures that use medicinal foods.

Ethnomedicine intertwines with the environment quite intimately, and with changing global forces, it is a very much threatened field. Pharmaceutical companies spend millions every year to research, and find new compounds to cure diseases. A lot of that valuable information is actually hidden in cultures that use medicinal foods. It is estimated by the WHO that 80% of the world uses plant medicines for treatment. However, those numbers are declining rapidly due to globalization. As young generations Westernize and move out of their hometowns, they do not carry with them the traditions or ideas that their elders have. Many young people do not see the value of herbal medicines, learning from Western ideals that what they use is considered quackery or unscientific. Such thinking has let valuable

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THE CABARET T

he Cabaret is at once an experience and story. Rather, stories melding into one common arena: the stage. What I find ever fascinating, rejuvenating, and inspiring is the element of transformation inherent in the Cabaret. Who you commonly know as your colleague, or professor, is not the same character on stage exuding bold dance movements and beautiful notes of music. There is a certain freedom on stage that cannot be described in words, but rather interpreted through performance for what is freedom without being bold? Frankly speaking, the Cabaret was an experiment in its first year. It was a vision that had to be sold. I recall approaching colleagues one-by-one with this idea that anyone would label as unrealistic, Rammy Assafto put it nicely. But over a period of days, a small

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BY RAMMY ASSAF

group of individuals who shared the vision came together with a goal. The basic premise was starting a forum for the rare talent that walked the halls and sat in the lectures taking place in Rosenstiel Medical Science Building every day. Some talent had been developed since childhood and professionally trained, while other talent was under the surface, waiting to be shared with the world given the right sort of training and opportunity.


The idea expanded, caught fire and soon enough we had a venue, student government funding, weekly practices, publicity and hopefully, an audience. Nonetheless, with a milieu of performers sharing the stage during the one and only dress rehearsal on the night before the actual show, it became clear that the Cabaret was far from a talent show. Rather, it was a show of talents, lifelong and new found passions, hard work, and peer mentorship. It is no coincidence that these values of a good performer are also what make a special medical student. A Cane.

PHOTOS BY FRANCISCO HALILI AND ERIC WEISS

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Still Learning BY MICHELLE SHNAYDER

FRANCISCO HALILI

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Finally, we had made it Our group stood tall and proud We were given the words To do no harm we all vowed

With friends by my side My spirits had lifted After all we had made it Through all the applicants they had sifted

The first day of class All were present and attentive Nobody here Was in need of incentive

The next exam It had gone better Must have been all that time I spent with dear Netter

Time to sign up for activities San Juan Bosco Clinic, Lotus House or both I could not wait to exemplify The modified Hippocratic Oath

But just when I thought The clouds were clearing All had started to change One night while volunteering

Several weeks had passed, And my time had come To perform a physical exam I got this…oh wait…um

I had gone through all the right steps Why was the vile not filling? I took out the needle and only then Blood started spilling

It had not gone straight as planned But no time to feel glum This I told myself Before I called my mum

I apologized profusely, “Next stick I’ll get it, I swear.” “Absolutely not!” “No way!” “I am getting out of here.”

The following day I was back in the trenches Studying away At the library benches

There had been many blunders in the past But this failure felt worse by compare I fought back the tears Knowing I had compromised this woman’s care

More time had passed The anatomy practical was near Standing outside the lab You could almost smell the fear

Once again I sought advice All told me I was still learning I knew they were right Yet my stomach was still churning

Another crushing defeat I had not done well Doubt starts creeping in Is this med school or hell?

Only after meditating And some serious self-reflection I had started to remember Why I had made this selection


MATTHEW CIMINERO19


PAIGE FINKELSTEIN

Life and Death in Anatomy BY DANIEL BALDOR I saw you whither tissue-thin Beautiful octogenarian Your back, plowing earth for garden My naivety.

And now empathy has changed because your vessel is cracked; I pour again to naught. My feet are wet.

I dug to the spine of books and body And chased your ghost through hollow torso Na誰ve. Obsessed and exhausted. Chasing bones. Time stood still The way it does under stars when I saw the Challenger explode through your eyes; I found that the blade and I are not so different Not as much, as you and I

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Your fingertips teach gratitude And I will challenge their constitution by steel and formalin Na誰ve. Chasing ghosts. Obsessed and exhausted. I return to earth. To wash my hands, my blade.


RAISING THE BAR...

MATTHEW CIMINERO

BY DANIEL LICHTSTEIN, MD

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s our first class of MD/MPH students complete their fourth year electives, embark on residency interviews, and approach graduation, I have been reflecting on what I hope will be among their most meaningful accomplishments as physicians. I am confident that every one of our students has “mastered” the core competencies of professionalism, medical knowledge, patient care, communication skills, practice-based learning and improvement, and systems-based practice. Hopefully each student will utilize this knowledge, experience, and skill to consistently deliver outstanding and compassionate medical care. I also anticipate that each student will remain committed to the critical issues involving public health and will go on to become leaders in implementing practices and policies benefitting those most in need. Furthermore, I challenge each of our graduates to be, as Atul Gawande says in his book Being Mortal, the kind of doctor who excels at “helping others deal with what medicine cannot do as well as what it can.” In his remarkable and thoughtprovoking book, Gawande emphasizes the critical role physicians should play in allowing patients to

“write their own stories” when facing terminal illness. We teach our students from day one to practice “shared decision-making” with their patients and to respect patient autonomy. Gawande urges us all to ask our patients, when serious illness occurs, “what are your fears and what are your hopes?” He writes poignantly about his role in his own father’s illness, and how his father, also a physician, was able to “write his own story” at the end of his life. I learned very recently that one of our current third-year students was able to utilize effective and compassionate shared decision-making with an elderly (96 year old) hospitalized man that led to a very meaningful change in the patient’s care. The student helped her patient “write his own story,” and his reaction to this experience demonstrated how much it truly meant to him. As he was about to go home from the hospital under the care of hospice, he thanked our student, held her hand, touched her face gently and blew her a kiss. There is no doubt in my mind that the student will never forget this patient or that moment. I have found, as has Dr. Gawande, that experiences helping patients and their families deal with end-of-life issues have been among the most meaningful I have had in my career as a physician. Each of our students and future physicians possesses the requisite skills and attitudes to embrace shared decision-making, and to care for patients facing end-of-life issues by helping their patients “write their own stories.” Nothing would make me prouder. C

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INDOOR TANNING LEGISLATION AND ADOLESCENT ACCESS A LITERATURE REVIEW AND CALL TO ACTION BY GAURAV SINGH & BRIAN BISHOP

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lorida is one of the nation’s most unique states. Millions flock to the Sunshine State for a variety of reasons that span relaxing on sandy beaches to shaking hands with Mickey Mouse. In an elderly tropical paradise where much time is spent outdoors, Florida is home to the second-largest melanoma rates in the country. It is also home to copious numbers of tanning salons.

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A recent study conducted by the University of Miami’s Department of Dermatology and Cutaneous Surgery revealed that Florida, a state with possibly the least need for tanning salons, has more indoor tanning locations than it does any brand fast food restaurant locations, or specific brand pharmacies. A distinguished University of Miami dermatology professor was quoted in the Miami Herald stating, “100 (tanning) facilities (were) associated with wellness centers and health spas, when it’s quite the opposite. They (tanning salons) are a health detriment.” Researchers counted 1,261 tanning salons in Florida, compared to 868 McDonald’s locations and 693 CVS/Pharmacies. That’s right— you’re more likely to find a shop to burn yourself to a crisp on a drive down US1 than you are likely to find a crispy treat to clog your arteries, or find a CVS to pick up the atorvastatin addressing years of crispy treat abuse. Despite known health effects of tanning, such as melanoma, it is difficult to argue against the knowledgeable consumer who chooses to engage in


miles of a tanning salon were the most significant policy-level predictors of youth tanning access. It also affirmed previous findings that legislation was not significantly associated with use at a state level. A 2013 literature review concluded that proximity to tanning facilities was the most associated contextual factor with intentional tanning. A 2012 study examined the regulations in all 50 states. 13 states had no statute regulation for minors. In states with some regulations, most young children under the age of 14 could legally tan without parental consent. California was the first state to ban tanning use before age 18, and a 2013 study indicated that this ban meaningfully decreased teen access. These findings were corroborated by a 2014 study utilizing 31,835 individuals from the national Youth Risk Behavior Surveys; results indicated that tanning laws with age restrictions may be effective in reducing indoor tanning. The most recent study published on this matter, in August of this year, found that teens report a decreased frequency of tanning after statewide youth access restriction laws are enacted.

MATTHEW CIMINERO

potentially deleterious behavior. We therefore turn our attention to tanning laws affecting adolescents, as adolescents may not have the maturity and prefrontal cortex development necessary to make informed choices. For the same reason that marketing cigarettes and alcohol to adolescents is no longer legal, it is prudent to consider the potential benefits of outlawing indoor tanning in adolescents. To examine the totality of evidence, a PubMed search for “adolescent indoor tanning laws” revealed 11 total results. Only 3 of these results were published before 2010. The first analysis of the impact of restricting sales of indoor tanning to youth was published in 2006. The study examined two states, Minnesota and Massachusetts, where tanning had already been restricted to minors. Despite the presence of these laws, 53% of businesses sold harmful UV radiation to minors. This study is important in highlighting the need for law enforcement and perhaps stringent penalties for transgressions, as the presence of the law is not self-sufficient. A 2011 study based on 6,125 adolescents across 100 of the United States’ most populous cities revealed that living in a state without youth-access legislation and living within 2

We hope that a balanced presentation of the evidence regarding indoor tanning legislation has convinced you that the passage of these laws is a step in the right direction to prevent the long-term impacts on our nation’s youth. These impacts are a burden to the healthcare infrastructure, and may present in epidemic form. This is a public health exigency, though perhaps not as chic as Ebola. Florida’s current laws allow minors under the age of 14 to tan with parental accompaniment, and for minors aged 14-17 to tan without parental accompaniment if given eye protection. These laws are considerably lax, especially given the questionable enforcement. Our call to action, to you, is to inform your state representative that you are concerned about adolescent tanning legislation. Email, call, write, or even stop by—it is empowering for them to hear from medical students and the future physician community. Feel free to attach a portion of this article as evidence for your claims. Your representatives’ contact information can be found at http://www. flsenate.gov/senators/find; simply type your zip code for a listing. You may also contact the authors (gsingh@med.miami.edu, bbishop@med.miami.edu) for additional information.

$

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A Walk At Night

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BY SHELLY BIRCH


The Hungry Games BY LOUIE CAI

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PHOTOS BY ERIC WEISS 27


WHAT IS THE COLOR OF YOUR REVOLUTION?

BY JEFFREY LIN

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low burn simmering, occasional voices piercing a steady murmur of discontent and suddenly, all explodes at the right time and the right place: political theater executed perfectly. Immolation in the name of social justice, mob killings that end with dismemberment, a refusal to stand down in front of a tank, a refusal to eat food until political systems change, a refusal to clear the area because there IS something to see here, folks. Moments turned into movements, growing by the strength of their ideas but more importantly, by the light shed upon those ideas. Can a revolution happen in the mind, or must it #trend, followed by primetime punditry, in order to exist? In short, it’s all about the brand: not something retro like Mad Men, but something ancient, something innate: the primal laws of attraction and groupthink.

In the year 17 C.E., during the Xin Dynasty (China’s 9th), it was the Red Eyebrow Rebels that rose up against Emperor Wang, distinguished by their eponymous makeup. United under the color most favored by their previous ruler under the Han Dynasty, it was a rebellion of farmers-turned-soldiers that ultimately went nowhere, after their compatriots in the battle against the Xin Dynasty succeeded in overthrowing the ruler, only to deal with their own rebellion years later.1 But, the color red has lasted well into modern times and continues to be the color of choice for the Communist Party in China. A millenia-and-a-half later, Martin Luther wrote his critique against Catholicism in 1517, slapping it on the door of the All Saints church in Wittenberg, Germany, effectively setting off the Protestant Reformation (while also making sure to print and disseminate copies of his Ninety-Five Theses across the rest of Europe). The result? 80 million followers of Lutheranism worldwide, just about four centuries later. It wasn’t the first printed piece widely disseminated (printing had already been around for almost 200


years in China, and about 80 years in Europe) but certainly one of the first revolutionary movements spread in this fashion.2 More recent and familiar, political brands include the Donkey and the Elephant, used to portray the Democratic and Republican Party respectively, as early as 1870.3 It was often used as caricature, but then the parties embraced the symbols and yet again, we now have have sleek logos for both, ighting for the same color scheme of red and blue, with some white stars thrown in (we’ll chat about red vs blue states later). The Communist Revolution of 1917 in Russia also branded itself effectively with the color red, as well as the hammer and sickle symbol to signify the working masses that they represented. The hammer and sickle was taken up by Communist movements around the

corporation today has one, to ensure that the delivery of their message was consistently evil, and not just haphazardly evil. Moving past that dark time (World War and all), we entered the post-war 1950s, where an iconic march against nuclear disarmament countered the rapidlydeveloping arms race followed the use of the atomic bomb on Hiroshima in 1945. The 1958 Aldermaston March was a 53-mile trek from London to Berkshire, England, the site of an atomic weapons research institute. One of the organizers charged with creating posters and signage came up with the now iconic peace sign for that particular march, incorporating the semaphore symbols for “N” and “D” (nuclear disarmament) into the circular logo with a line running down the middle, and two diagonal lines running

world and adopted by the Chinese, although they dropped it in favor of a simple 4+1 star pattern in red and yellow to commemorate the founding of the People’s Republic of China in 1949).4 In 1920, the Nazi Regime adopted the swastika, long a Buddhist, Hinduist and Jainist symbol (which had its own precursor as early as 10,000 B.C.E.), to be omnipresent in all of their propaganda, uniforms, flags and buildings. They made consistent use of the colors red, black and white, along with some sharp angular motifs that coincided with the rise of Constructivist era typography and design, and have long been used as a case study in highly effective branding.5 They had a branding manual for the regime, just like any large

away from the center towards the bottom, as if hands clasped in prayer. This would go on to become the de facto symbol for peaceful revolution, joined by the adaptation of the World War I “V” for “Victory” handsign (with index and middle finger raised, palm facing outwards) as another symbol for peace, largely by the countercultural movement of the 1960s. Indeed, it was truly a creative decade, with major advancements not just in political consciousness and the willingness to hit the streets for a cause, but also in clothing color, as tie-dye (not a single color, but more like a movement for color) came to represent that era. Selectively dying clothing and creating patterns by knotting and blocking has a long and


ancient tradition (are you beginning to see a pattern here?) in India (bandhani), Indonesia (batik) and Japan (shibori) but in America, it came to represent the Antiestablishment: how better to protest The Man than in than some zany-colored, cheaply-dyed clothing? As the Baby Boomers still live, and so too do their clothes and that symbolism.6 Contrast that with the garb and militancy of the Black Panther Party, which also stood for civil rights and equality during that era, but with a decidedly darker palette. Black-American, black-bereted and black-leather-jacketed, Huey Newton and Bobby Seale took up machine guns to protect themselves and the neighborhoods they chose to protect from the police, and their movement grew to the thousands, always represented by a simple image of their namesake feline, itself adopted from a voting rights group lead by Stokely Carmichael (who later became “Honorary Prime Minister” of the Black Panther Party). The Black Panthers became an icon of revolutionary protest and it goes without saying that like many successful political movements of the past, the New Black Panther Party continues its fight, most recently attracting attention in gun-lovin’ Texas as they continue their armed patrols. The year 1968 was punctuated by massive political protest in France, triggering new social movements afterwards so successfully that in hindsight, the entire year itself was branded as one of political revolution and kicked off numerous political movements around the world, sometimes called the “Color Revolutions.” For instance: the 1974 Carnation Revolution in Portugal was a series of peaceful protests against the government where all of the participants wore carnations. In the 1980s,

the Yellow Revolution came out of the Phillippines, a protest the Marcos regime at the time, marked by yellow ribbons worn by all of the protestors. In 1989, the Velvet Revolution in Czechoslovakia was a monthslong student protest against the government that ended with a violent police intervention, but also set the stage for a breakdown of communist rule in that country and eventually, in that region. But really, the ultimate expression of color can be found in a slightly more organized multi-color presentation: the rainbow pride flag adopted by the gay and lesbian rights movement, debuting at a Gay Pride Freedom Parade in San Francisco, in 1978. The now iconic 6-stripe pattern originally started with eight stripes, each color representing a principle that the movement stood for, but got simplified in the process, and now adorns bumper stickers and store windows around the world in support of a judgement free zone when it comes to sexuality. Interestingly, a 2-kilometer wide version of the rainbow flag ran across the entirety of Key West in 2003, and earned a brief moment in the Guinness Book of World Records before being cut up and sent around the world to a hundred different cities. Yes, it was the original creator of the flag, Gilbert Baker, who was commissioned to celebrate the 25th anniversary of the flag and yes, it ran the entire length of Duval Street. While we’re on the topic, and to connect a few of these historic trends, the AIDS organization ACT UP (AIDS Coalition to Unleash Power) adopted the pink triangle and the slogan SILENCE = DEATH to comment on how an ignorance or lack of action regarding issues of gay rights oppression is equivalent to the support of oppression in this arena. The triangle itself was used by the Nazis during World War II to “brand”


those identified as homosexual in the concentration campus, much the way yellow six-pointed stars were used to identify Jewish people. The appropriation of this potent symbol by gay rights activists in the 1970s, and its subsequent use by ACT UP in the late 1980s as illegal street activism masquerading as commercial advertising really opened the conversation about HIV and AIDS in the gay community, and serves as a sober reminder that the power of a symbol can be turned on its head and used for positive movement.7 To return now to the 2000s, It was a few years earlier during the 2000 presidential elections that NBC’s Tim Russert, announcing the voting results via a live-broadcasted election map of the states, decided to code the Democratic states as blue and Republican states as red, and even designated the purple states as those whose results hadn’t come in yet, and had exit polls too close to call. Interestingly, in the decades prior to that, the news networks had wanted to maintain neutrality and actually switched the coloring of the election result maps every four years, but after the networks decided to remain consistent following that election, the idea of a “Blue-Stater” or a “Red-Stater” stuck, and these politically-designated state colors took a life of their own, coinciding with stereotypes of redneck republicans in the deep south, or New England Blue Blood democrats. These are now permanent designations in American culture and as we move towards nationwide elections next year, be sure to pay attention to what qualities or characteristics are designated to each color. But, to continue with the “Color Revolutions” worldwide, the 2003 Rose Revolution in Georgia was lead by a resistance movement that thought elections that year were rigged, and eventually replaced Eduard

Shavvarzde with Mikhail Saashckaviali, who still rules today. The year after, we had a very visible Orange Revolution in 2004 in Ukraine, marked by similar protests against the presidential elections that lead to the replacement of Viktor Yanukovuich by Viktor Yuschenkko. President Yuschenkko eventually became victim to dioxin poisoning by a political enemy, and ran for re-election and political office before falling out.

What was newsworthy became something very visual and catchy, something that could cut through the clutter. Following that, the Purple Revolution also arose from elections, during the 2005 Iraq parliamentary elections where citizens, free to participate in countrywide elections had their fingers marked to show that they voted, and images of these fingers were linked with democracy, etc. This followed the US invasions into that country which started in 2003. In Asia, the 2007 in Myanmar was marked by the Saffron Revolution, because the saffron coloring of the Monk’s robes which took prominence was there.8


Note that all of this was before the rise of social media and the rapid expansion of Facebook, which really rose to prominence in 2005. Much of the coverage was still on television and the “early” internet, and the reporting of news around the world via websites and blogs began to accelerate, quickly outpacing the 24-hour television news cycle that was established decades earlier by CNN. What was newsworthy became something very visual and catchy, something that could cut through the clutter. It wasn’t just massive crowds blocking downtown traffic or taking over a government building, but a coordinated effort of thousands of individuals wearing orange hats, or waving purple banners, or wearing Guy Fawkes masks, that made a strong visual impression and captured the rest of the world, focusing their attention for at least a few minutes each evening on the news. But with the power to share, the power to like, the ability to comment and add to the conversation from afar, revolutions were able to shift from offline movements on the street to virtual ones online. When President Barack Obama first decided to run in 2008 for POTUS, his campaign went full-digital, hiring branding agencies and interactive firms not only to do the research but also to execute a multimedia plan that captured the internet, producing a political candidacy that rode the digital wave. The most iconic image that came out at that time was an image produced by Shepard Fairey, of OBEY GIANT street art fame, a three-color flat illustration of the candidate that turned into the HOPE poster, itself based on a photo taken by Associated Press photographer Mannie

Garcia that was later the source of legal contention, in terms of copyright by the photographer versus fair use of the image since it was distributed as part of the news.9 That image found itself on street corners and posters all cross the United States, as well as on the Facebook profile images and eventually, onto apps that allowed you to create your own Shepard Fairey-style flat color illustrations out of any image you uploaded. Of course, we know that the election was a success for Obama, and he went on to win a reelection four years later. During that period, Obama presided over the nation during a time of massive change around the world. The Jasmine revolution was in Tunisia, the first of movements considered that of the Arab Spring, or the democratization of the region in a series of revolutions that really kicked things off in 2010. In 2011, Egypt’s Tahrir Square was taken over, a massive revolution never seen before in that country which eventually lead to the ouster of Hosni Mubarak at the time. This set off revolutions that came right back to America and the Occupy Wall Street movement arose in September 2011, ten years after the events of 9-11, at the former site of the World Trade Center in New York City. Those protestors used a simple mathematical figure, the 99%, to capture the hearts of what so many individuals were feeling about income inequality in this country, and it was very effective. A tent city downtown attracted protesters from all over the world, and Occupy movements sprang up across the nation and circled the globe, kept alive by constant internet activism and news coverage.10


After that, we had the 2013 Bangkok government shutdown in Thailand, marked by rival groups where one wore red shirts (the anti-government group that supported an ousted leader) and the opposing group wore yellow (pro-gov’t, pro-establishment supporters). Just this past year, the Umbrella Revolution took off in Hong Kong, a student protest modeled on previous campaigns to take over public spaces and government buildings in an attempt to bring light to proposed electoral changes that would limit the ability of individuals to freely run for office, instead needing approval from an as-yet-undetermined nomination committee, before putting a panel to the people. These protestors used the symbol of yellow umbrellas quite effectively, again not just in real life but also across the Internet.11 They even had a logo contest online to select a single representative image but that came later in the movement, after much of the “contenders” were already disseminating around the world. Unfortunately, particuarly zealous progovernment protestors joined government officials in breaking up the street protests, and in the end, it didn’t matter how many people were following the protest online, if the revolution on the ground could not hold it down. In our country, the actions of police officers resulting in the deaths of young black men around the nation seemed to coalesce in a particularly vicious cycle at the end of 2014, and the #HandsUp and #BlackLivesMatter movement took over. All manner of protests exploded around the country, united by these very simple ideas/slogans/hashtags. As we have seen, it is now de rigeur to have a collection of previous profile pictures that showcase a rainbow catalog of political affiliations, some ubiquitous like the red equal sign from the Human Rights Campaign in support of same-sex marriage equality, to the more obscure and specific bright green color adopted by the visual effects industry in support of better regulations to protect their work as green-screen artists. During the “era” of #BlackLivesMatter, it was not uncommon

to see a blacked-out social media profile but then the question became: when would it be appropriate to allow color back in to your profile page? It’s incredible that in 2015, it really has become the power of photos and images that are easily transmitted through our status updates, Twitter messages and flashmobs that allow for a decentralized movement to rise up faster than ever. With the right branding (or hashtag), movements transfer from the streets to our our smartscreens and back again, and we seemingly have the ability to engage as much as we want. We can consume the information, but we can also disseminate and share

Consider that your daily actions have great power. it, and if we really wanted to mobilize, we would show up at City Hall and raise our hands, camera in hand. We now sign virtual petitions and write emails to legislators in support of our individual interests, and really try to rally together, despite our distances. The downside of course, is that the relative “ease” by which this happens means there is a competition for clicks and swipes, and a very fast turnover for movements and ideas which, to an non-participant, feels like a conveyer belt. To those people actively involved in protest movements on the ground, they must think of the longevity of their campaign, and how they can make it last by creating some kind of permanence in the form of a physical site or physical products (books, hats, t-shirts, pamphlets, etc.) but also sustainable by using the distributive and amplifying power of the internet and social media to move things forward in real-time. continued on next page


For those of us who feel that we have no time for any sort of revolutionary movement or protest, consider that your daily actions have great power, in both the short and long term. Your decision to read an article on a website about changes in healthcare coverage or residency training will reflect in search algorithms and pageviews that will support continued coverage of such issues. Your decision to add your name to a mailing list or online petition about any facet of medicine or healthcare will support that organization’s ability to advocate on your behalf. Your

decision to volunteer at a health clinic for the indigent or tutor a struggling high school student means that someone else became healthier, and someone else became smarter. Your decision to spend an extra hour or two studying each day will get you that much closer to practicing the kind of medicine that you desire, freeing yourself from the constraints of an undesired residency or job location, so that you can make that difference. Change is constant, and change is all around us, but we can always become agents of change, so keep up the good fight. H

REFERENCES 1. Rodriguez JP, “Red Eyebrow Rebellion 1723 C.E.” Encyclopedia of Slave Resistance and Rebellion, Volume 2 (Greenwood Press, 2007) 2. Bratcher D, “The 95 Theses of Martin Luther (1517)” Accessed at: www.cresourcei.org/creed95theses. html 3. “Famous cartoonist made donkey and elephant the symbols of political parties” The Washington Post, 1/27/2012 4. Kong M, “The Worker Who Forged the Red Flag” . Beijing This Month (71) October 1999, page 6263. 5. Heller S. “Iron Fists: Branding the 20th Century Totalitarian State Paperback” (Phaidon, 2011) 6. Kreider, K. TieDye (McGrawHill, 1989) 7. Baummann J “The SILENCE = DEATH Poster” New York Public Library; accessed at www.nypl.org/ blog/2013/11/22/silenceequalsdeathposter 8. “Colour Revolution” Wikipedia, accessed at en.wikipedia.org/wiki/Colour_revolution 9. Memmott M “ Shepard Fairey And AP Settle Copyright Dispute Over ‘Hope’ Poster” National Public Radio, January 11, 2011, accessed at www.npr.org/blogs/thetwo-way/2011/01/12/132860606/ shepard-fairey-and-ap-settle-copyright-dispute-over-hope-poster 10. “History of Inter Occupy” Accessed at /interoccupy.net/about/historyofio/ 11. Hume T and Park M, “Understanding the symbols of Hong Kong’s ‘Umbrella Revolution’” CNN September 30, 2014, accessed at edition.cnn.com/2014/09/30/world/asia/objectshongkongprotest/ index.html

IMAGES All images are from open-source, fair-use or copyright-free image websites.


Flowers For Daisy

BY FLETA BRAY

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The Doctor And The Dying Patient

BY EKATERINA KOSTIOUKHINA, MD

A shell, an empty corpse. A body that is not, what it was before. Just yesterday, I held your hand in mine, A warm hand with a warm smile. I held your hand and met your eyes, And saw just yesterday who lived inside.

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An old man’s shell with worn-out wrinkly skin, with broken lungs and sick within. But through your eyes, I could see YOU, the man who traveled far, the one who... Who conquered mountains and sailed dark seas. The one who’s loved ones are going to miss.


You looked at me, asking without words: -Let me go with dignity. I lived my life, I traveled far, I loved, I cried, I soared up high, and fell down low. I watched my children grow. My time has come to say goodbye. Dear doctor I hope you understand. My hands are weak, my mind is slow, I need your help to be my voice. I looked at you and squeezed your hand tight: -I want to fix you! like a watch! Please take this bitter pill. A needle stick with medicine! It’s just a little prick. Oh! Let me check your vitals, awaken you from sleep. You need an intervention! It might help you with this disease ...of growing old and breaking down. I’ve searched through textbooks and pages in small print. I found this article! It says that with this thing, which hurts just a little bit, we could make you stay longer! with us ... in this hard bed... with aches and pains... right here!

Just let me listen to your heart once more! The murmur and S3 that beat so slow and want to stop. Your rales, your crackles and your last breaths. -Please just let me go. It’s hard for you to see me die, I know. But just sit close and hold my hand, I will help you understand. My shell is worn, my joints all creak, My lungs wheeze, my heart has clicks. My legs don’t walk and I am stuck. In bed... with aches... with pains... Tied-up by plastic tubes that feed me when I can’t. That breath for me, keeping this alive. This shell, this worn-out shell that housed my soul to roam around, I used it well, it’s torn I’m leaving it behind. You see, my time has come. I have to go. Goodbye.

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Reprise

BY EMILY RYON

The dust hung lazily in the studio air before your bow disturbed it. Lying on the carpet in a patch of sunlight I listened to you play. And afterwards your hands always smelled of wood and rosin. Now having grown up I am startled by how much my hands resemble yours, balled up in anger or folded quietly in my lap or pushing a tack into the wall. On that last day when I finally reached you you had gone, but your hands were still warm and I held them in mine for hours until they were cold.

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PAIGE FINKELSTEIN


MATTHEW CIMINERO

I am a third year medical student and grew up in Miami, Florida. I’ve always appreciated the beauty of this city and our environment. I see myself as having two contrasting but not contradictory ways of looking at the world, the pragmatic scientific medical perspective and the aesthetic view through photography and writing. I began photography at age 12 with my mom’s 1980 35 mm camera, processing in the darkroom located in the basement of our middle school. Once I entered high school, I became more focused on the routine of academics and sports, losing touch with the photographic view of the world I had developed. Interestingly, with the advent of Instagram in 2010 and ease of digital photography, I was able to appreciate my environment through the lens of a camera again. I invested in a DSLR camera, traveling as often as I could.

      It is rewarding to know that some of my photography is appreciated by others.

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We are sun and moon, dear friend; we are sea and land. It is not​our purpose to become each other; it is to recognize each other, to learn to see the other and

honor him or her for what they are: each other’s opposite and complement.

— Hermann Hesse

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MATTHEW CIMINERO

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A Slow Death

BY GAURI AGARWAL, MD I hear of a man who walks in with small pieces of paper holding names of drugs uncommon words that promise to defeat tendrils of a tumor that are making their gains His body had convulsed His wife and child at his side Glioblastomamultiformetenozolomide Diagnosis given Treatment recommended Patient discharged He is told that he will need a thousand pieces of paper the cost of ten capsules which must be offered to another man who will grant him the elixir As this is beyond him he walks to his fate Better had he come in with a choking heart a piece of paper showing elevation of lines that would have taken him to a lab in which medicines would have been given quickly and without questions A slow death is more acceptable, Palatable in our times

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MATTHEW CIMINERO MATTHEW CIMINERO43


NNO

BY EMEKA ALBERT

“Next Two.” Two? The attending calls once more. “Sir and madam, please come inside.” A gentleman at the door is fidgeting with the leather handle to his briefcase in his left hand. A woman, assumed to be his wife, takes him by the right hand and walks him into the room. Many others behind him have been waiting for hours as well. There are sounds like a goat in the crowd, somewhere. Children are always a priority. We may need to begin calling three at a time. This is the chest clinic. An

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entire day, every week, dedicated to maladies of the lungs. Tuberculosis is indeed the focus. “Nno. What is the matter?” Cough for three weeks. Productive. Aches, aches all over. Clothing hangs too loose. Needs medication. Here are the laboratory results. Tests were done by some man in the village. “We will need to conduct an AFB test and a HIV screen. Please, take yourselves to see the nurse down the corridor on the left. I will decide the plan of action once these tests have been completed.”


This conversation repeats itself through the day. Some are different. Some come with x-rays. Low quality plain films courtesy of Boondocks General Hospital located in TheyLeftNoContactInformationville, Nigeria. The consultation room is small. One solid wood bench for the patients pushed up against the wall. One solid wood desk for the physician pushed up against the patients. Various tuberculosis prevention posters plaster the walls here and there. The one just above the patient bench features a cartoon gentleman, sitting and coughing, surrounded by frowning physicians standing over him. Actually, I’m not sure if they’re even physicians. I suppose it’s bad taste to assume every cartoon man with a stethoscope is a doctor. Patient has problem. Doctor has solution. Here, there is nothing more to it than that. Here, if you ask a construction worker about how his body pains prevent him from pouring cement or a housewife about how her fatigue leaves her with the inability to plate stew for her young children, you will receive a silent stare and an outstretched palm awaiting for that scribbled on piece of paper, their simple fix. However, some solutions don’t come so easily. A young boy, no taller than the guardrail that lines the main road, emerges from the lunchtime crowd in front of the clinic. The right sleeve of his faded plaid collared shirt covers his eyes from the glaring noon sun glinting off the windshields of the parked taxis; the left protects his mouth from the billowing red dust that blankets the yard.

center of town where the children gather for rounds upon rounds of football. These games bring the entire town together; his stories mirror champion victories at the World Cup. They enjoy each other’s company well into the afternoon until she becomes too weak to keep up with his stories and falls asleep. One evening, as clinic day came to a close, a nurse found the boy sitting out front on the side of the road. Standing at a distance beside the makeshift pharmacy, I watched the two exchange words that I could only infer from the way he stirred the Earth beneath him, his head bowed towards his elder. There, in the light of the setting sun, he began to cry in her arms. Without question, she embraced his trembling body with a compassion that couldn’t be substituted by any prescribed medication. There are many challenges that can be resolved with a simple fix. Occasionally, we’ll come across cases that require a little bit more attention. This is the side of medicine that I’ve loved ever since I decided that I wanted to spend my life serving others. This is the meaning of Nno. I am here for you. Emeka is a second year in the MD/MPH program. Over the summer, he completed his Capstone field experience by spending two months with the University of Nigeria College of Medicine’s Department of Community Health working with their HIV/AIDS, Tuberculosis, & Sickle Cell Disease clinics to evaluate their prevention, screening, and education initiatives to combat the effects of these endemic illnesses.

He is a regular at the clinic. Arrives by noon, greets the staff at the door, and wanders towards the inpatient wards. His grandmother, bedridden with Pott disease, awaits with a smile for his familiar face. He sits at the foot of the bed, swaying his Reeboks as his grandmother receives her isoniazid injection. The grimace on her face could only be countered by his tales of afterschool foot races down to the

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Dear Ava

BY PRIYANKA MEHROTRA MATTHEW CIMINERO

Your name will be Ava and you’ll weigh 5 lb 5 oz. You’ll use her thumb and refuse the pacifier. And then, you’ll cry every time her thumb tries to reattach to her hand. You’ll cry every 30 minutes and through the night. Ava, you will have your da’s big blue eyes. You’ll have your da’s chubby cheeks and blonde hair. But, you’ll say ma first. You’ll learn to crawl, stand, and fall. You’ll start running in circles around the kitchen dining table. And then, you’ll cry every time you fall. You’ll cry every 30 minutes, and it’ll be quieter through the night. Ava, you will have your dada’s wild imagination. You’ll have your dada’s irrational fear of spiders and the dark. But, at night, you’ll call mama first for the monsters. You’ll learn to sing the alphabet and tell her the sun is yellow. You’ll start reading Captain Underpants, and develop bad habits. And then, you’ll cry every time she slaps your fingers away from a boogie. You’ll cry every morning she drops you off to school and every afternoon she picks you up. Ava, you will have your daddy’s skillfully thrown temper tantrums. You’ll have your daddy’s quick wit and ridiculous humor. But, you’ll call mommy first for new magic tricks and jokes. You’ll decide on a college, maybe two, twenty, or none. You’ll start to like boys and ask to shop for new clothes and make-up. And then, you’ll cry every time she says no and asks for the status of your homework. You’ll cry every day you have an exam, for which you feel ill-prepared. Ava, you will have your dad’s stack of slips for after-school detention. You’ll have your dad’s drive and intelligence. But, you’ll call mom first for notices from the principal’s office. 46


You’ll become a screenwriter, chemical engineer, doctor, or anthropologist. You’ll by this time have given up on boys or have married one, two, twenty, or none. And then, you’ll cry on the days you feel homesick. You’ll cry every time you can’t come home for the holidays. Ava, you will have your father’s endless craving for a homemade meal. You’ll have your father’s hunger and strength. But, you’ll call your mother to find it all again. You’ll grow up, you’ll grow old, and parts of you will trickle away. You’ll call upon your parents with a weak voice. And then, this time you’ll call your mother, and she won’t be able to hear you. She says she is not your mom, mommy -- nor ma. She says you were all but a dream that had trickled away long ago. She says keep your detention slips and magic tricks, magic will not work. So she sits there with her eyes closed, She imagines a white house with a wraparound porch from generations past, Where Ava comes out and sits next to her mother, Where three little Ava’s come out and sit next to their ma. Where she rocks back and forth and smiles. So she sits there with her eyes closed, She smiles at what could have been, what may still be one day, Where she is no longer swallowed by a crimson sheet of Ava’s laughter. Where she may shed one tear, two, twenty, or none. Where Ava keeps and no longer trickles away. So Mother shuts her eyes, She imagines a white house with a wraparound porch from generations past, Where Ava walks back inside as the sun sets and the wind rustles, Where three little Avas follow their ma’s footsteps. So Mother shuts her eyes, And then, her smile fades, Because, Ava went back inside and it grew dark and cold outside, Because, Mother was too broken. Because Ma was never spoken and Ma was never heard. 47


ERIC WEISS

“Doctor Yet?” By Jo Duara

H

ey” he says late one Sunday evening on gchat, “Long time no talk”. “Yeah!” comes my prompt reply with obligatory exclamation point lest he think I’m underwhelmed by the idea of catching up on each other’s lives. “What’s good?” his usual replay, so I start typing, anticipatory message (“Andrew is typing . . . “) and I pause so that he’s probably getting the “Jo is typing” teaser as well. Both typing, both waiting, it’s a game of instant message chicken, tense with past loves, easy here with an old friend. He loses, but when I see the followup my heart sinks, “You a doctor yet?” Thus is elicited irrational anger and annoyance feeding an internal ongoing rant in which I bemoan how little others understand the process medical education, about how long this training is and how expensive it is and how lonely it can be.

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This irrational feeling, having been relived time and again, is something I’ve analyzed and nearly accepted so as not to let my annoyance slip out to others. It would be unfair to my well-meaning friend, after all. It is an unrealistic expectation of the general public to have grasped all of the levels of training and the degrees of competence; Intern, a subset of Resident – a doctor but not like the doctor you go to see when you go to The Doctor; a Fellow; an Attending; Practitioner; a Member Of; a Master Of. I am equally ignorant, I suppose, of Andrew’s career in music. He “mixes” a lot of things, I know that at least. Except nothing really gets mixed in this process. Sounds are overlaid, he says, and a lot of complexity goes into the final product that is so curtly summed up as “music”. A lot of recording goes on. Hours of exhaustive recording, weekends where he is pulling overnight call in the recording studio. I haven’t ever understood why musicians needed to pull overnights to record. Won’t the music still be there tomorrow? And the next day? No one’s life is at risk, no one has an electrolyte imbalance that needs tending. These are things I don’t understand not because they are ridiculous but because I just don’t understand them. Who knows what asinine questions I too might have? I venture one: “Almost. You a rockstar yet?”.  “Ha. Maybe someday”. “Yeah, someday.” “ I can’t even imagine what that would be like”, “What?” “Being an actual rockstar”. “Oh.” I don’t quite know how to respond. I haven’t thought about what it would be like to be famous since a brief existential crisis nestled somewhere between Renal and Respiratory when I convinced myself dropping out and pursuing comedy writing was something I owed myself and the world. “Yeah? Are you like basically a doctor when you go to work every day?” “No way”


and realize she’s gone. You think How did I not realize it would happen last night? She suddenly deteriorated, muttered and gasped for hours. She half-opened those blank eyes that looked but didn’t see. In those moments, I cannot accept the “not doctor yet” status as an excuse for not seeing impending death. In those moments, the “not yet” is painful because I feel as though a doctor, a true doctor, would have knowingly sighed, accepted what they knew so well to be someone’s final moments. Surely those that call themselves “doctor” see this? At this point, I am screaming internally I honestly have no idea.“I tend to hold a lot of hands”, I say. It’s the truth. Although when exactly that emergence from the cocoon happens, I cannot say. The moment the Apprehensive“I ask a lot of questions, I research a lot of answers, I But-Educated Guess becomes a Knowing Sigh is not learn a lot of new words, I feel a lot of feelings”. something I’ve considered. I feel a lot of the doctor feelings; in the hospital, there’s The diploma certifying my Medical Doctor status, once the feeling of elation when a patient you’ve studied, handed to me, doesn’t convey this power, nor does comforted, wiped, palpated, and presented takes a the stethoscope around my neck, the white coat on turn for the better. When he goes home. When I say my usual exit line “I’ve enjoyed meeting you very much, but I my shoulders or language of medicine fluid on my tongue. Now, I am just acting in those moments I feel would hope to never see you here again.” Which usually ill-equipped for the task; an imposter. But when the daily gets a laugh and most times an emphatic “I won’t be emotional toll of caretaking becomes real, the emotions back!”. There’s the confusion and frustration when a are as authentic as any joy, grief, frustration, or shame I patient just won’t listen, and won’t get the procedure, have ever felt. won’t take the medication, won’t be back for follow-up. There’s the subsequent task of reminding myself of the “So, do you cure people?” principle of Patient Autonomy and learning to practice “Umm . . . I don’t think so.”“But you don’t make them compassion in these moments. worse.” “No, I was specifically instructed not to.” There’s the camaraderie, the teamwork, the idea that “Can you look at a picture of this rash I have?” you’re on a voyage with this sick person, who is the captain of the ship that is his body on the rough sea that “Didn’t we just address the fact that I am not a medical professional yet?” is his illness, and perhaps the Internist is his first mate, “I just emailed it to you.” and the Residents his crew, and the med student “Great. I’ll add it to folder with the others.” wipes the poop deck (I told you I was funny). You, the “Ok so what do you think it is?” enthusiastic student, meet the patient first thing in the morning, you clap him (gently!) on the back and you say “When I have my degree I’ll go back to it and tell you my diagnosis.” “Mr. E! It’s Post-op day 3! How’s life sans gall bladder? “Seriously?? Come on. What do you think it might be.” You’re walking, right? You’re gonna race me down the “Hey, all I can say is ‘having this rash is probably very hall today?” “We’ll see” he says. Aye captain. difficult for you.’”. “Hydrocortisone cream?” “ There is certainly the grief. The emptiness of the room in the actual empty room when you come to pre-round Sure . . . why not." P “Do you tell patients you’re a doctor?” “Absolutely not. The opposite. I make it very clear that I am a medical student and I usually can’t help but apologize before, during, and after most interactions with them.” “That’s probably not doctor-like” “I would hope not!”. “So, then, what do you actually do?”

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STAFF + CONTRIBUTORS Daniel M. Lichtstein, M.D., MACP 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.

Gauri Agarwal, MD Assistant Professor of Medicine Assistant Regional Dean for Medical Curriculum Clerkship Director Integrated Medicine Dr. Agarwal lives in Boca Raton, FL with her husband and four children.

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.

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Matthew 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. 2nd Lt Eric M. Weiss, USAF 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!

Rammy Assaf MD/MPH Class of 2015

Gerard Smith MD/MBA Class of 2016

A California native and art/travel enthusiast. Passionate about medical humanities and the patient narrative. Career interest in capacity building of pediatric cancer and blood disorders in resource limited settings.

Born in Miami, interested in the intersections of business and medicine, avid reader and amateur chef.

Fleta Netter Bray MD Class of 2016

Gaurav Singh MD/MPH Class of 2016

I am a medical student at UM currently pursuing year off research between my third and fourth years. I enjoy crafts and writing. Most of the painting I do these days is finger painting with my son!

Has worked with leprosy patients in Nepal and HIV patients in Kenya. He is a board member of the international 501c(3) Nia Centre. He has received the U.S. President’s Volunteer Service Award for his contributions.


STAFF + CONTRIBUTORS Brian Bishop MD/MPH Class of 2016

Mary Lan MD/MPH Class of 2016

His passion for the field of Dermatology developed while working in underserved clinics in Spain and Italy where many with skin conditions are often stigmatized due to their appearance.

Mary is fascinated by the intersection between art and medicine. She enjoys learning about different cultures and how they express themselves. One of her many inspirations is Jill Bolte’s “Stroke of Insight.”

Shelly Birch MD/MPH Class of 2016

Jo Duara MD/MPH Class of 2016

Shelly is from suburban Chicago and enjoys painting as a way to relax.

Jo is an amateur writer who loves medicine, history, and genuine discussions about the human experience. She is interested in global health, tropical medicine and health disparities. She wishes to look life in the face and know it for what it is.

Emily Ryon MD/MPH Class of 2016

Francisco Halili MD Class of 2017

Emily Ryon is a 3rd year MD/MPH student. She enjoys drawing, playing guitar and busting rhymes.

Photography is, first and foremost, the art of observation. For me, the camera is 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.

Priyanka Mehrotra MD/MPH Class of 2016

Dixon Yang MD Class of 2017

An MS3 in the MD-MPH program interested in Pediatrics and Global Health. Writing whatever nonsensical thoughts I have helps me figure out few of the puzzle pieces and not get so lost in the jumble.

Born and raised in South Florida, and graduated from the University of Florida in 2013. Traveling has been some of my most memorable experiences because of what I learn from different cultures, which I hope to continue in my medical career.

Alexandra Levitt MD/MPH Class of 2016

Ariel Eber MD Class of 2017

Alex is a member of the MD/MPH class of 2016. She enjoys photography, red wine, and long walks on the beach.

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!

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STAFF + CONTRIBUTORS Mallory Monda MD/MPH Class of 2017

Michelle Shnayder MD/MPH Class of 2018

A second year Medical and Public Health student interested in Global Health Equity. She worked across West Africa, Haiti, Egypt and Israel. Recently, she worked with the World Health Organization to develop safe burial procedures during the Ebola outbreak.

Graduated from Brown University in 2014 with a BSc in Neuroscience and Science and Society. She 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.

Emeka Albert MD/MPH Class of 2017

Paige Finkelstein MD/MPH Class of 2018

Studied Biology and Creative Writing at UCF in Orlando, FL. He completed his Capstone field experience by spending two months with the University of Nigeria College of Medicine’s Department of Community Health.

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.

Jeffrey Lin MD/MPH Class of 2017

Samuel Kareff MD/MPH Class of 2018

Always representing New York (Queens, baby!), Jeff had a previous life as an art director in design and advertising, but decided that medicine would be cooler. He loves his classmates, his bicycle, his vegetables, and his fiancée, Jennifer.

Uma câmera na mão e uma idéia na cabeça.

Louie Cai MD/MPH Class of 2018

Stephen J. Allegra MD/MPH Class of 2018

Louie loves making puns and comics. Louie loves making puns in comics. Make sure you find the pun in his comic!

I’m a Leo who loves good food, stout beer, live music, and being on the water. North Jersey born and raised, I am unfortunately not from the Jersey Shore. My interests include running, hiking, swimming, longboarding, drawing, painting, guitar, and medicine.

Sandy Jiang MD/MPH Class of 2018

Alejandro Arboleda U.S. Fulbright Fellow (France); Research Associate, Ophthalmic Biophysics Center

An ethnomedicine anthropologist by training, Sandy is a 2D media artist, knitter, pianist, personal trainer, and food connoisseur. She loves traveling and collecting airplane magazines. She also makes her own soap, collects Amazon boxes, and building large sand castles.

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Born and bred in Miami and I am in Paris for a research fellowship.


STAFF + CONTRIBUTORS Jennifer Tibangin The Center for Integrated Pain Management Jennifer is a Los Angeles native and Miami transplant by way of New York City. She enjoys making lists, color-coding homework, and similar Virgo pursuits. The activity she enjoys best, however, is having adventures with her roommate, Jeffrey.

SAMUEL KAREFF

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10 TIPS FOR DATING YOUR

NON-MED-STUDENT

SIGNIFICANT OTHER (SO) 1. Appreciate your SO’s efforts.

If you are lucky enough to have a live-in cheerleader, please understand that a little acknowledgement goes a long way. Dishes don’t wash themselves, laundry doesn’t magically get washed and folded, and dinners aren’t spontaneously made. These domestic feats are acts of love and a little acknowledgement goes a long way.

2. If they’ve moved here for you, move at your partner’s pace. Moving to a new city, especially if they have no contacts in the state can be a traumatic experience. Chances are that your partner will adjust just fine, but the transition period requires patience and understanding on your end.

3. Keep your person in the loop.

Filling your SO in about your day, your problem based learning topic, and your schedule will go far in making your him or her feel like a partner in your journey.

4. But don’t share too many unnecessary details. With scant

time together, your SO does not need you to share the ten goriest slides from your derm presentation or the miscellaneous factoids about gnarly bodily functions.

5. Do not try to diagnose your SO. There is no need to drag them along 54

with you into the hypochondriac med student rabbit hole.

BY JENNIFER TIBANGIN

6. Respect his or her interests. Your partner is your link to the outside world, and don’t forget that the world is bigger than med school!

7. Carve out regular date time.

They understand that you’ve worked hard to get in and that you’re dedicated to being the best student you can be. But if you are fortunate enough to have a personal support system, remember to nurture them with non-med school related quality time. Adventures, no matter how small, are refreshing and essential.

8. Take a lot of photos. For better or for worse, it’s good to know where you came from later on, and we all know that a picture is worth a whole bunch of words.

9. Listen to them. Bad days are not

reserved for med students. Sometimes your partner will have them too, and it’s your responsibility to try to be fully present for them the way he or she is present for you. A white coat does not mean you have carte blanche in the relationship.

10. Support your partner’s goals.

In the excitement of medical school, it may be easy to forget that your SO has his or her own life path. But instead of disregarding their trajectory, check in regularly to see how you two can move forward and accomplish your goals as a couple. You two are, after all, on the same team.


BLITERANT

JOURNAL OF THE HUMANITIES AND SOCIAL SCIENCES IN MEDICINE AND PUBLIC HEALTH UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE

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