Obliterants Spring 2017 by Obliterants Team

OBLITERANTS Jour nal of the Humanities and Social Sciences in Medicine and Public Health

UPHEAVAL

Universityof Miami Miller School of Medicine Issue8-Spring2017

upÂˇheavÂˇal noun a violent or sudden change or disr uption to something.

EDITORIALADVISOR ABOUT OBLITERANTS Dr . Gaur i Agar w al, M .D. EDITORINCHIEF Emeka Egbebike

MANAGINGEDITOR Olivia Gar dner

VPOFDESIGN Cather ine Cichon

VPOFEDITING

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.

M olly M cKinney

VPOFART&PHOTO N icole Lin

COPYEDITOR Cather ine Zaw

SUBMISSIONS Obliterants is published annually. Faculty, staff, residents, and students are invited to e-mail their submissions to oblit er an t s@gm ail.com .

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Adr iana Gr ossman

FRONT COVER:

EDITORS

" Fam ily " by St eph en Allegr a

Stephen Allegr a M isha Ar mstr ong Jeffr ey Lin

BACK COVER: " Skogaf oss Wat er f all" " by An n Polcar i

UPHEAVAL LETTER FROM THE EDITOR

Hello, Reader s! Welcome to the Spr ing 2017 issue of the Obliter ants. We thank you for your interest in our liter ar y jour nal. The theme of this issue, as it is of this year, is all about change. Change can come in many for ms. It is a deviation from the status quo, the tr ansition from one state to another, the cer tain uncer tainty that shapes and reshapes our future. Change can be the catalyst for celebr ation, the grounds for gr ieving, and the inducement for innovation in how we see the world and inter act with one another. It is inevitable, for better or for wor se. So, from the bottom of our coffee cups, thank you to all of our contr ibuting wr iter s, poets, ar tists, and photogr apher s for your incredible pieces that will forever shape and reshape the future of this jour nal. This is Upheaval.

TA BLE OF CONT ENTS 5. Hero's Journey..................................................Neil Larson 10. The ART of Medicine..................Dr. Daniel Lichtstein 16. Empathy..........................................................Cathy Cichon 19. Persephone....................................................Shirin Razdan 22. Haikus..........................................................Stephen Allegra 24. The End of Lif e...........................................Nawara Alawa 27. Back When I Knew Better..............Adriana Grossman 31. Monday Mornings.........................................Anonymous 35. Other Side of the Train Tracks..................Sandy Jiang 39. Company..................................................Heather Farthing 43. Three of a Kind...............................James Patrick Ennen 45. The Veteran...........................................Nicolette Vassallo 50. Caridad Paf f Awards Speech.............Samuel A. Kareff 54. Dialectic: Polvo.......................................Molly McKinney 55. Upheaval.............................................................Sandy Jiang 4

WRITTENBY: HERO'S JOURNEY NEILLARSON There is a little bit of hero in each of us. This statement seems to resonate relatively louder as medical students. In college, we subjected ourselves to grueling basic science classes, in addition to numerous extracurriculars, often reluctantly opting out of social endeavors, and topped it off with the MCAT. As we beat the statistical odds, and gained an acceptance to medical school, the real work began. The exams came at a faster pace and the extracurriculars remained as well, ending second year with our first licensing exam. The long nights, early mornings and thousands of dollars in tuition later, our minds start to wonder if our non medical school friends at the dawn of their careers with a paycheck and a stable nine to five job in the real world would have the last laugh after all (?you?ll be wasting your twenties!? many of us were warned). So, why then do we do it? We do it for third year. The third year of medical school is when we finally have consistent, daily patient contact we had been wanting for so long. We are treated as a member of the patient?s healthcare team. After two long years in the classroom and library, we get the opportunity to apply what we know (while swiftly learning what we don?t) and contribute to the patient?s recovery process. It is rewarding, but also challenging. It?s no surprise that there is much in the clinical setting that a classroom can not prepare us for. However, when there is an ill patient, your ill patient, who you know you will be assessing again the following day, there is no better motivation to learn about the patient?s condition, prognosis, treatment plan etc. It lights a fire under you. The early mornings in the hospital and the late nights back in the library have a clear purpose that was too often not so visible those first two years. Before the start of our third year, my class was told that often, it is the medical student who spends the most time with a given patient out of the entire healthcare team. More so than the attending physician, as they usually have several patients to attend to while we may only have a few. This further inspires me to learn more about the patient and be able to be a reliable source of clinical information for them and a solid link to the rest of the team. But even beyond this, spending more time with the patient highlights the human element of medicine. I have heard third year be referred to as glorified shadowing as we are still relatively naive compared to the resident and attending physicians, and learning, not treating, is our primary goal. However, simply being there for the patient, having a conversation about their family, occupation, hobbies and life outside of the hospital that we will get them back to goes a long way to aid in the patient's recovery process. This reminds them that we are there for them as a person, not just to treat their condition. This is a special privilege entrusted to us as third year medical students, and one I believe, is a right of passage for all fledgling physicians. With the demands of modern medicine, lengthier patient interactions regrettably may be a concept of the past. But that doesn?t mean that as third year students, we can?t take what we learn from such intimate interactions and apply it as attending physicians. Whether it be asking our patient how her son?s baseball game went that she was talking about her last visit before we begin the physical exam, or simply placing a hand on another patient?s shoulder when delivering some bad news to let him know that you are there for him. Learning gestures such as these are arguably as important as a wide breadth of knowledge of disease processes or pharmacotherapy. This is something the classroom can?t teach, but third year can. Good doctors get the right diagnosis, great doctors do so while making the interaction personal. It is easy to think about how tired or hungry we may be when we are rounding on patients, (trust me), or let our thoughts revert to that looming shelf exam. But, keeping in mind that this hospital is full of sick or injured

"Superman T onight" Sandy J iang

patients that need my help, brings back into focus why I am here in the first place. Knowing that I can do something, anything for them, makes all of the grinding I did to get here make sense. I had to go to that place to get to this one. As a boy, like many others, I dreamed of saving the world, like some kind of superhero. I haven?t given up on this dream, but instead funneled it into a passion that drives me today. The title of Medical Doctor, has a connotation of prestige, that seems to bring with it a command of respect, and sometimes, awe from non medical personnel. It is a responsibility I wish to earn and continue to be worthy of when I eventually come into practice. Physicians have the ability to save someone?s life, or just as importantly, improve the quality of the time a patient may have left. That is heroic to me. Not all heroes wear capes, some wear white coats.

"Push and Shove" Stephen A llegra

"Embr ace Gr avity" Molly McKinney

THE "ART" OF MEDICINE His name was Art, and he died twenty years ago. However, it wasn?t until the last few years that I realized what a profound and long-lasting effect his words had on me.

WRITTENBY: DR.DANIELLICHTSTEIN "Cat" Har r ison Der mer

He and his wife had both been patients of mine for approximately fifteen years when he noted a non-tender lump in his upper leg while showering. He had been in excellent health with no chronic medical problems. He was a retired businessman, accomplished pianist, and a father and grandfather. A biopsy confirmed non-Hodgkin?s lymphoma. I referred him to a hematologist/oncologist and he began treatment. Despite the fact that he made multiple trips to the oncologist sixty miles away, Art continued to schedule regular visits with me every three months. All of his laboratory tests and imaging were being performed by the oncologist during his treatment. At the conclusion of one of his office visits, I asked him why he continued to schedule these visits with me regularly. I told him (he already knew) that the oncologist sent me a detailed report after each of his visits to him, and often called me, as well. Art?s response to me was direct and concise. He said, ?I come to see you because when you shut the door, I know that I have your undivided attention.? I was humbled and thanked him. However, the depth of the meaning of this to him did not really sink in with me until years after he died. Over the next several years, his disease progressed. During his visits with me we discussed the effects of his treatment, as well as his thoughts about his end-of-life care. Art

was realistic about his disease, and very open and honest during these visits. He had an advance directive and designated health care surrogate. He died in 1996. That same year, after eighteen years in private practice, I entered academic medicine. Since that time, I have had the privilege and opportunity to teach and mentor scores of students and residents. I have always felt that it was in the teaching of the art of medicine that I had the most to pass on to the physicians of the future. I frequently found myself recounting the multiple stories and anecdotes from my years in practice, and the story of my patient Art always comes up. Attentive listening is a highly valued skill of the doctor-patient relationship, and is always acknowledged as important by students when professionalism and communication/interpersonal skills are discussed early in medical school. During the time that Art was a patient, the distractions that are a part of today?s practice of medicine were not factors. I did not have an electronic medical record, did not have a computer in the examination room, and did not have a smart phone or other similar device. I could be ?there in the moment? with Art without these distractions. In today?s environment, it is rare not to have one or more of these ?get between? the physician and the patient during a visit. Had these distractions been present when Art was my patient, I wonder if I would have been able to provide him and my other patients with my ?undivided attention? as he had indicated. I think the answer to this is that we owe it to our patients to find the way. In Art?s case, it was important to him that he have someone other than his treating oncologist (of whom he thought very highly) be both available and interested in listening to his concerns and providing advice or guidance if requested. I was honored and humbled, to this day, that he chose me for that role. I did not realize at the time what an important lesson Art had taught me, and how I both could and actually felt responsible to pass this on to students and physicians-in-training. In doing so, being privileged to tell Art?s story has a greater impact on learners than speaking about the value of attentive listening in the abstract. When I tell it, each and every time, I feel that I am still ?there in the moment? with him. In Sir William Osler ?s words, ?Ever y pat ien t you see is a lesson in m u ch m or e t h an t h e m alady f r om w h ich h e su f f er s.? This very aptly applied to my relationship with Art. Thank you, Art, for being my teacher and mentor, and by extension, the teacher and mentor of a generation of future physicians.

"Ev ery patient you see is a lesson in much more than the malady from which he suffers." - Sir W illiam O sler 11

"Brickell City Center" Sandy R en

"tree_f ace" A lexander Bode

"1000x1000" Stephen A llegra

"I ncision" Paige Finkelstein

1613

WRITTENBY: CATHYCICHON

EMPATHY

?Oh, look at that. How interesting? ? The medical student gasps Staring with brazen curiosity ?Come look at this.? The rest cluster en masse A flock of white coats set twittering Round one glowing computer screen In a pitch black room They peer and point at A collapsed lung A giant tumor A brain defect ?How interesting,? they murmur They fold their arms and debate Noting the flaws here and there As though they are Art critics But the patient portrayed Has no idea yet, and may never see That most interesting image Of themselves Fingers trace the grayscale copy of A massive stroke A complex fracture A metastatic cancer. ?How interesting,? the flock hums But they never say, ?How devastating? And the subject does not yet know That interesting is perhaps just A synonym for it Obliviously, the flock carries on Ogling the most interesting cases Desperate to see the images of their Slowly dying patients How interesting.

"Scottish Seaside" Sandy J iang

PERSEPHONE

WRITTENBY: SHIRINRAZDAN

The earliest memory I have of you is from the weeks before your wedding. You were crouched beneath the dining table of your uncle?s home with all the children of our community, engaging each and every one of them in whatever inane topics they wanted to discuss with you. I remember joining you under the table in awe at how easily you would talk with them, the children, and then me, the teenager, and finally the uncles and aunties who would parade through the halls of the home showering you with blessings (under the dining table of course) for your upcoming nuptials. You greeted everyone with a kind smile and a warm embrace. You had time and patience for the tiniest babies and for the oldest grandparents. Your laughter was infectious. I don?t think I?ve ever met anyone more personable or genuine, not to mention beautiful. No wonder you were so loved. I still remember your piercing blue-green eyes sitting six years later in my home, with your husband and parents in tow, your baby at home with your aunt, as you discussed your diagnosis with my parents. I excused myself from the table. I left my home, not able to, no, not wanting to comprehend what I was hearing. I spent that afternoon shadowing at Ryder Trauma Center, distracting myself from the gravity of what was unfolding in your life. Everything seemed so real in that moment: the OR, the anesthesia, the ports and cameras, that the conversation your husband had with my father about your prognosis seemed too far-fetched, comical even. It was only when I got home that I learned about the details. And so began a story you weren?t writing. The following year and a half was filled with treatment, both conventional and alternative. You went to the best medical centers in the nation and tested the latest medications. All the while you continued working and raising your daughter. You continued to attend community picnics and

"A lways on Guard" M olly M cK inney

"LikePersephoneherself, you granted Hadeshistime, but your mind wasforever in themeadow and sunshineof theworld above."

social gatherings, when you had the strength, at least. And whenever you were seen in public, you looked as beautiful as you did during your engagement? smiling, laughing, playing with the kids, while at the same time having kahwa with the adults. Unfortunately, your disease was a coward. It envied the time you spent with family and friends and not with it, so it came back with a vengeance, trying to absorb every waking moment you had. It was possessive, like a deranged lover. It didn?t want to share you. It wanted to consume you. But you resisted. You showed bravery in the face of the devil. Like Persephone herself, you granted Hades his time, but your mind was forever in the meadows and sunshine of the world above. Although you had to endure prolonged hospitalizations, you remained connected to your work? taking phone calls, chairing meetings, and writing reports from your hospital bed. You still hung out with friends, although they had to come visit you because you were physically too weak to leave the hospital. You colored, wrote poetry, and told stories to whoever was around to listen? and believe me, there was always someone. My mother received a phone call that you were not doing well. She told me to visit you when I had a chance, and so I did, tearing myself away from my clinical rotations. You were still in that same bed, but this time your coloring books and laptop were set aside, and you were struggling with an oxygen mask, the edema in your lungs making it difficult for you to breathe. You looked tired, your eyes playing peekaboo from behind your lids, an effect of the strong opioids you were taking for pain. You weren?t able to speak much because you would immediately desaturate. I was uncomfortable. This was not the image I had of my vibrant and loquacious didi. You were a patient, and by far the sickest one I had seen. I didn?t know what to do, look at your vital signs or hug your mother who was quietly weeping in a corner of the room. So I just stood there awkwardly and spoke to your college friend, who periodically gave you sips of water through your nonrebreather. When the pulmonary nurse came in to perform an ABG, I excused myself saying, ?I?ll come back and check up on you later!? You weakly nodded and raised your hand to wave. Four days later you died. Only your parents ,

brother, husband, and in-laws were allowed in your room. The rest of us stood solemnly in the halls of the ICU, watching with bated breath the heart monitor in the nurses?station. I had never seen a blood pressure that low? I actually confused it for your respiratory rate. My father, rushing from his own rounds, came to join your family in quiet vigil. In fact, it was he who broke the news to the rest of us, coming out of your room with tears in his eyes, saying the words: ?heart rate zero.? And so began the catharsis. The months of anger, confusion, rage, and sadness poured out from everyone. The women howled, the men cried softly. But everyone wept. Everyone had hoped for a different outcome. Everyone who was at your uncle?s house celebrating your wedding with pomp and joy cursed the same God they prayed to for blessings. I was inconsolable. You were my didi. You were someone I admired and loved, perfect in every way. Hard-working, beautiful, kind, intelligent, and funny. When your door was finally opened for everyone to come in and pay our respects, I clearly remember thinking it was a mistake. I saw your chest rise! You were breathing! It wouldn?t have been the first time doctors were wrong. I turned to my father excitedly, because I thought I had cracked the code, but just as quickly as my hopes were raised, I realized that I was fooled. It wasn?t your chest that was rising; it was your mattress. Hospitals have great technology these days? great enough to make the dead seem living, but not great enough to actually keep them alive. The final memory I have of you is of your face on your pillow, eyes shut, your blue-greens forever hidden from the world, your hair disheveled, your mouth slightly agape. But you were still beautiful, preserved in silent perfection like true doll. I kissed your forehead and ran my hand over your hair. I felt betrayed by the same medicine I so respected. I felt cheated by the same God I prayed to every night. I was haunted by my final words to you, feeling like I had lied to a dying woman. A few hours later we all walked out of the hospital. It was still early afternoon. The sky was an overwhelming blue. The air was crisp and painfully refreshing. We had escaped from the underworld, but our Persephone was left behind. Hades had finally claimed her for posterity. I wish there was a silver lining, but like Demeter we are still waiting.

"Fear of Flying" H illary Goldstein

WRITTENBY: STEPHENALLEGRA

HAIKUS

Strong waves wash over Embattled shores to bring about Relief from the past.

Change of direction Is difficult because we Lead others onward.

Lend me your voice, Strong as lightning, For the way forward.

Appraisal of the Land, it was invaluable Whether we can keep?

Conflict of our time, Memory serves to remind That which we complete.

Under the thumb of Our own worst enemy, yet We forget our neighbor.

High ground is not safe. Eyes look down from above and Feet march up to rule.

"Pandemonium" N isreen Ezuddin

WRITTENBY: NAWARAALAWA THE END OF LIFE The end of life Is hard as it is Without having to worry about Walking Talking Eating The end of life Is hard as it is Without having to worry about Illness Dehydration Pain The end of life Is hard as it is Without having to worry about Electricity Food Water The end of life Is hard as it is Without having to worry about Brain Drain Dirty hospitals Missiles The end of life Is hard as it is Now imagine the end of life In war

In loving memory of Zouheir Koutouby 1926-2017

"T he End of L if e" N awara A lawa

BACK WHEN I KNEW BETTER

WRITTENBY: ADRIANAGROSSMAN

When I knew better Not to take the back roads late at night: Open mouthed porches With twelve step-tongues, Old men who sit in their lawn chairs waiting For someone to come home And let them know it?s time for bed. I knew better once How to take the edges of a too big night And fold them inward, over, napkin style; Set them in my lap Like a good girl does When someone?s watching. One o?clock and I?m still out walking This anxiousness, I?m trying to lose it Like a stubborn shadow. I missed you. Where are you when I miss you now? I used to know where to look When I?d lost you. A safe place like home, Or the dog house out back, The bathtub, dry and cold, My two asking hands? You always told me I knew better.

"W aves" K . A rrianna T hompson

"mar_gin" A lezander Bode

"D ominos" Shida H aghighat

UPHEAVAL IN MEDICAL WRITTENBY: MICHELLESHNAYDER SCHOOL: BURNOUT ANDCATHYCICHON

Up t o hal f of medical st udent s ex per iencebur nout ,y et Only one- t hir d of t hemseek hel p. Burnout has also been linked to substance abuse and suicidal ideation among medical students: 32% meet criteria for alcohol abuse1 - 20% have used psychostimulants1 - 11% have reported suicidal ideation2 -

Th is piece w as or igin ally w r it t en in r espon se t o t h e ar t icle " Kat h r yn" by Dr . David M u ller , w h ich w as pu blish ed in t h e New En glan d Jou r n al of M edicin e on M ar ch 23, 2017. 3 Medical school administrators who call solely for the expansion of mental health care access and the elimination of mental health stigma amongst medical trainees fail to recognize that these are symptomatic solutions to a national epidemic of burnout, depression, and suicide. In reality, medical students' issues with mental health begin long before the need for services. Fixed and demanding work hours, for instance, leave little time for daily mental health maintenance. Students often feel obligated to work through holidays, family celebrations, and friends?gatherings, to the exclusion of work-life balance. Too often, this results in mental and physical exhaustion, reliance on substances like psychostimulants, alcohol or other drugs, and ultimately depression and burnout. As future physicians and advocates for public health, we recognize the epidemic at our doorstep and believe this important issue is not discussed enough within the medical community. We argue that, like any other epidemic, we must identify the source and address it. In addition to expanding access to mental health care, we suggest prioritizing greater schedule flexibility. Evidence has shown that workers engaged in flexible schedule arrangements experience less stress and burnout than workers4 without flexibility. A study of third-year medical students found 5 that 71% met criteria for burnout and were more likely to disagree with the statement ?I have control over my daily schedule.? Offering students more freedom to dictate their personal time may be a simple way to shift medicine from a culture of performance and achievement to a culture of balance and health. Medical students and administrators must work together to better understand and prevent burnout in medical schools rather than advocate only for symptomatic fixes. 1. Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance use among physicians and medical students. Medical Student Research Journal 2014; 03:26-35. 2. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, Durning S, Moutier C, Szydlo DW, Novotny PJ, Sloan JA, Shanafelt TD. Burnout and suicidal ideation among U.S. medical students. Annals of Internal Medicine 2008; 149(5):334-341. 3. Muller D. Kathryn. New England Journal of Medicine 2017;376:1101-3. 4. Grzywacz JG, Carlson DS, Shulkin S. Schedule flexibility and stress: Linking formal flexible arrangements and perceived flexibility to employee health. Community, Work and Family 2008;11:199-214. 5. Mazurkiewicz R, Korenstein D, Fallar R, Ripp J. The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. Psychology, health & medicine 2012;17:188-95.

"H old O n" Cathy Cichon

"Burnout occurs when passionate, committed peoplebecome deeply disillusioned with a jobor career from which they havepreviously derived much of their identity and meaning. It comes as thethings that inspirepassion and enthusiasm arestripped away, and tedious or unpleasant things crowd in." 32

"re_f t" A lexander Bode

"T he upheav al of our w orl consciousness are one 33

ld and the upheav al of our and the same." - Carl Jung 34

OTHER SIDE OF WRITTENBY: THE TRACKS SANDYJIANG In our secret place, where the world around us halts for some stolen time, Our embraces, our moments, and fantasy we have constructed so sublime. Your hands large calloused, hard and worn with sweat and tears, Encapsulate my small smooth untainted new hands and erase both our fears. Two worlds somehow collided that brief moment when we caught each other ?s gaze, Intrigue at our immediate differences as we turned the corner in opposite ways. What?s your name, what do you do, and the curiosity began to grow, Separated by hundreds of miles but yet mentally so close as our exchanges at night flowStability, career, a ring, tried and true, cynical and the old, While I flit around the world like a feather unsure with many stories ahead yet to be told. Is this loneliness or boredom, we ask over and over, Why we would step across the tracks that moment halfway to pluck the same kind of clover. Cancer, tears, pain rankle your body and tore away at your heart,

For me to present in my white coat world, take an exam over, and come out with fame and glory. I stroke your face marked by creases and edges of age and tales to me unknown, As you hold my cheek smooth, privileged, young, in my pearly pristine world I?ve grownThe world is a lovely place! My world tells me of the goods and promises I have ahead, You shake your head, experience has shown me otherwise, you say instead. And we continue dancing across each other ?s tracks as the world continues to halt, We see the differences, the holes, and we see each other at fault. We stand as strangers to others, two completely different outwardly in league and generation, Two people in a world holding invisible hands in our imaginationYour world plagued with problems of the common, the ordinary, and the ground, While I create my own battles, flameless fires playing in mind without a sound. You hustle around in the cold, the tangible growing smaller yet racing you to beat its clock, While I sit in my warm, the abstract growing larger as I create keys to unsolved its lock.

While I only know of such pain in text, pictures, black and white, others had impart-

You are young, naĂŻve, optimistic in your white bread world, he accuses,

Laid off at a time when your body needed your income the most,

I say nothing, unable to admit he is not wrong in his views no matter what my excuses-

I can only rattle off statistics and policies the letters behind my name can only boast

The world is burning down around us as we meet in our secret place,

Everything taken away from you in moments, you?ve become another story-

Nothing more apparent now than the look on your face

I cannot be in your world and you cannot be in mine, He said, you have too much fear to be seen with me- not your fault but a flaw of societal design. The rich and the upper have good intentions to help us with your minds, I do not mean to confuse, But have you realized it is not possible to help us unless you?ve truly lived in our shoes? And the world continues to rage around us and I return to my world surrounded by luxury, I now begin to see the darkness in my gardensthorns, ugly, dark, longing, jealousy, and furyWe con t in u e t o st an d acr oss t h e t r ain t r ack s seein g each ot h er ?s w or lds af ar an d n ear , Your world continuing as if nothing happened, but my own visions now becoming less clear-

Detach, you say, you cannot love a man like me with your life ahead of you to go, Our child cannot be born like this in a society telling you no And I return to my world miles away with people of the dreams, creams, and means, While I look back at you surrounded by trees, bees, dirt covered greens. I go through the gestures of what my smiling society, rosy and pink expects of me, But now I know what it?s like to go across the train tracks and finally truly see.

"T erminus" Stephen A llegra

"Wecontinuetostand across thetrain tracksseeing each other'sworldsafar andnear" 36

"Gathering f or Prayer" Stephen A llegra

COMPANY

WRITTENBY: HEATHERFARTHING

walk that beach-time city like it's yours it's yours at noon walk it hard//sweat it onto clothes from the night before, onto new clothes, onto no clothes at all hardly because it is warm, despite the breeze there is the black-bright sun over neon over pink over Collins Avenue. if you pass a couple, the man is tall and ebony in white-pressed cold linen, and the woman is blonde in a sheer white shirt, and the woman is leaning towards the man; the man has his hand on the tight small draw of the woman's back before the sidewalk, waiting for a cab with a suitcase from a stuccoed hotel with no corners, round walls lace-lapped with palm leaves, sashay swapped in wind. walk that beach-time city like it's yours like it will, or won't, or might one day be unhappened, miss it now while you have it; have it now while you miss it. Love it. Hate loving it. Hate knowing you hate loving it; hate that you think of love like this at all; hate loving goodbyes; hate hating lying loveless crying hating and loving unloved, small and sad and disingenuous. Step sand sideways over a urine-cracked sidewalk and somebody will yell at you, notice you, offer you an empanada, ask you for a quarter; somebody will honk as you jaywalk, somebody is behind the storefront windows where you see yourself. Somebody will walk too slow just in front of you, some gaggle of kids with slick bathing suits from the ocean a street over, so you have to slink between brand-name cars parked parallel. Somebody will be walking in circles, kicking at the sidewalk on the telephone. This is a city of something whispered before you leave in the morning; steel your heart against sunset and sunrise above the bay because the sky cracks wide open like that for just anyone; that heat-sick pink will be here tomorrow for somebody else. Better to have it hazy from the distance of balconies.

"Y antai" K . A rrianna T hompson

Go to wine gardens. Listen to local poetry over twinkling lights and coconut trees. Wear midriff shirts and leather jackets and jeans with holes in the knees. Drink until your teeth are red, till your gums are red, till your blood runs red.

Do this while you're 25, 26, 27, 28, 29, 30. Rip that poetry up: well. Rip it line by line word by word ? Litter the words on the street on the way to your car; drop the words out the window as you race US1 home past old, new motels with their vintage and vacancy. Don't have kids; never have kids; never get married never get a dog never live in a house never replace any of those words. You said you could write better poetry but you don't write better poetry you drink red wine in wine gardens. walk that beach-time city like it's yours, like it's all you are on the far side of 25. As if the small, pastel houses and the reggaeton and the pre-teen in the high knee-socks speaking Spanish beside you belong to you. Ride between apartment and apartment. Watch the news. remember the feeling that you might be extraordinary; be ordinary. Never have kids, never get married, never go to dinner parties, never join a gym. Never live in the suburbs. If it is a time of day it is near nightfall, the wind picks up and headlights turn on and the groan of tires and there are more drunk bodies on the sidewalk, more couples before the sea, the sea the foam & the music from the night clubs. If there is weather it is a light rain from a red sky; If there is a couple it is two women, sharing just one cigarette. But if you are alone you don't have a shadow. You have a reflection in store windows a long, thin string of a reflection of ahard heart beat this side of 25.

"Fishing in Cuba" Shida H aghighat

"Buf f alo in M urchison N ational Park, U ganda" R achel L evy

"Spiritual D eer" Sandu J iangt

W R IT T E N B Y : THREE OF A KIND JAMESPATRICKENNEN Three of a kind Mother, Father, Son Things had been this way for eleven years They hoped for more Today would be the first time they would see their fourth They had said goodbye at this stage before Twice before

They were here for confirmation A harmony test had said something about three of a kind But there was nothing harmonious about it

Black and white images of their unborn danced across the screen The binary colors foreshadowed the character of news to come Which would it be? Delivery or demise Elation or exhaustion Change or stasis Our boys or our son A nursery or a guest bedroom I have a little brother or I?m an only child Invitations to a baby shower or an invitation to mourn, yet again

Prisma Cat sequence Sandy J iang

Salt and pepper static was enhanced A rich narrative was illuminated All was not well with baby The physician carefully told of embryological and emotional tales of what they feared And what was to come This wasn?t her first road trip helping a family navigate the unknown Should they continue with delivery, a future birthday cake bearing the glow of a single candle was unlikely

The soft, warm scent of vanilla saturated the air and helped soothe the sorrow Technical terms consoled the father, an engineer The son, perhaps more aware than we knew, had emotionally abandoned the room, transported by his video screen Nothing, nothing at all, soothed the mother Tears pulsed down her cheeks Stasis had prevailed And things would remain the same Mother, Father, Son Three of a kind.

THE VETERAN WRITTENBY:NICOLETTEVASSALLO ?VIETNAM VETERAN? ? the words on the patient?s baseball cap seemed to fill the already cramped room in the internist?s office. Notebook in hand, I scrawled down what I had heard so far: ?71-year-old male. Osteomyelitis left foot. Uncontrolled diabetes. Hospitalized 2 weeks. Wheelchair-bound.? I attempted to envision this man?s life forty years before ? how he looked in his Army uniform, how many lives he saved, how many friends he lost ? but instead all I could see was the aging man in the wheelchair in front of me, two cross-body bags for wound care wedged into the seat with him. It seemed that the only part of him that was unaffected by these forty years was his mind ? he kept making jokes with the doctor and his son.

"Bare and Cold" Stephen A llegra

For some reason, that upset me the most because this man was trapped in a failing body ?Your mom made eggs this morning!? The veteran jovially turned to his son, whose head was in his hands. The son had taken his father to the hospital a month ago after he noticed a foul odor coming from his foot. He brought his father into the office because he realized that his father had not taken his metformin and insulin since he had been discharged. His father had been unsure about his prescriptions after being hospitalized a month ago, so he hadn't taken them at all, wanting to see his usual doctor to have them rewritten. The look in the son?s eyes told me he had been carrying the burden of his father ?s health for a long time. I imagined that he must have looked up to his veteran father as a hero growing up, and

how hard it must have been to watch his father ?s health deteriorate. He cracked a smile at his father and turned back to the doctor. ?So, are you going to call the doctor at the hospital and yell at him? What?s the protocol??The son wanted consequences for the mistake. The doctor kept his eyes on thechart. I surmised that he was still processing the fact that his diabetic patient had been off his essential medications for quite some time. He made casual small talk with the father and son while he wrote the prescriptions, but I could tell that his mind was occupied with something else ? his patient?s declining health. He would eventually explain to the patient the importance of complying with his medication and that it would expedite the healing process; however, his first priority was to test the patient?s blood sugar. ?294? That?s pretty high!? The patient did not seem nearly as concerned about his health as his son was. It turns out he had extra insulin at home, but he had run out of lancets and knew he should not administer insulin without checking his blood sugar first. He had not told his son because he ?figured it wasn?t a big deal.? However, I had a feeling that the patient recognized that look in his son?s eyes, too. He had been minimizing his health issues so he would not worry his son any more than he already had. In the process, he let a severe infection go untreated and allowed his blood sugar to skyrocket. I realized the constant joking and the nonchalance were a coping mechanism. As the son pushed his father ?s wheelchair down the hall, I quickly put on a smile and thanked the patient for his service. The patient was on his way with new prescriptions and some lancets to use at home. Even so, I was left with a lingering uneasiness. I had witnessed a tragic family dynamic, one which a few new prescriptions would scarcely change.

"Giraf f es in M urchison N ational Park, U ganda" R achel L evy

"R ice Boy" K . A rrianna T hompson

"Classic Car" Shida H aghighat

WRITTENBY: CARIDAD PAFF SAMUELA.KAREFFTHE END SPEECH OF LIFE AWARDS The following transcript is a speech delivered by Samuel Kareff on behalf of the Class of 2018 at the Regional Medical Campus Paff Awards on April 24th 2017: Lately, the theme of patients' stories and their effects on our medical training has emanated from my professors and mentors, many of whom are in this room tonight. Through our patients' stories we not only diagnose medical and social problems but also build rapport, strengthen the patient-provider relationship, and even learn the deepest secrets that define their humanity and existence. At Caridad, I, along with several of my classmates and colleagues, have been privileged to hear such stories. Stories of immigrating to the United States to make a better life for themselves and their families. Stories of leaving their home countries due to drought, hunger, or repressive political systems. Stories of yearning to hold one's children whom have not been seen for two decades or more. And stories of fear of continuously evolving international relations concurrent with a growing wave of global isolationism. These stories will assuredly remain with me throughout both my training and my life. The Caridad Health Center thus holds a special place in the Class of 2018's heart as a symbol of trust, openness, acceptance, and solidarity in our local community. Its extremely hardworking, dedicated staff and leadership, along with its loyal and generous benefactors, have allowed us to enhance our medical school education and experience with the privilege of serving some of Palm Beach County's most underserved populations. In the words of some of our Class, "Caridad Clinic is the top choice for a great community partner " and "our days spent at Caridad are some of the most valuable, fulfilling, and educational." Tonight, we recognize Caridad's staff for opening its doors and heart to us to allow our participation as third- and fourth-year medical students during our Internal Medicine, Family Medicine, and Public Health clerkships. We thank Caridad's leadership for being a key Regional Medical Campus Department of Community Service partner in our only Saturday morning clinic outside of Miami for medical students of all levels. And, most importantly, we acknowledge and express our gratitude to all of Caridad's patients whose stories have undoubtedly shaped the manner by which we University of Miami MD/MPH students will practice medicine and public health in the twenty-first century and beyond. Thank you.

"O ne Second" K . A rrianna T hompson

"N apali Coast, K auai, H awaii" R achel L evy

"H avana Street" Shida H aghighat

WRITTENBY: DIALECTIC: POLVO MOLLYMCKINNEY Caution the ingredients Give the samples at the beginning

tape all babies. Fashion they are fed and coupons of formula to mothers Deplete the supply and the cash.

Shut down the construction project. Make more formula. Force the mother to produce it.

breasts?milk production, Grow the child to (more than anticipated) Water the fuel down A thin, white, and chalky liquid.

At the brink of starvation A stunted skeleton Wrinkling arms and neck. Malnourishment dims

a hard hat is useless leaving everything exposed: The skin. The soul.

The immune system?s fleets dwindle. Formula?s lack of armor A susceptible child. A scarcity of resources Germs infiltrate infants. Commandeering life?

No clean water or bottles? An infection?

Poorer areas and Diarrhea or dehydration

Manufactured dust. leads to death.

Orange cones: Dangerous? formula: It contaminates

We should warn mothers. It?s Not for those who can?t afford enough? the proper resources.

Formula in Spanish means dust. Formula is almost like Class.

?polvo? In poor areas: eating the crumbling structures. It?s deadly where it doesn?t belong.

UPHEAVAL

WRITTENBY: SANDYJIANG

Oh the irony of what is considered upheaval in your eyes and mine, What I call insurmountable problems so terrible and large, you are just trying to find a place to dineI stand in front of you, fresh, crisp, a presentation spent all day to make I fail to see the overalls worn and torn, calloused hands, eyes tired, muscles that ache I present to you numbers!, statistics!, problems! in research hours I have spent, And don?t consider that none of what I said, can any of you afford or have a single centYou?re just the ?community? I?ve come to talk about how to make better,When in truth I?m just another young millennial testing out privilege- just another trendsetter The words on my blue notebooks, alphabets behind my name, all call you underserved, In curtained rooms, I sip on wine and pour through pamphlets that have my name on them reserved I do not see the crumbs on your overalls- the daily sandwich I so call condemn in my hour, I call for action and raise so-called awareness but can do nothing in my power I post on social media of the causes that plague you and your society, I deem you the ones that need to be saved, and I the one who to do it in my superiority We define the marginalized and underserved in a specific color, state, and background, When in truth the bias is reversed, for perhaps the privileged are the ones needing to be found Have you worked a job- no then how can you talk about income and charity? What about age- how dare you preach what you deem right without experience or reality? Have you ever been plagued with disease that took away all that you know? Then, how can someone who?s never seen any of it at all tell a community how to better and grow?

"Family" Stephen A llegra

Excuse me ma?am, but when are we going to have food? Comes a voice in the middle of my magnificent speech, an intrudeI stutter, unable to answer no matter how many hours I?ve spent preparing, What I?ve failed to realize is my audience?s true needs- I am cold, rich, and uncaringThe smiles are patronizing, they understand that this is just another resume sentence, As they shuffle out the rooms with crisp new pamphlets that will be discarded across some fence The phone numbers only tell them where to go for aid, When in truth they would rather have an extra job, have security and be paid In their minds, they think poor girl she?s invented herself battles in her mind, When in truth the problems are quite simple, some places are just a little behindHer little degrees that promote helping the poor, needy, and marginalized When in truth her little white bread world has got this world all divided and compartmentalizedAnd round and round this circle never seems to endOne group calling another in need of some saving or help without realizing that each just needs a friend One is afraid to get their hands dirty and another is afraid of their hands too clean, Each looks at each other, too different, stuck up, lowly, too nice, too hopeful, but too meanNeither group refuses to leave their habits that have grown from experiences built for hundreds of days Each quick to anger and trample on each other ?s views and hate on each other ?s ways Righteous in ways deemed so obvious in black and white, When in reality there is only greyness around us in every passion, argument, and fight I stand there in an empty room, alone all of sudden, stale with a chillHours ago I felt warm nervous and excited about the ideas I was going to instill My ideas so clean and so brilliant sure to work- yes equality for all! But my ideas have changed, paradigms have shifted- I am now an upheaval

"Times of upheav al require n more leaders. People at all or appointed or self-appointe share leadership respo

"sp_an" A lexander Bode

not just more leadership but rganizational lev els, whether ed, must be empow ered to onsibilities" - R osalynn Carter

CONTRIBUTORSANDSTAFF Dr . Dan iel M . Lich t st ein , M .D., M ACP 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. Neil Lar son M.D. Program, Class of 2018 Neil Larson is from Northern California and completed undergraduate work at UC Irvine. He enjoys watching movies and traveling in his spare time. He is interested in a career in Emergency Medicine. Sh ir in Razdan M.D. Program, Class of 2018 Born in India. Raised in the 305. Likes soccer, books, Bollywood, and dancing. One day hopes to be an Academy Award winning actress.

Naw ar a Alaw a M.D. & M.P.H. Program, Class of 2018 Nawara is a first generation Syrian-American, born and raised in Miami. She attended undergrad at UM and majored in Religious Studies and Microbiology/Immunology. After graduating, she worked in healthcare payment and delivery reform at the Brookings Institution in Washington D.C. She has a passion for global health and is hoping to pursue a residency in pediatrics. Nicolet t e Vassallo M.D. Program, Class of 2020 Nicolette is a Netflix connoisseur and knitting extraordinaire trying to capture the more poignant moments in life. She loves microbiology and cooking, and makes sure the two never cross paths. San dy Jian g M.D. & M.P.H. Program, Class of 2019 A crochet artist who delights in making giant foods out of yarn, Sandy is an avid chef, artist, cheese connoisseur, world traveler, and aspiring pediatrician. When not out planting veggies, Sandy can be found in Yelp Elite (Rookie of the year 2016!) or living at the gym doing circuit training. Jam es Pat r ick En n en M.D. & M.P.H. Program, Class of 2018 Minnesota native enjoying the Florida Sunshine. I love all things outdoor adventure. I also enjoy hanging with local celebs like SAMUCA and DJShunky B.

CONTRIBUTORSANDSTAFF Heat h er Far t h in g M.D. & M.P.H. Program, Class of 2019 Heather is a medical and public health student who sometimes misses the North East and writes to keep herself sane. Sam u el A. Kar ef f M.D. & M.P.H. Program, Class of 2018 Samuel A. Kareff is a third-year MD/MPH candidate. He holds a BSFS in Science, Technology, and International Affairs with a concentration in Biotechnology and Global Health and a Certificate in Latin American Studies from the Edmund A. Walsh School of Foreign Service of Georgetown University. His interests include health practice, policy and education, along with global health, social justice and advocacy. He enjoys cooking, exercising and travelling in his spare time. Nisr een Ezu ddin M.D. Program, Class of 2017 The arts have been cultivated in me since childhood. I have always had a liking for 2-dimensional charcoal drawings and oil pastel paintings for its ability to render the artist with a degree of smudgability and play with depth and perception. I also enjoy photography and am a 1st degree black belt, mainly practicing wu-shu martial arts. Hillar y Goldst ein M.D. & M.P.H. Program, Class of 2018 Hillary is a former #JerseyGirl who acted briefly as a #VirginiaBelle and before seeking to be #MiamiFamous. She enjoys watching Black Mirror while wrangling data, and cortaditos.

M ich elle Sh n ayder M.D. & M.P.H. Program, 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. Michelle is currently the MD/MPH curriculum representative for her class, the director of the regional campus academic societies, a research assistant at the Caban-Martinez Lab, and an assistant manager for the DOCS Stonybrook Project. San dy Ren M.D. Program, Class of 2020 Sandy is a first year medical student from Texas who loves to use photography as a way to preserve memories and communicate ideas. You can find her and her camera at most food events, road trips, and even walks to Brickell Key.

Car esse Gam r et M.D. Program, Class of 2020 I'm from Naples, Florida. I attended UM for undergrad. I have grown up with a love a fishing and boating, which inspired my piece.

CONTRIBUTORSANDSTAFF Rach el Levy M.D. & M.P.H. Program, Class of 2018 Rachel Levy is a third year MD/MPH student from Boston, MA.

Alexan der Bode M.D. Program, Class of 2019

Paige Fin k elst ein M.D. & M.P.H. Program, Class of 2018

K. Ar r ian n a Th om pson M.D. Program, Class of 2020

An n Polcar i M.D. & M.P.H. Program, Class of 2018 Annie is a 3rd year MD/MPH student hoping to specialize in Plastic Surgery. She has a special interest in global surgery, & has spent a lot of time traveling to developing countries for public health work. She loves Notre Dame Football (sorry Canes!), the beach, & spending time with family. Har r ison Der m er M.D. Program, Class of 2019 Harrison Dermer is a second year MD student from Florida who does ink drawings and digital media in his free time.

Sh ida Hagh igh at M.D. & M.P.H. Program, Class of 2017 Shida allowed us to take some of her amazing photos off of her Facebook and for that we are thankful. Plus, she is #graduationspeechgoals.

CONTRIBUTORSANDSTAFF Em ek a Egbebik e M.D. & M.P.H. Program, Class of 2017 Bronx-born and Jersey-raised, Emeka studied Biology and Creative Writing at the University of Central Florida where he was also a member of their Cypress Dome literary journal team. He will graduate with an M.D. and M.P.H. and has matched into the Emergency Medicine program at Emory University. He will miss the friends, food, and Miami lifestyle that he will leave behind!

Olivia Gar dn er M.D. & Ph.D. Program, MS2 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. Cat h er in e Cich on M.D. & M.P.H. Program, Class of 2018 I am constantly fascinated by the intersection of medicine with art and how it can be applied both ways, by bringing more art into everyday medicine and by making medicine the subject of our art. When not painting or drawing, I love to participate in global health outreach, coffee runs, outdoor adventures, and spontaneous dance breaks. M olly M cKin n ey M.D. & M.P.H. Program, Class of 2020 Molly McKinney is from Sarasota, FL, went to Stanford University for undergrad and competed on the Varsity Sailing team. Molly is pursuing an MD/MPH degree and is excited to continue working with underserved populations. She writes poetry about social justice issues she cares about and loves spending time outdoors. Nicole Lin M.D. & M.P.H. Program, Class of 2020 She hails from Los Angeles, California. Weekday, she's a white coat medical student, but by weekend, she can be found in her black wetsuit, exploring the depths of the ocean as a conservation photographer and videographer. She has been to over 50 countries and hopes to continue traveling and creative pursuits during medical school.

Cat h er in e Zaw M.D. & M.P.H. Program, Class of 2020 5 percent medical student; 95 percent mango.

Adr ian a Gr ossm an , M PH, M SA, M Sc M.D.Program, Class of 2020 A Miami native, Minnesota transplant who loves the out of doors, writing poetry, playing piano, and doing public health outreach with the DOCS program and Bascom Palmer Eye Institute's new Balkan International Center. She lives for annoying her fiancĂŠ with pranks and curling up with her cat to listen to NPR in the morning.

CONTRIBUTORSANDSTAFF St eph en Allegr a M.D. & M.P.H. Program, Class of 2018 I'm originally from north NJ, went to college in upstate NY, and I have been involved in the visual and literary arts since high school. My interests outside medicine and global health include drawing, photography, guitar, outdoor sports, travel, reading history, and nature hikes.

M ish a Ar m st r on g M.D. & M.P.H. Program, Class of 2019 I grew up in Jacksonville, Florida and graduated from the University of North Florida. I am interested in social justice, ethics, and humanistic medicine. I have a love for books, documentaries, and great conversation.

Jef f r ey Lin M.D. & M.P.H. Program, Class of 2017 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, and is graduating this year with an MD/MPH degree. He will begin his family medicine residency at Harbor-UCLA and is looking forward to new experiences. He loves his classmates, his bicycle, his vegetables, and his wife Jennifer (MD/MPH class of 2020!)

"M ahi" Caresse Gamret

"Plexus" M ichelle Shnayder

www.website.com

Obliterants Spring 2017

Published on Jun 30, 2017

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