up·heav·al noun
aviolent or sudden changeor disruption to something.
Dr. Gauri Agarwal, M.D.
Emeka Egbebike
Olivia Gardner
VPOFDESIGN
Catherine Cichon
VPOFEDITING
Molly McKinney
VPOFART&PHOTO
Nicole Lin COPYEDITOR
Catherine Zaw
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.
Obliterants is published annually. Faculty, staff, residents, and students are invited to e-mail their submissions to oblit erant s@gm ail.com .
Adriana Grossman
Stephen Allegra
Misha Armstrong
Jeffrey Lin
Hello, Readers! Welcometo the Spring 2017issue of the Obliterants. Wethank you for your interest in our literary journal. The themeof this issue, asit is of this year, isall about change. Change can comein many forms. It isa deviation from the status quo, the transition from onestate to another, the certain uncertainty that shapes and reshapesour future. Change can bethe catalyst for celebration, the grounds for grieving,and the inducement for innovation in how weseethe world and interact with oneanother. It is inevitable, for better or for worse.
So, from the bottom of our coffeecups, thank you to all of our contributing writers, poets, artists, and photographers for your incrediblepiecesthat will forever shape and reshapethe future of this journal. This is Upheaval.
There is a little bit of hero in each of us Thisstatement seemsto resonate relatively louder as medical students In college, we subjected ourselves to gruelingbasic science classes,in addition to numerous extracurriculars, often reluctantly optingout 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 morningsand thousands of dollars in tuition later, our minds start to wonder if our non medical school friendsat 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 yearsin the classroom and library, we get the opportunityto apply what we know (while swiftly learning what we don?t) and contribute to the patient?s recovery process It isrewarding, but also challenging. It?s no surprise that there is much in the clinical settingthat 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 latenights 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 patientsto attend to while we may only have a few This further inspires me to learn more about the patient and be able to be areliable 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 highlightsthe 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. Thisis a special privilege entrusted to us as third year medical students, and one Ibelieve, 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 processesor pharmacotherapy. Thisis something the classroom can? t teach, but third year can. Good doctors get the right diagnosis, great doctors do so whilemaking 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 thishospital is full of sick or injured
patients that need my help, bringsback into focus whyI 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. Thetitle 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.
McKinney
His name was Art, and he died twenty years ago. However, it wasn? t until the last few years that I realized what aprofound and long-lasting effect his words had on me 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 duringhis 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?sresponse 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 thisto 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 alwayscomes 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?senvironment, 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?ashe 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 thisday, 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, ?Every pat ient you see is a lesson in m uch m ore t han t he m alady from w hich he suffers.?
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.
"Every patient you seeisa lesson in much more than themalady fromwhich he suffers."- Sir William Osler
?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 Acollapsed lung
A giant tumor Abrain 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 maynever see That most interesting image Of themselves
Fingers trace the grayscale copy of A massive stroke
A complex fracture
A metastaticcancer.
?How interesting,?the flock hums
But they never say, ?How devastating? And the subject doesnot yet know That interestingisperhaps just A synonym for it
Obliviously, the flock carries on Ogling the most interestingcases Desperate to see the imagesof their Slowly dyingpatients
How interesting
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 hallsof 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 ahalf wasfilled with treatment,both conventional and alternative You went to the best medical centersin the nation and tested the latest medications All the while you continued working and raising your daughter You continued to attend community picnicsand
"LikePersephoneherself,you grantedHadeshistime,butyour mindwasforever inthemeadow andsunshineoftheworldabove."
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 wakingmoment 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 wasaround 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 playingpeekaboo from behind your lids, an effect of the strongopioids you were taking for pain. You weren? t able to speak much because you would immediately desaturate. I was uncomfortable. This wasnot 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 hallsof 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-greensforever 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
Strong waveswash 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 wasinvaluable 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
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
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 whereto 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.
Burnout has also been linked to substance abuse and suicidal ideation among medical students:
- 32%meet criteria for alcohol abuse
- 20%haveusedpsychostimulants
- 11%havereported suicidalideation
on March 23, 2017.
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 workers without flexibility A study of third-year medical students found 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.
"H
Cathy Cichon
"Burnoutoccurswhenpassionate, committedpeoplebecomedeeply disillusionedwithajobor career from whichtheyhavepreviouslyderivedmuch oftheir identityandmeaning.Itcomesas thethingsthatinspirepassionand enthusiasm arestrippedaway,and tediousor unpleasantthingscrowdin."
Bode
"Theupheaval of our worl consciousnessare one
ld and theupheaval of our and thesame."
- Carl Jung
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 flow-
Stability, 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 betold
Is this loneliness or boredom, we ask over and over,
Why we would step acrossthe tracks that moment halfway to pluck the same kind of clover
Cancer, tears, pain rankle your body and tore away at your heart,
While I only know of such pain in text, pictures, black and white, others had impart-
Laid off at a time when your body needed your income the most,
I can only rattle off statistics and policies the letters behind my name can only boast
Everything taken away from you in moments, you?ve become another story-
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 grown-
The 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 acrosseach 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 imagination-
Your world plagued with problems of the common, the ordinary, and the ground,
While I create my own battles, flameless fires playingin mind without a sound
You hustle around in the cold, the tangible growing smaller yet racing you to beat itsclock,
While I sit in my warm, the abstract growing larger as I create keys to unsolved itslock.
You are young, naïve, optimistic in your white bread world,he accuses,
I say nothing, unable to admit he is not wrong in his views no matter what my excuses-
The world is burning down around us as we meet in our secret place,
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 fury-
We cont inue t o st and across t he t rain t racks seeing each ot her ?s w orlds afar and near,
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
"Gathering
for Prayer"
Stephen A llegra
walk that beach-time city like it's yoursit's yours at noonwalk it hard//sweat it onto clothes from the night before, onto new clothes, onto no clothesat all hardlybecause 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 yourslike 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 thisat all; hate loving goodbyes; hate hating lying loveless cryinghating and loving unloved, small and sad and disingenuous.
Step sand sideways over aurine-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 somebodyelse Better to have it hazy
from the distance of balconies
Go to wine gardens.
Listen to local poetry over twinkling lights and coconut trees. Wear midriff shirts and leather jackets and jeanswith holes in the knees
Drink until your teeth are red, till your gums are red,till your blood runsred. 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'syours, 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-socksspeaking Spanish beside you belong to you. Ride between apartment and apartment. Watch the news
remember the feelingthat you might be extraordinary; be ordinary. Never have kids, never get married,never go to dinner parties, never join agym. Never live in the suburbs
If it is a time of day it is near nightfall, the wind picksup and headlights turn on and the groan of tiresand 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 istwo 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
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
Aharmony test had said something about three of akind
But there was nothing harmonious about it
Black and white images of their unborn danced across the screen
Thebinary 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
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 talesof 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 vanillasaturated 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.
?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 wasthe 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 hisveteran father as a hero growing up, and
how hard it must have been to watch hisfather?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?sthe 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 medicationsfor quite some time He made casual small talk with the father and son while hewrote 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, hisfirst 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 hisson 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 prescriptionswould scarcely change.
K . A rrianna
T hompson
Thefollowingtranscript isa speech deliveredbySamuel Kareff onbehalf oftheClassof2018 at theRegional Medical CampusPaff AwardsonApril 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 thisroom 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 relationsconcurrent with a growing wave of global isolationism These stories will assuredlyremain 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 solidarityin 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 doorsand 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.
Caution tape all babies. Fashion the ingredients they are fed Give the samples and coupons of formula to mothers at the beginning Deplete the supply and the cash
Shut down the breasts?milk production, construction project. Grow the child to Make more formula. (more than anticipated) Force the mother to Water the fuel down produce it A thin, white,and chalky liquid
At the brink of starvation a hard hat is useless A stunted skeleton leaving everything exposed: Wrinkling arms and neck. The skin. Malnourishment dims The soul.
The immune system?s fleets dwindle. Formula?s lack of armor A susceptible child.
A scarcity of resources No clean water or bottles? Germs infiltrate infants An infection? Commandeering life?
Poorer areas and Manufactured dust Diarrhea or dehydration leads to death
Orange cones: We should warn mothers It?s Dangerous? formula: Not for those who can? t afford enough? It contaminates the proper resources
Formula in Spanish ?polvo? means dust In poor areas: Formula is almost like eating the crumbling structures Class It?s deadly where it doesn? t belong
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 dine-
I 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 youngmillennial 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 pamphletsthat have my name on them reserved
I do not see the crumbson 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 causesthat 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 isreversed, 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?
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 acrosssome fence
The phone numbers only tell them where to go for aid, When in truth they would rather have an extrajob, have security and be paid
In their minds,they think poor girl she?s invented herself battlesin 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 thisworld all divided and compartmentalized-
And round and round this circle never seems to end-
One 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 handstoo clean, Each looks at each other, too different, stuck up, lowly, too nice, too hopeful, but too mean-
Neither group refusesto 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
"Timesof upheaval require n moreleaders.Peopleat all or appointed or self-appointeshareleadership respo
not just more leadership but rganizational levels,whether ed,must beempowered to nsibilities"
- Rosalynn Carter
Dr. Daniel M. Licht st ein, 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
Neil Larson
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
Shirin 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 ara Alaw a
M D & M PH Program, Classof 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 DC She has a passion for global health and is hoping to pursue a residency in pediatrics.
Nicolet t e Vassallo
M D Program, Classof 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
Sandy Jiang
M D & M PH Program, Classof 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 rick Ennen
M D & M PH Program, Classof 2018
Minnesota native enjoying the Florida Sunshine. I love all things outdoor adventure. I also enjoyhanging with local celebs like SAMUCA and DJShunky B
Heat her Fart hing
M D & M PH 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 uel A Kareff
M D & M PH 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
Nisreen Ezuddin
M.D. Program, Classof 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.
Hillary Goldst ein
M D & M PH Program, Classof 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
Michelle Shnayder
M.D. & M.P.H. Program, Classof 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 DOCSStonybrook Project
Sandy 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 walksto Brickell Key
Caresse Gam ret
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
Rachel Levy
M.D. & M.P.H. Program, Classof 2018
Rachel Levy is a third year MD/MPH student from Boston,MA
Alexander Bode
M.D. Program, Classof 2019
Paige Finkelst ein
M D & M PH Program, Classof 2018
K. Arrianna Thom pson
M.D. Program, Classof 2020
Ann Polcari
M D & M PH Program, Classof 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
Harrison Derm 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
Shida Haghighat
M.D. & M.P.H. Program, Classof 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
Em eka Egbebike
M.D. & M.P.H. Program, Classof 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 PH 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 Gardner
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 neurodegenerativediseases.
Cat herine Cichon
M.D. & M.P.H. Program, Classof 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.
Molly McKinney
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 PH Program, Classof 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 travelingand creative pursuits during medical school
Cat herine Zaw
M D & M PH Program, Class of 2020
5 percent medical student; 95 percent mango.
Adriana Grossm an, MPH, MSA, MSc
M.D.Program, Classof 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 fiancé with pranks and curlingup with her cat to listen to NPRin the morning.
St ephen Allegra
M D & M PH Program, Classof 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
Misha Arm st rong
M D & M PH Program, Classof 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
Jeffrey Lin
M D & M PH Program, Classof 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 becooler, 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!)
