PsychSIGN Magazine, Volume 1

WELLNESS AND BURNOUT EDITION. VOLUME 1. MAY 2021

Table of Contents 44 Interview with Dr. Aggarwal Dr. Aggarwal is an Associate Professor and Program Director of Residency, at Rutgers New Jersey Medical School in Newark, New Jersey. She is an active researcher in the fields of stigma, resident empathy and wellness, and has published extensively in these fields.

28 Interview with Dr. Rubin Dr. Howard C. Rubin is the director of the Medical Student Wellbeing Program, and an Associate Clinical Professor at UCSF School of Medicine. In this interview, he shares his expertise on maintaining wellness during the medical school journey.

58 Interview with Grace Ro Grace Ro, graduate of the Rutgers NJMS class of 2021, will be starting psychiatry residency at the University of Rochester Medical Center this June. With a passion for music in medicine, she is thrilled to be able to further explore this at the Eastman Music School.

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LETTER FROM THE EDITOR

7 CONTRIBUTORS

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MAGAZINE EDITORS

36 WONDER

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VOLATILE HEART

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NEVER SAY THIS TO SOMEONE WITH DEPRESSION

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FROM: YOUR PATIENT WITH DEPRESSION

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SHOULD THE CABIN LOSE PRESSURE

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THE FUTURE OF CLIMATE ANXIETY

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INTERVIEW WITH DR. AGGARWAL

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THE FLOWERED HEAD WRAP

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METAPHORS IN MEDICINE:

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LATE NIGHT PHONE CALLS

BEWARE OF THE WAR NARRATIVE

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I AM JUST A MEDICAL STUDENT

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CREATIVITY AND THE ARTS IN MEDICAL SCHOOL

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BURNOUT ET WELLNESS

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LOSS AND REVIVAL

22 REFLECTION:

MY FIRST PSYCHIATRY INTERVIEW

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INTERVIEW WITH GRACE RO

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FIND HER WAY THROUGH

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I TRUST YOU

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I AM FROM

BULLET RULE

26 STANDARDIZED 28

INTERVIEW WITH DR. RUBIN

WHEN YOU TOUCH ME YOU TEND TO ME

ARTWORK BY MARINA ZAKHAREVICH

40 MASK

Letter From The Editor This magazine is a very dear passion project to my heart, and I am very proud and honored to have played a part in its production.

The vision behind this project was to bring together a collection of art, prose, and poetry written from medical students, to medical students. I believe that students who are interested in pursuing a career in Psychiatry tend to be emotionally attuned, and thoughtful, and I wanted to create an outlet for self-expression.

Portrait credit: Keith B. Bratcher, Jr.

More importantly, I believe that the medical student experience can be very isolating at times, and that burnout in itself can yield to feelings of alienation.

I hope that this e-magazine will help the readers feel less alone, and see the poetic beauty in this journey through other students’ lenses.

This project would not have been possible without the talented contributing writers, and artists, and especially without the contribution of our editors, illustrators, and graphic designer.

I hope you enjoy the first issue of PsychSIGN Magazine, as much as our team enjoyed putting it together.

Sincerely, Chaden Noureddine Editor in Chief Photo credit: Chaden Noureddine

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CONTRIBUTORS Contributing Writers: Elizabeth Chern Eziaghighala Chinaza Ryan Behmer Hansen Ling Jing Kendall Kelly Jessica Kerpez Marc Andrew Hem Lee Chaden Noureddine Dong Gue “Jimmy” Oh Ruchi Patel Jessica Sachs Matthew Saperstein Nikita Sedani Maria Shibatsuji Charles Tavares Eamon Thomasson Andrew Tran Bryant Yu Allison Zuckerberg and two anonymous writers

Contributing Artists: Temitope Ali Jesica Kerpez Chaden Noureddine Charles Tavares Maria Zakhaverich Graphic Designers: Charles Tavares Chaden Noureddine Cover Art: Illustrator: Temitope Ali Photographer: Chaden Noureddine Models: Aedan Hanna Allison Zuckerberg

SPECIAL THANKS TO: ZEINAB SAID, SARIN PAKHDIKIAN, BRIAN HODGE, PSYCHSIGN LEADERSHIP 20202021, DR. RASHI AGGARWAL, DR. HOWARD C. RUBIN, AND DR. PETROS LEVOUNIS

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MAGAZINE EDITORS CHADEN NOUREDDINE (SHE/HER/HERS) CHIEF EDITOR, ILLUSTRATOR, AND PHOTOGRAPHER

Chaden is a rising fourth-year medical student at Rutgers New Jersey Medical School. She immigrated from Lebanon to the United States at 17 years old. She completed a Bachelor of Arts degree at Rutgers, Newark, NJ where she majored in Biology and minored in Psychology, Chemistry, and Honors Studies.

Her interest in psychiatry was kindled from an early age when she saw the adversities patients with mental illnesses had to face, especially in a homogeneous society. She hopes to further her knowledge and create an impact in the fields of health justice, namely by impacting minority access to mental health, and reducing the stigma surrounding mental illnesses. She is also passionate about medical education, psychotherapy, peer wellness, and advocacy, namely for members of the LGBTQA+.

In her free time, she enjoys drawing, painting, writing poetry, brewing, drinking, and serving coffee, over-analyzing film tropes, as well as playing video games.

CHARLES TAVARES GRAPHIC DESIGNER, EDITOR, AND ILLUSTRATOR

Charles is an artist and art educator based in Newark, New Jersey. He earned a BFA in Studio Art, with a specialization in painting and drawing, from New Jersey City University before returning for teaching certification. He produces traditional and digital artwork professionally as well as personally. Other personal activities and interests include baking, woodworking, programming, electronic repair, as well as enjoying new video games, music, movies, and TV shows.

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RYAN BEHMER HANSEN

EDITOR

Ryan A. Behmer Hansen is a third-year medical student at Rutgers New Jersey Medical School. He grew up in Rochester, NY, studied engineering as an undergraduate and graduate student at Case Western Reserve University in Cleveland, OH, then moved to Newark, NJ for medical school. He is proud of the work NJMS and NJMS students do for the people of Newark, and believes student wellness is key for continuing student engagement in community-oriented work. For him, a sense of wellness arises from having consistency between his values and the work he engages in. Ryan is committed to psychiatry because of its uniquely patient-centered and holistic ethos, as well as the significant emphasis in training placed on the psychosocial factors impacting patients’ lives. Outside of work, Ryan enjoys cooking, sports, reading, and music. He lives with his wife Rosemary and their two dogs.

EAMON THOMASSON

EDITOR

Eamon Thomasson is a first-year medical student at Hackensack Meridian School of Medicine. He grew up outside Missoula, Montana and attended Columbia University for his B.S. degree in Biomedical Engineering. After graduation, he worked for four years in Boston, first at a tissue engineering startup and then in radiology research at Massachusetts General Hospital. While in Boston, he took an inspirational neurobiology course at Boston University that reignited his interest in neuroscience and mental health. His interest in psychiatry stems from interactions with a psychiatric researcher, clinical volunteering experiences, and a strong interest in human behavior, perception, and the brain. His interests in psychiatry include addiction psychiatry, psychoanalysis, research into biomarkers of mental illness, technology in psychiatry, and rural psychiatry. Outside of medicine, he enjoys listening to jazz and electronic music, reading fiction, and watching movies.

TEMITOPE OLORUNTOSIN RICHARD ALI

ILLUSTRATOR

Temitope Oloruntosin Richard Ali was born in Nigeria to the Yoruba tribe. He completed a Bachelors in Biological Sciences and a Masters in Biomedical Sciences at Rutgers - New Brunswick in 2018 and 2019 respectively. He would then attend New Jersey Medical School in 2020. His interest in psychiatry coincides with the fact that it was the field which finalized his decision to pursue medicine. He finds the human mind fascinating and knows many people who live with mental health disorders.

His interest in wellness comes from his beliefs about art. He believes all people should be able to express themselves through art regardless of their background. Through this belief he often encourages others to maintain their hobbies and interests.

During his free time he likes to draw. Most of his drawings are digital but he often practices with pencil and paper. Besides this he enjoys creating small video games.

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ALLISON ZUCKERBERG

EDITOR

Allison Zuckerberg is a second-year medical student from Hackensack Meridian School of Medicine (HMSOM). She grew up in Hawthorne, New Jersey and studied Behavioral Biology at Boston University. She has always been interested in questions of why people do what they do. While completing Premed courses, she studied various determinants of substance use disorder including its genetics. She believes that Psychiatry more than any other specialty requires one to be holistic, saying it is “an act of humanity.” She also thinks that for a physician to be present with their patients, they must have things that recharge them outside work. For Allison, wellness looks like writing about her experiences. She also loves to spend nights and weekends with family, friends, and her dog. She says that many mentors from HMSOM have helped her define wellness.

ELIZABETH CHERN

EDITOR

Elizabeth spent most of her childhood in Whippany, NJ (apart from living in Rhode Island for five years). She attended Rutgers University (New Brunswick) and the Rutgers Graduate School of Biomedical Sciences. Currently, she is a New Jersey Medical School student. As a psychology major, she nearly pursued a PhD in psychology, but opted for medicine as it combines both social and biological frameworks.

Elizabeth’s interest in wellness began while she was deciding on her career path in college. After experiencing burnout from juggling coursework and life stressors, she realized felt listlessness and aimless. Through cutting out meaningful activities, she had prevented herself from living out her values. This deprivation led to feeling disconnected and drained. You can find Elizabeth recharging herself and living out her values by going out on a run, baking up a storm, and volunteering at the NJMS studentrun clinic (Student Family Healthcare Clinic).

MOLLY WU

EDITOR Molly Wu is a first-year medical student from Hackensack Meridian School of Medicine. She was born in Shenzhen, China, and immigrated to the United States at 10 years old. She completed her Bachelor of Arts at New York University, majoring in Psychology and minoring in East Asian Studies, while participating in the Pre-Health program. She has considered psychiatry as her future career since her first course in psychology in high school. In her undergraduate volunteer work in an Asian senior center, she often came across patients with mental health needs unaddressed due to a stigma of mental illness in many Asian cultures. She hopes that, in the future, she will use her knowledge and training to help combat such stigma. Aside from medicine, Molly enjoys reading, music, tea, and video games.

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VOLATILE HEART

by Chaden Noureddine

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NEVER SAY THIS TO SOMEONE WITH DEPRESSION

by Eziaghighala Chinaza

Eziaghighala is a student attending the College of Medicine, University of Lagos, Nigeria.

She wrote this piece in order to reflect on her experience going through the passing of a friend, who had committed suicide. She wants to reflect on the role that religion and cultural backgrounds can play when giving advice to someone experiencing suicidal ideation.

It was 2 am in the morning when I heard my phone ring.

I laid comatose in my bed, hoping that if I could ignore the sounds in my sleep, they would go mute. The ringing persisted making me wonder who could be calling at this hour. With my eyes sealed shut and a stifled grunt, I grappled at the dark in an attempt to locate my phone. The conversation, unfolded like so:

I hung up.

This was Christmas 2017.

I have hated myself ever since.

Photo credit: Nicolas Lobo

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Chika killed herself the following morning.

The police found her lifeless body, alone, on her bed with an empty bottle of Sniper, and a cell phone. During the investigations, an officer called me for questioning.

and severe depression. Treatments range from psychological treatment (such as cognitive behavioral therapy [CBT], and interpersonal psychotherapy [IPT]) to pharmacological treatment (antidepressant medication such as selective serotonin The police officer showed me her notepad, reuptake inhibitors [SSRIs] and tricyclic and her last entry jumped off the page: antidepressants [TCAs]).

Nneka is my last hope.

My experience has made me realize that the I felt the earth shift. My breath caught at worst advice you could ever give someone the finality of the statement. Tears graced who no longer wishes to fight for their life, my cheeks like waterfalls. The officer was who thinks they have no reason to live, who far too kind and gave me room to grieve. is moments away from downing a full bottle I don't know if you have ever felt like of Sniper, who sees no hope… is prayer. a murderer before, but I knew that Prayer without a doctor's appointment feeling too well at that moment ... is futile, because if it weren't, my friend It was the worst I’ve ever felt. After Chika's would still be alive. Prayer is NOT a cure for burial, I did what anyone looking for depression. answers would do, I went online. I found This is not to say that prayer does not help. out that had I paid more attention, I would Most Nigerians resort to praying and have noticed that she hadn't been to church fasting when faced with challenges, in 4 months. myself included. Our whole system and She had taken a one-month leave from culture are particularly religious, leaving work and spent most of her time at home. most of us dependent on teachings from I would have noticed her weight-loss, her our religious backgrounds to serve as the disinterest in our girl-themed Christmas guiding principle in our lives. I have since shopping. learned that like every illness or health I would have been kinder to her when she problem, the first person of contact should called me at the worst possible time for her. be a physician or a specialist in that field.

Most importantly, I would have realized The Lagos state government has set up that I should not have told her to pray her helplines for people who want to commit suicide. condition away.

According to the World health Organization, Now that you've read my story, what do you depression is a common mental health intend to tell the next person who says they disorder. More than 264 million people of want to "talk"? all ages suffer from depression, it affects more women than men and in it can lead to suicide. Like most mental health disorders, there are treatment options for moderate

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FROM: YOUR PATIENT WITH DEPRESSION

by Anonymous

Doctor, next time I walk into your office, I need you to forgive me, Forgive me for missing my last appointment, for the drive to your office felt like a hundred miles; Forgive me for not having been “non-compliant" , For most days I do not care to eat, let alone keep up with my medication Forgive me for not maintaining eye contact, For my mind is cloudy, and my eyes are heavy.

The thing is, Doctor, you find it difficult to "deal" with patients like me, as many find my symptoms to be dreadful, as I have been painted as a “deviant” from the norm, as I receive empty looks of pity when I share my diagnosis.

The thing is, Doctor, I am a person, first and foremost, I am not a list of symptoms, I am not an eight lettered mneumonic.

I am not my diagnosis.

I do not ask for your pity, for generic tips, nor for tricks.

I ask you to be open, to ask me questions, to read my expressions.

I ask you to rid your mind of preconceived notions about people like me, For people like me have witnessed enough judgement.

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illustration by Chaden Noureddine

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THE FUTURE OF CLIMATE ANXIETY

by Eamon Thomasson

When I think about climate change, I think about fire. I think about recent instances of wildfire, like California’s Camp Fire in the summer of 2018 and the Australian wildfires of 2020. I also think about a forest fire which approached my home in 2007, not because of its specific connection to a changing climate, but because it made me realize the power of natural disasters. The “Black Cat” Fire burned many acres of the Frenchtown, Montana area in 2007, taking with it homes and many acres of land as it traversed canyons and valleys. My whole neighborhood was evacuated as this fire ravaged the landscape. In its aftermath, I remember feeling deeply relieved my home had been spared. Half a mile from my home, I looked out at a blackened field and contemplated what almost came to be.

While fires in Montana and in many parts of the world are not new phenomena, fire ecology research suggests we will face an increase in the number and intensity of fires in the coming decades. Between 1984 and 2015, the number of fires in the western United States doubled, according to a report by the US Global Change Research program. More broadly, NASA has determined we can anticipate climate changes to increase the frequency and severity of extreme weather and natural disasters, including hurricanes, floods, and droughts. Sea level rise is projected to increase by 1-8 feet by 2100.

The Center for Disease Control (CDC) has investigated the potential for climate issues to impact human health. Among these impacts are increased air pollution leading to respiratory diseases, changes in the habitat of disease-carrying vectors such as mosquitoes, and declines in crop yields due to natural disasters which will impact global food security. The health issue I’d like to highlight is the impact of climate on mental health in both the near and long term.

Climate change is making people anxious.

In a September 2020 poll conducted by the American Psychiatric Association, 67% of respondents noted they were extremely or somewhat anxious about the impact of climate change on the planet, while 55% percent of respondents indicated they were extremely or somewhat anxious about the impact of climate change on their mental health. By comparison, 75% of respondents said they were extremely or somewhat anxious about COVID-19.

What is the context of this anxiety? For some, this takes the form of PTSD as it relates to traumatic experience of natural disasters. For others, climate anxiety involves an existential dread resulting from dire projections of changing patterns of life in the coming generations, and potential difficulties which lie ahead as we adapt to climate realities.

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In a 2020 article in the Journal of Anxiety Disorders, Dr. Steven Taylor notes that climate anxiety “may be an appropriate response to the threat, or it may be disproportionate.” He brings up the possibility that individuals can be psychologically overwhelmed if they feel their own actions are insufficient to confront such threats. He notes how high levels of anxiety are likely to occur for victims of forced migration due to natural disasters, in particular.

Dr. Taylor’s article mentions vicarious consumption of news related to climate events as another source of climate anxiety.

highest income brackets. Especially in countries like the United States, the wealthiest groups may be able to lessen some of the most severe aspects of climate change, with greater resources for adaptation and relocation. Rather, populations with the fewest resources are poised to deal with the greatest impacts. Take, for example, the Marshall Islands in the Pacific Ocean, which have an average elevation of only 6 feet above sea level. Sea level rise puts the Marshall Islanders at great risk.

While the Marshall Islanders have taken major steps to adapt to climate change and have made clean energy production a priority on their islands, they are not the only group responsible for their own fate. Emissions from countries around the globe impact warming and sea level rise. If the Marshall Islanders ultimately leave their islands out of necessity, they would face the psychological impact of geographical and cultural displacement.

As Dr. Taylor points out in his article, younger people are more likely than older people to be anxious about the climate, presumably because young people today will be more impacted by future climate change. This is significant because research suggests chronic stress on the young developing brain may increase the risk of developing It is clear that the specter of climate mental illnesses including depression anxiety is looming. How can we address and anxiety. these new anxieties? We may need an updated approach. Just as the medical Climate anxiety will likely not be community has devised traumafelt as intensely by those in the most informed practices, the development of comfortable neighborhoods and a climate-informed approach may be the photo credit: Pixabay

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appropriate solution. In my research, I came across a group called the Climate Psychiatry Alliance, whose mission includes informing psychiatrists and therapists about the mental health impacts of climate change, as well as influencing policy through public advocacy. I look forward to following their efforts in this area.

patients having difficulty processing an uncertain climate future, I hope that through my own education I will be able to offer a measure of understanding and a well-informed, objective assessment.

While it is not obvious to me what the most effective approach will be, I look forward to participating in an ongoing deliberation within the medical community about climate anxiety and Hypotheses abound for how we should the challenges it presents for the future. address this challenge. As for me, I wonder if a good first step would be to educate myself more rigorously on the science of climate and our potential mechanisms of adaptation from local to the global levels. In doing so, I hope to improve my sense for what might distinguish between disproportionate and appropriate levels of climate anxiety. While the decision of an individual to engage in policy advocacy is deeply personal, by informing myself on climate issues, I hope to be able to better work with patients who seek to address their climate anxiety through public discourse and activism. For

18 image from Wikipedia Commons

METAPHORS IN MEDICINE: BEWARE OF THE WAR NARRATIVE

by Andrew Tran

Metaphors are a useful tool to shape the way that we view people, places, and things.

They also contribute to the creation of a narrative surrounding the aforementioned subject. Over the past year, this pandemic has led to many metaphors being ascribed to healthcare workers, with all the positive and negative consequences that come with them. I think one of the most damaging and harmful metaphors I have seen utilized to define myself as a healthcare professional has been the proliferation of the “war” narrative, brought on by metaphors comparing healthcare workers to “soldiers on the frontline” or other similar metaphors. I find these comparisons damaging, as they can be utilized to justify things such as inadequate PPE and unsafe working conditions. These metaphors weaponize patriotism in the name of creating martyrs out of healthcare workers. We are seen as soldiers who are bravely sacrificing themselves in the name of their country. Yet, such a comparison forces the responsibility and sacrifices on the individual. I believe that physicians would do anything they could within reason to help their patients, yet requiring them to sacrifice their own bodies and lives is too great of a sacrifice. The Hippocratic oath says nothing about having to take a proverbial “bullet” for our patients. We do the best we can to treat and heal them, and as much as medicine is a calling, it does

not justify the physical sacrifice of one’s life. Such comparisons make it easy for groups like healthcare administrators and government officials to justify the lack of PPE. They hide behind such statements and comparisons, not out of a desire to bring honor and appreciation to the healthcare workers, but as a way to distract from the true issue of PPE deficiencies and other related issues.

I love the medical profession, and I do see it as a true calling, but is it reasonable to require the sacrifice of our own life in the pursuit of such a profession? I believe such a request is unfair and unreasonable, thus, I choose to reject the war narrative and the frontline soldier metaphor. Surely with the diversity of the human language we can come to promote a more beneficial narrative that gives us healthcare workers the appropriate appreciation without leading to dehumanization and unfair requests of self-sacrifice.

photo credit: Jonathan Borba

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I AM JUST A MEDICAL STUDENT

by Kendall Kelly

There are people all around the world that need help, But I am just a medical student.

Patients everywhere need comfort and reassurance, But I am just a medical student.

Hospitals are understaffed, But I am just a medical student.

Healthcare providers are overworked, But I am just a medical student.

People around me are dying, But I am just a medical student.

During my interview I swore I wanted to help people, But I am just a medical student.

I keep telling myself that someday I will make a difference, But for now, I am just a medical student.

20 photo credit: Chaden Noureddine

BURNOUT ET WELLNESS

by Chaden Noureddine

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REFLECTION: MY FIRST PSYCHIATRY INTERVIEW

by Nikita Sedani

It was another beautiful, hot day in Grenada. Looking outside the window, my mind wandered as I stared at the luscious palm trees and colorful houses. My fellow peers and I were driving to our clinical site that day. As my focus drifted back to the road, I was taken aback by how long the trip was taking, to the point that I started feeling motion sickness. It was apparent we were driving to a more closed-off part of the island.

Finally, we reached the destination. We were at the psychiatric hospital. As we entered, I noticed it was slightly run down and dimly lit compared to the bright sunshine outside. The nausea was gone and excitement settled in. I was assigned to interview the patient for today I was eager to begin.

successful in school. However, he was diagnosed with schizophrenia in his late teen years and sent to the hospital. I was struggling to get a direct answer from him.

Instead of following a linear direction, the interview contained a lot of rambling to the point I didn’t know how to redirect to the answers I needed, such as his personal medical or family history.

However, you could tell from what he talked about that he craved human company but couldn’t get it. When I asked about his social life, it was apparent he hadn't had any fruitful friendships or relationships his entire life. He was 67 years old. His social line was his mother; she had visited him daily, but sadly passed two weeks ago.

In the past, when he was discharged from the hospital, the combination of his overfriendliness and odd mannerisms were seen as threatening on the streets, causing him to get beaten up. As harmless as he was, his life was safer inside the hospital.

We were introduced to Thomas (name changed). At first sight, he was dressed in second-hand clothing; he was old, and frail, yet energetic. Subconsciously, he reminded me of how my grandfather Another emotional chord struck me. I looked before he passed away. That struck couldn’t imagine living my life for so the first emotional cord. long without any companionship. As I continued the interview and asked how Immediately, you could tell he was he was dealing with his mother’s death, I intelligent. Our preceptor had mentioned was surprised how attached I was getting, that, before. He was an avid reader, this feeling was not something expected. I passionate about philosophy, and

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couldn’t tell. Was it because I was the one interviewing him that I felt a more direct experience with his story?

During this interview, the uncanny feeling of seeing a patient become human so rapidly in front of my eyes was scary. In my clinical interactions, it’s usually easy for me to displace myself emotionally from a patient’s problem and not get attached. This disturbed me. I was unsure why this interaction stood out more than the others. The unsettling feeling lingered in me for days after. I just couldn’t

shake off how I stopped viewing him as a patient.

As someone who is naturally empathetic, this experience made me wonder about the line I need to draw while treating patients in the future. The line of getting attached. The line between seeing someone as a patient and someone as human.

I realized, the more I “humanize” the patient, the more I’ll get attached. This is scary because I know that repeatedly crossing that line could lead to emotional burnout, a common problem in the medical field. With experience, I hope to find the balance.

23 photo credit: Alex Green

BULLET RULE

by Jessica Sachs

Find the holes It is a numbers game and Odds are you need to keep searching Because if the number of wounds doesn’t add up, something is missing, and one missing means...

Find the holes Turn it over, lift the leg up, pull, tug You need an even number You need the odds in your favor I mean his favor

What goes in must come out, every entrance has an exit It’s the way the world works It’s a whole damn circle Or is it a line?

Doesn’t matter because for now, it is broken, distorted, fragmented And you’re tasked with finding pieces Not with putting back together

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Which means If you start listening to those excruciating screams, it takes away And you need things to add up

Which means If you start feeling his hand clutching yours in agony, it takes away And you need things to add up

Once you lose sight Or rather, once you start to see this patient as more than a number of holes, then the penetrating wound is not a mere gunshot It is this life, his whole life

It is his torn-up Batman shirt and blood-streaked sneakers It is the terror in his eyes, his tear-soaked pillow, his ominous whimpers It is neither completely even nor completely odd But it is complete

But please Do not mistake being complete for being whole Not right now at least For now, find the holes photo credit: Anna Shvets

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STANDARDIZED

by Marc Andrew Hem Lee

This has to be just right. But I have so much to ask… His name is Mr. Gregory… I should have brought the checklist with me. Why can’t we bring the checklist into the room with us? Do they want us to get it right, or just fumble through taking a full history? And “Mr. Gregory?” That name is totally made up. More things to remember - remember to knock, remember to introduce myself, and remember to explain my role as a member of the team.

Is that clock right? I have 4 minutes until it’s my turn. I’ll have to ask Mr. Gregory to say more… the words that we were taught to use somehow automatically populate in my mind.

“Please say more about that. Anything else?”

Funny, I always feel like a waiter when I ask the patient if there is anything else. It comes out in the same, practiced way, like a service we are expected to perform. We take orders in the same, expected way as a waiter. “Would you like fries with your diagnosis today?”

Instead, I say, “I am curious about the nature of your pain. Can you walk me through the beginning?” Conveniently, there’s an acronym for this one… O.P.Q.R.S.T. Onset… Pain… no, that can’t be right. I don’t remember the rest. This isn’t going very well. What is pain anyway? Is it what is making us wait silently outside the door, with only our thoughts for company? I’m beginning to question whether we inflict pain on our patients when we don’t ask the questions they need to hear. How would I rate that on a scale from one to ten?

3 minutes to go - why did I get here so early?

I also remember that I should wait for a response after showing empathy. “Oh gosh!

I’m so sorry to hear that…” Let me try that again, it doesn’t sound right even in my head…

“I’m sorry to hear that. That must have been hard for you.” I guess we’re all acting in a way.

The standardized patient and I are in a scene.

I genuinely believe the words I say. I can even convey what I mean with my face. If only this door was a mirror, I could rehearse my empathy face.

2 minutes to start and the pressure is starting to get to me. Hang on, is this all fake right now?

Am I a fake? I feel so fake. Alright pause and breathe; every time, I have to remind myself that no, I belong here. This feeling of being out of place in this space sometimes... Will it ever go away? Will I ever find the balance between being responsible for knowing a lot, and being comfortable with not knowing everything?

So often we are tasked to be right, that we forget to ask ourselves what feels right. I am here because it feels right, and I am meant to claim this space. When I wear this coat of compassion, I should remember to share that compassion with myself, too. This is as much about discovering the patient’s humanity as it is about uncovering my own. Okay, panic attack over now!

1 minute to start. Summarize. Let me summarize your story. If I were to summarize my life, my story until now, where would I start?

My life began when one day I remembered to

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breathe. And when I breathed in, I realized that I had a voice. And when I used my voice to speak I could feel its resonance. And when I speak, I do it for others and that resonance is shared.

30 seconds to start. Past Medical History, Family History, Behavioral History, Safety, Review of Systems, Closure. You would think after asking for all of these histories we would know everything about our patient by the end of it. This may be the only time we ever meet – even standardized patients will have different names with different stories each time. And that makes me question, will this be the only time your full story gets told, patient? …That’s such a gift. There is nothing standardized about you. Except that, you know, you repeat the story for the person coming into the room after me. But it will be the only time it is told to me, so it adds something to my own story that wasn’t there before. So thank you for that.

This isn’t so bad. It actually doesn’t feel like an enormous task after all. I think I can do this now. This is the limit of my experience as a first-year, at this moment in my training.

I am comfortable with uncertainty, maybe even with my mistakes. What’s that saying?

Mistakes are a son of a .. is there a saying? I can make one up, and someone can quote me

one day. Mistakes are the mother of… no… mistakes are our lessons in humility. Maybe what’s standardized about it is that we acknowledge that the standard is not perfection but presence. Perhaps it doesn’t have to be just right. Perhaps it will never be that way.

15 seconds left. Is time going quickly or slowly? I can’t tell anymore. I wonder what my classmates are thinking, all standing in a row in their white coats, all waiting outside our doors to go in and say the same thing, make the same empathy face, give the same pauses, and ask the same questions. One day the patient will be real, but I will be saying the same things that I rehearsed. Like a standardized medical student. Maybe they should rename this exercise.

Time! Okay “Mr. Gregory,” I’m ready for you. [Knock Knock Knock]. “Hello Mr. Gregory, my name is Marc Hem Lee and I am a first-year medical student on the team here at Drexel Medicine. So tell me, what brings you in to see us today?”

27 photo credit: Erkan Utu, and Tima Miroshnichenko

INTERVIEW WITH DR. RUBIN Interviewed by Chaden Noureddine Edited by Charles Tavares

Chaden Noureddine: What interested you in working in student wellness and what began that passion for it?

Dr. Rubin: For many years, I was involved in what we call “resident process groups.”

These process groups are not group psychotherapy, but they can be a very intense bonding experience for residents as they are working through their training.

I had become more interested in the issues revolving wellness in education and the wellbeing of people who are in training, so it was a natural shift into a student wellbeing position. Coincidentally, a friend and colleague sent me an email saying: “Can you please forward this job announcement to people who may be interested in a position focusing on student wellbeing?” As I read his email, I thought, “I should apply for that!”

It was serendipitous, that the opportunity came to me in that way.

What have been some projects that you have worked on in student wellness?

I've been at USCF since about 2013. USCF was an early advocate of enhancing the wellbeing of medical students, and they did so through the Medical Student Well-being Program. It was started over 10 years ago with two basic components: direct treatment, and programming.

Direct treatment comes in the form of tailored health services, specifically made for medical students. One of the important components of the medical student wellbeing program is to provide short-term psychotherapy, as well as pharmacological services for psychiatric presentations. Assessment is crucial. We really try to figure out if a student is presenting with burnout or if the student is presenting with another underlying psychiatric disorder.

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The other component is programming. A good example of an event we had planned is Partners in Medicine, which was a dinner organized for students who were in relationships, or who were curious about the dynamics of balancing a relationship during medical school. Ultimately, it was an opportunity for students to talk to each other and learn about the strategies that maintained healthy relationships during a busy time in their lives.

What is the most rewarding aspect in working with student wellness?

Students are very bright and motivated, making them a great group of people to work with. When working with students there is an energy, an excitement, a vitality, which is truly unique to students. It is very rewarding.

When working with students, what can be particularly challenging?

Students know a lot, and sometimes that can be a blessing as well as a curse. With some understanding of basic pathophysiology, or understanding of psychiatry, people get overly worried that they might have a certain problem or condition.

That concept of awareness can be a double-edged sword.

Another challenge is the stigma regarding mental health issues in medicine. UCSF had started a program called “mental illness among us.” Students talked about their own challenges with mental health. This program was designed to be for students by students. I believe the title has been changed from “mental illness among us” to “mental health among us” to try to subvert that stigma of “illness.”

As a student, we never really learn how to deal with this awareness. For example, cardiovascular health awareness is key, but the challenge lies in motivating yourself to maintain positive behaviors while also balancing 60-hour weeks, shelves, and exams.

That's exactly it.

photo credit: Dr. Rubin

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Many people know what the right thing for them is to do. How do you engage that? How do you actualize it? It’s important to start with a conversation with yourself: you could get another two hours of studying if you stay up until two in the morning, but is that actually going to improve your score on your exam? Maybe it will, maybe it won't. We do have a little bit of scientific data on learning and memory consolidation, suggesting that it is not the best strategy. Another example is caffeine use. Caffeine can be an effective stimulant which can help students with studying; however, it can increase anxiety and cause GI upset.

Do you believe that the level of burnout has shifted through the years? Has it changed at all?

Through the years, from when I was in medical school to now, I think there's more awareness of students’ and trainees’ mental health needs. Prior to that, the stereotypical model in medicine was in “the days of the giants,” trainees “toughed it out.” Students didn't complain, didn't ask for what they needed, didn't take care of their own health, whether it was physical or mental. It's no accident that we see higher rates of depression and more incidents of suicide and suicide attempts in physicians.

In recent years there's been a shift in perspective; we realized that wellness is crucial in the training of good healers and physicians. This has been key in moving the student wellness movement forward. The challenge now lays in integrating awareness of wellbeing, and the opportunities to maintain it into very rigorous academic programs.

Are there are any particular stressors that are more prevalent in medical students’ lives compared to the past?

With changes, even good changes, come new stressors and new challenges. When I was in training it felt very insular, as there was a group of 150 medical students.

We were in our own social bubble, and we had a shared goal of studying, passing our exams, and learning as much as we could about medicine. Recently, there has been a shift focusing on medical students as part of a larger community, both locally and globally. Medical students are expected to do way more than studying and passing exams.

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As we are learning to be healers, we are also asking ourselves, “How do we act as agents for social change?” There has to be awareness of systemic racism, injustices, health disparities, and what is going on in the world around us. It all affects us as we learn. For instance, gun violence: some people think of it as a political issue, but it really is a health issue. Although these changes are positive and important, they can come with added stress, especially when compared to when we were insulated from the real world and only had to focus on passing exams.

Do you believe that there is a particular population of students that struggles with the medical school experience more than others?

Everyone who is accepted can handle the academic load.

The good news is that we are accepting students who reflect more of the diversity of our nation, and of our world. The ratio of men to women enrolled is now almost one, which is great. We're also trying to reflect the racial and ethnic diversity in our society, which is very powerful, as it also touches on socioeconomic diversity: people who are first-generation immigrants, people who are the first in their family to pursue higher education, etc.

It is awesome that those students are now achieving more, but I think it also creates a situation where they may face additional challenges. For instance, they may not necessarily have the structure, resources, or familial support other students may have. They may also have to deal with institutional racism, micro and macro aggressions from other students, staff or faculty.

photo credit: Dr. Rubin

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How would you recommend that students harbor empathy, reach out to each other, and make sure their peers are okay?

Good physicians are very curious. If you see someone whom you think may be having challenges, I would suggest just asking if they are okay. Putting that question out there creates an atmosphere where it's possible to get that help. It normalizes asking for help. Also, sharing our stories is crucial, it makes others feel less isolated. It creates an atmosphere safe from a “conspiracy of silence.”

Do you have any advice for students who want to become better wellness advocates for themselves, others, and their community?

You have to start by practicing wellness, for yourself.

One aspect of wellness is what I call “basic maintenance.” You have to ask yourself, what are the things that you need to do, or someone needs to do, to run well? They are going to be different for everyone; those components are eating well, getting exercise and sufficient sleep. Each student needs to put a certain time in each of those components, and the ratio for each one of us is different.

Another piece of wellness is academic wellness. That’s when you ask yourself, how do you study well? What's going to work for you? How often do you need to take breaks? Do you need certain kinds of help to facilitate that? Some people are better aural learners while some are better visual learners.

Then, we can talk about social wellness.

When starting medical school, how do you make sure to not lose contact with all your friends from college, your family, or other similar kinds of support.

Finally, there’s spiritual wellbeing. This is when you try to assess what gives you a sense of purpose. Is it praying? Is it attending church? Is it taking hikes, or making photographs?

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Ideally, you want to make sure you are addressing all of these different aspects of your wellness, and once you’re able to do that, you can be there for others.

Finally, what are some of your favorite wellness activities, and how do you maintain your personal wellbeing?

Exercise is really important to me. I was really lucky when I came to UCSF to discover that there's a pool right across the street from my office. I swim at least two to three times a week. We do know from research studies that if you're closer to a clinic, you're more likely to attend appointments. The same is true for the pool. If it's conveniently close, it's easier to go swimming.

Otherwise, I also prioritize photography, and writing. I try to make sure to set aside some time for my hobbies, every day. If you look at my Instagram account, I have a practice of doing a photo a day. Just in the same way that some people have a meditation practice, I have a photography practice.

That's amazing. It's so refreshing to hear a physician who prioritizes time for their passions or hobbies. As medical students, we sometimes feel like we have to justify indulging in our hobbies. Would you mind sharing your photography from Instagram?

Of course not, it's @Hcrubinsf.

Thank you so much. Do you have any closing words or advice for the reader?

I would say be yourself.

Sometimes people come into medical school and they feel like they're starting from scratch. In reality, the skills that enabled you to thrive in college and to thrive in your life so far are not null and void. You should not lose touch with your humanity and the things that brought you to medical school, as you embark on your training. photo credit: Dr. Rubin

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WHEN YOU TOUCH ME YOU TEND TO ME

by Allison Zuckerberg

This poem is a second-year medical student’s poetic reflections while taking a Neurology & Psychiatry preclinical course. The language is reflective of the material she was learning, at the time.

I've gone in every direction, but without localization, I'm empty-handed, parkinsonian; I cannot move but want to.

This black and white world is dystopian, And there is nothing to do.

Blank is the state Of a mind full of locations, but without destination, I'm empty-headed, parkinsonian; I cannot feel but want to.

I want it so much, Yet blank is my face…

What if I added you to me?

An already nervous system, I'm pathologic, But you feel physiologic.

The hair on the back of my neck stands As your fingers enter the crevices of my hands Yes! I think you've found land…

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Because when you touch me, you tend to me.

Things change about as fast as my eyes, nystagmic And like magic, it all starts to go...

The tides turn this cape To one of Good Hope, utopian.

I'm no longer static, but dynamic.

Something is growing like a sun could set on the scene and end it, But doesn't.

The sun rises on my sleepy continent, When I never thought I'd see green again…

When you give me your hands, Feelings bud, even bloom.

It’s anything but ordinary, garden variety.

As I get into bed, I think of how there's nothing there now, But good thoughts between my body and the bottom sheet.

It's a beautiful space, Like the barely there layers of meninges That caress my brain.

illustration credit: Chaden Noureddine

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WONDER

by Ling Jing

I want to know everything you know.

You teach me about the emus at the zoo, and I, resting my chin on a green rail, listen attentively.

I watch a lion kill a zebra on TV and ask you if the zebra can feel pain.

“No,” you answer, simply.

You take me to music lessons, because, although, you’ve never been able to carry a tune and “music didn’t exist” in your childhood.

You listen to every note, every ruined, every mastered devotion or wonderment seated, perhaps bitterness, resentment, regret that yours was so different.

You find our sadness strange, the sadness of strangers strange.

“How can success be so miserable?”

“What more could you want?”

“Life is sacrifice. There is no time for this.”

Once, visiting an empty house, you asked me how I felt.

“I don’t know. How do you feel?”

“Strange,” you say, after a pause.

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We tell you we are well “radiant with joy,” you describe proudly to an audience for we have come too far, given up too much, to change the paradigm now.

Once, we asked you about history, about memory, and you claim there is none, angrily.

I hear you talk about the the dances you never went to, the visits you never made, the nevers that you’ve accepted for this life but seem to never question, for better or for worse I’ve always wondered how you do it.

37 Photo credit: Anna Shvets

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ARTWORK BY

MARINA ZAKHAREVICH

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MASK

by Anonymous, New Jersey

Ever since I was a little girl I was told I’m too “quiet.”

When I was younger, anyone I’ve known -outside of my nuclear family or friends-, saw me as that girl who didn’t talk. Even my cousins thought I was “weird” because I would hide behind my parents instead of playing with them. I couldn’t help it.

In contrast to how I appeared, I did want to talk. I was just paralyzed by the overwhelming fear of talking to someone who didn’t know me, and what they would think of me. I didn’t know how to interact with new people, people I didn’t see on a daily basis. It was easier for me to observe people from afar. At a young age, little me found that interactions were overwhelming, she preferred to retreat to books rather than talk to someone new. She would internally beat herself up, wishing to be more like everyone else.

When I met someone new, I realized I was always more worried about impressing them, as opposed to engaging with them.

‘Is my body language okay? Am I smiling enough?’ Compared to my past self, I was making great strides, but at the same time, I always felt that I was so focused on being perceived correctly, that my personality was closeted. My college class size was small; my medical school class is huge.

In the beginning of medical school, I remember my heart racing as I would sit in the lecture hall surrounded by hundreds of other students. The first couple of days, people were talking to each other left and right, and I struggled to do so in a meaningful way.

‘Why couldn’t I? I’ve tried so hard. How is this still impacting my life…'

I was officially diagnosed with General and Social Anxiety when I was 17. When I entered college, I purposely participated in performances that involved a stage, and joined social extracurricular clubs.

However, I could never “win” against someone who I perceived as a natural communicator. I always felt my insecurity run through my brain ‘My friend does this so well, should I act more like her? Am I interesting enough to hold this person’s attention?’

I thought I was in control of my anxiety, but alas, it peaked. I truly struggled to adjust to a new learning environment.

Along with the stress of medical school itself, the additional social stress made my transition even more challenging, and it took me a while to overcome it.

Fast forward to 2020 and COVID hap-

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pened. It was everyone’s priority to wear a mask. To some, the mask felt like they were entrapped. But to me, the mask became one of the most liberating experiences of my life. For the first time in my life I have felt freedom. Freedom of judgment, freedom of scrutiny… freedom to be me.

nymity is liberating. No one can see my facial expressions or scrutinize my face.

If I were to draw a comparison, it would be to people who are more outspoken behind anonymous usernames on online forums. In real life, masks are the closest thing to anonymity.

I’m unsure what a post-COVID world will be like for people like me. I would hate to be dependent on a mask as a mean to appease my anxiety when I meet people.

Wearing a mask has been like a breath of fresh air. Socializing is so much... easier. I have been more open to extending conversations, rather than trying to end them. Eye contact is easier. I questioned why I could open myself up so much more easily. I came to the conclusion I was less preoccupied with how people were perceiving me. Basically, I felt less self-conscious, and more confident.

Now that I have experienced this liberating experience, I am optimistic that I will be able to bring this confidence to a bare-faced world.

As cliche as it sounds, I feel like I am hiding behind a mass. The pseudo-anoillustrations by: Chaden Noureddine

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photo credit: Anna Shvets

SHOULD THE CABIN LOSE PRESSURE

by Matthew Saperstein

“Should the cabin lose pressure…please place the mask over your own mouth and nose before assisting others.” On an airplane, we accept the notion that in order to best help others, we must first ensure our own well-being. With more than half of medical students screening positive for depression (Academic Medicine, 2014), why is it that we accept this belief as passengers on an airplane, but disregard it in our role as medical students?

As I sit alongside my mom, enjoying the fleeting days of winter break before embarking on another semester, I ponder this question.

While every medical student has their own answer to this question, I can’t help but think that the disregard for our own well-being partially stems from how society perceives medical students. With this perception, a selffulfilling prophecy drives medical students to think and act in accordance with how society expects medical students ought to think and act.

was in absolute awe of medical students! I viewed these chosen individuals as a collective of hard-working, extremely bright individuals whose futures were set; their biggest worry being their next exam. However, having now spent 561 days in the life of a medical student, I have been privy to many eye-opening realizations. These realizations have not come solely through my own experiences, but from open conversation amongst my dearest of friends.

As I reflect on my M1 year, one of the most impactful realizations is the fact that more often than not, the next exam has actually not been my greatest stressor! I say this not to diminish the abundance of moments when an upcoming exam entirely invaded my psyche, but rather to address the numerous other obstacles in life that we as medical students deal with on a daily basis. (After all, we are people first and medical students second.) If you catch me in a coffee shop staring off into space, I am likely not thinking about the rateSociety often views medical students as a limiting enzyme in a biochemical pathway, group of selfless, high-achieving individuals, but rather contemplating one of the following relentless in their pursuit to become questions… physicians and serve their communities. Prior to being accepted to medical school, I, myself,

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Am I sacrificing my personal life for my career? Is the financial and emotional burden of medical school worth it? What if my grandma passes away before I get to see her again? Do I have the time and energy required to sustain the relationship I’m in and excel academically?

These questions only represent a small fraction of the thoughts that consistently swirl in my mind as I attempt to balance medical school, a blossoming relationship, and my own well-being. I imagine the anxiety that overcomes me when pondering these questions would be attenuated if I heard more students voicing their apprehension over similar topics. Unfortunately, the publicly discussed concerns of medical students seem to revolve around class rank, board scores, and match statistics. With this in mind, I challenge any student who comes across this essay to open the dialogue among their classmates to depression, financial burden, and any other life concern that consistently arise in your thoughts.

patients inevitably and unknowingly suffer as well. When we are overcome by the grief of losing a friend, a parent, a sibling, or a child, we are not at our best. Our attention is divided, our thoughts run amok, and we cannot provide our patients with the focus and clarity that these individuals are desperately in need of. If the emotional prosperity of 21,622 medical students is not enough, consider the millions of patients who will be treated by the hands and minds of those 21,622 medical students.

During the arduous flight known as medical school, a bit of turbulence is inevitable.

As medical students, we will undoubtedly experience ups, downs, and unexpected turns during the journey. As the pilots of that journey, we must pay special attention to the many facets of our own well-being, addressing the emotional, financial, and familial obstacles that lay before us. When our masks are safely placed over our own mouth and nose, we can then dedicate ourselves to helping those around us. In addition, just as pilots turn to co-pilots and At this point, you may be thinking, “why flight attendants in times of stress, we as is it so critical that we heal the healers?” medical students must remember to reach Surprisingly, the answer to this question out to our friends, families, colleagues, and can actually be found in the personal counselors to help keep us aloft. statement of nearly every medical school applicant. The well-being of medical After all, we cannot direct the wind, but we students, residents, and physicians is can adjust our wings. absolutely critical in our lifelong aim to ‘serve our patients to the best of our ability.’

When healthcare workers suffer, our photo credit: Sourav Mishra

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INTERVIEW WITH DR. AGGARWAL interview by: Chaden Noureddine edited by: Charles Tavares and Ryan Behmer Hansen

Dr. Rashi Aggarwal is an Associate Professor and Program Director of Residency, at Rutgers New Jersey Medical School in Newark, New Jersey, where she serves as a Consultation Liaison Psychiatrist. She completed her residency training at Maimonides Medical Center in Brooklyn, New York which was followed by the completion of her fellowship in Psychosomatic Medicine at Mount Sinai Hospital in New York.

Dr. Aggarwal served as a member of the Governing Council for the IMG Section of the American Medical Association from 2013 - 2016. She is currently serving on the American Psychiatric Association’s Council on Medical Education and Lifelong Learning, and on the American Psychiatric Association's Workgroup on Psychiatrist Wellbeing.

Dr. Aggarwal is an active researcher in the fields of stigma, resident empathy and wellness, IMG education, training and acculturation and addiction disorders in consult-liaison setting and has published extensively in these fields.

Chaden: First of all, thank you very much for agreeing to do this interview. We are honored to feature you on the first volume of the magazine, especially considering your work and background focusing on resident burnout and wellness.

What drew you to this niche?

Dr. Aggarwal: When I was first a resident, in my first year of psychiatry residency, I started my career with six months in the medicine department; it’s a common requirement of psychiatric residencies. During this time, I noticed that I was becoming less like myself, I was not as nice as when I started. I think a lot of it was related to me spending less time indulging in activities that made me who I am. I was constantly working six days a week.

At times, I would find myself overwhelmed, and even hiding, when I was approached by a patient’s family member or loved one, as they always had difficult questions. That made me

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feel guilty. I felt like a bad person. I felt as if I had this dirty secret I was keeping from everyone else, and I was hiding that secret as hard as I could, everyday.

There was an emergency medicine resident who was rotating through Medicine at the time, and one of us had finally expressed how they felt ashamed since becoming less empathic, and that, to me, was a changing point; I felt more comfortable sharing about how I was feeling. I didn’t feel isolated in my shame. That moment made me realize my interest in the concept of empathy, and its application in medicine. I spent a majority of my residency researching empathy, reading about it, talking about it, and that was my way of making up for the lack of empathy that surrounds us in this field.

How would you define empathy, and burnout?

Now just to be clear, burnout and well-being are not mere opposite sides of the same spectrum, because you do not need to be burnt out in order to not be well or be unhappy.

The absence of burnout is similar to the absence of disease. You can’t just shortcut your way through wellness by doing some sessions regarding the topic, and checking off a couple of requirements. We can’t be lazy about it, and lecture our way through it. It almost becomes paradoxical when some of the time spent on these lectures could be used to practice actual wellness.

My primary interest was always well-being; however, with the rise of the topic of burn out, the two topics got intertwined. One of the main drivers of my interest in the topic was finding a way to optimize my own well being. I knew that optimizing my own wellbeing would be vital in helping others. I got involved with the APA task force on wellbeing and burnout for psychiatrists, and, the one major "light bulb" moment for me was realizing that burnout is really an organizational issue. To really address burnout in any meaningful way, you have to make organizational changes.

Many people who are working in the field of burnout dismiss the resilience aspect of it. Placing importance on resilience can mirror blaming the victim. We often hear that practicing wellness is the key to “fixing burnout.” To fix burnout we have to make changes on an institutional and organizational level. At the same time, we have to realize that well-being and resilience are also important. photo credit: Nataliya Vaitkevich

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You mentioned a correlation between resilience and victim-blaming, would you mind elaborating on that point?

Consider a scenario where you, as a student, are doing poorly, whether that is because of personal vulnerabilities, outside factors, or how you handle stress as a person.

Then, let’s say the following recommendation is made, “Exercise more, eat healthy, try yoga, you're not doing well and this will help.” This creates an interesting dilemma as it implies that you are the root of not doing well and you should be more resilient.

In some ways this is true. If you did these things you will feel better, but when these recommendations are made most people will hear: “I am less resilient than the others, and it's my fault.”

With physician and medical student burnout, there is so much literature which shows that medical students start out much more resilient than their counterparts in other professions, but within a few years of medical school and residency training, resilience levels start to decrease. This applies to empathy, as well. Most people come into medicine because they want to help others. Then by the third year of medical school, there is a sharp decline of resilience and empathy.

There is also a significant increase in cynicism among medical students in comparison with other professionals. If a group of highly resilient and empathic people all share a significant loss of those traits, then it can’t be a respective factor of each individual; it must be a systemic factor. While each of us can address our own stress and improve outcomes, the onus should not be on the individual.

Even something as simple as scheduling that prioritizes adequate rest, and sleep, can be fundamentally beneficial for well-being. The statement “everyone should eat better and should exercise” should be rephrased to “the system is not conducive to eating better and exercising, when it should be.” This is why people who really are passionate about the subject of burnout don't focus on individual well-being and resilience, but instead, focus on organizational accountability.

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Why do you believe medical students and physicians are subjected to burnout?

The culture of medicine has a facet of taking pride in overworking. Being able to say, "Oh, I was working until 7:00 PM" becomes a badge of pride. You're considered a "weak link" if you can't start at five and end around eight, at times.

Why is this acceptable? You're supposed to rest. You're supposed to eat. You're supposed to exercise. You're supposed to have a partner, and children, and dogs, and hobbies.

When are you going to do all that if you are working that many hours? When will you have time to better yourself, or help someone else in pain?

The problem with the system of medicine is that it seems to operate much like a factory would. In a factory each worker contributes to an assembly line, and at the end of the process there is a product. Everybody does their job. It is physically demanding, you work for eight hours, you clock in, you clock out, and every minute of your time is designed for maximum productivity. The problem arises from the fact that working in the medical field is not only physically demanding, but also emotionally demanding.

Even as a student, as you rotate, some of the encounters with patients are painful. You feel their distress. When somebody else is crying, screaming in pain, agonizing over their future, you absorb all of those emotions.

If there is not enough time to recover, then you are going to eventually burnout. There should not be a quota placed on what we do, especially when it comes to patients and their care. That's a serious problem in the culture of medicine.

That culture is fortunately changing, because your generation recognizes the dangers of burn out. One of the things we need to learn about in medicine is how every person has an optimal level of wellbeing to maintain happiness. Recognizing this level should be an absolute requirement in training.

photo credit: Olya Kobruseva

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What is some advice you would give students who wish to be wellness advocates for their peers?

I believe that in order to help others with their emotions, you have to be in tune with your own. You have to be able to recognize your own range of emotions; recognize and be attuned to when you’re feeling grief, joy, anger or shame. This is especially applicable to medical students, residents, physicians and psychiatrists; people who tend to deal with others’ emotions. Until you recognize your own range of expression, it can be challenging to support others.

Another piece of advice would be to approach your own emotions without judgment.

Often, students find themselves feeling frustrated. A voice in their head says “ I am healthy, I am so lucky, I am in medical school, everyone surrounding me is healthy, why am I feeling this way?” Students find themselves feeling guilty. It’s important to learn to extend empathy toward yourself. It is okay and normal to want more for yourself.

Finally, I believe that altruism is a great way to harbor a culture of wellness. Altruism and advocacy can come together naturally, at times. Sometimes it’s as small as giving a peer a compliment during a Zoom meeting. Small comments like “I love your background for this meeting” or “I thought your comment/question was very insightful” can truly make someone’s day. Then hopefully you can help that person feel more positive about themselves, so they’ll say something positive to another peer. Becoming involved in this positive feedback loop can truly be helpful, and make others feel less lonely. Also, ultimately, you are making yourself feel better because altruism can truly boost your self-image.

I think a great thing we can all learn is expressing gratitude and appreciation for each other. This can be helpful for both members of the conversation. For example, at the end of each class, someone is chosen, and a group of people are able to design a slide where they're able to express what they like about the person. This can be extremely helpful because at the end of the day the person will have this one slide to look back on, and reflect on the strengths that other people see in them. But then, also, the people who wrote the slides are able to feel good about making another person’s day. photo credit: Nataliya Vaitkevich

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How do you personally practice wellness?

Sleep! That is a vital aspect of my wellbeing. I also enjoy reading. I used to have shelves and shelves of books, but now I have recently moved to e-reading. I also love cooking. My daughter and I cook together often, which is a great way for us to bond, and enjoy a meal together.

Teaching is most definitely a way I practice wellness in my career. It gives me a sense of purpose and makes me see the impact one person can have. It also helps me give back.

Any last words for the reader?

When thinking about your own wellbeing, and its presence in the sphere of a bigger frame such as physician well-being, it is most important to consider your sphere of direct influence. This is where you can achieve the most impact, all while staying well and not overwhelming yourself. It’s a way for you to help and contribute directly, all while still being able to see your direct influence.

photo credit: Karolina Grabowska

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THE FLOWERED HEAD WRAP

by Allison Zuckerberg

I like to say that patient communication is an art. Each person is like a portrait, composed of many colors and creating a complicated yet complete masterpiece of a human being. Patients are best understood when considering each color that makes up the picture and, in this narrative, I cannot exclude how one patient’s colors blended with my own. For the rest of my career, I will remember the woman with the flowered headwrap.

This woman came into my life (and the emergency room) loudly. Dressed in slippers and a purple nightgown, she contrasted against the white of the hospital’s sterile walls like night and day. As I was only a weeks-old volunteer, I was taken aback by the sight of her and sorry for it.

A cane at her side and the arms of multiple staff members at the other, she screamed in pain as her supports struggled to help her onto a bed. Besides her nightwear, the only other thing she wore was a multicolored headwrap. As the staff left her side and I found myself alone with her, my first thought surprised me. “Please don’t talk to me,” I thought. I didn’t even know how I’d respond. I slowly returned to what I was doing since at first. Almost as if completing my request, she didn’t try to speak to me.

As I did not have access to electronic medical record, I didn’t know who this woman was or why she was in the hospital today. Although the pain that admitted this woman was clear, it also came and went- as did I, checking in on the rest of the adult unit. Even down the hall, I could hear screams crescendo in intensity and I found myself unable to focus on anything else. Every part of me wanted to help her. Even though I had no medical privileges, I kept thinking that there had to be something I could do for her. I could give emotional support, but what words could I offer to a patient in such pain? What can words do in the face of suffering? When our eyes eventually met, I began to acknowledge it. I saw its hold in her expression and recognized that pain could be palpable. I felt pain in my own heart as I sized her up. Her fists were full of blanket that someone must have given her. It also occurred to me that besides what she was experiencing, she was suffering an equal (if not greater pain) of being here totally alone. No one was at her side.

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“Please, stay with me,” she said. And then I realized that I didn’t need to think about what she might need, because she knew. She didn’t need my words, only a person with her. I gave her my hand in hers and as she screamed, I said nothing. And as she squeezed my hand, she began to communicate more of what she was experiencing, and it literally brought me to the hospital floor. However, I barely felt this. Instead, at eye level I began to see the pattern on her headwrap. It was handmade, with stitching that weaved around a multitude of flowers. Although the headwrap seemed old, the pattern made me think of youth and of life. This woman was African American and as I got a good look of her face, I realized that she was much younger than I thought.

However, the pain she was experiencing seemed to pull the lines of her face into its tightest spaces, which were well-worn into the skin around her eyes and mouth. I started to wonder if what ailed her was chronic, as the pain seemed to have aged her considerably.

With this idea, I was moved even more.

“We’re going to take deep breaths,” I said. It took three big inhales before she was able to complete this with me, but it was worth waiting for. After her exhales, the flowers seemed to still. “Okay, now we’re going to count down from 100,” I continued, and we did. There were numbers she found herself unable to speak or to keep up with my pace.

“Ninety-one,” I’d say, just to be met with silence. She couldn’t make out the words. “Ninetyone,” I repeated, patiently, until she could say it with me. Waiting continued to work, as eventually her counting became more even, and she took less pauses. As we continued, my surroundings returned to view. I began to see that others had been watching us, including a nurse standing close by with a chair. It was clear that she’d brought it for me, but I only shook my head. “Last time I was here I slipped into a coma,” said the patient. I continued to count as she told me more of her life story. Eighty-two. Eighty-one. Eighty.

“I was alone when it happened.” Seventy-nine. Seventy-eight. Seventy-seven. “It was three days before Christmas. My children didn’t know why I couldn’t be there. And no, I wasn’t supposed to have children. But I do, and they’re my life. I need to make it home for them.” illustration credit: Charles Tavares

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In reflection, I refused the chair because I had connected with my patient on the emergency room floor. Like the flowers on this woman’s headwrap, this woman’s story had more details than I could have seen at a distance. Between breaths, this woman revealed more of the person behind the pain; further, she was able to communicate what I needed to do to help her. With every number, and without any regular pace, I learned the intricacies of every flower’s stitching. We both started to settle after we reached zero. “I was born with sickle cell disease,” she finally told me. “I was never supposed to make it this long.”

“I will stay with you as long as you need,” I repeated.

What is good communication? I’d argue it is as subjective as “good art,” as two people may completely disagree that what I’d done was “good.” I’d once heard that a doctor should never sit on a patient’s bed, let alone the floor. However, I know a connection was made.

By entering the doorway of this patient’s life, I had become what she needed. I couldn’t uncurve her red blood cells or unclog her capillaries. I wasn’t even at a stage where I

could administer the medications to ease her pain. As a medical student, I now know how opioids treat acute sickle crises. However, I also know that on the day of this encounter the woman with the headwrap was suffering from pain secondary to her disease. I realized this communication was the medicine she required as much as the pharmaceuticals, if not more.

Before I finally did leave, I took one last look again at the woman’s face but knew I needn’t have. I knew her face’s details even at my increasing distance, and to this day I remember the colorful flowers.

52 illustration credit: Charles Tavares

LATE NIGHT PHONE CALLS

by Bryant Yu

*Ring. Ring.* I answered the flashing office phone.

Immediately, the voice on the other end asked, “What’s easier: hanging or jumping?”

I felt like a deer caught in headlights.

On the suicide helpline, I encountered many different voices. Some whispered. Some shouted.

However, none caught me off guard like this one. It was only my third shift.

At first, I assessed the caller’s risk for suicide. I probed her more about her situation while also validating her feelings. The more I got to know Sarah, the more her emotions pulled me in. All of her life she struggled to find acceptance in Texas as a lesbian.

When she came out to her family, they disowned her. She had finally found one person who was able to understand her. She believed she ruined that relationship through misplaced anger. Broken by the loss, she wanted to take her own life. By talking to Sarah for two hours, I managed to keep her calm while getting her the emergency services she desperately needed.

About 5 years ago, I’d taken my first calls on the helpline. It wasn’t until recently on a psychiatry inpatient unit that I truly understood what happened to Sarah and those other callers.

I loved getting to see and talk with similar patients and hearing their stories, once more.

53 Photo credit: Andre Moura

CREATIVITY AND THE ARTS IN MEDICAL SCHOOL

by Jessica Kerpez

From a young age, I have been surrounded by individuals with a love for creativity and the arts.

This first began when my sister taught me the basics of drawing in our free time. Whether it was sculpture, painting, or photography the majority of my family has been involved with the arts. Some made it into a full-time career. For instance, my extended family in Betschdorf, France has run a pottery shop for generations. Our closest family friends ran an art studio gallery in town, where we could partake and teach classes to the public. In high school and throughout college, I grew to love photography and became well versed in photoshop, while I continued to paint in my free time.

When I grew older, my love for medicine stemmed from a fascination with evolution and genetics. As I began to pursue studying Biology in college, I still managed to pursue my creative interests . Even though I was getting busier with my schoolwork, I still set aside an hour or two each week to either paint, play piano, or pursue photography. Looking back, I believe that my passion for the arts helped me learn how to conceptualize topics in a more abstract manner, and to evaluate all potential solutions to a problem I was

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facing. Although there may be more “black and white” solutions in science, the process of obtaining a solution requires having an open mind.

When I was first matriculated into medical school, I did not set aside any time to pursue my creative hobbies. It becomes easier to focus on the task at hand, and to not set aside any time for yourself during the week. However, over time, I learned to balance my time more effectively. Setting aside a few hours to engage in hobbies, such as painting, is a pure stress reliever. Once I learned to manage my time, engaging in my creative outlets has helped me study more effectively and has maximized my productivity.

For those of you who may come from a more artistic background and just entered the medical field, I encourage you to pursue what you love doing…

artworks by Jessica Kerpez

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LOSS AND REVIVAL

by Dong Gue "Jimmy" Oh

I look into the sky Color fading from orange and blue, back to orange and black Staring speechlessly until the marvels die Then I stop staring and turn my back But beyond the color lies the Universe Unfathomable, mysterious space full of everything and nothing That Ancient Greeks worshipped and modern astronomers traverse And continue searching for stars, black holes, or anything I look at the patient Story unfolding from family and hobbies, to jobs and stress Listening carefully until time hastens Then I stop listening and redress But beyond the story lies the universe Unfathomable, mysterious space full of bliss and pain That ancient healers discussed and modern physicians scrutinize And continue searching for concern, answers, or something I look in the mirror Smile beaming from lunches and meetings, to workshops and rounds Skipping proudly until fatigue overweighs Then I stop skipping and plod But beyond the smile lies the universe Unfathomable, mysterious space full of loss but also revival That the skipper remembered and the plodder forgets And must start searching to skip once again Loss that families mourn and accept in my arms Revival that once-wounded rejoice and celebrate in my arms

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photo credit: Philippe Donn

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INTERVIEW WITH GRACE RO

by Elizabeth Chern

A focus on wellness has surged within the upheaval the COVID-19 pandemic has caused. At the height of the pandemic, the ways we stayed connected and found fulfillment were seemingly wrenched away from us. Many of us still struggle with isolation and uncertainty about the future as the pandemic continues to evolve and unfold. We struggle to make meaning out of the events we’ve lived through, the people we’ve lost, and the new reality we’re currently experiencing. Through this chaos, the importance of seeking balance and investing in the activities that recharge and renew you has become even more important.

Wellness is an individual practice that spans activities like taking nature walks, working out, spending time with families, or creating music. As a busy medical student it can be frustrating to listen to wellness talks and be told to invest in your wellness---especially when your to-do-list never seems to shrinks. It almost feels like chasing after a mirage when you pile on the constraints and isolation the pandemic has gifted us.

This is why it was so refreshing for me to be able to interview Grace Ro, a current M4 at New Jersey Medical School (NJMS), who is a talented musician and invests in music as part of her personal wellness. For those unfamiliar with Grace Ro, she is a New Jersey native who grew up in Plainsboro, NJ and attended Boston College, where she majored in psychology with a focus on neuroscience. She is a talented violinist who can also play the piano and sing. Grace comes from a musical family that performed music together at home and at church. Her family consists of her brother who plays the viola, piano and guitar, her father who plays the guitar, and her mother who plays the piano.

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To hone her craft, she participated in numerous regional orchestras, competitions, and in college performed with several chamber music groups. As a medical student, she kept her skills sharp by performing at various NJMS events such as classical recitals, Coffee House and Follies.

We started this interview by gathering a brief synopsis of Grace’s academic history and journey to college and medical school. Her lifelong passion for music is blatantly evident and her expressions of self-doubt were extremely relatable. She had questions about time management and academic achievement that I believe we’ve all asked ourselves at some point.

“It’s a funny story, now that we’re talking about musical things. In high school I was applying to college and I didn’t get into the program of my dreams. I wondered if I wasted my time – maybe I should have spent less time on extracurricular activities and focused more on academics. My fear was that the things I excelled in were not as valuable because they were not academic.

Entering college, I thought, ‘I’m going to put the music stuff on hold and really focus on performing well in my premed classes. I’ll participate in all the right clubs, get good grades, and do research.’ I didn’t bring my violin to campus and I lasted, I think, not even a few weeks. A few weeks in, I realized that I couldn’t stop doing something I’ve loved since childhood. I called my parents and asked if they could bring me my violin. Literally, within the day, they booked a hotel room and drove up to campus.

Even throughout college with all the academic challenges and club activities, playing my violin was something I did at least once a week. I would practice challenging pieces with my classmates and receive coaching sessions from professors in the music department.

This led to many close friendships and immense growth as a musician.”

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The second half of our interview focused on Grace’s experiences in medical school. What struck me was the passion Grace displayed for music and the way she continued to celebrate music while in medical school. It frequently feels like there is immense pressure to focus solely on academics and leave your passions by the wayside. We spent our high school years trying to get into the right colleges and our undergraduate years trying to get into medical school. While in medical school we are all striving to enter into residencies and burnout can become a real issue. It was such an encouragement to listen to Grace’s journey and the ways she creatively incorporated her passion for music into her time at NJMS.

“When I entered medical school, I faced the same type of conflict again.

Medical school is a big deal because everyone is highly intelligent and very passionate about medicine. I thought to myself, ‘How do I do this? Will music be a part of my medical school experience?’ I was struggling with the idea of allowing myself to allot time to do something I really love.

I quickly found that there were quite a few musical medical students who shared this passion with me. It wasn’t enough for me to practice in my room on my own – I wanted to build a community that could share music with each other and those around us. This led to the start of the bi-annual Classical Music Lunch Series in 2018 which brings together students, residents, attendings and hospital staff to enjoy a live recital to promote wellbeing. Conversations about music also extended to my clinical interactions, where I met countless patients who had incredible careers in music, or simply loved music and could be uplifted by playing a song at the bedside. I ultimately fell in love with psychiatry because this specialty focused on the patient as a person, which opened the door to truly understanding and learning about each individual’s goals, mindset and passions. Through many conversations with my mentors in psychiatry, I found that this was a field where I could continue to keep music connected to medicine.

Psychiatry is open to creativity and innovation. It’s not just a + b = c for every single patient. In seeking to treat patients, you treat each one as a fresh canvas that you bring your tools, paints, and skills to. While on the subject of music, I think of the process as a composition, ready to be embellished and personalized for each patient.”

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What I loved the most about Grace’s story is the way she was able to not only continue to reinvigorate herself through music, but also the way she uses music to connect to others. Grace gave her first talk on music and healing during the 2020 Rutgers ECHO Webinar Series. Shortly after, she was invited as a keynote speaker of the 2020 Urban Mental Health Conference where she spoke about the effects of music on stress, and emotional responses in Alzheimer’s patients. Her presentations included live violin performances as well as an interactive improvisation exercise that was enjoyed by many participants.

This summer, Grace will be starting her psychiatry residency at the University of Rochester Medical Center (URMC).

The University of Rochester has an affiliated music conservatory called the Eastman School of Music. This opens up the doors for her to audit courses and to potentially explore mental health for musicians in ways that help them to manage their health while still maintaining their creativity and passion. Grace’s passions and values led her to a niche within medicine and it’s exciting to think about what she will do in the future.

If you are a cynic like me, it sometimes feels like “cultivating wellness” is code for “try harder to be happy”. As if the concept is working to convince you that trying harder at relaxing is the salve for burnout and exhaustion. Yet, I find myself with a different view having worked on this issue of the PsychSIGN magazine and having conducted this interview. I found many of Grace’s responses insightful and honest about the time constraints, self-doubt, and struggles to balance academics and wellness. What struck me the most was Grace’s grounded personality, persistence, and creativity in finding outlets that maintained her wellness. It’s my hope that our interview serves as an encouragement to readers.

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FIND HER WAY THROUGH

by Maria Shibatsuji

Streaks of neon blue In her long dark hair the cat-eye glasses a sprinkle of acne on her cheeks Black shirt and sweats stamped with the hospital logo Wise beyond her 15 years Holding her family together After her parents’ unraveling marriage While helping her mother and siblings heal, She lost her way She knows the routine, She’s been through it before coping skills and groups adjusting medications daily check-ins rating her mood from 1 to 10 "She nods when asked if she wanted to die But denies that she had a plan She cares deeply about school Takes the hardest classes, Prides herself on her flawless grades To graduate school is her goal So much self-inflicted pressure" I wrote in my notes She begs to go home when I chat with her one-on-one "My mom needs help with my siblings" she says

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My younger self identifies with her An anxious perfectionist Sensitive and self-aware I want to reassure her That I understand her struggles I had the same ones, too I hope she knows Her life will unfold The way it is meant to The hard times, the bumps along the road will never go away but she is resilient and will always find her way through I still think about her Almost a year later Wonder if she realized There is life to live After high school So much time For growth and lessons To create and live a beautiful, fulfilling life

63 photo credit: Karolina Grabowska

I TRUST YOU

by Ruchi Patel

I sat in the library holding back tears as I read my co-student’s text. It’s not anyone’s fault. We gave Mr. N the full workup. I flip back to the medical chart re-reading the ICU transfer note for the third time. I reply, I just feel guilty…

He trusted me.

own mantra that for every one patient that answers my questions there will be two who won’t. I explain the medication we will give him tonight and smile at the patient sitter as I leave.

The next morning, with just one call of his name, he turns his head. His face is sweaty and his eyes sunken. I ask how he is doing. “I did not sleep,” he replies. “Did the medication help at all?” “I feel less worry,” he responds.

His eyes widen as he speaks to me. He is making the most intense eye contact with me, yet I feel he is seeing right through me.

“Okay, you’ll take Mr. N as a new pick-up patient.” I open his chart and mentally boil him down into a one-liner, as expected for a “doctor-in-training:” 30-year-old male recently diagnosed with Immune Thrombocytopenic Purpura put on steroids now presenting with 7 days of insomnia and suicidal ideations. I read the brief staccato sentences that were his social history: “Works as an uber driver. Wife “Can we talk about the thoughts you had in works at McDonalds. 2 kids. Immigrated from the emergency department yesterday?”

Romania 3 years ago.”

He squints and looks away.

As I walk into his room, I see a young, tall, dark-haired man. The gown seemed out of place on him. He looks up at me revealing the bags under his eyes. Gently, I introduce myself. I ask a couple of questions and then ask “I know you are worried that you aren’t sleeping, but they mentioned in the ED that you wanted to kill yourself. Do you still feel that way now?”

“I don’t want to talk about that. I move on.

Past is gone.”

“What about your thoughts now?”

“I don’t want to talk about such things. Not good things.”

I sigh. “Okay, can I listen to your heart?”

He narrows his eyes and responds in a movie- I listen as the consult psychiatry team attempts esque accent, “I don’t want to talk about it to ask the same questions. I am slightly anymore. I am tired. Please give me something relieved that they get the same refusal as me. to sleep.”

At 2 pm, when we get a call from his nurse I try to change the subject, but he no longer that he is not feeling well, I am eager to use wants to answer questions, he has “told us the time to make progress. When I enter, I see everything.” I had grown accustomed to my him sitting in the chair next to his bed. His

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hair was matted on his head from sweat and As my intern and I open the door back into the his gown was slumping off his shoulder. He ward, we hear screaming. lifts his head out of his hands to grab the glass of water from the nurse that he takes down in one swift gulp.

The next morning, I see my other patients first, bracing myself when I come to Mr. N’s “I heard you’re not feeling well.” room last. I nod and smile at the security guard stationed outside his new room that is “I’m dizzy and my head hurts. I feel drunk.” now closer to the nurse’s station. He walks in He puts his head back in his hands. He begins with me. to breathe deeply.

“Hi Mr. N, how are you doing?”

“What’s going on? What do you feel? Dizzy?

Nauseous?”

He turns his head towards me and sits up.

“I am very sorry. I hear what I did. I don’t His head slowly rises, and his eyes open remember. I remember a little bit. Is she wide. He stares at the ceiling, mumbling in okay?”

Romanian. I make out the word “Jesus”.

I try to give a reassuring half-smile.

“Who are you talking to? Are you talking to Jesus?” I ask.

“Yes, she wasn’t injured, and she knows you did not mean to. What do you remember He nods as he continues to mumble and stare. from yesterday?”

“Do you see Jesus?” He nods again.

I rise from next to him and tell the nurse and patient sitter “I’m going to grab my resident.”

They both nod in agreement.

He is not able to recount much. He looks at me with a different look today: Desperation.

“What is wrong with me?” he asks.

“We are not sure, but we are working to figure

65 photo credit: Dalila Dalprat

it out. But we need you to be honest with us when you answer questions.”

“Yes, I will,” he agrees.

over two weeks I had built that trust on my own: with my time, with my words, with who I was.

He started to sleep through the nights, but Later, I watch from the doorway as he he continued to have night sweats and then evades the psychiatry teams’ questions fevers. One morning, he complained of again. mild neck pain. We decided to get a lumbar puncture. He worried about the procedure, The next morning, I come to his room. He but I reassured him. As usual, he said eagerly turns in his bed to face me. “I am “Okay, I trust you.” ready. Today I will say everything. But I can only tell you and the psychiatrist. No one Those words were all that I remembered else.” as I read his ICU transfer note that night, I sit with the psychiatry team for 45 minutes as they elegantly weave his story. We walk out relieved. We did it. I felt as though I had made it to the top of the hill, and standing at the top was Mr. N, waiting for me to reach him.

The next morning, he greets me with such eagerness as though he had been waiting for my arrival. “I will be even more honest today. I was not allowed to tell you before anything because I have a voice telling me not to tell you. But now, I can tell you.”

During his stay, at times, he would refuse to take his medications. A page from the nurse would summon me to explain to him that I knew about the medication change and both I and the psychiatrist thought the medication was a good choice. He would comply, ending our conversations with “I trust you.” I felt fulfilled as a medical student and, for once, felt my role was useful. I was not the one writing notes, signing orders, or making the medication changes but I was the one he trusted. I felt accomplished.

It was not the trust I was proud of, but that

describing his descent into septic shock and intubation. The elation I felt to be on his medical team came crashing down and was replaced with a feeling of guilt. That feeling engulfed me but quickly left me empty with one question, “Why did he even trust me?”

We fear paternalistic medicine for the burden it places on a patient, but on the opposite side of the spectrum, maternalistic medicine bears weight on the provider. As I followed Mr. N’s recovery and have continued with my training, I have begun to understand the unpredictability of medicine and how trying to triumph over that unpredictability is not always feasible. A good physician is deserving of trust even if the outcome is not perfect.

A good physician is deserving of trust if they strive for the best but can also admit their mistakes, value their patient’s input, and communicate fairly. Although I cannot answer the question of whether I deserved Mr. N’s trust, I know, better now, the intent in which to earn it.

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I AM FROM

by Marc Andrew Hem Lee

I am from looking out of my apartment’s bay windows at the street/ From looking out at my patient, the face shield a window between us From letting the hair on my head grow long/ And from removing all hair from my face.

I am from masks that seal my lower visage/ And in exchange for my safety, the nose bridge bruise it leaves behind.

From having 15 minutes to eat lunch/ And from using only 14 – the last 1 is for “Hello” and “Thank you.”

From wondering aloud if life will always be this way in our profession from now on/ And from receiving no clear answer.

I am from squeezing the hand of the first patient on my service who died/ And from our service team never taking moments to grieve when we lose patients.

And last year’s Spring spent indoors studying for that big exam/ And Slow Medicine, that no exam metric can aptly measure.

I am from Medicine becoming an integral part of my life experience/ And from Medicine not becoming the entirety of my life experience.

I am the quiet guardian of my essence/ I exist. I am here. I am present.

67 photo credit: Mo

Thank you for reading!

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