Ars Literarium Volume 5

Volume 5 - Summer 2020 Volume 5 - Summer 2020

The literary journal of Rutgers New Jersey Medical School and Schools for Biomedical and Health Sciences

ARS LITERARIUM ARS LITERARIUM The literary journal of Rutgers New Jersey Medical School and Schools for Biomedical and Health Sciences

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Ars Literarium Volume V

Ars Literarium Volume V Ars Literarium is published annually by the Healthcare Foundation Center for Humanism and Medicine at New Jersey Medical School

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Ars Literarium Council Members Dorian J. Wilson, MD

Director of the Healthcare Foundation Center for Humanism and

Medicine, Rutgers New Jersey Medical School Tanya Norment

Program Administrator of the Healthcare Foundation Center for

Humanism and Medicine, Rutgers New Jersey Medical School

Faculty Advisors Beth A. Pletcher, MD

Associate Professor of Pediatrics and Medicine, Rutgers New Jersey

Medical School Andrew Berman, MD

Professor of Medicine, Rutgers New Jersey Medical School Editors-In-Chief Sudeep Peddireddy, MS-1 Shruti Varadarajan, MS-1 Editors Tiffany Chen, MS-1 / Graphic Design Nivetha Srinivasan, MS-1 / Art Coordinator, Marketing Benjamin Zhou, MS-1 / Art Coordinator, Marketing Vishal Dhruva, MS-1 / Literary Coordinator Veer Patel, MS-1 / Literary Coordinator Parisorn Thepmankorn, MS-1 / Literary Coordinator

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Ars Literarium Volume V

Acknowledgements Ars Literarium’s annual publication is possible due to the support of The Healthcare Foundation Center for Humanism and Medicine at Rutgers New Jersey Medical School.

With special appreciation and gratitude to The Healthcare Foundation of New Jersey for their generous support.

Thank you to Tanya Norment, Dr. Pletcher, and Dr. Berman for their advice, mentorship, and guidance throughout the year.

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Mission Statement Ars Literarium seeks to express the medical narrative through the creative voices of the members of the Rutgers Biomedical Health Sciences Campus in Newark, NJ. The journal provides an outlet for members of the community who spend endless hours managing the stresses and responsibilities of patient care to find peace through creative expression. Transforming memories or emotions from an intense day spent with patients into words or visual art allows for a stronger, healthier connection to the self and a deeper appreciation of the patient perspective.

For information, inquiries, and submissions, please email us at: arslit@njms.rutgers.edu

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Ars Literarium Volume V

Dear Reader, Here’s a simple exercise: hold the word “healthcare” in your mind and see what images surface.

One might think of off-white hallways, flowing white coats, needles, saline and maybe that unmistakable waiting room smell lingering in the air. The more cheerful among us might think of fresh life or the pleasure of a compassionate moment between two people. Perhaps the occasional macabre thought of an unyielding illness and its attendant anxiety might settle heavily among your other thoughts. This is all to say that, like all facets of life, healthcare has its share of mundane, beautiful, and even gutting moments.

In the following pages, healthcare is presented in ways you might have envisioned it, or perhaps in ways completely different from your perspective. In these pages, members of the RBHS community offer their perspectives on the myriad expressions the word healthcare can take on through their art, photography, poetry, and stories. As you’ll see, they incorporate themes that follow us at all points of our lives: fear, beauty, loss, hope, gratitude, etc. And spoiler alert: they are all amazing. Moreover, as different as these forms are, they all point back to an essential truth: namely, healthcare is really nothing without the people on either end of the prescription pad. Every action taken by each doctor, nurse, therapist, and social worker in conjunction with the patient brings meaning to a healthcare encounter. In other words, humanism is a foundation for all these pieces just as it is the foundation for healthcare at large. As this issue is being put together, the coronavirus (COVID-19) pandemic is ravaging many countries around the world.

It is as important a time as any to remind ourselves that humanism is inextricably linked to healthcare and that all opportunities to offer healthcare to someone are opportunities to offer a moment of humanity at a vulnerable time.

Medicine exemplifies the perseverance and courage of the human spirit like few other fields.

We in healthcare are faced with responsibilities and decisions that could quite literally tip the scales of life and death. Nothing exemplifies this better than the present moment, as healthcare workers are doing everything in their capacity to deal with one of the biggest public health crises of this century. In the midst of this chaos, it is more important than ever that we are reminded of our impact on the people we serve, and their impact on us.

It is our pleasure to introduce the fifth edition of Ars Literarium to you. We hope you have as much fun going through it as we did putting it together.

Sincerely, Editors of Ars Literarium

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Table of Contents Tree of Lungs (Front Cover) by Nivetha Srinivasan

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Home Visit by Robert Romanzi 9 Gen X by Michael Teters 10 Sisterhood: Healing Through Loss & Gain by Denise Agnew

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Ether, The Anesthesiologist’s Prayer by Dr. Jeremy S. Grayson 12

Why Suicide? by Rohit Mukherjee 13 Metastasis or Metamorphosis by Thu M. Truong 15 Inspirations from the Anatomy Lab by Chaden Noureddine

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The Girl with the Blue Lips by Benjamin Mather

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Losing Myself by Victoria D. Cason 18 Herpetology Lesson by Dr. Mina N. Le 19 Axilla Study by Kayla Baker 20 About New Year’s Eve by Mark Wolman 21 Emotion by Tiffany Y. Chen 22 Frames by Lauren Hutnik 23 Anterior Forearm by Brenda Romero 24 Miracle at University Hospital by Dr. Stacey Williams

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Shaken by Dr. Jeremy S. Grayson 26

Made Broken by Dr. Debra Zharnest 27 “disinhibited” by Adiba Anam 28 Views from the OR by Nivetha Srinivasan 29 Fractured by Laurie Flynn 30 One Heart, Two Countries by Dr. Willy Roque

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Ars Literarium Volume V Aging by Benjamin Zhou 32 Finding Solace. by Dr. Willy Roque 33

1967 Now by Dr. Vanessa Soetanto 36 To My Child by Julie Liston 37 Man’s Best Friend by Tiffany Y. Chen 38 Scythe Upon the Grasses by Dr. Mina N. Le

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A Glimpse of Honduras Through a Health Lens by Calvin Qian

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My Angel by Nivetha Srinivasan 44 Autism by Carol Marcus Connor 45 Whirlwind of a Day by Abby Heller 46 Waiting, Gone by Robert Marsessa 47 Metamorphosis by Carol Apai 48 Intersecting Pentagons by Adiba K. Anam 49 Art of Medicine by Jennifer Fang 50 Liquid Sunshine by Dr. Mubashir Shabil Billah 51 The Old Delhi Market (Back Cover) by Dr. Joseph Benevenia and Laureen Benevenia

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Home Visit Acrylic Paint

Robert Romanzi

Class of 2023 Rutgers New Jersey Medical School 9

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Gen X

Encaustic, Oils, Press type on Panel

Michael Teters, DABR

Medical Physicist, Assistant Professor, Department of Medical Imaging Sciences Rutgers Biomedical and Health Sciences / School of Health Professions 10

Sisterhood: Healing Through Loss & Gain Acrylic Paint

Denise Agnew

Secretary Rutgers Cancer Institute of New Jersey 11

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Ether Green down Blue up Yellow goes to 2.

Then to 4 and 6 and 8— Sunshine blinds.

The Anesthesiologist’s Prayer Now I lay you down to sleep, For a moment your soul is mine to keep.

You will not die before you wake, For souls are never mine to take.

Mind— Erased.

Float away, But go not far; I hear that you’re still here.

Violated for hours— A moment it’s to you.

What is gone will not be missed When the ether leaves your room.

Jeremy S. Grayson, MD

Associate Professor, Department of Anesthesiology and Pediatrics Robert Wood Johnson Medical School 12

Why Suicide?

I was bathed with anxiety, coated by the charm of impending death that she gleamed on my vessel, I stood next to her soaked in fear to question,

“Why is it that you no longer find the will to live?”

An improbable reality for most, yet a visceral experience for her. I sat, watching willfully, as she soundly slept with rails containing her hands to prevent her from suffocating her own breath. Masking what she felt inside, hidden from those around her condemning her to the term “behavioral disorder.” Her label drew me to her, as I dealt with labels growing up in a classist society which stigmatizes against emotional fallibility and glorifies the social prowess in masculinity. Lingering by her, I waited through several passing moments which yearned through the rotation of earth around our sun and hung to the wake of dawn. Deafening silence had entrapped her room, thrown across the walls, reverberated and nested in my ear drum. Placed under the spell of uncertainty, I grew resistant to the hold of slumber and stood resolute to receive a confirmation.

Confirmation, you might ask?

Yes.

I desire to understand what fills one’s heart with contempt and drowns its peace with an ocean of regret and uncertainty as the end of life draws near. What predisposes the soul to the act of injuring “god’s greatest gift”? What tirelessly sheds away the thick cover of a mother’s tender sweet love, a father’s bravery, or selfless camaraderie to a stage of anomie.

What colors this normlessness, is the truth I wish to understand.

Later that night, the sun peeked through the window, displacing its ray through the door which croaked. Finally, her eyes parted as the grasp of night loosened. She misread my demeanor, misjudged my tone, and grew fearful of my presence. “Who are you! What do you want, just come and kill me.”

Surprised – “Kill you? That’s quite extreme, I rather wish to understand, why one wants to be killed.”

She addressed my concerns with “Why does it matter to you?”

I anxiously responded, “What you feel is a reflection of how one feels toward you, whether you emit love or hate, one should expect the same in return. What makes you so hateful? What makes one so helpless?”

She extended her neck to see the sun and said “I haven’t seen the sun for over a week, I’ve been forced to sleep, cut open, tubes shoved through me, restrained, and told ‘your cancer is terminal, I’m sorry.’” She continued, “I’m a civil engineer from Poland, traveling from Krakow to here I’ve experienced the gifts of a lavish life, and comforted by the birth of two beautiful children.” She paused, her vascular fists tightened, her mandible clamped, and tearfully she muttered, “Whom were diagnosed with autism and blindness.” They weren’t able to see their own mother, whose love for them endlessly leaked out of her. They could not feel nor understand the complexities of life nor perceive the very notion of their family. She quit her job, and became what she noted a “victim” to their fate. Growing to dispel her qualms about becoming unequipped to help her children thrive after her diagnosis, she yearned to escape. She felt that death encompassed liberation and expelled the sorrow she felt day to day. She could no longer wait, and thus, came actions which resulted in her imprisonment before me. I asked her, “What would you change, if illness wasn’t your reality?”

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A calm entered our atmosphere:

“I would love more, and always choose to love, even when I faced such drastic defeat.”

In that moment, I learned, something I never expected to learn from entering the room as her monitor.

She had never wished to leave her children nor her own life. She sought to free herself from the stigmatization brought to her and her children based on disposition. She longed to feel that her children were “typical” and not “abnormal.” These words which characterized her own and her children’s lives masked their happiness, imprisoned them with helplessness, enough so that she would have grown to hate and cease to cling to her existence. As she continued to share beyond her insecurities, I felt that the paint of the walls had changed. As I looked around, I had a revelation. Walls once covered with fear and anguish, now seemed to be colored with the liberation of freeing oneself of fear with love.

Compelled by her strength, I finally told myself, “Death can wait.”

Rohit Mukherjee, BA, EMT-B, BLS, MHFA

Research Assistant, Rutgers Tobacco Dependence Program Rutgers School of Public Health 14

Metastasis or Metamorphosis Colored Pencil and Water Pencil

Thu M. Truong

Class of 2023 New Jersey Medical School 15

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Inspirations from the Anatomy Lab Watercolor on Watercolor Paper

From top to bottom, left to right: Heart, Stomach, Liver with Vessels, Gallbladder

Chaden Noureddine

Class of 2022 Rutgers New Jersey Medical School 16

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The Girl with the Blue Lips Acrylic Paint

Benjamin Mather

Level 3 Student, Accelerated BSN Program Rutgers School of Nursing 17

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Losing Myself Where have I gone?

Who’s that staring back at me?

Head spinning, confused

With eyes that used to shine, now dull

I’m losing part of me

Shoulders slumped and unbothered by life

That part that everyone used to see

Forgetfulness taking over

Torn to pieces is my personality

I don’t even remember my name

Shards of glass not put together

Those faded pieces must come back!

I’m losing me

I’m barely here

Once full of smiles, energy, and joy

I’m losing me

No more

Drowning in sorrows

I see those missing pieces twirling around me

Feelings of doom

I reach out a hand to grasp them

Love suppressed

Slipping through my fingers, they fade

Not revealing itself to even me

Into… nothingness

The smile seems genuine when others are around

Gloom has taken over my soul

Acting that’s so convincing

Words often spoken in monotone

Has everyone fooled

A flat affect so familiar

Not seeing my pain

Tears hiding behind my eyes

Nor hearing my cries

Heart barely beating

Even I believe the lies!

The despair so deep, I’m numb all over

Broken is my strength

I’m losing me

I’ve become undone

Laughter seems foreign

Now, just a speck of who I used to be

Pleasure?... Missing

All because… I’m losing me

Looking in the mirror, I don’t even recognize her

Victoria D. Cason

Community Health Worker Rutgers Community Health Center 18

Herpetology Lesson An embryonic turtle, newly formed, is neither male nor female, for its sex is not determined by its chromosomes, not programmed in its every cell. Instead,

below a certain temperature, it’ll hatch a male. It’s female if the air is warm.

They keep the ratio half-and-half, adapt to climate change, by changing when they spawn.

A trait we see as fundamental—sex— in turtles follows from prevailing winds!

And what a marvel reptiles can correct for global warming. Praise the terrapins.

Mina N. Le, MD

Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Rutgers New Jersey Medical School 19

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Axilla Study Pen and Colored Pencil

Kayla Baker

Employee in Peter Cole Lab Rutgers Cancer Institute of New Jersey 20

About New Year’s Eve How can I sing and dance when others are grieving and crying?

How can I smile and laugh when others are sick or dying?

Celebrate and wine and dine?

When others go hungry?

No. While New Year’s Eve is a time to be hopeful and to look ahead It remains a reflective and somber time for me

Mark Wolman, MPH

Program Manager, Global Tuberculosis Institute Rutgers New Jersey Medical School 21

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Emotion Pen

Tiffany Y. Chen

Class of 2023 Rutgers New Jersey Medical School 22

Frames Charcoal

Lauren Hutnik

Class of 2023 Rutgers New Jersey Medical School 23

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Anterior Forearm Digital

Brenda Romero

Class of 2023 Rutgers New Jersey Medical School 24

Miracle at University Hospital Beep beep beep

The other doctors said He’s gone

It cried from the scars

But she could not stop

He felt pain from the veins

But it was too late

its name was C P R

His heart beat stopped

she just graduated

One nurse grabbed her hands

from the school of nursing

One doctor grabbed her wrist

and today was her first day at UMD

She prayed to GOD

she had to take out the bullet

My first day is not supposed to be like this

that was a serpent As she put her head down AS HANDS HIT THE CHEST

And walked away

Lips to lips hit the mouth

She didn’t realize

For the soul that was bout to enter

her tears fell on his face

Heaven GOD’S house one of them somehow She begged hang in there

fell into his mouth

To the patient

he then coughed and hiccuped

Even though she knew

this was what MIRACLES ARE ABOUT

His wings and halo was waiting she turned back around the emergency room was in hysteria the first thing he said was could you get me something from the cafeteria

Stacey Williams

Patient Accountant University Hospital 25

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Shaken Photograph

Jeremy S. Grayson, MD

Associate Professor, Department of Anesthesiology and Pediatrics Robert Wood Johnson Medical School 26

Made Broken I wish they told me it was going to be so soon

Someone better would have said the right thing.

If only someone else were here.

Not me, her chosen reaper.

The eyes of the mother staring at me

Months later they’ll ask if I remember as

Are empty.

They do.

The painted-on expression is made impassive.

The rattling of her chest in the background of my

Theirs and mine.

dreams.

Grateful for square breathing from yoga.

It does not touch me.

Hoping that good posture is

That first moment in medicine when I was

An armor.

Made broken.

The rattling of her chest is just a sound.

Not me, her chosen reaper.

It does not touch me.

Months later they’ll ask if I remember as

I am untouched

They do.

By this.

The rattling of her chest in the background of my They wait.

dreams.

I wait.

It does not touch me.

That first moment in medicine when I was

I’m so sorry. I don’t hear her heart beating anymore.

Made broken.

The words are so quiet. Later they’ll say I was firm, though.

It should have been more profound But wasn’t.

Debra Zharnest, MD

Pediatrics Resident, PGY-3 Robert Wood Johnson Medical School 27

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“disinhibited” you

it’s been a while since

are

‘a while’ has meant anything

bold

to you

crimson lipstick

and i wonder

nail lacquer to match

if you wonder

“can you tell me what year it is?”

why we seem s t u c k

silver bangles clink together

so stuck on this thing that comes

your hand drifts over your hair

and only goes

not

so

quite

please

touching

don’t mind the questions

“the year? I don’t go through that shit.”

we have yet to know

your paramour laughs

when you’re not here

not yet accustomed to

where do you go

how your words rise proud blistering true

Adiba Anam

Class of 2021 Robert Wood Johnson Medical School 28

Views from the OR Chalk Pastel

Nivetha Srinivasan

Class of 2023 Rutgers New Jersey Medical School 29

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Fractured Darkness descended upon her As the words slipped past his lips Her mind refusing to comprehend Her body present Yet she was no longer there drifting away she stands on her mountaintop Spying the landscape She identifies and separates Life’s stages Oh, how her life had changed Unlike the mountain’s landscape Which grows more sparse With increasing altitude Her landscape explodes in fullness: Rainbows of colors Richness of sound Tastes Textures Loves And loss So much loss She’s fractured

Laurie Flynn, RN

University Correctional Health Care / University Behavioral Health Care Staff Nurse Central Reception and Assignment Facility Prison 30

One Heart, Two Countries There, fresh coffee beans.

Here, my back and bag of nostalgia.

There, my mom’s tears.

Here, my father’s pride.

There, the roots of my being.

Here, the same tree in autumn, winter and spring.

There, an honest hug.

Here, academic ambition.

There, my nonna’s pesto.

Here, the cash register.

There, a city with no space or time.

Here, eternal caffeine.

There, where the torch was lit.

Here, my pocket and a lighter.

There, the houses in rubble.

Here, concrete and wood.

There, unscalable wall.

Here, steel columns.

Here, my culture’s passion Here, with me, my people and their history Their history and empathy, Their empathy and warm arms, Their warm arms and ambition, Their ambition.

Here, the light.

Willy Roque, MD

Internal Medicine Resident, PGY-2 New Jersey Medical School 31

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Aging Pencil

Benjamin Zhou

Class of 2023 Rutgers New Jersey Medical School 32

Finding Solace.

I don’t have a home.

Don’t misunderstand me; I am fortunate enough to have somewhere to rest my head every night, a place with electricity and running water. Many people, I’ve discovered, don’t even have that. I know that I am lucky. But whenever, in polite conversation, a colleague or acquaintance asks me where my home is, I pause for a few seconds. They mean, “Where are you from, originally?” or “Where did you grow up?”, which would be easy enough to answer. It’s that word – home – that stops me in my tracks.

If you asked me where I grew up, I’d tell you Venezuela. But the Venezuela that I grew up in, the country filled with friends and family, has crumbled into dust. One by one, the people that I know and love have scattered into the distance to find new places to live. I was one of them. I made the decision, like my grandfather, to become a physician. I knew that if I wanted to fulfill this dream, I had to go outside of Venezuela’s borders. So I left, too.

Newark, USA. Located on the East Coast. Every morning, as I walk to the bustling inner-city hospital where I am a resident, I see a hundred faces like mine. People who are new and curious about the city, people who are a million miles from the land they grew up on. Even within the walls of the hospital, I have discovered a rich array of cultural backgrounds when I talk to the staff. They are from India, China, the Philippines, South Korea, South Africa, South America. Yet we have all ended up in this one place, working together to make the world a better one, while an invisible string is tied between our hearts and the distant countries we once lived in, connecting us to our origins, and to each other.

No matter how stressed or exhausted I am, I always choose to spend an extra minute to walk through the medical school on the way to the hospital. I did this yesterday morning, and this morning, and I can imagine that I will do it even when I am old and grey. Each time I look at the university logo, I feel a tug on that internal string. I represent the medical school, whenever I am in my white coat, but I also represent Venezuela.

I have talked about this to several of the international residents and staff here at the hospital, and found that while they may not walk through the medical school every morning like me, they feel the same way. They choose to honor this feeling in other ways, each specific to their culture and personality. Each time I have a conversation like this, where I am able to learn a new snippet of information about a different culture, I feel myself get lighter.

Several weeks ago, I asked one of the ultrasound technicians, Mrs. R, for her story.

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“I moved from India twenty years ago,” she answered. “I was a radiologist, in a busy hospital. I haven’t been back since.” I didn’t ask if she meant that she hadn’t been back to India, or that she hadn’t been back to radiology – I had a feeling that both were true.

“And why did you leave?”

“We knew we had to move to the USA,” she said, looking into the distance as if she was seeing something in her memories. “We wanted our sons to have more opportunities than we did.”

Like me, Mrs. R made a sacrifice to achieve her dreams. But her dream was different than mine; raising her sons in America, allowing them to have a better life than she had, while working part-time jobs to pay the bills.

I could see in her eyes that this change had taken a toll on her, even if she didn’t regret it. I wondered if she preferred being a radiologist to being an ultrasound technician.

My grandfather, too, was a physician in Venezuela. One of my warmest childhood memories is being taken to his home office, where he had a flourishing collection of books about history and art. This is how he had always whittled away at the stress of being a medical student, then a resident, and finally a doctor. I discovered that each person must have an outlet for stress, or a way to reduce it, or else it can consume you. This is what leads to the high rates of anxiety and depression in the medical world. I watched and absorbed the way he got this comfort and reassurance from art, so when it was my turn to enter the medical profession, it seemed natural that I would get my comfort from art, too. I often walk to the MoMa or the Met, and slowly let my mind travel through my favorite paintings.

The Harvesters, by Bruegel, with its golden sheathes of wheat and rolling paddocks into the distance. Degas’ dancers, delicate and whimsical, and Rosseau’s gypsy sleeping under the desert moon. Each of these paintings transports me into a world that is far away from my own, but I see a part of myself in all of them, just like each colleague I work with, and each person whose culture I learn about. A facial expression, a delicate brush stroke or a piece of scenery that I can imagine driving past. Any of these things allow me to connect the art to my own life, my own soul. There is something about making connections that combats loneliness like nothing else.

After I walk through the medical school each morning, I pass by Mr. B, the security guard. Even though he is still on his night shift, he is always quick to greet me and wish me a good morning, as happy as if he is on vacation.

“Good morning, Doctor,” he says each time, and I feel a burst of pride to be referred to in this way. It adds a spring to my step as I shift into intern-robot mode, ready to get things done.

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One day, I decided to come in early, so that I could stay and talk to him. I wanted to find out more about this kind-hearted man, and connect with him in the same way that I did with each of the staff at the hospital. Unlike many of my colleagues, I found that Mr B grew up in Newark. Like me, and my grandfather, he cultivated a passion for art that carried him through tough times. Mr. B’s art form of choice is jazz music; especially John Coltrane. On a Friday, when he gets home after a long week, he listens to Miles Davis instead.

When I got back to my apartment, I searched up Miles Davis, and listened to an album with my eyes closed. I imagined what Mr B felt when he heard this music; if he thought about his childhood in Newark, his family, or the night he had had at work. As I listened, just like when I looked at paintings or the university logo, I began to feel the weight of the day melting off my shoulders. With every minute that went by, I felt lighter.

I felt like I was home.

Willy Roque, MD

Internal Medicine Resident, PGY-2 New Jersey Medical School 35

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1967 Now Chalk Pastel

Vanessa Soetanto, MD

Internal Medicine Resident - Pediatrics PGY-2 Rutgers New Jersey Medical School 36

To My Child I lie here in my hospital bed with thoughts I need to say I pause to thank the Lord first that things are still okay I can’t express the fear in us that night three weeks ago The chance that we could keep you at that time was pretty low They put me in this bed, and here I have to stay I’m told that though it’s hard for me you’re better off this way Each day that I can carry you, each moment I can give The doctors have assured us will help your chance to live I don’t know if you’re a boy or girl, I really don’t even care All that matters now to me is that you are still there I have had some all night talks with you in hopes that you might hear And every little kick I felt helped take away some fear The longer that I lie here, the bigger that you grow My “mother’s love” grows stronger than anything I know So baby, please be patient and I’ll be patient too For it will be well worth it the moment I see you Love, Mom

Julie Liston

Executive Director, Ambulatory Care Services Robert Wood Johnson Medical School 37

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Man’s Best Friend Chalk Pastel

Tiffany Y. Chen

Class of 2023 Rutgers New Jersey Medical School 38

Scythe Upon the Grasses Some must employ the scythe Upon the grasses, That the walks be smooth For the feet of the angel. ~Philip Larkin

That January, I was an intern on General Surgery, working 100-hour workweeks. Every fifth night, I took overnight call, covering more than five dozen hospitalized patients, including complicated Cardiothoracic and Transplant patients, in addition to handling direct admissions. There would be life-and-death crises. When I was on call, I wouldn’t get a lick of sleep all night.

Dr. Bellaire was the bright light of that month for me. He was bookish and intellectually inclined like me; we could talk to each other. This mattered for a lot when I felt like an outsider, not only as a woman in surgical training, but also as a Southerner relocated to Minnesota just six months before. When we would rhapsodize about Plato and Shakespeare over our hernia repairs and appendectomies, I’d regret that he had to be twice my age and my attending. I would thrill when he put his gloved hand on mine to guide my instrument, or when we made eye contact over our masks; his eyes behind his glasses had a soulfulness to them.

During one hernia case he asked me, as we dissected the abdominal wall, “What three arteries do you expect to find at about this level?” Although it was possible that his question was directed at our medical student, I was eager to impress him, so I spoke up quickly: “The superficial external pudendal, the superficial circumflex iliac, and the superficial epigastric.” He replied, “Wow! I’m impressed! I’ve never heard an intern reel off the right answer like that.” I’m generally suspicious of compliments, but this one was even more suspect: how could that be true? Didn’t categorical interns actually study this stuff? Then he cast a shadow on the whole thing by saying, “Did someone tip you off that I always ask that question?” I was taken aback, deflated.

Absolutely no one had tipped me off. Credit was due to my own insight into what to read the night before, not to someone helping me cheat, and I was irked that I had no way to prove it.

One Wednesday evening late in the month, Dr. Bellaire came into the physician workroom as I was signing out to the intern on call. There were going to be two organ procurements that night: would I be available to help?

I was no longer on his service by then, so this would be purely voluntary. The pain of it was that I’d been hours away from only my third day off in nearly four long weeks. Transplant also wasn’t important for me to learn, given that I wasn’t planning to become a general surgeon.

Tactfully hesitating, I asked, “Will I be useful?” I knew he was already going to have a fellow, someone five years senior to me, as his first assistant.

“You will be,” he said, and that was enough for me to take it.

The plan, he said, was as follows: a taxi would pick us up outside our emergency room at 10 PM and take us to the first hospital, where a team from the Mayo Clinic would be harvesting the liver. We’d take the

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kidneys and pancreas. From there we’d be driven to the second hospital, where the heart had been promised to a team at Michigan, and all the solid organs of the abdomen would go to us. It wouldn’t be our job to put the harvested organs into new patients; that would be a daytime task for other teams. We would only be performing the surgery to get the organs out of people who were newly brain-dead.

“Go home and take a nap first,” he said, from the doorway of the workroom.

I went home and tried, but it was too early to fall asleep. I couldn’t manage it.

I arrived in the emergency-room parking lot at 9:55 PM, the first team member to get there. It was bitterly cold, even for Minnesota in January. The Transplant fellow joined me in the backseat of the cab, Dr. Bellaire sat down in front, and we were off. We were driven to a private hospital not affiliated with our university training program, where we had to stop at the information desk and ask for directions to the operating room, then head to the locker rooms to change.

Even though the hospital was new to me, every operating room is still similar and still feels like home: it was past ten o’clock at night, but the lights were bright and the nurses cheerful, garbed in uniform blue. I asked, “This is OR 7, right?” One of the circulating nurses replied, “Oh yes. This is the only OR going right now.

And it’s the only one that looks like that,” gesturing to the patient on the table. She was referring to the fact that in most operations, you cut as small an opening in the skin as you need to get the job done. In contrast, this patient’s chest and abdomen were wide open to the air, lungs on display, intestines spilling out. A team of three surgeons from the Mayo Clinic, which is an hour and a half away, were hard at work on extracting the liver. We had to watch them at first, since there wasn’t space for all of us to operate on the body at once.

The patient was a 65-year-old man who had bled into his brain. Since his organs were so old, they wouldn’t be useful for transplantation into other people, and I learned that we were actually harvesting them for research in the lab. Once the Mayo people had made off with their liver, the three of us stepped up to the operating table, where Dr. Bellaire guided the fellow, David, through the procedure. My assignment was to sew up the partly emptied body at the end. “Just do a makeshift job,” Dr. Bellaire told me. “They’re going to open him up again for embalming.” He showed me what technique to use: a crude “whip stitch,” leaving a stripe of conspicuous diagonal blue lines on the man’s pale skin, from his breastbone to his pubis.

It was almost two o’clock in the morning when we were done, but we learned that the second procurement wouldn’t be going until 4 AM, so we had two hours to kill.

“Why don’t we go and knock back a few beers?” David said to Dr. Bellaire, at the door to the men’s locker room. “Why don’t we go to Sex World?”

“Ooh, don’t leave me out of that,” I said, and they laughed.

We ended up grabbing some chicken Kiev in the hospital cafeteria and then taking the taxi back to the U for a nap in the resident lounge. The only problem: there were only two couches in the lounge, and two shortbacked recliners. I put the two recliners together foot-to-foot and leaned them each back, creating a sleeping surface with several up-and-down angles.

“I’ll take that one,” said Dr. Bellaire.

“No, I’ll take it,” I said.

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“No no, you two take the couches.”

“I’m sleeping here,” I insisted, getting onto the recliners.

He looked at me, and I held his gaze, feeling uncomfortably disrespectful as an intern arguing with an attending, but also refusing to let him have less than “the best seat in the house.”

Finally he relented and went to gather pillows and blankets, and he and David lay down on the couches.

At this time two young people not wearing scrubs, perhaps Internal Medicine residents, came into the lounge. It was a guy and a girl, and they were surprised by our presence. I heard them say something about obtundation, and Dr. Bellaire asked them about their obtunded patient. The guy was disproportionately animated in discussing it, and then the two of them abruptly left the room.

“Did you notice,” observed Dr. Bellaire, “that they weren’t really talking about obtundation when they first came in?”

“Ohhh!” I said, putting it together.

“They didn’t think we’d be here,” he said.

We turned the lights off, and set our alarms for an hour. Again I couldn’t sleep. An hour later, I was the one exhorting the other two to rise.

After Dr. Bellaire sat up, I sat down on his couch, a decorous distance away from him. The couch was all warm from his having slept on it, and I could feel the warmth through my back, shoulder, and arm, exciting me.

“Did you get any sleep?” he asked me.

“No,” I said honestly.

“Aw,” he said softly, giving me a tender look. “I thought you did. You looked so peaceful.”

It gave me a rush to realize he’d been watching me while he thought I’d been asleep, and while I thought he’d been asleep.

Armed with three cans of caffeinated soda from the vending machine, we set off at four in the morning.

The ride to the second hospital took us through the most dangerous part of town, North Minneapolis, which David explained was known as “Murderapolis” when he was growing up. The female taxi driver remarked that she would normally take the freeway shortcut, and not tackle these city streets. “But tonight it’s so cold that no one’s going to be out trying anything.”

This patient was a 39-year-old woman who had been in a car accident. She had flown out of an SUV and hit her head. Because she was young and healthy, her organs were being harvested for transplantation into other people. Her husband had signed the consent papers. It turned out that Michigan had turned down the heart, for some reason. A surgical team from Loyola University in Chicago had flown up to take it for themselves.

One of the kidneys was destined for North Dakota, while the other kidney had been claimed by a local hospital.

I noticed that her pancreas was beautiful, not like the old man’s fatty, misshapen one. She lay opened on the operating table, small-breasted, her nipples erect.

At the beginning of the case she was technically alive, and the dissections had to proceed carefully with the cautery, because she bled like any living patient. Then at one point the anesthetist stood up, said, “You don’t need me anymore,” and left the room. The woman had transformed from patient to cadaver. Henceforth the organ dissection went quicker because it could be done with scissors, as she no longer bled where she was cut.

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Ars Literarium Volume V We gathered the organs we wanted, and the body was transferred to a gurney bearing a body bag.

Early that morning, our work was done and we were sitting in the emergency room lobby waiting for our next taxi. I was carrying the box that contained the pancreas, while David was carrying the box that contained the liver. “You know,” I said to Dr. Bellaire, “I keep meaning to ask you if you knew my aunt. She was a resident at Mass General during the same years that you were.”

I said her name and he said, “That sounds familiar. I definitely knew her. Hell, maybe I even dated her!”

“Jesus Christ!” I said in disgust, even though I knew he just was kidding and trying to get a rise out of me.

Back at the U, David and I branched off and went to the operating room, where he had me stand guard over the liver and pancreas while he went off to find the person to pass them off to. I looked at the day’s OR schedule and saw a new case listed, newly added since the day before: Cadaveric Liver Transplant

We had just made that operation possible. Someone with end-stage liver failure was about to get a new lease on life. They would have just received the telephone call the previous evening.

Looking up at that screen, reflecting on the way we’d stayed up all night to get someone that liver, I blazed with pride for my chosen profession.

Dr. Bellaire returned and held out his fist palm-down. I thought he wanted to fist-bump. It took a moment before he could explain what he wanted me to do. Finally I put up my open hand under his fist, and he uncurled his fingers and pressed two pieces of chocolate into my palm.

“They’re not Hershey’s,” he said as he walked away. He knew I hated Hershey’s.

When I went home I was too sleepy to be productive, so I stayed up idly until mid-afternoon and then slept until it was time to go back to work on Friday morning.

Mina N. Le, MD

Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Rutgers New Jersey Medical School 42

A Glimpse of Honduras Through a Health Lens Photograph

LucĂ­a, who lives alone in San Juan de Flores, receives a home care visit from a Honduran physician. The nearest tertiary care center is two hours away by car.

Calvin Qian

Class of 2023 Robert Wood Johnson Medical School 43

Ars Literarium Volume V

My Angel I still remember her smile as if it were yesterday, now a year has passed and I’m left wondering why it had to be this way.

If only I knew earlier, if only I had known what was wrong, That her own body was attacking her for so long.

It wasn’t supposed to be, She had her kids futures that she wanted to see.

She understood me and she really cared, I just want to go back to all the times we shared.

Life truly is fleeting as they say, One day may be colorful and the next empty and gray.

Nivetha Srinivasan

Class of 2023 Rutgers New Jersey Medical School 44

Autism Oh what sweet, beautiful smiley faces, kind hearted, and, What deep thoughts you have, What a way to celebrate with all the strength you have, Some are so young, Some have grown old, But altogether you are not forgotten, You are ours forever, You will always be loved, held, and hugged.

Carol Marcus Connor

Ambulatory Care Technician, Department of Medicine University Hospital 45

Ars Literarium Volume V

Whirlwind of a Day Photograph

Abby Heller

Lab Manager/ Research Technician of Chiara Manzini Lab Department of Neruoscience and Cell Biology Robert Wood Johnson Medical School 46

Waiting

Gone

The empty room

I am already outside

As you first walk in

Although I sit at my desk and type

I am sure he wondered

My head is not in it, I see myself leaving

Why is he even here

Leaving out the doors that are waiting in front

For Vivitrol, that will work

The eyes of the building, that await all

So he hopes and prays

And each as they walk through

I can just imagine

I am there now as I sit at my desk.

Myself, where he is.

I see myself getting in my truck, and starting

Thinking if only I did not have this

To drive away, to home, and walking inside

Knowing feeling that this

To my home, to get dressed, out of these clothes

Or that will make it better

That I have been working in all day

Never asking the question

And has the smells of work on them, from the day

Why is it wrong?

And I see myself settling in to rest, as I sit at my desk.

Robert Marsessa

Community Coordinator, Department of Psychiatry Rutgers New Jersey Medical School 47

Ars Literarium Volume V

Metamorphosis A lone voice rises above the tympanic dripping of an electric coffee pot. I cease the customary flurry of morning movement, the tugging on of shoes and wrapping of scarf, to listen. My grandmother’s voice, thin and defiant, delivers a cheerful melody. I follow the sound and peer into her room. She continues to sing, smiling at me from her cozy cocoon of blankets.

She hasn’t always been this way, this frail-framed embodiment of confusion. The transformation began several years ago, when Tuesdays became Thursdays, and Saturdays were Wednesdays. Then she relinquished her baby blue Chevy, the one that transported me to ice skating practice, school, and birthday parties. Bit by bit her stubborn independence subsided, and she agreed to leave her house of six decades and move in with us.

She tired more easily, seemed less oriented and we suspected an inevitable hardening of the arteries. Then, during a routine checkup Dr. Ramsaroop diagnosed Alzheimer’s Disease. Alzheimer’s cannot be determined conclusively until after death, but Grandma had all of the typical symptoms. From that point forth we knew: Grandma’s brain was dying.

In the years since her diagnosis, Grandma has led me through a tangle of questions. I am frustrated by my inability to empathize with her. I cannot imagine the sensations that she feels, or the thought processes which convince her that her hallucinations are real. She doesn’t recognize me anymore; I am “that woman,” or “the one in the room next to mine.” I miss her. I miss the woman with perennially strawberry blond hair who coached me through the stock market club in seventh grade, and who made a strangely tasty rice and raisin casserole every time I was home sick. I wonder what becomes of a soul obscured by physiological deterioration? Is the spirit that loved me as a child still in there?

Slowly, brilliantly, answers come through. Rays of hope, glimmers of accessibility pierce through the muddied stained glass of neurological ailment. As we sit in the kitchen drinking tea, Grandma describes her heart wrenching divorce fifty-five years in the past. Pain stabs through the cottony clouds of forgetfulness. I stand up and give her a hug. “Oh, thank you!” she exclaims, surprise and happiness mingling. I feel the tingle of connection, a warm rush of recognition. This is Grandma.

I don’t think Grandma will ever remember my name. In her metamorphosis my role too has changed. I am now parent. And in this an indelible truth emerges: that above all love transcends the bounds of age and illness. Before, when she had her own house and car and neighborhood, Grandma used to sing me to sleep, a little off key. I see her now in her room singing once again. I return her smile. She recedes into her blanket cocoon, as I begin to stretch my multicolored wings of adulthood.

Carol Apai

Class of 2021 Rutgers New Jersey Medical School 48

Intersecting Pentagons Description and Oil on Canvas

During my Psychiatry clerkship, I administered the Mini-Mental Status Exam to my patients to assess and trend changes in cognitive functioning. The MMSE includes a portion called the Pentagon Drawing Test where patients are asked to copy two intersecting pentagons. Some patients produced perfect replicas while the more cognitively impaired produced stand-alone pentagons, quadrangles or simply disjointed lines. I found this variability to be incredibly visually striking and sought to display it on canvas, in order of increasing impairment.

Adiba K. Anam

Class of 2021 Rutgers Robert Wood Johnson Medical School 49

Ars Literarium Volume V

Art of Medicine

Digital

Adapted from Voltaire

Jennifer Fang

Class of 2023 Robert Wood Johnson Medical School 50

Liquid Sunshine Photograph

Mubashir Shabil Billah, MD

Urology Resident, PGY-4 Rutgers New Jersey Medical School 51

Ars Literarium Volume V

The Old Delhi Market: A Photo Essay of Medicinal Spices Description and Photograph

There is great wisdom in the awareness of “knowing� what is unknown. The shop owners in the Old Delhi spice market are deeply connected to their ancestors. Since the 17th century, throughout the market, vibrant aromatic spices are sold and traded by 9th and 10th generations of families. Traditions are honored and richly woven into daily rituals that move life forward. Sustenance of mind, body and spirit is achieved through the preparation of flavorful foods meant to heal and nourish. The ancient Ayurvedic scripts mention the use of these spices in curing ailments.

Pictures of the market place. Center clockwise from top left spices: 1. Ginger (antinausea), 2. Coriander Seed (improves digestion), 3. Turmeric (anti- inflammatory), 4.

Black Cardamon (respiratory health), 5. Cinnamon (hypoglycemic), 6. Cumin (lowers cholesterol).

Accompanying photograph is on the back cover.

Joseph Benevenia, MD & Laureen Benevenia

Professor and Chair of Department fo Orthopaedics Rutgers New Jersey Medical School 52