SCOPE Volume V: 2015

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SCOPE 2014-2015 路 Volume V Editors in Chief Heidi Kim Shelly Xie Faculty Advisors

Junior Editors

Lynne Kirk, M.D.

Mishi Bhushan

John Sadler, M.D.

Janie Cao

Jim Wagner, M.D.

Benjamin Weia

Contributors Ambereen Ahmed

Kenrick Lam

Lawrence Aung

Kajal Mehta

Agnelio Cardentey

Shalvi Patel

Mike Clark

Elise Rasmussen

Shanup Dalal

Jake Rice

Kathleen Evans

Herbert Rosenbaum

Bethany Johnston

Tyler Ellis Smith

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Letter from the Editors

Welcome to the fifth issue of SCOPE, the medical humanities journal of UT Southwestern Medical School. This issue features a diverse collection of works in visual arts, nonfiction, fiction, and poetry that reflect the thoughts and growth of our medical students as they journey through different stages of their medical education.

The editorial team would like to thank the authors as well as the faculty reviewers for contributing their time and effort in the production of this issue. We hope our readers will enjoy the works and experience the compassion, empathy, and emotional struggles together with our students. These are elements often forgotten in medicine, and we hope our readers will be reminded of how vital they are to our profession. We also hope that SCOPE will inspire further interest in the medical humanities and motivate more people to express themselves through the humanities and arts.

SCOPE Editorial Team Heidi Kim Shelly Xie Mishi Bhushan Janie Cao Benjamin Weia

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Table of Contents 2014-2015 路 Volume V Untitled

By Tyler Ellis Smith Preclinical

Front cover 8

By Mike Clark Incomplete

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By Shalvi Patel My Ego

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By Kenrick Lam Poem to a Cadaver

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By Lawrence Aung Gran Calavera Anatomica

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By Agnelio Cardentey

Simplicity in Intricacy I

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By Ambereen Ahmed Fading Minds

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By Jake Rice

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Table of Contents 2014-2015 路 Volume V Outbound, 7:30 p.m.

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By Bethany Johnston The Girl in the Green Shirt

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By Elise Rasmussen Simplicity in Intricacy II & III

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By Ambereen Ahmed Untitled

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By Kathleen Evans Untitled for You

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By Herbert Rosenbaum Wings of an Angel

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By Shanup Dalal

A Corner of the World

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By Kajal Mehta About the Contributors

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Preclinical

By Mike Clark

Proteins and channels and ions and enzymes In lumens and spaces and membranes and at times Seem more to remember The med fire-hose awaits But every Wednesday gives us a taste Called Seldin, Sprague, Fashena, or Cary Estabrook or Pritchard are our-six where we Physically examine Listen, learn and observe A peek at our future and the patients we’ll serve So we fill in the bubbles and name every bone Coffeehouses and libraries become our new homes Laying the foundation For what really drives me Clinical use at the end of the pre

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Incomplete

By Shalvi Patel 9

My Ego: On Physican Assistants and Nurse Practitioners

By Kenrick Lam Dear Forebrain, I hate PA’s and NP’s on a visceral level. This hate is completely illogical and would never hold weight in any argument. But here are the reasons why I cry every time on the wards when I work with NP’s and PA’s (which from now on I will refer to lovingly as PANPs).

1) PANPs are way too qualified. I need some subservience in my life.

A fresh PA graduate is just as, if not more, qualified than a fresh MD graduate when it comes to taking care of patients. The same can be said about NP’s. I mean, is there a difference between what MD’s and PANPs do (operationally) in most specialties in their first three years of residency? In patient outcomes? Answer to both questions: Nothing. (1, 2).

2) 2) PANPs are gunning for my IQ. I must be smarter than PANPs because a) I chose to pursue a life-sucking, buzz-killing occupation that will undoubtedly wreck at least one of my close relationships.

And b) I took the MCAT, that’s got to count for something right?

Instead of a standardized test, the PA program at UTSW requires applicants to have at least 200 hours of professional healthcare experience (nurse, phlebotomist, ER technician, etc.), which is paltry to Duke’s medical school requirement of 1,000 hours.

Standardized tests always trump clinical experience.

3) PANPs are my competition…and they look really competitive right now. Over the past 35 years there has been a growing body of evidence that PANPs deliver equivalent care in the primary care setting (3, 4). Plus, their role in subspecialty, emergency, and acute care settings is expanding as well, though the outcomes in these areas are not as well-validated (5, 6, 7, 8). And now, many states are giving PANPs significantly more autonomy; Washington State, for instance, enables PA’s to open their own practices.

4)The PANPs’ curriculum is too clinically relevant. Only pansies bypass the year of heartbeat-robbing minutia in lieu of practical courses such as “Clinical Decision Making.”

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Unfortunately, I am only an incensed, pen-wielding ego of a medical school student, and I can’t do anything to stop this. In fact, it would only limit access to healthcare if I tred to restrict the practices of PANPs. These men and women have the same skill and knowledge as residents do. And if residents can pass the boards and go on to practice on their own, then why not qualified NP’s and PA’s? Maybe it’s time we drop the letters ‘N’ from NP and ‘A’ from PA. Yours truly, Your sulking ego Works Cited Singh, S., Fletcher, K. E., Schapira, M. M., Conti, M., Tarima, S., Biblo, L. A. and Whittle, J. (2011), A comparison of outcomes of general medical inpatient care provided by a hospitalist-physician assistant model vs a traditional residentbased model. J. Hosp. Med., 6: 122–130. doi: 10.1002/jhm.82 Miller, W., Riehl, E., Napier, M. Barber, K., & Dabideen, H. (1998). Use of physician assistants as surgery/trauma house staff at an American College of Surgeonsverified level II trauma center. The Journal of Trauma, 44(2), 372–376 SOX HC. Quality of Patient Care by Nurse Practitioners and Physician's Assistants: A Ten-Year Perspective. Ann Intern Med. 1979;91:459-468. doi:10.7326/0003-4819-91-3-459 Horrocks, S, Anderson Elizabeth, Salisbury Chris.Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors BMJ 2002; 324 :819 Nevidjon B, Rieger P, Miller Murphy C, et al. Filling the gap: development of the oncology nurse practitioner workforce. J Oncol Pract. 2010 Jan;6(1):2-6.

Warriner, IK, Meirik, O, Hoffman, M, et al (2006). Rates of complication in firsttrimester manual vacuum aspiration abortion done by doctors and mid-level providers in South Africa and Vietnam: a randomised controlled equivalence trial.

The Lancet, 368(9551), p1965–1972 Doan, Q., Sabhaney, V., Kissoon, N., Sheps, S. and Singer, J. (2011), A systematic review: The role and impact of the physician assistant in the emergency department. Emergency Medicine Australasia, 23: 7–15. doi: 10.1111/j.17426723.2010.01368.x Newhouse J, Stanik-Hutt J, White KM, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ 2011;29:230-250

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Poem to a Cadaver

By Lawrence Aung From a card I was told

Cachexia had left you emaciated

that you died of C.H.F

But I had left you hollow

eighty-eight years old

And on your face I had expected

Our time together seemed the same

grief suffering or sorrow

But I never quite caught your name

but instead you were still

And on each day

Death

you must have felt

is

Like a fallen tree

stillness

on the veldt,

And in

whose leaves

that stillness

the wind

a solemn dignity

had stripped away

You taught me that Death,

I held your heart

death awaits us all

It was a seed

and that's a given

covered in rich black clay

but in your clouded eyes

rooted in a bloody soil

I gazed and I saw

the last remnants of your life

a quiet heaven

were a considerable toil

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Gran Calavera Anatomica

By Agnelio Cardentey 13

Simplicity in Intricacy I

By Ambereen Ahmed

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Fading Minds

By Jake Rice There was pain in his eyes but no fear could be found, He had faced death before and won every round.

This time was different, both he and I knew, I helplessly wondered just what I could do.

I smiled as he mumbled; I tried to stay strong, But my hero was defeated and it just felt so wrong.

True pain this man knew, the type that crushes the heart, Though decades since the war, nightmares still tore him apart.

But the true nightmare he lived did not include a gun, It was the worst nightmare of all, he had outlived his son.

These were heroes of war, who had managed not to fall, But now a diseased brain would soon claim them all.

Their minds constantly struggled to determine what was real, Grasping for the dignity this disease promised to steal.

As his life drew to an end I stood by his bed, He acknowledged my presence with a slight tilt of the head.

Unable to speak, he lifted a trembling hand,

I grabbed it, he squeezed, a simple gesture so grand.

Despite the situation his smile was serine, As I looked at my grandfather I realized one last thing.

He was not scared to die, he had accepted his fate, So he shifted his thoughts to that very first date.

With his mind on his wife and that magical night, He took one last breath and followed the light.

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Outbound, 7:30 p.m.

By Bethany Johnston My poetry was awful but you made me send it anyway.

And when Mr. Collins wrote back I could tell he wasn't impressed, but you shook with joy.

You always wanted me to write.

Holiday chatter, the smell of coffee bubbling, and small clicks of rumikube tiles heralded the coming rain.

A thunderhead of embroidered denim.

Sun showers of journals and books.

Neatly gift wrapped and signed: with love, Carol & Eve. From your seat at the card table you would lean into me and speak over the sound of compressed air: What made Uncle Joe hate the Cowboys?

What made Grandma tick, beneath that scalp of poodle-hair, behind the clear blue heirlooms set in her head like gems?

Well, you said, you knew.

Or at least had your theories.

The Family Shrink.

And incidentally, a shark-shrink, too.

The field trips, I loved our field trips.

You, me, and the double-wide, scooting through the parking lot at Barnes & Noble, towards the grand adventures ahead between the walls of books.

I'd like to see your face without all the plastic jewelry, your frame without the walker, your mind un-bled, with sight and capacity restored.

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Would your contended wisdom permit me?

Might I draw back the years when your breath was borne in tanks, when you dragged your life behind you on wheels and drown them in some dark, black oblivion?

If I could, were you here today as you are now, I'd hardly recognize you if it weren't for the way you'd lean to your right, and explain to my mother the current chemistry of my brain, in this strange mix of grief and joy.

We were thankful for small mercies.

For the evening hours at the station where we hugged you goodbye and we put you on the train, and watched your outline, yellow in the curtained window, fade into the dusk.

But it wasn’t before you pulled the whole train over and made the conductor wait.

After all, you never wanted to go on a Monday.

You always preferred to travel on Tuesdays.

And that morning I saw raindrops in Texas for the first time in months, as if you broke free into the clouds and attempted to end the drought by the sheer force of your stubborn will.

Note: Bethany wrote and read this poem at her aunt’s memorial in 2011. Dr. Carol Lewis, a 1971 UTSW grad, was one of only 10 women in her class. She died from ILD when she took herself off the ventilator at 7:30 one evening in September. Bethany had to fly in from her interview at UTHSCSA to make the farewell party at St. Paul.

They gave her two minutes after removing the ventilator, but true to form she stuck around for almost 12 more hours. In the poem, the “double-wide” was what she affectionately called the special, extra-large cart that held not one, but two oxygen tanks. She had a ruptured AVM in 1989, and UTSW neurosurgeon Dr. Duke Samson saved her life. She was still a force of nature, but Bethany’s been told she was even more brilliant before the bleed.

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The Girl in the Green Shirt

By Elise Rasmussen The smell of canned green beans rushed into my nostrils as the luminescent green juice ran all over my tray. So much for the little sections that were supposed to contain each food item in its separate compartment. The transgression seemingly vanished as the liquid quickly disappeared, soaked up by the bread roll as if it were a starving sponge.

Peering around at the long line of strangers dressed in tank tops and flip flops, I felt like I was a 12 year old kid at Glen Lake Summer Camp instead of an orientation before starting medical school. I took in the room in its entirety: mouths opening and closing as morsels of food were shoveled in, hands trying to gain an advantage through wild gesticulation, heads nodding and shaking excitedly, feet tapping the floor (was it the caffeine or nervousness?), chairs being pushed around in all directions to make space for the hands, heads, feet. The voices all rolled into one wave of sound that slammed into me and filled me with the overwhelming urge to vomit.

I didn't. I told myself that the quest for friendship might perhaps be hindered or even prolonged indefinitely with the acrid smell of my gastric contents. Duly reminded, I managed to swallow it down and began looking for a seat. My eyes roved around the room and begged the occupants at each table to glance their way and give the tacit invitation to join. Just as acknowledgement and acceptance neared, each potential pair of eyes darted away to examine something, anything, else just in the nick of time.

How peculiar it is to feel so alone in a room full of people. It does say something about the nature of loneliness. It isn't the physical proximity to others but rather, the emotional connectedness that gives us a sense of belonging. Otherwise, we'd feel most comfortable in a hospital surrounded by rooms on all sides or a dorm room or even a concert venue with people jostling for position. But we know that isn't right because isolation can be overpowering in the largest of cities. And how do you even begin to connect with one person when there are a multitude? While a greater number of people may statistically increase the chances of finding one other being with whom to bond, the sheer number of potential options 18

is paralyzing for many of us. Where to start how to begin what to say what if I say something stupid what if I look like an idiot what if I don't say anything what if no one says hello do I have food on my face do my clothes match do they think I don't belong here do I belong here? To be rejected in front of so many others...oh the humiliation. And that's how I felt at that particular moment. MS1's they called us, but let's be honest, I felt like an MSnothing. I certainly didn't feel like I belonged to the MS family.

What a funny thing to be so scared to initiate a simple conversation. I would have traded my right hemisphere to have been more like the scarecrow and less like the cowardly lion. Who needs a brain anyway when you don't have the guts to use it to converse with those around you? I'd like to say that I marched right up to a table and initiated a verbal exchange, but I would be lying to you. I also could say that I melted into the floor with only a pile of green beans to show for my prior existence, but that wouldn't be true either.

I was saved by the girl in the green shirt. "Do you want to sit here?" It was a simple question, but the relief on my face must have been palpable. Her words seemed to loosen my tongue as I found myself replying, "Yeah, thanks." With that invitation, I suddenly found myself joining a table full of my fellow classmates, and the act of connecting with the unique individuals of that group allowed me to take a small step towards incorporating myself into the MS1 class. I bit into that soggy roll and felt content as I started to form relationships with my classmates who have continuously enriched my time in medical school.

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Simplicity in Intricacy II

By Ambereen Ahmed

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Simplicity in Intricacy III

By Ambereen Ahmed

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Untitled

By Kathleen Evans During my second night on trauma call, I had had a very slow day, only receiving my first page at 8 p.m. for a man with abdominal trauma. As we were admitting him, two police officers wheeled in another patient, a middle-aged woman. She had been found unconscious in her neighborhood with her clothing partly removed and disheveled. Every feature of her face was bruised, bloodied, and swollen. She could only groan in pain but could move her arms and legs spontaneously. Police weren’t sure what happened but guessed she was the victim of a sexual assault.

We carefully removed her clothing and accessories and put them in brown bags for the police; we taped bags around her hands to preserve any evidence under her fingernails. CT scans showed bilateral orbital fractures as well as a temporal skull fracture and axonal injury. After the scans, she started vomiting blood, and we intubated to protect her airway. Once she was medically stable, we paged the OB-GYN Intermediate Care Clinic to do a forensic medical exam for the suspected sexual assault.

The OB-GYN resident who answered the page said she was not comfortable with the patient’s medical stability and wanted to wait until morning. We asked her to please reconsider, as we were confident in the patient’s medical stability and did not want her to have to remain covered in blood and dirt. The resident then said she couldn’t conduct the exam because part of the exam was having the patient say, in her own words, what happened. She was intubated, so she couldn’t speak even if she wanted. My trauma resident begged the OB-GYN to break up the components of the exam and collect evidence now. She ended by simply saying, “If it were you on that table, what would you want?” The two policemen weren’t as delicate, saying if it were their wife, they “would be raising ****ing hell.” The OB-GYN resident returned an hour later and said she could break the exam into pieces and began the forensic work-up on the patient.

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I am glad the system eventually worked for the patient, but I am disappointed it happened the way it did. This trauma occurred at the same time a Columbia University student was carrying a mattress around campus to protest the handling of her sexual assault investigation. It was at the same time the NFL knew Ray Rice punched his now-wife unconscious but only suspended him after a tape of it surfaced. It is clear that our society has a problem in the way it views women and reacts to violence against women. Too many times institutions react in a manner against the woman or do not act at all. I felt like my trauma team was made part of the problem because we had to choose between putting vital medical care first at the sake of jeopardizing action toward catching the assailant It didn’t help that the system seemed designed against helping women in this case – the patient was so brutally beaten by her assailant that she couldn’t speak, which could have helped her assailant by delaying the collection of evidence against him.

As a health care facility, we should never be part of the societal problem of victims feeling helpless. Because hospitals are the only places that can conduct forensic exams, we have to make victims feel comfortable and, if they can speak, heard. Hospitals should have a low threshold of suspicion and should be able to defer to police for a history if the patient cannot speak for him or herself. We are moving in the right direction by allowing victims to receive a sexual assault test regardless of whether they want to pursue legal action, but that’s not enough. If we want society to respect women, if we want society to change the lack of action against sexual assault, it starts with the people best able to determine if a sexual assault occurred. It starts with us.

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Untitled for You

By Herbert Rosenbaum The soft whirring of the suction vacuum Fills the otherwise quiet room.

And the fluorescent light shines behind her bed and gives her A glowing aura.

The end is particularly sobering Especially as a soon-to-be practitioner of medicine For I know all the signs and symptoms of death Down to the molecular level it is instructed And yet there is absolutely nothing to do But wait.

I introduce myself She raises her arm and waves her hand as if to say, “Hello,�

Even though her random movements Are just pathology of finality.

But do they have to be?

Is it such a travesty to pretend that she greeted me upon my entrance?

Call me a victim of denial, but I see life until one’s last breath And it is so crazy to assume she welcomed me Allowed me to sit at her bedside with her gesture?

Look, her curly hair has little pigtails!

Her fingernails are painted a red so vibrant!

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I can tell how much she is loved Her family and friends sent the nicest cards.

And I remind her of that love.

If only she could speak, what might she say?

Would she tell me about her life? Her career? Her family?

Or perhaps just that the spot on her right leg is really itchy And the gloves the nurses put on her hands are certainly not helping.

This one sided communication reminds me She can hear my words.

With one corporal sense.

It allows our connection As a Jew reads Psalms to a Christian woman With a Bible found at her bedside She can hear our similar traditionAnd she strokes my hand.

A soul lives inside.

It is believed our ability to hear is last lost in death.

How beautiful to live one’s entire life with the ability to listen!

If only we all appreciated this gift with all senses intact I pray you forgave The resident physician who spoke so callously To you…at you…actually, it was above you to me She forgot your humanity in your final days I tried desperately to defend you from her apathy.

My dear, silent, fading friend I promise we are not all like her.

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Wings of an Angel

By Shanup Dalal It is said that you will never forget your first patient and your first patient death. Ms. X was one in the same for me, but I will not forget her for much more.

I remember an air of nervousness overwhelming me as I walked down to the emergency department to see her. As I entered the room, I saw her lying motionless, with only her lips moving as she mumbled incoherent words. She was in an altered state of mind, more so than her usual baseline of Alzheimer's. Upon asking her daughter some questions, I began to paint a picture of the strong woman Ms. X used to be before her Alzheimer’s, a single mother who raised her 8 children alone. More importantly, I began to piece together the puzzle of what caused this acute presentation. The daughter began to relay how her mother was having burning upon urination and a subjective fever in the days prior to this ED visit. The story continued, and all signs began to point to a complicated UTI leading to her altered state.

Ms. X was admitted that evening to the telemetry unit, where we realized she had an abnormal heart rhythm most likely due to her heart medication. Her medication was immediately stopped, but her atrial fibrillation returned as she became hemodynamically unstable, worsening her clinical presentation. The cardiologists and internists were at a stalemate when it came to treating the patient’s cardiac symptoms. The cardiologists wanted the patient placed on amiodarone, a medicine with more severe side effects than the Sotalol the patient was currently on. Whereas the internists were worried amiodarone would worsen the patient's underlying pulmonary and thyroid problems, the cardiologists were worried the sotalol would worsen her atrial fibrillation. Through these disagreements, the patient's condition continued to worsen, and the physicians began to truly neglect Ms. X. She began to clench her blanket between her teeth, as she squeezed my hands as hard as she could while crying during her physical exam. She was in pain but was not receiving any pain medications because the physicians believed her most dire problem was her cardiac state.

Something needed to be done. However, what could a medical student with limited clinical education do? It was not until the next day when Ms. X cried during morning rounds that I immediately turned around and went to my chief resident to ask that she order pain medications. Surprisingly she was not angry, but asked “What would you like to give her?” Though shocked at first, I proceeded to state what hours of research led me to believe: “Withdraw the morphine because it would worsen her 26

hemodynamic instability, and provide IV acetaminophen.” Two hours later, nurses administered IV acetaminophen, and she began to show signs of pain relief. To everyone's surprise she began to speak to her family the next morning. This t urnaround was not expected, especially by Ms. X's daughter who stated, “You doctors wear white coats that are like the wings of an angel. You all are my mother's angels.” That evening, Ms. X had her last breath.

Her pulse raced into the 150s, and she became unstable once again, ultimately passing away. Ms. X had a moment of clarity before she passed and was able to say her last words to her family. I will never know how it was possible for Ms. X to make such a drastic change in a few hours and then pass away the following day. However, I do know that she was not in pain in her last few hours.

I have quickly learned that we, as medical students, have the unique opportunity of getting to know patients on a deeper level than most physicians because of the amount of time spent with the patient. Empathy is something all medical students possess; it just needs to be practiced. To do so, students must be able to approach attendings without fear of judgment. It must be stressed that student input is welcomed and encouraged. In doing so, we will not go into residency believing we are angels that are meant to save patients. Rather, we will begin to see ourselves as human beings helping other human beings. We will begin to realize our white coats are not wings of angels, but rather a privilege that gives us the means to enter the world of the patient. If we learn to convey the information we garner from patients to physicians, the care for the patient will be much more geared towards all of the patient's needs rather than one aspect of it. In addition, we students will begin to develop into physicians who will actually see the patients for who they truly are and not only view them as another dollar.

Through Ms. X’s teachings, I now know that our fear should not cloud our clinical judgment and that we should become the voice of patients when they do not have a voice of their own.

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A Corner of the World

By Kajal Mehta The following is a series of photographs—a photostory—documenting a day in the villages of India from the perspective of a mobile medical camp. Every morning, we drove into a remote village and were quickly surrounded by children who immediately dropped their chores to see the curious new vehicle. We set up in whatever open forum was available and saw the mob of patients, one by one: prescribing medications and checking blood sugars and blood pressures in hopes that this would tide them over until they could make it, if ever, to a physician.

The most striking part of these trips was always the patients. They say human nature is the same around the world; perhaps it is, but the way they approach life is completely different. There is openness, and a visceral kindness and generosity that immediately take you in: no need for doors or locks, insistence on having the tea and biscuits they can barely afford, genuine feelings in the eyes that speak to you. They live with so little, yet are seemingly unbound by material stress. They live out their lives, and only have pride in their wrinkles and leathery skin. They live in the moment, yet are surprisingly unbound by time. They simply live.

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ABOUT THE CONTRIBUTORS

2014-2015 Ÿ Volume V

Ambereen Ahmed, M.D. Class of 2018, is a first- year medical student who graduated from the University of Houston with a minor in Studio Art. During her classes, she realized that drawing nude figures allows us to see the human body in its simplest form— no distractions, no statements by apparel, just simply the unfaltering human physique. She believes that the world should be seen through different perspectives. As students of medicine, our perspective can sometimes be mechanical. Looking at the world through the lens of an artist can allow you to see things for what they really are. She continues her pursuit as an artist in her spare time and recently has sold many of her pieces.

Lawrence Aung, M.D. Class of 2018, is a first- year at UTSW. He went to the University of Miami for his undergraduate degree. He has an interest in contemporary art and photography. His favorite poet is W.B Yeats.

Agnelio Cardentey, M.D. Class of 2017, drew this piece on his personal whiteboards after he saw Dia De Los Muertos face-paintings and became inspired to add more anatomical detail.

Mike Clark, M.D. Class of 2018, wrote this piece reflecting on the gulf between preclinical didactics and the humanistic future of practicing. UT Southwestern’s Academic Colleges and the creative arts have played a meaningful role in his appreciation of a global perspective.

Shanup Dalal, M.D. Class of 2016, is a third- year medical student at UTSW who will b applying to med-peds residencies. The opportunity to treat a patient’s illness, in addition to the psychosocial problems the patient faces, is what drew him into medicine. He believes that in order to truly treat a patient a physician must not only look at the illness, but also see the patient as a human being who needs someone to listen. The reflection essays he writes are not only to satisfy his rotations’ requirements, but to serve as a reminder to himself that a white coat is a privilege that gives physicians the ability to help patients.

Kathleen Evans, M.D. Class of 2016, is a third-year medical student. She has always been interested in writing and graduated with a BA in journalism from the University of Oklahoma. This is her first publication, and she hopes to continue to write about her experiences in medicine.

Bethany Johnston, M.D. Class of 2017, is an MS2 who loves a good story, soccer, and anything punny.

Kenrick Lam, M.D. Class of 2016, is a third-year medical student curious about the hierarchy in medicine. He wrote this piece after observing the opinions of some physician assistants and nurse practitioners squashed by MD’s. He does not understand why they are considered to have less expertise and is still trying to find out.

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Kajal Mehta, M.D. Class of 2016, is a third-year medical student at UTSW with plans for a career in public health. She chose to share this set of pictures from her global health experience in Jodhpur, India because there is a whole world captured by photograph which cannot be otherwise described in words. She hopes taking the time to reflect on these images will serve as a reminder to see the human in our patients when they come to us.

Shalvi Patel, M.D. Class of 2017 with Distinction in Global Health, has a love for both art and global health.

She combines them here to portray a bigger message: most global health efforts are often left incomplete because we struggle to understand the needs of those we wish to serve, and we instead create our own ideas about what is needed, ignoring the underlying issues at hand. These incomplete and untitled pieces represent how global health projects are temporary and often leave the bigger problems unsolved. Global health is an ongoing project that must constantly be worked on - it can never be fully complete.

Elise Rasmussen, M.D. Class of 2016, is a third- year medical student who continues to hate canned green beans and is looking forward to the day when she can afford fresh green beans. She is currently trying to decide what to do with her life but is excited for the free time in 4th year to spend time with her amazing classmates before residency.

Jake Rice, M.D. Class of 2017, is a second-year medical student and a veteran of the United States Navy. He wrote this poem while reflecting on his grandfather's final years in the dementia wing of a VA nursing facility.

Herbert Rosenbaum, M.D. Class of 2017, is a native of San Antonio, Texas and an alumnus of The George Washington University. His medical interests include primary care, geriatric medicine, and end-of-life management, particularly hospice care. His poem "Untitled" defends the human essence of each and every patient while highlighting the importance of valuing individualized human dignity and empathy until their last breaths. This piece serves as an unabashed criticism of the status quo of American healthcare in its treatment, or lack thereof, of patients who are nearing their final moments. Mr. Rosenbaum urges his physician and medical student readers to start meaningfully addressing the elephant in the room (and perhaps American medical culture's biggest failure): death and dying.

Tyler Ellis Smith, M.D. Class of 2016, has been photographing wildlife and landscapes since 2006. Tyler was born and raised in San Antonio and attended UT Austin where he earned a B.S. in cellular and molecular biology. He then came to UT Southwestern where he is currently in his third year and interested in neurology.

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“While medicine is to be your vocation, or calling, see to it that you have also an avocation – some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”

– William Osler, from After Twenty-Five Years, in Aequanimitas.

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