The Pulse - Spring 2021 by Temple Health

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PULSE

Lewis Katz School of Medicine at Temple University 2021

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PULSE

elcome to the 2021 issue of The Pulse, the literary magazine for the Lewis Katz School of Medicine (LKSOM) at Temple University. The Pulse is a student-run publication featuring poetry, prose, and artwork by medical students. Our mission is to promote humanism by creating an environment in which creativity and medicine are celebrated and shared. The past year has been a challenging one. From the COVID-19 pandemic disrupting our medical school journey and life as we knew it, to the repeated tragedies highlighting the pervasive and systemic racism present in our society and within medicine, we have faced unprecedented uncertainty and compounded trauma. We have all experienced loss – lost time in the hospital or MERB, missed experiences with family and friends, deaths of people we loved or cared for. Yet we have also witnessed moments of triumph and togetherness, which have given us hope that we will emerge from this year stronger in both our individual and collective commitment to medicine and our stance against racism.

Challenges inspire humanism. This edition of The Pulse highlights that fact, featuring the work of LKSOM students who found creative, humanistic ways to express and process the challenges of the past year. This issue is divided into 3 sections, each reflecting one of the year’s major themes. The first section, Perseverance, shares stories of COVID-19, and the heartbreak and resilience that accompanied the pandemic both within and beyond medicine. The second section, Justice, features powerful prose expressing fear, anger, and exhaustion as the COVID pandemic and senseless killings of Breonna Taylor, George Floyd, and countless others laid bare the racial and ethnic inequities and injustices that continue to plague America. The third and final section, Becoming, shares students’ reflections on memorable moments along their path to becoming physicians. Special thanks to the students who contributed writing, art, and photography. We hope you enjoy this edition of The Pulse.

The Pulse EDITORS

Katya ahr, miranda haslam, eileen storey

PerseverAnce Justice

becoming

Table of contents PerseverAnce 6 8 12 14 15

JUSTICE 20 22 23 24 26 28

becoming 32 34 35 36 39 40 44 46 49 52

perseverance

Acrylic painting by

rebecca mayeda

a collection of stories about the covid-19 pandemic

Bending the rules Emily Hancin

shiver ran down my spine as I sat on my hands on the hard plastic chair in the testing facility. I wondered how many COVID-positive patients had been in this chair before me, how long I would have to launder my clothes before they were considered decontaminated. A nurse opened the curtain to the room wearing the body armor of medicine, and greeted me before jamming the dreaded swab into what felt like my brain. I thought it was over until the nurse asked me what I’m sure she thought was a simple question.

who got remotely close to me to “please, God, go another way.” I was wearing a huge fluorescent “danger” sign, but to those who didn’t know better, I was nothing but an invisible threat.

“So, what happened?”

The nurse stooped down to my level and handed me a box of tissues. She looked at me with mascara-caked eyes from behind her face shield. “You need to go home and not think about this,” she said. “Go sit in bed and read a book, knit, watch some Netflix...have you ever seen ‘PS I Love You’? I loved that movie; you should watch it when you get home.”

I opened my mouth to speak but my tear ducts beat me to it as I thought about the unlucky prolonged interaction I had with an unknowingly COVID-positive family member, the feelings of fear and guilt that were part of my new identity as a potential vector of disease for my recent contacts. An hour earlier, I had strategically planned out the least populated path to walk to the testing site. As I went, I mentally pleaded with anyone

I knew exactly what she was practicing: the art of distraction. As a medical student and former EMT, I am a firm believer in it myself. I also knew that I was being a difficult patient. This poor nurse happened to ask the wrong question at the wrong time to set off the powder keg that had become my life over the last 24 hours. She had other patients to see, and I was taking up her time. She probably just wanted to avoid sending a sob-

bing patient back out through the waiting room. I humored her and, between sniffles, told her I would put her favorite movie on my watch list.

not to do exactly what she was doing at that very moment.

She went on to offer a flurry of encouraging words in response to my litany of sorrows as I tried to compose myself. Then came the kairotic moment.

As that nurse embraced me that morning, she clothed me with a new meaning of compassion. I will think about her when I am working the last hour of a long shift and I am met with an anxious patient who wants to know if I could explain their test results one more time. I will think about her the next time a patient cries in front of me, and I can’t find the words to comfort them. I will think about her when I ask, “How are you feeling today,” and I will demand more than a oneword answer. Her job was to tickle my brain with a nasopharyngeal swab; instead, she awakened my empathetic ear.

“I’d hug you but I have all this... stuff on…” I laughed through my tears, thinking about how odd it was for a nurse to offer to hug a patient in a world now characterized by social distancing and avoiding people at all costs. As I continued to blot my face so the patients on the other side of the curtain wouldn’t think the test itself had traumatized me, she had a change of heart. “You know what?” she said, terminating her thought before she wrapped her arms around me. The blue paper gown she had on rubbed against my arms in a way that felt foreign, yet motherly. One of only a few people who could see my “danger” sign disregarded it, hugging a potentially COVID-positive stranger, a visible threat whom she had known for just five minutes. As my tears melted into her gown, I wondered how many times her superiors must have told her

There were no witnesses. I never got her name.

Just before I left the testing facility, I crumpled up my damp tissue in my hand, gripping it like a security blanket. The nurse held up the tube containing my swab and looked at it in the light for a moment. I waited for her to use the magic in her eyes to transform it into something beautiful. “It’s going to be negative, I feel it,” she said. “You’re going to be okay.” She was right.

The 2020 Residency personal statement M.D. Creager

kay. One more time – My Personal Statement.

My fingers lay on my keys, while my eyes stared through my computer, unfocused; my thoughts standing somewhere between a racing mind and a quiet mind, as if waiting for a train that was not coming. The hospital felt less and less like an institution to house my future career, and more like the only place that existed, that was real. It was the only place where people were; and would be - and had been. Life outside of the hospital, on the other hand, no longer felt real at all. For one, it was lonely. No longer could I look forward to seeing my friends and having them over to play board games or have a drink. The few times I might have, even if it were to maintain some semblance of sanity, I could not escape a feeling of guilt, as if I would now be responsible for the next hospital admission. No, maintaining some semblance of sanity seemed impossible. In fact, it became easier to do the opposite – to escape to my room, away from even my roommates, to pour myself a bigger glass, to hide in a scripted world where my conversation was limited to “continue to next episode?” “Yes,” my pointer finger would say. This world was safe. It was sensible, sane. The world between the hospital and Netflix wasn’t. Beyond the world being reduced to a shadow of the bustle that had once existed, I, like so many others, would find myself fuming with rage every

“

At this point, the hospital is the only place that is real, that is. It is the place to go to feel something, to have an in-person conversation, to feel connection, to be productive, to escape my apartment. It is where I want to be, to feel human.”

time I turned on the news. I am a fourth-year med student, and so I am at the crossroads of being completely useless and predominantly necessary to medicine. In the current state, if I were to be pulled from rotations again, the hospital would keep on running, and the world would keep on spinning. And yet, these final few months are crucial to my foundation; in less than a year, my peers and I will become residents and be the frontline workers caring for the multitudes of patients at home and on ventilators. The days I do spend in the hospital are days that I feel alive. I can do something, make a difference. Perhaps my difference is trivial and just involves helping to complete the background research on a patient or their disease. However, there is a sense of purpose in that work. I look forward to the hours spent working in the call rooms with the residents, to talking about the insanity that we see in the world around us, to laughing and joking. I wonder if the residents appreciate my company as much as I appreciate theirs – for them, this is work. Yet for me, they are a friendship – fleeting, but it gets me through the days.

The patients that heal and go back home to their families inspire me. The ones that are less fortunate drive me to learn more, to become the best student and future physician I can be. They all teach me the immense value in sitting and listening to their whole story. It makes their care and everyone’s experience worthwhile. They speak of their children and their grandparents. They mourn their loved ones, and dream of doing their favorite activities once again. Even those who are sedated and intubated become a rallying cry to do better. And so, in any other year, if you asked me why I wanted to be a resident physician, I would answer with eloquent descriptions of my passion for science, serving diverse populations, collaborative approaches to innovative ideas, etc. This year however, my answer is different. At this point, the hospital is the only place that is real, that is. It is the place to go to feel something, to have an in-person conversation, to feel connection, to be productive, to escape my apartment. It is where I want to be, to feel human.

embers of the Class of 2021 help convert Temple’s Liacouras Center into a COVID-19 surge facility in April 2020. Photo by Joe Franzen.

COVID COUNTRY jenny schadt

ules get broken in Covid country. Only enough PPE for one, so only one may enter, But the job requires 2. I pass through the door, long sleeve shirt under my scrub top, But I’ve never been more naked. In the dim light 3 patients lie sleeping in a row beneath windows in what used to be a waiting room. I guess it still is a waiting room. The patient in bed one can walk, a simple transfer, but complicated by incontinence. With every lingering second I feel the air around me becoming more viscous. Moving through virus, as I turn to throw away the sheets he catches my eye. The patient in bed number 4. Upright, gown half off, revealing a skinny frame of dark brown skin, Blending with the darkness of the early morning, White whiskers engulfing his nasal cannula. His eyes are not like all the others I see in the night: Glassy Far away Half closed No, at 3am this man’s eyes are different: Wide Alert Perceiving Watching the few feeble steps his neighbor just made, Watching her strained journey of 2 feet Watching her collapse onto the bed Spent.

Our eyes meet and I am exposed in my nakedness. No yellow gown to cover me, he can see right through to my blue scrubs. He raises his hand in a wave and I see him smile. I raise my hand back and suddenly I want to stay there forever In Covid country, naked and exposed. I want to draw close to this man And ask him why his eyes are different, I want him to tell me all they have seen. I want to grab pad and pen and record his whole life story And if i run out of paper I will use my mask And if I run out of mask I will use my scrubs And if I run out of scrubs I will use my skin I will peel away layers of protection Making myself vulnerable for the privilege of hearing his truth, his triumphs, his pitfalls, his mirth, his sorrow; All that has brought him here To Covid country Under this window At this time of night Looking at me. Teaching me, with his eyes That to protect oneself is a deep human instinct, but the instinct of human connection runs much deeper.

Photos by

Vered schwell

the dollhouse F

or forty years, my grandma (lovingly known as “Oma”) created a beautiful dreamland at her dollhouse shop, “All Small Miniatures.” Whether a little girl who’d saved up her allowance for a new doll, or a lifelong customer who only bought the best handmade pieces, Oma dedicated herself to giving everyone the same special experience that came from her love for all things small. Growing up in her shop, I watched her carefully select the details that brought a dollhouse to life— from cereal bowls and glasses of milk on a kitchen counter, to skeins of fabric spilling out of a trunk in a sewing room. I practiced creating my own scenes behind the safety of her counter, proudly taking

megan patton

the hefty keyring to each cabinet and selecting the treasures that would temporarily bring life to the worlds I envisioned. Each visit she’d return me home with a bag of delicate things I’d chosen in exchange for my work as her shopkeeper— new wallpaper, a miniature version of our dog, even a teeny-tiny stethoscope. Before I was born, Oma sold a dollhouse to my other grandma. After surviving the affections of more than ten grandchildren it assumed residence in my basement, with the hope that I could eke out the last bits of joy from an old house on its last legs. After growing up arranging furniture in dollhouses that didn’t belong to me, I finally had a house to call my own. The four-

room bungalow wasn’t exactly the grand house that I’d dreamt of, but Oma reassured me that simple was better—we’d make it perfect. And make it perfect she did: scouring catalogs and retailer shows for furniture that matched my descriptions, sewing bed linens in fabrics I’d selected, and calling me excitedly after finding a piece we’d been looking for. Eventually, as I grew older and my attention turned away from the little house, it collected dust in the basement, only to be acknowledged when someone bruised themselves on its sharp corners. When I left home to go to college, and eventually medical school, it was without a person to give it life. Oma was diagnosed with dementia a few years ago. Our nightly phone calls made me recognize the changes, which first appeared in forgotten names and unexpected lapses into her native German. My fears were confirmed upon finding notes in her pockets with her name and address, or a poorly drawn-out map to the hair salon— attempts of a ferociously independent woman to compensate for her failing memory.

Her one constant was her love for my grandpa, “Opa,” the center of her life for seventy years. Their love story began when she was the telephone operator who answered his call. He liked the sound of her voice, so he asked her out, and after some convincing, she agreed. They fell in love, and shortly after when he was approved to immigrate to the US, he refused to leave Germany unless she went with him. Within days they were married in the courthouse, Oma in a suit she sewed herself, surrounded only by their love and a few witnesses. Seventy years later, when their eyes met across a room, they still lit up the same way. Opa’s death last year shattered her world. He was her safety and guide, and what she lost in ability he found a way to provide for her. Despite her failing memory, grief overpowered her. She stopped eating and wandered through each day aimlessly. Seeing her so lost left me feeling like someone had pressed the air out of my lungs. Then the pandemic arrived. Between endocrinology lectures, I worried about her constantly. I begged my mom to take Oma out of her nursing home for fear of how

egan with her grandmother, “Oma”.

visitor restrictions would affect her cognitively, or that the virus would sweep through the facility and infect her. I called upon my siblings to nag my mother too, and Oma soon moved into our house. Since medical school canceled our in-person classes, I was home to help. I woke up earlier to study before Oma needed breakfast. I learned to make dreaded showers exciting with music and singing. We had moments I will long treasure — days so lucid she remembered the checked shirt Opa wore on their first date, days we cried at how little time we have left together, days we fought over whether or not it was “shower day,” and days we cuddled up in bed with ice cream and Netflix. One dreary March morning, my brother dusted off the old empty dollhouse and set it next to a loveseat in the sunroom. Each day after breakfast, Oma gravitated to that sunny spot, breathing new life into our little house with the same determination and meticulousness that guided her in the shop

for forty years. I patiently let her decide where to put things and fit my hands into the furthest corners where her fingers are no longer nimble enough to maneuver, guiding her the way she once guided me. Most days, she doesn’t know who I am. Sometimes she calls me “Opa,” other days I’m “Mom”– names that aren’t my own, but that carry the meaning of love, and comfort, and home. I used to dread the day she’d forget my name, yet its arrival went unnoticed. At home with Oma, far from medical school, emails flooded my inbox with calls from fellow students for help: let’s make masks, let’s distribute food, let’s help out at testing sites. I couldn’t help feeling purposeless, like I had abandoned my colleagues on the front lines. But I soon realized that my purpose here with Oma was far more important than anywhere else. It was watching her sitting contently in the sunroom that I realized I was carrying out the most important duty of my life so far. I could finally be the safe place for Oma that she had been for me.

JUSTICe

Photo provided by

Temple university hospital

a collection of stories about racial injustice

I am tired anonymous

am so, so, tired. I am tired of learning about all the things that kill. The cancers, the pathogens, the atrophy, the mutations, I can read about them for hours. Faceless microbes and random gene deletions are not cruel when they hurt us. Although it may seem ruthless, nature has its reasons. Sometimes it is as simple as A, G, C, T, or the overlapping niches of one grand ecosystem, but the world always makes sense. I can study a disease until I see its logic. I can draw a pathway until all the lines connect. I can’t understand the killing. George Floyd. Freddie Gray. Eric Garner. Michael Brown. Ahmaud Arbery. Trayvon Martin. Emmett Till. People. Human beings. Patients who evaded polio, and tetanus, and smallpox, and influenza,

only their lives crushed under the pull of a trigger. It isn’t natural. There is no sense to it. Yet the killing keeps happening over fraudulent checks, over owning a knife, over missing stamps on cigarettes, and stolen swisher cigars, over being Black, over being Black, over being Black. I am tired of scavenging for reasons. There isn’t anything natural about it. In a world where we are all on one side against illness fighting for our lives, a battle we can learn to win over time, people are taking lives. I am tired of the senselessness. There is no scientific measure that would weigh a Black life as less than a white one, let alone some merchandise or accusal, but I cannot find a thumb to push off the scale. I am tired of fighting for a cure for diseases Black children may not live to fight because they are growing up in a world with something worse than the infinite flashcards of things that can ail us. They’re growing up with people. I am tired of hoping I can find a treatment for that.

something that is

hard to look at Jenny schadt

esterday a police officer tackled a Black man outside my apartment building. On the narrow, empty side street, he may have thought he was alone, not anticipating that I would see from 6 stories above. My stomach churned as the man’s friends gathered, shouting, as they quickly became outnumbered by the police officers who arrived on their bikes, and kept arriving, a steady stream, until they outnumbered anyone else on that street 3:1. I watched tensions ebb and flow, crescendo-decrescendo, like a heart with a broken valve. When I first started listening to heart sounds, I could barely make out where the lub began and the dub ended, but the more I listened, the easier it became for me to distinguish a functional heart from a pathological one. It’s the same with racial injustice, I suppose. It’s hard to look at, but the more I see it, the easier it is to spot, Even when the murmur is subtle. Medical school has taught me how to fix a pathological heart, to save a life. But it has not taught me how to remedy a society that is diseased, even though it too can kill.

Portraits by

Trina Wijangco

2020:

A progress note Phil Delrosario

2020 is a year like no other Subjective: Objective: in many ways, 2020 is a year just like others they teach us review of systems from head to tail, ...er... and in reviewing the systems we’ve had – I suspect multi-organ failure. is it really only COVID that’s killing our patients? or with fixing social ills, have we lost our patience? don’t know what’s worse: not housing folks, not even a shack? or hearing another Black person getting shot in the back. politicians think problems are solved by trickling down money, but like botulism, toxins are often hidden in honey. without grounding interventions in working class analysis, before we know it, we can’t breathe; trickle down paralysis what good is bailing out corps, when the corpses are piling? unemployment and evictions, our patients keep filing. for military, Congress easily passes seven forty billion, yet voids in pandemic relief could still use some filling in. damned insurance keeps on finding ways to deny: a patient is suffering, burned from feet to their eyes and every single day, scared their bills are so high gets no opioids; he’s “drug seeking, ugh, you believe this guy?” police, yikes, I think we got an autoimmune disorder, somehow people existing’s a threat to law and order.

“

Is it really only COVID that’s killing our patients? or with fixing social ills, have we lost our patience? don’t know what’s worse: not housing folks, not even a shack? or hearing another Black person getting shot in the back.” I admit clearing pathology is a very messy process, but I’ll take a protest if it means people will die less. but lest we let medicine off too easy, we also treat our patients in ways that make me queasy: restraining them, sedating them, calling 302, bringing in security, guarding like a jail might do. school taught us it was race that causes health disparity, rather than capitalism that makes living wages a rarity. redlining turns into flat lining in a generation or two; food deserts and crowding breed diabetes and flu. my resident sighs, “ugh they’ll just leave AMA”; but when you’re called an addict and difficult, who’s going to stay? they’ve waited 10 hours and have to pick up their kids, or maybe they’ve already missed two of their shifts. I’m a brown kid far from my motherland, training in a world of white; rather show up for my patients than ‘play the game’ in faculty’s sight. I wasn’t taught that taking up unnecessary space was preferred, yet, evaluations have rewarded those who speak loudly with more words. I find it hard to navigate this hidden curriculum unpacking and challenging every single little “-ism.” but I do benefit from a lot of systems and I am complicit, and I have to interrogate my privilege in order to fix it. there is still so much I’m learning and unlearning and I hope my patients’ trust, I am earning. Assessment: healthcare needs a better sequel Plan: stay humble, stay critical, and serve the people

MY father’s story Anonymous

By an LKSOM student, shared in the voice of their father

veryday was normal. Get up, and be at work in the early morning. Work, get everything done, and leave for my next job. Finish that job late and come home. Shower, sleep, and repeat. I also work on weekends. My family means the world to me, so I do what needs to be done. When COVID-19 hit, everything changed. Governor Phil Murphy of New Jersey said they were closing all “nonessential” businesses. The number of cases started spiking in NJ. People started worrying. In my first job, we were gonna close down, since we didn’t meet the standards for being “essential”. Or so I thought. We distribute products like brochures, toys, and nonessential items. Instead, we stayed open. It didn’t make sense but we did. So, I kept coming into work. Then, one of my coworkers got COVID-19. He’s a custodian at our company and cleans all the warehouses. He was coming to work sick and he’d been all over our facility. I was so scared. We waited for our bosses to announce that we would close the warehouse to clean it. But, nothing happened. They never said anything. It felt like a nightmare. I was getting so

anxious and scared. I spoke to my coworkers, everyone felt anxiety about going to work everyday. We were afraid we might get it. I have a wife with health conditions, I have my own health issues, and we got kids at home. The supervisors told us we had two options. One, use our vacation/sick leave to stay away until things blow over, but we only have 2 weeks. Two, we can leave and file for unemployment while the government figures out how to stop this virus but we won’t have a job once it ends. So, I took the first option. I stayed home for two weeks, using my vacation time. A few days into my vacation, I got a call from a coworker. She said another coworker, a good friend, was out sick. He was fighting a high fever, lost his sense of smell, and his body ached. All classic COVID-19 symptoms. I’ll be honest, I was scared shitless now. I bumped fists with him about a week earlier. I told my family and everyone was worried but they reassured me, it will be fine. His symptoms worsened as the days passed by. He finally managed to go to the doctor and get tested. Took almost a week for his results to come in. Positive. Now, we had the second case at my job.

I didn’t have much vacation time left. I asked around and the company wasn’t saying anything. My anxiety was through the roof. How is this legal? I call my coworker again. She says they brought someone in to clean. I feel relieved. She says don’t be. It’s a random guy walking around spraying Lysol on some counters and wiping here and there. No professionals, no masks, no heavy cleaning gear. A random guy with a bottle of Lysol. Yep, Lysol, you heard me. My two weeks were up, and I was to return to work the next day. Everyone was trying to calm me down. We enjoyed my wife’s birthday. Everyone said a prayer the night before, hoping I would be safe. Everyone kept asking all week, why wasn’t the warehouse cleaned? The answer still hasn’t changed. Still nothing. I’m scared to touch anything, even with gloves on. So I went back to work. Now, everyday, I wake up filled with fear and anxiety. I don’t know what to do. The people at our job are all Latino. Some of them are not citizens. We are all in this together though. They won’t speak up because they don’t want to get in trouble and get deported. I get it. Family comes first. Without money, we cannot eat.

We have to use our own masks to do the job. We aren’t doing social distancing. There are hundreds of us in a warehouse. It’s not that simple. I have my own gloves and masks. Enough to get me by. As the weeks pass, more and more people show up to work sick. And the worst part, no one is saying if they are positive. Eight coworkers went out to be tested and we never found out the results. They won’t tell us. Everything is hush hush, like a code of silence. All this for shipping brochures, catalogues, and toys. All at our expense. We could die. Every Sunday, I get physically sick. I genuinely feel sick as my mind worries about going to work again on Monday. I have to keep it together though, for my family. I think every Sunday I should quit. Get unemployment. Walk away. But then I lose my job for good. For someone like me, it is an impossible choice. For them, the owners, the managers, it is nothing. Everyday, they make me risk my life and my families’ and all my coworkers’ lives. All for profits. They act as if nothing has changed. As if it’s just a normal day. We are just numbers and we’re expendable. Not them. Us! I don’t know how long I can last.

n Friday June 5, 2020, The Temple medical community knelt for 8 minutes and 46 seconds in honor of George Floyd and countless others, and in recognition of the health disparities that emerge as a result of systemic racism. Photos by Michael Creager & Temple University Hospital.

White coats for

black lives

Becoming

Photo provided by

lewis katz school of medicine

a collection of stories about the med school journey

daily ritual anonymous

wash your hands with soap and water, religiously, like saying a prayer; say the lord’s prayer three times as you wash your hands; therefore attend church at each washing; take your communion, say amen; wonder if you have caught covid yet; wonder if you are unwittingly diagnosed with the new disease of the day; wash your scrubs after every dissection, always a little too late, always the night before the next dissection; wring them well so a puddle doesn’t form on your ceiling again; last time it dripped down, like it was raining inside, like your ceiling was weeping; did it make you cry or was that still the ceiling; hang your scrubs to dry; pray they are dry by morning; wash your body with soap and water; try to scrub the formaldehyde out of your pores; turn the shower knob all the way left; let your body steam to lyse under your shower head; try to scrub

the formaldehyde off; scrub so hard the trembling of your fingers does not factor into the scrubbing; shed your skin like you are molting; leave behind the molt like it no longer belongs on your body, like you have outgrown that version of yourself; this new skin will cope better in the new day; simply trust that it will, as if it were a more effective prayer of hope you have been hiding under the old; you’ve been waiting for this moment all day; make sure to burn it into your skin; cauterize your nerve endings because the pink baby skin is a little too sensitive, a little too vulnerable still; wake up in the early am to rinse and repeat; snooze your alarm first; put on your scrubs though they are still slightly damp; walk downstairs for your morning cup of caffeine; drink it on your way out, you’re running late; drink it while staring at the watermark on your ceiling; is it cosmetic or permanent?

Acrylic paintings by

Trina Wijangco

Memories from

A former life T

Julia marino

he chart says: “Pt found hanging in garage by girlfriend. Duration of anoxia unknown.” Dylan, the patient, frustrated by his incomprehensibly slurred speech, gives his pencil a weak, clumsy toss. I retrieve it, and implore him again to try to use it to point to an alphabet board, to tell me what he needs. He points: “H.” I nod. He points: “E.” Good, good, I tell him. Keep going. “L.” I keep my eyes on the board, nervous. “P.” He is my age. In the three months he stays at the hospital, I never meet his parents. The art therapist reports that he painted something dark and angry, a red and black mass tangled in the middle of the page. “What did you paint?” she asked. He nodded toward the paper: “Dylan.” Another patient: Patrick. Patrick’s dad leans in close to him and quietly says, “I wish I could make myself really small. I’d make myself really small, yeah.” His voice is soft, like he’s telling a bedtime story. I listen over the noise of the sink, where I am washing the spoons I used for swallowing therapy. “Wish I could make myself so small, I could crawl into your brain with my toolbox.” He chuckles a little and Patrick gives him a strangled smile, shifts slightly in his wheelchair. “I’d go in there with my hammers and screwdrivers, fix your brain up.” A patient on the pediatric floor, status-post anoxic brain injury. He looks like Patrick, I think, only younger. Only with so many more years ahead, trapped in his broken body, plagued by painful random hypertonic spasms. During my session, he does not respond to a single command. The child’s parents keep their faces inches from his and beg him to make a sound, to use his voice. “Say ‘ah.’ Say ‘ah.’ Ah. Ah,” his mom says. “Nice and easy. You can do this.” The patient, eyes half open, does nothing. His mom leans closer. “Say ‘ah.’ You can do it, sweetheart.” She touches his cheek. The child’s brother, playing nearby with a train set from the hospital, loudly exhales: “Ah.” The child’s mom, without taking her eyes off the child, says, “Shh, it’s his therapy time.” The brother says nothing, looks back down at the train in his lap. I ache for all of them.

a personal story anonymous

y first memories center around weaving through towers of clothing racks, sleeping on plump plastic piles of neatly wrapped dresses and drawing on left over pieces of receipts that customers didn’t want. Growing up in my parent’s clothing store in a windowless swap meet in South Central Los Angeles was filled with adventures, and despite the occasional wish to breathe the fresh outside air or feel the sunlight on my face, I was happy exploring by myself. Life in the swap meet, however, wasn’t always fun times. South Central LA was the center of the LA riots a few years prior to my birth, and since then was riddled with gang activity and crime. Violence, although not a norm, wasn’t surprising, and I can speak of a handful of times when I learned how to drop, duck and cover. I was told never to talk to the strange men leaning against the women’s bathroom, speaking words about easy money and opportunities to any young woman that would pass. In retrospect, I find

it alarming how many childhood adventures I had that could have gone wrong, but this was home. This was where my friends and family worked, breathed, and lived. This was where I wanted to stay. Whenever someone asked me what I wanted to do in the future, my answer was always the same. I admired my hardworking parents, and I was proud of my abilities to help them out. Besides, I didn’t know how to become anything else. When I voiced my plans to my parents, they were absolutely devastated. They didn’t want this life for me. I didn’t understand it then, but there was a sense of shame that wrapped around their form. Certain childhood mysteries became clear in this moment—why my parents never brought up their work to my peers’ parents, or why they could never help me with my homework like other parents could. My parents wanted me to go to college, unlike themselves who couldn’t finish high school for various reasons.

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Having seen the violence, the confusion, and the pain that people in my community faced on a day-to-day basis, I wanted to use my privilege to give back. Becoming a physician was a way for me to merge my love for the science of the human body and to stay true to my heart and help my community.” They wanted me to have weekends off and holidays, to work in a safe environment, and to work for pleasure, not just to survive. This moment was the pivoting point in my life journey. Going to college was hard. The problem didn’t lie in the grades or the scores but the single fact that I had no idea what I needed to do to get to college. I didn’t know what a SAT was or what college applications entailed. I didn’t know that extracurricular activities were encouraged to show that one was “well-rounded.” My afterschool days were now spent in clubs instead of cashiering. I felt that my personality shifted as well, becoming more

assertive and more resilient at every obstacle that I encountered. Despite all this, my heart continued to stay with my community. I still spent my Christmases working at the store and explored other ways I could help my community by volunteering in hospitals and nursing homes, places I knew were in desperate need of assistance. I think my love for my community and the need to help the world that my parents wanted me to leave behind truly shaped my future and my identity. I became the first person in my family and my community to go to college. It was exhilarating, knowing that I was accomplishing something

that seemed so unreachable at the time. I ended up in a fancy, expensive private school that was only possible with the hefty scholarship I received. I was suddenly surrounded by people that were from a very different world than I was. On orientation day, I had a hard time making friends. Trying to forge a bond with strangers was rough when I couldn’t relate to most of the conversation. Talks about annual ski trips, concerts, and summer homes went up and over my head and it was on this day that my Imposter Syndrome began. Feeling like an imposter never left me, even when I found my passion in medicine and decided to take a leap into the unknown once again. Having seen the violence, the confusion, and the pain that people in my community faced on a day-to-day basis, I wanted to use my privilege to give back. Becoming a physician was a way for me to merge my love for the science of the human body and to stay true to my heart and help my community. However the thoughts of whether I, a young woman from South Central LA, was allowed to do so were constantly in my mind even as a medical student. I am a fourth year student now. Graduation is a few months away and I cannot say for certain that these feelings of being an imposter have faded. I am a different person than I was when I told my parents I wanted to work in their shop for the rest of my life. My background, my struggles and my leaps of faith all shaped me to be the person I am today. If I had to choose one theme to describe my life, I would say it was ‘Living through Uncertainty,’ especially with current world-changing events. How my personal journey will affect me in the future is yet to be determined, but I know that wherever I end up, my core values of compassion, determination and growth will remain the same.

photos of

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cenes of Philadelphia, from the Art Museum to the Schuylkill River Trail to Citizens Bank Park. Photos by Eileen Storey.

30 minutes in the e.d. dillon warr

uring the summer between my M1 and M2 year, I was in the TUH ED, closing out my first week of the Temple EM work study program. On the hospital bed in front of me lay a man, slightly overweight, inebriated, with a laceration to the front of his forehead—a product of some fight he told me. I had just finished cleaning out his wound and preparing the bedside table with the supplies I would need. He was set to be the first person I would ever suture. I was excited but nervous to move beyond the fake, plastic skin on which I had practiced to my first real laceration. “Trauma in the trauma bay.” I looked up from the bedside table, where I was fumbling with the needle driver as I loaded my suture, when I heard the announcement overhead. My resident turned to me, then to the patient, and said we needed to leave this for now and come back later. The patient grunted his approval, and all I could do was follow blindly as the resident hurried to the trauma bay. We entered into a room of chaos. A boy lay bloodied on the table. He was 18. His body was riddled with gunshot wounds. The code had already begun—nurses, students, and available staff were on his chest, compressing. My resident was whisked away to help, leaving me surrounded by a flurry of activity, now lost in this whirlwind of words and bodies. The trauma team must have arrived at some point. Before this could register, they cut into his chest. And before I could blink, they had his chest cavity exposed—a clamshell thoracotomy I would later learn. Still frozen to the ground, I watched as the trauma team tried to find a source of bleeding—

anything they could clamp to stop the blood from pooling in his chest. But then, it suddenly got quiet, like a balloon letting out its last bit of air—time of death. The silence lay heavily across the room, people’s once loud commands reduced to mere mutters. As people shuffled away from the table and out of the room, defeated, I moved closer to the table. I could not tear myself away. The boy’s eyes were open, his mouth was ajar. His chest cavity lay open, his heart quivering with whatever remaining electrical activity it could muster. The blood in his chest ran slowly down his side onto the table, and then dripped onto the floor—pooling in the places where feet had not yet had a chance to smear it. I could have stood there for the rest of the night. Instead, I felt a tap on my shoulder. The resident was there to take me back to finish suturing. I wandered back to my lacerated patient, passively following my resident back to a room that seemed like a different world from the one I had just left. There, I found my patient fast asleep, snoring comfortably, eyes still taped shut. I picked up the suture I had left behind, struggling to load the needle as my hands shook uncontrollably. I watched as my hands continued to shake with every pass of the needle, despite trying my hardest to steady them. My body acted on its own accord, numbly following the guidance of the resident beside me. I don’t remember much of the rest of the laceration repair—my mind was lost in a nebulous haze. But as I cut the

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AS I cut the suture of my last stitch, I felt a dam of emotion break—first was a wave of relief, and then a rush of excitement. I had done it! I could feel my heart racing as I wiped the wound dry. Laceration repair number one.

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suture of my last stitch, I felt a dam of emotion break—first was a wave of relief, and then a rush of excitement. I had done it! I could feel my heart racing as I wiped the wound dry. Laceration repair number one. My mind still adrift from my body, I attempted to autopilot back to the computer and sign-out for the night. Before I could move too far from the patient’s bedside, my resident grabbed me and had me sit at one of the many stools littering the floor of the ED. He asked me if that was my first thoracotomy. I nodded mutely. He asked me how I was feeling. I shrugged, still unable to phonate. He took a seat in the stool next to me, looked me in the eyes, and let me know that he was once in this position too. That if I ever wanted someone to talk to, he would be there for me. I smiled weakly, still speechless. We sat together for a few quiet moments before he stood up and put his hand on my shoulder as he walked away. As I left the hospital that Friday night, my mind remained behind. How could I simultaneously be so thrilled to have sutured someone when just moments earlier an 18-year-old kid died on the trauma bay table, riddled with holes. Should I be sad? Am I allowed to be happy? I recalled my resident that night, grateful to have affirmation that these thoughts were not mine to bear alone. Despite now being an M4 who has traversed countless clinical encounters and rotations, it is this moment as a work study student that still remains emblazoned in my memory. In this span of

thirty minutes, I witnessed a thoracotomy and sutured a patient, both for the first time. Undoubtedly, this moment set me on a path towards emergency medicine. However, what left the most lasting impression was not the rush of excitement I felt as I cut the suture of my last stitch of the laceration repair, nor was it the shock of seeing the trauma team heroically attempt to save an adolescent boy riddled with gunshot wounds. Rather, it was the EM resident who sat me down at the end of the night and asked if I was okay. The resident who patiently waited while I struggled to load the needle, my hands shaking uncontrollably, despite my futile attempts to steady them. The resident who guided me, and worked with me, to help our patient. Working as a swim coach before medical school, I found joy in the opportunity to share my passion for the sport and my love of team success with a new generation of swimmers. It was an opportunity that I relished. This moment in the ED as an M1 showed me that the opportunity for mentorship also existed in medicine. Specifically, it highlighted the power of helping young learners navigate the intangible components of medicine—it’s not all about the transmission of medical knowledge. Now, I envision my future career in EM as one that involves medical education, one where I can help to train the next team of physicians. In the same way that I coached aspiring swimmers, I hope to guide medical students and eventually residents as they work towards achieving their potential as physicians. One day, I too will watch patiently as they struggle to load a needle. One day, I too will sit them down and ask if they are okay—that may be all they need.

gardening anonymous

he morning sun hangs heavy in the red sky as I poke holes in dew-coated dirt with bare fingers. Growing things is supposed to be therapeutic so I am told. Ritualistic as you become one with the earth crusting underneath your chewed fingernails, into your palm lines, the head, the life, the heart. Which is why the spade lies upturned amongst weeds. The stench of mulch settles close into the folds of my clothes, my wrists, my neck like perfume wrapping me in nature’s essence. I am searching for nirvana as if heaven ferments with eggshells and newspaper and coffee grounds. But the earth only grows drier as the sky opens up to the sun. It crumbles at my touch - everything I touch turns to dust. I paw at the ground that falls

away from me leaving a pit too large for seeds. I measure it with my fists to see if it’s large enough to bury the morning blues or night terrors or my discontent. It’s not and now I’m too exhausted and my fingers too raw to keep digging for the crumbling (decaying?) nirvana or grave. Instead, I pour a cup of coffee, composting the grounds as an offering to my backyard. The steam fills the kitchen, mulch lingering within. The coffee tastes gritty, feels gritty as if laced with dirt. My tongue, the backs of my teeth stain rough and brown with the solution I swish in my mouth. It leaves behind a grainy coating I cannot spit out. Even after I wash my mug, my skin feels dusty with earth.

THIRST anonymous

hen I looked out the window this morning, the sun was already heavy with summer heat despite the clock and calendar. Someone had left a flower pot on the patio. Round yellow flowers with petals like rays shivered in the wind. Full faces turned to mirror the sun, to drink in warmth and light and reflect it back. I wondered what name they went by. Stripped back down to underwear, my exposed skin ached with unseasonable heat and dryness. An ache like a fever dream of rain on skin condensing like perspiration, like dew. I looked to the open sky, thinking of water. The terracotta pot shimmered, sintering by sun fire. I felt my own clay body baking in this backyard kiln. I felt it steaming to burst.

I wondered if flowers dreamed of wet too. With the lengthening shadows, the petals wrinkle, weary, wary of relentless heat. Those full faces close with drooping necks and bend away from blinding brightness. A spring beacon bowing to the season’s turn. I wonder, Who left the nameless out to die?

napshots of flowers in a backyard garden. Photos by Eileen Storey.

iew of North Philadelphia from the top of Temple’s Ontario East Parking Garage in January 2020. Photo by Eileen Storey.

A stitch in time

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undles of colorful thread from the entire color wheel blanketed my living room floor for a Mother’s Day afternoon of cross-stitching. Each thread stroke filled me with a sense of purpose, an exuberant satisfaction as I saw my first stitched flower petal bloom into life. I threw on a few more stitches of light purple, accentuated by the green for leaves, and a burgundy red outline for an overall emboldening. Red, my mind wanders when I think about red. Red takes me across the hemisphere to my grandparents’ house in India where walls are adorned with years of my grandmother’s paintings and sewing projects. Red, my grandmother’s favorite color. A color so fierce, powerful– fire to her spirited creativity. The colors erupting off the canvas,

Khyati Somayaji each crafted doll intentionally placed on the shelf. Grandma let me pick one creation, but in that moment, I wanted it all – her artwork, her inventiveness, a loving family she had raised herself, travels around the world. In those moments, she was the most relentless woman. She carried herself gracefully, with my grandfather neither on or over her shadow, but perfectly beside. I found my grandma on FaceTime later that day, our coveted communication during the pandemic. The hazy picture eventually settled on her face, a slight delay in her voice as she cleared her throat and brushed strands of hair from her exhausted face. She articulated her usual three-word greeting: Good morning Kanna. I always blamed the poor phone signal for the breaks in speech, but

today I noticed a constant tremble in her bottom lip. Her eyes tried to fixate on me but sometimes just stared at nothing at all. She beamed when I showed her my new colorful stitches, yearning to leap out of the screen, away from her reality into mine. Instead, she responded saying there was too much purple in the design. Typical. Five minutes into conversation my family already started asking for my grandpa. Has he been eating recently? Did he take the Levodopa? Oh, still not helping. Is a home nurse able to come from the city during the pandemic? He fell…again? Grandma doesn’t fully answer these questions anymore, she doesn’t have a response. She coaxes grandpa awake from a rigid position. By the end of the day, she’s too tired to support his slow shuffles from the living room to bed, so he sleeps on the couch. I see my grandpa grab the phone with both hands, his expressionless face still able to carve out the tiniest smile. He used to smile all the time, vibrantly with his loud cackles and big juicy kisses. It’s difficult for him to wave though his iPhone camera now. His hand freezes midair until we plead with him to move it away from his face. When he does, I see my grandma, the corners of her nose bright pink, brushing away tears in a frenzy. My grandpa was diagnosed with Progressive Supranuclear Palsy (PSP) two years ago. He coughed, almost choked, every time he ate, and we questioned why he ate so quickly. He walked five steps behind us. We’d urge him to walk faster. He started nebulizer treatments because he couldn’t catch his breath at night. You’re getting better, we said. The neurologist showed us Grandpa’s MRI, his midbrain shriveled up, hiding from

plain sight like it wanted a break from the destruction of his own body. His calves shrunk in half, neck hung limp, he could hear us, but he was motionless. When he stopped calling for my grandma, his Ammi, we got a call at 2:40 AM – my dad was in India on an emergency travel permit within 24 hours, twenty minutes too late for my grandpa’s last breath. August 2nd, 2020 10:35 PM – too late. A stitch in time saves nine. An indisputable fact. Yet on occasion, there simply is nothing left to stitch. No matter how many colors of thread. The therapies, medications, interventions, there was nothing for my grandpa. My hero and my best friend. The man who exemplified hard work and sacrifice. I was bothered by how little I and the world knew about PSP. I watched family testimonials, read clinical research – uncommon, no genetic cause, no cure, 6- to 7-year prognosis that “varies.” I was angry at the unknown that was my reality. The unknowns of disease that take lives faster than we can take them back. Grandpa also taught me humility and kindness, which has been the biggest asset. The power to listen, understand, and provide the space to reflect and grow from each other when the world does not grant us this luxury has been cathartic. With every stitch I make, I am filled with gratitude for life. I asked my grandma if she wants to start a cross-stitch project with me. She smiled and said she’s not quite ready to do that yet. “Sure” – acceptance, “take your time, Mama” – patience. And that is 2020.

embers of the Class of 2021 participated in countless narrative medicine experiences throughout their time in medical school, using words and other forms of creative expression to reflect on their path to becoming MDs. Their writing and photos have been featured on the narrative medicine website over the past four years.

Class of 2021

Path to MD

CO-EDITORS Katya Ahr Miranda Haslam Eileen Storey ADVISOR Mike Vitez contributors M.D. Creager phil delrosario Emily hancin julia marino Megan Patton Jenny Schadt vered schwell Khyati Somayaji dillon warr trina wijangco Cover PHOTOS rebecca mayeda temple university hospital Lewis katz school of medicine