Connective Tissue 2022 by Cheever Center for Medical Humanities & Ethics

LITERATURE & VISUAL ARTS JOURNAL

VOLUME XV • 2022

Cover Art “Pele’s Well” by Richard Usatine, M.D. Faculty, Long School of Medicine

Submit your art and literature for consideration in the 2023 journal to: ConnectiveTissueJournal@gmail.com For entry guidelines, to view past journals, and for more information about joining a committee visit: https://www.texashumanities.org/connective_tissue

The works published in this journal were selected based on their artistic and literary merit and do not reflect the personal views of UT Health San Antonio, the Center for Medical Humanities & Ethics, or the editorial staff.

VOLUME XV • 2022 EDITORS IN CHIEF Roshni Ray Chelsea Wu

EDITORIAL LEAD Christopher Zhu

ADVERTISING DIRECTOR Jose Garcia

LAYOUT EDITOR Christopher Zhu

MS1 LIASONS Sana Suhail Theresa Vanderventer

LITERARY EDITOR Sanaa Prasla

FACULTY ADVISORS Kristy Kosub, M.D. Rachel Pearson, M.D., Ph.D. Ruth Berggren, M.D.

ART EDITOR Kajal Dalal SOCIAL MEDIA EDITOR Winona Gbedey

SELECTION PANEL Adam Brantley

Jonathan Espenan

Nisha Kalyanpur

Rajeev Pathapati

Shwetha Prabakar

Vy Vu

Aaron Clark

Eduardo Gonzalez

Lucijana Krokar

Bethany Pierce

Aaron Singh

Becky Wang

Alaa Diab

Kaivalya Gudooru

Elizabeth Long

Sonia Razaqyar

Abhishek Soni

Caroline Zhu

EE L DTI TO T E R SF’ RO N OT M EFA C U LT Y Welcome to the 2022 edition of Connective Tissue, the literary magazine of the Center for Medical Humanities and Ethics and the University of Texas Health Science Center at San Antonio. This journal, curated by a team of student editors who are themselves impressive artists and writers, showcases the creative talents of students, faculty, and staff from across our community. At a time when healthcare spaces are contested and health workers have felt ourselves besieged by an ongoing pandemic, these pieces document the human connection that makes healing possible within an imperfect world. Sometimes, as in Faiz Khan’s poem “The Refugee,” we search for the right words to share a life-changing diagnosis — a diagnosis that, once made and addressed, can make life better. Other times, we recognize our patients even when we cannot change the fundamental causes of their suffering. In “Move on,” Christine Beshay bears witness to the anguish of a formerly incarcerated patient who has been released only to die of lung cancer. And sometimes our patients recognize us. In her poem “I Know Who You Are,” Lauren C. Jameson describes returning daily to the bedside of a patient whose heart stopped in the operating room, and the glorious moment when her patient is extubated and recognizes the student who held their hand every day in the ICU. Many pieces here in fact belie the “we” and “they” of healthcare workers and patients. Resident Daniel Burt’s elegy to a brother lost to mental illness, and physician-researcher Dorothy Parma’s poem of the anxiety that makes her toes “gnaw on each other” blur the supposed boundaries between physicians and others. Healer-mothers throughout these pages document the joy and anguish that attend parenting. Our visual artists return to images of nature, recalling William Butler Yeats’ great poem “The Lake Isle of Innisfree,” in which the poet yearns for “the peace that comes dropping slow” when one is immersed in the beauty of nature. We all need these things: to recognize each other in our times of suffering, to be recognized, and to connect with each other and with the natural world. May this journal provide, for you, many moments of rich human connection.

Rachel Pearson, M.D. Ph.D. Assistant Director for Humanities, Center for Medical Humanities and Ethics Joe R. and Teresa Lozano Long Distinguished Professor of Bioethics

IPN O RT M ERM AO I TR IOAFMA PAT I E N T: M I M I Charles Emmett Cheever, Jr 1928-2021 A banker and philanthropist, a family man and promoter of humanitarian values, Charlie graduated from the US Military Academy at West Point and the University of Texas School of Law. He had a long and distinguished career as President, Chairman and CEO of Broadway Bank. He served as the Co-Chair of our Center’s advisory council for many years, and we are forever indebted to Charlie for his leadership, wise counsel (as well as wise-cracking humor), and his generous financial support. Remembered by his friends as one who embraced the spirit of giving back to the community, he was a member of St Anthony de Padua Catholic Church, a major supporter of the Girl Scouts, of Seton Home for pregnant and parenting teen moms, and an advisory board member of Crosspoint San Antonio. These are but a few examples of Charlie’s civic engagement. Crosspoint’s website says it “exists to build safer and stronger communities by empowering individuals to lead productive lives”. In my view, that’s the example manifested by Charlie himself: both in what he stood for, and in the role modeling he provided to me. I enjoyed the lunches we shared, in pre-COVID times. When I became Center director, Charlie was among our earliest supporters. He never wavered in his support of our mission of teaching ethics and professionalism while nurturing empathy and humanitarian values. He was committed to our service-learning and ethics education. I remember how funny Charlie thought I was, back in the early days, for proposing an evening of poetry and music as a fundraiser for the Center. He said “Ruth, this is San Antonio. We’d prefer whiskey and story-telling”. But this is the same man who called me after countless board meetings to say “Ruth, that was the best meeting we’ve ever had”. I took these affirmations to heart, and felt empowered to lead a more productive life! Thanks to Charlie and the Cheever family, our Center has a sustainable future, and thousands of Texas physicians have grounding in ethical decision-making and service to humanity. I am particularly grateful to Jean, Charlie’s daughter, for carrying Charlie’s torch in supporting our Center’s mission. Ruth Berggren, MD, MACP Director, Center for Medical Humanities & Ethics Professor of Medicine/Infectious Diseases

E D I TO R S ’ N OT E Dear Reader,

Dear Reader,

I must confess to you that as a kid, I loved scribbling in the margins of textbooks. My drawings were nonsensical, representing what my brain probably felt like. Now, I don’t scribble anymore, but the habit of writing in books persists — I underline words, jot down questions, bookmark pages I want to return to. I have found the margins to be a place where our ideas can converse with the texts we so cherish, a place where we can note down our secret thoughts or wildest imaginings.

It has been an honor to be a part of Connective Tissue throughout medical school and to be an Editor in Chief this year. For me, I heard about CT first from Dr. Sakaguchi during my interview day. His first words to me, in that second-floor library room, were “Do you want to be a writer?” Nothing about my resume would indicate as much, but he knew.

In our 15th volume of Connective Tissue, these notes from the margins were given the space to take center stage. From the smallest of creatures to the grandest gestures of love, these pieces represent cherished truths our community has brought from the margins. Thoughts that lingered in our minds now exist on the page. Voices that have for far too long been marginalized and continue to be pushed to the margins demand to be heard. We hope you will listen. I want to thank the CMHE for their long-standing support of Connective Tissue, the faculty & staff (Dr. Pearson, Dr. Kosub, Dr. Berggren, Sheila Hotchkin) for their guidance, our contributors for sharing their creativity with us, and lastly I want to thank you, dear reader, for picking up this magazine. Whether you read one piece or the journal’s entirety, I hope you find the beauty in the margins. If you feel inspired by a piece, feel free to jot down a note to yourself. Make this journal yours with as much imagination and joy as possible. Chelsea Wu Editor in Chief, Connective Tissue Vol. 15 Student, Long School of Medicine, Class of 2022

iii

Chelsea and my story begins in a very cold dorm room, the first night of orientation. Apart from the chill and part from nerves, we stayed up talking about the things we aspired to do, the things we feared in the upcoming four years. It seems perfect, then, that we close this chapter of our lives having been able to put our own piece of art together. I have never done anything like CT before, and I am so grateful to Drs. Kosub, Pearson, Berggren for supporting this journal. I’m grateful to all those who submit their art and writing. And to Chelsea — thank you for being the first to hear the thoughts from my margins and simply ask, “Why not?” Roshni Ray Editor in Chief, Connective Tissue Vol. 15 Student, Long School of Medicine, Class of 2022

Your Brain will be always in the Heart of San Antonio Maryam Bahadori

Fellow, Postdoctoral Research

Picture of one of the brain donors to Biggs Alzheimer's Institute, taken by his daughter. Dad, I miss you! I don’t know which way it went! Did the world turn its back on you, or did you turn your back on the world?

CONTENTS AWARDS P PHOTOGRAPHY WINNER

From Battleground to Playground Salma Yazji

L LITERATURE

A VISUAL ARTS

WINNER

Letter to Rudy 3 Lorelle Knight-Dunn, M.D.

Camden Street Bridge Overpass Alex Hood

55-WORD STORIES

WINNER

I Miss My Brother Janet Li

HONORABLE MENTION

Mirrored Waters 5 Richard Usatine, M.D.

HONORABLE MENTION

Irreversible 7 Daniel Burt, M.D.

Bliss 6 Neil Mark D'Souza, M.D.

In Hindsight Winona Gbedey

COMMITTEE SELECTIONS P Your Brain will be always in

L Finally Megana Challa

P Nobody Nowhere Meredith Hosek

A The Missing Piece Calvin Madsen

A Brain Fruit and Spinal Tree Maryam Bahadori

L Body of Anxiety 19 Dorothy Long Parma, M.D., M.P.H.

the Heart of San Antonio Maryam Bahadori

L Physiology of Love A.P. (Pete) Shepherd, Ph.D.

A The Place where you can Feel

P Trifecta of

Neurodegeneration

A Peace in Pieces 20 Victoria Oluwatoosin Onigbinde, M.S.R.C.

P The Gifts of Orion Dawson Tan L Masutāgādenā

(Master Gardener) Jon Courand, M.D.

Hector Lopez

A Reflections From the

Margins

Sammar Ghannam M.D., M.P.H.

31 32

We're Told to Do No Harm

Jessica Wong

P The Little Things: Suspicious

Subject

P A Night Under the Stars Dawson Tan

P First Embrace Veronica Bove

A Camouflage Nichole Henkes

L Her Fingers Hayley Favre, M.D.

L Auscultations: Embracing

Craig Sisson, M.D.

Change

Sopuru Ijeoma Onukwube

First Code Ida Vaziri

L I Know Who You Are Lauren C. Jameson A Anatomy Tutoring Stephanie Batch

Comfort Care

L All Hail the Queen 27 Christine Benton Criswell, M.D.

Javier Hernandez

& Valleys

Silence

Natalie Ridge, D.O.

Caitlyn Fastenau, B.S.

P Life: A Series of Peaks

New admission in the COVID intensive care unit 33 Sammar Ghannam, M.D., M.P.H.

P Midway Sammy Russell

L Branches Malavika Perinchery

P Unfocus Your Focus Prerna Das

L Buzzard Watching Cara Borelli, D.O.

A Afternoon Nap Stephanie Batch

A "Okurimono. The Gift." 38 Cristian Fernandez-Falcon, M.D.

P The Long-Nosed Gardener Sarah Cox

A Deliberate Notes 63 Sammar Ghannam, M.D., M.P.H.

L Auscultations: Growing Pains 39 Nathaniel Edoghotu

A Scala Naturae Stephanie Batch

A First Time I Saw Grandma

P Departed. Christopher Zhu

P Joy at the Microscope Shelbey Bauman

Move On

Learning

P LAND Christopher Zhu

Like Clockwork

The Refugee

P In Formation Sammy Russell

Autonomy

A Chosen Lily Hahn

A Thanksgiving Diet

L Desperation Rebecca Ajtai

A Rockstar Ripped Off Anjali Prasad

L A Song for Orpheus’s Lyre:

P Cross-sections of Care Joshua Sanchez

Christine Beshay

Holly Miller

A Unseen colors Divya Chandramohan, M.D. 55

Winona Gbedey

Sanjana Reddy

L The American Healthcare

System

Not Alone

Chloe Jensen

Anna Isabela Tomotaki

Jessica Wong Faiz Khan

A Daughter’s Ode to Her Departed Father Glory Hughes

A Untitled No. 104 Evan Saenger, D.O.

Craig Sisson, M.D.

A Between the Lines Amanda Means

A Tranquil Winter Nghi Tran

L A Back Porch Kind of Summer 61 Susannah E. Nicholson, M.D., M.S.

P PHOTOGRAPHY

A Avalanche Lake Christian Jacobsen

L Little Crooked Tree Steven Hlozek

L Fearfully Strong Paulina H. Mazurek, Ed.D.

P A View from the Margin David Nweke

L Scavenger Hunt 69 Dorothy Long Parma, M.D., M.P.H. P The Unbeaten Path Brandon Driggs

A VISUAL ARTS

P Holland Lake in Winter Meredith Hosek

L LITERATURE

Sushmitha Ramesh

P The Little Things: Minute

Warrior

Use Magic

55-WORD STORY

WINNER, PHOTOGRAPHY From Battleground to Playground Salma Yazji

Student, Long School of Medicine, Class of 2023

Za'atari Refugee Camp, 2014. Syrian children play on a slide set surrounded by a barbed-wire fence. Their families escaped the civil war and have sought refuge along the Syrian-Jordanian border.

W I N N E R, 55-WO R D STO R I ES I Miss My Brother

Janet Li

Student, School of Health Professions, Class of 2022

10-year-old female with a runny nose and cough. No concerning findings on exam. Dad pulls me aside. The patient’s brother is awaiting a heart transplant in the hospital. Dad thinks her cough is because she misses him. She wants to keep a part of him with her. What does a patient’s chart not tell us?

H O N O R A B L E M E N T I O N, 55-WO R D STO R I ES In Hindsight

Winona Gbedey

Student, Long School of Medicine, Class of 2023

I met you at your end. Weathered by illness, you looked much older than your thirty years. Pale, emaciated; shiny purple scars where scalpels and needles had once pierced your flesh. You said they were from battles, hard-fought and won. Each imperfection, a badge of honor. I didn’t think this battle would be your last.

This story is inspired by a patient I had while rotating through the Gynecology Oncology service. She was a few years older than me, yet battling with stage III ovarian cancer and numerous serious comorbidities that made surgery a dangerous, last-ditch option. She contracted COVID before her surgery and passed away shortly after. She wasn’t my first death, nor my last, but her death really affected me.

W I N N E R , L I T E R AT U R E Letter to Rudy

Lorelle Knight-Dunn, M.D.

Resident, Department of Emergency Medicine

Dear Rudy: I’ve had many patients like you. I never thought that I’d say that as an emergency medicine resident, but I’ve watched many folks walk the long road toward the end just like you did. That’s just the nature of our training these days. I’ve known many cases like yours. And I knew from the beginning how your story would end. I saw the blood, and I knew the statistics, and I felt, deep down, that you were on that road. I didn’t want to acknowledge it in front of you, but I did when you asked me to. And even though we talked about hope, I knew the statistics. Yet, every morning you said, “Hey, you!” and after every afternoon chat you said, “I’ll see you tomorrow.” And for a whole month in that ICU, you did. And I didn’t sign up for that; I signed up for the constant rotary of new faces, and new complaints, and new challenges. Not the ICU. Not longitudinal care. But you made me look forward to rounds, and you laughed when I admitted that to you. You were a hospital corpsman a long time ago; you recalled the strained relationship between emergency folks and inpatient rounds. At 5 P.M. on my last day there you had your nurse call me to bedside just to wish me well. You said, “I hope to never see you again.” It made me laugh. And when I got the text that you had passed a week later, I actually cried. I don’t typically cry. See, Rudy, I’ve had many patients like you. I’ve had folks too stubborn to embrace death, individuals too cheerful to show pain, and people who promised me that we could talk about Advanced Directives tomorrow. I’ve cared for patients who got better and then worse, old men like yourself who really weren’t that old, and people with families. And I’m sure that I’ve had others who have obstinately sworn, “I’ll see you afterward,” to an entire surgical team before passing. And yet, when I learned of your death in particular, all I could think about was how grateful I was that I’d told you a dozen times that I enjoyed talking to you. It’s a universal thing in our training to have a patient who won’t let you forget them. We all have someone. And I have tried to put my finger on why you, of all people . . . but I’ve never really succeeded. I’ve told myself, “He humanized me,” and “He was a breath of fresh air,” and “He had the attitude that I want to have when I’m in his shoes,” but none of that captures the whole of it.

I’ve had many patients — and yet absolutely no patients — like you, Rudy. I’m lucky to have met you.

WINNER, VISUAL ARTS Camden Street Bridge Overpass Oil on Canvas Alex Hood Staff

This oil painting depicts the FISH installation art piece, which hangs under the overpass at Camden Street Bridge on the San Antonio River Walk. It captures the bridge and its floating fiberglass fish in the warm late afternoon sun during the summer of 2020. The original painting is 30"x40" and has been featured in the newspapers MySanAntonio and the Beaumont Enterprise.

HONORABLE MENTION, PHOTOGRAPHY Mirrored Waters

Richard Usatine, M.D.

Faculty, Long School of Medicine

A snowy Egret takes measured steps on the margins of San Antonio. This small but majestic Egret carefully walks on black legs with yellow feet across the mirrored waters of the pond at the Audubon Center. The early morning light reflects the scene of fauna and flora in a world that we rarely see. In the midst of the pandemic, after a year of not traveling outside our city, I found this beautiful scene on the margins of our metropolis. Photographed with Nikon D850 and 500 mm Nikon prime telephoto lens.

HONORABLE MENTION, VISUAL ARTS Bliss

Oil on Board Neil Mark D'Souza, M.D.

Resident, Department of Radiation Oncology

H O N O R A B L E M E N T I O N , L I T E R AT U R E Irreversible

Daniel Burt, M.D.

Resident, Department of Psychiatry and Behavioral Health

I find you when I spot the homeless man hiding his face in a paper bag, beside his scattered things and in moments of creative excitement when I really listen, home and alone with candles and warm tea We were raised side-by-side in New England’s Forest We had mapped our way to what only we knew was an “X” that marked the “Elephant Graveyard” A hidden place where lazy, thin pines somehow collect cow- and coyote bones In a way I raised you, and in another, you raised me That’s what brothers do Then our family’s soul-splitter, SchiZo-fricko-pHreno-genetic Curse, skipped over me and found only you 5-year-plans and reality’s retainers can sink like the Titanic when you’re a pig in a straw boat Like rushing light just barely mis-striking a prism and consequently, escaped now irreversibly in both ends of creation I study mental health because I needed to save you, though it may have been too late You’ll always be my younger brother, even if by only two years 2 years is a flash of light when you’re getting old I miss you

Nobody Nowhere Meredith Hosek

Student, Long School of Medicine, Class of 2023

Brain Fruit and Spinal Tree Watercolor Maryam Bahadori

Postdoctoral Research Fellow

Your outer world is a reflection of your inner world of mind! You should start by changing your beliefs, emotions, and attitude!

Physiology of Love

A.P. (Pete) Shepherd, Ph.D. Professor Emeritus

Consider, Lover, that the static little homunculus tattooed on my brain Feels all I feel in hand and lips and face. So, when we kiss, through circumferential axons, our dancing potentials race Letting our two homunculi synaptically embrace.

Trifecta of Neurodegeneration Caitlyn Fastenau, B.S.

Student, Graduate School of Biomedical Sciences, Class of 2025

This is a high-magnification immunofluorescence image of brain tissue isolated from a transgenic mouse model of Alzheimer's Disease. Microglia, the innate immune cell of the brain, are in red; Sialylation, a post-translational modification observed in disease, are in green; and Nuclei are in blue. The striking orange and yellow colors depict the potential interaction of Sialylation on/around microglia, giving this triple stain an intriguing view of the Trifecta of Neurodegeneration.

The Gifts of Orion Dawson Tan

Student, Long School of Medicine, Class of 2025

The Orion nebula can be seen in the center with the Flame and Horsehead nebulae in the top left. The bright star Tau Orionis may be seen on the right. All of these are located within the Orion constellation.

Masutāgādenā (Master Gardener) Jon Courand, M.D.

Faculty, Department of Pediatrics and Office of Graduate Medical Education

Infinitely hot, infinitely dense … beyond time, before law Pure energy unbounded instantly, an expanding softball in vacuum’s flight. Strings to matter, particles to atoms molded by gravity’s relentless draw together massive clouds, agitated and kinetic coalesce in this early universe… light!

Fire harnessed, coal ignited, steam driven, combustion, fission, fusion, renewed 12 seconds over Carolina dunes, sound barrier, escape velocity, and Voyager 14 billion miles away. In the four decades between Hawking’s bet and Event Horizon’s photograph, Higgs too was proven, the fabric of space-time tugged and warped from melding quasars, we detect the faintest of waves.

Blue stars live fast, die young in titanic explosions brighter than ten thousand suns eject building-block elements, seeding dusty gas grains, bound swirling to a distant Sol who shepherds its rocky worlds and vapor giants on stable orbital runs within a dark lattice, embedded like jewels of the Via Lactea and central black hole.

Ancient energy of the cosmos resides in us all, the Prana Vayus flow crown to spine Quiet your mind, felt deeper than pulse, alive in the fingertip’s vibration effects In another tradition, this essence is Chi uniting the body, one’s spirit and mind restoring our balance, the focus on breath to guide inner journeys unknown to where next.

In an inky black void, rests a pearl of teal blue, with lavaliere clouds and water as rain a series of caretakers roam this new earth, their dominance brief then soon ushered out when a recent newcomer, weaker and small, advantaged in groups and the folds of its brain this Spark of consciousness held instinct in check, Olduavi’s warm basin — Homosapien’s route.

Look to the heavens to ponder our fate, invite curiosity and her irresistible charms. Misguided to think that the hand which loosed time’s arrow and evolution’s power would be done in this celestial garden, contented to rest in static arms. Our Universe is in bloom, and we perhaps are the newest flowers!

The human race has been on a journey which began a very long time ago. We are not finished traveling.

A Night Under the Stars Dawson Tan

Student, Long School of Medicine, Class of 2025

A silhouette picture of a couple enjoying the bright Texas stars in a San Antonio park on the outskirts of the city.

First Embrace Veronica Bove

Staff, Department of General Surgery

At last, our first embrace.

Her Fingers

Hayley Favre, M.D.

Resident, Department of Opthalmology

In her fingers calculating how to bring a toy to life, I see my hands practicing incisions with a keratome knife. She observes and mimics constantly the steps others make, As knowledge and skills of attendings, I strive to replicate. The joy in her smile erases the burden of responsibility. Arriving home after she is asleep, I think of quitting guiltily. Missing precious moments with her in this growing state, I hope one day she will see strength and fully appreciate — The sacrifice of medicine, the goal of improving sight To inspire her to follow her own dream and shine her light bright. I care for her more dearly than words can explain, May this journey in motherhood and doctoring help me finally gain Peace, serenity, and fulfillment at the end of the day While somehow showing her how deeply she is cherished by me in every way.

Reflections on learning how to be a new doctor and mom, observing the growth of my daughter in the midst of my own training as an Ophthalmology resident.

Finally

Megana Challa

Student, Long School of Medicine, Class of 2023

He looked at me with equal parts curiosity and fear. Curiosity because I was a new face, fear because I was dressed like the rest of them. For a split second, both were in absolute balance, but just as I took a step towards him, fear won. He turned away from me, sought the comfort of his mother’s arms, and let out a cry that was so piercing, it left an ache in me that I still remember to this day. He didn’t want a needle in his arm, another needle to take away his life strength, another needle to show him what his family already knew, that he needed something that was difficult to come by — he needed not one but three organs. He was a four-year-old boy, old enough to hop on one foot and draw a square but not old enough to skip around and tie his shoes. He was meant to be on the playground chasing his friends and swinging on the monkey bars yet instead, he was here in the hospital tied to machines that made weird sounds and pumped him full of fluids. So he didn’t like me. I was the person who woke him up every morning just as soon as he finally found a way to fall asleep. I was the one that came in and told him he couldn’t eat when all he really craved was chocolate chip cookies. I was the one that kept poking at his belly, trying to determine the extent of the process waging war in his body. I was both his jailor and his healer. How can the two coexist? The day after one of the many procedures he was scheduled for, I walked into his room. He had just finished the octreotide drip the night before and was fast asleep cradled between his tablet and favorite blanket. I had come to give the family the good news that he could start taking in nutritional content orally. The relief and joy in the room were palpable. With the parents beaming and talking excitedly in the corner, I was restless to see his reaction. He slowly opened his eyes and felt the new atmosphere around him. Just as a smile began to draw on his face, he looked towards me and immediately started crying for a hug from his mother. But amid his tears and his mom’s intermittent soothing words, he finally understood: food was a go, and chocolate chip cookies were coming soon. The corners of his mouth tipped up and even though the smile wasn’t directed at me, he was happy. Finally.

One piece of a long story about a little boy from my Pediatrics rotation.

The Missing Piece

Photo with Digital Art Overlay Calvin Madsen

Student, Long School of Medicine, Class of 2023

This piece is a tribute to the wonderful promotors and promotoras that serve the underprivileged population in San Antonio. These remarkable people help bridge the gap between healthcare providers and their disadvantaged patients, providing them with the resources they need to find transportation, insurance, and overall access to healthcare. They often visit these patients’ homes to go over medication regimens, assess living conditions, and assist with any other barriers to healthcare that may not be readily known by the provider. These promotor(a)s are the keystone to these patients' healthcare, the missing piece needed to live a longer, healthier life. They are the bridge between provider and patient, and between the patient and a better life. Just as a bridge crumbles without its keystone, so too would the quality of life of these patients deteriorate without the service of their selfless promotor(a).

Body of Anxiety

Dorothy Long Parma, M.D., M.P.H.

Faculty, Population Health Science, Long School of Medicine

For the silent majority, especially in these pandemic times. This vocal minority speaks only for myself; but maybe you hear your own voice in mine? Seems like this every day, now a struggle to breathe past the weight in my chest, approximately the size of a large domesticated cat. Gut tying itself in knots; my tongue does its level best to carve a crevasse to the outside world, gouge a channel through my bottom front teeth My toes gnaw on each other; that’s old hat, but the mouth stuff is new since December; my entire body thrums in time with my beating heart

Walking amidst this internal cacophony birdsong, green leaves fall beneath my notice; regulated breathing helps, barely; the need to push past the weight instead of just letting the breath be. Sleep the only respite and those golden moments of first waking, when limbs are loose, and the cat is elsewhere.

Peace in Pieces

Charcoal Victoria Oluwatoosin Onigbinde, M.S.R.C. Student, School of Health Professions, Class of 2023

The Place Where You Can Feel Silence Oil on Canvas Natalie Ridge, D.O.

Resident, Department of Radiation Oncology

We're Told to Do No Harm Javier Hernandez

Student, Long School of Medicine, Class of 2023

She can’t breathe well. Her liver has cancer. We told her not to worry, we’re here to help. But we don’t know what’s going on. We’ll just need to take a quick look. The look took her lungs. Now she’s on a ventilator. She’s sent home to die, there’s nothing left for us to do.

This experience was particularly impactful to me because she was my first patient when I began my medicine wards. I followed her from the beginning of her stay to its unfortunate end. No intervention comes without its risks. Regardless if it’s diagnostic or therapeutic, you must always be mindful of complications.

Comfort Care Jessica Wong

Student, Long School of Medicine, Class of 2023

She had put off her cancer for a year Comfort care and hospice, the only options left Every morning I asked, “How are you feeling today?” Some days she smiled, others she cried What little comfort could I provide? That final reverent Sunday I held her hand as we said our goodbyes, A prayer unspoken.

The Little Things: Suspicious Subject Craig Sisson, M.D.

Faculty, Department of Emergency Medicine

I didn't have to travel during COVID to keep my photography going, I just had to look for the little things in my back yard.

Camouflage

Fiber Art Nichole Henkes

Student, Long School of Medicine, Class of 2023

Original design. Hand-embroidered; cotton thread on cotton.

A U S C U LTAT I O N S Embracing Change

Sopuru Ijeoma Onukwube

Student, Long School of Medicine, Class of 2024

Growing up in a country that lacked basic amenities, the USA was painted as an image of a land flowing with milk and honey, with roads paved in gold — a nation where there was no hindrance between an individual and their pursuit of happiness. “LOOK AT ME SIR! I AM TALKING TO YOU!!” I screamed in my head, hurt and confused. My professor, never looking up to acknowledge me or my questions, dismissed me with “I can’t understand your accent; go ask someone else.” I know my accent is different, but we are speaking the same language! I know my nationality is different, but we are all human! I know my skin is different, but we were all created with value! Moments like these were frequent, and piece by piece, my rose-colored view faded into a greyish monotone, and with immense sadness I realized “I am no more. I am a shell of who I used to be.” “Sopuruchukwu is gone, hey I.J” So suffocated was I under the cloud of things that made me different, I couldn’t see myself nor what I was capable of. All I could see was what I was not: White. Who knew culture shock was a lonely pit? No, Honey! This is not a land flowing with milk and honey; this is not a place where all dreams come true. This is a place where your pursuit of happiness is contingent on the color of your skin. Fast forward to the present, I have a community of friends, leaders, and faculty with an appreciation for diversity and a heart for inclusion. They gave me the foundation I needed to find my voice and regain the person I thought I had lost. In recovering my identity, I recovered my passion for excellence. Truly, the world is a better place when you feel less alone. Is this a minority experience? I don’t believe so. Don’t you know someone with experiences similar?

Auscultations aims to amplify the voices of minorities in our health care community through storytelling and reflective listening. This page contains a story from one of our contributors. As you can see, stories are powerful. We invite you to engage in this campus-wide initiative by joining our team or sharing your stories with us at auscultations.uthsa@gmail.com.

Life: A Series of Peaks & Valleys Hector Lopez

Faculty, Mays Cancer Center

All Hail the Queen

Christine Benton Criswell, M.D.

Faculty, Department of Diagnostic Radiology

It was Wednesday — Foot Day — and, as usual, Madeline had arrived early. As her attending, I’d mentioned to her at the beginning of her rotation that Foot Day was our hardest day, and ever since then, she’d made a point of coming in well before the rest of us. She was sitting, as she always did, with perfect posture, her gaze fixed on the screen in front of her. She was a small, delicate person, and the giant monitors we used to look at the X-rays made her look even smaller. Her hair was pulled back into a neat, low ponytail, and, instead of wearing scrubs like the other residents, she’d chosen a modest dress and plain but professional-looking shoes. She wore no makeup, and her only jewelry was a simple wedding band. I walked over to her desk and saw an X-ray image of a deformed, postoperative foot behind her. “Good morning, Madeline. Are you ready for another Foot Day? It looks like you’ve gotten a head start.” “Yes, Doctor, I have.” Her face was solemn and her eyes, wide open. As she spoke, she sat up even taller and folded her hands in her lap. I smiled. “You know, it’s good of you to come in so early, but you don’t need to. 8 a.m. is fine. We’ll get through the work, one way or another!” I chuckled, then waited to see if she would smile. Her face remained solemn. My heart sank. I’d been trying to get Madeline to smile since day one. She was a model resident — intelligent, curious, disciplined, respectful. We all adored her. And in many ways, she reminded me of myself when I was a resident. So, it pained me to think she might be unhappy. A little later that morning, one of our third-year residents stopped by to say hello. Ryan is famous in the department for his talent for telling funny stories, so I wondered if he could cheer Madeline up. “Ryan, remember that story you told me about your first rounding experience?” I asked. “Will you tell it now? I’d love to hear it again.” He agreed and then treated us to an enthusiastic recounting of the time he was so intent on keeping up with his attending that he followed him right into the bathroom. Ryan’s eyes twinkled, then he looked at each of us to check our reactions. My colleague and I were laughing to the point of tears, but Madeline’s face was, as usual, blank. Ryan’s victorious smile faded. Fortunately, I had another opportunity to put a smile on her face after reviewing the most interesting cases I’d seen over the past week.

“Madeline,” I said, pulling up a complex foot X-ray on the computer. “Let’s look at something together.” Without saying a word, she came over and sat down next to me. “I’m going to show you a case, and I want you to tell me what you think about it. Now, this is a complicated case. Don’t feel bad if you have trouble with this one.” “Yes, Doctor.” “OK, here you go,” I said, moving out of the way. “Take as much time as you need.” She moved her chair in front of the monitor, positioned her right hand on the mouse, and then leaned forward. I watched as her eyes moved left, right, up, down, then back to the left, back to the right, and on and on. Every now and then, they’d stop and stare, and she’d swipe and click the mouse to adjust the image just so. After just a couple of minutes, she sat up straight, turned her head toward me, and said, “OK, Doctor. I’m ready.” “Wow. That was fast. Well, go ahead.” I sat back in my chair. She turned her face back to the monitor. “Well, the patient is likely diabetic — and I think that because of all of the vascular calcifications. So, this pattern here…” She used the mouse pointer to make a circular motion around the midfoot “…of midfoot collapse, midfoot and forefoot fractures, and midfoot dislocations is most likely due to Charcot arthropathy.” Then, she moved the mouse to the fifth toe. “Here, there’s an ulcer,” pointing to a focus of soft tissue distortion at the lateral fifth toe. “And here…” drawing a circle around the tip of the fifth toe, “is an area of osteolysis. This is consistent with osteomyelitis.” Now, Charcot arthropathy cases are intimidating — even for seasoned radiologists. And the ulceration and osteolysis she noticed were subtle. I looked at her with awe. “Madeline, that’s fantastic! You spotted all of the findings — even the subtle ones. And not just that, but you were able to put them together to see the big picture. I’m really impressed.” Then I locked eyes with her. “You know, Madeline, I think you have a gift. Your work — your ability to spot things, your ability to synthesize the findings, your reports. All of it is extraordinary. Especially considering that you’re just starting out. I think you’re going to do great things. In fact, I know it. You have such a bright future.” I beamed.

Then, in her gentle way, she looked at me, blinked a few times, and whispered, “Thank you, Doctor.” But still — no smile. —————— Soon enough, it was time for lunch. As my colleague and I prepared to go, I asked Madeline if she’d like to join us. She said no, she’d better stay behind and study. Then she pulled a big book out of her satchel. Now that’s dedication, I thought. My colleague and I set out for the doctor’s lounge. On the way there, though, I discovered that I’d somehow left my purse behind. I told my colleague to go on without me, then turned around and headed back to the reading room. Just as I was opening the door, I heard music coming from inside the normally quiet room. It was bold and loud, with a heavy beat and quick rhythm. I recognized it immediately: “Another One Bites the Dust” by Queen. I opened the door a smidge more and looked around for Madeline. She was alone, sitting at her desk, with her phone in hand and a small speaker by her side. I could see her, but she couldn’t see me, and, curious, I began watching her. She was typing and swiping on her phone, and as she did, the music got softer, then louder, then started over from the beginning. All at once, she started moving. Her foot began tapping to the beat. Her fingers started thumping the desk. Her torso started swaying, and her head started bopping — left, right, forward, back. Then, she started singing. Her normally hushed voice was powerful and clear, so loud that I could hear her over the music. When the song ended, she set down her phone and turned to the computer. I could just see her pull up her list of dictations for the day. Positioning her cursor at the top of the list, she restarted the music. With each line of the chorus, she clicked the mouse, and the dictations in her queue flew into the Pending Attending Approval list. As she did so, she once again began singing and dancing in her chair, tapping and thumping and swaying and bopping. I began tapping my foot, too, and before long, I was silently chanting the refrain right along with her. Then, through that crack in the door, I saw something amazing. As she danced and sang, she broke free from whatever it was that had held her back: she smiled — a big, beautiful, joyous smile. And like magic, that dark room began shining and sparkling and smiling back. Dr. Madeline was happy — and my heart was, too.

Reflections From the Margins Digital Sammar Ghannam M.D., M.P.H.

Resident, Department of Internal Medicine & Radiology

This work was inspired by my interactions with my patients. In the same way they see themselves in me, I see myself in them. I can tell the difference it makes with my patients when I enter the room and their doctor understands their language, cultural preferences, fears, and anxieties. Alternatively, I know what it feels like to be on the opposite side, to feel misunderstood and overlooked. As a Muslim woman pursuing medicine, I was initially concerned with the lack of representation within my field of radiology, and within the greater medical community. Having this immediate sense of comfort and connection with my patients reminds me of the honor and privilege it is to be in service to them. It makes every minute of hard work worth it.

I Know Who You Are Lauren C. Jameson

Student, Long School of Medicine, Class of 2023

Wide eyes, blank expression Something is very wrong here Your insides are trying to escape Code blue, OR 5 We line up to press on your chest You come back to us One machine breathes for you Another acts as your kidneys You have more tubes than appendages We have a routine I come and talk to you each day One day you squeeze my hand back Defying the odds You’re not ready to go Your lungs decide to breathe on their own When I come to see you next I introduce myself as if we are strangers You grin and say “I know who you are"

I wrote this poem as a reflection of my experience caring for my first critically ill patient as a third-year medical student.

Anatomy Tutoring Oil on Canvas Stephanie Batch

Student, Long School of Medicine, Class of 2025

First Code Ida Vaziri

Student, Long School of Medicine, Class of 2023

“Code blue, sky tower” — our patient. Rushed over from horizon, crowding into the elevator. “Heading to the code?” We nodded. “16 people in the elevator,” my resident remarked. More in and out of the room. Compressions continued. Shock. Asystole. “Who’s calling it?” My attending answered. I’d held her hand this morning. “Help me” she’d said.

New admission in the COVID intensive care unit Sammar Ghannam, M.D., M.P.H.

Resident, Department of Internal Medicine & Radiology

“Yo quiero vivir” “Yo quiero vivir” “Yo quiero vivir” Is the answer to every question you ask. You acknowledge understanding however, that is his only answer to all of your questions. What is really in your hands? Can you promise that to him? Is it guaranteed? “Yo quiero vivir” “Yo quiero vivir” “Yo quiero vivir”

Midway

Sammy Russell

Student, Long School of Medicine, Class of 2025

A moment is frozen in time of the fast-spinning Gravitron that you can ride at a local carnival, this one being the Midway Rodeo Carnival in Fort Worth.

Branches

Malavika Perinchery

Student, Long School of Medicine, Class of 2023

Have you ever seen a tree wither away? First, it drops one leaf; then another. The transformation happens slowly, but surely. If you pay attention to it, every day, you can clearly see what’s going to happen. But if you don’t, you don’t notice until all you’re left with is branches. Just branches. It finally hit me today; what it is that I’ve been watching this week on the pediatric heme-onc inpatient unit. I’m watching young people die. I’m watching in real time as death wraps its tendrils around small, innocent souls. I wish I were exaggerating; I wish this was just a trick of prose, but no. This is what is happening. And if I think about this reality too hard, I want to alternatively scream and cry at the unfairness of it all. I think about my patients and the patients on my floor almost constantly. I think about the pregnant silence that fills the room once we tell them about another metastasis. I think about the parents who sleep on the chairs in the hospital room while their children go in and out of consciousness. I think about the child who is too young to know why they even have to undergo chemotherapy. When I watch a tree wither away, I wonder if anyone noticed that first leaf fall. I wonder if anyone saw what was coming. Because now, all I see are branches.

I wrote this while I was rotating through the inpatient pediatric heme-onc unit at UH. It was a profoundly moving experience and shaped the way I see medicine today.

Unfocus Your Focus Prerna Das

Student, Long School of Medicine, Class of 2025

Life offers us so much to appreciate every day, but it is easy to miss if we are caught up in the demands of our responsibilities. Pictured here, the student looking up from their studies to notice the sunset reminds us to take a step back and redirect our focus from what we are entangled with to appreciate the beauties that each day carries. The soft definition in the photograph evokes a sense of comfort and reiterates the beauty that we may find when we ease our focus.

LAND

Christopher Zhu

Student, Long School of Medicine, Class of 2023

"Okurimono. The Gift."

Acrylic on Canvas Cristian Fernandez Falcon, M.D. Faculty, Department of Family Medicine

A U S C U LTAT I O N S Growing Pains

Nathaniel Edoghotu

Student, Long School of Medicine, Class of 2024

One. Two. Three. Four. I got to know each of these walls very well. It seemed that we got closer every day... too close, actually. They kept closing in on me, almost to the point where I was gasping for air. Is this what medical school is supposed to be like? I worked so hard to get to this point, but this is NOT what I expected. Far from it in fact. Medical school was supposed to be this exciting chapter in my life. New city. New people. New experiences. COVID stripped that away from me and many of my classmates. We’ll probably be known as the “Covid Class”, but I digress. Sure, it was convenient to roll out of bed and complete my quiz. It was nice to grab a snack while the lecture blared in the background. But this way of life quickly became old. Humans weren’t meant to be isolated from each other. I reverted to unhealthy habits that I thought I buried long ago. I stopped eating. Stayed in bed longer than usual. Blinds were closed and lights turned off. Life shouldn’t be like this. I finally put my pride aside and sought help. Things slowly started looking up. I built an amazing network of friends who I can lean on at any time. I grew so much during this experience. Would I do it over again? Absolutely not. Am I grateful that I went through it? Without a doubt. Everything happened for a reason! It was very uncomfortable for me to share this story, but if this helps even one person, it was well worth it. To whoever is reading this, I just want you to know that you are not alone in this journey. Please don’t be afraid to seek help. You got this!

Auscultations strives to amplify minority voices by hosting storytelling events, inviting guests on The Auscultations Podcast, and feature written stories on Connective Tissue. For more information, you can reach us at auscultations.uthsa@gmail.com.

Departed.

Christopher Zhu

Student, Long School of Medicine, Class of 2023

Move On

Christine Beshay

Student, Long School of Medicine, Class of 2022

Out of prison, but now sick Wishes he could do it over Tears. “I was a different person then.” We wait for results. Cancer, metastasized to lung “Don’t dwell on the past,” I tell him. I pray for him. “I’m gonna go see my grandbabies.” Prison took from his life, now cancer threatens what remains.

Learning

Holly Miller

Student, Long School of Medicine, Class of 2023

I thought she would be skeptical of me; worried about being judged. But she’s happy to talk. She answers my questions, asks her own. She wants to learn, and I’m surprised. She wants everything I have to teach. She wants to be a good mom. She trusts me. But I didn’t think to trust her.

Unseen Colors

Ballpoint Pens Divya Chandramohan, M.D.

Fellow, Division of Infectious Diseases

Portrait of a Mandarin Duck: Executed in 11'' x 14'' Bristol smooth paper, exclusively using colored ballpoint pens. This piece is an experimentation with different art techniques. The scumbling technique used by oil painters to give depth to an image is done by moving the art brush in circles, with circles of a color overlapping the others already painted, so the various colors show through in areas. I present to you this technique, used to color the background. The perceiver is the judge of whether this works well with ballpoint artwork also.

Autonomy

Winona Gbedey

Student, Long School of Medicine, Class of 2023

We descended on our patient like vultures. Cocooned in his blankets, hooked to his dialysis machine, there was no escape from the impending storm. “You could die without this test.” “No, nothing invasive.” With stern voices: “Then choose. Bronchoscopy or hospice.” Silence stretched between us. He looked like a child beneath those blankets. “Fine. Hospice.”

This 55-word story was inspired by a patient encounter I had during internal medicine, where a patient ultimately declined treatment for a recurrent large, loculated, exudative pleural effusion. Because he kept changing his mind about treatment, and because we weren't doing anything for him, we had a very pointed conversation with him while he was in dialysis that went very similarly to the one detailed in this story. He eventually made his decision, but I think about how we got him to that point often.

A Thanksgiving Diet Sanjana Reddy

Student, Long School of Medicine, Class of 2023

Do you understand what we’re saying? The daughter’s eyes flickered between the floor and my own. She asks me later how to spell Hepatocellular Carcinoma. Should I tell my mother I’m pregnant? Do you think she has long enough? Take her home, let her eat as much homemade Thanksgiving food as she can. Find joy often.

Rockstar Ripped Off Digital Art Anjali Prasad

Student, Long School of Medicine, Class of 2023

I met this star of a patient, who was so organized with her medications and appointments that management was a breeze for me. The red strings represent the contrasting lack of control she has over her social struggles — legal issues, family issues, financial scams — that appear in the vague margins of our scope as "healthcare providers" and her overall health and wellbeing.

Cross-sections of Care Joshua Sanchez

Student, Long School of Medicine, Class of 2023

A barrage of mail, a stolen car, threatened loss of benefits, a collection of clocks, a nostalgic childhood, and a love for nature and simplicity are just a few things hidden behind people we meet for only a moment. The shadow in this photograph represents what we as healthcare providers are often limited to seeing during our encounters — a cross-section of the daily struggles patients endure; the difficulties and severe costs they experience while fighting for care; and the goals, relationships, and experiences that make up the lives we try to improve.

The American Healthcare System Chloe Jensen

Student, Long School of Medicine, Class of 2023

It’s different from the picture. The picture shows a vibrant yellow. Quaint, with a little yard and a fence. The paint is muddy mustard greyed by smoke or smog. The yard is dirt, and cans, and trash the window, broken. It had to be witnessed — felt — in person. Because in the picture, This Place is perfect.

Not Alone

Anna Isabela Tomotaki

Student, Long School of Medicine, Class of 2024

Women already feel the weight of the world Then a new life comes But it feels wrong Sadness amplified by guilt Heaviness in your limbs Heaviness in your heart Countless mothers have felt this pain This pain has a name You are not alone I repeat to her on the phone You are not alone

Holland Lake in Winter Meredith Hosek

Student, Long School of Medicine, Class of 2023

Tranquil Winter Digital Painting Nghi Tran

Student, Long School of Medicine, Class of 2023

Buzzard Watching Cara Borelli, D.O.

Resident, Department of Emergency Medicine

The vulture picked at the javelina carcass with the timidity of a long-term patron at a diner trying the chef ’s newest experimental prickly-pear pie. A second and a third much larger vultures landed at the scene, and the first deferentially stepped back. Two teenagers sat across the arroyo, watching the vultures. “Did you know buzzards are related to storks?” she asked. “No, I didn’t,” he replied. “Storks, huh?” “Storks and herons.” “I wonder who I’m related to,” he said after a minute. The larger two vultures had picked a hole through the upper abdomen of the javelina. The first vulture, after watching patiently, and in a moment of great boldness, darted forward and ripped off a piece of javelina rump. The larger two paused their careful evisceration to stare at the first vulture, who retreated with its rump piece to stand behind a nearby yucca. “Does it matter who we’re related to?” she asked. “I had to leave after my uncle shot that guy for his boots,” he said. “But, to be fair, they were great boots.” He sighed and looked off behind him. “Are any storks out there?” The desert opened up like a fan. The sun shone on the rain-drenched ocotillos with their green arms reaching upwards toward the light.

The Long-Nosed Gardener Sarah Cox

Student, Long School of Medicine, Class of 2023

Photograph taken with a Canon 77D at the San Antonio Zoo.

Scala Naturae Mixed Media Stephanie Batch

Student, Long School of Medicine, Class of 2025

Joy at the Microscope Shelbey Bauman

Student, Long School of Medicine, Class of 2022

A winking smiley face captured in a random stomach biopsy. A subtle reminder that joy can be found in all areas of medicine if we take a moment to recognize it.

Like Clockwork Jessica Wong

Student, Long School of Medicine, Class of 2023

Another month, another Crohn’s flare-up, another hospital admission. It should be outpatient but he doesn’t have insurance, keeps missing appointments, can’t afford Infliximab at $30,000/year, for the rest of his life. They say insanity is doing the same thing over and over and expecting different results. We give him his infusion. Another month... Repeat.

The Refugee Faiz Khan

Student, Long School of Medicine, Class of 2023

Clinic was closed three weeks due to lockdown I stumble my way through Urdu conversation with a refugee from Rohingya He is about to lose his job From frequent bathroom breaks at work I looked at his blood sugar Elevated I pause to think of how to say “Sir, looks like you may have Diabetes”

In Formation Sammy Russell

Student, Long School of Medicine, Class of 2025

Depicted here is what you might see when you look into the sky during the Bastille Day celebration in Paris, France.

Chosen

Acryla Gouache Painting Lily Hahn

Student, Long School of Medicine, Class of 2024

Desperation Rebecca Ajtai

Staff, School of Health Professions

Icebergs are melting They say

But I am melting, my resolve Disappearing with the shoreline

Oceans rising And corals drying up

And there’s no one else here No one to call for back-up

All faster than we anticipated Faster than we can outrun

I know she understands Spinning steadily on her axis

But that’s not my concern Not tonight

She is a single parent too Never alone, but always lonely

As you call out from your crayon sheets And your brother

And soon, I find myself at your bedside Cradling your soft body in my wearied arms

Softly snoring in his bunk above you Will soon wake from your wailing

Out the window, a desperate moon is rising Faster than we can outrun

I try to let you cry it out You must learn, the experts say

A Song for Orpheus’s Lyre: A Daughter’s Ode to Her Departed Father Glory Hughes

Student, Long School of Medicine, Class of 2022

On that slithering dusk, I boated down Years spent searching for the you below ground Foolish as sailors who lay their fates on the rocks where the thirst of sirens waits

It was then my belly felt your whisper My flesh sensed blight before I knew winter As I turned my gaze, the gods set you free How your spirit welcomed that sweet relief

In the murky depths, I glimpsed a strange man I reached to save him, his heart in my hand but all that sprouted was decay, rot, moss Wilting through grasp, like your half-strength, half-thoughts

But if it all ended the same for you, if my eyes are what broke your dreary blue, could not my touch have been the last you knew? Oh, how I crave the warmth your skin once grew

When his daughter heard of her father’s crypt, her weeping wail, the sacred sound that slipped echoed in willows like my drumming tears, when your hollow cheeks foretold final years

But your gift was patience at Hades’ door You waited at twilight, at hope’s last shore My love wades with you forevermore Just vow to return when my soul meets yours

I thought her cries would always plague my dreams I feared his blood would ever stain my green But her mourning joined the songs of the reeds The river’s time washed my weary hands clean

This poem was inspired by many things, but mainly my experience with my father, who was disabled by a hemorrhagic stroke 3 years ago and passed away in the Fall of 2021, and my first patient death as a third-year medical student. Both deaths were unexpected, and both were of fathers who are missed dearly by their daughters. This poem is an ode to those lost and those still here.

Untitled No. 104 or Fire shimmers across my face as I watch you float up to the rafters, out through the hole you made in the roof, and into the stars Acrylic Paint Evan Saenger, D.O.

Faculty, Department of Internal Medicine

The Little Things: Minute Warrior Craig Sisson, M.D.

Faculty, Department of Emergency Medicine

Between the Lines Micron Pen on Paper Amanda Means

Student, Long School of Medicine, Class of 2022

This drawing is an homage to pathology, a specialty that often involves careful consideration of the margins. Between the flower petals and snake scales, a variety of tissues, cell types, fungi, and parasites may be found if you look carefully.

A Back Porch Kind of Summer Susannah E. Nicholson, M.D., M.S. Faculty, Department of Surgery

South Texas June air sits like a Weighted, humid blanket covering the earth, That barometric drop Working its way to my knees. I can feel the gravity… depravity? Pulling me into the stamped concrete underfoot. Thunder rumbles, A distant low belly chuckle, Poking fun at our human sense of self-importance. “Is it going to storm?” Five-year-old, clinging to my arm Fear in his eyes of a Bomb Cyclone. “Yes, sweet boy, yes.” Ping… ping… ping… On the metal roof Pitter, patter, pitter, patter… The air no longer heavy with intention, Cools the beads of sweat Collecting on our upper lips. Rushing wind leaves hairs on end, Cleaning out the back porch sauna. Flash of light illuminates a sky full of cumulonimbus. Rain now beats down on roof and grass, emerald green— Negative space surrounding void Between tumble of sunflowers, wild with rage… And brilliance. Colors so vivid, so true…

Interrupted suddenly by purple umbrella, Day of the Dead images dance in print. Five-year-old scrawny legs in rubber boots Yelling, “Come on Mama!” “Dance with me! I’m not afraid!” We twirl in that summer rain, As it washes and cleanses Our fears and doubts Of this world. So unlike those dreary, cold Winter rains… that soak and penetrate your bones. And just like that, Sun is bursting through billowing gray. Pitter, Patter, Pitter, Patter. Ping… ping… ping… Nitrogen and oxygen splitting, Reshuffling of oxygen atoms Crisp, sparks of ozone Cleanse our nasal palettes. Vibrant rainbow sky, Unfolding drama. Sun and clouds and brilliant blue, Ramparts against the grey, Settling the day. Air once again pregnant with summer heat and H2O… And Hope… On the back porch.

A Back Porch Kind of Summer — I wrote the poem one summer day.

Afternoon Nap Oil on Canvas Stephanie Batch

Student, Long School of Medicine, Class of 2025

This piece is inspired by my memories of my dad in the hospital when he had coronary artery bypass graft surgery. As my family and I stayed by his side throughout his recovery, I remember glancing over to see my mom and dad napping together on the couch beside the hospital bed. Using warm tonal hues to imply a dreamy and nostalgic atmosphere, I wanted to capture this moment of intimacy and tenderness during this chapter in our family's lives.

Deliberate Notes

Oil on Canvas Sammar Ghannam, M.D., M.P.H.

Resident, Department of Internal Medicine & Radiology

First Time I Saw Grandma Use Magic Pencil/Pen Sushmitha Ramesh

Student, Long School of Medicine, Class of 2022

Avalanche Lake Oil on Canvas Christian Jacobsen

Student, Long School of Medicine, Class of 2022

Little Crooked Tree Steven Hlozek

Student, Long School of Medicine, Class of 2023

There are three trees in my view, Two of them are nothing new, While both of them are beautiful, The third is much more unusual, It leans mostly to the left, But then juts to the right, It certainly wouldn’t be described as upright, I’ve watched it stand through many storms, With that funny shape, and somewhat tangled form, Sometimes I wish that it could speak, because if it did, I know its story would be unique. There are many taller and straighter trees that stand close by, But those I don’t often admire, and I don’t know why. It’s this little crooked tree, off to the side, That I find myself gazing at, for most of the time.

Adversity begets beauty.

Fearfully Strong

Paulina H. Mazurek, Ed.D.

Director of Wellness & Professional Formation, Long School of Medicine

I despised you.

But who would I be without you?

You shamed and humiliated me. You hurt and tormented me, caused me so much pain. You were unpredictable, not knowing when you would attack.

I was scared, but I fought, I fought for the life I wanted and deserved. I found strength I didn’t know because you led me to believe it didn’t exist, and never would. I took a risk, blinded to what could be on the other side.

You were so strong; and I, so weak. I lost — Every. Single. Time. I was exhausted and powerless. I was lonely and disheartened; I had lost it all. I grieved, longed for the life I once imagined. I was terrified of you, I felt unsafe, so I ran, and I hid. I hid for so long, much too long. I was tired of your control, tired of you owning me. Despite help and support, it was up to me. I committed to fight back.

On befriending agoraphobia and panic disorder.

I see you differently now, and I am grateful. Without you, I may have never learned compassion, especially towards myself. Without you, I may have never found confidence and strength. Without you, I may have never learned to get back up. Without you, I may have never found my purpose. I am resilient. I am free. I am me.

A View from the Margin David Nweke

Student, Long School of Medicine, Class of 2025

Cuartel de Ballajá in Old San Juan, Puerto Rico. Taken from the periphery of the central plaza days after COVID-19 was declared a pandemic.

Scavenger Hunt

Dorothy Long Parma, M.D., M.P.H.

Faculty, Population Health Sciences, Long School of Medicine

Follow the leader across woodland paths make a soil potato in the long grass look for something that does not belong — Christ! a mango! leave it be and move on. Observe the velvet crinkled parasol of a mushroom wade in the shallows, what do you see? plump lime-green waterweed and a solitary catfish. Bring back notes and treasures transposition is fastest in vivo fresh is sticky mess dried — easiest. Come back to the circle and sing of all the wonders you have found.

The Unbeaten Path Brandon Driggs

Student, Long School of Medicine, Class of 2023

True marvels often lie on unbeaten paths — in both life and medicine alike.

Through creative expression and reflection, we nurture our collective humanity and cultivate meaningful connections among students, faculty, staff, patients and friends of UT Health San Antonio. We are