54 minute read
Flight: Portrait with Birds of the Olympian Gods Caroline Zhu
HONORABLE MENTION, LITERATURE
The Saint in the Courtyard Roshni Ray
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Student, Long School of Medicine, Class of 2022
The Saint in the courtyard watches me as I run into clinic, my white coat flapping behind me. I shoot the statue a glance, ask for a quick blessing, and continue my jog. I am one of the medical student leaders for the San Antonio Refugee Health Clinic. Patients recognize me as the “Bengali one.” They tell me their stories in broken Bengali, entreating me to believe them. They describe their lives from Before. They were doctors and leading businessmen. They were completing college degrees and raising families. When they speak of Before, it’s often idyllic and wistful, when they had their own identities. Now they’re all tossed into one category: refugee. Clinic is where they tell their stories because it’s often the only place they can. We speak their languages; we bring no assumptions. We look like their friends; we look like the children they have lost. One night, there is a woman who is clearly frustrated in the waiting room. She looks up at me suspiciously when I approach her to fill out consent forms. I introduce myself in Bengali and sit down next to her. She says nothing for a minute and then says, “How old are you?” I tell her my age but assure her I’m a student and a physician will see her later. At this, her eyes fill with tears. She grabs my hands, and I am taken aback. She clutches them to her chest and tells me her story between sobs. Her son drowned in the sea while they were trying to escape. He would have been my age by now. She describes the boat to me: the fear, the wind and the salt. She shows me his grainy passport photo. “I have nothing else to remember him. Every night, I see he’s alone in the boat asking for his mother.” After we see her for a history and physical exam, I start the process of connecting her with resources at our clinic. I write a note for physical therapy and I administer an RHS-15 (a screening tool for emotional distress in refugees). I ask about transportation and health insurance–she has neither. I walk her to the Center for Refugee Services (CRS) and see what resources are available for her. The entire process is time consuming, and the paperwork is tedious and often rejected, but we persist. I ask her to return in two weeks for follow-up. She thanks us, says she will pray for us, and leaves. She never returns.
On a different night, a woman comes in who is older than me by two years. Three of her four children are doing chaotic laps around the room as I start her interview. The other child, a baby in her arms, yanks on my stethoscope as I take her history.
HONORABLE MENTION, LITERATURE
“A little dot in my eye,” she describes in Bengali, gesturing the size with her hand. “It’s not bad, but it’s hard doing my makeup.” She describes the history of the dot and the nature of it. I ask her if anything else was going on, “No, no, just this dot.” Before I start asking about any associated symptoms, she looks at me and asks, “Pani?” (Hindi word for water). I nod and get her a cup. She gulps it down as if she hasn’t had water for years. “Can I ask – are you thirsty all the time?” She frowns, “Yes.” “And how many times a day are you going to the bathroom?” A pause. “Uh, 14 times a day. Why?” “Has anyone ever told you anything about having high sugar in your blood?” We learn that she had gestational diabetes in two of her four pregnancies. Her A1C returns at 15.6. Her husband looks after the kids while the attending explains the medications. She looks at me: “We don’t have money for this.” I know she does not. “Will I die if I don’t take it?” I explain to her what the likelihoods are and the extent to which our clinic can help her. She looks crestfallen. “The kids need food. It’s cheaper to die.” The following moment stretches out for miles. I haven’t been trained for this, I think. I say, “Your family needs you too.” The team and I give her a moment to process and talk to her husband. When I come back in, I ask her what she’s decided.
She meets my eyes when she says, “I didn’t die in the war. I won’t die now.” With those words, our fight begins. We take her to the Center for Refugee Services, which will advocate for her and the medications she will now need. Forms are interpreted, labs are ordered. The process to get her resources begins all over again. The Saint in the courtyard watches us fight for each patient. We are reminded every day to be as resilient as our patients, who have traversed war and lost homes to be here. We persevere for both the patients who do return and those who do not. We cannot take them back to who they were Before, but we can hear their stories and provide medical care to help them reclaim the identities that were stripped from them. When she comes back to clinic, she wears a bright yellow and intricately beaded dress. Her eyelids have a golden sheen, and she closes her eyes so I can see better, “How do I look?” “Beautiful,” I say, laughing at her pose, “What’s the occasion?” “I feel good for the first time in a while today.”
HONORABLE MENTION, VISUAL ARTS
Flight: Portrait with Birds of the Olympian Gods Colored Pencil Drawing Caroline Zhu
Student, Long School of Medicine, Class of 2022
As Emily Dickinson once personified hope as a bird, this portrait done in the Arcimboldo style brings together birds of the Greek Olympian Gods. Recovery Madeline Hazle
Student, Long School of Medicine, Class of 2022
He’s 86 years old and recovered from infection, But still struggles to catch his breath on 15L of oxygen. COVID damaged his lungs and defeated his spirit. He longs for human connection after being in isolation. His face lights up when we tell him his granddaughter can come visit. “She’s all I have," he says.
Nearly Dead, but Was Gifted Life Brian Warnecke, D.O.
Resident, Department of Medicine
Tough times arose, alcohol was his escape Liver failure, cirrhosis was his end game Odds were against him, 25% chance of Life So young at 30 No job no insurance no hope Miracles arose, financial issues vanished A new Life and second chance were gifted with a transplant The rest has yet to be written
Pyroclastic Cataclysm Zach Seal
Student, Long School of Medicine, Class of 2021
They Didn’t Know It Was Loaded Stephanie Seale
Student, Long School of Medicine, Class of 2022
The worst day came from play delivered with a shout, “Bang!” and a bang. So we pushed resolve through his chest and epi through his veins, and someone asked if it was in vain.
We’d known with “GSW, GCS 3," but maybe elsewhere his heart still beats and they said goodbyes, at the very least.
Ten healers crowd a crying woman I cut off all her clothes. “What are you doing? You ruined my pants!” Sorry, these are the rules. “There’s nothing wrong with me!” Oh, we all know. “How much is this going to cost? I have a baby. I lost my job, I can’t afford this.” A lot.
American Health Care Adam Vinall
Student, Long School of Medicine, Class of 2022
Ascend Kristy Y. Kosub, M.D.
Professor, Department of Medicine
Community of Common River: Aleta Wondo, Ethiopia Amy Shoga Tinsae Tareku
Student, Long School of Medicine, Class of 2023 Program Manager, Common River
The Women of Common River Steadfast in their commitment to their Female Literacy Class Walk miles through the mountains, the forest, the winding paths, One foot after the other for hours each day. At the end of their trek, the work begins. Now, the women proudly say Nabbawa Dandeemo. Borressa Dandeemo. I can read. I can write. I can sign my name. I can create notes on health, nutrition, and sanitation, I can operate my cell phone. I can manage my bank account. Finally, I can hear my voice being heard.
The Children of Common River Some of whom came to call Common River home when they had none All of whom are readied with their daily lunch, school supplies, uniforms, and sports equipment To cultivate a wealth of knowledge and skill. Empowered by their education, interwoven with Amharic, Sidaamu Afoo, and English, they help harvest food for their community, greet visitors from around the world, and contribute to coffee tradition with their elders. They are gatekeepers to both the future of Aleta Wondo and time-honored traditions of the past.
The Generations of Families in Aleta Wondo have long treasured enset, “a tree against hunger," nurtured for seven years before harvest. Families come together to dedicate every October and November to the thousands of ripe berries collected, sun dried, pounded, washed, freshly roasted and consumed together at the end of a hard day’s work. Three Rounds for everyone, Of the World-Famous Sidama Coffee.
Common River. Is a name known by all in Aleta Wondo, A place that has time and time again risen to its challenges, To persevere as a place of Knowledge. Empowerment. Sustenance. Protection. Health. A beacon of Hope. And must continue to do so.
Nabbawa Dandeemo, Borressa Dandeemo. (I can read, I can write.)
Common River School
Tinsae Tareku was raised in Aleta Wondo and returned to his hometown after graduating from the Department of English at Hawassa College of Teacher Education in Ethiopia. He started as a primary school teacher at Common River and currently leads the entire program. He also founded Aleta Wondo’s very first Community Health Club. This poem is inspired by his dedication to the health, education, and growth of the Common River community. Tinsae and I would like to thank Donna Sillan, co-founder of Common River, for her years of dedication to the Common River community and for her guidance in creating this poem. Donna is also the photographer for both of the pictures shown above. This was a candid photograph taken at the conclusion of a meningioma surgery after I had scrubbed out. I was inspired to take the picture because of the interesting lighting and framing. The patient graciously gave consent for publication.
Neurosurgery: The Chiefs Eithan Kotkowski, Ph.D.
M.D./Ph.D. Student, Long School of Medicine, Class of 2021
The Experience of Diagnosis Emily Sherry
Student, Long School of Medicine, Class of 2022
First it’s me asking, When did this begin? Very quickly I responded, I’m glad you came in.
After his history, vitals, and physical, I summarize back his story, Let him know we’re talking with radiology and the laboratory.
He shakes and he worries, Will I need surgery? I can’t definitively answer that yet, without diagnostic perjury.
It’s too late in the day for our usual consults, Tomorrow we’ll have more scans and results.
The scans come back, there’s definitely a mass; Blocking the pancreatic head, it’s not something that will pass.
I break the news—there’s a tumor. The pain that comes and grows— Unfortunately it’s not acute, or constipation, or stones.
He asks, What say you? How’s the biopsy? I’m confused and alone, I haven’t a proxy.
We walk with you sir and we’ll do what you prefer, To support you in waters that are unknown and a blur.
For now he’s got warm tea and a blanket, a book and a rosary, And in a little while we’ll know just how much to hurry.
I’ll keep coming by, I’ll listen to his abdomen, lungs, and heart; I’ll care for the person of the present, who can’t be found in a chart. Fire in the Woods Oil painting on Masonite Casey Strobelt
Student, Long School of Medicine, Class of 2023
yspotua Sajani Raja
Student, Long School of Medicine, Class of 2024
this they will know when they see me in death I am agender and even in life I suffered of a peculiar condition: a withering soul a mere symptom born of the unmet desire to be recognized as unconditionally human my humanity is called into question every day but who are you to invalidate my choices when shikhandini was lauded for their genderfluidity shredded cardiac tissue suffused with emptiness is what they will find every "she" is a dart tipped with venom shot from unsuspecting mouths "she" becomes a constantly reopened wound in my heart never left alone long enough to heal I am sick, dying of lips clamped tightly over corrections I could never issue of choked up throats and guilt of sleepless nights spent questioning the color drains out of my chest cavity in a river of dark ichor that constantly oozes from a heart burst long ago edema and necrosis is what they will find when they cut me open on the operating table even in death they'll call me she but my pronouns are they/them
A poem about the pain caused by gender dysphoria and misgendering.
MictlanteCOVID Pen on Paper Daron Antonio Smith
Student, School of Nursing, Class of 2022
Student, School of Nursing, Class of 2022
MictlanteCOVID: A depiction of Mictlantecuhtli, Lord of the Underworld, based on Mesoamerican Codices. Two Plagues: An examination of two different plagues affecting Mexican Indigenous people, 500 years apart.
The COVID Warrior Aashish Rajesh, M.B.B.S.
Resident, Department of Surgery
Sweat trickled through layers of plastic. Struggling to breathe through the airtight seal, I turned my patient prone, to feel and to console and yet not to contaminate, panicking within. The heaving chest was reassuring as I recalled the two toothless grins who yelled ”Papa” to us on the phone. Another sterile day had dawned!
Today’s lunch will be peanut butter and jelly for the 93rd time. You don’t seem to mind. Stay in your pj’s? Yes, let’s. No need to do hair; can’t go anywhere. Don’t ask me why ‘comb’ is c-o-m-b and ‘come’ has silent e. I can only be supermom or super teacher. Today’s looking like neither.
Homeschool Joanna Moore
Student, Long School of Medicine, Class of 2023
Side by Side, Do No Harm Alaa Diab
Student, School of Dentistry, Class of 2022
It’s May, midst of a pandemic. But again, another grave injustice, a life murdered in broad daylight. Fast forward days later to our green field, side by side, 6 feet apart, yet we’re connected somehow. Kneeling together in silence to comprehend the suffering of those oppressed. Emphasizing the importance of do no harm in healthcare.
I was told, “They only leave the COVID ICU by dying.” But I met a survivor. He wept quietly. He spoke of nightmares, of being kidnapped and tied down. He was ready to meet Jesus. He recalls trying to pull tubes, wires, and wants to apologize to his doctors. “Three friends died. Why not me?”
White coats for black lives was a day in 2020 when many health care professionals at UT Health San Antonio came as one and took a stand against systemic racism. This story emphasizes our unity as one, and also remembering our oath and our duty to speak about and stop the inequality in health care seen against black communities and minorities.
Survivor Kristy Y. Kosub, M.D.
Professor, Department of Medicine
Grief Malavika Perinchery
Student, Long School of Medicine, Class of 2023
Grief isn’t a waterfall; it’s a tidal wave. The first wave is the worst. It’s a gargantuan force that strikes you when you’re least expecting it. When you first hear the news, grief takes over your body, your mind, and your soul; your breath comes out in ragged sobs, your hands shake. Time seems to stop as you try to make sense of what’s just happened. There’s no way to prepare for that tidal wave. It leaves you emotionally raw, vulnerable, stripped. No amount of hugs or condolences or love can help. You and you alone have to ride out that wave and come across the other side, all in one piece. If you can’t make it past that first wave, there’s just no way that you can weather what’s yet to come. The second wave brings with it a brand new demon: regret. Regret has a way of gnawing at your exposed wounds, leaving you naked, smarting, and clutching nothing but a handful of “should’ves,” “could’ves” and “would’ves.” They pile up until you feel like you can’t carry their weight anymore. Although the second wave doesn’t have the force of the first, the wounds it leaves are deep. It takes months, sometimes even years, to patch up the skin that was sloughed off. But, in time, you recover. The third wave is not at all like the first or second; in fact, some may say that it’s a manifestation of your own emotions — anger, fire, upset. You rage at the world, asking why something so unfair could happen; you’re frustrated at God, the circumstances, and anyone else you can find to blame. Anger may seem powerful, but it’s nothing more than masked sorrow. Its threats are hollow. Just as a torch can’t set fire to the vast ocean, your anger can’t turn back time. What has happened has happened; a new reality beckons, extending its hand. Even if you don’t want to, you have no choice but to accept. Time waits for no one. After grief has washed over you thrice, there’s nothing much left for it to pick at. You are nearly empty. But try as it might, there’s one thing that grief can never take away — memories. Made up of the smiles, the sunshine, and the laughter that marked the moments with the person now gone, memories live on in the heart forever. When grief realizes that it is no match for the power of memories, it leaves, giving you the ability to rebuild what’s left. In time, these wounds fade to mere scars, showing the world (and ourselves) what we are capable of handling. And slowly, we move on, bit by bit, until grief only hits us faintly, like the tranquil lapping of waves against the seashore. Grief isn’t a waterfall; it’s a tidal wave. But once you survive its ravages, you are left stronger and more capable than before. Armed with the power of memories, you carry on, head held high. And that person, whoever they may be, resides in your heart forever.
This is a short piece that I wrote in 2017, soon after my grandmother’s passing. She meant a lot to me, and this was my first experience with profound grief. One Edward Harris Jr.
Student, Long School of Medicine, Class of 2022
I love this genuine brotherly embrace where it is difficult to tell which arms belong to whom.
Serenity Watercolor on Paper Nichole Henkes
Student, Long School of Medicine, Class of 2023 Bloom Alcohol Ink on Yupo Paper Jane Margaret Anderson
Student, Long School of Medicine, Class of 2022
Patient Notes Winona Gbedey
Student, Long School of Medicine, Class of 2023
Chief Complaint: “I don’t trust you.” History of Present Illness: Your patient is a 78-year-old African-American woman who presents today with a deep-seated mistrust in the American health care and justice systems. At first, she is hesitant to speak to you, wary of the white coat that adorns your body, but soon she realizes that you are here to help, not hurt.
Her symptoms first began more than 400 years ago when the first enslaved Africans arrived at the new British colony of Virginia. Upon further questioning, she reveals she lives with a hereditary condition, passed down from generation to generation for centuries. After seeing the confusion still on your face, she clarifies further. Her condition, rooted in her ancestry, is the history shared among her people—Black friends, family, and stranger alike, both near and far, past and present. This history details the horrors and triumphs that have brought them to where they are today. It lives on through them. Slavery and the Emancipation Proclamation. Segregation and the Civil Rights Act of 1964. Systemic racism and Former President Barack Obama.
Suddenly, she stops. You glance up from your patient note, only to see that caution has overtaken her once again. You urge her to continue; she shouldn’t have to mute herself to get the care that she needs, even if her physicians are less knowledgeable on a subject than she is. She looks skeptical but ultimately continues.
As of late, most things seem to aggravate her symptoms: the unjust murders of unarmed Black men and women by the very people who are supposed to protect them; the disproportionate numbers of black and brown bodies falling to COVID-19; the recent attack on her nation’s capital by domestic terrorists masquerading as patriots. However, the actions of the younger generations, publicly denouncing white supremacy, racism, sexism, homophobia, and the inhumane detainment of refugees make her feel better. But, still, it isn’t enough.
“People who look like you and me, we’re the ones dying. Have been for ages, but no one seems to care. Obviously, this place wasn’t made for us.”
Past Medical History: Curious to find out what else has elicited her symptoms in the past, you delve into her PMH. The room descends into yet another uncomfortable silence. Her leg bounces; her fingers tremble. You give her the space needed to decide whether to answer you.
Eventually she tells you that she herself has not experienced many negative outcomes in her limited interactions with the health care field. “Limited,” though, because her family and friends have, from one physician misdiagnosing a friend with malaria when he actually had a DVT to another physician dismissing her sister’s cry for help as she entered into preterm labor.
How many people must suffer because of their doctors’ incompetence? she demands. How many must die? And to be told that you’re “noncompliant” and “defiant” because you know you deserve better than what you’re getting? Truly reprehensible. But this isn’t new. Similar things happen all across the country every day and have been for a long time now.
You wonder to yourself, have you ever felt a shame that burns as hot or as deep as this?
Social History: Without any prompting from you, your patient reveals that she often experiences casual acts of racism in her everyday life. Shop owners following her as she admires clothing items; curious hands grabbing at her afro without her consent. She’s encountered so many such acts during her time on this Earth that she has long grown accustomed to them.
Other instances, she will never get used to, no matter how hard she tries. Fearing for her life when getting pulled over for a “routine traffic stop”; fearing that she’ll end up like her kin if she visits the wrong hospital, sees the wrong doctor. She has feared so much over the years that it has become a permanent fixture in her life. Her eyes are glossy as she tells you her story. You reach out to offer a comforting touch, but she pulls away.
“I have been on this Earth for 78 years now, yet so little has changed. For every step forward, we take two steps back. With enough ‘progress,’ we’ll end up right back where we started. I’ve come to realize that maybe we weren’t meant to win this race.”
Review of Systems:
General: As mentioned in the PMH, black and brown bodies have historically been mistreated and abused. They have been used to make revolutionary medical discoveries in nearly every major specialty. But most of these studies were conducted without any regard for the person laying on the table. Though these experiments stretch as far back as colonial times, maybe even further, many are still being conducted today, contributing to the inherent mistrust racial and ethnic minorities feel when visiting health care establishments. Despite knowing numerous examples that could fall under each category of this ROS, your patient decides to focus on only a few during this appointment.
GU: The collection of and experimentation on Henrietta Lacks’ cervical cancer cells without her knowledge or permission; Dr. J. Marion Sims, who created and perfected landmark gynecological procedures by mutilating the genitalia of countless Black women without even giving them anesthesia; the Tuskegee Syphilis experiment, which allowed the slow, painful decline of hundreds of Black men when treatment was readily available and easily accessible.
Dermatological: A national 2016 study that revealed that nearly 40% of White first- and second-year medical students believe Black patients have “thicker skin” and “less sensitive nerve endings.”
Neurological: The problematic 1990s study that aimed to prove a genetic etiology for aggression in the Black population by only recruiting low-income Black boys; depriving them of their medications, parents, and water; and pumping them full of fenfluramine, a drug that, at the time, was suspected of inducing aggressive behaviors.
“I appreciate your kind words, but do you even know what I’m talking about?”
Physical exam findings: Your patient exhibits a significant degree of white coat hypertension and anxiety but otherwise is in NAD. General inspection reveals dark skin, full lips, and kinky hair, a list of physical features that labels her as “other” and tethers her to a blood-soaked history as old as this country.
Assessment: You return to your note. After talking with her, you now believe that her fears are justified. She has an extensive understanding of her condition, probably even more than you, despite your medical training. The country's record of inhumane treatment and experimentation on minorities, in addition to her PMH and SH, culminate in the resentment, loathing, fear, and caution intrinsic to the very concept of medical distrust. Major systemic changes must occur to alleviate her symptoms.
“I’ll admit, I am prejudiced. For me, it’s always been us versus them. We fought for our freedom. They spat on us and screamed in our faces, dragged us through the streets and hung us from trees. They made it clear that we weren’t welcome here. I pray each day that your generation never knows what it’s like to hate and to be hated. It eats you up from the inside out.”
Plan: Although little can be done at this appointment to rectify implicit biases, institutional and systemic racism, and racebased mistreatment, you two work together to formulate a plan to address her most pressing concerns.
1. Recruit more people of color into the field of medicine and continue to support them once they matriculate.
2. Incorporate the history of medical experimentation and medical racism into medical school curricula to educate future physicians on the errors of the past (and present).
3. Include the dermatological manifestations of disease on both light and dark skin in lecture materials to reduce untimely or inappropriate diagnoses.
4. Encourage peaceful discourse on these and other challenging topics.
5. Patience is key, and therapy, too, if needed.
You assure her that steps will be taken to ameliorate the issue, hopefully long term. She thanks you as you close your note. Before you leave the room, you tell her your truth: Being Black isn’t a disease, and it shouldn’t be treated as such. You tell her, I’m sorry you’ve had to carry this burden with you for so many years.
She finally relaxes.
“It was nice talking to you, sweetie. And—I’m proud of you. You don’t know how happy I am to see someone who looks like me where you are. You make me ... hopeful. I haven’t felt like this in a long time.”
As someone who typically writes short stories, this is a new type of project for me, but I wanted to share it anyway because it is important to me. I decided to use this format because it felt the most conducive with the type of story I wanted to tell. This was written in response to recent events over the past several years. The patient's story and quotes were made from the culmination of conversations I've had with numerous Black women while volunteering at the county hospital in undergrad, working in a rural nonprofit during my gap year, and interviewing patients during some of my longitudinal preceptorship visits. As a black woman myself, the things I heard did not shock me so much as they did disappoint. "Patient Notes" is a call to action for the hopes of a better tomorrow.
Hummingbird in Flight Kevin Proud, M.D.
Alumnus, Long School of Medicine, Class of 2007
Hummingbird preparing to take a drink!
The Last Promise I Made || Kept Christopher Zhu
Student, Long School of Medicine, Class of 2023
when we eloped fifty years ago a bearer a ring my parents appall I said to you
in sickness in health till death do us part in a promised land built on broken vows a viral generation gifts
an iPad, your face but no time awake, silence infinite as your melted mute lungs leak:
I do I do Yes I do
intubate me you may now I’m positive you leave me breathless flustered in the same way the room turns negative my melted mute lungs leak:
a promise in sickness till death due us part but I sure as hell ain’t saying goodbye on an iPad, this god damn generation
When we met our parents scoffed won’t last a year now look married for fifty in a promised land built upon unbroken vows:
I do I do
Yes I do
love you Through the Eyes of a Mother Acrylic on Canvas Vanessa Trivino
Student, Long School of Medicine, Class of 2022
I originally painted this piece of Mother Mary and her baby Jesus for my family home this past summer. Now that I look back on it, it reminds me of all of the mothers I saw holding their newborn babies throughout my clinical rotations. The love, warmth, and hope that filled their eyes as they looked at their babies for the first time was such a beautiful experience to witness. Although this year was filled with difficulties and uncertainty, for many it was filled with new life. Seeing the mothers' joy and happiness reminded me that there is so much beauty around us, in each task we do, in each day we live, in every person we encounter. It can be a temptation to get drowned by all of the difficulties and suffering, but that beauty and hope around us remain, and all we can do is look at life and others as if looking through the eyes of a Mother.
It Could Have Been Her Sajani Raja
Student, Long School of Medicine, Class of 2024
When the abdomen splits open under the unwavering touch of my partner’s scalpel, I am taken aback by what is inside. I knew that the patient had pancreatic cancer—I had seen the metastases on the lungs, so similar to the lesions that killed my aunt just three months prior—but I wasn’t expecting such devastating tissue damage. It looked like the cancer had exploded inside the abdomen, coating the outer body wall, leaving patches of discoloration on the liver. The large intestine and pancreas were gone, the small intestine shriveled, the stomach an amorphous blob compared with the well-defined organs in neighboring cadavers. It was clear the patient had suffered in her last moments, considering the sheer amount of organ dysfunction with which she was living. When I examine the patchy white lesions on the lungs, I can’t help but think about my aunt. She was always laughing when I was around, eager to hide the burden of living with metastatic breast cancer. The last time I made plans to visit her, she was bedridden from the side effects of her brain tumor, and she asked me to stay home. She spent her final moments on a ventilator, having air blown into her failing, cancer-filled lungs. Her vibrance in life was hardly apparent in the ashy tinge to her face as the casket was lowered into the ground. I think about the lily I placed next to her body, the tears I shed as I looked upon her corpse, and I wonder. This woman before me, my first patient, is not so different from my aunt. Both had their lives stolen from them by cancer—my aunt died much earlier in her life, but both women suffered just the same. And yet. I had a privilege that the other woman’s family members did not. I was given closure. Through the next series of dissections, as we poke and prod at the liver and cleave the stomach, as my tankmates complain about the mass of scar tissue in the abdomen and how impossible it is to find the celiac trunk embedded within, I can’t help but feel as if I am cutting into my aunt’s body. This could have been her. At one point, this body that my tankmates and I complain about so haphazardly was a living, breathing person, and she made the choice to become a teaching tool after death. What right do we have to complain at all when this woman so generously afforded us the privilege of poking around her lifeless corpse? It takes us six dissections to find the celiac trunk. By that point, I am not complaining.
A reflection on the gift of body donation and how cancer affects patients and their families in life and in death. We Are The Same Ivelisse Velázquez Negrón, M.D.
Resident, Department of Psychiatry
We were made from the same essence Our eyes opened to the same light Our souls were filled from the same hope And our minds from the same strength
Our bodies carry the same trauma That our ancestors printed in our blood Our hearts ache from the same scars That were carved at an early age
Our innocence was robbed from us Because we never understood consent Society only taught us how to behave And how to embrace guilt when we don’t
Guilt of not knowing best Of wanting more than this Of being our true selves Of wanting to be truly free
And now we carry the same the cloud Because silence is less painful Than admitting that we failed And lost our “most important” virtue
Now at night is hard to sleep And during the day is hard to trust Because we are safe in our secret space That we created away from all
And we decided to call it stress Or to call it a bellyache Some days we justify it and take the blame And then submerge in a lake of pain
And though everyone thinks we are different Because I wear a coat and you a hospital gown It was only your courage that set us apart The day you decided it was enough
You let it all escape through your lips And like a hurricane full of words You figured how to be free And began your journey to heal
And instead of being me the one who helped you It was you who helped me And by being a mere spectator I ended up being saved
-We are the same -I am here to learn
"We Are The Same" is a poem that I wrote on how patients are not different from us. It is about how patients can help us and teach us with their life experiences and their courage how to ask for help for ourselves. Sometimes we think we should know and we should be able to take care of our problems without difficulties. However, patients are more than just patients. They are human beings, as we are, who suffer, as we do, and are able to help us grow in unimaginable ways. "We Are The Same" also touches topics that are important for all women like consent, guilt and shame.
Flightless but Fearless Noah Hodson
Student, Long School of Medicine, Class of 2022
Taken on a small island off the coast of Chile, South America.
Till We Roam Again Watercolor on Paper Tran Nguyen, M.D.
Resident, Department of Family Medicine Breathe Life Emily Sherry
Student, Long School of Medicine, Class of 2022
Alone Charcoal on Paper Amanda Lipsitt, M.D.
Fellow, Division of Pediatric Hematology-Oncology
During medical school, I took an elective fetal anatomy class to prepare for pediatric residency. I was the only student enrolled that month. Many times I found myself alone in a quiet room in the back of the anatomy lab; however, I was never quite alone. I drew this as a tribute to my teacher that month. Looking Up Acrylic and Gouache on Canvas Lina Mahmood, M.D.
Resident, Department of Pediatrics
In Shades of Grey Ballpoint Pen on Paper Divya Chandramohan, M.D.
Fellow, Division of Infectious Diseases
Executed while exploring the interplay between lights and shadows, inspired by Rembrandt's etchings. Names Chelsea Wu
Student, Long School of Medicine, Class of 2022
I do not recall the first time I learned my name. I imagine my ears welcomed the two syllables. The first hard with consonants and the latter a soft glide. Tickling the inner hairs in just the right place, nestling the name first in architecture.
Later in memory.
Now I can pick up my name like a symphony motif, the way it can sound like a command, a tender whisper, a question, validation from a stranger’s mouth, clunky with uncertain sounds. How my mother can make it sound a threat of crows or a bowl of her warmest wontons.
Names, how they sound when we are not there to hear them. A car splinters into another, and bodies unable to grasp their own gravity paint across the sky. A father shouts the name of a daughter who was just beginning to learn her own. A 7-year-old girl asks for her sister’s body not knowing that her skin, ribs, and vertebrae had failed to protect her. That no one whispered in her ears her ephemeral name and their eternal love.
What is a name but a pleading with the other side, a reminder that we have planted ourselves here. Here. And here. Names— a way to see each other. And how we rarely say our own names unless asked.
Bittersweet Aashish Rajesh, M.B.B.S.
Resident, Department of Surgery
He was beaming yellow as he proudly showed me the new liver his ten-year-old had painted on canvas. His liver failure had worsened, and he needed an urgent transplant. In a parallel world, surgeons watched tensely as his donor survived off life support. The silence blared as the canvas slipped through his hands.
Open Space Acrylic on Canvas Sushmitha Ramesh
Student, Long School of Medicine, Class of 2022
Muscle Memory Chelsea Wu
Student, Long School of Medicine, Class of 2022
The role of the medical student is to hold pressure at the femoral artery. But instead, his blood leapt out like a ballerina, arching backwards into puddles, diverging from the choreography. We could not contain the dance. But soon, the performance tires. He rests. His body relearns the dance. With the right steps this time.
Madam Mesentery Digital Drawing Evan Marshall Gregg, M.D. , M.P.H.
Resident, Department of Psychiatry
Questions William Kortbein, M.D.
Resident, Department of Psychiatry
Have you ever won a fistfight with the devil? Is 300 a good blood pressure? Did you ever win the lottery in a past life? Is God awake? Don’t you think sunshine and exercise are the best medicine… for my schizophrenia… that I don’t have? These are the questions I’m asked on the psych ward.
Don’t Assume What Their Need Is Jennifer Sanchez
Student, School of Occupational Therapy, Class of 2022
I assumed instead of asking I talked instead of listening My idea was good, but theirs was better How can I assume what their need is, when I didn’t ask or listen to them? I am not they, and they are not me We don’t understand them They don’t understand us We both want change Abused, alone together: women learning independence. I am tasked with teaching health— They need ways to pay for meds. While sitting in my warm apartment, loving husband just outside, I listen as they share a harrowing experience to a camera and projected faces. Once again, the mic cuts out. Thanks for sharing — could you repeat?
Troubled Connection Chloe Jensen
Student, Long School of Medicine, Class of 2023
This 55-word story is a reflection on my experiences volunteering at a residence for survivors of sexual assault, human trafficking, or abuse.
January 1st, 2021 Chloe Jensen
Student, Long School of Medicine, Class of 2023
Last night, fireworks fought the sky they burst in defiant sparkles, glittering and glorying— declared victory over the night as the lighters, in turn, cried triumph over a cruel year dead and gone.
Don’t Despair Alaa Diab
Student, School of Dentistry, Class of 2022
2020 was filled with many events. This photograph highlights rekindling hope despite the hardships faced in 2020: having hope for the better as demonstrated by the rose, standing up against any type of oppression and injustice, educating others, and doing our part in a pandemic by wearing a mask and being safe. Transience Skyler Kanegi
Student, Long School of Medicine, Class of 2023
Absence seems the same as Breath, the inverse of our mortal Coil. To flesh, what differs life from Death, I wonder as I lift the
Edge of epidermis, fascia, peel the Features from a stranger’s face, at once Grotesque, complex, relaxed, in fact a Husk of alien form, a replica so
Ill-conceived I wonder if I am deceived. Joke’s on them, though; I still learned the Kidney is different from the spleen. And Looking further I can see the languid vagus
Meandering among the fragments of its thoughts, Not one but billions end to end, Of gasp, of touch, of heart, of breath, Perhaps if I could understand
Quite how these signals came to be— Remind myself of how to breathe— Such dreams would come that mirror how This person lived, removed from now,
Ubiquitous in moments past, Voice silenced yet residual flesh Which lingers still in mortal plane, Expresses echoes infinite—
Yearn nevermore for spoils of life, his Zenith reached, his story told
Grief, Gratitude, and Guilt Jazy Hill
Student, Long School of Medicine, Class of 2021
Grief, gratitude, and guilt Join hands this Thanksgiving
I come from a culture Where the expectation is to leave Leave for college, leave for a job In our pre-COVID world Distance was easily eliminated So we created it
As the world clamped down Social distancing arrived Physical proximity became a luxury
We came together Moved by closed schools, remote jobs Now separated by a short drive A mere bike ride Rather than thousands of miles
As I sit on the couch Reading news of our disaster I realize I have traded interviews and airport lobbies For my brother’s arm around my shoulder And my sister’s head in my lap
Grief, gratitude, and guilt Join hands this Thanksgiving Let’s bow our heads and pray For those who lost time together As we gained it
Sunset over the Aegean Eugene Stolow, M.D., M.P.H.
Resident, Department of Medicine
A striking sunset over the Aegean Sea, Santorini, Greece. The Psychiatric Evaluation of Dog Acrylic on Canvas Marlow Taylor, M.D.
Resident, Department of Psychiatry
A: Pico appears well groomed but upon closer inspection malodorous from rolling around in the mud and certainly has not bathed in several days. His nails certainly need clipping. There is increased kinetic activity observed in frequent tail wags. Appears puppy-like despite documented geriatric age. Frequently observed to interact with internal stimuli—or merely snapping at flies. Speech is indiscernible but delivered at increased volume with punctuated emphasis on “woof” when another dog walks by. M: Stated mood “woof” is congruent with attentive affect with unconstricted range at times appearing perplexed, at other times inquisitive. S: Ready to move at a moment’s notice, able to sit, shake, fetch, and roll over upon command. I: Clearly well above average based on ability to successfully beg for scraps with varied tactics and covert forays into the trash. T: Consistently goal directed but with obviously paranoid thought content notable for overtly homicidal thoughts toward squirrels and possums who may or may not invade his yard. Endorsing grandiose thoughts that he owns the couch. Judgment is quite poor as evidenced by his breakneck sprints toward bicycles and heavy machinery. Insight is questionable as he almost certainly believes himself to not be a dog.
Learning to Smile with My Eyes Ariadna Perez-Sanchez, M.D.
Resident, Department of Medicine
Emotions are hidden underneath the mask Masks have changed human interaction, challenging us to adapt Since the start, expressions have always prevailed over words Now, how can I show them that I am happy? How can I tell them that I am sorry? When can we go back to seeing a smile and smiling back?
A Beautiful Soul Jon Trout
Student, Long School of Medicine, Class of 2024
“A Butterfinger Is what I desire.”
A nurse responds On his own time, Out of pocket, To answer this final wish.
“This is it?” “This is it...” Care is withdrawn. Color begins to fade. A calm, peaceful Countenance remains.
Reverently and quietly, A white cocoon Surrounds her.
“She was A beautiful soul.”
In honor of the amazing nurses who care for patients as individuals and go above and beyond every day, and the patients that face their mortality with courage and grace.
The Water Bucket and the Lightning Rod Brian Ryder Connolly, M.D.
Resident, Department of Rehabilitation Medicine
Lightning is believed to strike the Earth millions of times every year. Because of its frequent displays of force and destruction, it has often caused its observers to feel helpless when met with its awesome power. The early American settlers were no stranger to this feeling, and often struggled to protect themselves from the thunderstorms that set fire to their ships, churches, barns, homes, and other important structures. In an effort to minimize the damage caused by lightning fires, Benjamin Franklin founded the Union Fire Company in Philadelphia in 1736. These early firemen endeavored to extinguish fires with buckets of water and carried salvage bags to rescue valuables when saving a structure was no longer feasible.
While the firefighting tactics employed by the brave colonists provided a small amount of protection against lightning, Franklin understood that the easiest lightning fires to extinguish were those that never started at all. Thus, driven by curiosity and a desire to protect his city, Franklin created the lightning rod in 1749. Franklin’s invention worked by intercepting lightning strikes and safely passing their electric currents to the ground.
Like lightning, SARS-CoV-2 has left many of our patients and health care providers defenseless before an invisible foe. As the virus reached American shores, our health care system’s role was like that of the early firemen of the Union Fire Company, who strived to salvage what they could amidst a seemingly relentless assault. Just as the firemen attempted to put out lightning fires with ostensibly futile buckets of water, our front-line providers attempted to use an array of medications and treatments to combat the disease and injury left in the pandemic’s wake. While these early treatments were crucial for the health of our nation and were met with mild success, far too many of our loved ones lost their lives.
Fortunately, medical care around the world has been shifting to become more like that of the lightning rod, which aims to prevent catastrophe from occurring in the first place. Social distancing, mask wearing, remote employment and learning, and rapid vaccine development have and will continue to prevent the loss of irreplaceable lives.
The lightning rod has allowed vulnerable structures such as the Empire State Building, which sustains dozens of lightning strikes each year, to exist virtually unharmed. In the future, as health care continues to adopt the role of the lightning rod, similar protection can be provided to even our most vulnerable patients.
Sticking Together Laura Madeline Wright
Student, Long School of Medicine, Class of 2022 Name a Better Trio - Malleus, Incus, Stapes Embroidery Floss on Aida Cloth Laura Madeline Wright
Student, Long School of Medicine, Class of 2022
The Skull - Protecting What Makes You You Embroidery Floss on Aida Cloth Laura Madeline Wright
Student, Long School of Medicine, Class of 2022
Ziggy the English Mastiff Audrey Marie Dockery
BSN-DNP Student, School of Nursing, Class of 2023
This is my dog Ziggy. He is an English mastiff, 200 lbs and 10 years old. He has been my dog since he was 6 weeks old. I chose him as my dog because he was pushing his brothers and sisters away, just to get to the teat! I knew he was a strongminded dog, even at such a young age, and I knew that energy would carry him throughout his life, even in the midst of a pandemic! This is a picture of him in my backyard where I have grown up most of my life, Brushy Creek in Round Rock, Texas. He is sitting on our limestone rock, waiting to see if any animals will visit us from across the creek. This picture gives me hope and inspires me to dive deeper into nature and appreciate my scenery, regardless of lockdown or not!
Portrait of My Grandmother as a Nurse Charcoal on Paper Laura Berardo
Student, Long School of Medicine, Class of 2021
This is a portrait of my grandmother as a young nurse many years ago. She was the first health care provider in my family and an inspiration for my choice to pursue medicine.
When Death Comes Knocking Waridibo E. Allison, M.D., Ph.D.
Assistant Professor/Research, Division of Infectious Diseases
Death knocked at his door. He heard and ignored it.
Perhaps that’s why he talked to me, The emergency room doctor that he saw.
Perhaps that’s why I stopped, Sat, listened to him some more.
He spoke of strength he used to have, But didn’t anymore.
He spoke of the never-used laptop He got from his children, The Christmas before.
He spoke of the God He didn’t believe in, How he hadn’t since the war.
I said, right up until the end, There’s a chance to believe once more.
I said, I’d visit him on the ward So we could talk some more.
Two days passed, death knocked again. He heard and opened the door.
Death is an inevitable part of medicine. Sometimes we — patient and doctor — know it’s time: A long life has been lived, and we wait patiently together for death to arrive. Sometimes it is too soon, too tragic, too wrong - so we fight it together until the very end. Sometimes we win, sometimes we lose. Always I am awed by the bravery of the patient who hears death knocking. I remember vividly many of the patient deaths I have experienced since I became a doctor 20 years ago. This poem is about one of them. Moth Jazy Hill
Student, Long School of Medicine, Class of 2021
The brown speckled moth Has flattened itself against my window It had flown toward the sparkling Christmas lights Draped around my room. I expected the smack of the window to deter it Force it to fly away Away from the clear pain But it must want the light more Than it feared harm
You can’t breathe sir Your oxygen is turned so high You talk through gritted teeth You fight with each shaky breath Your will is so strong
But sir, You aren’t getting any better Your cancer has spread Your lungs have given out That beautiful salvation you see It may appear clearly to you But your body can’t reach it. That perseverance that has blessed you your whole life Cannot break through glass
Sir, I am asking you to sign this paper It says when you do fly away We will not break your bones trying to bring you back Please sir, Don’t ask me to push a tube down your delicate throat So your family can watch Your shuddered, mechanical breaths.
I don’t know what changed your mind Why you quit fighting And signed the DNR
It seems that your signature Was your choice to let go. As you passed two hours later With family surrounding you There were no alarms or screams You glided peacefully away from this painful world Toward your true light
A Routine Exam Kip Winden, D.O.
Resident, Department of Anesthesiology
He wanted to die. His left temporal exit wound is obscured by dressings. Pupils nonreactive, corneal reflexes negative. Ocular movement undetectable. Jaw reflex, nothing. No gag or cough. We pinch hard but no pain elicited. Ten minutes of apnea; blood gas confirms. Brain death is called. Rounds continue, pager goes off, six notes to write.
A Hush Descended Sarah Cox
Student, Long School of Medicine, Class of 2023
Photograph taken with a Canon 77D at Deception Pass, Washington.
Roadtrip Memos Zuha M. Alam
Applicant, Long School of Medicine
Darkness enveloped in blacks and blues melts into farmhouse browns and maroons, erupts into crimsons and fiery hues. As quickly as a sky morphs on a Texan cruise, a quiet drive from Dallas to Austin isn’t news. The joy in simple things, like traveling in twos, would soon be a feeling I’d learn to lose. Stronger Together Oil on Canvas Sarah Cox
Student, Long School of Medicine, Class of 2023
Wound Healing Winona Gbedey
Student, Long School of Medicine, Class of 2023
My history is carved deep into my skin, A rich tapestry of what was, What will be, And what could have been. These stories, They’re mine to keep And mine to tell.
So dissect through my walls Like a specimen on your table. Let my body be your guide. Peel away parts of me Until you find What stitched me back to life.
One day we’ll reach The very core of my being, And you’ll see what gave me these scars.
The inspiration for this piece struck me late at night while reviewing for the first MSK (musculoskeletal) weekly quiz. Scar formation. I thought it fascinating, how several layers of skin must be breeched before our bodies decide to memorialize our injuries. This got me thinking about my own scars, and how they merely serve as reminders of funny stories to tell my friends. Emotional scars, though, they're different. They inflict so much pain without even piercing the skin. Somehow, they cut deeper than physical wounds. "Wound Healing" explores that dichotomy.
Pandemic Blues Nilam J. Soni, M.D., M.Sc.
Professor/Clinical, Department of Medicine
My face mask is getting yellow Everyone seems to be more mellow The death toll keeps rising But few want to keep compromising The politicians are evil Fighting and making upheaval While the health care workers keep asking When will all of this be passing We are getting tired of the distancing As we are of being online listening Old work keeps piling up That I wish I could dump Is this the new norm? Or will we get back to our usual form? It is easy to lose sight And want to give up this fight But I remember all the unmasked faces Of those who kept me in the races Those memories bring me much joy And serve as my daily ploy To keep pushing forward And being a good hospital steward A message to all of my friends Keep your chins up until the end As it’s slowly starting to mend One day we’ll all go on vacation And leave behind this coronacation But for now I send you a big hug Though it’s virtual and requires a plug I’m hoping it won’t be long Just keep on being strong.
Out of My Head Susannah Nicholson, M.D.
Associate Professor, Department of Surgery
Out of my head Head out Out of time Time to head out Out of sight Sight the point Point the way out Out of my mind Mind your words Words flow out Out onto paper Paper thin thought Thought you were there There you were not Not in my mind Mind your heart Heart pumping blood Blood flows out Out to my limbs Limbs take me out Out I shout Shout out the words Words flow out Out of my head Head out to the silence Silence yourself Yourself, out Out! Out of my head! Head out.
Remember when you dreamed of being where you are now? Ariadna Perez-Sanchez, M.D.
Resident, Department of Medicine Wings of Hope Cynthia Jiang
Student, Long School of Medicine, Class of 2022
This is a watercolor painting of a bird that was always outside my window. I started watercolor painting while studying for Step 1 as a form of stress relief this past April during COVID.
Mount Rundle and Vermilion Lakes, Banff National Park Subrata Debnath, M.B.B.S., M.P.H., Ph.D.
Assistant Professor/Research, Department of Medicine
Fireweed flowers at Vermilion Lakes in front of Mount Rundle. My son and I captured this late afternoon moment while biking around Banff National Park on August 1, 2019. The Sakura, or Cherry Blossom, is a symbol of hope and resilience due to its unfailing bloom year after year. This Sakura was photographed in Kumamoto, Japan, San Antonio's sister city since 1987. On August 5, 2020, San Antonio Mayor Ron Nirenberg read a proclamation recognizing August 6-12, 2020, as "San Antonio-Kumamoto Peace Week" in commemoration of 75 years of peace between the United States and Japan. Kumamoto-En , which occupies a small corner of the San Antonio Botanical Garden, was a gift from our sister city, Kumamoto.
Sakura: Resilience in Bloom Amy Shoga
Student, Long School of Medicine, Class of 2023
a summary Aarushi Aggarwal
Student, Long School of Medicine, Class of 2022
heeding guidance from those dedicated to advancement, not dependent on the utterance of gratitude from others
onerous times slowly stretching us thin, yet we are more elastic than we remember
passive smiles soon to be visible again, each more significant than before
embracing the opportunity shared adversity has given, to understand our neighbors even more
You valiantly carried your shield into battle now cast it off like a pearl falling from its chain your head raised to the sky to see the final sunset to feel your chest become light to laugh the memories away and soon you will see your first sunrise
Untitled
Narine Wandrey, M.D.
Alumna, Long School of Medicine, Class of 2018
This poem is dedicated to all those who battle cancer, and to my first young adult patient with cancer who fought that battle. You taught me more on the wards as a third-year medical student than you would ever know. Your courage is not forgotten.
Lux Aeterna Zach Seal
Student, Long School of Medicine, Class of 2021
The civil unrest in summer 2020, following the killings of George Floyd, Breonna Taylor, Ahmaud Arbery, and too many others, prompted us as students to evaluate our relationships with race, privilege, and biases. Conversations in our community revealed a desire and need for a stronger student-led effort to illuminate the experiences of minority* students. This led a team of medical students to come together to create Auscultations as a platform to address this important need. Auscultations aims to amplify the voices of minorities in our health care community through storytelling and reflective listening. Oftentimes, narratives are dictated by those who hold power; by facilitating a space for vulnerability, honesty, and awareness, Auscultations hopes to validate historically marginalized voices, promote empathy, and challenge the status quo. The following 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 simply sharing your stories with us. You can reach us through email at auscultations.uthsa@gmail.com to learn how you and your story can help shape our campus narrative.
Best, The Auscultations Team
*Minority includes sexual orientation, race, ethnicity, gender identity, religious affiliation, age, disability, neurodiversity, etc.
How I Got Here Yousef Salem
Student, Long School of Medicine, Class of 2024
According to the Association of American Medical Colleges, 80 percent of admitted students come from the top 40 percent of income nationwide. This is my story from the bottom 20 percent: When I was 8, my family did not have a stable income, so I helped my mom apply for food stamps. We received the bare minimum amount for food, $300/month for our entire family, and played a game of stretching that as long as possible. But we never made it to the last week. It just had to suffice. Over nine years, we rode a rollercoaster of ups and downs where our situation improved briefly, and then an unexpected car repair or a high utility bill would add pressure again. We knew exactly how long it took before getting cut off from electricity and water. Sometimes we made without. We dreaded going home after school where there was no A/C or lights. After graduating high school, I applied to university even though I couldn’t actually afford it, but everyone around me was doing it. I applied for a scholarship and was rejected, so I reached out to Financial Aid to explain my situation. I got lucky in finding someone who empathetically walked me through the appeals process. Thankfully, I won the scholarship, which meant I could work less while helping keep a roof over our heads. Between this increased stability, further hard work, and many other lucky breaks, I was able to focus on studying medicine, and now here I am.
At some point, we will treat “non-compliant” patients who need to feed their kids. Or they delay treatment until the point of no return because they had to pay rent. I am thankful for my experiences as they allow me to better understand the difficulties these patients face, and I hope to see more students in medical school who have overcome similar challenges.
Yousef Salem, then and now. (Left: family photo. Above: Photo by Hannah Cook, Student, Long School of Medicine Class of 2024)
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 .
