Connective Tissue 2015

Literature & Visual Arts Journal

Volume VIII • 2015

Cover Art

(see page 16) “Migration” by Carlos Moreno

Honorable Mention, Visual Arts Category NOTE FROM THE AUTHOR: In “Migration,” I express my perception of current and historical points of view on issues of immigration and the value of diversity. This is my expression of the past, present and future as related to our mutual symbiotic existence. As an observer, but at the same time a participant, I feel a sense of time standing still and myself afloat, as if skydiving.

Submit your art and literature for consideration in the 2016 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 the UT Health Science Center San Antonio, the Center for Medical Humanities & Ethics or the editorial staff.

Volume VIII • 2015 Editor in Chief Chris Yan, MS4

Center for Medical Humanities & Ethics, Fellow of Medical Humanities

Executive Editor Grace Cheney, MS2

Executive Editor Jane Yoon, MS2

Director of Design Sara Noble, MS2

Editorial Staff Whitley Aamodt, MS4 Luyang Jin, MS1 Inez Leal, MS3 Karen Lin, MS2

Copy Editor Sheila Hotchkin

Faculty Advisors Jerald Winakur, M.D. Lee Robinson, J.D. Ruth Berggren, M.D.

Art & Photography Selection Panel Julia Blood, MS3 Spencer Cope, MS1 Arielle Ferris, DPT Student Jacob Ferris, MS3 Maggie Gainer, MS3 Sammar Ghannam, UTSA FAME Freshman Chris Lam, MS2 Patricia Stievo, MOT1 Nathan Sweed, MS2

Literature Selection Panel Sam Butler, PA1 Shaoli Chaudhuri, MS2 Abby Coldren, MS4 Chris Lam, MS2 Rob Schonhoff, PA1 Nathan Sweed, MS2

E d i to r ’ s N ot e

Chris Yan Editor in Chief Connective Tissue Volume VIII

In 2011, when I picked up my first copy of Connective Tissue as a first-year medical student, I viewed it as a fun art and literature publication simply for enjoyment. After being with the journal these past four years, I realize how valuable it is to our community as a voice not just for creativity and artistry but for humanism. I am a believer in the ability of our humble publication to give voice and meaning to the things we go to work for every day and to somehow show us that our goals are ultimately aligned, if not the same. Our mission, to nurture a collective humanity and build meaningful connections within the UT Health Science Center at San Antonio, is realized more and more each year.

In recent years, we have seen more and more submissions from across the Health Science Center. This year, after a strong effort by our advisors, editorial committee, selection panels, and you, our contributors and supporters, we received close to 200 submissions in literature, photography and visual art—our largest number yet. Our artists and authors are students and working professionals spanning disciplines and from outside health care. What is striking is how this alone has made Connective Tissue better and better. It is not that art and literature have suddenly boomed in our community. We’ve simply heard from more of you. It is clear that you all have much to share, and we are proud to give voice to your work.

A special thanks to Dr. Ruth Berggren and the Center for Medical Humanities & Ethics for making this journal possible; to Sheila Hotchkin for her editorial expertise; to Dr. Jerald Winakur and Lee Robinson for their support and guidance; to the editorial committee and selection panel members who gave the gift of their time to help create this year’s journal; and to all of the artists and authors who have shared their lives and passions with Connective Tissue.

It is your work that gives Connective Tissue its voice and relevance and that ultimately reveals to us the greater story of ourselves: one institution of many individual stories, connected by a common thread of humanity and compassion.

And so, without further ado, it is my pleasure to present, in its eighth volume, the 2015 edition of Connective Tissue.

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P o rt r a i t o f a Pat i e n t : M i m i NOTE

from the Mimi was diagnosed with leukemia in November 2013.

Artist

In my panic, I asked if I would be allowed to take photos to document her life. I feared the worst.

I wanted her parents to have that reminder of her “Courage,” “Strength” and “Hope.”

Courage

Veronica Bove School of Medicine, Div. of Plastic & Reconstructive Surgery, Healthcare Receptionist– Intermediate

iii

A 5 5 - word story by

M i m i ’ s Dad

My knees felt weak, I couldn’t catch my breath. I ran out of the room and cried. My baby had cancer, and all I could think was, “She’s going to die.” Treatment began almost immediately. She is doing great and continues to receive chemo. Her doctor is a godsend. Her strength has restored my faith.

Strength

Veronica Bove School of Medicine, Div. of Plastic & Reconstructive Surgery, Healthcare Receptionist– Intermediate

iv

A 5 5 - word story by

Mimi’s MOM

I lay on the stretcher with my fevering baby waiting for results. The doctor pulls the stool closer and says, “It’s leukemia, just like we suspected. I’m sorry, mom.” I held my Mimi tighter than ever and cried, and just like that our world was turned upside down. She is now 14 months in remission.

Mimi present day

Hope

Veronica Bove School of Medicine, Div. of Plastic & Reconstructive Surgery, Healthcare Receptionist– Intermediate

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C o n t e n ts Winners

Honorable Mention

L Literature

Histories of a Present Illness

L Literature

8

Shaoli Chaudhuri A Visual Arts

Flowers For The Borderland

10

Alcatraz Hospital Ward

Migration

16

Carlos Moreno, R.N., M.S.N. P Photography

11

12

Nathan Sweed A Visual Arts

David Baker P Photography

Vivisection

White Rhino

17

Susan Buentello

Ann Hua

Committee Selections L Adipose Mia Gonzales

18

25 L Primary Impact Helen Lukefahr Tanner, M.P.H.

A Brown Eyes Jennifer Leet

19

L Fibrillary Tangles Christopher K. Lam, BSME

P Stairway to Heaven N. Carol Dornbluth, M.D.

20

A Surviving the Ocean’s Grip 27 Carlos Moreno, R.N., M.S.N.

L MRI Mo H. Saidi, M.D.

21

P Kasahoun Katherine Berry

28

L One Morning H. Korman

29 30

23

L The Years of the Pages Monica Sok

31

24

A The Art of Neurology Ali Walsh

22 L Hero for a Rainy Day Dorothy Long Parma, M.D., M.P.H. P Collecting Water in

the Rain

Katherine Berry A Vibration Kavina Patel

26

P Vietnamese Peddler Patrick Nguyen, M.D.

32 33

A Riverwalk Jennifer Leet

34 L Napping Toddler Pose Dorothy Long Parma, M.D., M.P.H.

P View to Old San Juan Alyssa Laurel

46

underground railroad

L Borderline Weiran Wu, M.D., Ph.D.

47

L Mac at the End Elizabeth Allen

48

66

A Oh Georgia Kimberly Vogelsang

67

P The Gift Jessica Hollingsworth, M.D.

68

L After the Rain Rebecca Ajtai

69

52

P Dewdrops David Roland Rodriguez, M.A.

70

P Desert Window Spencer Cope

53

P Papa’s Secrets Mai Luk

71

L Ragdoll Pamela Camosy, M.D.

54

72 L La Lou Danny Duke, M.D., Posthumous

P The Battlefield Jessica Hollingsworth, M.D.

56

P Purified by Fire Ryan R. Sheridan, D.M.D.

57

73 L 326A Sara Noble, Director of Design

L A Minor Hit Susan Seale Jarvis, J.D.

58

L Spin Class Jane Yoon, Executive Editor

A Enteral Sea Rachel Baker

62

75 P Open Doors Grace Cheney, Executive Editor

P Clownfish Alex Pong

64

35

A The Saga Christian Cueva, M.D.

50

A Untitled Kimberly Vogelsang

36

A Lionfish Alex Pong

51

L Independence Day Johanna McLendon

37

L

A The Patient Inside of Me Sammar Ghannam

39

P wwjd Harry Burg

40

P Black and White James Liu

41

L Patmos Michael Miller, M.D.

42

P Eiffel Lights Mai Luk

44

A Pieces of a Memory Heidi McDonald

45

L

Literature

A

A n Unfinished

Apostrophe to Marriage

38

Visual Arts

65

Patricia Wathen, M.D. P Door County James Liu

A I love you, Dad Mary Lou Quiroz

L The Unknown Story Ciera Kaylynn Ward

L This is not your

Cervando Martinez, M.D.

P

Photography

Editors’ section

L Holding Clinic in

Sabana Real

Chris Yan, Editor in Chief

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76

W i n n e r, L iterature Histories of a Present Illness Shaoli Chaudhuri

School of Medicine, MS2

Ms. Z. is a 25-year-old Asian woman with a history of doubt. It keeps her up at night, weaves itself into her dreams, follows her along her daily commute down I-10. At times, it suffocates her—but she attributes this to GERD.

Mr. R. knows she will sigh to herself and later recount the story of the old, senile man who won’t take care of himself or leave his house, and what the heck is she supposed to do with illegal patients like him?

Ms. Z. comes into clinic alone, as per usual. She keeps her complaints—chief or otherwise—tucked into herself, obscured by a calm smile and tortoise shell glasses.

And during the appointment, Mr. R. will sit on the bench with the white tissue paper and nod, wishing the Doctora Rogers had an orange prescription bottle for el miedo.

But the doubt remains inescapable. It grasps at the hem of her white coat, weighing it down as if she has choked the pockets with rocks; it slows her steps as she rounds with her attending.

Mr. R. is a 65-year-old Hispanic man with a history of fear.

‘Noncompliance,’ his doctor writes in her notes.

Mr. R. arrives at the clinic with his daughter to translate. The doctora, he knows, will chide him for missing his last two appointments. She doesn’t understand. She doesn’t see the Migra, the Border Patrol, lurking outside his apartment windows. She doesn’t have to take a 15-minute detour to avoid the police station every day on the way to work.

She doesn’t live in fear, like it’s a darkened room.

El miedo is a shadowed being creeping into his dreams, keeping him awake throughout the night.

8

Ms. Z. does what she needs to, of course. She rounds first thing in the morning. She writes her notes. Sees her patients. But when she lies down and closes her eyes in the call room or her sparsely furnished apartment (which, let’s be honest, looks a lot like the call room), behind her eyelids, Ms. Z. sees her failures.

She sees her first C of medical school. The million unchecked to-dos on her to-do list. She sees her reflection in the mirror—small, brittle, nothing remarkable except for the darkening circles under her eyes. And the doubt seethes through her, viscous and slow like too much blood has collected in her vessels. Polycythemia, she’ll say to herself automatically as she tries to fall asleep.

She can’t.

A few months back, Mr. R.’s PCP diagnosed him with “tinnitus,” but only because she can’t hear the same harsh ringing in her ears that he can. The sound that always morphs into his brother’s last yells before the Border Patrol packed him into their steel van.

Packed him tight with the others like cold meat, while Mr. R. hid in the brush.

His PCP also diagnosed Mr. R. with “dysgeusia from medications,” but she doesn’t taste the Chihuahuan Desert in her mouth like he can, doesn’t feel the gritty texture of sand drying her throat and smothering her words when they took Juan Carlos away so many years ago. Back to Chiapas while Mr. R. remained in the U.S. “According to his daughter, patient is still upset about recent death of his brother who lived in Mexico,” Mr. R.’s PCP wrote during the last visit. Mr. R. simply studied his nails as the doctora typed, and he let his daughter do the talking.

NOTE

Last night, a full moon feather-edged with streetlights filtered through Ms. Z.’s closed curtains and cast her room in a ghostly light. It illuminated her oak desk, her copies of Harrison’s and First Aid, her mountains of handwritten notes.

She lay awake again, blocking out school, thinking instead of her mother and her boyfriend back in California. The smell of her mother’s home-cooked food, the comforting pressure of Adam’s hand on her shoulder. She should call them, she thought to herself for the hundredth time that month. Then she crumpled back into the covers, as easily as crepe paper.

From his seat on the exam table, Mr R. hears the creak of the door. Surprise flashes across his face.

A new doctora shakes his hand.

Ms. Z. and Mr. R. smile at one another, simultaneously aware and ignorant of the ache that comes with the effort. Both wishing themselves back home, alone, with the shades pulled over the windows.

from the For all the people who live in the shadows

Author

Para todas las personas que viven en las sombras

9

W i n n e r, V isual A rts

Flowers For The Borderland David Baker

Creative Media Services, Medical Illustrator

NOTE

10

from the Oil on canvas, 2014

artist

42� x 42�

W i n n e r, P hotography

Alcatraz Hospital Ward

Ann Hua

School of Medicine, MS2

11

H o n o r a b l e M e n t i o n , L iterature Vivisection

A Poem by Nathan Sweed School of Medicine, MS2

I.

II.

“Now you see here boy, light, from an image, travels toward a lens, yes, is bent by the lens, here—against its trajectory—now at a distance passed the lens, you see, here, the image is reconstructed. Now just in front of or just behind that distance— well it’s like you’ve cut the tip off a cone—so—you see, a circle. So you’ve got your lens, many images, many cones, many points—and—many circles. Yes, now photographers will even use this effect, they call it ‘boh-keh’. And see, where the circles intersect, light adds to light—and—their inten-sity becomes greater— not the points boy—the intersections.”

The room came into focus. Next to me a very luxurious-looking hedgehog. I squinted my eyes. Yes, exactly. A very, very luxurious-looking hedgehog.

“Medicinal,” came a voice.

“Medicinal,” it came again, this time bringing with it a rather tall, thin man and, what belonged to him, this, exquisite white, enormous mustache sitting over these—spaced teeth through which emerged a very clenched, “Sandy.”

The word drained out.

He turned away so that I was now, my head turned against my pillow, looking at the thick seams of a fitted tan coat. I initiated to reach my hand, but dismissed the thought.

“Sandy, my boy, short for ‘Ampersand,’ you know.

Like the conjugate. Eight percent improved recovery time in patients administered hedgehog therapy.

N-E-J-M. That’ll be the New England Journal of Medicine. Very scientific son, very pres-ti-gi-ous.”

My right wrist felt heavy. There amongst the plastic hospital bands, amongst the tape and the tubes and the unruly little adjustable straps that stabbed into my forearm with the sharp unspoken promise that I would be cared for were I a man or a birch tree, there was my watch.

I lifted my head from the bed and stared at this— weight. I stared as my stomach diffused across my body. I stared—as the corners of my mouth drew tight, I stared at this maddening weight.

“I think—” I could barely speak. “Sir, I keep my watch on this hand.” I gestured left-wise with my forehead.

He looked into his lap and then at the table beside us that held his instruments.

He placed his hand on my shoulder.

“I’m sorry son. Your arms— we had to switch them.”

12

He said it just like that. Preh-stij-ee-us.

“Eight percent, colonel. Eight percent, but only in subjects unaware of the study.” I had not seen this man but there he was by my footside, planted deeply in a medical chart. He all but lacked shoulders. His head emblazoned with a sharp, dark widow’s peak.

He looked as though he might, at any moment, disrobe his human exterior and slither mercurially right out the door.

III. “Five—percent if they were aware of the study.” And to himself, “A nontrivial loss.” His lips came together and flattened against each other, thinning further his already thin face. He looked at me, his eyes widened, “Eight percent with the therapy alone, nothing else. Five percent when we administered therapy and subsequently told subjects about the study.” His mouth exaggerated his speech to indicate that this was him explaining. “Down to two when we told them about that study,” the nurse chimed, her head dipping back and forth as if she was echoing a commercial she’d seen too many times. “And up to nine when we told them about that!” the widthless indigent shot back. “Up—to— nine!”

“And after that?” I had to ask.

He slunk back into his chart smiling. “Study’s ongoing.”

“THEY DIED!” The colonel put his hands up and launched toward me. He waited for laughter.

A corner of tan coat glanced my forearm. I felt the sensations change. Skin, Tape, Skin, Tape, Tube, Tape, Skin.

“You’ll like this one I think.”

His eyebrows went up. Yet a new seriousness dawned over his face.

“What would you call Achilles if he were an amputee?”

He gauged my face curiously. Over his shoulder I saw frustration mounting in the nurse’s eyes. I caught her mouthing the answer as she turned toward one of the several stainless steel carts that dutifully lined the walls—one-half beige, one-half seafoam green. Her head bobbled in its orbit as she played out a brief caricature of the old man. The colonel, noticing my interest, glanced back, and then immediately around again—this time closer—he took my face in his hand. “Courage, my boy.”

“It’s the first casualty in a symbolic rebellion.”

None came.

The man by the footside exited. He did not disrobe.

He remained, by appearance, and, in effect, at least—a man.

13

IV.

V.

He sat me up and took my face in his hands as he peered curiously into my eyes. He was comforting, and I trusted that his hands knew better where my face ought to be than it itself did. And—odd as it was, I couldn’t help but notice—his hands, they smelled—good.

“Invaginated cornea,” he announced as if to be narrating to the room. He placed his instrument on the bed against my thigh—victory. He rose up, placed his hands on his sides, and moved back.

I looked at him, waiting for my explanation.

He bent at the waist. He let his face drift near to mine. His exceedingly round bifocals slouched on the bridge of his nose.

“Have you been to a fun house?”

This was directed at me.

“Those mirrors with a dip or a bend in the center—” his hand cupped a “U” out of the air. “From a distance you might notice only a slight alteration,” his hand waved between us, “a previously absent arc, let’s say. But as you draw nearer the distortion becomes—profound, so profound that, the image, when, placed eccentrically,” his hands shifted down and away from his midsection, “will curve around that original imperfection until—” his hands now separated and his fingers traced two long opposing curves over his head.

I laid back into my pillow. For a few moments they just left me. I hadn’t seen them leave but I knew they were gone. And with them whatever sense of urgency I may have felt left as well. I watched the ceiling and thought about points of light bent around like a crescent. I thought about Ampersand and The Colonel. I thought about the New England Journal of Medicine and of every letter falling out of every sentence falling off of every page.

I must have been gone for some time when I began to feel something creeping along the back of my head. Suddenly, and without pretense, an array of press-on nails gored my neck. One exceptionally audacious hand lifted my head and its sympathetic ally upended the pillow beneath it.

The offenders, having startled me fully, slid away as quickly as they had emerged, and, soon after, in their place the warm sensation of breath lingered behind my ear and sat heavy on my shoulder. Strands of hair grazed my face one after another after another in an endless parade of wisps and flicks. A set of lips hovered above me.

“That’s— one— cool— underbelly.”

And they touched.

He sat and pushed the glasses up his nose while he looked at me over them. “Like a crescent moon.”

The colonel placed his hands on the man’s shoulders and looked at me. He looked. He looked desperately.

14

VI. I awoke hours later to the colonel thumbing through my chart.

“You’re going to die here, you know. On earth. You weren’t built for space. Haven’t got the vestibules, no. No, I suspect you’ll never make it past the troposphere.”

“I suppose not, Colonel.”

He leaned in. His eyes were right on mine.

“Cerulean,” he said.

I swear his whiskers were in his voice. I swear I heard the space that framed his teeth He was bent over right on top of me.

“The lie they tell you is that your first patient is a cadaver.”

He was in my head—“cerulean.”

“That’s the big trick, that’s their biggest trick.”

He became raspier, madder “That’s— their— biggest— trick.”

He arched over me.

“Cerulean.”

It was the shadow of a thought. It gurgled and gasped like a shower drain from behind his teeth.

There in that dimly lit room he had offered me an invitation—and I obliged it. As only I could. There in that hawked desert of a man and his reflection.

There without the grace of madness I obliged it.

And his brow lowered and I saw pity.

NOTE

from the For Ruth Zisman. Thank you for everything.

A u t ho r

15

H o n o r a b l e M e n t i o n , V isual A rts

Migration

Carlos Moreno, R.N., M.S.N. South Texas Veterans Health System, Frank Tejeda Outpatient Clinic, Mental Health Services, Instructor of Creative Arts Expression Group NOTE

from the In “Migration,� I express my perception of current and historical points of view on issues of

artist 16

immigration and the value of diversity. This is my expression of the past, present and future as related to our mutual symbiotic existence. As an observer, but at the same time a participant, I feel a sense of time standing still and myself afloat, as if skydiving.

H o n o r a b l e M e n t i o n , P hotography

White Rhino Susan Buentello

Briscoe Library, Librarian, Retired

17

Adipose

Mia Gonzales School of Medicine, MS2

At a certain age Chemicals change And the deposition Of adipose along The perimeter Becomes a great concern To everyone Small, white, lipid-filled cells marshmallows on a slide sex On the surface Cells that don’t do Only store chemical energy Keep the organs warm Cover the body in a plush sheet Aggregate under the clavicle Just below the waist It’s here we see something Simple begin to Perplex At a certain age Fluff cells become more Useful than ever An invitation to femme Intended for survival Now keeping everyone warm

18

Brown Eyes Jennifer Leet

School of Medicine, MS2

19

Stairway to Heaven Melk Abbey, Melk, Austria N. Carol Dornbluth, M.D.

School of Medicine, Dept. of Radiology, Clinical Associate Professor

NOTE

20

from the Melk Abbey sits atop a rocky outcrop in the Danube Valley, Built around 900 years ago, it was

artist

presented to the Benedictine monks. After near total destruction by fire, it was rebuilt in the 18th century and served as a palace with great halls and a huge library.

MRI

Mo H. Saidi, M.D. School of Medicine, Dept. of OB/GYN, Professor, Retired

Thirty more minutes to go captive in the bright tube click, click, click IV fluid runs into my vein drop, drop, drop knock, knock, knock.

I’m pulled out, the ceiling fan dries my sweaty face. I’m dizzy when I rise. I walk to the car the birds circle above, disappear in the whitened skies. Lightheaded, I hold the handle for a while.

My head bound in a positioning block; I’m pulled farther into the hole: tuck, tuck, tuck. kick, kick, kick boom, boom, boom a pause, then click, click, click Slim flow of air enters the tube cools my face, hands dong, dong, dong. bang, bang, bang the rectangular frame above my head glows with fluorescent light ding, ding, ding knock, knock, knock I wiggle my toes, unable to see the sun above the roof scattered clouds, the birds the branches. I think of the leaves and ants in the Amazon: one, ten five hundred and fifty-nine of Doc Paterson’s plums four, seven, so sweet and so cold.

Beeeeep, beeeeep, beeeep.

NOTE

from the A physician-writer, Mo H. Saidi is the co-founder and editor of Voices de la Luna: A Quarterly

Author

Poetry & Arts Magazine. His latest work, The Marchers: A Novel, will be published in 2015 by Word Studio Press.

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Hero for a Rainy Day

Dorothy Long Parma, M.D., M.P.H. School of Medicine, Institute for Health Promotion Research Dept. of Epidemiology and Biostatistics, Instructor/Research

You haven’t asked for gummies in a long time.

It was the green one, as I recall That got stuck. You coughed. You cried, Distressed. Drooling.

I felt your expanded chest, firm, Pressure with nowhere to go.

You were choking. I turned you on your belly Head down, and applied back blows.

No, that’s not right, you are too big for that.

Not a baby anymore. I sat you up, Still you coughed.

I wrapped my arms around you and made A fist of my hands. I pushed, hard and fast Up against your sternum. And again.

Again.

You vomited orange juice and gummy Crying, the pressure inside you eased.

I sat you down by the bathroom sink And washed your face; took off your soiled clothes, Changed you into your pajamas.

“No more gummies,” you said.

I could only nod in relief.

22

Later, at the end of your favorite book, I read: “Our hero for a rainy day -- is…”

You jumped up and shouted, “Mommy!”

A wide smile on your face.

I looked at you for a moment. How could you know…?

“Thank you, sweetie,” was all I could say.

Later still, as you drowsed in my arms I thanked God for the miracle of you.

Your father says I may have saved your life.

I have tried not to think about whether I had performed the rescue technique Correctly.

You are alive. That’s all that matters.

Collecting Water in the Rain Katherine Berry

School of Medicine, MS2 NOTE

from the During the rainy season, a young girl leaves the relative dryness of the kitchen to collect water from

Artist

the rain harvester. Common River, Aleta Wondo, Ethiopia. Common River, a partner of the UT Health Science Center’s Ethiopia Outreach global heath initiative, serves to empower and educate the Sidama Zone of Ethiopia.

23

Vibration Kavina Patel

School of Medicine/UTSA FAME Program, Freshman

NOTE

24

from the Every feeling or thought has a vibration on our life. The effect of the vibration resonates to

artist

multiple aspects of our life. This modern abstract painting is done with acrylics on canvas.

Primary Impact

Helen Lukefahr Tanner, M.P.H. School of Health Professions, PAS1

Primary Care - what does that mean?

The front line, the “quarterback,” the triage M.D. Internal medicine, family practice and peds; There are many more, but those are the main three.

Important roles to play in patient care; So many needs, so little time to share.

Medical education is long. The debt is high; The pay is low. The patients whiz by.

Burnout looms. Insurance demands.

Billing is central. Seems to be out of our hands.

Costs are increasing. Limited access to care.

Affordable Care Act - Is this good or a snare?

Seems like this is good for me - a PCP. But, holy moly! - Primary care and government funding?

Private insurance - so frustrating; No insurance - equally infuriating.

Can we sustain this? I do not know.

But, my passion is medicine - forward I will go.

Work/life balance. Does it exist?

Shortage of docs. Other providers enlist.

PA’s certainly help fill the gap.

Well-trained, devoted, help increase patient cap.

Change is constant. Health care is essential.

Primary care forever has potential.

Teamwork, flexibility, an open mind Three attributes that cause success to align.

Where will we be in 2024?

I hope we will be where we haven’t been before.

I’m an advocate for a new way to practice.

The need is clear - the old way is amiss.

Patient Centered Medical Home.

Innovative? Yes. Too far to roam?

NOTE

Backed by many. Contagious support.

Even NEJM is quick to report.

Collaboration and Quality. Comprehensive Team.

Accessibility to providers - technology is a dream.

Promise is there. Primary care mission enhanced.

Patient centered care - medical care advanced.

Perhaps this method will initiate a turn.

It already is. So much to learn.

The future is here. Time to endow.

Many innovators already implementing now.

Are there other ways we should consider?

Sure - but which is the winning bidder?

Other options? They are there.

Money is tempting - perhaps concierge?

Is it for me? Maybe. Not sure.

I like to help the underserved.

Telehealth. Expanded specialty access.

Better care for rural health success.

Hospitalist model. Contract work.

Moonlighting, CMEs, “Doc-in-the box” casework.

Life is longer. Geriatrics is big.

Obesity, Cardio, COPD - too many cigs.

Public health issues, Cancer concerns.

So much to think about - so much to discern.

Pharmacogenomics. PSAs - do we run?

Antibiotic resistance - don’t be the smoking gun.

The road map is forming; we can all be a part.

Of a movement to navigate through a new start.

Primary care - such an opportunity To do what you love and impact so many.

from the After returning to school to pursue PA studies as a second career, I am constantly struck by the

A u t ho r

ongoing, complex issues a primary care provider faces (or will face). This is a poetic expression of where I see the future of primary care - at this point in my career as a student.

25

Fibrillary Tangles

Christopher K. Lam, BSME School of Medicine, MS2

those relaxing days selling lemonade, a run – chirping all around that sound! oh puddles on the ground, grass pokin’ ‘tween my toes, a breath, the sun shining life into my hands.

I say to you, always remember those days;

NOTE

26

these days: never forget, I tell myself. at my feet, the warm life of blood! wait. breathe. glass piercing through my soles ...spirits soak the rug... oh. this feeling! butterflies all inside, the runs – I’ve only lemons these taxing days.

from the For readers who may be less familiar with medical terminology, the title alludes to a finding in

A u t ho r

the brains of patients with Alzheimer’s disease (neurofibrillary tangles).

Surviving the Ocean’s Grip Carlos Moreno, R.N., M.S.N.

South Texas Veterans Health System, Frank Tejeda Outpatient Clinic, Mental Health Services, Instructor of Creative Arts Expression Group NOTE

from the During my teenage years, my cousin from New York would visit my family every summer in Rincon,

Artist

Puerto Rico. One summer day we were sitting on our surfboards waiting to catch the good waves.

The ocean was calm, but panic set in when we realized that the strong current was pulling us out to sea. We paddled on the surfboards to no avail. We decided our best hope was to abandon our surfboards and begin swimming. We began to petition God to save our souls. Fighting for our lives, we began praying the Lord’s Prayer. He prayed in English, and I prayed in Spanish.

While we were swimming, a large school of silver-colored sardines was passing in front of us.

Suddenly, due to exhaustion, I began sinking. Dazed, I had a vision of a big man wearing a long conical pointed cap. He was throwing fish skeletons onto my back. The pounding of the bones on my skin was unbearably painful. I awakened from my trance and started swimming as hard as I could to the surface to catch that life-saving breath of air. At that moment, that long-awaited powerful wave miraculously engulfed our limp bodies and swept us to shore.

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Kasahoun

Katherine Berry School of Medicine, MS2

NOTE

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from the Kasahoun admires crosses for sale outside Entoto Maryam Church, Addis Ababa, Ethiopia.

artist

Kasahoun was one of the Ethiopians on the transportation and translation team for our 2014 UT Health Science Center Ethiopia Outreach global health initiative.

One Morning H. Korman

School of Medicine, MS1

Shabbat Shalom.

This place feels like home, The stone under my hands worn and weathered by the oils of my ancestors, The protectors of my identity and origin Today is a day of days, So normal, but so shining, glowing like Jerusalem stone in the morning I look out my window I feel the energy flowing; some ether is growing within me, An ether unknown, some piece unshown is slowly unearthed before me.

Buildings, ruins, and cities, Stories, friendships, and memories, So much has been heard but unspoken, so much has been felt but untouched The shell of this heart broken open, But its beats have grown so much.

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The Years of the Pages Monica Sok

School of Medicine, MS2

On day one we stood and swore an oath Together we donned white coats and stethoscopes To treat our patients right and never gloat To respect medicine and always hope Then we learned and dissected body parts Memorizing the arteries and nerves Studying what was once a beating heart Paying our cadavers respect they deserve We practiced reflexes and looking into eyes Palpating abdomen and testing ears Stammering and writing our HPIs Getting over our interviewing fears Hitting rock bottom and letting tears fall Learning to climb up and back into shape Nights of flashcards – Staph, Strep, and them all Flu and testing for worms via scotch tape Then studying became not so bad There were times for sports, coffee shops, and fun Able to visit home and mom and dad Nice dinners, movies, and soaking up the sun There are many patients we were blessed to meet Pill-rolling tremors in a man so kind Champagne legs in a lady so sweet Dilated veins and red spots intertwined We near the end and we shut the books We take the STEP and hold our heads high And now in fresh, pressed, green scrubs we look Ready for the next stage with a bright eye

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The Art of Neurology Ali Walsh

School of Medicine, MS2

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Vietnamese Peddler Patrick Nguyen, M.D.

School of Medicine, Dept. of Surgery, Assistant Professor

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Riverwalk Jennifer Leet

School of Medicine, MS2

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Napping Toddler Pose

Dorothy Long Parma, M.D., M.P.H. School of Medicine, Institute for Health Promotion Research Dept. of Epidemiology and Biostatistics, Instructor/Research

I am a tree, upright Branches reaching toward the sun In whose shade you seek comfort And nourishment.

Your head rests in the crook of my arm My arm, curved, hand open, fingers sending out To allow chi to flow through And spare my limb from bearing your full weight.

I breathe deeply from my dan-tian (lower abdomen) You open one eye, and smile, And breathe in‌. and out Mouthing the words as you do Matching me breath for breath.

One thing only is awry: my roots of flesh Are augmented by four wooden chair legs My back supported by a square green pillow.

I must breathe in a microcosmic orbit To make up for being seated, six-legged.

I listen to the wind blowing in the trees The train on the tracks The soft sounds of night.

As you drift and doze I come out of the posture And put you to bed.

NOTE

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from the ‌dedicated to my son, now weaned;

A u t ho r

and to the joyous memories, and poetry, that grew out of the nursing experience.

I love you, Dad Mary Lou Quiroz

Friend of the UT Health Science Center NOTE

from the

Artist

Submitted by Alice Gong, M.D., William and Rita Head Distinguished Chair in Developmental and Environmental Neonatology

I am very moved by this painting by my friend Mary Lou Quiroz. It shows a very strong father who is masculine enough to wear purple and also to openly love his son. You can hear the giggling of the boy who is being held up in the air. The boy is delighted about being scratched by his father’s facial hair. It reminds me of times when my husband would toss our kids up and catch them, much to their delight. I would like to dedicate this to all the fathers who openly love their children.

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Untitled

Kimberly Vogelsang School of Medicine, MS3

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Independence Day Johanna McLendon

School of Medicine, MS4

Her hands were cold Her lips were chapped Her side was torn Her lungs collapsed I pushed down on her chest Over And over And over again I filled her lungs with air 1, 2, 3, 4, 5— Breathe— 1, 2, 3, 4, 5 I was a human machine Among machines The monitor went silent And so did I I was so calm She was so calm And dead Her hands were cold

NOTE

from the I wrote this poem in response to my first experience with the death of a patient.

Author

She presented to the Emergency Department on the third day of my year of clinical rotations, July 4th, Independence Day. I will never forget her.

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The Unknown Story Ciera Kaylynn Ward

School of Medicine, MS2

I do not know the story— Where you come from or where you go.

I do not know your future plans, Past pains, nor present woes.

I do not know the story, But I know why you are here.

And while you stay, I’ll guide the way.

I’ll help you fight your fear.

I do not know the story, But I see you are in pain.

With all my might, I’ll remedy.

Your peace I’ll help obtain.

I do not know the story, Of what happens when you leave.

Once you are well, I hope you find New heights you can achieve.

I do not know your story, But am grateful for the time To serve you in your story And for you being part of mine.

NOTE

from the Heavenly Father God,

A u t ho r

38

Thank you for all you have blessed me with. I dedicate my life, my hands, my skills to you. Please use me to show Your love to others. Thank you for being the Author to my story.

In the name of Jesus Christ, the Savior, Amen

The Patient Inside of Me Sammar Ghannam

School of Medicine/UTSA FAME Program, Freshman

NOTE

from the “A painter should not only paint what he sees before him, but also what he sees within himself.”

Artist

—C.W. Eckersberg

Oil on Masonite, 16”x20”

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wwjd

Harry Burg Information Management & Services, Manager, Database Administration

NOTE

40

from the what would YOU do?

artist

Black and White James Liu

School of Medicine, MS3

NOTE

from the Etosha National Park, Namibia

Artist

41

Patmos

Michael Miller, M.D. School of Medicine, Dept. of Psychiatry, PGY-2

They shuffle me back to the room, the upper room I call it, where before this meeting is over, one of them will betray me. Like my family did. I do not want to drink from this cup, but if I must, then so be it. Been here since the beginning of the day. Need to get out, have work to do.

There they are, arranged at the table, all facing me, with the woman in virginal white, seated at the head to judge the quick and the dead. But I know there is a justice higher than that of man, and I will be judged by him.

How did you sleep? the mother asks. Her children are around her, also robed in white. Computers are in front of each of them. Coffees in hand. Candies in a jar on the back table. How they turn their own house into a market.

Now they fix their eyes on me. They place me at the foot of the table, where we are told to sit. I should not have to answer their questions, but even he ate with sinners.

Good, I say.

Good, she says. And it was good.

Did you have any bad dreams? She asks. I had the dream again, the one where my friend climbs down the ladder and talks to me. He’s a good friend. He listens to me. He understands me. Tells me what’s going to happen, what I need to do. I miss my friend.

No, I say. She nods her head, looks back at the radiant gamma splendor before her.

Hearing any voices, seeing anything that nobody else can see? Out of the mouths of babes. What is invisible is clearly seen, so there is no excuse. But if I affirm, there

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is no excuse from this place. They will have my head on a plate. And while I would pluck out my eye if need be, I have to get out. I have work to do.

No, I say. I continue to give them scraps. You don’t give dogs what is sacred, pearls before swine. One of the sons perks up.

No more angels? He pounces, the philistine. They don’t like to hear about my friend. About the truth. They have eyes but cannot see, ears but they do not listen. See how they sit smugly on their thrones, surrounded by things. Things that moths eat and rust destroys. Things they buy at the market. Their home. But not my home—I look forward. They sip on coffee now, but one day, they will look up and ask to dip their finger in my water, just enough to cool their scorched tongues. But it will be too late.

No angels, I say. They continue typing, sipping coffee.

None of them are looking at me now, all of them staring stupidly at their computer screens.

What are your plans for when you leave here? Mother asks. They cannot see that I am more than a man. I am not a man. I began as one, but now I am becoming more than a man, as you will witness. Your medicines will not stop me. You dress yourself like lilies of the field, but your bad fruit betrays you. I will eat the bad fruit for now, but you cannot keep me here forever. These walls will come tumbling down, and I will go forth into the world. I know because my friend has shown me. He took me up to the mountaintop and showed me the promised land, to be forged out of this fallen world. I have work to do.

Go home, see my family, I say. The family that put me in here. They don’t understand either. That’s why I’m here: their betrayal. Only my friend understands. No, I won’t go back to that. The old world, with all its troubles and tumults, has passed.

And I smile. Because I know they cannot keep me here forever. Another weekend, yes, but they can’t keep me here forever. I will take their bad medicine. I can recover.

What they tear down, I will rebuild. And I will get out of here. I have work to do.

I’ve been so good. Won’t you let me out? I have work to do.

I’m still concerned about your internal preoccupation, the shepherd says, her flock listening now. You haven’t been to group. You’re not eating well. The nurses say you spend all day in your room and when you do come out, you stand in the corner and don’t talk to anyone.

Here she goes again. Telling me I don’t look well, I don’t act right. Only looking on the outward appearance. And the food? Not by bread alone.

But I’ve been so good, I repeat. Won’t you let me out? I have work to do.

And I’m not too comfortable about this work you keep bringing up, she says. I think you need to stay at least over the weekend.

And so the conversation is over. Again, I am betrayed.

Forsaken. They take me out of the room back to the commons, where group is happening. I sit on the couch next to the lost sheep, but I do not listen. I look forward, past this valley of shadows, lifeless shades of people gliding over the tile floor.

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Eiffel Lights Mai Luk

School of Dentistry, DS3

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Pieces of a Memory Heidi McDonald

School of Medicine, MS2

NOTE

from the This painting represents the night my husband and I first said, “I love you.� The shoe in the

Artist

picture is the shoe he was wearing that night, and the sequins are from my dress. It was one of the best nights of our lives, and whenever we see that picture, we are taken back to that night.

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View to Old San Juan Alyssa Laurel

School of Health Professions, MOT1

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Borderline

Weiran Wu, M.D., Ph.D. School of Medicine, Dept. of Psychiatry, Clinical Faculty

Fidgety soul dangling on the edge of future and past, Hummed by the past, never rests in a heaven.

Twitchy mind swinging at the split of day and night, Tapped by the night, never anchors in a haven.

Mommy’s necklace with a broken pendant, heart-like Slips through fingers, never attached to her heart.

Daddy’s rampage with a dark fetish, twist-like Clips through flesh, never healed from his twist.

Abandoned like an unsteady shallop, lost in furious ocean.

A meteor flitted by, emptiness is the only leftover.

Wrathful like an unpredicted tornado, rips off frightened virgin.

A storm skimmed over, impulsivity is the only hangover.

Blurred image dissociates without sense of self; Shattered intimacy derealizes without memory of belief.

NOTE

from the This poem depicts borderline personality disorder.

Author

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Mac at the End Elizabeth Allen

Office of Communications, Media Relations Officer

“It tires me to read. I just watch (slowly, with breath, big eyes widen, then wander) without my glasses, I see shadows on the wall.

It’s like watching clouds.

They change shape. I (breathe) see faces.”

He can see a sliver of sky out the hospital window he doesn’t want to see more of it although I offer to open the shade.

He’s been wanting a long, hot soak At least (smiles) he’s getting a sponge bath from the nurses cheery, plump, fresh-faced.

Mac used to be a big-bellied East Texas good ol’ boy Raised up in the family grocery “The Sto’” Small items for their poor customers A few eggs at a time Some bread Some credit He loves to tell stories of the sto’ Mac is a famous talker.

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Now his shelf of a belly has receded, vanished, consumed.

A big-boned man, his eyes moon out of his face all hills and planes and caverns, neck attached to a fading body.

His left side is no good. If he touches his own skin, the jangled, short-circuited nerves shoot tingles up and down his body It almost hurts, like a funnybone almost hurts.

A funnybone the size of half his body.

He says he has Bell’s palsy too In half his face He’s seen that in others But his face is still mobile His left eyebrow moves with his right Both eyes widen when he makes wry remarks The left corner of his mouth talks just as much as the right; Mac is a famous talker.

He is having a hard time breathing, he said, sitting up in his hospital bed, You’d think I’d have an easier time If I’d just lie down, but no.

He said My therapist said you know what to do if you’re having a hard time breathing, don’t you?

He said Just shut up, right?

Yes, just shut up.

Mac is a famous talker.

NOTE

from the Mac (Robert McLeroy) was a friend and a veteran photographer at the San Antonio Express-News.

A u t ho r

He was kind, and he had a lot of stories. He had a stroke in the spring of 2009, and it was a long time since I’d seen him when we visited in the hospital late that year. He died soon afterward.

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“The Saga” at San Fernando Cathedral, San Antonio, TX Christian Cueva, M.D.

School of Medicine, Dept. of Internal Medicine, PGY-1

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Lionfish Alex Pong

School of Medicine, MS2

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An Unfinished Apostrophe to Marriage Cervando Martinez, M.D.

School of Medicine, Dept. of Psychiatry, Professor

We kept putting you off, You waited patiently.

Arguments against you were marshaled: You will jinx the relationship.

You are too complicated.

There is no point to it.

You refused to leave the premises though.

Didn’t take offense.

Dutiful, quiet, tolerant of ambivalence and worries.

Finally Sylvia and I weakened and we asked you to join us.

This time you played the reluctant one, asking if we were really, really sure.

We insisted we were.

Our kids, family, and church all said it was time to get on with it. This had gone on long enough.

You know the rest of the story.

NOTE

52

from the This apostrophe was inspired by the book of poetry—New Addresses by Kenneth Koch—which

A u t ho r

contained a collection of apostrophes to such things as stammering, my twenties, consciousness, and other worthy objects. It was also inspired by my marriage to my wonderful wife, Sylvia.

Desert Window Spencer Cope

School of Medicine, MS1

NOTE

from the The early glow of sunrise helps to highlight the warm colors of the desert as viewed through the

Artist

picturesque “Mesa Arch” in Southern Utah’s Arches National Park.

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Ragdoll

Pamela Camosy, M.D. School of Medicine, Dept. of Family and Community Medicine, Assistant Professor

The Raggedy Ann doll was lovingly handmade by Adriana, a young patient of mine in her early twenties, who stitched it while she was pregnant. The doll was special, cut and sewn with excitement and happiness.

Her husband was a Navy sailor, serving overseas on an unaccompanied tour, so she had time on her hands and a creative spirit. Adriana obviously loved her husband and her unborn baby very much and missed her husband enormously. At every visit she pleaded with me, “Please, Dr Camosy, can’t you get my husband home?”

Unfortunately for her and multitudes of military wives, a pregnancy is not a reason to end an overseas tour and bring the father-to-be home.

often show her just where I felt her baby’s head, bottom, feet.

Adriana completed the Raggedy Ann doll when she was about seven months pregnant and brought it to her next appointment. My clinic staff and I were all smiles. The doll was crisp and smiling and pretty, about the size of a real baby. With the help of a few other wives from the squadron, she told us, she had set up the baby’s crib in a corner of their small bedroom. She asked me again, this time with tears in her eyes, “Can’t you get my husband home? I really need him here when I go into labor.”

Early in her pregnancy, when she learned that I, too, was a “crafter,” she brought the cloth pieces of the rag doll to her prenatal appointments to show me as the project progressed. A white cloth arm and hand here, now the flowery pinafore dress, then the pretty red yarn hair braided just right. She had thrown herself into the project and it seemed to help her deal with her pregnancy alone, without the man she loved by her side to share the excitement and to celebrate the milestones.

Adriana lost the baby during the third trimester; in medical terms it was an intrauterine fetal demise; in lay terms, a stillbirth, and in human terms, a tragedy. One day, she called the clinic to report that she had not felt her baby move for several hours, and I agreed to meet her on the OB ward. When I could not find a fetal heartbeat with the Doppler scope, we went to Radiology for a formal ultrasound, both of us on the verge of panic. There was no cardiac activity, and it appeared that the cord was around the baby’s neck. “The baby has died,” I told Adriana gently. ‘’I am so sorry.”

At each prenatal visit I measured her abdomen, telling her that the number of centimeters was about equal to the weeks of her pregnancy. We hugged each other when I first heard the baby’s heartbeat with my fetoscope. In those days real-time ultrasound was not widespread, and static ultrasound was not routinely done in healthy lowrisk pregnancies, so we “watched” the baby grow as best we could as the weeks passed: her abdomen grew nicely, fetal movement was great, and at her appointments I let her listen to the heartbeat with my fetoscope and could

Ironically, now I could bring her husband home. Through the American Red Cross office at the hospital, I spoke with her husband via telephone on my end and radio on his. The connection was garbled and full of static since he was in the field, but I was able to tell Robert the sad news and assure him that I would take care of his wife until he could return stateside. I told him that his commander and the Red Cross will arrange his immediate flight home. My healer’s heart was breaking.

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Before he returned home from overseas, though, their baby - their dead baby - had to be delivered. With the guidance of the obstetrician on duty, and with heaviness in all our hearts, we administered IV pitocin to stimulate uterine contractions. Adriana’s mother and one of the labor nurses stayed with her continuously, each holding one of her hands. She was scared, and I was scared…this was a new experience for me, after delivering dozens of babies who were more or less healthy but all alive.

I thought to ask Adriana if she wanted to see the baby (yes, she did) and if she wanted the baby baptized (also yes). Less than an hour later, I delivered the limp, lifeless baby, a little boy, with the umbilical cord tight around his neck. The nurse wrapped him in a blanket, placed a small stockinette cap on his head and gave the little angel to his mother to hold, to make a memory, to say good-bye.

“Hello, little Jason,” she murmured; every one of us had tears in our eyes, as we witnessed this precious life, taken far too soon. A small basin of water had been set next to Adriana, and the nurse poured water over the little boy’s pale blue forehead, reciting “I baptize you in the name of the Father and the Son and the Holy Spirit.

Amen.” “Amen,” I said to myself. “God, he’s yours now.”

Adriana and Robert were finally together a few days later, for the grieving. Her handmade Raggedy Ann doll became a symbol to them of their broken hearts, so they gave it to me, to remove the sad reminder and to thank me for my care. It is the most special gift a patient has ever given me; the doll and Adriana’s story are still with me thirty years later.

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The Battlefield

Jessica Hollingsworth, M.D. School of Medicine, Dept. of Internal Medicine, PGY-1

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Purified by Fire

Ryan R. Sheridan, D.M.D. School of Dentistry, Dept. of Comprehensive Dentistry, Perpetual Student

NOTE

from the There comes a time where it is abundantly clear that fate calls you to terminate an endeavor and

Artist

begin anew. Sending the albatross off in a pyre of flames is a bittersweet victory. Yet, despite this perceived retreat, a fiery inferno marks the opportunity to rethink, recreate and reinnovate.

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A Minor Hit

Susan Seale Jarvis, J.D. Center for Medical Humanities & Ethics, Advisory Council Member

Rick Jacobson looks closely at the picture on the front page: a young man lying flat on the muddy ground, staring up. The look is too blank, too painful, too familiar.

What caused the blow this time? An unexploded IED? A forgotten land mine from a previous confrontation? Or another “friendly fire” mistake? He reads the caption: “Saturday night hero suffers a minor hit.”

The conference room door opens. Members of the junior and senior staff of the Colbert Sports Medicine Center file in.

“You know I can’t let it go at that, Sidney. I’ll need a personal interview with Adrian Broussard and some basic tests before I can approve him for play. Frankly, the guy looked totally out of it in the picture.”

“It’s called Photoshopping, Rick. You’ve spent too much time in the military, over in those Godforsaken deserts or wherever. Sensationalism is what sells today, boy.

All those photographers are ‘doctoring up’ their pictures.

Pardon the pun.”

The minions at the table laugh.

“You see the game on TV Saturday night, Rick? Adrian Broussard took a minor hit, and some bleeding hearts are already crying Coach Magee should have taken him out of the game before that last play. Can you imagine? It was that last play that won the game, cinched the Warriors going to the conference playoffs. Now all we have to do is make sure Adrian plays in the big one. The League has requested a medical examination for him before the game. You’re the reviewing physician this month, so it’s all yours. Get the forms ASAP and give the green light.”

“Do what you have to, Rick. You know the drill. Ask the quarterback a few questions, fill out the form saying he’s good to go and it’s a done deal. Just keep the questions simple. I imagine our star player isn’t the brightest star in the planet if you know what I mean.

Most athletes aren’t. Ask him who’s president and what day it is. Even have a damn calendar on your desk. Just make sure it’s facing him.”

Rick looks across the conference room table at Sidney Colbert, senior partner in the medical clinic and chair of the committee that will soon vote on Rick’s admission as full partner to the group. Years ago Sidney mastered the art of leaving unsaid what is most implied: In this case, Adrian Broussard will play in the playoffs, no questions asked, and no need to remind Rick the clinic’s lucrative contract as team physicians for the Warriors is up for renewal next month. Give Adrian the okay to play, the clinic gets the Warrior contract renewal and Rick makes partner.

The following morning a slender young man enters Rick’s office at 9 o’clock. Right on time. Walking beside him is a slight, elderly woman dressed in what Rick knows must be her “Sunday best”: small cloche hat, impeccable white gloves and sensible stacked heels.

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Another laugh from the conference table, loud and long.

Rick does not join in.

“I hope you don’t mind my grandmother coming along, Doctor. She feels pretty strongly about this examination.

She’s all the family I got, so I thought it might be okay.”

The speaker’s voice is Southern, soft, with the same

respectful intonations Rick was taught to use toward his elders years ago. How long has it been since he heard such respect in a younger voice? Too long, way too long.

The slight figure extends a hand. “I am Margaret Alice Broussard, Doctor. Thank you for allowing me to stay.”

Rick smiles inwardly, extending his own hand. It never occurred to Margaret Alice Broussard she wouldn’t be staying. He wonders if Adrian realizes how lucky he is to have such a formidable ally on his side.

“Not at all, Mrs. Broussard. In fact, a family member’s input in an examination like this can be most helpful.

Providing the patient approves, of course.”

“It was right after one of our practice sessions last year.

That’s when I was kinda out of it on the field for a while.

A guard on our opposing scrimmage team really sacked me, and I lost my helmet.”

“Did Coach Magee know about this?” Rick already knows the answer.

“Yes sir. But he just told me to ‘suck it up’ and stay in there. He doesn’t like quitters you know. He’s been telling me that since I joined the team four years ago.

That’s what makes him a winning coach. He doesn’t allow for quitters.”

“Okay, let’s get started with a few basic questions. Then you’ll have a written test and physical exam.” Rick goes through a battery of perfunctory oral questions, including the inane ones about the president and the date.

“Stop defending your coach, Adrian. We both know he’s not interested in what shape you’ll be in ten years from now. It’s just the next game, the next win he cares about. Why do you think he pushed you to sign right after high school even though he knew you had an academic scholarship to the state university? And why does he keeps threatening to kick you off the team if you complain about your injuries?” Ignoring her grandson’s warning frown, she turns to Rick.

“Now I’m going to ask a few questions about any physical or mental symptoms you may be having. Your grandmother may want to comment also.”

“Tell us, Doctor, and please be honest. What will be the consequences if Adrian continues to play and receives more hits to the head?”

Soon Rick begins to worry. Both responders admit to the increasing frequency of Adrian’s headaches, dizziness and trouble with balance.

The opening Rick has been hoping for. “First, let me explain that players in ‘back’ positions like Adrian are three times more likely to receive head injuries. That includes quarterbacks, receivers, running backs and defensive backs. Every time Adrian receives a new blow, the risk of permanent brain damage increases. Frankly, a few more blows and he can easilly suffer such damage.

Recent studies show soldiers who step on IEDs and

Adrian grins, relaxing for the first time. “I better approve, Doctor. I live with this lady, and she’s the best cook in the city.”

“When did you first notice these symptoms, Adrian?” The patient is proving to be quick to perceive the questions and respond in an articulate manner.

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athletes suffering repeated head blows suffer similar damage to certain brain cells. I’m ordering additional tests today. I’ll review the file, complete my assessment and make a decision. I must tell you that if necessary I will have to recommend Adrian be permanently disqualified from playing football based on my medical findings.”

Adrian raises his voice for the first time. “No way, Doctor.

Do you have any idea what I’ll lose if I quit playing? For the first time in her life, my grandmother has security, real security. I watched her work three jobs at a time for years to make sure we were able to move out of the projects and keep me away from the gangs. Now we have a home in a gated community with a swimming pool and an elevator, mind you, an elevator!”

“Enough, Adrian. First, I don’t even like the gated community. The only folks I talk to are the neighbors’ gardeners and pool people. And as for an elevator, I’m perfectly capable up climbing up one flight of stairs. To be honest, I never use the fool thing anyway.”

Rick gets the picture: The grateful grandson is determined to repay the grandmother for all her sacrifices only he’s totally clueless as to what will really satisfy her.

“Exactly what do you propose to do, Doctor?” Margaret Alice Broussard gets right to the point.

“I will review all the test results this weekend and give my recommendations to the Warriors with a copy to the League on Monday morning. I can assure you both that Adrian’s well-being will be my first and only priority.”

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Margaret Alice smiles broadly; Adrian frowns.

“In the meantime, I’m going to ask a favor of you both.

An old military buddy of mine, Leon Fontenot, is now a patient over at the VA hospital here. He is also from New Orleans and is always complaining about wanting a good bowl of filé gumbo. He says the hospital cafeteria makes it too weak and too thin. I bet Mrs. Broussard could really brighten his day with a little Cajun cuisine. You’ll find him in Room 534. Let me know Monday morning how he’s doing. I know I can count on you both.” Rick leaves before either can refuse the request.

The following Monday morning Rick shows up the at clinic early, wondering which party will reach him first. The first contact is a phone call, abrupt and to the point. Caller ID shows Sidney Colbert.

“Do you have any idea the damage you’ve done, Dr. Jacobson? The Warriors are not renewing their contract with the clinic. In addition, you’ve ruined a fine young man’s career, destroyed his livelihood. No doubt he’ll be a homeless wreck in a year or two, like those veterans you’re always visiting. The unwashed living under the bridges. You have thirty minutes to pack your things before security escorts you out of the building…”

Rick quietly places the phone back in its cradle.

Ten minutes later there’s a light tap on his office door.

Contact from party number two. Adrian and Margaret Alice enter.

The grandmother speaks first. “We visited your friend Leon several times over the weekend, Doctor. Such a fine young man, but oh so confused. Kept thinking I was his mother and Aaron his Army buddy Clyde. Every time he mentioned Clyde he’d start sobbing. Kind of like a little baby.”

Aaron smiles for the first time. “Don’t worry about us, Doctor. I’ve been taking online courses at the state university during football season and attending classes on campus in the summers. I’ll graduate with a degree in journalism in two months. Already have a job as a sports reporter for the local newspaper.”

Rick turns to the silent young man standing before him, anticipating an outburst of anger. “Have you heard from the Warriors yet about my report? I’m really sorry I had to do this.”

Two years later:

“Yes, I’ve heard from the Warriors, Doctor. But more important, I heard two of the nurses at the VA discussing Leon’s case. Said he stepped on an IED in Afghanistan and suffered permanent brain damage. Got me to thinking about what you said last week—how you compared the brain damage from IEDs to frequent sports concussions.

Guess I’d rather be around and aware for a long time to come than leave my grandmother living alone in a house in a gated community with an elevator. The choice is a real no brainer in my books.”

Margaret Alice speaks up. “What about you, Doctor? We know the Warriors’ contract with your clinic is up for renewal soon. Your bosses can’t be too pleased with your report.” Bull’s-eye. The grandmother from New Orleans keeps up with her sports news.

“Don’t worry about me, Mrs. Broussard. I’ve already lined up a position with a nonprofit to help rehab veterans and athletes who’ve suffered traumatic brain injuries. I think the two groups can help each other. I just hope the future isn’t too hard on you and Aaron.”

Rick looks closely at the picture on the front page: a young man standing, staring at the camera. The face is a little fuller, a little older, quite familiar. Why the broad smile? A starring role on a reality TV show? A new celebrity bride? A lucrative endorsement? He reads the caption: “Former quarterback wins Pulitzer for exposé on head injuries in pro sports. Says there’s no such thing as ‘a minor hit.’”

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Antrum

Enteral Sea Rachel Baker

School of Medicine, MS4

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Jejunum

Colon

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Clownfish Alex Pong

School of Medicine, MS2

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This is not your underground railroad Patricia Wathen, M.D.

School of Medicine, Dept. of Internal Medicine, Professor of Medicine

My dear friend, I will never tell you that I was a link in a chain passing a family from El Salvador to Texas to the next destination.

Because this is not your underground railroad.

You found an old picture from the Carolinas.

Two smiling white men in the foreground hold up tobacco leaves.

Away in the distance, stooped in the field: your grandfather.

It’s the only picture you can find of him.

Schoolchildren shot down. The nation mourns.

But every week, you say, the same number are killed in Detroit, Chicago, Los Angeles.

Black kids - a chain stretching backEach death a broken link, badly forged and never mended.

There is no room in that world for the newly broken coming over the border with their own baggage of loss.

You can’t carry one more thing. I get that.

The do-gooders rushing to help: toothpaste and clothes and lawyers.

It’s all too much; their earnestness and caring...

Always within you is that other place: the market where your ancestors lost their final shred of dignity, lost their personhood and lost their children’s children who still are lost looking for a border they can cross where someone will welcome them.

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Door County James Liu

School of Medicine, MS3

NOTE

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from the Door County Orchard, Wisconsin

artist

Oh Georgia

Kimberly Vogelsang School of Medicine, MS3

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The Gift

Jessica Hollingsworth, M.D. School of Medicine, Dept. of Internal Medicine, PGY-1

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After the Rain Rebecca Ajtai

Texas Heart Institute, Medical Librarian

What shall I do now?

Now that the world has stopped crying.

Now, as the sun stretches and yawns its big yellow mouth, weary from its cat nap.

What shall I do now?

Now that the earth has hiccuped back to life and asphalt rivers are sizzling back up to the sky (as if the sun wanted a souvenir).

What shall I do now?

Now that I have time to waste.

Now that the symphony is over; the clouds are packing up their instruments and heading home.

The sparrow is popping around for grubs.

What shall I do now?

I will lounge listlessly on this porch, and wait for the rain.

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Dewdrops

David Roland Rodriguez, M.A. School of Medicine, Greehey Children’s Cancer Research Institute, Information Technology Specialist NOTE

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from the A visual communication of life providing a unique view of elements and textures.

artist

Papa’s Secrets Mai Luk

School of Dentistry, DS3

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La Lou

Danny Duke, M.D., Posthumous Center for Medical Humanities & Ethics, Friend

Not only is happiness possible with no money to spend, happiness is actually more likely without funds at certain times in your life.

When I was in medical school, Judy worked as an elementary school teacher. I spent each day in class, and she commanded a class of third-grade students in a poor district in San Antonio. In the evening, I studied.

After coming home from teaching, Judy cooked night after night, every casserole known to man, the variety limited only by our meager budget. Almost all included canned soup, and noodles, and possibly ground hamburger. We were never hungry, and yet rarely satisfied.

The first year of Judy’s and my marriage, the Internal Revenue Service returned money to us that the system, in some preposterous optimistic belief, had withheld from Judy’s checks. We owed little in taxes. They sent the rest back. To us, the unexpected return was a windfall. We did not yet have children, our furniture was rented, our car was payment free – thanks to the generosity of Judy’s father – so the bonus came with no strings attached. We decided to spend it on our first anniversary.

In the 1970s the premier San Antonio restaurant was La Louisiane, or “La Lou” to the locals. The establishment was a two-story stucco affair, sitting proudly along the side of a seedy stretch of Broadway Avenue, with New Orleans-style wrought-iron grating over the windows and front door. I called to make a reservation. The owner, Mr. Darius, made a habit of answering the telephone. He would be pleased to accommodate us.

We were beside ourselves with anticipation. Judy still had tucked away a piece or two from the wardrobe her mother had picked out for her (and paid for) before our honeymoon. I owned a tie. We dressed up as best we

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could and proceeded to the restaurant at the appointed hour. The maitre d’ welcomed us warmly and took us up the stairs to a table for two in what appeared to us a splendid room with claret draperies. The people look so beautiful as we walked by. Mirrors reflected everywhere, and crisp white linens glowed in the soft light of the massive crystal chandeliers. Our tax refund allowed us to order from the extensive menu without restraint.

Oh, and the food was delectable, as was the wine. I carried a smaller frame in those days. I would like to think that accounted for my state of pleasant intoxication as I excused myself to go to the men’s room. When I disappeared behind the door, our waiter came to the table and said to Judy in a voice that carried, “I think he went in the ladies’ room.”

Soon enough I returned to our table. I confessed, “You won’t believe what I just did.” Judy replied that everyone in the restaurant knew what I did.

For dessert, the waiter brought alongside our table a portable table complete with chafing dish and burner, and sugar and butter and lemons and ever-so-plump strawberries. With brandy, he flamed the most elegant strawberry dessert in my memory, “Strawberries Flambé,” topped off with vanilla ice cream one step beyond knee-deep rich. I took mental notes. Even on a student’s budget, we would repeat this dessert at home for friends, secretly remembering the evening I learned the recipe.

After that night, I gave myself a challenge. I would work hard, so that the next time we came to La Lou, we could actually afford it. in MEMORIAM Danny Duke, M.D. January 21, 1947 — July 5, 2004

Ed i to rs ’ S e c t i o n D irector of D esign 326A

Sara Noble School of Medicine, MS2

New admit.

87-year-old female, non-responsive to daughter at bedside.

Workup inconclusive.

Her eyes are shut tight, but I can see the magic has faded from them.

The daughter’s eyes are open wide, but I can’t see behind her tears.

Suffocating tension fragmented by long, rhythmic slurps of soup from 326B. I collect myself: “Hola, abuela.”

NOTE

from the 55-word stories are bite-sized pieces of creative writing that offer an opportunity for therapeutic

A u t ho r

reflection. This form of medical narrative has been published in JAMA and other medical journals.

I recently attended a workshop titled “Building Resilience: An Innovative Reflective Writing Method for Clinical Palliative Care— the 55-Word Story” at the 2015 American Academy of Hospice and Palliative Medicine Annual Assembly. I certainly don’t consider myself a writer, but I left the workshop feeling empowered—and I hope that sharing this method can help other “non-writers” try their hand at the medical narrative.

The process is simple: 1. Reflect on a pivotal experience.

2. Write freely for 10-15 minutes.

3. Take another 5-10 minutes to edit down to exactly 55 words—no more, no less.

The 55-word story is a novel, time-efficient and powerful self-care tool for clinicians to reflect, reduce the potential for burnout, and mitigate the stress of caring for our patients.

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Ed i to rs ’ S e c t i o n E x ecutive E ditor Spin Class Jane Yoon

School of Medicine, MS2

I gave in and signed up for a Gym membership on January 1st.

I walked into my first spin class and Immediately regretted everything.

I turned to leave, half of a second too late.

The instructor’s eyes locked onto mine.

Trapped in that unfortunate eye contact, I realized it was too late to leave.

With the push of every pedal, my muscles Tangled tortuously around each other like a frayed knot.

My lungs clawed into my ribcage, gripping each bone.

My heartbeat pulsated inside my eardrums.

The instructor’s deafening voice pounded in my head.

“FEEL THE BURN! DON’T QUIT!”

A bead of sweat dangled dangerously at the tip of my nose.

I lowered myself into the bike seat and began slowing down.

I was going to quit. I am a quitter.

And I’m perfectly fine with that.

Spying me from the corner of her eyes, she hopped off her bike And sprinted towards me like a maniac, her fists punching the air.

She stuck her face right up to mine and Yelled with spit and sweat spraying all over my face.

“WHEN YOU ARE TIRED AND IN PAIN, WHEN YOU FEEL LIKE GIVING UP, WHAT IS THAT ONE THING THAT MOTIVATES YOU?” Taco Bell Gordita, you bitch.

I hated her energy, her enthusiasm, her strength.

I hated her.

NOTE

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from the I have not attended another spin class since 2011, and I do not plan to ever again.

A u t ho r

Instead, I have decided to eat less and just consider the walk between my apartment and the school as a form of exercise.

Ed i to rs ’ S e c t i o n E x ecutive E ditor

Open Doors Grace Cheney

School of Medicine, MS2

NOTE

from the A playful Kenyan boy takes a break from sweeping his father’s storefront near Lake Naivasha.

Artist

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Ed i to rs ’ S e c t i o n E ditor in C hief Holding Clinic in Sabana Real Chris Yan

School of Medicine, MS4, Center for Medical Humanities & Ethics, Fellow of Medical Humanities

The road to Sabana Real is cut from rock and soil by secondhand motorcycles and the feet of women carrying clay-colored vegetables.

We take in the mountain and its people like manna from God, sustenance firmed in secret before sun or water. The caravan stops twenty miles in, a crowd of men and women, children and chickens gathers around a cinder block hut. Clinic opens.

A man with swollen hands comes from a far-off sugarcane field for vitamins.

A woman is told she is pregnant with her fourth child. We have bags of lollipops for the children, but no shade for the elderly. A frail man coughs weakly as we put on masks, fearing the worst.

Someone’s toe is infected. Someone’s knee is crooked. Someone’s baby is starving.

Someone is waiting, someone is watching, someone is saying “The American doctors are here with free pills.”

Or is it? In the airport, I look for postcards for my mother and father. The plastic rack has pictures of palm trees and phrases like “Carribean Paradise.” No pictures of the Haitian woman to whom I gave a sack of granola bars, the girl in her arms, or the one clutching her hemline.

Nor the tree canopy from the side of the mountain road to Sabana Real, the children chasing down our swaying truck of students and supplies.

I seal up these images in a place that’s not home. And then, on the back, what would I write? Maybe something bittersweet, like “Having a great time, wish you were here.”

And the boys’ feet are caked in mud and their guts are filled with worms. But they laugh too, and play, and terrorize the windows with little furious hands and fingers—boys who have appetites for lollipops but not soap.

And the girls squeal in delight under the squeeze of a blood pressure cuff, run out with our butterfly stickers on their foreheads. Perhaps the world is not such a mystery.

NOTE

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from the Written on the plane while coming home from a global health trip to the Dominican Republic,

A u t ho r

March 2012. Special thanks to the CMHE, the 2011-12 Project Hispaniola Team, and my mentor, Dr. Ruth Berggren, for the experience.

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

We are Connective Tissue.