Connective Tissue 2018

LITERATURE & VISUAL ARTS JOURNAL

VOLUME XI • 2018

Cover Art

“The Ugly Duckling� by Cindy Yang, MS3 - full image appears on P. 56

For entry guidelines, to view past journals, and for more information about joining a committee, visit: https://www.texashumanities.org/connective_tissue Contact the CT Editorial Staff at connectivetissuejournal@gmail.com

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

VOLUME XI • 2018 EDITORS-IN-CHIEF Mazen Hassan Luyang Jin MS4

MS3

EXECUTIVE EDITOR Alexis Ramos

EDITORIAL STAFF Hilary Hopkins

MS2

MS3

DIRECTOR OF DESIGN Lina Mahmood

Cindy Yang

COPY EDITOR Sheila Hotchkin

FACULTY ADVISORS Jerald Winakur, MD Lee Robinson, JD Ruth Berggren, MD

MS3

MS2

Assistant Dir., CMHE

SELECTION PANEL Glennette Castillo

Jonathan Espenan

Harriet King

Tran Nguyen

Narine Wandrey

Grace Cheney

MS1

MS1

MS4

MS4

MS4

Sammar Ghannam MS1

Hannah Korman

Chidinma Okani

Cindy Wu

Alumni, MD

Minyoung Chung

Jeremiah Gress

MS0

Jesi Mooneyham

Miriam Volosen

Christopher Zhu

MS1

MS4

MS1

MS3

MS4

MS1

MS0

E D I TO RS ’ N OT E MAZEN HASSAN LUYANG JIN Editors-in-Chief

In biology, connective tissue supports and binds other tissues of the body.

That is precisely what this journal aims to do, and therein lies our mission: 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.

As editors, our job is to give everyone at our institution the opportunity to share their creative spirit through whatever form or expression is available to them. The human experience is powerful, unique and complicated. That’s what makes art invaluable. It’s a humbling experience to put together all these works of art for reflection and inspiration for the entire community.

We would like to offer special thanks to our mentors, Dr. Jerry Winakur, Ms. Lee Robinson, and Dr. Ruth Berggren for their continued support and guidance year after year; to the editorial staff and selection committee members who have given their time and energy to create this journal; and to the artists and authors who shared their work.

We hope this year’s issue of Connective Tissue resonates with and entertains members and friends of the UT Health San Antonio community.

Sincerely,

Mazen Hassan

Editor-in-Chief, Connective Tissue Vol. 11 Student, Long School of Medicine, Class of 2018

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Luyang Jin Editor-in-Chief, Connective Tissue Vol. 11 Student, Long School of Medicine, Class of 2019

IN MEMORIAM Ryan Folsom, MS, Neuroscience 24 March 1988 — 7 January 2018

It is an honor to dedicate this volume of Connective Tissue to the memory of Ryan Folsom—a medical school classmate who was months away from graduating with the Class of 2018.

Ryan was an extraordinary student dedicated to becoming an orthopedic surgeon when his life was tragically cut short while traveling to a residency interview. Words can’t express how much Ryan meant to everyone around him. While this journal showcases artwork that people have produced as their legacies, Ryan’s legacy was apparent in all the lives he touched. Sometimes art comes from the way another human touches our souls. That was an art of Ryan’s that will forever be remembered.

The Connective Tissue that binds our community together will forever be strengthened by his kindness, intelligence, patience and dedication to everyone around him.

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C O M M U N I T Y C O N N E C T I O N : C A R LO S H E R R E RA

Fifty Miles

Featured photos courtesy of Carlos Herrera

Summary: Carlos Herrera is a first-year occupational therapy student. Before entering the OT program, he was an elementary school special education teacher for eight years. He has an extensive background in music/music production and has recently been experimenting with the use of audio narrative to entertain and to educate himself and others.

Featured Voices: Carlos Herrera - Host Bridgett Piernik-Yoder, PhD, OTR - Interviewee

UT Health San Antonio School of Health Professions, Department of Occupational Therapy, Chair

Rebecca Gomez, PhD, LCSW - Interviewee Our Lady of the Lake University, Worden School of Social Service, MSW Program Director

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http://www.theoccupationallens.com

Prologue: What is Occupational Justice? “The notion that all individuals have an inherent worth and all individuals have the right to engage in occupations that are important and valued to them...If a person is limited in being able to pursue these activities... that becomes a justice or an injustice issue.� -Dr. Piernik-Yoder Act One: Meet Alex Alex is a 21-year-old youth who has been homeless for two years. Alex tells Carlos the account of his long trek from a broken home across the State of Texas... and the meaningful things that he lost and found along the way.

Act Two: The Imperfect System: Aging Out Dr. Rebecca Gomez, a researcher and assistant professor, speaks about youth homelessness, foster care, and the complexities of forming identity within a system of revolving doors and faces.

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G LO B A L H E A LT H C O N N E C T I O N : M O U M I N I N I AO N E

Ouvre ton Esprit Moumini Niaone, MD Physician, Burkina Faso

Tu verras des miracles partout,

Translated by Ruth Berggren, MD Open your Spirit...

You will see miracles everywhere,

Tu verras le bonheur dans les petites choses,

You will see happiness in the smallest things,

Le sens des évènements te sera plus clair,

The meaning of events will be clearer to you,

Tes questions seront plus pertinentes,

Your questions will be more pertinent,

Les réponses aux questions engendreront d’autres questions.

The answers to the questions will bring more questions.

Tu découvriras peut-être,

You will discover, perhaps,

Que nous sommes à des chapitres différents de notre vie, et que nous sommes ici pour apprendre des leçons différentes.

That we are each in different chapters of our own lives, and that we are here to learn different lessons.

Tu découvriras peut-être que tu peux bien apporter ta touche unique à la beauté de notre monde.

You will discover, perhaps, that you can bring your unique touch to the beauty of our world.

Tu verras peut-être que, l’amour et la paix se construisent d’abord à l’intérieur. Que l’effort de se connaître soi­-même peut être une douloureuse experience, mais mérite d’être essayé.

You will see, perhaps, that love and peace are first built on the inside. That the effort to know oneself could be a painful experience but is worth a try.

Ouvre ton Esprit...

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Tu apprendras peut-être à t’aimer mieux. Tu découvriras tes limites et accepteras celles des autres.

You will learn, perhaps, to better love yourself. You will discover your limits and accept those of others.

Enfin, tu m’aideras peut-être à convaincre les autres que, si nous souffrons, c’est parce que nous vivons sur la même planète mais pas dans le même monde.

Finally, you could, perhaps, help me to convince others that, if we suffer, it is because we live on the same planet but not in the same world.

Que la solution pour une paix durable et un amour sincère entre les humains, devra passer par une connection entre nos mondes (Riche-Pauvre, FortFaible, Gouverneurs-Gouvernés, Rural-Urbain, Soignant-Soigné, Nord-Sud, Sud-Sud...Une seule planète, un seul monde etc...).

That the solution for durable peace and sincere love among humans should come to pass through a connection between our worlds (Rich-Poor, StrongWeak, Governors-Governed, Rural-Urban, HealerHealed, North-South, South-South ... One planet, one world etc..).

Accepter de vivre dans le même monde pour espérer se connaître, se comprendre, se tolérer, s’aimer et donc s’entre aider.

To accept living in the same world in the hope of knowing, understanding, tolerating, loving, and thus helping one another.

Créer une vraie COMMUNAUTÉ des Humains.

To create a true COMMUNITY of Humans.

Ouvre l’esprit, tu n’es pas ici pour rien.

Open your spirit, you are here for a reason.

Le monde pourrait être différent, si tu le veux bien.

The world could be different, if you will it to be.

BURKINA FASO - This is the Sacred Baobab tree of Dierma, Burkina Faso, which symbolizes wisdom, communication and collaboration.

It is the tree beneath which, in West African culture, one sits to have discussions. It thus represents our spirit of community. Photos courtesy of Moumini Niaone, MD, Fulbright Scholar and Global Health collaborator with the Center for Medical Humanities & Ethics.

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C O N T E N TS CATEGORY WINNERS P PHOTOGRAPHY

L LITERATURE

WINNER

WINNER

Hope 10

Team 6

Vinh-Son Nguyen

HONORABLE MENTION

Horseshoe Bend

Amanda Wedelich

11

Richard Tran

A VISUAL ARTS WINNER

12

Heart of Gold

Cassandra Jones

14

HONORABLE MENTION

HONORABLE MENTION

Bodies 13

Branches of the Abdominal Aorta 15

Omar Akram

Lorelle Knight

COMMITTEE SELECTIONS L To the Nameless Woman

and Her Child

Jelina Marie Castillo

A I Got Your Back Keerthana Pakanati

16

P Dendritic Boughs Connie Cheng

17

L Loss 18 Rosemary Liu P Grace 19 Chase Romere A Untitled 20 Lina Mahmood P Bwindi Impenetrable

National Park, 2017 Charlotte Collins

L Picture This Micah Park

21 22

A State of Mind Kavina Patel

43

P Congregations 33 Sammar Ghannam

P Testify Onto the Sun Charles Ratcliff II

44

L One Moment Rebecca Nekolaichuk

34

A Study of the Eye Lina Mahmood

45

A Cheartcoal Series Marlow Taylor

35

P Healthcare Reframed Garrett Kneese

46

P Not-So-Silent Night Cindy Yang

36

P West End Boathouse Marina,

32

L A Conversation Narine Wandrey

37

P Agrarian Utopia Barrington Hwang

38

L Captor of Time Alexis Tracy

39

A Arabian 29 Lauren Facer

A Codicia 40 Jose Torres

P Day Two Raj Sehgal, MD

P Only in Texas Bonnie Moreno

30

L Breathe 31 Jessica Hill

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41

L Vitamins 42 Gretel Sanchez

New Orleans, LA Kent Coker

47

L Cogito 48 Eithan Kotkowski P Cooking in Rural

Nawawasito, Nicaragua Jaswanth Raj Kintada

A Growth Mindset Giselle Castillo

49 50

A Computing 51 Lina Mahmood P One Day is Today Omar Akram

52

A Universa Vasa Alexis Tracy

53

P The Ugly Duckling Cindy Yang

56

L Scattered Pearl Narine Wandrey

54

A Civil War Jonathan Espenan

57

A Sunset 55 Sammar Ghannam

55-WORD STORIES WINNER

The Saddest Silence Natasha Mitra

58

55

55

59

Yvonne Uyanwune

61

55

Pink Nails

62

55

Rachel Dang

Sammar Ghannam

HONORABLE MENTION

The First One

A Night in the Trauma Bay

55

She Said Her Goodbye from Afar

Morgan Fletcher

55

Missing 60

55

PTSD 60

55

Nic-anahuac 61

55

Claude Hardy

L LITERATURE

A VISUAL ARTS

64

Seventeen 65 Lorelle Knight

55

More Than Just a Third-Year Medical Student

Barrington Hwang

65

Untitled 63 Innocence 63 Vinh-Son Nguyen

Zachary Tran

55

Rosemary Liu

Jonathan Espenan

Sadie Trammell Velasquez, MD

55

62

The Man Who is an Island

Linley 64 Luke Lehman

P PHOTOGRAPHY

55

55-WORD STORY

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W I N N E R, P H OTO G RA P H Y

Hope

Vinh-Son Nguyen Student, Long School of Medicine, Class of 2020

Celebrated on June 1st, Vietnam’s National Children’s Day marks the beginning of summer. Children are off from school, and their parents take them around the city for fun, but in this children’s hospital most kids do not have the health or freedom to celebrate their holiday. Beds line the hallways end to end with nothing more than a ceiling fan to circulate air in the musty room. Things that are not pictured are the parents that sleep underneath the beds and siblings that spend their holiday in the hospital supporting their brothers or sisters getting chemotherapy. Truly, National Children’s Day takes on a whole new meaning when some children cannot even muster up the energy to leave their beds. Nurses do the best they can to make this day special for all the patients. They administer hope in the form of a goodie bag and a juice box.

NOTE

10

from the

H O N O R A B L E M E N T I O N , P H OTO G RA P H Y

Horseshoe Bend Amanda Wedelich

Student, Long School of Medicine, Class of 2020

NOTE

from the

Glen Canyon National Recreation Area, Arizona

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W I N N E R, L I T E RAT U R E Team 6

Richard Tran Student, Long School of Medicine, Class of 2020

Low weight, confusion, resistance, unease

Attendings console with great expertise

CD fours, viral loads, “watch the low K”

While trainees tap feet, check wrists – done, why stay?

HIV is more than just a disease

“Their lone self, their mistakes, it’s their unease” It’s not good. The scans show metastases And damaged organs. AIDS Cancers, they say Low weight, confusion, resistance, unease

Teachers remind, these ones have the most need The unvisited still proclaim, still plead “HIV is more than just a disease”

Lovers and loved ones yearn for guarantees Weddings and kids, a future past today HIV is more than just a disease

They talk and they talk. Rounds last forever Numbers don’t change but they still look better More human, more dignity, less unease HIV is more than just a disease

I originally shadowed the HIV team back in MS1 year, and it took a full year later to actually sit down and write this piece.

“Team Six” was one of those pieces that just came together out of nowhere, while I was sitting there bored one day over winter break. I had a few ideas in the back of my head all the while, but nothing really clicked until I just started putting some pen to paper. Then, before I knew it, it transformed itself into a poem; I honestly thought it was going to be one of those 6-55 stories at first. But I think poetry was a good choice in this case. It better conveys the reality of the experience when you try to tie the intangibility of emotions to the rigid, limited structure that poetry offers. It’s also more challenging, but I digress.

On a more technical note, this is a poem that the literature world would probably call a “subverted villanelle”. There’s 19 lines, broken into the traditional 6 stanzas, 2 repeating refrains, and it’s mostly in iambic pentameter. The subversion happens later on in the poem when I decide to mess with both the refrains and the rhyme scheme because it makes for more interesting writing. I hope you enjoyed this short piece and hopefully got something from it - I know I thoroughly enjoyed writing it. Thanks for reading!

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H O N O R A B L E M E N T I O N , L I T E RAT U R E Bodies

Omar Akram Student, Long School of Medicine, Class of 2021

You were a king— Power at your fingertips, riches in your palms— The sky turned green with envy Wishing it were half as boundless as what you held.

You called the world yours, and so it was; There was nothing more to want in this life But life itself So you built empires in your name Ensuring your eternal existence You conquered colonized constructed Renaming lands after yourself Planting your roots firmly into them so nothing, Not even death, could pull you out—until he did Laughing at how you fell for his beloved ruse, immortality, As all your monuments slowly crumbled to dust.

You were a traveler— Drifting through streets, borders, and years Knowing none of them was yours to keep; Some feared you, mistaking your running for hunting When, in fact, you were the prey Searching for sanctuary for you and your children, Rubber bullets bomb blasts broken glass smoke Eternally chasing you, real or imagined, A constant refugee in both mind and body Running and hiding, running and hiding, If not for yourself then for those you carried.

Your body, stigmatized shamed shunned, sheltered bodies Your body pushed until it could no longer shelter itself.

You were a collector— The way you chose to take-take-take It was a wonder there was anything left— Bodies of beings buried millions of years, With heat and pressure made jewels you scavenged Recruiting skin-and-bones bodies to dig up your treasure Fight your battles Eat your chemicals Live in your rubble

And yet you still said, Not enough.

You took from the earth You took from the sky You took from the poor To build your riches high How sad—an existence spent chasing that which doesn’t last You made sure you were burned into memory You forgot—memories last only as long as the bodies that hold them.

You were an artist— Your labor, at times taken for granted, Rippled further than your eyes could see.

You danced down sidewalks, Teeth winking at frowns, stretching closed lips With those who lacked laugh lines.

You sang along grocery aisles, Opening your throat to open hearts Of those with full carts and food stamps alike.

You painted over walls, Bare hands sharing brushes, splashing colors For forever sensory pleasure of passers-by.

You made so much light, the sun fell each night in awe Promising to return brighter the next morning.

Conscious, you said, Is the only thing we can be; Seeds you planted gave life long after you lost yours.

You are a body— Lying isolated in a metal tank Pulled apart by inexperienced hands Sliced open with scalpels and scissors Drowned in formaldehyde Naked You will be admired, studied, learned from And finally, burned to ashes You are everything You are nothing.

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W I N N E R, V I S U A L A RTS

Heart of Gold Cassandra Jones

Student, Long School of Medicine, Class of 2020 Heart of Gold was inspired by the strength that medical professionals demonstrate while caring for our patients. Although the waves of our problems may feel as if they are crashing down on us, we persist. Despite many days feeling as if we are drowning in the world around us, we persist. Even when we are comforting our patients as tears flow from their eyes like a glistening sea, we persist. We persist because our patients need us to. We rise above the results we don’t want to hear, we are stronger than the negative words spoken in our direction, and we daily disprove discouraging beliefs about us.

We provide a light needed during times of darkness. We have hearts of gold.

NOTE

14

from the

H O N O R A B L E M E N T I O N , V I S U A L A RTS

Branches of the Abdominal Aorta Lorelle Knight

Student, Long School of Medicine, Class of 2020

15

To the Nameless Woman and Her Child Jelina Marie Castillo

Student, Long School of Medicine, Class of 2020

Sometimes, I pray Littered streets and cobalt rain How can one truly measure pain?

I never knew the smell of blood Could be so raw and vulnerable and human Sometimes, I’m not enough Her thin frame to match my ego Tension and silence and the mosquitoes I never knew the way a mother must feel To watch her daughter be so scared and alone Sometimes, I try The shush of the nurse at her every whine My eyes screamed the lie that everything was fine I never knew the answers to the attending’s questions I was too focused on her salt seeping through our clenched hands Sometimes, I still see her And all my well-made plans unravel The eclipse of my white coat apparel I know, I know, I’m not ready and she is my lesson But I’m raw and vulnerable And only human

Inspired by a patient encounter from my first global health experience in Pune, India.

16

I Got Your Back Keerthana Pakanati

Student, Long School of Medicine, Class of 2020

17

Loss

Rosemary Liu Student, Long School of Medicine, Class of 2019

Loss is perhaps the cruelest state To have held, and then to have empty hands We are sturdy flesh and bone We are frail heart and brain The world, we try to conquer Yet time confines our days Tell me which is crueler, Drawn out loss as disease pervades Or to turn suddenly and find she — he — is gone

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Grace

Chase Romere Student, Long School of Medicine, Class of 2019 NOTE

from the Nodding syndrome, a rare and progressive form of

epilepsy, primarily affects children between 5 and 15 years old and tends to be geographically isolated to Northern Uganda, Tanzania, and South Sudan. The disease is characterized by episodes of repetitive dropping forward of the head, from which it gets its name. I was part of a team of researchers and medical students that spent time with Grace and Walter, two siblings with nodding syndrome in the Omoro District of Northern Uganda.

The cause of and treatments for nodding syndrome have yet to be determined, but what was so inspiring about our visit with Grace, Walter, and their family was that they remained optimistic and hopeful despite the circumstances.

19

Untitled

Lina Mahmood Student, Long School of Medicine, Class of 2020

20

Bwindi Impenetrable National Park, 2017 Charlotte Collins

Student, Long School of Medicine, Class of 2019

NOTE

from the

Southwestern Uganda

21

Picture This Micah Park

Student, Long School of Medicine, Class of 2020

Picture this:

You’re 23 years old. You’re finishing the last semester of your engineering degree. It’s taken you

one extra year, but that’s okay, because engineering is hard. You’re happy, you’re proud of yourself. The world seems to be open before you.

You think about what you want to do after college. You’ve been talking about a graduation trip

with your friends. Your parents are talking to you about getting a girlfriend. They’re more concerned about it than you are. It’s really annoying. You wish they’d back off from your life a little bit, but you understand where they’re coming from. You moved from Nigeria when you were 4 years old. You have hardly any memories of your homeland, but you remember the few times your grandmother came to visit. Your parents just want the best for you. And you don’t disagree—you want to make them proud, too.

You’ve been feeling a bit tired recently. You feel a bit of stomach ache, and you’ve been losing

your appetite. You’re eating less. You used to bench 150 pounds as warm-up, but now you feel a bit strained even to do that. It’s probably stress from school. You’re worried about finding a job after you get that degree. Feeling burnt out, possibly. You could be depressed, but it feels a bit different now. OK, so let’s go see the school doctor. Take advantage of the school insurance. The doctor takes some blood samples for tests and tells you to come back in a week.

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***

You’re 23 years old. You’re in your first year of medical school. You’ve spent more time in the

library in the past month than you have ever before. Or at least it feels like it. You’re sick of staring at the computer, staring at books, staring at notes, staring at PowerPoints with blue background and yellow Comic Sans. You’re sick of your life.

Tomorrow you have to see your preceptor. It’s this thing called preceptorship where you shadow a

doctor about once a month. Aside from that, you don’t know what else you’re supposed to do. Your preceptor is a hospitalist. Her subspecialty is called palliative. You don’t know what that means. From what you’ve heard, it sounds like mostly pain management or hospice. When you went last time, she printed you a list of patient names, and you sat around a table and heard the residents talk about it. You had no idea what they were talking about. You’re trying to memorize the enzymes of the Krebs Cycle, and they’re talking about morphine dosing?

Whatever. You like your preceptor; she’s nice. At least you don’t have to wear formal clothes to

your preceptorship like some of your classmates do. You can wear your scrubs.

It’s late. After midnight, you get headaches that rise up from the back of your neck to your ears,

but you’ve got to power through. Instead of sleeping in pajamas, you’ll be sleeping in your scrubs tonight. It’ll shave off several minutes in the morning.

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***

You are lying on a hospital bed. The doctors say you have three infections in your bloodstream.

You don’t really understand how that can happen, but you believe it because you feel terrible. Bags of fluid hanging above your head drip stuff into your arms. There’s a pair of tubes in your nostrils that are helping you breath, because right now it’s tiring even to do that. Your parents are sitting next to you on those vinyl-covered hospital chairs that are marginally more comfortable than they look. They say there are some new doctors coming to see you this afternoon. The window blinds are open, and the bright sunlight is filtering through. It’s broad daylight but you’re exhausted. You fall asleep. ***

In the afternoons, the palliative team does this thing called “family meetings.” It’s not table

rounds, at least. You can walk around and burn off some calories. Try not to get in anyone’s way, at least. Remember, you’re on the bottom rung of the hierarchy. Don’t screw up in your first year.

You stand outside the patient room. Medicine is here. Heme/Onc team is here. This is going to

be a pretty big team. This is the pre-meeting. Your preceptor is talking about cancer—Burkitt lymphoma.

Oh, you learned that, didn’t you? In First Aid, there’s a picture of an African kid with Burkitt lymphoma on his jaw. Apparently, this patient had one in in his stomach that had metastasized to almost everywhere except his jaw. You didn’t even know that was possible. ***

The doctors are here. About half a dozen of them, most wearing their long white coats, except

for the one in the corner, who wears a white coat that only comes down to her waist. You’ve learned that medical students wear short coats. She looks your age. She probably is your age. She’s a student, like you.

24

They’re standing around your bed, like generals around a battle plan. Except it’s your sick body

in the middle. You want to go to sleep, but they won’t let you.

“It’s a blood cancer,” you hear someone say. Ah yes, that’s what you have. It’s the source of all

your problems.

You open your eyes, and it’s one of the long-coat doctors speaking. He’s standing directly at your

feet, and he’s talking to your parents. He speaks confidently, and everyone is listening to him. It’s obvious he’s the one in charge.

“As you know… And the lymphoma didn’t respond… We’re thinking about a third round.”

You want to interject, but you can’t. You can only moan. They try to talk to you, but their voices

are fading in and out.

You’re tired. The doctor’s voice is ringing in your head and giving you a headache. You think

back to the first doctor you saw, the one who gave you the blood tests. You wonder if he remembers you. This isn’t how you expected things to turn out. ***

They went over in the pre-meeting: The first line of chemo is our best agent. If the patient

doesn’t respond to that, the chance that the patient will respond to the second chemo is much less. And the third line—even less so. As in impossible.

He’s dying. He’s only 23 years old but he’s dying.

The mother talks about an NIH trial she’s read online. She speaks with a thick accent, but you

understand. Besides, you’re only a medical student. You’re not the person who has to worry about talking to patient’s caregivers. That’s the attending’s job.

25

The mother wants to try the NIH trial. Maybe, but the patient is too sick right now. He can’t

walk, and he’s almost delirious.

The conversation comes back to the third round of chemo again.

You wonder why you’re even here. You thought they were supposed to be discussing end-of-life

care with the palliative care team. ***

Suddenly the room goes quiet. A soft voice is calling your name. You open your eyes. It’s a bit

blurry, but you see her. She’s standing next to you, leaning in toward you.

“Sir, can you hear me?” she asks. You feel a light touch on your arm.

You nod, and you try your best to keep your eyes open, but that’s hard when it’s a struggle even

to breathe.

“We understand you want to pursue a third round of chemo… But what if …”

You hear a sigh. You know that sigh—it’s your father. You’ve heard that sigh only once before,

when your grandmother died. You saw your father silently weeping, and you heard him sigh like so.

“What if…”

You don’t want to think about it. You’re 23 years old. You want to live. You should be finishing

college. Every breath is a labor. You hear your father sigh once more, and it hurts. ***

Hardly five minutes had passed since your preceptor began talking, and the family meeting is

over. As you leave, you notice the mother and the father wiping their eyes. The patient’s eyes are closed. You can’t tell if he’s awake or not.

26

The medicine and the heme/onc teams say their goodbyes. The palliative residents leave to

check up on their patients. It’s just you and your preceptor now.

“I thought you were going to talk about end-of-life care,” you ask, using some words you just

learned this morning.

“I wanted to, but it was the heme/onc who was leading that meeting,” she responds.

“I’m not—I don’t understand,” you say. “I thought it was made clear in the pre-meeting that he

was dying. The third chemo’s not going to help him, is it?”

“No.” Your preceptor sighs. “Did you notice how the parents started crying when I said ‘what if?’

“It would have been too much. We spent too much time in the beginning talking about treatment

options.”

“Will there be another family meeting, then?”

She shrugs. “I wish they knew that it’s better for them to spend the time they have left together

at home, instead of pursuing one aggressive treatment after another until he dies.” ***

Your room has been dimmed to match the darkness outside. Your parents have gone down to

the hospital cafeteria for dinner. It feels a bit nice to be alone so that you can think.

You will never finish college. There is a good chance you will never leave this hospital. You

won’t find a girlfriend, and you certainly will not marry. You will not go to Europe for the graduation trip that you and your friends had been talking about. Ever since you were in middle school, you had wanted to go see the Strasbourg Cathedral in France. You saw a picture of its rose window in a travel book and marveled at its hypnotic kaleidoscope of patterns and colors. Though you were only a child, you felt a touch of religious awe. It was the first time you felt your heart ache for something beautiful.

27

Tears gather at your eyes. You want to be able to pray, but you don’t believe in anything. You

never thought about it because you had better things to do. Now you will never be able to think about it. You wish your parents would come back soon and pray for you.

You are alone in the hospital room. You’re afraid.

You are 23 years old, and the time has come for you to die.

***

It is another late night. Every night seems to be a late night in medical school. You have two

years of this. Next year, you will take the big Step 1 exam. Then third and fourth years are rotations.

Then residency, and then maybe fellowship. The road ahead seems endless. It feels as if you will never be a doctor.

You think about your uncle who is a doctor. You used to play with his stethoscope when you

were little, and he let you shadow him when you were in high school. He was the one who encouraged you to think about medicine, and he was prouder than your parents when you announced your acceptance into medical school.

Your head hurts. You haven’t yet figured out the most efficient way to study. You decide to go to

sleep despite having one more lecture to review. Turn off the lights, and plug your phone into the charger. As your mind settles and your thoughts become dim with slumber, the image of the Burkitt lymphoma patient flits into your mind. You wonder what will happen to him. You wonder when he will die.

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You are 23 years old. It is time for you to sleep.

Arabian

Lauren Facer Student, Long School of Medicine, Class of 2019

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Day Two

Raj Sehgal, MD

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Breathe Jessica Hill

Student, Long School of Medicine, Class of 2021

Dear friend, I watch you trudge on Never pausing With such determination that I wonder if you fear That coming up for air Breathing Will make you want to never return To the cold waters of reading Of memorization Of confusion But friend, I also know the bottom of that lake The place people sink without air No longer humanitarians Ghosts barely visible through the darkness Perhaps you are stronger than me And you can swim farther for longer Or maybe you feel that you have no other choice Maybe the cold water is your safe place After all, you had to be exceptional to get here You tell yourself you have to be perfect to stay But friend please know If you want to breathe Or rest Or just surface long enough to smile Do so Believe you are strong enough to dive back in The pause will not freeze your limbs And the world deserves to hear your laugh

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Dendritic Boughs Connie Cheng

Student, Long School of Medicine, Class of 2020 NOTE

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from the

Reaching up to grow, reaching out to connect.

Congregations Sammar Ghannam

Student, Long School of Medicine, Class of 2021

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One Moment

Rebecca Nekolaichuk Student, Long School of Medicine, Class of 2018

In one infinite moment, you were Gone.

Flying off to Neverland.

We were Expected to be Stronger Than them.

Assuredly, Inescapably, We aren’t.

And how could we be Anything But human?

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Cheartcoal Series Marlow Taylor

Student, Long School of Medicine, Class of 2020

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Not-So-Silent Night Cindy Yang

Student, Long School of Medicine, Class of 2019

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A Conversation Narine Wandrey

Student, Long School of Medicine, Class of 2018

There is a place where I wander By risk, I come It is my secret, but it is yours too.

There the adolescent moon rises above mountains and a garden Gentle arc of motion in the Sky An elegant proof for those who choose to see.

Astral garden, below it two flowing springs where water touches Sky And beyond a meadow pristine.

Sky and Earth This is their risk—an inflection point of meeting.

This is their conversation—a place of gathered ethereal dreams.

And we are to risk, our thoughts not just probability I woke up laughing—I ran through the meadow It is your secret, but mine dreamed to reality.

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Agrarian Utopia Barrington Hwang

Student, Long School of Medicine, Class of 2019 NOTE

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from the

Denpasar, Bali, Indonesia

Captor of Time Alexis Tracy

Student, Long School of Medicine, Class of 2018

Wrinkled and wise Crinkled and tired Folds so deep Those eyes heavy with secrets to keep A lifetime of rays so strong Hair speckled pepper gray Skin tough like leather and worn Youth now long gone away Decades of marks and scars that adorn Cover the many angles of you Within so many layers to be born Many stories as time did quickly accrue Those eyes once crystal blue Detailed like a novel That only a lifetime of knowledge and experience could ensue I am honored to be among you The pleasure is all mine To me you are a beautiful captor of time

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Codicia

Jose Torres Student, Long School of Medicine, Class of 2019

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Only in Texas Bonnie Moreno

Administrative Assistant - Senior, Department of Obstetrics and Gynecology

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Vitamins

Gretel Sanchez Student, Long School of Medicine, Class of 2021

We take care of our bodies.

We diet and exercise and take our vitamins.

And when we fall ill, we don’t mind saying “My body is tired and sick and in pain.”

The body is important, but the mind is just the same yet when it comes to our mental frame, we cannot speak of our illness without feeling the shame.

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State of Mind Kavina Patel

Student, Long School of Medicine, Class of 2021

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Testify Onto the Sun Charles Ratcliff II

Student, School of Health Professions, Class of 2019 NOTE

Religious architecture has been known to inspire joy within many and inspire

from the countless artists to create their own outsider works. Stained glass is intriguing in its function of encompassing art, powered by nature- the fusion of religion, art, and nature.

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Study of the Eye Lina Mahmood

Student, Long School of Medicine, Class of 2020

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Healthcare Reframed Garrett Kneese

Student, Long School of Medicine, Class of 2021 NOTE

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We came upon a small concrete home where an 87-year old woman lived. Debilitated

from the by decades of farm-labor, and nearly blind, this woman was living out the remainder

of her life within a mile of where she was born in rural Ecuador. After a close physical exam and history by the attending physician, we administered medicines for a throat infection and prepared to depart. The attending on our team, however, noticed that her cow had not been milked in quite some time. She began to milk the cow. We traded off, as each person’s hands grew weary, and set aside our traditional views of healthcare to provide the most basic of such to this woman. Looking back, I noticed that the woman was initially appalled at our response to the situation. Why would doctors milk someone’s cow? I learned that, sometimes, healing goes beyond medicine, beyond the clinical history, and beyond what we’ve learned in the classroom

West End Boathouse Marina, New Orleans, LA Kent Coker

Standardized Patient Educator, H-E-B Clinical Skills Center

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Cogito

Eithan Kotkowski MD/PhD Student, Graduate School of Biosciences, Class of 2021

A drop among eternity, Swift and fierce as summer rain, I contemplate its harmony, Within the confines of my brain.

From senses grasping sound and sight, Composing tapestries of mind, I hearken to a life contrite, The who’s and what’s I’ve left behind.

Within the system’s ebbs and flows, Besets the figment of control, This web of cells that house my throes, The very essence of my soul.

To wander out of time and place, Amidst a conscious sea of fraught, I choose to bask in life’s embrace, To love the alchemy of thought.

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Cooking in Rural Nawawasito, Nicaragua Jaswanth Raj Kintada

Student, Long School of Medicine, Class of 2020 NOTE

from the

On this stove, a mother of two was preparing a modest breakfast of rice, bread and beans for her family.

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Growth Mindset Giselle Castillo

Student, Long School of Medicine, Class of 2021

NOTE

from the Growth Mindset - The belief that your brain has the ability to become stronger

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and grow. Helping your brain grow includes making mistakes, learning new things, stepping out of your comfort zone, and viewing challenges as opportunities for growth, things symbolized by the water flowing out of the watering can.

Computing Lina Mahmood

Student, Long School of Medicine, Class of 2020

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One Day is Today Omar Akram

Student, Long School of Medicine, Class of 2021

NOTE

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from the

Taken at the annual Martin Luther King March of San Antonio, January 15, 2018

Universa Vasa Alexis Tracy

Student, Long School of Medicine, Class of 2018

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Scattered Pearl Narine Wandrey

Student, Long School of Medicine, Class of 2018

What is soul but a scattered pearl?

A promise to become infinity

And is body yet a vessel of gold?

A promise to be loved endlessly

Let these two halves come together to be whole

To be understood, do you see my soul?

They are of earth and celestial home Are you my vessel?

To hold and love my soul To brave the tempest sea only to be smothered by sand With the hopes of being uncovered to seek the treasure trove here not known Drowned by ecstasy Saved by probability Falling into each other’s being; For it’s not the physicality The pleasure-seeking harmony or the synapses of cerebrum, for they digress with time.

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And a scattered pearl I am indeed Upon a necklace I won’t be strewn But to find my vessel of gold, my home To find my shell and again be born.

Sunset Sammar Ghannam Student, Long School of Medicine, Class of 2021

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The Ugly Duckling Cindy Yang

Student, Long School of Medicine, Class of 2019

NOTE

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from the

Hallstätter See, Austria

Civil War

Jonathan Espenan Student, Long School of Medicine, Class of 2021

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5 5 - W O R D STO R I E S The 55-word story is a form of “micro” literature that provides an opportunity for time-efficient reflection and serves as a tool for self-care. Over the past three years, hundreds of students, residents, and faculty have participated in Project 6-55, a reflective writing workshop that teaches this approach to narrative medicine. We are pleased to share this collection of 55-word stories.

W I N N E R, 5 5 - W O R D STO RY The Saddest Silence Natasha Mitra

Student, Long School of Medicine, Class of 2019

Hardened belly ballooning outward, she writhes in pain.

Her pale, slippery skin soaking the sheets and beads of sweat matting her hair.

She wails, “Just make it stop!”

The ultrasound probe jerks, searching desperately.

“Ma’am, there’s no heartbeat.”

Silence lingers.

Her hands muffle her sobs; convulsive cries propel her body.

“Can I still hold her?”

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H O N O R A B L E M E N T I O N , 5 5 - W O R D STO RY The First One Yvonne Uyanwune

Student, Long School of Medicine, Class of 2019

We knew her for two days Why did it hurt so much?

Her brother, by her bedside Her niece, on the next flight Multiple strokes in the past but this was different Code status: DNR/DNI Eyes closed, jaw open, unresponsive to voice/pain We knew her for only two days Why did it hurt so much?

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Missing

Sadie Trammell Velasquez, MD Clinical Assistant Professor, Division of General and Hospital Medicine

I missed Thanksgiving, my sister’s graduation, morning runs with my other sister. I didn’t know I would miss so much. What else would I miss or lose over four years of medical school, three to seven years of residency, and beyond? I missed my sister run Boston in 2013, I’m thankful I didn’t lose her.

PTSD

Zachary Tran Student, Long School of Medicine, Class of 2018

To the other side of the globe, he went.

To protect his love, his country.

To war, which drove it apart.

To gratitude he returned, no.

To only malice and spite.

To drugs, he found solace.

To cocaine, hatred numbed.

To our psychiatry unit we met.

To hear what hadn’t been heard before.

“Thank you.”

My background as the son of Vietnamese immigrants allowed me to connect with a veteran in a way no one else could.

The structure of the piece is deliberate in that each line becomes shorter and then gradually longer. The final line abruptly disrupts this configuration, signifying the patient’s own change in pattern from my words of gratitude.

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Nic-anahuac Claude Hardy

Student, Long School of Medicine, Class of 2020

La salud global es llena del olvido.

Cuando los detalles te cautivan, cosas simples son olvidado, como el agua.

Agua turbia en ríos fríos. Agua tibia en tu botella perdida.

Agua clara que nenes necesitan, pero no lo pueden beber.

Y cuando el cuerpo se pone seca, le olvidamos el agua salada en la lluvia.

A Night in the Trauma Bay Rachel Dang

Student, Long School of Medicine, Class of 2019

He lay there with a tube in his throat.

We were waiting for him to sober up before removing it.

I hoped when he opened his eyes and saw his Asian medical student, his Hispanic nurse, and his Black X-ray tech He’d feel ashamed of the swastika tattoos all over the body we cared for.

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Pink Nails

Sammar Ghannam Student, Long School of Medicine, Class of 2021

Her nails were still painted.

They were a bright, lively pink.

Was that her favorite color?

Did she get her nails done for her birthday?

Her son’s wedding?

She left me guessing.

Creating a picture of her in my mind.

Her delicately painted nails were the last bit of life that was accidentally left over.

She Said Her Goodbye from Afar Morgan Fletcher

Student, Long School of Medicine, Class of 2019

It came on suddenly, without warning and all-consuming.

Her body, once a vessel in which her mind lived comfortably, was now dead weight.

Her only source of communication, now a disconnected landline.

Family came, family went, but her eyes could not see them.

They made their peace with her.

She said her goodbye from afar.

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Untitled

Jonathan Espenan Student, Long School of Medicine, Class of 2021

“Hey it’s me …. Joe, your new anatomy cadaver.

It seems you know about me, like how I died of heart disease at seventy-six.

I can hear you joking, about how my parts resemble food, and lamenting my excess storage.

But as you learn in this room, just remember, We’re all made of the same shit.”

Innocence

Vinh-Son Nguyen Student, Long School of Medicine, Class of 2020

Walking in the patient’s room, I see her friend.

“Where is she?” I ask. Her friend points to the bathroom.

The door slowly creaks open I see a towering wheeled IV machine with bags, tubes, and wires coiling down.

With my eyes I trace them to a tiny girl no older than 5, receiving chemo.

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Linley

Luke Lehman Student, Long School of Medicine, Class of 2021

How do we measure life?

It can be measured in years- she had 23.

But does that not leave out the substance of life?

Were we to measure life by its impact on others She lived more richly than most.

I don’t think it was colon cancer’s victory after all.

I think it was hers.

The Man Who is an Island Rosemary Liu

Student, Long School of Medicine, Class of 2019

They say, “No man is an island,” but this man may very well be.

He lies there. No visitors. It’s been a week.

Admitted for suicidal ideation but now the issue is placement.

Cycled through so many care facilities; many will no longer take him.

At least we’ve been treating his pain — or have we?

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Seventeen Lorelle Knight

Student, Long School of Medicine, Class of 2020

“I’ve lost weight,” he said.

“That’s good,” I told him.

I saw his mouth press into a line.

“131/74,” I said. “That’s good,” I told him.

His mouth made that line again.

I moved on; next patient.

“Seventeen,” the nurse announced quietly.

I looked up.

“That man’s A1C was seventeen. Blood sugar 545. No insurance.”

More Than Just a Third-Year Medical Student Barrington Hwang

Student, Long School of Medicine, Class of 2019

“Who are you?”

I ask myself that constantly throughout medical school. I only take orders and focus on the current moment, so I can go home to study at a (un)reasonable hour. But as I perform chest compressions on a dying patient, I realize: I’m important. I’m more than just a third-year medical student.

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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

.