Connective Tissue 2019

LITERATURE & VISUAL ARTS JOURNAL

VOLUME XII • 2019

Cover Art

“Food is Free� by Rajitha Reddy, MS3 - full image appears on P. 62

For entry guidelines, to view past journals, and for more information about joining a committee, visit: https://www.texashumanities.org/literature-art/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 XII • 2019 EDITORS-IN-CHIEF Hilary Hopkins Hye Ryung Yang MS4

MS4

EDITORIAL STAFF Alexis Ramos

Jonathan Espenan

Sammar Ghannam

Christopher Zhu

COPY EDITOR

FACULTY ADVISOR

MS3

MS2

MS2

MS0

Ruth Berggren, MD

Sheila Hotchkin

Director, Center for Medical Humanities & Ethics

Assistant Director, Center for Medical Humanities & Ethics

SELECTION PANEL Glennette Castillo MS2

Nathanael Franks MS2

Rosemary Liu

Sanaa Prasla MS1

Emily Sherry

MS4

Carlos Ontiveros

Alexis Ramos

Lauren Wagner

Melissa Dang

Sara Lalani

MS2

MS4

MS1

MS3

Jonathan Espenan

Luke Lehman

Bethany Pierce

Isabelle Seto

MS2

MS2

MS1

MS4

MS1

MS4

Averi White MS3

E D I TO RS ’ N OT E HILARY HOPKINS HYE RYUNG YANG Editors-in-Chief

A special thank you to the Center for Medical Humanities & Ethics, Sheila Hotchkin, Dr. Ruth Berggren, Dr. Jerald Winakur, Lee Robinson, our editorial staff, and the selection committee for their hard work and dedication.

Finally, thank you to our readers!

We are honored to be Editors-in-Chief of Connective Tissue in our final year of medical school. It is a pleasure to lead a project that has enriched our education these four long years. In the same way we hold Connective Tissue close to our hearts, this year we’re sharing a new cause with you. This is the first year Connective Tissue has a theme. We could think of none more important or urgent than Environmental Health. You will find works related to Environmental Health featured in this issue.We want to thank the artists and authors who submitted Environmental Health works this year--we are truly impressed by your artistry and skill.

Our passion for Connective Tissue stems from a desire to bring light to what unifies us. The shared experiences of healers are powerfully displayed through creative works. The threat posed by climate change is shared by all of us and is of particular importance to health care professionals. We spoke with Kristina D. Mena, MSPH, PhD, from the UTHealth School of Public Health to learn more. “Understanding how hazards move through the environment and the range of ways people are exposed can help strategize mitigation to minimize exposure and disease,” Dr. Mena explains. “More importantly, environmental health involves people and how we impact and are impacted by our environment.”

Environmental changes reverberate through all aspects of life, from public infrastructure to policy making. Healthcare is no exception. We at Connective tissue are proud to highlight the relationship between medicine and the environment.

We hope this edition continues the tradition of showing students that they are not alone and reminds us of both the majesty of and responsibility we owe to our environment.

Hilary & Hye

Hilary Hopkins

Editor-in-Chief, Connective Tissue Vol. 12 Student, Long School of Medicine, Class of 2019

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Hye Ryung Yang Editor-in-Chief, Connective Tissue Vol. 12 Student, Long School of Medicine, Class of 2019

IN MEMORIAM Edith McAllister 18 February 1918 — 1 July 2018 I met Edith McAllister soon after I arrived in San Antonio in 2002, thanks to Dr. Marvin Forland, who introduced me after I spoke at an event at the McNay Art Museum. We took an instant liking to each other, though I suspect every person she met walked away with the same illusion of being special to her! It was her smile, her enthusiasm and energy that made you feel that way.

But she really went out of her way to befriend and support me personally, as well as the Center for Medical Humanities & Ethics, agreeing to chair our advisory board even though I know for a fact she was completely swamped with such roles. She raised a significant amount of money for us and brought many friends to know our organization. She and I went on to have a deep personal friendship, and that continued right up to the moment of her passing last year at the age of 100, more than a decade after I left the city. It would have been inconceivable ever for me to pass through town on a return trip without seeing her.

I recall several important lessons I learned from her; in fact, for her 90th birthday I summarized those lessons for her in a poem that I called, “If You Can’t Be Her, You Can Be a Better You.” I’m proud to say she framed this and put it on the wall in her dining room. I won’t reproduce the entire poem here because much of it would not make sense to anyone but her. The lessons I saw from being with her, though she may not have articulated them quite this way, were: 1. Show up!

2. Have fun!

3. Leave a legacy of love, because what else survives in human hearts?

4. God is in the details, which means do it right, sweat the small stuff but don’t forget – 5. – that it is all small stuff.

6. Don’t look back because you bump into yesterday.

7. Use it or lose it.

I’m sure there were more, but those were the ones that I took away. I can’t imagine I will ever meet someone who lived so fully for 100 years on the planet with such optimism, enthusiasm and energy, and affected so many people. It’s a good goal to set for ourselves but, quite honestly, impossible for mortals.

Abraham Verghese, MD, MACP Founding Director, Center for Medical Humanities & Ethics Linda R. Meier and Joan F. Lane Provostial Professor Vice Chair for the Theory and Practice of Medicine Stanford School of Medicine

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G LO B A L H E A LT H C O N N E C T I O N

Vitamin I Rajitha Reddy

Student, Long School of Medicine, Class of 2020 Ethiopia Outreach Global Health Team

1st-place winner at the University of Texas Medical Branch Global Health Education Symposium Photography Contest Rajitha took this photo in June 2018 while visiting Common River in Aleta Wondo. Common River is a U.S.-based nongovernmental organization implementing a community development program in the heart of the Sidama coffee-growing region, Each summer, a group of students from the “Foundations in Global Health� elective spends three weeks working at Common River.

iv

The woman in the photograph says she is over 100 years old and was impregnated by an Italian soldier during the occupation of Ethiopia by Italy (1935-1936). I guess if she was 16 years old in 1936, she would have been born in 1920, which would make her at least 98 years old today.

She describes giving birth to a baby girl and raising her for a few years. Then, she says, the Italian soldier came back to Ethiopia and took the child with him, and this woman never saw her daughter again. She has always longed for her. One day our friend and 10-year collaborator, Common River co-founder Donna Sillan, was shopping in the Aleta Wondo market. This woman came up to her without introduction, and she began shouting that her Italian daughter had returned to her at last! She wept and wept and would not be dissuaded from her belief that Donna is her long-lost daughter. Rather than try to dissuade the woman, Donna finally decided to accept the charge to stand in for the long-lost daughter, as best she could. Each time Donna visits Aleta Wondo, she pays several visits to the woman, who takes Donna’s face in her hands, gazes lovingly at her, and weeps.

Inside the woman’s hut is just enough space for a tiny charcoal cooking fire, with a place for the cow and its food. Just 2 feet from the cow’s space, there is a pallet of straw on the ground, layered with ancient blankets where the old woman sleeps. The floor is packed dirt, and the walls are made of woven basketry and a mixture of mud and cow dung; the roof is thatched and leaky. For a long time the woman had “patched” the leak with large banana plant leaves. Later, Common River was able to repair the roof. Common River also has a mini “meals on wheels” program for a half dozen elders who live nearby in huts just like this one. Young boys - orphans from the Common River School - are charged with bringing the elders a prepared hot meal once a day on weekdays. In between times, the elders survive on a starchy substance from the core of the enset tree, also known as false banana. They make a grainy powder out of this stuff and bury it in the ground, where it ferments.

Then they eat it when there is nothing else to eat. To me, it does not taste edible. It has no protein, but it is pure carbohydrate and provides life-sustaining calories. When she visits her Ethiopian mother, the “Italian daughter” Donna brings food, medicine, clean clothes and blankets, along with sweet-smelling lotion that she massages into the woman’s wrinkled hands. Raji and I witnessed their emotional reunion this June, and Raji took this photo.

Ruth Berggren, MD

Director, Center for Medical Humanities & Ethics Professor, Department of Medicine

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C O N T E N TS AWARDS P PHOTOGRAPHY

L LITERATURE

A VISUAL ARTS

55

WINNER

WINNER

WINNER

WINNER

8

12

Solar Eclipse

Richard Usatine, MD

The Truth About a Eulogy 9 Michelle Vasquez

ENVIRONMENTAL HEALTH FEATURE

ENVIRONMENTAL HEALTH FEATURE

10 Before It’s Too Late

14 I Walk Among the Soulless 11

Noah Hodson

subhanAllah

15

Sijil Patel

ENVIRONMENTAL HEALTH FEATURE

Anonymous

55-WORD STORIES Tortilla Soup Andrew Braun

ENVIRONMENTAL HEALTH FEATURE

Nature’s Therapy

15

Cynthia Jiang

Something in the Water Sara Springfield Schmit

COMMITTEE SELECTIONS P Incoming, series 16

P Flow 24

Barrington Hwang 55

Steroid-Induced Psychosis

16

P The No-Wishing Well

Julia Kirsten 55

Untimely Demise

17

P Laguna Quilotoa

The End

P Soul Food on the Go

17 18

Vinh-Son Nguyen

A A Bilateral Pleural Illusion

19

Christian Jacobsen

P Cloud Walk

20

Patali Shikhi Cheruku

P Bison at Tallgrass through the Seasons

L A Night at Sea

21

P Mountains Beyond Mountains 28 Mikaela Miller

L Consequences 29

P Panther Falls P Zen

30

55

Palu, September 2018 Jacob Canfield

35

Lina Mahmood

36

Hannah Ramirez

A This is Your Brain on Residency 37 Bracken G. Smith, DMD

P Seasoned 38 Hye Ryung Yang

39

L on losing you

39

P Sunrise Yellowstone

40

Richard Usatine, MD

31

P Cueva De Los Astros

41

Sarah Khoury

32

Vinh-Son Nguyen

23

Do No Harm?

Alyssa Smith

Richard Usatine, MD

P Balance 23 Veronica Riggs

29

Nicholas Shaffer

22

35

Sammar Ghannam

Nathanael Franks

L Skipping Stones Pantoum

55

P Floating Gardens

Across the Border, Found More Borders

Jessica Hill

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A Maya

A Head Fog 27

Brian Doss

55

34

Jonathan Espenan

Aarushi Aggarwal

Hye Ryung Yang

Sanaa Prasla

26

Clare Mundy

A Food, series 22

L Mother Earth

A Ode to Failures Sarah Khoury

A Art of the Sea is but a Shell, Such Beauty 27

Kimberly Vogelsang, MD

L The Art of Not Healing

25

Nathanael Franks

Madeline Hazle

33

Averi White

Blake Seeker

Maggie Zhang 55

P Children atop Kony’s Rock

Chirag Buch

P Chrysaora fuscescens Raj Sehgal, MD

32

42

L The 8th Floor

43

55

Alexis Ramos

P “They can heal you, trust them” 64 Freedom 55 Michael Grzeskowiak, MD

L I Feel Like I Knew You Backwards

55

44

Anonymous

45

Colin Coker

L Rose (rohz) n. 1 a thorny shrub bearing flowers in various colors. 46 Edward Harris Jr.

A Nature’s Palette

55

Luke Lehman 55

P Fragile Existence

Pink Sweater

Zachary Cope

Katharina Tosti

A Constant War

55

Chris Gilson

48

James Liu

L Steps to Mindfulness

56

Chelsea Wu

49

Sammar Ghannam

A The Dead Teach the Living

50

Jake Ritter

A Seashells On My Mind A Hummingbird Sign

Jonathan Espenan

L Sacrifice Zone

57

P Burning the Midnight Oil

57 58

Chelsea Wu

A Hand 53 Maggie McGlothlin

P Church Bells

54

Nels Davis Carroll, MD

P Crown of Thorns

54

59

A Child of Antigua

68

L Socks in the Hand of a Surgeon 69 P Free-Range Chicken

70

Blake Seeker

60

Katharina Tosti

P Burkina Faso Mother and Child 71 Ruth Berggren, MD

Traitor 61 Madeline Hazle

55

P Monica 67 Averi White

Pavela Bambekova

52

66

Phyllis Clark Nichols

P Nature vs. Industry

51

A Fresh Harvest, A Still Life

George W. (Bill) Nichols, PhD

A Snowdrift at Frozen Lake

55

A de los Muertos

L Rain 65

Sammar Ghannam

Marlow Taylor

A Edward Hopper’s Corn Hill: A Study

65

Averi White

Lorelle Knight

P Tropical Urban Sprawl

The Silly Question Julia Kirsten

Keerthana Pakanati

47

55

L A Father’s Lullaby

72

Jordan Kampschmidt

A Forgotten Struggle

61

Aarushi Aggarwal 55

The Best Friend

61

Anonymous

P Food is Free

62

Rajitha Reddy

L Battles of the Heart

63

Brian Doss

Nels Davis Carroll, MD

L LITERATURE

A VISUAL ARTS

P PHOTOGRAPHY

55

55-WORD STORY

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.

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

Richard Usatine, MD Professor, Department of Medicine

This composite of the American total solar eclipse of Aug. 21, 2017, was taken in Oregon. Photographs of the sun were taken from the beginning of the eclipse to the end of this miraculous event. The middle image shows totality, when the moon is completely covering the photosphere of the sun. On either side of totality, the diamond ring formations occur with just a small amount of sun peeking out around the moon. Nikon D810, 24 -70 mm lens.

NOTE

from the

P  See Dr. Usatine’s other two photographs on pages 31 (Panther Falls) and 40 (Sunrise Yellowstone): each photograph was chosen because it shows the majesty of nature seen within the United States, from the incredible celestial event of a total solar eclipse to the beauty of an amazing waterfall deep within the forests of the Northwest to the glory of a sunrise in our first national park. Together, they show the wondrous beauty of our planet, including our sky, sun, trees and water.

8

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

Student, Long School of Medicine, Class of 2022

NOTE

from the

This piece is color pencil on drawing board. My initial reaction when I first saw the Grand Canyon was praising God by saying the phrase “subhanAllah,” which roughly translates to “Glory to God” in Arabic.

9

F E AT U R E , P H OTO G RA P H Y

Before It’s Too Late Noah Hodson

Student, Long School of Medicine, Class of 2022

NOTE

10

from the

Taken at Perito Moreno Glacier in Argentina, 2018.

F E AT U R E , V I S U A L A RTS

Nature’s Therapy Cynthia Jiang

Student, Long School of Medicine, Class of 2022

NOTE

from the

Oil on canvas. The Torres del Paine mountains in Patagonia were the inspiration for these paintings.

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W I N N E R, L I T E RAT U R E The Truth About a Eulogy Michelle Vasquez

Senior Marketing Specialist, Marketing, Communications & Media, UT Health San Antonio

“I loved him. He was my best friend. And even the bad times were good.”

These are all the words I could muster to say at my husband Drew’s funeral. There was so much to say, and that’s all I could come up with.

He died in my arms as I tried to get the attention of the hospice nurse, even though that would have made no difference. He’d had a recurring brain tumor for the better part of 10 years. And as his last breath on this earth left him, I felt it empty his soul into nothingness.

“Nothingness” has a quality that is inexplicable, but you know it and you feel it. I felt his nothingness, and I also felt mine. I was nothing without him.

While I felt “nothing,” it was also painful beyond belief. I remember hearing Dido’s song “Here with Me,” falling to my knees and just screaming. My friends, horrified for me, let me wail the death wail. The death wail comes from your deepest bowels of pain, rises to your diaphragm and projects to the depths of anyone who hears it.

When you are living with a terminally sick person, you hear about the death rattle, the telling sign of imminent death. It is guttural and hacking and takes every last ounce of energy left in the person before they expire. The death rattle was the signal that triggered my death wail. The two always go together.

I couldn’t help the conflicting feelings of sadness that he was dying coupled with the guilt that I would outlive him. Even if I had accepted his death, there would always be a big hole in my life. The thought of living at all made me wish that I, too, could die. Either way, the hole was still there.

Beyond the memories of what it was to be together “in sickness and in health,” all I had left was a box of ties, suits and clothes lovingly bought to make him both proud and comfortable during his illness.

It’s funny, but many times people don’t think about what being dressed well does for a sick person.

Looking “well” gave my husband a certain sense of pride. He did not act sick. His doctors treated him with dignity, and even people on the street nodded toward him as he struggled across the street with his walker or rolled along in his wheelchair.

He might have been sick, but I’d be damned if I would let him look that way. There were few things I had 12

control over during his illness, but how he was dressed was within my power of influence. What was left of his hair was always immaculately combed. He was always stylish, dressed with the latest from Ralph Lauren or Banana Republic. Seat covers for his wheelchair and accessory bags for his walker coordinated with his outfit. He was, in a word, dapper.

I wanted to control and hold on to any sense of normal life we could have together. Part of how I did that was through his appearance. How much of this control was for him and how much was for me, I will never know. Perhaps it was really about how much we loved each other. Or, in his acquiescence, it could have been how he tried to placate me, despite having to rely on me for so much.

What was important to me was that he would be treated with dignity and respect in his dying days. He didn’t and I didn’t want pity. What we wanted was to have a normal dinner between two people who loved each other. We wanted to hold hands, enjoy a glass of wine with our meal and walk or roll home afterward.

There was also pleasure in having a dinner party among friends at home where we prepared the meal, him putting meal ingredients in the sack on his walker and then bringing them to me so that I could chop and sauté. He would set the table, even though he had to do so with one hand. And that hand always took mine during the meal. This act was a ritual acknowledged by both friends and family as part of the glue between us.

We often laughed at the absurdity of our situation. The alternative was tears. All we wanted was to hold on to each moment we had with love, laughter and the frequent phrase, “this sucks.” He would defiantly utter that as his vocabulary and strength to communicate diminished.

Even when words may have failed us, our actions toward each other spoke volumes. The sweet caresses in the shower, he on his bench and me standing so that we would always be touching, safety permitting. We would exchange tender kisses on the forehead, on the cheek, on the lips and wherever we could.

These tender moments made me wonder if I was the caregiver or the patient. He took care of me, shielding me from as much of his pain and horror as was humanly possible. Only after he died was I fully aware of his anger from knowing that we had limited time.

Despite the fact that we shared everything, we each carried the very heavy facts and isolation – he that he was dying and I that I would be living. And even now, I live knowing we loved each other beyond words and that having words fail in the moment of a eulogy is worth so much less than the memories and actions between us.

Michelle describes a true story of having too few words for her husband’s eulogy.

The memory of being with her husband through death haunted her until she realized that what they had was everlasting.

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F E AT U R E , L I T E RAT U R E I Walk Among the Soulless Anonymous

A museum opens as a pitiful reminder,

I walk among the soulless

Of what was, what is and what should be.

With nothing but the smell of distress

I move along the halls of the past and wonder

Filling their noses.

Where are our souls, and why can’t we see?

“Stars” shine, but not in the skies,

I walk among the soulless

Desperate for the spotlight to prove they exist.

With nothing but the taste of bitterness

A poster here, a movie there, maybe a song full of lies,

Heavy on their tongues.

A new hit that speaks of love that has never been kissed.

With pride we once roamed the lands, Building and planting ... seems so long ago.

I walk among the soulless

Now weapons and arms we see in children’s hands,

With nothing but the sound of nothingness

Have we forgotten that we reap what we sow?

Deafening their ears.

I walk among the soulless

A contagious disease plagues the Earth,

With nothing but the sight of ugliness

Power, greed and the pursuit of needs,

Blinding their eyes.

Replace humanity to prove self-worth.

Thoughtless actions in every corner of the world,

I walk among the soulless

“Civilized” nations waging wars ... killing.

With nothing but the touch of coldness

In the name of “freedom” and “peace”! How absurd!

Freezing their hearts.

My heart is bleeding ... my tears spilling.

I walk among the soulless I cry to the angels, but heaven no longer heeds.

My only weapons are the words I express.

I seek not to conquer nor strangers to impress.

Fear of others does not drive me to oppress.

I walk among the soulless A response to the Arab Spring.

14

Proud in who I am ... I can be nothing else.

W I N N E R, 5 5 - W O R D STO RY Tortilla Soup Andrew Braun

Student, Long School of Medicine, Class of 2020

The Mexican restaurant made up for its small size with a cavalcade of vibrant colors. Reds, yellows, and oranges poured over my grandmother’s face and snuck their way into every wrinkle, every story, lighting up the rest of the room like the sun.

The last look of her face before she was diagnosed with cancer.

F E AT U R E , 5 5 - W O R D STO RY Something in the Water Sara Springfield Schmit

Friend of UT Health San Antonio

“It’s cancer,” the oncologist informed the young girl, and hated himself for it.

She couldn’t believe it.

But she wasn’t the only one. She was the fifth person from this border town to be diagnosed with a devastating disease too early in life.

Maybe it wasn’t a coincidence.

Maybe it was something in the water.

15

Incoming, series

Barrington Hwang

Student, Long School of Medicine, Class of 2019

Steroid-Induced Psychosis Julia Kirsten

Student, Long School of Medicine, Class of 2020

“But I’m a cheetah now!” the patient sobbed. The patient’s mother took the prescription from the physician.

“We want the old you back,” the patient’s mother pleaded.

“You want the sloth.”

“We want you.”

“I’m both the sloth and the cheetah. The cheetah just never had a chance.”

The patient sprinted out of the room.

16

Untimely Demise Maggie Zhang

Student, Long School of Medicine, Class of 2020

A life of misfortune with a daughter forced across the border. Now the sole provider for multiple young grandchildren. Her CT scan slowly, hesitantly loaded on the screen, spelling out untimely demise. There sprawled one monster of a liver, twice its normal size and littered with metastases.

A moment of silence fills the small workroom.

The End

Madeline Hazle Student, Long School of Medicine, Class of 2022

I investigated every muscle, artery, and organ, but I still know nothing about you.

Ninety-one years of life, and I contemplate your death the most.

I see hints of your demiseblood filling your brain, tumors lining your body, bruises covering your arms.

I wonder about your last moments.

Did you suffer or go peacefully?

17

Soul Food On the Go Vinh-Son Nguyen

Student, Long School of Medicine, Class of 2020

On the inpatient unit of the pediatric hematology-oncology floor, Eight sets of families are packed into a tiny room. One obstacle for cancer patients, especially children, is appetite and proper nutrition. Even in Vietnam, hospital food does not have the greatest reputation for being the most exciting. That is why these two ladies and other parents of patients take turns every day of the week to whip up a hearty meal for all the children. When cooped up in the hospital for months at a time, nothing touches the soul like a home-cooked meal.

NOTE

18

from the

A Bilateral Pleural Illusion Christian Jacobsen

Student, Long School of Medicine, Class of 2022

19

Cloud Walk

Patali Shikhi Cheruku Student, Long School of Medicine, Class of 2021

NOTE

20

from the

Cloud Forest, Singapore. In addition to its stunning architecture and plant life, visiting the Cloud Forest was an incredible way to learn about such a fragile ecosystem and why people should try to preserve biodiversity across the world.

Bison at Tallgrass through the Seasons Kimberly Vogelsang, MD

Graduate, Long School of Medicine, Class of 2016

The Tallgrass Prairie Preserve is one of the largest protected remnants of tallgrass prairie left on Earth. The Great American Prairie originally spanned 14 states from Texas to Minnesota, but with urban sprawl and conversion to cropland, less than 4 percent of the original prairie is left.

Starting in the late ‘80s the Nature Conservancy has worked to restore the prairie ecosystem in this 39,000-acre preserve. There are approximately 2,500 free-range bison as well as carefully planned controlled burns that help maintain the delicate prairie ecosystem. Over the past year and a half, I have visited the preserve on a regular basis and photographed the bison, capturing these roaming giants as the prairie changes around them throughout the seasons.

NOTE

from the

21

The Art of Not Healing Jessica Hill

Student, Long School of Medicine, Class of 2021

I listen over the phone To your rapid, shallow breaths Your high-pitched wheezes As you try to regain control And push away the panic attack If I were working in the hospital And your respiration failed I could treat you Between the tubes and masks and oxygen tanks I could get you breathing again But I’m not with you We are hundreds of miles away So that I could learn The art of healing You tell me how you don’t know what to do You are overwhelmed And scared “Try to breathe Inhale slowly, calmly” But I can hardly advise you Through my own tears What do I do Without a physical solution I have forgotten what it is like To be a sister I can’t solve this Nor do you want me to You need a partner Not a doctor

Food, series Hye Ryung Yang 22

Student, Long School of Medicine, Class of 2019

So I sit on the phone with you Taking my own staggered breaths Trying to be the person you need me to be Learning the art of not healing

Balance

Veronica Riggs Student, Long School of Medicine, Class of 2020

Mother Earth Sanaa Prasla

Student, Long School of Medicine, Class of 2022

I am the blistering heat just outside your A/C haven.

I am the noiseless suffocation lingering above the metropolis.

I am the poisoned waters your food calls home.

I am your only Earth—hear my cry.

23

Flow

Chirag Buch Student, Long School of Medicine, Class of 2020

24

The No-Wishing Well Blake Seeker

Student, Long School of Medicine, Class of 2020

NOTE

from the

There are no coins in the bottom of this freshwater spring. There are only children washing and laughing and gathering what they can carry. Taken in Aleta Wondo, Ethiopia.

25

Laguna Quilotoa - A Quichua Gaze into Pristine Precolonial Ecuador Nathanael Franks

Student, Long School of Medicine, Class of 2021

NOTE

26

from the

Playa Cangrejos, Lima, Peru

A Night at Sea Brian Doss

Student, Long School of Medicine, Class of 2021

The moon is full; the billows roll The sun has set below The stars decide, that we abide Upon the sea we know The moon’s brief flash; the whitecaps crash The sun has set above The stars shine bright; replace moon’s light Upon the sea with love The moon has gone; the waves end dawn The sun gives life away The stars are clear; they call you here Upon the sea you stay

Art of the Sea is but a Shell, Such Beauty Clare Mundy

Student, Long School of Medicine, Class of 2019 NOTE

from the

Candle Holder Medium, Wall Shelf Medium: Wood, Natural Shells

27

Mountains Beyond Mountains Mikaela Miller

Student, Long School of Medicine, Class of 2021

28

Across the Border, Found More Borders Nathanael Franks

Student, Long School of Medicine, Class of 2021

Persecuted at Home, I was afraid.

Burnt in the desert, I was malnourished.

Reached the border, I cried.

Shivering in the Center, I coughed.

Bused across the new land, I was lost.

Missing family, I was lonely.

Now afraid, malnourished, crying, coughing, lost, and lonely, The border only led to new borders, And homelessness, too.

Dozens of asylum seekers arrive at the San Antonio Greyhound bus station every single day. Texas receives more border crossings than any other state, the bulk of which occur in the Rio Grande Valley. Migrant families that have passed the credible fear interview (CFI) for asylum at the Karnes City and Dilley Family Detention Centers are dropped off at this bus station in San Antonio by Immigration and Customs Enforcement (ICE). From this station, they are dispersed to sponsoring families around the United States, where they wait to be seen by an immigration judge to be granted or denied asylum.

Consequences Aarushi Aggarwal

Student, Long School of Medicine, Class of 2022

I yearn to give my cousins a hug My uncles, aunts, and grandma, too But every time I look at flights I stop and remember the harm toxic smog can do I won’t be able to breathe or wear contacts to see Or appreciate the treasures sold on the side of the streets It’s sad to think that people there don’t have a choice But to live their lives despite choking on their voice Kids and adults flood the hospitals wheezing And sound just as bad as heavy smokers heaving All I can do is sit and wait for this season to pass So that I may see my beloved family at last

This piece was written to raise awareness of pollution in New Delhi, India, where all of my extended family resides.

29

Skipping Stones Pantoum Nicholas Shaffer

Student, Long School of Medicine, Class of 2021

As I walk the banks of the river, a stone disturbs the water.

Ripples emanate from where it touches, creating covers of concentric circles.

A stone disturbs the water, thrown without a destination.

It creates covers of concentric circles that must appear odd to the creatures below.

Thrown without a destination, the stone skims the surface.

Appearing odd to the creatures below, as they dart around in their sunken world.

The stone skims the surface and appears as if it is dancing.

The creatures in their sunken world see the ripples as a swirling galaxy.

30

The stone dances on the water and, when exhausted, sinks to the bottom.

The ripples, like a swirling galaxy, disappear, and the water is once again still.

The stone sinks to the bottom, and the current moves it, rounding its jagged edges.

The still water does not reflect what is happening beneath.

The current rounds the rock’s jagged edges.

Ripples surface from where it touches, Not reflecting what is happening beneath as I walk the banks of the river.

Panther Falls

Richard Usatine, MD Professor, Department of Medicine The Panther Falls photograph was taken while standing in the river below the falls with a Nikon D810 and a Nikon 14-24mm lens on a tripod. I was wearing gators to protect me from the cold water up to my waist. My photographer friend was captured holding his tripod while looking up at the falls to give perspective on the height of the falls. This was taken on August 23, 2017, in the Columbia River Gorge of Oregon.

NOTE

from the

P  See Dr. Usatine’s other two photographs on pages 8 (Solar Eclipse) and 40 (Sunrise Yellowstone).

31

Palu, September 2018 Jacob Canfield

Student, Long School of Medicine, Class of 2022

The Earth groaned, and the waves raged forth.

In minutes, The flood was upon them.

Crashing, Cries, Chaos, Then silence.

How would they face this devastation?

Out of debris that held up homes, storefronts, holy places, Clinics were made.

Out of fishermen, school teachers, police officers, Healers were made.

All came together, To restore Palu.

Zen

Vinh-Son Nguyen Student, Long School of Medicine, Class of 2020 “You carry Mother Earth within you. She is not outside of you. Mother Earth is not just your environment. In that insight of inter-being, it is possible to have real communication with the Earth, which is the highest form of prayer.� - Thich Nhat Hanh NOTE

32

from the

Children atop Kony’s Rock: Gulu, Uganda Averi White

Student, Long School of Medicine, Class of 2020

Last year, when my global health team arrived in Omoro District, our driver immediately pointed out Joseph Kony’s childhood home, a small hut like all the others we had already seen along the way. I wondered how this little quiet place had given birth to so much evil--how the other members of this community had felt the day Kony banged two rocks together atop a plateau, now called Kony’s Rock, declaring himself a god. The homes of the children in this picture, identical to the hut Kony grew up in, back up to Kony’s Rock.

Their parents described the banging noise and their terror as Kony sat atop his rock, using the Acholi people below as target practice. Eventually, they fled to refugee camps. For years, even after families returned from the refugee camps, people were scared to climb the rock. However, in the last few years, the local people have slowly but surely reclaimed the rock. Today, the rock is a reminder of the endurance and bravery of the Acholi people. In this photograph, a new generation looks out across beautiful Acholi land from atop the rock.

NOTE

from the

33

Ode to Failures Sarah Khoury

Student, Graduate School of Biomedical Sciences, Class of 2019 NOTE

34

from the This is a sweptfield image of neurotic tissue that was harvested from a mouse that has undergone a stroke. The nuclei of cells are imaged in blue, a protein found within the mitochondria is imaged green, and astrocytes are imaged in red.

Astrocytes, the main caretakers of the brain, may be the key to stroke treatment in the future.

Maya

NOTE

Jonathan Espenan

from the High-gloss enamel on canvas.

"Every good painter paints what he is." -Jackson Pollock

Student, Long School of Medicine, Class of 2021

Do No Harm?

Lina Mahmood

Student, Long School of Medicine, Class of 2020

“I just wanna go home.” Is “treatment” only what eliminates or controls the disease? Should I be grateful we decided to focus on getting her the coffee and Jell-O she had been asking for since she first came in? Should we have done more? One week post-discharge, text reads: she died peacefully at home.

She was a really sweet, pleasant lady who just wanted to see her grandkids and be with her family when her time came.

Our team worked so hard to help her get better, but with everything else her body was going through, it seemed more cruel to keep her in the hospital for what looked like the last weeks of her life.

35

Head Fog

Hannah Ramirez Student of Physical Therapy, School of Health Professions, Class of 2020

NOTE

36

from the

A visual representation of anxiety and depression

This is Your Brain on Residency Bracken G. Smith, DMD

Resident of Endodontics, School of Dentistry, Class of 2020 NOTE

from the Medium: 11� x 14� pencil (self-portrait): Becoming a professional health care provider is challenging. The journey

drives you repeatedly to mental, physical, and emotional exhaustion, constantly pushing you outside your comfort zone and stretching you beyond your capacity. This process of improvement is painful. Why do we do it? So those we have the privilege to care for may live pain-free.

37

Seasoned

Hye Ryung Yang Student, Long School of Medicine, Class of 2019

38

on losing you Alyssa Smith

Student, Long School of Medicine, Class of 2020

we found death in the attic, silent and still he said sometimes you have to act alone and we pretended to understand months passed like scenery from a window in a train and i sat in the emergency room quiet, thinking

Floating Gardens Sammar Ghannam

Student, Long School of Medicine, Class of 2021 NOTE

from the

Taken at the United States Botanic Garden

sometimes you have to be alone and not even forever can bring you back to me 39

Sunrise Yellowstone Richard Usatine, MD

Professor, Department of Medicine

NOTE

from the The sun is peeking out above the trees at sunrise on a misty summer morning in Yellowstone National Park. The photograph was taken with a Nikon D750 and a Nikon 200-500 mm lens on a tripod on August 6, 2018.

P  See Dr. Usatine’s other two photographs on pages 8 (Solar Eclipse) and 31 (Panther Falls).

40

Cueva De Los Astros Sarah Khoury

Student, Graduate School of Biomedical Sciences, Class of 2019

NOTE

This is a microscopic image of brain tissue that was harvested from a pig that received a traumatic brain injury (TBI). The

from the cells imaged here are astrocytes, the caretakers of the brain. Astrocytes are the main source of healing within the brain when brain injury occurs and may be the future focus of treatments for TBI.

41

Chrysaora fuscescens (Pacific Sea Nettle), Texas State Aquarium Raj Sehgal, MD

Clinical Associate Professor, Department of Medicine

42

The 8th Floor Alexis Ramos

Student, Long School of Medicine, Class of 2020

She woke up. In a specific and deliberate way, she woke up as if she had done so millions of times in a past life. The brown-haired woman rolled on to her side to silence the sound that signaled the beginning of the day, a blazing alarm. She’s greeted by a small child rushing into the room with open arms. “Mommy!” the 8-year-old proclaimed. The woman gathered the strength to dress the child for school and sent her to the bus with a wave goodbye. The cracked blinds in the kitchen let in a stream of sunlight, and the automatic coffee maker filled the room with an aroma of fresh beans. Sitting at the end of the long dining room table was her husband. They chatted briefly about the weather that day, which was cloudy but still unusually warm for the month of December. The man walked out the door while the woman cleaned up the table. The routine went on and on, with the woman waking every morning until one day she did not.

The woman stopped waking up. A brain infection left the woman somewhere between asleep and comatose. I met her in the hospital on the 8th floor, unresponsive where she had lain for weeks. The new alarm rang at five o’clock sharp. Her husband always lay on a chair positioned at the other side of the room. He would shut off the noise with his left hand, greet me as I walked in, and open the blinds to darkness with his right hand.

When I left, he’d go down to the cafeteria to buy two cups of coffee—one for his wife and one for himself. And one cup always remained full by her bedside. He talked to her as if she was fully conscious about sporting events and family members. The routine went on and on, with him waking every morning until one day palliative care doctors wanted to chat.

Comfort measures and relocation were discussed. The man refused. He stated he wouldn’t give up on his wife. The argument continued for hours. The doctors said they would try again tomorrow to reason with him. And they did. They came back to discuss the man’s options every afternoon, and the man always refused. The routine went on and on, arguing every afternoon until one day she woke up. She woke up. In a specific and deliberate way, she woke up as if she had done so millions of times in a past life. A woman that medicine saw as declining returned to her baseline. “I knew she would wake up,” the husband smiled. He said that to me every day until they were discharged. And I found that to be the greatest routine of all.

43

I Feel Like I Knew You Backwards Anonymous

I feel like I knew you backwards.

I knew your death before I knew your birth; I saw your last moments before I saw your first.

An alpha-1 page, help, here we go.

And then a one-pager in a news story, oh no.

I didn’t know your name, but I knew your numbers.

Blood, pressors, CPR, but you still went under.

I cleaned you up, I got to know you.

A short prayer, a sense of wonder.

Who? Why? Tears, don’t cry.

More alpha-1s and GSWs on the way.

Barely any time to pray…

I learned later, you’re a father, husband and friend.

A son, church-goer, and the list goes on to no end.

I didn’t know you, but I know you a little better now.

Damn, I wish you knew how, How much your loved ones miss you now that you’re gone, And how much they truly loved you all along.

I wish I knew you forwards.

44

Fragile Existence Colin Coker

Friend of UT Health San Antonio

45

Rose (rohz) n. 1 a thorny shrub bearing flowers in various colors.

Edward Harris Jr.

Student, Long School of Medicine, Class of 2022

Seated on my porch, I find the sunrise peeking over the trees.

From a distance, and before putting on my glasses, I see a blur of scattered color…

Ah! Now I see: a bush freckled with roses.

The workers are early.

They’re wearing torn gloves and straw hats.

Carefully, they remove the sleepy flowers from their nurturing beds.

After being hurled onto the big truck, they are sent to the shop to receive their formal fittings.

Work is done diligently and, gradually, ornate vases become their new homes.

Different roses separated by color and size become the messengers of necessary obligations.

They are taught salutations and learn to say, “Congratulations.”

They begin to welcome life and attempt to dishearten death.

Assorted ribbons and price tags declare their graduation.

Once bought, they face great anticipation, for they know the emotions they provoke will determine their fate.

46

Finally, they are handed over to symbolize words the giver’s limited mouth could not recall.

Once accomplished, the beautiful roses are placed on the finest table and soon become remnants of a moment now past.

Then, uninvited, time steps in.

Vibrant petals begin to dull and shrivel…

Water no longer quenches thirsts…

Sunlight fails to regain what is lost…

And the symbolic words lose their translation…

Until a week ago, I witnessed in admiration that very same bundle of glorious roses and its lengthy preparations.

Yet, in all their glory, and in all their delicate proceedings, I’m far more amazed at how quickly the roses withered… and how long their thorns lasted thereafter.

Nature’s Palette Katharina Tosti

Student, School of Dentistry, Class of 2021

NOTE

from the

Going back to the roots of nature by blurring the lines between the human form and Mother Nature.

47

Tropical Urban Sprawl James Liu

Graduate, Long School of Medicine, Class of 2016

48

Edward Hopper’s Corn Hill: A Study Sammar Ghannam

Student, Long School of Medicine, Class of 2021

NOTE

from the

Medium: oil paint

49

The Dead Teach the Living Jake Ritter

Student, Long School of Medicine, Class of 2019

NOTE

50

from the The quote “Mortui vivos docent,� the dead teach the living, is written above the entrance to the anatomy lab. Learning anatomy in a medical anatomy course is an opportunity that all artists would take. I am very grateful that I had that opportunity, and to those selfless individuals who donated their bodies to teach us.

de los Muertos Jonathan Espenan

Student, Long School of Medicine, Class of 2021 NOTE

from the

Digital painting, iPad.

51

A black hole opens

in the mouth of this earth, burns into each layer

shelled hollow from the heat. We crawl into a planet desolate, black mantle &

gusts of acrid air, call ourselves survivors of the sacrifice:

a blue mourning, a knife wedged

in each blood cell, draining.

Each time someone breathes clean air, someone else inhales uranium, drinks from

a nuclear landfill & surrenders

to a blood oath, silhouettes

of red flowers impinged in stone from the radiation.

Before all this spillage, before lines

became the language for land, we used

to wonder why we didn’t float

into the sky, or why the stars

didn’t come rushing at us

even as we reached for them. We thought that

anything that happened to the planet would happen to us.

Sacrifice Zone

Last year’s hurricane(s) swallowed Chelsea Wu

cities whole, traded land for ocean & invaded Student, Long School of Medicine, Class of 2022 civilian homes, left

sheltering a drowned photograph & lost hearts.

At 6 years old, my nephew is diagnosed with leukemia & his mother

drowns into the phone, asks us

to bring a cure from America.

My mother surmises lead paint, toxins braided

into the wall of their new Chinese home

teaches the body to outgrow itself.

I thought I could understand why

sacrifice is a race

between land & cities & states

& countries & planets & multiverses, how victory is a loss, and space is both

absence and presence

intertwined & obliterated.

Our bodies always in search

of the next new thing

anything that happens to us happens to the planet.

52

But here we are, all along, a ripple in this wind,

not a forgiving resurrected, but

a danger, raging.

Hand

Maggie McGlothlin Student, Long School of Medicine, Class of 2021

53

Nels Davis Carroll, MD Resident, Department of Cardiothoracic Surgery

Church Bells

54

Crown of Thorns

Freedom

Michael Grzeskowiak, MD Resident, Department of Medicine

She traveled the country in the back of her van, vent and all.

Trail-blazing, defying the limits of her quadriplegia.

Pink Sweater

But now was time. She said she had done it all.

Student, Long School of Medicine, Class of 2021

Luke Lehman

She made the believers believe.

She created happiness where others thought wasn’t possible.

Maybe she was right.

We turned off the vent. She smiled.

A Constant War Chris Gilson

Student, Long School of Medicine, Class of 2019

97, alone Nursing home Ready to go Full arrest Family arrives “We want everything done” Everything was done ICU Ventilated, but alive Where the pink sweater had been A bruised and broken chest 2 days’ struggle Died under the fluorescent lights “Surrounded by family”

He harnesses his helmet, completing his garb; Thousands of times had he done this before.

Who, I was later told, hadn’t visited her in two years Only twelve, he dresses fluidly like a businessman.

Complete, he is ready to wage war.

Fearless, undaunted, He exits the safety of his home and enters the domain of his rival, The source of his five skin cancers, The sun.

55

Steps to Mindfulness Chelsea Wu

Student, Long School of Medicine, Class of 2022

1.

Listen to the farmer pick the grape, dry its entrails, sell to a merchant, who packages the raisin into a little red box in your palm, notched ridges and dry juices gushing. Taste the plastic borders release amylase and leftovers from this morning’s breakfast. A splash of wine fermenting on the corkscrew and freshly laid steel 2. for railroads. I travel from New York to San Francisco

by Leland Stanford’s commission. The train’s wheels shave over the yellowed skulls and knuckled finger puppets. I cannot find the string that led the Chinese here, the hand that wrote the paper sons and daughters nor the hand that led my parents here. How easy it was to carry citizenship between our palms, to adopt names that swallow like grapes, to eat American barbecue with jasmine rice.

3.

My father risks infection to slice open the bulbous growth on my sister’s nose. The blood maps new trails onto his glove. He listens to my mother’s heart beat (the same in every language) but he cannot name the hiccup, the offset syncopation, the silences that hurt too much to deserve this language. My mother knows she will not die this way, shrouded in unheard rhythms like skipping stones falling prematurely into the creek.

She ends every call with I love you & when I say it back, I unstitch the seam of my tongue, allow the blood to walk the same trail, iron rusting underneath the vineyard.

56

Seashells On My Mind Keerthana Pakanati

Student, Long School of Medicine, Class of 2020

Hummingbird Sign Lorelle Knight

Student, Long School of Medicine, Class of 2020 NOTE

from the Acrylic on canvas. Progressive

supranuclear palsy is classically associated with cerebellar and midbrain atrophy, the latter of which causes a distinct “hummingbird sign� on MRI.

57

Snowdrift at Frozen Lake Marlow Taylor

Student, Long School of Medicine, Class of 2020

58

Nature vs. Industry: Outlining the Contours of the New Day Pavela Bambekova Student, Long School of Medicine, Class of 2020

59

Burning the Midnight Oil Katharina Tosti Student, School of Dentistry, Class of 2021 NOTE

60

from the

A young woman selling meat and seafood at a night market on the streets in Thailand.

Traitor

Madeline Hazle Student, Long School of Medicine, Class of 2022

He looks around at nature’s beauty, And wonders why the EarthThe source of life, the center of his cultureHas betrayed him.

The toxic water he drinks and air he breathes Is slowly and quietly killing his people.

Another injustice caused by the white man, Who has turned the environment against its native people.

A Forgotten Struggle Aarushi Aggarwal

The Best Friend Anonymous

Student, Long School of Medicine, Class of 2022

Everyone has enemies For him, it’s the wind, the rain, the cold He seeks shelter for 72 hours The walls of the psych ward fighting his battles For now Until he’s sent out to the streets again, to pick up where he left off How long must he run before his enemies turn the tide?

“Sick contacts? Yeah, it’s a shelter.

With AIDS, I have to be really careful.

I know even a cold is dangerous.

That’s why this mask is my best friend - all day, all night.”

I examine her.

The strings of her mask had eroded deep into the tissue of her ears.

Bloody, raw, and clearly infected.

61

Food is Free Rajitha Reddy

Student, Long School of Medicine, Class of 2020

62

Battles of the Heart Brian Doss

Student, Long School of Medicine, Class of 2021

The sun has long since fled the sky The moon shines upon me Everything fades as my eyes close I force them open once more An ever-raging battle My friends have ceased speaking My family has left me alone With a weak and weary gaze I try in vain to overcome myself An ever-constant battle

My heart has a hole I yearn to fill But that is not permitted How much longer can it last I am isolated and alone An ever-dreary battle

A million fears; a billion tears From a life I do not want Close my eyes; take a breath I do it for what will come An ever-hopeful battle

Walls are closing all around me My eyes seek an escape No door or window opens I am trapped and imprisoned An ever-dismal battle

Hope is all that carries me This life is but a phase That is why I do not quit I will soon see my hope An ever-closing battle

A hundred calls upon my time Yield a thousand weary sighs My body cries out in protest I push myself forward An ever-losing battle A free-verse poem that peers into what lies beneath the surface of the calm, collected, and confident student.

63

“They can heal you, trust them�

Zachary Cope

Student, Long School of Medicine, Class of 2022 NOTE

from the As I began medical school applications, I spent a summer in Peru, where I traveled to remote villages with local

physicians and medical students. These providers travel each year to these communities to identify serious illness, distribute vital medications and supplies, and build trust among the locals. Many of these patients do not speak Spanish, but rather Quechua, an indigenous, dying dialect. This patient in particular had walked over 3 miles to visit the clinic this day, and upon interpretation from Spanish to Quechua, the assistant's words were (now translated into English), "These people can heal you, trust them."

These words stayed with me as I applied to medical school and have since started my medical training. I promised myself then, and maintain this commitment, to always remain worthy of my patients' trust.

64

The Silly Question Julia Kirsten

Student, Long School of Medicine, Class of 2020

Sixteen years old and 95% of her body was covered in scars from a fire that overtook her room when she was two. Eager for a connection, I asked, “You’re from Corpus! Do you like the beach there?” She glanced at my badge, gauging my competence, and said with a smirk, “I don’t do the beach.”

Rain: Masaka, Uganda Averi White

Student, Long School of Medicine, Class of 2020

When it rains in Masaka, everything shuts down. The sound of staticky rain fills the air, and for a moment you are stuck in the black-and-white, salt-and-pepper show that plagued your childhood.

Unable to change the station, unable to go anywhere. Signals crossed, red dirt roads flooded. The rain pangs on the schoolhouse’s tin roof. At first it is soft, and the swallows swoop in through the open windows to take refuge in their carefully built nests among the rafters above. Then the sound grows louder. Someone has turned the television’s volume up as high as it will go, and the salt-and-pepper show is in full force. I find myself shouting at the students over the noise. I refuse to let the rain shut me down, but here the rain wins, and I find myself dissolving into the rainy season.

I close my eyes and, for a moment, I am in the middle of a Texas rainstorm on my front porch at home. Slowly rocking as the rain leaks through the old gutters. I open my eyes, and I am back in Masaka, surrounded by green glory and red roads.

Students run from the school’s kitchen to their dormitories with their bowls of lunch – some huddled together under umbrellas, others with sweaters on their heads or hoods up, some with nothing at all.

The rain pours into the washbasin outside, and it overflows with each new drop, melting the bar of soap away.

We all dissolve, we all dissolve. And I admit that if I dissolve completely here, among the beauty of the green valleys, the red roads, and the kind people, I will be happy.

65

Fresh Harvest, A Still Life Sammar Ghannam

Student, Long School of Medicine, Class of 2021 NOTE

66

from the

Medium: oil paint

Monica: Pader Pader District, Uganda Monica: District, Uganda

Averi White Nodding syndrome is an epileptic

Student, Long School of Medicine, Class of 2020 encephalopathy characterized by involuntary head nodding, progressive

cognitive decline, and muscle The Nodding syndrome iswasting. an epileptic encephalopathy cause of Nodding syndrome is currently characterized by involuntary head nodding, unknown, but experts suspect that it may progressive cognitive decline, and muscle wasting. be related to a parasite. The condition The of Nodding affectscause typical children betweensyndrome the ages of is currently unknown, but overnight, expertsand suspect that it may be 3 and 18 seemingly is isolated toto Northern Uganda The and the related a parasite. condition affects typical surroundingbetween regions. children the ages of 3 and 18 seemingly overnight and is isolated to Northern Uganda Part of our time in Gulu is spent visiting and the surrounding regions. children with Nodding syndrome in surrounding districts.

Part of our timeUnfortunately, in Gulu isthe spent visiting children children of Pader District get little to with Nodding syndrome innosurrounding districts. support from government officials. Monica, Unfortunately, the children of Pader District get 18, was the second patient we met in Pader little noby support officials.

District,to and far the mostfrom severe government case.

Monica, 18, was the second patient we met in Pader and by the farbush. the most severe case.

Monica’sDistrict, home is deep within The path leading to her family’s hut is Monica’s home is deep within the bush. The path simply a clearing through tall grass, no leading herwide. family’s huttheispath simply a clearing more thanto a foot Eventually, through grass, more than a foot wide. became tootall rough for ourno vehicle and we set out on foot. the Whenpath we arrived at Eventually, became too rough for our Monica’s hut, herwe mother vehicle, and set greeted out onourfoot. When we arrived team.

She explained, many others, that at Monica’s hut,likeher mother greeted our team.

Monica’s symptoms started years ago in She explained, like many others, that Monica’s the refugee camps. symptoms started years ago in the refugee camps.

We went in, two a time, meet Monica.

We went in, attwo at ato time, to meet Monica. She She laid naked on a mat on the floor of the lay naked on a mat on the floor of the hut. Her hut. Her left arm and hand had severe left arm and hand had severe contractures. There contractures. There were clear signs of were clearand signs of malnutrition malnutrition dehydration.

I knelt by her and dehydration.

Iside knelt by her sidewhispering and held and held her hand, the her hand, whispering words to Amazing Grace. the words to “Amazing Grace.”

Afterward, we allwestood hut, every one of helpless. us feeling helpless.

Dr.we Abel Afterwards, all stoodoutside outside ofher her hut, every singlesingle one of us feeling Dr. Abel explained that couldexplained that we could her without risking refeeding syndrome. needed to be notnot feed feed her without risking refeeding syndrome.

She desperately neededShe to be desperately admitted to a hospital, yet even theadmitted to a did not have the resources did or capacity to carethe for her.

We simply or stood near her, and asked for God for hospital,closest yet hospital even the closest hospital not have resources capacity to care her. We simply stood near hera miracle. and asked God for a miracle.

The next Monica a miracle.

A physician fromwith Waco, Texas, withacross a brand-new hospital across Theday, next day, Monicareceived received a miracle.

A physician from Waco, Texas a brand-new hospital the Nile calledcalled Restoration Gateway randomly contacted our host mother, Jolly. Shortly Dr. Tim Jolly.

McCall Shortly afterward, the NileRiver River Restoration Gateway randomly contacted our afterwards, host mother, our team to see Monica again, time we were helpless.but A few daystime later Dr. Dr. Timaccompanied McCall accompanied our once team to but seethis Monica oncenotagain, this weMcCall were not helpless. A few called JollyMcCall to announce that Monica been admitted that to the Monica hospital. In had her first week admitted at Restorationto Gateway days later, Dr. called Jolly had to announce been the hospital. In her first gained 6.5 pounds. week atMonica Restoration Gateway, Monica gained 6.5 pounds.

67

Child of Antigua

George W. (Bill) Nichols, PhD Advisory Council Member, Center for Medical Humanities & Ethics

NOTE

from the Picasso says, “Art is a lie that

makes us realize the truth.”

Every portrait I paint tells a story, sometimes more than one. The position of the body, the clothes she wears, the look in her eyes, the runny nose, the unkempt hair – they’re all a part of her story. You, the viewer, get to imagine the scenes in her life.

I saw this street child near the market in Antigua, Guatemala, while on a global health trip with a group of medical students. When she walked past and turned back to look at me, the look in her eyes was paralyzing. Her mother gave me permission to take some photographs. Upon returning home, what I saw in those photographs revisited my thoughts until I reached for the brushes and paints to create on canvas what I imagined her story to be.

A good portrait stimulates the imagination and causes one to seek the deeper meaning. I can capture some the physical characteristics of light and space around this subject, but I cannot capture the meaning and value of this girl’s life.

The same holds true for a doctor-patient relationship.

68

Socks in the Hand of a Surgeon Phyllis Clark Nichols

Advisory Council Member, Center for Medical Humanities & Ethics

It was the morning after four nights in the hospital, four long, sleepless nights after my husband’s major surgery and three nights in ICU. In my clearest thinking, I knew he was improving, and I was grateful. In my exhaustion and weariness, I sensed an inner voice in me wanting to erupt and scream, “Stop it. No more. No more needles. No more tubes. No more strange sounds coming from foreign machines. Just … no … more.” That was my mental state.

In the early morning, I helped my husband from his bed just to stand and move and hopefully relieve some of his bed fatigue. As we made the move to his standing position, the bulb of his drain tube fell off, just fell off. Not a big deal in the scheme of things, and it was much more alarming for me than for him. Not life threatening, not painful, not dangerous, just body fluids spilling out seemingly everywhere. It was just one more big, scary thing.

At that moment while I was making certain my husband was okay, trying to secure the tubing, and putting towels on the floor, our surgeon arrived in a white starched shirt, blue suit, and looking as if he was headed to make to an important presentation. He took one look at the situation, instinctively grabbed gloves, used calming words for me, and started helping me clean my husband’s legs and the floor. His two residents stepped in to help, and he dismissed them to keep making rounds. His words were, “I’ve got this.” After the cleaning up was done, I watched this phenomenal surgeon, who had been up to his elbows in my husband’s body only four days prior, get down on his knees to put clean socks on my husband’s feet, all the while talking calmly to us both.

Who does that? One who is truly called to relieve human suffering. One who gives new meaning to the word healer. That scene is etched in my memory for all time. As a person of faith, another image came to my mind so quickly. Alongside this picture of a highlyacclaimed, skilled surgeon on his knees is the poignant image of Jesus washing His disciples’ feet. I witnessed what it means to be a servant healer that morning.

69

Free-Range Chicken Blake Seeker

Student, Long School of Medicine, Class of 2020

70

Burkina Faso Mother and Child Ruth Berggren, MD

Professor, Department. of Medicine NOTE

from the I took this photo in the village of Dierma, Burkina Faso, in November 2018. The Center for Medical Humanities & Ethics

has established a network of Community Health Clubs in Burkina Faso, following the initiative of one of our former students, Samy Bendjemil. Dr. Bendjemil had a Fulbright Scholarship to launch this work, as did Dr. Moumini Niaone, who continues as our Burkinabe collaborator. The health clubs continue to thrive, as do their members, spreading health messages about water, sanitation, hygiene, common-unity and peace.

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A Father’s Lullaby Jordan Kampschmidt

Student, Long School of Medicine, Class of 2019

Paging palliative to OB operating room.

A father, gently singing the first lullaby to his baby boy, with bright tears in his eyes.

A medical student pages palliative to the OB operating room.

A father, woefully finishes the last lullaby he will ever sing to his little boy.

Then he thanked everyone in the room, for the literal moment of love.

Every day that a physician comes to work bears the opportunity to be the most important day in a patient’s life. It may be the day patients find out they are to become parents, or that they will never have a child that is biologically their own. It may be the day they are told they have cancer, or that their cancer has finally gone into remission. While this isn’t a new revelation, in my brief experience in clinical environments I would often let this drift farther back in my thoughts, until the day the most heartbreaking and uplifting experiences of my medical education thus far both occurred in the same operation, my first caesarian on Ob-Gyn. I was informed ahead of time that this would be a difficult case, but the attending and family were willing to allow me to assist. At this point in my rotation I was beginning to more strongly consider Ob-Gyn as a career, and I thought this case would help me determine if I could handle the emotional impact of a difficult outcome. I had shared in the joy of new parents meeting their first child for the first time, and like many medical students on their delivery days, I was enthralled. For this family, though, it would not be that kind of delivery.

The parents knew from prenatal testing that their boy had a genetic condition that would very likely result in his passing shortly after birth. They had discussed goals of care with the surgeon and had elected for a caesarian delivery; they wanted to expose the baby to the least traumatic birth possible and had prioritized their baby’s comfort and maximizing the time they had with their child over resuscitative interventions. Everyone entering the OR that afternoon believed they were prepared for the events to follow and harbored no false illusions.

As the surgery progressed, it became more and more apparent that the baby’s condition was unfavorable. Dad was at the head of the table, kneeling behind the curtain and holding his 72

wife’s trembling hand. Dad was humming lightly; he was just on the other side of the curtain from me, so, other than her, I might have been the only one to hear him. As we delicately cleaned baby, I brought Dad around to hold his quiet little boy. He gently cradled his son in his arms and returned to his stool with his wife. For a moment, the operating room was silent but for the sounds of work coming from our instruments. And then he sang.

He sang uplifting hymns, comforting melodies from folk songs, and a gentle lullaby. He rocked his son gently, singing the only lullaby he’d ever get with his boy, and he leaned against me through the curtain. At first I panicked, thinking my leg had fallen asleep, but the pressure was only slight, and I realized he was actually laying into his wife’s arms so that they both could hold their son and sing goodbye.

I always knew at some point I would experience the death of a patient, and it would be difficult. I might even cry about it. I could never have expected the way that this experience left me shaken. I didn’t cry then, as we had work to finish for Mom. I cried after the surgery was completed, after we had gently cleaned Mom and baby. As the attending, resident, and I were preparing to send the family to their recovery room, Dad stepped forward, shook everyone’s hand, and thanked us for the time we spent giving his family these precious few moments. I’ve shaken a lot of patients’ hands, even a lot of brand-new fathers’ hands, but I will never forget the feeling of shaking his hand, looking into his eyes, and having him thank me. That day I walked out of the delivery rooms, past the med student work room, into the dark, empty conference room, and sat in awe, alone, letting time and the experience wash over me. I had begun to process this experience in my own way, seeing it as a sad and tragic moment for this family, but that was my impression; this father had reminded me that it is the patient who defines their own experience, and while the moment was certainly difficult, they had decided to find joy. I had approached this birth as a proving ground for myself, testing my mettle in the presence of a difficult clinical scenario. I was looking at this as an abstract event, forgetting that this was a family’s entire reality condensed into a moment, and it was theirs to shape, to feel, to hold. In his handshake, that father gave my humanity back to me, reminding me to never leave it behind.

I don’t know that I truly understand the complex emotions I experienced that day, and perhaps I never will. I wrote the poem at the beginning to help me process some of it. My experiences that day remind me to treat every patient encounter with the knowledge that the individual seated across from me in the exam room is trusting me to guide them with their most precious commodity, their health. For me, it may just be “another day at the office,” but for the patient, this may be the appointment they have been anticipating with trepidation or zeal.

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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.

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