ASCENSUS 3rd Edition, WCMC by Allison Maritza Lasky

Ascensus Journal of Humanities Volume III September 2014 Weill Cornell Medical College ISBN: 978-163315205-2

Editors: Du Cheng ’17 Natasha Mehta ’16 Jared Moon ’17 Daniel Shalev ’15 Rachael Venn ’16 Faculty Advisors: Susan Ball, MD Randi Diamond, MD With special thanks to the Liz Claiborne Center for Humanism in Medicien and support from the Office of Academic Affairs and NIH grant “Enacting the Social and Behavioral Sciences in Clinical Training.”

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To Our Readers As medical practitioners, we are surrounded by suffering. It is our duty to respond to this suffering with an arsenal of tools derived from both the science and art of medicine. Our ability to do good work is predicated on a sharp sensitivity to human suffering; to the healer, suffering should be the great affront. And yet, we are often so surrounded by pain that it is easy to become desensitized to it and to dehumanize those who experience it. Both through cultivating their own humanity and reflecting on the experiences of their patients, our contributors remind us what it means to hurt and what it means to heal. Rather than being alienated by the intensity of experience that many of us are exposed to everyday, our contributors remind us how sharing in these experiences deepen the connections we share with each other and with our patients. Ascensus: Volume III spans a diverse range of themes and mediums. Our contributors occupy a range of positions across all branches of our tri-institutional community , consisting of Weill Cornell Medical College - New York-Presbyterian Hospital, The Rockefeller University, and The Memorial Sloan Kettering Cancer Institute. The work they do in our community is as diverse as the work we are showcasing; and yet, all share the common goal of enriching life and alleviating suffering. Each piece in Ascensus may stand alone as a unique visage from an individual, but collectively, they represent the voice of a community. Some of the work shared is poignant, some fascinating, some hilarious, but all represents the shared lives of our patients and colleagues. We invite you to consider this work both in the context of its own merit and beauty, but also in the context of our professional and personal dedication to the field of medicine, to the beauty and uniqueness of each life we aim to heal. The Ascensus Editorial Team iv

Table of Contents Julia M. Rosenberg.......................................................................................1 Medical Student, Class of 2015 Prose, From Their Eyes Michelina Stoddard.....................................................................................4 MD-PhD student, Entering Class of 2012 Painting, Untitled Khatiya Chelidze..........................................................................................5 Medical Student, Class of 2017 Creative Nonfiction, Ten Dr. Kim Overby, MD MBE........................................................................7 Attending Physician, Medical Ethics Drawing, Untitled 1 Neal Parikh...................................................................................................8 Neurology Resident, Post-Graduate Year 2 Poem, Tango With a Demented Steak-Eating Man and His Daughter Dr. Gus Kappler, MD..................................................................................9 Voluntary Faculty, Department of Surgery Photograph, Epiphany Johnathan R. Barclay.................................................................................10 Medical Student, Class of 2017 Poem, Classic Skytops Du Cheng...................................................................................................11 MD-PhD Student, Entering Class of 2013 Photograph, Untitled 1 v

Dr. Veronica Lo Faso, MD........................................................................12 Attending Physician, Geriatrics Prose, Itâ&#x20AC;&#x2122;s All About the Sparkle Du Cheng....................................................................................................15 MD-PhD Student, Entering Class of 2013 Photograph, Bonfire Dr. Veronica Lo Faso, MD........................................................................16 Attending Physician, Geriatrics Poem, Drowning in Gray Scott Breitinger...........................................................................................17 Medical Student, Class of 2015 Photograph, Washington Sq. Nocturne Abimbola Ayengbesan...............................................................................18 Medical Student, Class of 2017 Prose, Sources of Contemporary Art: The Human Body and Science Evan Oâ&#x20AC;&#x2122;Dea.................................................................................................21 Medical Student, Class of 2017 Painting, Untitled Emily R. Grodinsky....................................................................................22 Medical Student, Class of 2016 Prose, Perspective Tapojyoti Das.............................................................................................24 Graduate Student Post-Processed Photograph, Blue Mutants James X. Wang...........................................................................................25 Medical Student, Class of 2016 Poem, Brain Drought vi

James X. Wang...........................................................................................26 Medical Student, Class of 2016 Poem, Beehive During a Rainstorm Scott Breitinger...........................................................................................27 Medical Student, Class of 2015 Drawing, Study of Ugolino Bonnie Stockwell........................................................................................28 Social Work Intern Short Story, Excerpt from ‘Labyrinth Road’ Tapojyoti Das.............................................................................................34 Graduate Student Photograph, Cinderella Anthony Choi............................................................................................35 Medical Student, Class of 2015 Prose, Bound Dr. Clara Tow, MD....................................................................................38 Internal Medicine Resident, Alumna Photograph, Untitled Madeleine Schachter, JD...........................................................................39 Department of Public Health Short Story, Fire Buddy Lara Wahlberg, BS RN OCN...................................................................45 Nurse Practitioner Student, Palliative Care Service Drawing, Untitled Ersilia DeFilippis.......................................................................................46 Medical Student, Class of 2015 Poem, Especially for Her vii

Jordan Roberts...........................................................................................48 Medical Student, Class of 2016 Photograph, Calm After the Storm Matt Schelke...............................................................................................49 Medical Student, Class of 2017 Prose, The Palazzo Chupi and American Democracy Genevieve Chartrand................................................................................55 Medical Student, Class of 2016 Comic, Kenny the Kidney Dr. Gus Kappler, MD................................................................................56 Voluntary Faculty, Department of Surgery Prose, Pearls Jasmin M. Harpe........................................................................................58 Medical Student, Class of 2017 Poem, Untitled Dr. Rosemary Stevens, PhD MPH..........................................................59 Professor of Psychiatry Painting, Yellow Roses Millet Israeli...............................................................................................60 Palliative Care Social Work Intern Prose, In the Room Lara Wahlberg............................................................................................61 Nurse Practitioner Student, Palliative Care Service Drawing, Untitled Rachael Venn.............................................................................................62 Medical Student, Class of 2016 Prose, Q24 viii

Ben Scherban.............................................................................................65 Medical Student, Class of 2017 Poem, Whispers Dr. Kim Overby, MD MBE......................................................................67 Attending Physician, Medical Ethics Painting, Winter Woods Daniel Shalev..............................................................................................68 Medical Student, Class of 2015 Prose, Remembering Dr. Clara Tow, MD....................................................................................72 Internal Medicine Resident, Alumna Photograph, Untitled Dr. Mary Simmerling, PhD......................................................................73 Assistant Professor for Research Integrity, Medicine Poem, Sanctuary Dr. Mary Simmerling, PhD......................................................................74 Assistant Professor for Research Integrity, Medicine Poem, Easy Dr. Mary Simmerling, PhD......................................................................75 Assistant Professor for Research Integrity, Medicine Poem, Sister Andres Gottfried.......................................................................................76 Internal Medicine Resident, Post-Graduate Year 2 Poem, A Physician Letting Go Du Cheng...................................................................................................77 MD-PhD Student, Entering Class of 2013 Photograph, Harbor in Humboldt Bay ix

Dr. Krithiga Sekar, MD PhD....................................................................78 Neurology Resident, Post-Graduate Year 2 Prose, Letter to Mr. Smith Dr. Gus Kappler, MD................................................................................80 Voluntary Faculty, Department of Surgery Painting, 65th and 3rd, NYC Dr. Kim Overby, MD MBE......................................................................81 Attending Physician, Medical Ethics Poem, Reconciliation Jordan Roberts...........................................................................................83 Medical Student, Class of 2016 Photograph, December, Poetâ&#x20AC;&#x2122;s Walk Millet Israeli...............................................................................................84 Palliative Care Social Work Intern Prose, The Mother Dr. Kim Overby, MD MBE......................................................................86 Attending Physician, Medical Ethics Painting, Still Water Bonnie Stockwell.......................................................................................87 Social Work Intern Poem, Dream of a Daughter Bonnie Stockwell.......................................................................................88 Social Work Intern Poem, Winter Beach Du Cheng...................................................................................................89 MD-PhD Student, Entering Class of 2013 Photograph, Untitled x

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Dr. Beverly Tchang, MD...........................................................................90 Internal Medicine Resident, Class 2016 Prose, Aur Kismet

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From Their Eyes Julia M Rosenberg Based on an Experience in a Health Clinic in Santa Cruz La Laguna, Guatemala They came to our houses yesterday to tell us about it. We are to arrive at the Puesto de Salud at 9:00 AM for a rooftop discussion. So here we are, wandering into the clinic at 9:15 AM, our swollen bellies uniting us even though we don’t want such a classification, and we stand in silence. Most of us have brought a son or daughter. They won’t care for the talk, but the morning snack means one less mouth to feed later. We mill about in the front hallway. A gringa girl and her backpack have already laid claim to the one bench. The gringa could almost pass as one of us with her dark long hair, long skirt, and short stature, if not for her pasty white skin. She’s clutching a book and a bottle of agua pura and looks around, smiling too often. We’ve gotten used to the gringos though, their faces beet red and glistening with sweat after walking up to our highland town from gringo-landia down by the shore. We stare at the ground in silence. There’s been a change. We won’t be on the rooftop terrace overlooking the volcanoes and the lake, where, from that vantage point, the few lanchas dotting the lake, with their white tails streaming past, would look almost like shooting stars in the night sky. Instead, we are ushered to a corner exam room with windows blocked off by dusty shelves and by a big metal tank that looks like those air machines they use to inflate children’s balloons. A few plastic chairs have been placed between the shelves and an exam table. One of the clinic girls points towards the room and we file inside, filling up the seats, in silence. There aren’t enough chairs, so the gringa and her backpack hop

ASCENSUS onto the exam table, and the children choose between their mother’s laps or the floor. There are five of us today. They say that there are 13 other pregnant women, but only we have come. A boy in jeans and purple T-shirt, his jet black hair greased heavily, a pencil behind his right ear, scurries into the room yielding an unsteady 8-foot measuring tool. He disappears for a moment and he’s back, dragging that cumbersome scale. We sit in silence. We just want this to be over, but we wait without complaint. We know that the clinic girl is from San Juan, because unlike our plain black skirts, her corte is colored and stitched with shining threads, and her guipil is intricately embroidered with flowers and birds, unlike our simple red tops with alternating yellow and blue triangles on the collar. She pushes up her glasses—you can always tell when someone has more education when they have glasses—and reaches towards one of the dusty shelves. She pulls out some of the posters and gives each of us one. She says something to the gringa in Spanish that we can’t understand and then starts speaking in our native K’aqchiquel, explaining the poster. We listen in silence. The poster has pictures of pregnant women in some of the boxes. Others boxes show of babies in their mothers’ arms or blood coming from below the woman’s corte or money or boats or cars or hospitals or medical tools. There are words, but we do not know how to read them. The girl from San Juan explains that the words are in Spanish tells us more about each box. It starts to make sense, although we quickly realize that by the time she has moved onto the fifth box, we can’t quite remember what that first picture of a family is supposed to signify. The girl from San Juan tells us to put the posters on our walls. A bleeding woman right next to our Lord and Savior. We’ll bring it home; it is perfect kindling for our wood stove. Now the woman from San Juan is asking us to be measured. We sit in silence as the first woman to volunteer (who would volunteer?), wearing her heavy corte, guipil, and apron, walks up to the scale. She kicks off her pink flip-flops before stepping up and turning to face us. But we cannot see her face. We all keep our eyes downcast, trained on a spot on the floor.

Volume III That woman stands there, facing us but not facing us, for an eternity. The numbers are finally read off for all to hear. Then she must stand and watch as the San Juan woman enters numbers into her calculator, furiously typing, scribbling, and glancing at cryptic charts. “NORMAL!” she announces, and the first woman sits. We all take our turns. One is overweight and looks embarrassed. We would not be embarrassed; we wish we could have enough food to eat well. Food. Finally, the last weight is done and Miss San Juan slips away, reappearing with a steaming pitcher of atole. We clutch our mugs while she pours us the warm, chunky, and sweet mixture, and we sit in silence while she hands out piña, which she tells us is from the gringa. The gringa has no idea we’re talking about her though, blissfully unaware, pineapple juice dripping down her ghostly white arm. Most of us place the pineapple slice on our dusty corte; we’ll carry it home later to give to one of our children. One less mouth to feed. Miss San Juan disappears one more time and comes back with bags atole for us to bring home, the powder from the bright orange packages spilling out over our cortes. But first! We must sign a paper. We do not know how, so we dip our thumb into ink and it’s pressed it forcefully onto the page, leaving behind our black mark of illiteracy. At last, the ritual is done and we can finish our food and leave as we please. We sit in silence. ------Gringa – white person Agua pura – bottled water Atole – warm drink of corn or soy powder + sugar Lanchas – boat taxis Corte – traditional Mayan skirt Guipil – traditional Mayan shirt Puesto de Salud – health post Piña - pineapple

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Untitled Michelina Stoddard

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Ten Khatiya Chelidze I learned to sleep when I was ten years old, sharing a bedroom with my sister and granddad in an apartment in Bensonhurst. Walking into the foyer of the building we lived in, I imagined the dusty floor was a polished marble, the piss-stained walls freshly painted. I imagined the teenagers drinking in the shadows were a suited concierge at his desk, that the dirty flickering lightbulbs were lamps burning brightly. Gail (6E) said the building was nice when it was built. With a doorman and everything. Gail was old. I was young. We moved in. 6D. Cockroach poison was sprayed and mousetraps were set, to no avail. I learned to sleep through anything: the screech of the train passing outside my window, granddad’s apnoeic snoring, mice scampering, my neighbors’ loud marital problems, my sister’s late-night TV watching and crunchy UTZ chip-eating, and the bell toll of the church outside. I learned the bells by heart, what the melodies meant: when the sun was up, when someone was getting married, when someone died. Even when awake, everything came to me through the dimming candle of sleep. I slept through the fire when our building’s arsonist set it for the third time (2A, PTSD [Vietnam subtype]). Ruslana of 3B told me about her parents sexually abusing her and I said, eyelids drooping, that explains the pictures all over your apartment. Katie (6C, BFF) started dating some guy that hit her and I tried not to have nightmare about those times her dad threw furniture at her mom in the next room, and how we wordlessly turned up the volume on Charmed, watching in silence and with great concentration. I slept through Gail’s son’s suicide entirely. I didn’t hear his body swinging over the bathtub next door or Gail wailing and Max lapping at her tears. My parents worried about my muteness. On her way out to the odd jobs she worked then, mom asked me to tell her about my life, what was I thinking, what was I feeling, why was I so closed off. There’s nothing to say, I said. Because I knew, somehow instinctively knew, that talking would lead to feeling, and feeling would lead to crying, and that I may cry so loudly that I would wake up, really wake up and melt into a teary puddle that dripped

ASCENSUS though the parquet and onto 5Dâ&#x20AC;&#x2122;s head, and 5D was crazy and would come upstairs to complain and my mom would be late to work and not make money and we wouldnâ&#x20AC;&#x2122;t eat and it would be all my fault. So I scratched at my elbows and said I was tired and went to the room I shared and laid down on the futon, staring at the ceiling, dreaming but not sleeping, my knuckle in my mouth.

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Untitled Kim Overby

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Tango With a Demented Steak -Eating Man and his Daughter Neal Parikh

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masticate!

regurgitation

expectorate!

aspiration decompensation

activation INTUBATION

bewildered supplication

medication? exasperation

pontification perhaps, some manipulation

resuscitate! expiration

ooh, litigation

palliate! e m a n c i p a t i o n ...on probation infatuated, the young physician seeks solace in

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Epiphany Gus Kappler

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Classic Skytops Johnathan R. Barclay

- After William Carlos Williams It’s a grand house in the shape of a dirty boot six stories tall on the laces sit about thirty charcoal birds charred feathers patrolling along the tongue— beak to tail wingtip to nape flying through sordid smoke letting it stream through their eyes leaving a stream in their wake—

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Untitled 1 Du Cheng

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It’s All About the Sparkle Veronica Lo Faso So let me tell you about my week. It was, on the surface, like many of my Mondays - full of frantic phone calls laden with the entire range of human experiences. There was sadness, joy, loneliness, death and, of course, the usual colds. I should tell you, that I’m a doctor and I care for the elderly. I also make medical house calls in Manhattan - something that gives me great satisfaction. But in many ways this week was anything but ordinary because after years of studying science and medicine I finally figured it out. You know - the meaning of life. It’s all about the sparkle…. Let me step back and explain. I got a call this week from Jerry. His aunt is ninety-nine years old and one of my homebound patients. “Doctor?” “Yes Jerry. How can I help you?” “It’s my Aunt Edna. I think she’s dying.” “Oh,” I say wishing something more brilliant had sprung to mind. “Tell me about what’s going on.” And he does. As he recounts the events of the last few days, my mind wanders to last months’ visit with Edna. “Hi, Edna. How are you?” She looks up from bed (where she spends most of her time these days) and, from a face that screams to be photographed, shine the brightest blue eyes I’ve ever seen. They sparkle like sapphires. She

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smiles and says, “I’m the same-only worse.” And she was right. We laugh and wonder at her 100th birthday coming up this summer. I depart, very cognizant that each time may be the last time I see this extraordinary woman. She looks up and those eyes keep shining. What is it, I wonder, that keeps her going, fighting the debility and isolation. Where does that strength come from? I marvel at it each time I’m with her. “So there’s a slight fever, huh?” I ask Jerry. “Yes, she has had bladder infections,” I say. “Yes, I know she doesn’t want the hospital. Let’s try an antibiotic.” I hang up, and worry. And wonder if her eyes are open. Meanwhile across town, Pearl has taken to bed. “What do you mean?” I ask her concerned brother. “I don’t know, she’s just stopped eating and won’t get up.” “I’ll be over.” And I go. In the cab over, I think about my time with Pearl - almost 4 years now. Despite many an impediment, she still insisted on going out every day to the store at age ninety - five and was mad that her legs wouldn’t hold up for more shopping. Bingo every day - the belle of her senior living facility. Oh yes - and eyes that twinkled like stars. “Pearl, can you tell me what’s wrong?” I ask furtively She looked up from a wheelchair. The face was expressionless. The eyes dull. “I’m tired,” she said And I knew she meant more. Her exam was unrevealing as were her blood tests. It was as if the life had been sucked out of her.

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“Do you want to go to the hospital?” “Absolutely not!” “Is there anything I can do for you?” I ask, hoping I could make some small contribution. “Just let me be” “Are you feeling depressed?” I ask, almost choking on the words that felt so clinical at such a poignant moment. She managed a smile. “Depressed? How would you feel at 97 with all my problems? I’ve lived a good life. Everybody loves me. That’s enough” The truth is I didn’t know how she felt. But I did know that the end was near. And I was right. She lasted only a few weeks. For years my colleagues and I have wondered at the varied responses patients have to illness, aging and death. What kept some people vibrant and well into their ninth decades and why could some, much younger, barely tolerate a hangnail. So many great scholars have touted methods of predicting longevity and postulating about outcomes. How long will she live? When should I expect to see decline? I too have succumbed to testing every possible cause for decline, both physical and psychiatric, often throwing my hands up in frustration when nothing tangible is found. Maybe I should have just looked into their eyes. The Chinese would call it the Qi, I guess. The Christians, perhaps the soul. Me, I call it the sparkle. I got a call from Jerry later in the week. Edna was up eating and reading the NY Times. “Oh, I said… Great.” And suddenly, my sparkle was back.

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Bonfire Du Cheng

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Drowning in Grey Veronica Lo Faso Yes, usually… Most of the time it resolves… I can’t say for sure but.. In your case it’s unlikely to recur… I find most people improve, but some… I rarely see any problems… The data is not really in on this but… I’m sorry...that so rarely occurs… I know..there’s ongoing research but… I guess this is our best option… Most people die within 6 months but… It’s not clear how this will play out… Let’s watch and see … No, not usually..

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Washington Sq. Nocturne Scott Breitinger

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Sources of Contemporary Art: The Human Body and Science Bola Ayangbesan In todayâ&#x20AC;&#x2122;s technologically advanced world, there is a growing sense that we should take control over our bodies and social circumstances rather than just accepting what we inherited. Stories about breast implants and mood changing drugs have moved from the health and beauty section to the front page. Although all scientific and technological progress of human society is geared towards the transformation of the human species as we currently know it, it is clear that humans are no longer the most important things in the universe. As complex machines develop to be more human-like, the more the aforementioned statement becomes obvious. The term posthuman has been used by Jeffrey Deitch to suggest that humans are entering a new phase of evolution in which biotechnology and computer science will give us the power to reconstruct and extend human bodies in artificial ways that take us far beyond biological evolution. 1 The idea of posthuman art revolves around the use of technology to promote discontinuity. In essence, discontinuity from the mundane governance of physiological and biological laws pertinent towards the continual establishment of human nature. Posthuman art does not consist of the production of something completely new. Rather, it consists of combining things that already exist, but which had previously been held as separate. Such amalgamation produces aesthetic appreciation of the human ability to modify the connections in their thought paths, or to have them modified. This process of aesthetic stimulation is heightened when concepts are forced together from relatively diverse locations in a discontinuous way. According to Robertson, â&#x20AC;&#x153;many people are ambivalent about the interface of human bodies with technology. We may feel alienated by technology or fear

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our dependence on it, yet we also are fascinated by it and always hungry for the latest developments.”2 Artists are concerned not just with how genetically, surgically, and mechanically altered bodies may look, but with what they mean. Australian artist Stelarc maintains that technological redesign of the body is not just an exciting experiment, but is necessary for human survival.3 “The body according to Stelarc, is no longer capable of adequately confronting a reality that is evolving at uncontrollable velocities: the technologies and their use in systems of social organization imposed and implemented by the economic strategies of the last century have modified the environment in a radical manner that is dangerous to the human body, rendering the habitat unfriendly to man and provoking the need to make use of artificial ‘cures’ for the safeguarding of individuals.”4 Such assertion, however, begs the question of human exceptionalism. Yet, according to Robertson, the distinction between humans and everything-but-us eroded with the advent of evolutionary biology. Darwin’s theory of natural selection insists that there is a basic continuity in nature, not just among species, but among all living things, who ultimately share a common ancestry.5 In the Fairy Tales, Monsters, and the Genetic Imagination exhibition and panel talk I attended back in the spring of 2012, artists such as Kate Clark explained their works in light of this absence of human exceptionalism. For Kate Clark, her work displays a sense of anthropomorphism and the human relationship with animals. Another artist, Meghan Boody depicts composite creatures as symbols of the complex self, shown as one type of creature in the process of being transformed into another. Furthermore, Treton Doyle Hancock’s work deals with the idea of how we make sense out of the things we don’t know. Likewise, images of hybrid beings by Saya Woolfalk offer optimistic alternatives to natural biology as a force shaping what life may yet become. Inspired by the abundant flora and fauna of the Brazilian rain forest, Woolfalk creates world of new life-forms that are governed by a radically inverted set of natural laws. A more caution-

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ary note is struck by Patricia Piccinini’s transgenic creatures. Piccinini’s transgenic creatures not only challenge us to reconsider what it means to be human, but reopen the issue of fundamental rights tied to the human identity.6 Piccinini stated that we should consider “our relationship with the things we create.”7 Nevertheless, the positive implications of biotechnological advancements are obvious to Stelarc. Stelarc proposes building a stronger, less vulnerable body with synthetic skin, greater brain capacity, fewer organs, and microcircuits that enhance hearing, sight and other senses.8 Yet the unexpected implications are well put forward by Patricia Piccinini. In accordance with her transgenic creatures, Piccinini questions the resultant effect of living in a world that includes semi-humans who provide beneficial support for the essence of continual human establishment. Would we grant them some human rights but not others and give them limited political power? And what if they rebelled against being used for these “human” purposes?9 It is obvious from these questions that we will soon be forced by technological advances to develop a new morality. We will need to build a new moral structure that will give people a framework of how to deal with the enormous choices they will have to make in terms of genetic alteration. The limits of life will no longer be something that can be taken for granted. We will have to create a new moral vision to cope with them.10 ------1 Jean Robertson and Craig McDaniel. Themes of Contemporary Art; Visual Art after 1980 (New York: Oxford 2010), 97. 2 Ibid., 97. 3 Ibid., 99. 4 Ibid., 99. 5 Ibid., 256. 6 Ibid., 265. 7 Ibid., 266. 8 Ibid., 99. 9 Ibid., 265. 10 http://www.artic.edu/~pcarroll/PostHuman.html

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Untitled Evan Oâ&#x20AC;&#x2122;Dea

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Perspective Emily R. Grodinsky I fear burning out and caring too much about things that donâ&#x20AC;&#x2122;t matter, like #32 that I got wrong on that quiz but should have known. I am lucky that being a medical student and entering a medical profession is the right fit for me, but sometimes I forget. Burn out. I find the science of the human body, the intricacies of forming a diagnosis, and listening to patients fascinating and stimulating. Being a medical student is fulfilling to me and I hope it will one day have a positive impact on my patients, but sometimes I forget. Burn out. As a medical student interested in human rights and global health, I have the privilege of learning about and advocating for the health of others who are not quite as lucky as I am. This helps me remember. Medicine is a path I have chosen to pursue, and I can do so without being arrested, beaten or having my family not know where I am. I can make these choices without fearing for my life because of the freedoms I have in this country, because of my family and friendsâ&#x20AC;&#x2122; support and because of the education and resources that are available to me. Ultimately, my ability to speak out and hopefully impact change one day comes from feeling safe, supported and free. My ability to be who I am, and to be happy, is undeniably related to not being persecuted by others because of a group with whom I identify, the people I love or the issues important to me. Defining my identity in this way has been relatively recent. Becoming involved with the Weill Cornell Center for Human Rights my first year of medical school was the first time I became part of the legal process that grants individuals asylum - the right to stay legally in the United States after fleeing from persecution in oneâ&#x20AC;&#x2122;s home country. Having had the opportunity to assist with four evaluations, I have heard the stories of four incredible people who are mothers, fathers, human rights activists, community educators and politicians fighting

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for a better nation for their families and who left their communities only when it was absolutely necessary. I have learned that by granting these individuals asylum, we are preventing them from being sent home to situations that would endanger their lives and the lives of those they love. When given a second chance in a safer setting as an asylee, some continue to bravely share their stories and work in the community advocating for others like them who temporarily lose the ability to advocate for themselves. This helps me remember that it doesnâ&#x20AC;&#x2122;t matter if I got #32 wrong on that quiz. I can sweep away the ashes and regrow.

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Blue Mutants Tapojyoti Das

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Brain Drought James Wang Today my brain barely rains, While I pain in vain to pen this train of mock insane. Perhaps I will entertain some champagne.

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Beehive During A Rainstorm James Wang The sky overcast The hive abuzz With arcane rhythms Humming, mending, dancing, bumping Climbing, fanning, flying, pulsing Hypnotic Hypnotically forging ahead as the droplets come Down And then rainbow We all go free

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Study of Ugolino Scott Breitinger

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Excerpt from “Labyrinth Road” Bonnie Stockwell I’d been to heaven once before, I was pretty sure, though getting there by way of the middle stall of the girls’ lavatory at Fallstaff Elementary during recess did cast a somewhat dubious light on the experience. My best friend Eileen Becker and I had hatched the plan for this private field trip while huddled by the hopscotch court at the far end of the schoolyard blacktop. To the darting eyes of the lunch aide, we must have appeared unremarkable, two second graders awaiting their turn to toss the heel, but, in fact, Eileen and I, our bodies taking on the chill of the red brick face of the building’s outer wall through thin spring jackets, were locked deep in a debate over the nature of God and what heaven must be like. Well not a debate actually, for there wasn’t much disagreement between us - God was a gentle white-bearded-and-robed ubergrandfather and heaven, his glorious domain, but the sixty four thousand dollar question was did you have to die to get there, or, as I believed, and Eileen doubted, could you travel there via the mind, by sheer brain power. “You don’t even go to heaven right after you die - you have to wait in the cemetery until the Messiah comes,” Eileen contended, but I could tell by the way she ran her fingers down from her part to behind her ears, retucking already tucked in strands of hair, that her heart wasn’t in it; that if heaven could be gotten to, she wanted to go. “I think we could get there,” I whispered purely for effect - no one else was near enough to hear us over the jump rope girls’ chant. Producing a rumpled Kleenex from her pocket just in time to catch two clear drips off the tip of her nose, Eileen stared at me, “What makes you so sure?” I could have been looking in a funhouse mirror with only minor distortions - she had my long blond hair just less stringy, no bangs; my same long face without the dimples or freckles; a nose nearly as long as mine but beakier; and was earnest like me,

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only far more practical. Tissue in the pocket was the dead giveaway it was Eileen. “I had a babysitter last weekend who said the mind is the most powerful thing, more powerful than atom bombs, and that if I concentrated hard enough, I would be able to fly…” I paused, neglecting to include that this same babysitter invited three friends over to our house, a girl and two boys, which Mother certainly wouldn’t have allowed, and that they smoked skinny cigarettes, blowing the smoke out in rings through the back porch screen. I checked Eileen’s eyes to be certain she was still with me and then continued in a hush tone, “and I did.” “Did what?” “I flew. At least I think I did. It might have been dreaming, because the babysitter and her friends said I had to lay down and close my eyes in order to think hard enough to do it, but really, I swear, I can remember flying.” Only a best friend, and one like Eileen, who never succumbed to pettiness or lorded it over anybody, could be trusted so completely. Visibly wrestling with her skepticism, she assured me “I’ve had that feeling in bed just before I fall asleep like I’m floating.” “This wasn’t floating—I was pumping my arms and legs, swooshing along the walls like in an angel in a painting only alive,” I said with the mixed exhilaration and fear that typifies a revelation divulged only once to one person in the whole universe. It took a few seconds but Eileen didn’t fail me—I could see her wheels turning rapidly in the desired direction. “So you think we could get to heaven the same way?” she asked, almost inaudibly. “We could try,” I took her hand up unaware. “When? I have Hebrew after school.” On Tuesdays and Thursdays Eileen was picked up at Fallstaff by a yellow school bus and driven to Beth-El temple for two hours of language instruction, bible stories, holiday arts and crafts, and prayer. I walked home alone those afternoons, even in a crowd of neighborhood kids, alone without Eileen. “Why not now?” I peered across the yard, skimming the heads of the milling crowd to check the clock—still twenty minutes left. “Not

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here—the babysitter said you can’t have any distractions—but maybe we could get inside…” Before I had the chance to finish the thought, Eileen interjected, “I know, you ask a Safety if you can go to the bathroom, and a minute later, I’ll ask a different one, then I’ll meet you there, in the girls’ room, the one across from Miss Offit’s.” Safeties were deputized students who wore orange halters that crossed their chests, buckling at the waist, and who monitored the halls and open spaces throughout the school day. I didn’t like talking to them, but I had to give Eileen kudos for her plan. “You’d make a good spy.” I squeezed her forearm and walked off toward the green double doors beside which two sixth grade Safeties, a boy and a girl, seemed to be involved in a game of upright Twister. They must not have noticed the catch in my weak ‘I have to go to the bathroom’ or wondered why my eyes were glued to my Jack Purcells because they said nothing as I passed into the building, though, with the buzz in my ears, I doubt I would have heard them anyway. Inside, the empty corridor stretched like a giant air-conditioning duct to the right and left; along the wall facing me trailed a ribbon of gray lockers, closed but for the wayward one or two left ajar by someone too hungry to bother holding up the lever inside the handle. Miss Offit’s room was to the left. I’d walked these halls in every weather—full of kid action, or after the bell had rung, settling into silence. I’d even braved them in the middle of a class period if Mrs. Schill asked me to deliver a message to the principal’s office, but never did they seem so prodigious as on this day. Maybe it was the look of the exit doors at the far end, a diaphragm of light pulsing at the base of a deep well, or perhaps the faint squeak of my tennis shoe soles colliding with the floor tile, something about the air in there gave me the feeling a miracle might happen. Pushing open the lavatory door, I entered solemnly. Sunlight drenched the high windows, one of which was propped open allowing in also the erratic chorus of the playground, an amoeba of sound. While waiting, I thought to wash my hands, this was a holy enterprise after all, and called for a certain degree of cleanliness, of dignity. The

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pink soap from the dispenser dripped through the cracked cups of my hands. If we did get to heaven, could we come back, or would we simply disappear? I could see Daddy reading the evening edition of the Baltimore Sun—GIRLS VANISH FROM FALLSTAFF BATHROOM—or would our bodies be left behind? Is this what death was—going without any luggage? Eileen’s arrival interrupted this stream of consciousness. She was breathing hard. “What happened?” I asked in alarm. “Oh, nothing, I just had to run because I came in by the auditorium.” Unzipping her windbreaker, Eileen scanned the red floor of the bathroom as if looking for a seat. Strewn with toilet paper and splatters of unidentifiable liquid drops, it was none too inviting. “What should we do?” she worried out loud. I hadn’t exactly worked out the details. Suddenly, my eyes fell upon the stalls, dark and semi-private—they seemed the perfect little transportation compartments. “Why don’t you go in one stall and I’ll go in the next one—then if anybody comes, we’ll be where we’re supposed to be.” “Good idea,” Eileen said, already inside the corner cubicle, closing the door. I moved into the box beside hers and, with a turn of my wrist, clicked the silver dial to its ‘locked’ position. Facing the toilet bowl, I found it had no solid lid like at home. “Do you think we can sit on the toilet with our clothes on?” I heard Eileen say through the metal wall between us. If I’d put my ear then to its surface, I would have felt the vibration of her words. “I guess so,” I answered, backing my butt gingerly onto the porcelain rim. “Better not forget and go pee.” We both laughed, but I shuddered at what a disaster it would be to turn up in heaven accident victims. “Okay, let’s start. Close your eyes. No wait…” I leaned forward, “Hold my hand.” Eileen’s hand appeared under the partition as on the occasion when you’re out of paper and you ask your neighbor for some, but hers was empty until my hand made its way into it, interlacing our fingers in a shared fist. “Okay. Now close your eyes and think of heaven. Keep them closed no matter what and think really hard.”

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At first the back of my eyeballs became a gauzy red-orange inkblot that mutated to purple and then black with a few gold snippets of cirrus cloud. I breathed in as deeply as I could with my chest flattened against my thighs and one arm outstretched. Heaven is up, I thought and reflexively lifted my chin skyward, injecting a whole new dynamic into the kaleidoscope at work beneath my shuttered eyelids. There was the sensation of rising, not wafting as a balloon, but rushing upwards like a rocket, bright bits sparking off me, a glittering cape. Eileen’s hand squeezed mine tighter. “Are you okay?” I whispered. “Yeah.” “See anything yet?” “Just colors.” “Hey, me too.” Encouraged that at least we were on the same plane, I began to think about heaven in earnest—the place where everything earthly is over and done with, worry, work, yelling, where no more bad things can happen. That’s when my mind went green, a lush, luscious green that seemed to deepen and grow textured, becoming a field of thick, moist, tender grass. Running your fingers through it would be like combing the hair of God, I thought. The field itself started to rise then into a hillside, becoming a mountain slope at the top edge of which appeared to be a fence. Not a chain link fence, not even a split rail—rather it was a demarcation generated by everything on the other side being completely other, unseen before and therefore indescribable. “Wait—I think I’m somewhere… It’s a green field and there is something up ahead…Do you see it?” I asked Eileen breathlessly. “I am climbing…” Before she had a chance to answer, the door to the hallway burst in and a loud voice made louder by annoyance blared down on us, “Girls. Bonnie. Eileen. Are you in there?” Unable to help opening my eyes, I saw two adult feet make their way through the rectangles of space beneath the stall doors, stopping directly in front of mine. We let go our hands and stood up. “Would you please come out here?” the voice said, in a camouflage calm tone like Mother used just before she let the hairbrush fly. I recognized it as Miss Sands, the

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fourth grade teacher and, reluctantly, turned the latch. We emerged at precisely the same moment, Eileen and I, ready to take our lumps. “What in God’s name were you two thinking? Do you know how worried Miss Carol was that something had happened to you?” Miss Sands’ freckles jumped with each word. “You’d better go apologize to her. And there may have to be consequences. What were you doing anyway?” Eileen’s eyes met mine on their way to the floor, which is where every kid searches for an emergency exit from the scrutiny of an angry teacher, no matter what the offence, and, in them, I read not to tell. “We just had to go to the bathroom,” I lied. Miss Sands nudged open the doors, first behind me and then behind Eileen, conducting a search of her own. Finding no cigarettes or matches, fireworks or other contraband, she pointed a long-nailed finger at us, “Don’t ever do that again girls. This is a community. We treat each other with respect. Now go, the bell’s about to ring.” As we walked down the hallway, bustling with children, I put my mouth close to Eileen’s ear and said, “I saw it. I saw heaven.” She looked battered. “It was probably from leaning over so long.” Even though I didn’t think she meant it, I decided not to tell her about the moving lights beyond the fence, my welcoming committee, about the relief in them, about my rapture. I kept it to myself alone, a touchstone, a tissue deep inside my pocket.

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Cinderella Tapojyoti Das

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Bound Anthony Choi “God damn it.” Joan didn’t used to swear all the time. Perhaps she was just getting old. Or maybe she just stopped caring about things. And wasn’t god a hoax anyway? What started as reading a series of obituaries following Christopher Hitchens’ death last year had led to her skimming through his essays and eventually going through his books. The result was her being disgusted with religion for the first time in her life. And now, swearing, which would have garnered stern looks and at times outright physical punishment during her youth, just didn’t seem that bad anymore. It was liberating, even. Liberty. That’s all she really wanted. But now, just twenty minutes into her tennis game, her crusty flip phone was ringing with obnoxious jubilance. She had tried to change the ringtone once but had given up; it hadn’t seemed that important. But now, a nasally tune was threatening her weekly tennis match with Constance, and she regretted ever getting that crummy phone. Two hours of tennis, of fresh air, of freedom. That’s all she wanted. It was probably Abdul calling. If only it was in another context… but Joan knew Frank was being visited by the doctor right now, and Abdul was calling because the doctor had wanted to speak with her regarding Frank’s care. Disimpaction. Polyethylene glycol. At best, these words sounded like something a mechanic would talk about; at worst they sounded like… well… shit. Either way, she didn’t want to hear about it. Why couldn’t the doctor take care of it? And Abdul was there – he was the home aide for god’s sake. It’s not that she didn’t care about Frank. They had been together for over ten years now, and she spent most of every day with him. Although not married, they lived together, went on vacations together, and on occasion even got intimate. The only reason they weren’t mar-

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ried was that government benefits were better if they stayed single on paper. Not her proudest decision, but she was old now, and had paid her fair share of taxes. All in all, they were as happy as she decided it was reasonable for people their age to be, but nagging her was the thought that perhaps there was another reason that kept the frayed couple from tying the knot. Frank was now bed-bound, or at least, he chose to be bed-bound, which was why the doctor came to see him in their apartment. Frank hardly left the room anymore except to go to his place in the Hamptons, but of course, he had a room there too. Joan had to wheel him around if she wanted him to accompany her anywhere, and she was getting tired of it. Most days he just lay there with his pasty, mottled legs propped up, the telly on, unwilling and perhaps unable to move. She still wasn’t sure. Even so, she felt guilty leaving Frank for more than a couple hours. Maybe five years ago she would have considered marrying him even if that meant foregoing some benefits. He hadn’t been the most mobile back then, but he definitely had more wit and vigor. She still remembered when she saw Frank for the first time at a friend’s dinner engagement. She had just plucked a tiny morsel of catered salmon topped with capers from a rather cleverly designed pewter platter in the shape of a fish. She didn’t even like seafood but it was what people were eating here. As she turned to try to locate the Pinot Grigio, she had heard a roar of laughter coming from the living room. A small group was gathered around a seated gentleman with thick brown glasses, jovially relishing every single word that sprang from his smiling mouth. Throughout the night, she recalled that even in his wheelchair Frank seemed taller than everyone else, able to weave in and out of conversations and crowds alike. She was sure Frank had been a fine psychiatrist when he was still practicing. But now what was Joan left with? Frank had what they called spinal stenosis that made it very difficult to move, legs that looked like a mixture between a log and a marshmallow, and diarrhea and constipation somehow at the same time. Worst of all, Frank was losing his mind, and didn’t even know it despite his former job.

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Still, Joan thought, Frank’s situation was much better than her friend Susan’s. The doctor visited her at home too. Poor Susan, health ever deteriorating, needed a wheelchair to get around, but lived on the fifth floor of a small apartment building that only had stairs. Wasn’t there some law that required all buildings to be accessible by disabled people? The ADA, or something, from 1990…but maybe that was just for public buildings or newer ones. Joan wasn’t sure. Damn, she was getting old. But yes, poor Susan. She couldn’t move to a new apartment because she was paying rent control rates and couldn’t afford another place. So she was stuck. Literally stuck rotting in her own home with no way to get down... Joan held up her hand to signal to Constance to hold off on the serve. Yes, Frank didn’t have it that bad, Joan thought, as she trudged to her phone whilst squinting toward the sky. It was her. Joan felt just as stuck as poor Susan. Stuck taking care of Frank. Stuck at home while her friends chatted about last night’s opera over margaritas. Bound to Frank’s bed as much as he was.

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Untitled Clara Tow

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Fire Buddy Madeleine Schachter Timothy lived in New York City, only two blocks from the firehouse. He liked to look at the big red fire engine. When he walked to school, he waved to the firefighters, and they waved back. They were all Timothy’s friends, but his best friend at the firehouse was Mike. Mike was a grown-up and did serious work as a firefighter, but whenever he was at the firehouse, he always found time to talk to Timothy. Timothy would ride his bike to the firehouse and the other firefighters would call out, “Hey, Mike, your Fire Buddy, Timothy, is here!” Then Mike would appear from the back of the firehouse and say, “Hi there, Timothy. How’s my Fire Buddy today?” That made Timothy feel very special. Timothy would help Mike polish the fire truck and would try on Mike’s helmet. “See this ladder, Fire Buddy?” Mike asked. “It can take me way up in the sky.” “How high can it take you?” “It can take me up so high that I feel like I’m near the stars. If I ever get really close to a star, I’m going to reach out and tickle it!” Timothy and Mike laughed at Mike’s joke. Before Timothy went home, Mike always reached into his pocket and pulled out a bag of gumdrops. He’d offer some to Timothy. “Help yourself, Fire Buddy,” Mike would say. Timothy and Mike both liked the red gumdrops best because they were the same color as the fire truck. “See you soon, Fire Buddy!” Mike always called as Timothy started to ride home. *** One day, on the way home from school, Timothy passed the firehouse, but it was empty. Timothy knew that meant the firefighters

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were off somewhere helping to put out a fire. When Timothy got home, his Mom was sitting in the living room, watching television. The news was on, and Timothy could see ambulances, police cars, and fire trucks on TV. Timothy’s Mom jumped up and hugged Timothy. Sometimes Timothy squirmed a bit when his Mom hugged him, but this time he knew that it was more than his Mom’s usual “I’m glad to see you hug;” it was a “something’s wrong hug.” Timothy’s Mom told him that something very bad had happened. An old, empty building outside of town had caught fire. Timothy and his family were safe, but there had been a lot of fire and smoke. “Do you think Mike, is there, putting out the fire?” Timothy asked. “Yes, Timothy, Mike is there,” Timothy’s mother answered. “Mike is very brave.” *** That evening, Timothy’s Mom came into his room where Timothy had been playing with his toy fire trucks. Timothy could see that his Mom had been crying. She knelt down next to Timothy. “Timothy, I have to tell you something that is very, very sad. Your firefighter friend, Mike, was trying to put out the fir, and he got hurt.” She said, “Mike died,” and explained that Timothy wouldn’t be able to see Mike or be with him anymore. Then Timothy began to cry, too. Timothy and his Mom hugged one another very tightly for a long time. Then she said, “This is very sad, Timothy. I know that you’ll miss Mike. He was a good friend and he was very lucky to have had you as his Fire Buddy.” *** The next day, Timothy’s Mom suggested that they walk over to the firehouse together. When they got there, some of the firefighters were standing near the fire truck. When they saw Timothy, they said hello very quietly. They didn’t call for Mike to come out like they usually did. One of the firefighters reached out and patted Timothy’s shoulder. Timothy knew that the firefighters were sad about Mike, too. Timothy didn’t know what to say to them. Then he thought about what his

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Mom had said to him. “This is very sad,” Timothy told the firefighters in a soft voice. “Mike was a good friend, and he was lucky to have you as his friends.” The firefighters smiled small smiles. “Mike was lucky to have had you as his Fire Buddy,” one said. “He sure was,” said another. *** The weeks went by. Sometimes Timothy felt so sad and missed Mike so much that he started to cry. When he felt that way, he would find his Mom and they would hug one another. “I’m sad that Mike died,” Timothy said. “Yes, it’s very sad,” his Mom agreed. “I know you miss Mike very much.” “Thinking about Mike makes me cry,” said Timothy. “Yes, it makes me cry, too,” said his Mom. Then Timothy’s Mom asked softly, “but does thinking about Mike also make you smile sometimes?” His Mom’s question surprised Timothy a little. He was quiet as he thought about Mike. “Yes,” Timothy said. “I smile when I remember that Mike wanted to tickle a star.” “And do you smile other times when you think about Mike?” Timothy’s Mom asked gently. Timothy thought some more. “I smile when I remember that Mike let me wear his helmet,” Timothy said. “And I smile whenever I eat gumdrops. ’Specially the red ones! I remember how we both liked the red ones best because they’re the same color as the fire truck.” “Well,” said Timothy’s mother, “thinking about Mike is very sad, but even now thinking about Mike makes us smile, too. Whenever we’re feeling sad, we can think about climbing the ladder to try to tickle the stars, and wearing Mike’s helmet, and sharing those red gumdrops.” “Okay,” Timothy said quietly. “Mike was very special and very brave and a very good friend,” Timothy’s Mom said as Timothy cuddled with her. “And very, very

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lucky to have had you as his Fire Buddy.”

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Discuss and Discover Themes to Explore Together Parents and healthcare providers have experience “curing” small bruises with colorful Band-Aids, but the devastating impact of a death of a loved one or another patient befriended during a hospital stay is not as readily susceptible to the murmurings of motherhood or distraction. Fire Buddy is the story of a young boy who suffers the loss of his firefighter friend. The story offers a way to explain that while death is very sad and makes even grown-ups cry, we also smile as we remember. The boy is reassured that the firefighter who died was lucky to have had the boy for his “fire buddy,” inspiring an opportunity for an adult reader of the story to elicit fond memories of one now lost and to assure a child that he similarly enhanced another life.

1. Why is Timothy sad? Timothy is sad because his friend, Mike the firefighter, has died. Timothy’s Mom has explained to Timothy that this means that he won’t be able to see Mike anymore. 2. What does Timothy do when he feels sad? Timothy finds his Mom, who hugs him. Moms never run out of hugs! Timothy and his Mom know that hugs can help bring comfort.

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Timothy’s Mom cries because, like Timothy, she is sad that Mike has died. And she is sad because she knows that Timothy is sad. Grown-ups cry, too, when they’re sad. 4. If Timothy is sad, why does he sometimes smile when he thinks of Mike? Timothy smiles when he thinks of happy times he and Mike shared. Timothy remembers Mike said that he was climbing the ladder to try to tickle the stars. Timothy remembers that he wore Mike’s helmet. And he remembers that red gumdrops were their favorite because they were the same color as the fire truck. Even though Timothy misses Mike very much, memories of Mike make Timothy smile. 5. Why does Timothy’s Mom tell Timothy that Mike was lucky to have had Timothy for his “fire buddy”? Timothy’s Mom knows that although it’s very, very sad that Mike died, Timothy helped bring Mike joy and happiness while he was alive. That’s very important. It means that Timothy enriched Mike’s life

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Untitled Lara Wahlberg

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Especially for Her Ersilia DeFilippis Medical student Intern Resident Attending One by one, people flooded the room Overwhelmed by a sense of imminent doom Someone paged me, he said Fever Hypotension Tachycardia Alone these words were manageable Together they were terrible Especially for her. Amidst the chaos, I watched her bright blue eyes Her facial expressions held no lies I saw the terror I saw her fear As if the end were near. Why today of all days? Just a few hours later it would have changed The chemotherapy order was ready Just as her pulses were becoming thready Blood cultures sent Antibiotics and fluids coursing her veins I hoped they would ease her visible pains.

Volume III One liter. Then another. And another. I waited. I hoped. The next morning, Medical student Intern Resident Attending Entered the room once again No longer asking what and when Afebrile Alert Stable Alone they were good Together they were wonderful Especially for her

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Calm After the Storm Jordan Roberts

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The Palazzo Chupi and American Democracy Matt Schelke Walk through Greenwich Village and block upon block of brownstones, townhouses, shingled porches, and shuttered windows confronts you in an undulating tide of rustic brick, sandstone, and wood. The result is noble yet subdued - until one sees the Palazzo Chupi. On West 11th Street a massive pink Italianate estate rises above a former horse stable and dominates the surrounding rooftops. At first, the height and the color are shocking: eleven stories compared to the neighborhoodâ&#x20AC;&#x2122;s usual three, and a bright, Mardi Gras pink instead of the browns, and whites found elsewhere in the Village. But the most uproarious features of the structure are its decorations: Gothic windows compete with Venetian balconies and giant columns on a massive front balcony clash with filigreed stonework on an adjacent window ledge. The entire faĂ§ade is a jumble of conflicting elements, as if different moments of architectural history happened to splatter across the buildingâ&#x20AC;&#x2122;s walls without any clear rationale for their placement or scale. A mess, perhaps, and completely out of place for Greenwich Village, but the Palazzo Chupi provides an ideal counterpoint for the surrounding townhouses. Both the Palazzo and the townhouses reinvent historical building styles but with two very different attitudes toward the architectural past. Built in the nineteenth century, the townhouses try to remove all traces of the original settings of their columns, lintels, arches, and pediments and make them into entirely domestic ornaments. In contrast, the Palazzo - built in 2008 - jubilantly proclaims a mash-up of historical styles that makes the viewer very aware of the discord between the styles of different eras. These differing approaches reach beyond architecture and reveal a deeper

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contrast within the American identity between the attempt to find unity between individuals by portraying the various productions of history as emanations of a common human nature and the celebration of the incommensurable differences between the values of different eras and regions. Ultimately, this clash is rooted in the values of American democracy: the equality given to all citizens by the vote and the freedom of speech that provides every individual with a voice. The former is best represented in the writings of Ralph Waldo Emerson and permeates the townhouses’ distinctive aesthetic. The background of Emerson’s thought was Unitarian theology, which claimed that all men were equally capable of understanding the word of God; in Emerson, this becomes the assertion that all human achievements, whether artistic or theological, can be understood through the experiences common to everyone— work, family life, and the changes of the life-span. In his essay entitled History, Emerson describes how the literature of past eras can be found in the mind of every human: [Man] finds that the poet was no odd fellow who described strange and impossible situations, but that universal man wrote by his pen a confession true for one and true for all…. One after another [man] comes up in his private adventures with every fable of Aesop, of Homer, of Hafiz, of Ariosto, of Chaucer, of Scott, and verifies them with his own head and hands.

The words of past poets should be “true for one and for all”; they are not the subjective fantasies of a single individual but shared understandings of the entire species, and “there is one mind common to all individual men”, as Emerson begins his essay. The common denominators of human life give meaning to and “verify” the past; instead of an irreducible diversity of cultures and peoples, classes and statuses there is only one universal human nature. War is an extreme case of common human aggression; governments arise from the same desire for social attachment that animates familial loyalty. Every life is a microcosm of history that can translate the distant events, personages, and cultures of historical narratives into the terms of ordinary life. Similarly, the townhouses translate an array of historical

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architectural styles into decorations for domestic dwellings, a context that is ingrained in common experience. Corinthian columns are removed from their original setting in temple porticos and brought into the orbit of family life through their use as doorway accents; Romanesque windows are detached from the sacred interior of churches and become embellishments for bedrooms and kitchens. Emerson himself links monumental, public architecture to the domestic roots of its builders: “the Doric temple preserves the semblance of the wooden cabin in which the Dorian dwelt… the Indian and Egyptian temples still betray the mounds and subterranean houses of their forefathers”. The importance of history is the way in which it can illuminate and dignify the ordinary human life of today. Compared to the aesthetic integration of the townhouses, the Palazzo Chupi affirms the conflicts between different styles and presents itself as a playful amalgam of architectural history. In spirit, it is very close to the value pluralism of American pragmatism, a later outgrowth of Emerson’s transcendentalism. William James suggests this multitude of contrasting values when he describes how clarity and logic, ideals that have dominated Western philosophy, are merely a subset of the diverse range of human experiences: [Religious experiences] suggest that our natural experience, our strictly moralistic and prudential perspective may be only a fragment of real human experience…. The word “and” trails along after every sentence. Something always escapes.

The world is too multifaceted to be described in a self-contained, cohesive system, and to reduce the many experiences and the many goods to a unity is to miss the richness of the string of “ands” and ignore the variety of moments that one finds throughout life. The Palazzo Chupi highlights this string of “ands” by piling features from multiple eras and countries onto the same façade and thus denying the existence of any single arrangement that could unify them. One can find moments of order—the homogenous pink paint that covers the building, for example—but these are always disrupted by visual mayhem, forcing the visitor to realize that perhaps the best response to the irreducible variety of the world is a playful flexibility with one’s

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frameworks. Instead of viewing architecture from the fixed perspective of the single-family dwelling, the Palazzo is a skeptic, both appreciating and doubting the merits of any single way of building. These approaches to architecture represent contrasting facets of the American identity that are ultimately manifestations of American democracy. As a government founded on popular approval, democracy shapes culture in two reciprocal directions. First, culture becomes universal by focusing on aspects of life that are shared by all members of a society. No democratic citizen is inherently above the others, and so there is no justification for high culture available only to a priestly, noble, or ruling class. Both political policy and artistic productions are shaped by common denominators; in America, these have chiefly been domestic and occupational affairs. Hence we have the everyman heroes of Arthur Miller and the hotels, gas stations, train cars, and restaurants of Edward Hopper. In architecture, this is captured by the reduction of monumental architecture to the scale of the Village townhouses. Opposing universalization is the effort to reveal the personal idiosyncrasies of all voices, and to celebrate the diversity that results. Hence the sacred aura that attaches to individuals whom we call geniuses or visionaries, and who represent merely an extreme case of the belief that every person has a unique perspective. This is the aesthetic of the Palazzo Chupi, which presents a purposively heterogeneous front in recognition of the irreducible diversity of the various stylistic voices from which it is composed. Democracy encourages the culture of common denominators because no citizen is naturally above any other; it encourages individual idiosyncrasy because every citizen has a political voice. Clearly, though, equality and personal uniqueness cannot easily coexist, and the weaknesses of both are seen through the visual impact of the townhouses and the Palazzo. By miniaturizing the columns and windows of temples and cathedrals, the townhouses dilute the monumentality of their sources and appear diminutive and shallow; similarly, reducing culture to experiences shared across an entire society dims the intensity of perspective found in smaller groups that forge a way of life different than that of the rest of the

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populace. Much of the impact of Italian Renaissance art, for example, depended on the cultivation and learning of elite patron families, who had interests and aims that were quite disconnected from those of the average Italian; the American aversion to elitism deprives us of such rich cultural productions. At the extreme, the aesthetic of the townhouses produces the oppressive monotony of suburban tract developments. The opposing attempt to appreciate the contribution of each individual voice, instead of generating emotional and intellectual power, produces a cacophony in which no distinct consensus can come forward. Though the Palazzo is exciting and playful, the eye wandering across its façade can never rest at a clear center of gravity and quickly becomes fatigued. Consider if our architectural landscape were populated exclusively by structures like the Palazzo— would this seething clash of styles not produce a maelstrom of visual warfare? The mélange of historical styles seems superficial, capturing only their outer decorations without allowing them to reinforce each other and provide a unified statement just as the projection of individual personalities loses the force of shared modes of expression. Is there a middle way between the universalization of the townhomes and Emerson and the individuality of the Palazzo and James? In fact, American cultural strength is rooted in neither the equality nor the diversity characteristic of democracy. Rather, it lies in the dual values of specialization and selectivity— which most often manifest in the economic freedom to form small, creative groups that can produce the best products and services for a specified audience. In companies, firms, and institutions the ideas of a single personality can be realized and expanded through the common projects of the group while the selectivity of the organization’s membership and its occupation of a certain niche ensure that its productions are not diluted by the need to express the desires of an entire society. This may seem distant from the material of art and architecture, but consider how many American aesthetic achievements have been mercantile rather than artistic— the assembly line, the personal computer, or the transcontinental railroad. Economic freedom and the specialized groups that result provide an intellectual environment between uniformity

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and individuality, between the townhouses and the Palazzo. Like the medieval guilds or the schools of Italian Renaissance painting, companies provide shared avenues of realization that make individual visions robust without becoming academic. For the Greeks, art was the art of the citizens; for the Christians, the art of the believers; for us moderns, the art of the industrialists, the businessmen, and the merchants.

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Genevieve Chartrand

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Pearls Gus Kappler My pearl of knowledge or wisdom strikes the smooth glistening surface of my students’ minds as a stone would the surface of a lake radiating waves of moving fluid, but inevitably slowly decreasing in amplitude with increasing distance until the original energy is totally dissipated. But, my students’ minds have an extraordinary ability to retain the energy laden pearl and its ability to generate waves so that it may be dropped upon minds of others and thus be transmitted to many without exhausting its original energy. And the new radiating waves in the form of the sound of speech spread the knowledge and wisdom in concentric circles touching all those who are paying attention. The secondary recipients also have in varying degrees of accomplishment the powers of retention and the process is repeated again and again as education. Not to say that with repetition the pearls are not reworked. The latter are dynamic clusters of energetic thought which is altered and modified by new knowledge, research, misinterpretation, experience, prejudice, and technologic advances. Therefore, it is crucial that there are those with the ability to decipher deviations from the pearl’s original message. Those guardians of common sense and original wisdom (not sin) are called historians. They once depended on texts; now they use the power of computers. And who will protect the “integrity” of the computers to insure that the original pearl’s intent is accurately preserved? Will those with the “power” just manipulate the content to their advantage? We must hope that they have been imbued with the original unblemished pearl of honesty and integrity. Now, some of us want our presence on earth to make a difference and be remembered. Every United States President strives for his defining legacy. Especially the library named in his honor. As presidents, those with “household” names are remembered for their

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achievements; actors, ball players, other politicians, mass murders, scientists, musicians, news anchors. But with time and the changing interests of new generations within a few time cycles most but the greatest names become diluted by other happenings and the new comers. The former are the declarative celebrities. Now we more common folk have the ability to become the anonymous contributors to the human race in making a difference by doing exactly what I initially described. We all have pearls of wisdom in relationships, knowledge, science, acting, journalism, our professions, and just plain living life. Share the pearls with others and watch the concentric circles spread your anonymous personalized contributions. This process could replicate an infinite number of times accomplishing much more than that of the declarative heroes.

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Untitled Jasmin Harpe A flower is a flower no matter what the color is. Some flowers have unique patterns and characteristics, Some are poisonous and known to harm, Some are statistically shown to have more offspring, Some dominate while others become extinct, Yet all share one thing in common: They all just want to thrive and grow and be happy as a flower can be

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Yellow Roses Rosemary Stevens

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In the Room Millet Israeli The day began with a visit to the room of a patient who had died early that morning. The ICU team suggested his family might need our “support.” His wife and daughter were at his bedside. We entered tentatively, offering condolences and asking if they wanted to be alone. “No,” they said, “stay.” So we stayed for a while. And we talked about the man lying in the bed behind us. About his love of life, his playful spirit, his impatience, his restlessness, his illness, his last days. I glanced back at him, his mouth agape, his eyes closed, his body still. Meanwhile, the sounds of the busy ICU were masked by soothing music. The kind you hear at the spa, all chimes and water trickling. The room was peaceful. I knew this family’s life had changed that day. I was cautious about staying too long, or saying the wrong thing. I said that he sounded like a wonderful husband, father and grandpa. His son-in-law entered the room. A tall man, big, strong. I watched him approach the bed, and turn away to wipe his eyes. They needed to be alone. Again I said, “I’m so sorry,” and I stepped out into the noisy ICU, the curtain closing behind me. I had not met them until that morning and I’d likely never see them again. But that day we shared a sacred space. A room full of a dead man’s spirit. We could all feel him there even though his body lay still, so so still on the ICU bed. He was there in the room. He was there.

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Untitled Lara Wahlberg

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Q24 Rachael Venn I write entirely to find out what I’m thinking, what I’m looking at, what I see and what it means. What I want and what I fear. Joan Didion said that, and it stuck. In her essay, she taught me about the strength of words and the intentioned construction of narrative. We, as medical students, have experiences that are utterly baffling—experiences that create a jumbled mess when we try to think about them. But Didion would argue that with every letter placed on a page, we give those experiences a physical shape, a substance, and a texture, and in doing so, take another step towards figuring them out. I write to understand. And yet today, I am dreading this. My first patient died. The ED admitted her to our service 21 days ago with a chief complaint of dyspnea and altered mental status. Past medical history: notable for squamous cell lung carcinoma (no evidence of disease) and cerebrovascular accident. At least once a day for 21 days I went into her room to talk to her. I looked at her eyes in an attempt to gauge her responsiveness, listened to her heart for a regular rate and rhythm, and auscultated her lungs for crackles. She never talked back. It wasn’t clear to me or to the rest of the medical team what accounted for her acute change in mental status. We treated her for a pneumonia that we could never prove existed and peered into her body by all means possible—PET, CT, MRI, ultrasound—all unremarkable. And then her O2 saturation started to fall on nasal cannula, then on non-rebreather, and we put her on BiPAP. I looked at her eyes, listened to her heart, and auscultated her lungs. But her white count continued to rise, and her BUN and creatinine bumped, and her hemoglobin dropped. She had melena in the setting of an upper GI

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bleed. I looked in her eyes, listened to her heart, and auscultated her lungs. Then we gave her fluids and her BUN and creatinine got higher still, and she was acidotic and hypocaclemic, and her white count reached 41, and her AST and ALT came back at 500. And then finally the family said stop. “Comfort care isn’t giving up,” I told them. “We can look at this as the start of a new kind of process. The process of letting her go.” What did I know. One by one, I discontinued her medications. “You should take off the bicarb drip,” my attending told me, “it will only prolong this, and her husband is exhausted.” It was true—he, himself, was in his late 70s and had started spending nights by her bedside, slumped over in a chair because, despite my best efforts, we couldn’t get a cot in her step-down room. We prescribed a morphine drip, and he watched her breaths as they became less frequent and more shallow, and we all knew that each day, she was drifting further and further away. It happened in the morning during rounds. All eight of us were walking to see a new admission, and I watched a nurse whisper something into my attending’s ear. She turned, pointed to me from down the hall, and motioned to follow her into my patient’s room. It was clear what this meant. When I entered, I was immediately struck by how pale she appeared. I had seen her not one hour before, and yet, in that time, the pink hue of her cheeks had escaped her, instead replaced by a chalky pallor. Following my resident to her bedside, I had a sense that this would be more difficult than I had expected. I attempted to quell whatever visceral emotion started to bubble up inside of me while listening to his lesson on the mechanics of pronouncing someone’s death. Following his instruction reflexively, I took out my penlight and looked in her eyes. Her pupils appeared as small floating black discs that made no attempt to hide from my light. It was deeply jarring. I pressed the diaphragm of my stethoscope to

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her chest and listened to her heart. It was eerily quiet. I auscultated her lungs. It sounded like emptiness. Throughout this whole process, I felt like I had been punched in the stomach, like I had been assaulted, violated, seen something that I shouldn’t have. I wanted to cry, run far far away, and regress to childhood so that I could be wrapped in a blanket, swaddled by my mother, anyone’s mother really. But I couldn’t. For it was time to continue rounding. I’m dreading this because when I started writing, I knew that I was doomed to fail. I can generate a differential diagnosis for dyspnea and altered mental status; describe the treatment for an upper GI bleed; explain the pathophysiology of pre-renal, intrinsic renal, and post-renal failure; or identify an anion-gap acidosis. But I can’t figure out what it means to see someone alive one moment and then dead in the next. I won’t understand. What I want—to be a doctor, to take care of people, to stand at the bedside and try to make them better—is so inextricably tied up in what I fear—having to watch some of them die. So for now, I’m done writing. I have a new patient. The ED admitted her to our service 2 days ago with a chief complaint of syncope. Past medical history: notable for peripheral vascular disease. This morning on exam, her pupils were equal, round, and reactive to light; her heart had a regular rate and rhythm; and her lungs were clear to auscultation bilaterally.

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Whispers Ben Scherban I. Here it lies Still and sullen and stiff covered with cuts Unencumbered by cares divorced from tired dreams Of being and time do you really foretell the future or have you already forgotten In the land of the dead the conscious man is king II. Yes Flesh becomes fleshness Death becomes deadness in its immanence now there is nothing but the this the brief halo made manifest in the inheritance of a formaldehyde heaven Naked in its nothingness Nothing in its nakedness the splendid majesty is gone For nothing is As nothing does

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And nothing is As good as nothing at isnâ&#x20AC;&#x2122;t The body finally transcends its truth The abstract is III. Why take what is not given I have it heard said The fabric of immortality is not carved in stone Or even made of matter But written in the minds of those who come after Yet what is this compared to life itself The squalid mockery of a cramped, cramped lie Even to have been given the memory of the fallen And when that shell too is snatched by a jealous eternity What matters the matter then Or the mind Or the memory Only spirit survives If you are what you were How can you be what you have become? I will tell you When I hear the small still voice Babbling I have felt nothing once and it was not nothing And I have glimpsed in it The stale Promise This is but a breath within two folds of forever

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Winter Woods Kim Overby

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Remembering Daniel Shalev When my grandfather died somewhat suddenly while I was in high school, it seemed weirdly inconsequential to myself and my siblings. Although he was connected to us by blood, we had grown up in the United States and had only seldom seen him because he lived in Israel with the rest of my extended family. When we were very young, we had spent warm, dreamy summers visiting with him and my grandmother in Israel, exploring the dusty histories of his adopted country. He was a kind man; he told us stories, took care of us, complimented us often and never criticized or yelled. But those times were far removed from the realities of daily life in New York. We had never shared enough of the simple substance of routine with him to really know him or feel a connection. And it had been years since we had visited Israel. We gave our sincere condolences to my grandmother over the phone and hugged our grieving father extra tightly as he prepared to embark on his hastily planned journey to Tel-Aviv to support my grandmother and make arrangements. We didn’t miss school or lose sleep. We didn’t think long about him. We didn’t cry. I think back now and feel regretful that we didn’t engage more with his death. That we felt his death inconsequential must have made my father and grandmother feel like we thought his life was inconsequential. In the year after he died, my father would often gently interject small facts about my grandfather into conversations. These were tender and tentative gifts to us: how he had graduated at the top of his class from the London School of Economics, how he and my grandmother had made a meaningful life in England and then started anew in Israel after World War II, how kind he had been through the many troubles my grandmother’s family had faced in the long years after the war. I imagine my father hoped that we would admire these small distilled gems of him, and so give them meaning and worth.

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I don’t think we ever rebuffed him, but we were young and callous and certainly we took no special care with those precious memories. To us, my grandfather was an insubstantial idiosyncrasy of our father’s past, now gone and nearly forgotten. Since then, I’ve thought of him occasionally in the context of my medical training. I’ve realized these recent years that when family or patients share knowledge of themselves with you, it’s a sacred act. The value we ascribe to the flashes of insight we are gifted about those we care for—whether patients or family—is the way we demonstrate that they matter. Grandparents know this, parents know this, patients know this. *** I met Mr. P when I came to his home as a medical student joining a visiting geriatrician. In all fairness, ‘met’ may be a generous verb to use; he had very advanced Alzheimer’s and no longer interacted with the environment much. Instead, he spent his days sitting quietly and looking out over his large living room and being shuttled between his recliner and the adjacent hospital bed by his wife and his aide. As soon as we walked in and sat down, I felt a sense of frustration. What did they want from us here? There was nothing medicine could offer this man. His skin was relatively intact, he was fed a high calorie gruel that kept his weight livable if not ideal, and he seemed to be beyond complaint and in no particular pain. His existence was simple and unperturbed. For us, there were no labs to draw, no laying on of the hands that could ease this man’s suffering. As we sat down in the living room with Mr. P and his wife, either she or my attending mentioned to me by way of explanation that he had used to come to Cornell to see his doctors: neurologists, internists and the like, I imagined. But now, his condition made it too difficult to bring him across town because he could not walk on his own and became upset outside, even in a wheelchair. My attending spoke with his wife, who gave the detailed updates of

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a consummate caretaker: diet, sleep, elimination, and so forth. She was a vibrant, wizened woman. The care she took describing his condition gave the impression that she was deeply devoted to him, even though he could no longer reciprocate that devotion. My frustration gave way to tenderness in the face of her tireless love; it made me hope that someone would be there to tend me in my autumnal time and tell the story of the best me. As they spoke, I began to look around the room. The wall behind his bed was huge, with massive dark wooden bookshelves and white panels covered with the memorabilia of a life rich with accomplishment and meaning. I could tell by the hung award plaques that he had been a gifted teacher with a brilliant intellect. The memorabilia on display referenced outstanding work, teaching, prestigious universities. The books on his shelf spoke to a man deeply invested in intellectual pursuits, but also in the well-being of his community: books on travel, health, law, philosophy, and history. His wife caught me looking and spoke to me a little bit about him. I was struck at how she shared with me—like a proud confidante, like a witness. I imagine it was how my grandmother would have spoken to me about my grandfather if I had ever bothered to ask. She told me how smart he had been. How gifted he was at his work as a public health lawyer and professor at Columbia. How he had come to this country and made his way, despite the difficulties. I accepted these small, time-smoothed stones from her and rolled them around in my hand, trying to show her that I knew that they mattered. My grandfather doesn’t come up much anymore. It’s been years since I visited Israel. My younger cousins don’t even remember him. I wish I had held on to a little bit more of him. Mrs. P’s stories reminded me of him and I felt oddly connected to the man sitting in front of me staring past me. There is something strikingly similar between the way that patients share with their doctors and families share with their descendants. I think maybe it’s about fostering the intimacy we need as physicians and as family. Mostly, though, it’s about remembering. Remembering is a balm; it eases the pain of loss and calms the fear that one day we too will be gone. It’s one of the great generos-

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ities we can bestow on people we meet both as doctors and as fellow humans. Probably the many doctors who Mr. P went to before he got too sick did more than we did. I imagine they drew blood, ran tests, and prescribed medications. I imagine that they spent more time examining his body and hearing his heart beating in his chest. But we knew things, too. He is diminished now, but he was a great man. Here. Let a few small shards of this manâ&#x20AC;&#x2122;s story be known: he came from Europe after the war, he made it through law school, he cared about health like we do, he earned the uncompromising love of his formidable, brilliant wife. He mattered. Imagine him for a second. His other doctors may not remember him. You may not remember him. But I will.

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Untitled Clara Tow

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Sanctuary Mary Simmerling The winter sun shined brightly as familiar shadows cut new patterns across the rented room. We used the caterer she had suggested for our wedding there were flowers and photos and bracelets mementos I couldnâ&#x20AC;&#x2122;t recognize people Iâ&#x20AC;&#x2122;d never met. (thank you for coming yes we will stay a few more days no, our son is back in New York please have some food) In the glass room overlooking the frozen waters I wore a single turquoise ribbon through the top of my black dress. A gesture towards hope as if it had not already run its course as if we were not there for her as if we were not now without her.

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Easy Mary Simmerling As I turned I heard her say You make it look so easy To walk And I remembered a tear filled exercise about loss Years ago in graduate school What would you do if you lost this And then this And then also this. And I wondered was this her loss Or all of ours Where are the subtractions being made Why do I now feel them so deeply As if they were my own. And as I turned again I felt my legs So strong underneath me Carry me away.

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Sister Mary Simmerling They called me in the morning Laughing, and teasing each other. Can you believe this is how we are spending our day? (Itâ&#x20AC;&#x2122;s probably just gas pain.) They promised to call again later to recap their wasted time. They said donâ&#x20AC;&#x2122;t worrywe have to go now, the doctor is here. It was the day that would become my pregnancy counting day (go home and rest now, Mary) the day we learned she way dying (the cancer is everywhere, there is nothing we can do). I arrived at dusk she had been transferred to the big hospital by then. We had already become like ghosts translucent and unmoored.

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A Physician Letting Go Andres Gottfried An aggressive cancer has taken hostage a colleague in his prime. Feeling robbed of his desired season, he wonders, when to let go, after all his hard work and invested time. How to give up his life, to accept this treason, to farewell without woe? In three short months his hand went from wielding a neurosurgical knife, to occupying a PCA pump as his new device. Without reason, he has become the bedridden stroke patient he knew so well, yet is no longer the more wise to tell. What duplicity to his existence this must be! To dwell, to feel, to see his whole body slowly decay. Yet a will to live still flickers in his eyes, but for how long should he fight this pain away? For how long should he plea? How to comfort this humble man in dismay? How to help him let go in peace, to leave the quay, and depart to the sea.

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Harbor in Humboldt Bay Du Cheng

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Letter to Mr. S Krithiga Sekar Dear Mr. Smith, I am writing this letter to tell how lucky I feel to have met you and gotten to know you over the last few weeks. I wanted to tell you a few things that I never had time to convey when I was taking care of you. In addition, I also wanted to apologize for the things that I wish I and the rest of our medical team could have done to help you get to a place where you were more ready and able to let go. First I wanted to tell you that I too grew up in Africa, Nigeria, West Africa in fact, and the man who helped raise me until I was 6 years old was also named Mamadu. He was a lot like you: a tall, dark man with a huge white smile, strong, simple and reserved but who I trusted without ever having to try. Maybe it’s because you reminded me of him that I grew to care for you so immediately and without any effort. You were always so polite, so frank and so warm. Maybe it’s also because you were alone, without your own people by your side that I felt like you allowed me to be part of your family at the end of your life. And for that I want to thank you. I also want to say sorry for so many things. For not getting to your pain medication adjustments on time because I was so swamped with other seemingly more pressing things all day. For asking you about your pain and symptoms more than your life and thoughts. For always wanting to run out and grab you your favorite mushroom soup when it wasn’t on the menu but never having enough time. For only coming back to see you a second time on the evenings when you were very sick. But most of all I’m sorry that I didn’t have the courage to tell you the truth until the end - that you were dying quickly and your time left here to spend with your loved ones was almost over. I wish I had pushed oncology to give you a flat out ‘no’ for an answer. I wish

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I had insisted that we get your wife and 4 children to NYC when I had first started on service. I wish someone had told you that the end was coming months ago so you could have gone home to be at peace. Finally, I wish you had been able to listen to us and see that the fight you were fighting would never end. I wish you had been less willing to believe in a medical miracle and more willing to live in the real here and now - with your family who loves you and in the country that you were so proud to be from. More experienced doctors always told me that you learn best from your patients and over time you will come to remember many who made you the doctor you become. Well, you are on my list. I will never let someone linger on in a hope based on little reality ever again. You have taught me that medicine isnâ&#x20AC;&#x2122;t only about what you can offer as treatment to patients. Itâ&#x20AC;&#x2122;s also about what you are willing to withhold in order to really care for those who trust in your judgment. So thank you again, Mr. Smith, for your courage and bravery in dying so far away from your home and your family and your friends. While I know it could never be the same or never be enough, I hope that you could gain some comfort at the end of your time in being around us - your family and friends here at NYP hospital who grew to know and care for you so much. I am happy knowing that you are finally at peace and without pain. Sincerely, Krithiga Sekar

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65th and 3rd, NYC Gus Kappler

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Reconciliation Kim Overby In the snow the pine trees hunker down like shaggy beasts that can go no farther. But in the spring new growth arises, tiny candles held vertical at the tip of each dark bough; As if they were standing vigil and spoke with outstretched arms a language we both understood. Strange, that I might still feel the pull of something hidden in those sorcererâ&#x20AC;&#x2122;s sleeves. Beneath branches that angle upwards like silent thunderclouds, I lie down upon a pool of dry tears the color of your hair. On autumn evenings white moths will gather in the warm folds Of their skirts

82 then fly off one by one as unknowing as flakes of snow.

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December, Poetâ&#x20AC;&#x2122;s Walk Jordan Roberts

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The Mother Millet Israeli She sits beside the bed, clutching her prayer book. It’s quiet. Other than his rattling breath and the hiss of his oxygen mask. Across the room, his wife slouches in her chair, asleep, exhausted. He lays there, the white sheet pulled to his chin, clean but for the growing puddle of fluid leaking, dripping from his mouth. That familiar smell. I think of when my little boy got sick on that long drive. And we didn’t have a change of clothes. So we drove with the windows open. Because of that smell. Sour. The smell of disease. His wife frowns in her sleep, turns her head away from him, as though unwilling to face the end. His mother shrugs her shoulders. Sleep-deprived. As she must have been when he was a newborn. “He asked me to let him go. And I want to do that for him. But I can’t. I can’t.” Her eyes rise and fall with each breath. Watching. As she must have watched him at night, in his crib, making sure he was safe. I tell her to sing to him. She hums a Hebrew lullaby. One that I recognize from my childhood. One my grandmother used to sing. She is still his mother. I tell her its okay to touch him. She rests her hand on his forehead. As she must have done when he was a child and sick with a fever. I offer lotion. And essential oil. Because what else can I do. And I say that I’ll be back. While I’m away, he dies. Soothed by the lullabies of his childhood. Anointed with lavender. Later, I enter his room one last time. To say what people say when someone has died. “I’m sorry,” I say, “so sorry.” We sit silently at the foot of his bed. His labored breathing has stopped. He is covered with a clean white sheet. And I recall my grandfather wrapped in a white sheet. I place my hand on her arm. She sighs heavily. “Were you here?” I ask. She nods. “He was here, he was breathing. And then he was gone...” She takes a deep breath. “He slipped away from me.” I glance at him. Sunlight illuminates the bed. He has slipped away. “He’s peaceful now,” I

Volume III whisper. She clasps my hand, nodding. “He’s not in pain, not suffering anymore,” she says. We both nod now. And I just sit with her. For a while. Because, really, what else can I do.

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Still Water Kim Overby

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Dream of a Daughter Bonnie Stockwell You beckon, but I wonâ&#x20AC;&#x2122;t follow into the lasso of silver-tipped green that surrounds you at the knees and, in no time at all, I hear voices, like a chime over the door on the far shore, cascading. What a shabby suit this skin seems. I call to your back, and spit something out, a rubber band from the mail maybe, that sails pitiably short. Here on the lone side, I see you disappearing still, but couldnâ&#x20AC;&#x2122;t swear by oasis or mirage, being so new to the desert.

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Winter Beach Bonnie Stockwell More bountiful somehow: unfurling waves bolt over bolt spread upon the salt ice a lace sheen; and on the sand stark evidence of the seaâ&#x20AC;&#x2122;s stubborn delivery of what even death cares not for. So late in coming as to be ridiculous now, this season of knowing. Yet the snowy egret tenses for fish, not flight, as we pass by.

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Untitled Du Cheng

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Reflections Beverly Tchang

Aur Kismet I didn’t know she was back until I saw her eldest son pacing in front of the room. He was as I remembered him, black coat and high hat, long white beard. The age around his eyes made it hard to believe he was anyone’s son, with a step like that, he could only be the esteemed grandfather of a clan. But it was she who was the matriarch, and this became obvious as the days went by and she lay in her bed without so much as a whimper of pain despite multiple sources of her suffering. She initially came in a month ago with diffuse lymphadenopathy, and as I took care of her, every day brought a new problem—atrial fibrillation, aortic stenosis, pulmonary edema. Anyone with any medical understanding would have wondered how this woman had even the strength to speak. She became known first as a medical mystery, infectious work-up completely negative and oncology work-up entirely confusing, then was known as an unusual T-cell lymphoma masked by a B-cell polyclonality. As her primary doctor, though, I knew her as the woman with crowds of children by her side, and every day a different pair. Once, I tried to get a sense of how large her family was. She definitely had eight children, and some indefinite number of grandchildren. When my approximations led me to something like “grandchildren = 82,” I gave up on trying to keep track of her family members. We decided for the sake of communication, that all plans would be discussed with her eldest son, David, and he would disperse as he sought fit. Eventually, she left us for the lymphoma floor and finally left them for sub-acute rehabilitation facility. It was sad to see her again in the ICU. When I visited her, I was met by one of her daughters, who instant-

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ly recognized me from when I had been her doctor months before. I looked at her, lying on the bed, sedated and intubated, and could see that there was still so much strength in every wrinkle of her face. The daughter and I exchanged comforting words. She, too, had a strength in her smile despite the way she wrung her hands. The next morning, her room was empty. Bed sheets were missing, a specific sign of someone’s death. The waiting room outside the ICU was filled with men in dark robes and hats, harmonizing their prayers, white shawls floating around their necks. It was as if a queen had died. *** I don’t need 80 days to know I’m dying He was 29 years old. He had been in the hospital for 82 days. His time in the hospital was split between the ICU and the bone marrow transplant floor, largely because he (or we) could not hit a balance between his pain and his breathlessness. My first visit with him was brief. He seemed so young at first, lying in bed, barely a movement, eyes fixated on the television. The graft versus host disease had infiltrated his muscles to the point of atrophy and paralysis. We offered pleasantries and placations, but despite this, he gave little indication that we were even in the room. I said something that brought his eyes to angrily stare at me. I don’t know what I said, but it made me happy to see him glare. It surprised me when I later discovered he had a son. A son whom he refused to let visit him. It seemed that his real time tug-of-war between pain control and respiratory depression paralleled an internal dialogue that represented his own wishes for life vs. death. Sometimes I imagined what that dialogue would be like. You’re still young. But you’re old too. You have a son; does that mean you’re a father? Does being a father mean you’re an adult? You’re old enough to be a father, and too young to be the father you want to be. But you’re still young, and don’t you feel that now especially, with food being brought to your bed side three times a day, and

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water and amenities brought to you at your request? You’re too young to die, though. Aren’t old people the ones who die? (Except you are dying. Does that make you young or old?) You can’t let your son see you because you don’t feel like a father, you don’t feel like an adult, you don’t feel old. How can your son come here with football in hand, asking you to play with him, when you can’t even move your feet. Can you pick him up anymore? Then again, is it enough that you at least have a son? At least a part of you will live on after you die. Does that make you an adult? Does that make you old? Is that enough to say that your journey—however short it has been—is complete? Can you say that at least you left behind a beautiful 5-year-old gift to the world. Do you think about your mortality this way? Do you think about wanting to ask someone to help you answer these questions? Do you think about who you could ask? Do you come up with anyone? Is our job here to create a father figure for you, so that you can ask him, “Did I do enough? Was I enough of a father that I can say I am a father. Did I do enough that I can die peacefully knowing I played a role for someone, even with my meager life?” How often do these thoughts run through your head? You must have turned over these cards many times over the past eighty days, and now, why bother. You feel better staring into space and not thinking about it. So let’s focus on the small things that maybe we can fix: your pain, energy, appetite, mood, whatever it may be. We’re tired, too, of looking at a big picture without answers. That day when the blizzard paused and the window let in a sliver of snow-dusted sunlight, you pulled out your phone—lighter than a child but with a gesture so heavy—and showed us your son. I saw his father in him; I see him in you. Then you asked us if your brother can visit from Jamaica. Let’s see what we can do. *** Voiceless. Why did she press the pump so much overnight? There is so much you can learn from numbers in a chart. We can

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tell you when a patient was asleep and for how long. Moreover, numbers elicit more questions. What happened at 03:00 that made her press the button twenty times in one hour? She was in the hospital for newly diagnosed esophageal cancer, stage IV. A tracheostomy was placed because the disease was compromising her airway. She had few complaints, just mild all-around neck pain from the lymphadenopathy and excess salivary and tracheal secretions. Last night, she woke up breathless, suffocating. “Choking,” she wrote down. It was quiet both inside and outside her room, but in her head she was screaming. She tapped on the call button to alert the clerk and waited, and waited, and waited. It took far too long for a nurse to come check on her, and she had been suffocating the whole time. We later discovered that she was febrile overnight. Medically, it was impossible for her to be in respiratory compromise, but in reality, her distress was real. Imagine for yourself the darkness of late night hours silencing your senses, the quietness beyond the bed and disease rising in your throat leaving you deaf and mute. *** It takes the average person 15 minutes to fall asleep So much of palliative care seems to be a slow unfolding of emotions and stories. We follow patients day after day, sometimes twice each day, and we ask and probe and urge ourselves into developing deeper connections. It is a languid ocean wave, steady and stable. When an emergency consult comes in, we know someone is actively dying. Not just dying in the “stage IV cancer” way, but in the “He looks gray/yellow/blue” way. I realized that palliative care does not take a 1-hour family meeting or a 30-minute emotional exploration. When you might only have 15 minutes before a patient dies to establish rapport, discuss goals of care, and offer end-of-life comfort options, palliative care only takes 15 minutes. He was a 92-year-old man with advanced Parkinson’s dementia,

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accompanied by his 86-year-old wife. She sat still by the bedside, with the look of someone who had been through this multiple times before. Unsurprisingly, she stated with her first breath that they were both ready for his death. For their last anniversary, she explained, he gifted her two cemetery lots, side by side. We listened to her story, how she used to work as a curator at the Metropolitan Museum of Art, how he was an equally brilliant man, and how his interactions have become more and more muted over the past week. Sometimes he will reach his hand out for her, and sometimes he will reach his hand out. “This is the end,” we said. She looked at us, breath held, and sighed. “Thank you. I just wanted a doctor to tell me for sure.” She left to make phone calls and gather family. Later that night, as he was being transferred to a private room, she told us, “He better not be alive when I come back in the morning.” It was a strange thing to hear but not a strange thing for her to say. She had said her good-byes already. She had probably been saying good-bye every day.

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More about:

Ascensus is Weill Cornellâ&#x20AC;&#x2122;s journal of the arts and humanities. It was founded by a group of medical students at the medical college in 2011 and has been published annually for the past three years with the support of Weill Cornellâ&#x20AC;&#x2122;s Office of Academic Affairs and the Liz Claiborne Center for Humanism in Medicine. Ascensus is led and organized by medical students with the support of faculty advisors Dr. Randi Diamond and Dr. Susan Ball, however it features work from all members of the Weill Cornell community including faculty, house-staff, medical and graduate students, social workers, and nursing. Over the past three years, Ascensus has featured rich visual and written work by countless members of the Weill Cornell community on topics both medical and non. The editorial team takes pride in the quality and diversity of the work they are so privileged to showcase each year and hopes to continue serving the community through this publication for many years to come.

ASCENSUS is supported by the Liz Claiborne Center for Humanism in Medicine. For more information, visit: http://cornellaging.org/claiborne.html For inquiries and submissions, please email us at: wcmc.lit@gmail.com

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