2019
AN ARTS & LITERARY MAGAZINE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE VOLUME 6 | 2019
Cover Image Svalbard, Norway | May 2017 William Zehring, PhD | Professor of Biochemistry, Department of Medical Education
Black Diamonds is an arts and literary magazine of Geisinger Commonwealth School of Medicine. All content is the property of each respective author/artist. No part of this magazine may be reproduced without the permission of the author/artist of each submission.
F
or thousands of people living in northeastern Pennsylvania (NEPA) during the 19th and 20th centuries, coal was precious. It was the black diamond they mined and the substance that supported their
lives. Formed in ancient times under the massive pressure of the sediment above it, coal became the foundation of an entire economy in NEPA. That economy has all but vanished from this part of the country, but today, NEPA is witnessing the formation of a new and valuable resource. Created under the pressure of a great need for future physicians, Geisinger Commonwealth School of Medicine now exists. New students are coming in to NEPA every year to begin the process of being transformed into physicians through the steady, constant pressures of medical school. And like the rich veins of coal that extended through the region, these future physicians are now stretched across counties in northeastern and central Pennsylvania. For many of these students and their teachers, the arts are an important part of life outside of medicine. Our hope is that this journal can serve as a showcase for their expression and be an inspiration to those who read it.
Zachary Wolfe, MD MD Class of 2015
03
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Geisinger Commonwealth School of Medicine is committed to non-discrimination in all employment and educational opportunities.
table of contents Editor’s Piece Transitions in trust // black diamond trail the view from between the divide arches Life Beyond the diagnosis waterfall nescopeck state park the arrhythmias translucence untitled 1 who is behind the stethoscope? A day in the life: residency
06 08 10 11 12 13 15 16 19 20 21 22
25 26 27 28 29 30 33 34 35 36 38
untitled 2 Earth, water, air: New Orleans earth, water, air: leesburg earth, water, air: seattle LeaF railway // glimmer of gold essay A Patient in need // empathy untitled 3 prattler making routines meaningful glow
05
Editor’s Piece | OLApeju simoyan, md, mph, bds, faafp Program Director, Geisinger Marworth Addiction Medicine Fellowship | associate professor Art and science inform each other. From the earliest drawings of neurons by Santiago Ramón y Cajal to Rosalind Franklin’s X-ray diffraction images giving us the first glimpse of DNA, creative expression has been an important
As I was preparing to write this piece, I spent some
a straight path. If only we could experience smooth,
time reflecting on the interesting names of two of our
uninterrupted sailing through each phase of life!
student performing arts groups — The Arrhythmias
means of disseminating
and FlatLine. I thought about how these could relate to
scientific knowledge.
the concept of transitions, the theme of this issue of
These pioneering
Black Diamonds. These names reflect the heartbeat,
endeavors deepen our
the essence of human life. Arrhythmias are irregular
knowledge and enhance our lives. We need your support to continue the pursuit of beauty and
rhythms, some of which are “innocent” and transient while others are life-threatening. At the other extreme, a “flatline” is observed on the cardiac monitor when
However, the reality is that life is hardly ever a straight path or a “flatline” from point A to point B. Real life is usually filled with unexpected twists and turns, interruptions to our “regular rhythms,” in essence, “arrhythmias.” Life’s challenges may include the loss of a loved one, academic problems, divorce or having a family member who is addicted to drugs or alcohol, to name a few. While we cannot completely avoid life’s difficul-
truth. Please consider
the heart stops beating. The ideal situation is some-
a charitable gift to fund
where in between — when the heart beats at a normal
the annual publication of
rate and with a regular rhythm. Although the flatline
Black Diamonds.
in this context symbolizes the absence of life, for the
Consider the concept of improvisation as it relates to
purposes of this discussion, let’s assume it represents
music. Improvisation in music allows musicians to
ekg pattern from vecteezy.com
06
Tra n s itions : Improvising through the arrhythmias of life
ties and challenges, we can exert some control over how we respond to them.
deal with the unexpected, to deal with mistakes so that they are
This issue features the three winning essays from the Glimmers of
not recognized as such, and to keep playing. Similarly, our ability to
Gold essay competition which was organized by GCSOM’s chapter of
accept and deal with life’s challenges, adapting to new situations while
the Gold Humanism Honor Society. These heartfelt stories put a hu-
accepting our limitations can be viewed as a form of improvisation.
man face on illness and remind us of the importance of compassion
A jazz musician improvises, playing what hasn’t been rehearsed and
in the delivery of healthcare.
responding to cues in the moment. By learning to adapt to change and prepare for the unexpected, we can “improvise” our way through life’s transitions — the unexpected arrhythmias.
I hope that you will enjoy this is-
As a novice on the saxophone, I have found that this instrument lends
sue of Black
itself very well to improvisation, which is a good thing because learn-
Diamonds
ing to play a new instrument can be stressful! With time and regular
and be
practice, it becomes less stressful and more enjoyable. Ideally, play-
inspired to
ing a musical instrument is one of many activities that can serve to
do what
mitigate the stress we experience in daily life. For many, in addition to
it takes to
hobbies, our faith, family and friends play a significant role in helping
maintain
us maintain balance in our lives.
balance in
In this issue, third-year medical student Amelia Mackarey writes about her experience transitioning to her clerkship years in her essay, Transitions in Trust. Drew Cornwell, DO, a second-year anesthesiology resident, gives us a glimpse into his daily routine as he helps patients to transition between the realms of unconsciousness and wakefulness.
your life, especially during times of transition.
Transitions in trust
the medical student’s journey
Amelia Mackarey MD class of 2020
G
o ahead. Make the first incision.” My attending offers me the scalpel,
the corners of his eyes crinkling with encouragement. “Oh, no. I couldn’t,” I sputter and gesture defeat with my hands. “I’m not ready,” I admit. I am a just a medical student: I have so much more to learn. But even in my brief exposure to medical education and medicine, I’ve rec-
Waterfall ognized that these fields are built on a Andres Rodriguez foundation of comprehensive underClass of 2021standing, steadfast integrity and, most 08
importantly, profound trust. Throughout the course
is not that placed in you by your peers, preceptors or
of my education, I’ve noticed that this trust has
your patients. Rather, it is the trust that you place in
become more internally focused. During our first two
yourself, something that is personal, yet so power-
years of training, we trust that the material we are
ful. It is the trust that emanates from within you and
being taught is relevant and applicable. We believe
characterizes each interaction and encounter you
that if we devote ourselves to learning countless
have with your patients. It is the trust that inspires
details and endless facts, we will one day be able to
you to provide the best care possible; it is reassuring
treat, to comfort and to serve our patients with poise
to your patients. It is the trust that gives you both the
and grace.
confidence to answer a question and the strength to know when you should be asking one instead. It is
As we transition to our clinical clerkships, the desire
the trust that allows you to scrub in for one opera-
to help our patients is what solidifies the founda-
tion with pride but to step back from another with
tion of trust in our education, our instructors and
humility. In reflecting on my education and each of
ultimately, ourselves. We accept the guidance of-
the transitions and changes throughout, I am grate-
fered by peers, residents and attending physicians
ful for the greatest skillset with which it has befitted
because we have confidence in them. We push
me: the trust it has fostered in me.
ourselves, working long hours in order to glean the most from each experience. We challenge ourselves
I am a medical student: I have learned so much, and
to watch educational videos, read medical literature
I trust in myself to learn so much more.
and spend extra hours rounding, charting, observing and practicing, trusting that these exercises will help
“OK,” I exhale. “Scalpel,” I say, as I accept the instru-
us become better physicians.
ment from my attending’s outstretched hand.
However, the hours of studying and shadowing
“Incision,” I announce. I trust myself as I calmly etch
are not what define us, nor the reason our patients
a small, steady cut in my patient’s reciprocally trust-
have faith in us. Through all my educational experi-
ing flesh.
ences, I have learned that the most important trust
the hours of studying and shadowing are not what define us, nor the reason our patients have faith in us. Photo:: Black diamond trail William Zehring, PhD 09
My world fell silent. Staring, wondering what next
the heartbreak I feel with them. I’m not unaware.
Blank thoughts, words swirling As I say the words, The questions, endless How would I tell my family?
As I shatter their whole world, I listen, quiet.
The answers, hopeless A new grandmother, What this really meant, The doctor knew so little.
A friend, brother, pet owner, You are a human.
What my dreams are, crushed. I am with you now, Shattered by the words
a partner in this journey.
I try to find the courage
“We will do our best.”
“I will try my best.”
-Anonymous 10
If only they knew,
Arches Alayna Craig-Lucas MD Class of 2021 11
Glimmers of Gold essay contest winner 12
li f e b e yond the diagnosis Kristin Hare MD Class of 2020 I was only 16 years old when my mom was
remember taking her to doctors’ appointments,
diagnosed with multiple sclerosis (MS). At first,
my tiny weightless body pushing her wheelchair
I did not really think much of it, as I knew a lot
in and out of old buildings that were anything but
of people in my community who suffered from
handicap friendly. As we began to realize the se-
this disease. I saw them continue to work, raise
verity of her condition, fear struck my family over
families, enjoy outings and evenings with friends.
both her state of health and our financial strug-
What I did not know was that within a few
gles to support her. I grew more and more angry
months, my entire perception of illness would
over the years as her condition not only weighed
forever be challenged.
heavily on her, but on everyone who loved her too.
I watched as my mom gradually lost control over
I recall taking her to the neurologist one day. The
her body; first her legs became weak and numb,
physician asked all of the typical medical ques-
and then her arms and hands. Within just two
tions related to her condition, but never once
years, she was already bound to a wheelchair. I
asked how she was doing mentally and emo-
tionally. How was she coping with her new state of normal? How was she getting around at home? How was she handling the transition from being a working woman for 30 years to now being wheelchair bound in her own home? I thought he would want to know these things. At a very young age, my mom’s illness gave me insight into the fact that health goes way beyond the physical. I watched as my mom’s memory started to decline and her muscles began to atrophy and there was no longer any medical solution. Then what? I wanted so desperately for her physicians to ask me how I was doing, or how our family was functioning as a unit. In reality, none of us were doing well. I struggled with this constant guilt of feeling down over my mom’s condition, but being too scared to speak up, since my mother was the one who was actually sick. She struggled over being a burden to all of us. As I transitioned into my late teen years I began to watch how growing up in turn took a toll on my mom. She was extremely upset about being unable to help me with shopping for college, decorating and moving into my dorm room. She was heartbroken that she couldn’t come visit me at school when I was sick or stressed because she was now dependent on a caretaker and had lost most of her
Waterfall Andres Rodriguez MD Class of 2021 13
health goes way beyond the physical freedom. Again, illness goes beyond the physical, but this is often un-
physician’s office. Her illness had progressed beyond a clinical presen-
recognized in the healthcare setting. I empathize with physicians who
tation; it had become a new way of life.
want to provide the best patient care, as it can be extremely challenging. Working diligently to properly assess and diagnose patients while
If there is one thing that I have learned over the past few years, it is
formulating treatment plans can be a daunting task, especially when
that no one illness is routine. Not every person with the same diagno-
one physician is assigned a dozen or more patients at a time. Howev-
sis presents the same way clinically nor do they respond to treatment
er, in order to provide the best patient care, one must truly understand
the same way. We are taught what different diseases are according
the patient’s concerns beyond the medical diagnosis.
to textbook definitions and clinical presentations. While being able to identify medical conditions is critically important, being able to identify
My mom was diagnosed with severe depression within a year of
how those conditions change patients’ lives is just as important. No
her MS diagnosis. Physicians kept telling us that she was so down
single physician will ever be able to understand all that patients go
because of her disease. It seemed like they could understand why
through, but taking extra time to ask patients and their loved ones
someone with MS would be depressed, but it did not feel like anybody
about their concerns outside of the hospital setting shows that we as
understood that an illness involves so much more than just the course
healthcare professionals care more than just about a patient’s imme-
of the disease. She was not just depressed because she had MS. She
diate medical needs. It is important for physicians to recognize that an
was depressed because she was missing out on shopping for prom
illness is more than just a physical change. It is a change in a person’s
dresses with her daughter and being able to ambulate to volunteer
future plans, family decisions and perception of who they are in life.
in the community and go to work. She was missing out on making family dinners and cooking our favorite family dishes for the holidays. Her life was missing the moments that one cannot see in a hospital or
14
Nescopeck State Park William Zehring, phD 15
The arrhythmias Elizabeth Zygmunt Director of Media and Public Relations
Most of us would say that inventing meaning while letting loose is the essence and promise of jazz. – Robert Christgau, music journalist
B
eing successful in medical school is difficult and requires great discipline. Most students
find the need to adopt punishing study schedules that offer little respite from the sane, orderly, uncompromising mindset of the sciences. Yet every Sunday afternoon, GCSOM’s fourth-floor student lounge erupts in joyous sound that veers from gospel to blues and everywhere in between in a burst of music that is anything but sane, orderly or uncompromising.
16
Meet “The Arrhythmias,” a jazz group founded
if we were feeling stressed — we didn’t want to
by first-year students Emily Christie and Jessie
put anyone in the position where they felt they
De Angelis, both of whom play alto sax.
had to come. We have enough stress.”
“Jessie and I met during orientation and
Perhaps unsurprisingly, given the emotive and
bonded over the fact that we both play saxo-
freeing form of jazz, the students who gath-
phone,” Emily said. “We talked about how we
ered to “informally jam” found great release
would love to put together a group that would
in the sessions. “In the jazz environment, you
meet and jam informally. When discussing the
create insanity — but it’s beautiful,” said Emily.
group, we agreed that we didn’t have to meet
“Sometimes, especially if it’s a test week, I
17
start out playing timidly, but then, as the practice goes on, I let loose and as the sound comes together, it’s thrilling. We all love our group now. No one misses it.” Jessie said that, in addition to emotional release, playing jazz indulges the musician’s creative energy — something she feels is crucial for students who hope to become caring and empathetic practitioners. “Jazz allows improvisation,” she said. “You play what you feel. That taps into your creative side. There’s a lot of teamwork in a jazz band, too. Those things are important in medicine.” Emily agreed, adding, “Playing jazz is very useful for personal interactions — it opens you up to adversity and struggle, even if it’s only in songs. I think it’s better to be open with people. Drawing from creative processes helps you develop better ways to approach patients.”
18
“Drawing
The Arrhythmias have been playing together for several months and have a vocalist, a keyboard player and a violin, in addition to
from creative
the saxophones. They also have a playlist
processes
and Bess,” to the gospel sound of “Mercy,
helps you
of songs ranging from “Summertime,” the bluesy aria from George Gershwin’s “Porgy Mercy, Mercy.” Now, Emily and Jessie think it’s time to take their joyful noise on the road. They are currently talking to volunteer groups,
develop
senior centers and nursing homes, where
better ways
might enjoy a break from routine. As Emily
to approach
in any environment.”
patients”
they hope to spread a bit of their group’s “beautiful insanity” to others who could said, “One thing I’ve learned about jazz is that, with it, you can find joy and happiness
Translucence Alayna Craig-Lucas MD Class of 2021 19
untitled 1 Janis Williams staff 20
Asawer Nihal MBS class of 2019
Grab your stethoscope
Ask them to talk slow
Sure enough you solve their medical concern
Press it against their heart
Let them know all your time
And put them at ease
Hear it beat fast
Is theirs
Smile
Take a second and reflect
But not before you realize
Reassure them they are alive
On everything they’ve shared
To them you are thankful
Listen to their lungs
Assure them you will try your best
For confiding in you
You know how the melody goes
Tell them to lay down and rest their head
Gratitude you feel
On the hospital bed
Because you comforted them to heal
Look them in their eyes
The smile you can’t conceal
Ask them how they feel
Examine them the way you’ve been taught
Helps you approach your next patient
Listen to their words
For over six years
With stethoscope in hand.
But don’t forget emotions can also show fear
Be confident in your ability
Assess their body language
And treat them with humility
21
a day in the life
Drew Cornwell, DO second-year Anesthesiology resident
induce emerge repeat 22
Induce, emerge, repeat. Isn’t that the usual
[5:28 AM] Out the door. Apple in hand. I’ll
anesthesiologist’s day? The routine may be
eat more during my AM break. I’ve never
similar day to day, but no anesthetic is the
been able to eat much this early. I love that
same. Each case in the OR has a myriad
my door-to-door walk to the hospital is 12
of variables influenced by a patient’s type
minutes.
of surgery, medical comorbidities and how my attending and I plan to deliver the
[5:45 AM] “Hey man, how was your night?”
anesthesia.
I say to the senior on night float as I walk in the workroom. “AAA rupture, it was wild.”
[5:05 AM] Why is my alarm going so early?
Scrubs are on, stethoscope utility belt is
Where’s my phone? Today is...Monday...no,
on, “Batman?” Head down to OR 17 to start
Tuesday? Shoot, Tuesday. I’m giving the
my room setup.
morning report lecture at 6 AM.
[6:05 AM] Lecture begins. I teach 15 min-
[7:30 AM] Attending has come by and met
properly against the vocal cords to monitor
utes on noninvasive versus invasive blood
the patient. We’re ready to head to the OR.
the recurrent laryngeal nerve. After three
pressure monitoring. Man, I wish I could
Patient is still nervous; 2 mg IV midazolam
months in the OR, intubation has become
throw an arterial line in everyone. The chief
will help. “I call this the ‘I don’t care juice.’”
much easier.
residents fire off some questions and we
She laughs.
wrap up.
[8:08 AM] Tube is taped, the ventilator [7:43 AM] In the room, monitors are set up
switched on, and patient positioned. Sur-
[6:45 AM] Went by pharmacy, picked up
and attached to the patient. My attending
geon asks for a timeout. Incision.
drug bag, drew up my syringes. Fentanyl,
arrives. “How do you want to induce, Drew?”
lidocaine, propofol and rocuronium.
[8:45 AM] Blood pressure has been trend[7:47 AM] Patient is asleep and apneic.
ing down. I started phenylephrine infusion.
[7:05 AM] Seated bedside in pre-op, talking
Turn on the sevoflurane and squeeze the
Should be good rest of the case, but I’ll
to my first patient. A routine physical by
bag a few times. Still strange to think I’m
titrate it as needed.
PCP found a large nodule in the thyroid. A
doing 100% of her ventilation.
biopsy was concerning for cancer. She’s
[9:28 AM] Attending gives me a 15-minute
anxious. I need to remind myself that this is
[7:48 AM] Paralytic pushed: time to intu-
an everyday occurrence for me, but not her.
bate. We use a video laryngoscope since
I have 10 minutes to earn her trust.
the specialized breathing tube needs to seat
break. Where’d my protein bar end up? [10:40 AM] Pathologist calls with report:
23
benign adenoma. Surgeon says that it’s 10
can get the room turned over and ready.
minutes until closing. Time to get to work to prepare for wake-up.
reading for my cases tomorrow and hopefully get some other general studying. 45-60
[12:32 PM] Second case started smoothly
minutes/day is my goal.
and I’m getting a lunch break from a senior [10:56 AM] Patient is at 0.3 MAC and
resident. I run into my buddy who is a sur-
[9:45 PM] Wife and I relax watching old
breathing spontaneously. I’ll need a smooth
gery resident and we catch up over lunch.
episodes of The Office. I made a s’more for
extubation without coughing. My attending
dessert. Can’t beat that.
has talked me through his method. Smooth
[3:25 PM] Time to get to an afternoon lec-
as silk, out comes the breathing tube. Eyes
ture, third case is just wrapping up, but all
[10:25 PM] I need to go to bed, 7:15 AM
open as I quietly say, “You’re all done.”
has gone well.
case start tomorrow. Five minutes into starting a podcast, I’ve passed out.
[11:01 AM] Recovery room is ready. I get
[4:48 PM] Pharmacology lecture is done.
the patient to shoot me a “thumbs-up” as
I’ll prep my cases for tomorrow and call my
Induce, emerge, repeat. In the book of daily
the ENT resident and I push the bed to
attending during my walk home.
life as an anesthesiology resident these are
recovery.
merely chapter headings as I escort my [5:32 PM] “Daddy!” I might be tired, but
patient into the realm of unconsciousness,
[11:14 AM] Sign-out given. Patient is still
nothing brightens a day like coming home
assume control of their physiology and
groggy but talking to me. I write orders for
to family.
smoothly return them to their original state
post-op pain and nausea management.
24
of awareness. It’s a book that is hard to
Time for the case, a partial parathyroidec-
[7:20 PM] Two kids can be a zoo to get
tomy. I start my stopwatch to see how fast I
to bed. I track down a textbook and start
put down.
Untitled 2 Janis Williams staff 25
Earth, Water, Air: New Orleans Heather M. Davis Director of Marketing and Communications 26
Earth, Water, Air: Leesburg Heather M. Davis Director of Marketing and Communications 27
Earth, Water, Air: seattle Heather M. Davis Director of Marketing and Communications 28
leaf Miriam Eagleson MD Class of 2021 29
Glimmers essay contest winner vanessa thiel MD class of 2020 “What are some symptoms of hyperthyroidism?” The instructor asks. It is now our turn to eagerly recite the facts imprinted in our minds. “Diaphoresis, tachycardia” Ah, yes. I nod my head, as I recall the feeling of my heart racing, trying to escape the confines of my chest. What is happening? I would wonder. I remember walking across my college campus, making my way from one class to the next; but boy, it felt as if I had just run a marathon. I remember climbing a flight of stairs, feeling astonishingly winded after minimal exertion. Now, I know I’m not the most athletic person in the world, but wow! Was I out of shape or what?! Even as I sat at my desk five minutes after the start of class, I could not seem to catch my breath! Also, was it hot in
Endrailway of Season Danjustin Sylvestre collins md class staffof 2021 34
here or was it just me? I felt flushed, uncomfortable and slightly concerned at my lack of fitness.
s of Gold “Weight loss, excess hunger”
“Tremors”
it worse, the embarrassment of seeming
Oh yes. I remember that as well. I recall
Oh, the tremors. This was by far one of the
nervous, made me nervous! The shaking
sitting at the library with my close friend,
most concerning things I remember. As I
increased, my confusion and frustration
studying for yet another midterm exam.
sat in my molecular biology lab, I remem-
growing stronger. My embarrassment
We had just eaten dinner not too long ago.
ber grabbing the pipette and attempting
peaked when my lab instructor began to
Two hours, maybe. Yet I could already feel
to transfer my samples. My hand hovered
notice my apparent incompetence. What
the stir of my stomach, the familiar feeling
over the tubes, tightly grasping the pipette,
the heck is wrong with me?!
of hunger I had become accustomed to
attempting to stop the shaking. For some
recently. I pulled out some snacks, acknowl-
reason I could not seem to aim correctly. I
“Exophthalmos”
edging the confused look on my friend’s
used my left hand to steady the right, only
Hearing this symptom, I shift uncomfort-
face. “I don’t know, I’m just so hungry lately!”
slightly improving the process. I looked
ably in my chair. I look around and wonder:
It was almost convenient — I mean, who
sheepishly at my lab partner, embarrassed.
does everyone notice?
doesn’t love food? And happily, I ate away
She chuckled a little, slightly confused as
without gaining a single pound. I even lost a
to why I seemed so nervous. But that’s the
I was diagnosed with Graves’ disease
few pounds, to my own pleasant surprise!
thing — I wasn’t nervous. Or was I? To make
in May 2015. After lab tests, radioactive
31
As medical students, we often rattle off a list of symptom without even considering the consequences to the patient.
32
iodine uptake scans, and antibody testing, I ran home
being the healthy 21-year-old I was prior to this diagno-
to look up the symptoms and complications. Alas,
sis. It was similar to having a cold and a stuffy nose —
everything I felt in the past few months made sense! I
you never really appreciate the feeling of a clear nostril
could breathe a sigh of relief — I finally had an answer!
until you can no longer breathe. Before this experience,
I wasn’t out of shape or nervous in lab. It was all a
I never appreciated being healthy. Now, I had a chronic
product of this disease! I felt vindicated.
condition that required close monitoring and follow-up. I had to consider treatment options, schedule appoint-
I also remember hearing about protrusion or “bulg-
ments and remember to take my medication twice a
ing” of the eyes. I found pictures online, pictures that
day.
depicted worst case scenarios — severe bulging, with some individuals even requiring surgery. I remember
As medical students, we often rattle off a list of symp-
no longer feeling vindicated. I remember feeling fright-
toms without even considering the consequences to
ened.
the patient. These words are no longer products of thought but rather reflexes: lists now imprinted on our
My thoughts raced. How did my eyes look? Were they
minds after endless hours of study. As we go through
bulging? Would they get worse? Would I need surgery?
these lists, let us remember that these symptoms are
Do I look abnormal? For weeks I would lie in my bed
more than just that; they are experiences, memories,
unable to fall asleep, constantly anxious and worried
emotions felt by the patient. Symptoms are not just
about my eyes and what this disease could potentially
tremors, palpitations or weight loss. They include
do. I also worried about the treatment — possible radia-
confusion, frustration and fear. They are moments in
tion, possible surgery? I worried about the complica-
time that may stick in a person’s mind forever. Simi-
tions — thyroid storm? Arrhythmia?
larly, a disease is more than just a diagnosis — it is an event, and often a realization of one’s own vulnerability.
I felt overwhelmed and frightened. I was in over my
Remembering this can help us to understand, connect
head. The possibilities introduced by this new diagno-
and to truly empathize with our patients.
sis made it feel as if my whole world had been turned upside down. I wanted nothing more but to go back to
Patient presents with chief complaint of…
Help me, I scream Chronic pain? Something stronger?
Addiction
Chronic pain A little bit longer?
I’m sorry, there is nothing more we can do
Terminal Am I not a healer? Can you not wave your magic wand and make this disappear? What is my prognosis? Statistics How long ’til I heal? Uncertainty No, No
Can I not wave my magic wand and make this disappear? What is my prognosis? Statistics How long ’til I heal? Uncertainty You see,
You see, The coats we don,
vanessa thiel MD class of 2020
a patient in need
Terminal Illness?
empathy
I come to you for answers
The coat you don, The tools you carry Suggest an answer to my questions A solution to my pain Why do you turn your back?
The tools we carry, We are supposed to be healers We are supposed to have answers Even when there are no solutions, We cannot turn our backs
Treetoes Linda Bradley Guest artist 33
untitled 3 janis williams staff 34
prattler
Eshiemomoh Osilama MBS class of 2019 A holy intention,
just over-zealously,
a whole-hearted attempt.
as my closed eyes blunder
The words and worlds amalgamate
off,
affixed by and to
innocently,
a selfless and divinely trusting
from chasing
egotism.
chasteness to
They fly up from my heart
a dreamy otherworld –
and flitter for a moment on my tongue –
my knees sore and still soaked in
but only syllables slip,
syllables.
well-meaning, yet unrepresentative, only syllables drip
But an air always comes,
from my lips and
atoning
puddle around my knees.
and torrid, to evaporate the puddle
Piffling, prattling,
up, up, and away –
feigning a commitment to piety,
to decode and transpose
a commitment to prayerful sobriety.
each time I fall asleep,
My hands keep crossed intently, devoutly,
each time my spirit is willing,
with my head bowed
and, each time my flesh is weak.
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Glimmers of Gold essay contest winner 36
Making Routines
Meaningful Esther good MD class of 2020
O
ne of the most profound moments in my clinical
putting on a patient’s socks and shoes is not usually part of a physician’s job description. She could have put on her own socks and shoes, although not without some difficulty. The physician had other patients waiting to be seen and could have hurried out as soon as he had
finished examining her. Was it really fair to make other patients wait while he did something she could have done by herself?
rotations occurred on a busy day in the clinic. My
preceptor had patients scheduled until late in the evening
It seems that there are always other patients waiting. The
and was already behind schedule with his morning pa-
mismatch of supply and demand in healthcare is appar-
tients. We were with an elderly patient who had wounds
ent in most of my rotations. There simply aren’t enough
on her foot and he knelt down in front of her to examine
providers to meet the needs of all the patients who seek
it. He removed her sock and shoe so that he could prop-
their care — at least not in a timely fashion. Physicians
erly assess the wounds’ healing while he asked her about
and other healthcare professionals are faced with the
her pain and the different medications she had tried.
dilemma of whether to provide care to as many patients
Afterward, while holding her foot in his hand, he gently
as possible, but sacrifice the amount of time and level of
pulled the sock back onto her foot and slipped her shoe
attention they can afford to give each patient, or to offer
on over it.
thorough, high-quality care to fewer patients, leaving others without any services at all. The healthcare systems
“Thank you, Doctor!” the patient said, again and again.
they work for often appear to be driven by profit margins
Her face was filled with gratitude and surprise. After all,
rather than by concern for patients.
I don’t believe there is an easy solution to this problem, and
acknowledge a patient’s pain during a procedure or anxiety
I don’t expect the physician shortage in the U.S. and across
over a new diagnosis. During such times, I look around for
the world to be rectified any time soon. There will always be more patients. There will always be more need. Physicians
I think
who work too hard to meet unrealistic demands, either out of a sense of obligation or due to the requirements of the healthcare systems they work for, risk burning out and jeopardizing their own mental and physical health. In this environment where there is always more to do, how can we serve our patients well? How can we see the humanity in patients rather than seeing them as statistics and numbers?
responses that I can emulate: the nurse who reaches out and holds the patient’s hand, or the physician who takes an extra few minutes to explain the next steps to a patient.
of my preceptor, kneeling
And of course, I think of my preceptor, kneeling in front of a patient, putting on her socks and shoes. Could he have put those 60 seconds to better use? The impact that the lost time had on his other patients was likely negligible at best. But it was incredibly meaningful to that patient. By helping her with such a simple, personal task, he showed her that she was valuable and worthy of his time. He demonstrated that he saw her as a person, beyond the clinical presenta-
In his New York Times article “Doctor Talk to Me,” Anatole Broyard says, “To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.”1. Perhaps it is too much to expect physicians to appreciate the full depth of how illness affects each of their patients, but maybe a starting point, as Mr.
in front of a patient, putting on
Broyard suggests, is simply acknowledging this incongruity. We can begin by keeping at the forefront of our minds that our routines are not our patients’ routines. With that in mind, we can push ourselves to offer the extra word of support, helping hand, or listening ear whenever possible. It’s easy for even seasoned healthcare professionals to get so busy with the task at hand that they forget to
tion of the wound he was examining. I hope to carry that lesson with me throughout my future career as a physician, especially on the days when I am caught up in a crazy schedule, and I am tempted to view my patients as a list of tasks that need to be marked off before I can go home. I want to make those small gestures that acknowledge my patients’ humanity as part of my
her socks
routine so that I never forget that my role as a physician is in service to them.
and shoes 1. Broyard, A. (1990, August 26). “Doctor Talk to Me.” New York Times, p. 1. Retrieved from http://www.nytimes.com
37
glow dan sylvestre MD class of 2021
Even after so many passes,
Winter chomping at the bit,
The poignance of The Fall still feels novel,
to tug you out-into the abyss,
Like all the moods of Man were held captive in
Like the undertow of Summer’s shoreline lapping,
oaks and maples,
Just as unforgiving,
suspended specks of dust in golden rays,
but without the salt and glow,
Tiny galloping spirits of change,
Spring now seeming but young, naïve,
liberated by brisk breezes,
Gradually...
To sail on yellow wings,
then all at once.
Then orange-red, Then brown,
Gradual indeed,
Then flightless.
But look enough and one soon sees,
Waning warmth, waxing shadow,
A different glow in ice and snow,
Whirls enraptured in remembering,
Friends that warm the darkest months,
Gradually... then all at once.
A deeper whirl, a river flow, Gradually... then all at once.
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COMMITTEE
Olapeju Simoyan, MD, MPH, BDS, FAAFP Editor in chief Vanessa Thiel Managing Editor Miriam Eagleson Layout Designer Heather M Davis, MFA Production Manager Amelia Mackarey Student Editorial Assistant Alysha Nicholls, MSHE STAFF Editorial Assistant