Black Diamonds 2022

AN ARTS & LITERARY MAGAZINE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE

VOLUME 9 | 2022

Cover Image

Alternate Plan (Pinar del Rio, Cuba)

William Jeffries, PhD | Provost and Vice Dean for 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.

Geisinger Commonwealth School of Medicine is committed to non-discrimination in all employment and educational opportunities.

For 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

Moving sideways: finding Agency in the unexpected

Amanda Caleb, PhD Editor-in-chief and Professor of Medical Humanities

My father has dementia—has had the diagnosis for nearly five years and symptoms for several before that. Our conversations are anything but linear: sometimes they are circular, and increasingly they are sideways. I’ve grown to like sideways, even though it goes against a deep urge to push forward, to arrive at a destination, and to skip pages to get to the conclusion. With a diagnosis like dementia, sideways is better than the alternative. There is no getting better or going back to how things once were, and

disease progression signals further bodily and mental decline. Both backwards and forwards lead to either impossibility or a finality we’re not ready for. But moving sideways means living differently each day, neither worse nor better, but appreciating our relationship in the moment. Moving sideways has allowed me to appreciate how my dad’s mind works and how what I perceive as non sequiturs are simply his sideways movement in a story. His sideways talk has forced me to slow down, to appreciate the rich interconnectedness of his lived experience and his way of processing a life well lived, to recognize his agency in moving sideways, and to reflect on my own drive to go forward rather than dwell in

the complexities of moving sideways.

Sideways can be seen as undesirable: When we describe something as “going sideways,” We mean it didn’t go to plan, or that we lost control. Moving sideways embraces that which is unplanned and creates agency: We choose to move sideways, to adjust to the unexpected, and to find our agency in the unexpected.

Moving sideways requires balance of keeping sight of the path before and the path ahead while learning from the unintended path. It requires accepting unexpected movement, of surrendering to being unable to control everything, and recognizing the gift of a different world view.

In many ways, an arts and literary magazine like Black Diamonds is always moving sideways, offering us glimpses in all directions and exposing us to the familiar in unfamiliar ways, challenging us to look and live sideways and restructure our perspective. In this issue, MBS student Jahasia W. Gillespie’s poem reminds us that roadblocks

which require sideway movement provide us with the introspection to learn about ourselves, the perspective to see our world differently, and to appreciate the ability to continue to move, even if indirectly. Second-year medical student Sophie

Roe’s essay about “street rounds” is a reminder about perception: what some view as stepping backward is moving sideways, finding ways to improve a structurally unjust situation. This essay calls us to see moving sideways is an act of bravery and resiliency, one that can teach us compassion and to move sideways with others.

Living through a pandemic has meant a lot of sideways movement, which could feel frustrating and interminable. I hope in reading this issue you gain a greater appreciation for the power and perspective of moving sideways.

The Narrows

T. Riley potter MD class of 2025

The Currents

t. Riley Potter MD class of 2025 Managing Editor

The early-morning sun reflected on red rocks a thousand feet above me as I moved from one side of the slot canyon to the next, cool from the mountain-spring water of the river. The river’s current pushed against me relentlessly as I hiked upstream. Rocks, likened to slippery bowling balls by many who traversed this path before me, moved as I took each step. There was no other way, no firm ground within sight. Just an unyielding river, walls of smooth rock to either side, and the dim morning light as a guide forward.

To try and walk directly against a strong current is often futile. It may work for the first few steps, but after a while, legs tire and spirits drain. If one can reimagine how to hike, however, and call on their adaptability to teach themselves anew in an unfamiliar environment, progress might just be possible. With walking-stick in hand, pointed downstream for stability, there was one tactic that could ensure a methodical, persistent path—

moving sideways.

This was me a few short months ago while hiking an awe-inspiring, exhilarating trail through what is termed “The Narrows” of Zion National Park in Utah. There is no other choice but to traverse the river, often wading through waistdeep water. I highlight this scenario as it is a good metaphor for medicine, medical school, and our world. There are so many challenges in our lives and while tackling them “head on” may be tempting, a more nuanced approach is often necessary. By “moving sideways,” as is the theme of this issue of Black Diamonds, we can see our world in new ways and identify different, important viewpoints, shining a light on novel approaches and unlocking our inner ingenuity.

Throughout this issue, our community at Geisinger Commonwealth School of Medicine provides excellent examples of how “moving sideways” can be a positive, enriching experience. It is my hope that, through these pages, we may all gain new perspectives that help us travel through the currents of our lives.

Motion in medicine

Digital drawing xinyu li MD Class OF 2024

A hurdle.

Evan calvo

MD class of 2024

A red circle under a blazing sun, An odd April heat. I stood appraising The eight hurdles I was to overcome, Standing proudly, immovable they seemed.

The blast of a gun, filling the floral air. Six proud hurdles I overcame, but alas The seventh brought me to the ground, my knees Red – gravel, blood – my stride broken. I pressed on. I approached the eighth – tepid, apprehensive. Out of fear of again meeting the ground, I went around. Sideways, but still forward, And in the end it was all the same.

Lofty and desired is to surmount, From peaks, we miss the beauty of valleys.

FROM Speechless to words of wisdom

Khevna p. joShi MD Class of 2025

When I was a young child, even before the age of 5, I was diagnosed with a serious speech disorder. Whenever I spoke, I found that it was very difficult for me to get words out of my mouth – they almost felt as if they were stuck in my throat, and words that started with vowels were especially difficult for me to say. This heavily impaired my childhood social development and relationships with many people, including my teachers, my friends at school, and to some extent, my parents, although as my support system, they were the ones who understood me best.

I started seeing a speech pathologist when I was 5 years old. After attending a few speech therapy sessions, my therapist told me that my

disorder would not improve. She informed my family and I that I would continue to experience this difficulty with speaking, that my development would be stalled, that I would not perform well academically, and that I would not be able to pursue a college or career of my choice. But my parents refused to believe this, as they were strongly of the belief that with a positive mindset and optimistic attitude, anything is possible. It was at this time that I realized that my progress would not move forward in a straight line. My path would not be as simple and straightforward as that of my peers. It would have many more obstacles and speed bumps of its own, and at times, I knew that I would need to

move backwards or even in unexpected directions to make any forward progress.

While I continued to attend these speech therapy sessions for 7 years, my parents drew me a wheel that they stuck to my door. On this wheel, they listed all the positive qualities that I had – my kindness, how outgoing I was, how loving and caring I was, my intelligence, my laugh, and more. They told me that instead of focusing on the negatives of my speech disorder and the problems that it has been causing in my life, I should focus on my positive character traits and capitalize on those the best I could. I would be lying if I wrote that there were no tough times, but I can say that with my new growth mindset that my parents inspired me to adopt, it was much easier for me to overcome those times, and in fact grow from those experiences.

While focusing on those positive characteristics and continuing my therapy treatment, I was eventually completely cured of my disorder – to this day, I am attending medical school, was able

to attend an Ivy League college, and have given multiple public presentations with ease, including a TEDx talk.

Upon reflecting on this experience, I realized that if I had not moved sideways to strive to achieve all that I hoped to, I would not have internalized all the values that I have instilled as part of my belief system today. I have walked through a door that I thought was permanently shut, perpetually on the horizon, just by being mindful and looking at the positive side of things and focusing on the present, and not what the future may or may not bring. By adopting the same mentality, I continue to walk through several doors today whenever I encounter challenges to overcome, by viewing them as problems to be solved rather than looming issues to be feared. By living today to the fullest and best of my ability, I was able to surpass my illness, become the better person that I wanted to be, and most importantly, leave that door open for many, many more behind me with similar stories.

Untitled Rebecca lees MD Class of 2023

Keep Moving sideways

Jahasia w. gillespie

Mbs class of 2022

Roadblocks …

Discouragement … Writer’s block … Disappointment … Sadness … Loss … Stagnant … Lost … Bad days … Delays … Sideways …

To my younger self

These words will make you who you are in your better days

In the moment it will be the hardest, wondering “why you” … “what did you do”

I wish I could tell you how these moments are responsible for molding you

These words are a part of your path – your story–your journey

To my younger self The challenges you are about to face All the road blocks ahead

Embrace them gracefully – what a bittersweet taste

As this will show the perseverance you’ve faced

To my younger self You have big dreams with little representation Choose to look at the cup half full – instead of discouragement

A sign to help decide your destination Become what you needed for the future generation

To my younger self Your outlet is writing

So its normal to feel overwhelmed and want the clock to stop But sometimes we need a mental break from everything including writing

So appreciate a little writers block

To my younger self

Everyone won’t understand your choices So ignore all the negative voices

Let the disappointment guide you through it

Frustration is normal

The rewarded satisfaction afterwards helps prove it

To my younger self

Feeling sad is okay as long as you’re able to pull through it

The feelings of sadness will be so helpful

A girl once guarded now being able to sympathize and empathize Your Sadness will be responsible for your interpersonal skills

When your words are no longer words but what you actually feel

To my younger self You’re not as young anymore

Working with people now

Understanding and relating to them

Caring and helping them in anyway how

You’ve seen so much loss

Grief is natural whether it be a loved one or a patient you tried not to become emotionally attached to Loss will make you grateful for someone’s dedication

Loss will teach you strength, acceptance, and appreciation

To my younger self You’re not as young anymore

I know you’re thinking – now is a time for decisions Or how you should know all of your plans by now Or how being stagnant isn’t an option

But everyone has their own pace at this thing called life To be successful and happy – there is no secret concoction

To my younger self

You’re not as young anymore

There will be times of confusion

Times you feel Lost These are the best times of reflection

Reflect on your positives and keep those up

Reflect on your negatives and figure out how to make a better you Feeling lost is natural

As long as you use the time to figure out what you want to do

To my younger self

You’re not as young anymore

So there will be a lot of bad days

As an adult you’re allowed to have one – It won’t last forever

A bad day can be setting you up for a great week

Sort of like a rainy week followed by a weekend with perfect weather

To my younger self

You’re not as young anymore Life may hit you with many delays

But those are just roadblocks

Temporary stops

Stops that may push you sideways but eventually you’ll move forward

Stops that help you reflect inward

Necessary stops!

To my younger self

You’re not as young anymore but keep moving sideways

Along the sides of your family

Along the sides of your community

Along the sides of your patients

Along the sides of your colleagues

Along the sides of your friends

Along the sides of each other

To my younger self

Keep moving sideways

No matter the struggle to see the achievement in the end No matter the feeling of displacement

Or the silent imposter syndrome from within Keep Moving Sideways

Because even if the direction of the steps your feet are taking aren’t of your choosing You’re still moving

Thoughts

Rebecca lees MD Class of 2023

What if?

(In honor of my late twin sister, Emma)

Maya van gieson MD class of 2025

What if?

What if you were here?

Would we like the same foods?

What if you were here?

Would we be best friends?

Would we still get into a sibling quarrel now and again?

Would we share secrets late at night?

What if people confused our names?

Would we laugh and identify ourselves?

Would we go along with it?

Would we ever try to be the other?

What if one of us was better at school?

Would we tutor each other?

Would we edit each other’s papers?

Would we study together?

What if?

Would we go to different colleges?

Would we call each other every day?

The question remains, and it always will.

You, twin sister, are gone. Your brief time on this Earth was beautiful, but I will always wonder what more time could have been.

You are in my heart forever, but what if you could be by my side?

What if?

Serenity in

the uncertain Olivia granja, msc MD Class of 2025

Spill

Eshiemomoh osilama, mbs

MD class of 2024

Sunshine, in the mornings, spills. It slips and slithers as it tills. Routine and unremitting, yet still, I find it bestilling –how the Sunshine unravels and ribbons, like the crest of a breaking wave.

I’m always drowsy in the mornings, from eyeing the light and the course of its routes. But I love the taste and the remedies of Sunshine in the mornings; as the rays flood up to my lips, it reminds me of spilt orange juice.

Catch a waveCalifornia

Janis williams Administrative Assistant for Student affairs

Early bird gets the wave

Jessica fanelli MD class of 2026

Ribeye with apple-ginger-parsnip puree

Justin kosman MD Class of 2024

Justin Kosman MD Class of 2024

Control is everything. Each day is filled with the gut-wrenching anxiety of a never-ending pursuit of academic progress with a hovering fear of the unexpected. What happens is not up to me. Relief is necessary whenever possible and for however brief. For my entire life, that oasis took the form of a hardwood basketball court and a ball where, regardless of our amateur status, we would battle each Friday for the humble title of a day’s cham pion. The world melted away when we took the court. With each play, I was nothing short of pres ent. The smell of a sweaty gym, the grip of tight laces around your ankles, the un-mistakable ping of a newly inflated ball, and the absolute solitude of arriving before everyone else to shoot around.

Each sensation providing a deep refuge from the uncontrollability of my world. The outcome was dependent on one thing, me.

For those two hours, I was in control. Every move, every cut, every pass, every shot, every decision required unconditional concentration. The subconscious instinct of each move was welcomed without excess thought or analysis. For those few hours, a different person took over.

It was meditation. It was therapy. It was music. It was channeled frustration. I felt invincible and my identity was molded based on my physical ability to produce ecstasy through hoops. I was unstop pable. Until something stopped me.

A wayward landing struck a sensation that was altogether perplexing, unfamiliar, and immediately obvious. In one fraction of a second, everything

was taken from me. One fateful twist on a lifetime of skeletal wear and my oasis was removed. My control was taken from me. Not only of the game

I loved, but the body I once housed. For the next two years, I would wake and greet a body unfa miliar to the one I had known. A leg that suffered an injury so detrimental to its function that it assumed its own sentience, seceded from my body plan, and set out to taunt me. In one slight moment, my athletic career had ended, and with it went my self-confidence. The world changed for me. I had been forced to evict my entire identity because of some torn cartilage I could not even see with my own eyes. It was about more than giving up a sport, it was about giving up a mind set I had constructed my entire life, and missing out on a mindfulness that few activities could reproduce.

I existed for months with an emptiness that is only recognizable to those with nothing to look forward to. It was as if I was no longer in control over anything, even my body. I was trapped. One day, I encountered something that reawakened what it felt like to be present. Until that point, I had coasted with an aloof disregard for the world around me due to my never-ending inward focus toward understanding the new body I was given. What I encountered was a dish at a restaurant. Some pureed something or other with some meat on top. At least at first. For whatever reason it be came more than that, all in an instant. The sight of radiant pink with a dark brown sear on top. The ambient fragrance of ginger and apple. The smooth texture of pulsed parsnips coating the roof of my mouth. The precarious balance of salt, acid, and fat demanded my attention. I had no

choice but to enjoy each bite. For a few moments, I was amnestic and existed wholly in the moment.

I had to make it for myself and so I did. I chased that feeling. The following few months were met with reinvigoration as I baked, basted, broiled, stewed, steamed, seared, sautéed, and simmered every type of cuisine I could think of in pursuit of achieving that taste of control that I once had. I gripped a pan with the same unadulterated pas sion that I once gripped a basketball. With each meal I was transfixed in time, bathed in a sensory experience that commanded my attention. The end result depended on me and the reaction my body produced to the ingredients laid in front of me. I was in control once again. For those few moments with the stove alight and the range hood roaring, I felt like myself again. It was about

more than trading hobbies or filling time, it was about appreciating my body again and what it can do. It was not in a way I could have imagined at the time, but in this case, a lateral move felt more like a leap forward back to the feeling of pride. My frustration melted into appreciation and compas sion for my circumstances. Although I relish the appreciative hums of satisfied friends and family as they eat what I make for them, I am going to keep cooking for myself and the body I now oc cupy.

Lake Scranton xinyu li MD Class of 2024

Observation point

T. Riley potter MD class of 2025

Switchbacks

Nicholas mynarski MD class of 2023

That time I didn’t do an ultramarathon

Iris johnston

Library specialist

I have long loved and admired Diana Nayad, the woman who swam unassisted from Havana to Key West at the age of 64. Like all endurance athletes, her skill is not to go fast, but to keep going. I identify with that. Tall and chubby all my life, I am no speedy sprinter. Drop me in the ocean or plop me on an elliptical, and I can entertain myself for hours. I go slow, but I keep going.

I’ve always wanted to see exactly how long I can keep going. Marathons don’t interest me; again, speed is a problem. Ultramarathons, on the other hand, vary not just in distance but in how participants complete them. Almost everyone attempting an ultra walks part of it. Some ultras

are only walking, as with the One Day Hike (ODH), a pair of noncompetitive ultramarathons that follow a flat path along the Chesapeake & Ohio Canal. The 100km ultra begins in the Georgetown neighborhood of Washington, DC and goes all the way through Maryland to finish in Bolivar, West Virginia. I went with the “fun run,” which is 50km and begins at the midpoint of the 100km. You know – achievable, realistic goals are important.

Speaking of goals, this was the first one I had made for myself in a long time. I have a vague superstition that goals are somehow tempting fate, that planning for things only makes them less likely. But walking 50km (about 31 miles) requires preparation. I began preparing for the May 2019 ODH in October 2018. I got good sneakers, got in touch with a trainer, and put

together a schedule. I even enlisted a “buddy,” in the form of Brett, a fit soccer dude I’d known for over a decade. We’d gone on many long walks and supported each other during many stressful times. Part of me wanted to walk alone, but Brett was enthusiastic and pledged to cheer me on. Plus, he lived in DC, so I could sleep in his guest room the night before rather than in my car.

I started with 2-hour walks around the Hills neighborhood, or 2 loops around Lake Scranton. This was only a little longer than I walked regularly. It was easy, even fun.

By January I was ready to push myself and walked from my apartment near Zummo’s Cafe past Geisinger Commonwealth and Lackawanna County Courthouse, down Pittston Avenue, all the way to the CVS in Moosic. Then I changed my socks, turned around, and walked back to Zummo’s. The walk, a hair under 10 miles, took 5 hours and left me dumb with fatigue. 2 days later I did it again.

Athletes talk about the runner’s high, the endorphin rush. For me, the best I can admit to is

a kind of rueful superiority, a smugness that I’ve done “what they think a fat girl can’t do.” During these long training walks, I was cranky. I’d snipe at my boyfriend – he couldn’t walk 6 hours on pavement all by himself!

“No, I could not,” he readily admitted, bewildered at what I wanted from him. I don’t know what I wanted, either. Validation? Marathons, lonely by nature, spit at your need for validation. Health?

My feet ached so much I couldn’t wear work shoes, and by following my trainer’s advice to “Eat simple carbs! Don’t count them, just eat them!”

I abandoned my diet and gained 35 pounds. Worst of all, I couldn’t sleep. I was obsessed with everything I needed to do to achieve my goal. Get past 12 miles. Get past sciatica, neuralgia, headaches. Get past the nagging worry that this isn’t fun, doesn’t make me happy, and doesn’t matter.

The weather warmed. I started training at Rickett’s Glenn State Park, up and down its gorgeous Falls Trail. The blessed cushioning dirt

helped me walk 18 miles a few days after maxing out at 12 on pavement. And although I was not alone- there are fewer pedestrians on Keyser Avenue than in the middle of the woods – I felt a pleasant solitude rather than loneliness. It was fun again.

Then the One Day Hike. Arriving in DC, something was immediately off. Brett had a work function and a housewarming the night before and was disappointed that I opted to stay in rather than come with him. In the morning he skipped breakfast. I sheepishly followed suit, knowing I’m prone to hypoglycemia but wanting to get back in sync with my friend.

As we drove to the ODH pick-up spot, Brett told me he had a goal of completing the walk in just under 8 hours, at a speed of 4 miles per hour. He said it like it was nothing. I stared at him. “I can’t walk that fast,” I said.

“You’ll be fine,” said someone who looked like my friend but was suddenly puffing his chest and grinning a little too wide.

“Brett, my goal here isn’t even necessarily to finish, let alone finish at speed.”

As we waited to begin, I looked at the other participants. Almost uniformly white and wealthylooking, they were also, every one of them, smaller than me. The few walkers who didn’t have the signature loose-limbed whippet body of a marathoner were slender. I felt enormous. I was enormous; despite what the trainer said, those 35 pounds were not all muscle. In a photo on the ODH website I look like a giant pile with a number bib tacked to it.

By mile two, Brett was chanting, “PICK it up, PICK it up, PICK UP the pace!” while other walkers streamed around us. I was going uncomfortably fast, and it wasn’t good enough. We slipped to the back of the crowd.

During mile four I had a panic attack. I sat, sobbing, while the fastest 100km walkers trickled past. When I finally got it together and apologized,

“You’ll be fine.”

Brett said through clenched teeth, “I’m not angry. Stop it.” He caught up with an investment banker acquaintance while I plodded behind, sucking applesauce and feeling extremely sorry for myself. Then I felt a blister on my instep. Don’t ask me how it got there. Who ever heard of getting a blister on their instep?

I had a goal. The goal was to attend the 50km One Day Hike. To go as far as I could. At the first aid station I decided that “as far as I can go,” was six miles. The shame, the panic attack, and the new blister – despite my broken-in shoes and familiar socks- proved to be as much as I could handle. Brett kept walking, and I dropped out.

That’s the story of the time I didn’t do an ultramarathon. I could give you the silver linings, which I myself clung to in the months that followed. For example, walking a mile to work now is literally effortless. Scranton Running Co. made a forever client. I got to see the C&O Canal path, which is almost tropically fecund and full of black vultures you won’t see in NEPA. At the

finish line I met Adaeze, a seasoned marathoner stuck volunteering thanks to a broken ankle. Passing Gatorade to finishers, I told my story and admitted that I was already annoyed with myself for quitting. Adaeze said, “you DNF’d,” or Did Not Finish, “right? That means you can’t get your distance officially confirmed. It doesn’t mean you can’t keep walking.”

A brilliant loophole. With cotton padding my blister and a new spring in my step, I walked backwards. From the finish line to the fifth aid station- the 24-mile mark for everyone else, but the 12-mile mark for me. Twelve miles had given me so much trouble in January and February. Now I felt tired, but not drained. I drank Gatorade and stared at the black vultures. Then I turned around and walked back to the finish line. My official distance for the 2019 ODH is six miles, but in my heart I know I walked a little more than 18. I somehow managed to both fail and meet my goal. I just needed to be okay with it not looking the way I planned.

Endless Mountains fall

Jessica fanelli MD Class of 2026

A yellow wood

Katherine Mullen

MD

Class of 2024

Two roads diverged and yet Tall grass obscured my vision on the path I… Well, I am not sure if I chose it Did it choose me? Was it God?

Impossible to tell

And once I wandered a ways I had no notion of returning Although, having a notion implies awareness I do not know if I was aware Impossible to tell The difference is felt I cannot conceive where another path may have led In retrospect, maybe I can comment Or write my experience down in what I think is enlightened prose But, it is impossible to tell

Portal, Scilly Ireland

William Jeffries, PhD Provost AND Vice dean for education

Lessons learned from the streets

Sophie roe

MD Class of 2025

I met him at a camp located on a grassy patch alongside the highway. His face was sunken and he was in a large red tent that seemed oversized for his emaciated body. He smiled a toothless smile when we approached, and he and his encampment-mate expressed that they were happy to see “street medicine.” They asked where we went to medical school and we told them, also explaining that we were only going into our second and third years and had a long way to go before we’d become doctors. He had come here all the way from Tennessee and his cat, who he’s had for 11 years, traveled with him. They were trying to get off the street. I kneeled down to get on his level and inquired “Do you have any health conditions?” I explained, “You don’t have to tell me

if you do or what they are, it just might make you eligible for supportive housing.” “Oh, I’ve got all of ‘em,” and then went on, “I have” and then mouthed that highly stigmatized fourletter word the same way I’d seen a patient do it before. I will never forget his face – a face I’d only seen in our HIV/AIDS clinical lectures – or his textbook symptoms and the difficulty he’d had adhering to medication because of his homelessness. On top of this, he had a slipped disk that made it hard to move much and a rotator cuff injury that had made him unable to lift his left arm sideways for the past few years. He had a PCP he saw regularly at the health clinic around the corner, but when he tried to get a surgery referral, he had fallen

through the cracks. Nonetheless, he remained adherent to his medications, took care of his cat’s health needs, and radiated this positive mindset and warmhearted spirit that benefitted those in his camp and those who visited. Despite his best attempts to move sideways, his health was regressing just by virtue of his being on the streets in this condition. How can we as a society fail to offer this person an alternative to living on the streets that would enable him to move sideways, both mentally and physically, rather than backwards?

housing and the only shelter options won’t allow pets. She has responded to this unexpected setback by taking action. She has since gotten herself on waiting lists and has even been posting TikTok videos because “people are getting houses on TikTok these days.” She isn’t letting the beratement from neighbors or periodic police check-ins phase her and hinder progress toward her goal; rather, she copes and remains hopeful. She moves sideways.

I met her outside of her home in a large and beautiful urban park. With her tent positioned next to a very busy road, people constantly honk at her, yell at her, even throw condoms at her tent. They post on Neighborly about her “aggressive” dog although she responsibly keeps him on a leash, and he was very docile when I pet him. Little did her neighbors know, the park ranger allows her to stay there because she cleans up trash in the park. She ended up here because she lost her

What bravery it must take to be exposed, with no security but a tent, in such a highly populated area, all for the sake of staying with, and caring for, one’s pets. Why does this person become a scapegoat for the community’s anger, the subject of hostile online posts and condoms being thrown at her? Here we have a member of our community who does no harm, and in fact adds value by cleaning up the park, who has demonstrated incredible strength and bravery through struggle. We as a society are better off if we help – not hinder – her as she tries to move

sideways.

I met them under a bridge. They had been gradually moving sideways across the country from Seattle since they were four years old. I can tell by their facial expressions and demeanor that something was not OK at home and hasn’t been OK since then. Now they are undergoing treatment to become another gender, thanks to a local clinic that prescribes them the medication to make this transition. This is clearly a step forward, which is rare for them because their life circumstances have made it hard to move forward. They share a tent with a friend who they appreciate and rely on “like a sister.” This is also moving forward. Yet people driving by or running on the trail look on and assume this person isn’t trying to move forward or even sideways – they assume they have let themself fall far behind. Really, they’ve just been moving sideways since they were 4 and continue, sometimes even moving forward.

As I traveled around the city going on “street rounds” with two different organizations this summer, I met people experiencing homelessness who were transitioning – literally or theoretically – into another stage of their lives. Each had ended up on the streets, which society views as moving backwards, but they chose to view it as moving sideways. They now respond to homelessness and other challenges they face with resilience. I feel humbled and grateful that I was able to stand in solidarity with them and try to help address some of their medical and service needs, as I bore witness to their resilience through struggle. I will remember what they taught me as I confront the challenges of my second year of medical school. If we could adopt a mindset in which we conceptualize unprecedented hardship, bad fortune, or even mistakes as moving sideways rather than moving backwards, how much more resilient could we become? How much more compassionate – Toward ourselves and others – could we become?

Enchanting morning my nguyen MD class of 2025

Vivid night my nguyen MD class of 2025

Stillness of the jungle

Olivia granja, Msc MD Class of 2026

Wishful thinking

Olivia granja, Msc MD Class of 2026

At a time when I longed to be where I am now, I stood still in the silence of the jungle, near the water — meditatively thinking that this day would come.

Time, the mountain, and its travelers

Tom cronin

MD

Class of 2024

Time moves straight up the Mountain.

The Travelers cannot. It is impossible. The Mountain is too grand and treacherous for any Traveler to bend to their will.

The avalanches and falling boulders, the snakes hiding in the cracks and the fatigue of it all. These things have an intractable influence on the Travelers’ course.

It is all so daunting.

But the Travelers needn’t worry, for they cannot fall. As Time marches necessarily and unwavering up the Mountain, it carries the Travelers with it. Even the most treacherous slopes and obstacles that the Mountain has in store can do no more

than alter the Travelers’ paths, for even the mighty Mountain bows to Time.

And one mustn’t discount the will of the Travelers, for they are not so meek. They fight the Mountain to plot their own course. For the sake of beauty, discoveries to be made, beckoning ridge lines too perfect to ignore, and perhaps most of all, for the sake of other Travelers.

Still, the word – fall – exists in the vernacular of these Travelers, as they do not share the perspective of Time.

For Time, all paths lead up the Mountain, for Time makes it so. The Travelers cannot fall. They can only ever move sideways as they ascend all the same.

Serenity

Khevna p. joshi MD class of 2026

Resting place

Julia ma MD class of 2025

Winter’s cold beauty

Jessica fanelli MD class of 2026

Winter sun

Jessica fanelli MD class of 2026

Rip current

Julia ma

MD Class of 2025

It was a chance meeting — we discovered that we both went to the same university, graduated a year apart, and yet, she was graduating from her residency program, and I had just started my first year at medical school. Both almost 30. Different stage of life. They say that when you encounter a rip current at the beach, you shouldn’t swim against it. Instead, you can either stay in place and let it carry you out until it fades or swim parallel to the shore until you escape it. In essence, moving sideways. It’s difficult to keep your head afloat among relentless waves, but sometimes, all you can do is let the wave fall over you and float back up to breathe.

It was a quiet morning, shattered by a phone call with my sister’s voice, “Daddy’s unconscious. They’re doing CPR and stuff on him, but he’s not responding. They’re taking him to the hospital.”

My mind was in weary shock, comprehending, yet not comprehending, wondering why because there was no apparent reason.

Two hours later, I received another phone call. There was a funeral and a graduation the next week.

In a job interview, a manager asked me, “Why didn’t you study further?” I eventually decided on the words, “Family issues.” Perhaps staying in a laboratory job for 6 years indicated I was not very proactive, but I didn’t know how to tell him that the job wasn’t originally for my career development. It was for survival. For holding onto the house my father left behind for us. It was the first thing that came along, and I just went for it in my blind grief. I’m sure my mother had unfortunately received many well-intended comments about how her two daughters should be heading out and living their best lives — how

she should sell the house and get on with her life. The fact was we were barely holding the four walls together, let alone thinking of our next steps in life.

In my father’s eulogy, I mentioned trying to find some gift he had given me as a memento I could carry with me, but I realized that everything in my room was a gift from him. He was the father who gave up his comfortable job back in his home country to come to a foreign land and take up a job that worked him to his bone because he wanted his children to be educated here. He moved sideways so we could move forward.

It was easy as a young adult to think that I sacrificed my last seven years of life because of an event that derailed all that I had envisioned it to be. After all, I had watched my friends move on, get engaged, get married, travel, get promoted — it’s easy to feel invisible and let it fester into bitterness. But maybe it wasn’t sacrifice. Maybe it’s like the way a baby bird falls from the nest to catch the wind on its first flight — an act of

surrender. Surrendering this time so that my sister could graduate. So that my mom had someone beside her. Surrendering this time as my father did for us, and like many others who have taken pauses in their lives to help us.

I am often reminded of a letter I wrote to someone who had lost her father in an accident. Perhaps when I wrote the letter, I was also writing to myself — to myself 10 years from now, 20 years from now, 30 years. Live with the sorrow and the pain. Live with it and let not your heart be hardened. It is in living with pain that we know how to carry it and thus help others carry theirs. It is in living with this sorrow that we understand this verse: “I know what it is to be in need, and I know what it is to have in plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do all things through Him who gives me strength.” It is in living with pain that we become stronger, more humble, and more compassionate because this is our road.

View from three Perspectives

Julia ma MD class of 2025

A Definition.

Evan calvo

MD class of 2024

I tried to define grit. To capture, to Measure, to study, that which purports to Keep us sturdy. Nebulous but so real. I don’t know if I succeeded. I tried.

Will you say I have grit since I pushed on After falling down? What if I said that I quit shortly thereafter? Do I still Have grit? Or did I once, but no longer?

Maybe no one has grit. Grit. Gritty. Will You say I am Gritty? Orange beard — coarse, Dirty — resting on my hockey jersey? Or is that the wrong gritty? Who can say?

Years spent and gray hairs earned defining grit — I don’t know if I succeeded; I tried.

4.19.2022 one

Karen Ann Ephlin, MD, FAAP Clinical assistant Professor of

pediatrics

4.19.2022 two

Karen Ann Ephlin, MD, FAAP

Clinical assistant

Professor of pediatrics

4.19.2022 three Karen Ann Ephlin, MD, FAAP Clinical assistant

Professor of pediatrics

Lyn’s choice

Digital painting dianna l. quijano MD class of 2026

Vesicular transport

Ceili hamill

MD class of 2025

“Two steps forward, one step back” the professor says “COPII vesicles move anterograde and COPI vesicles move retrograde.”

For me, two weeks into medical school, this is more than a helpful mnemonic for classes of coated vesicles. It is everything I am feeling. I step around the hardwood floors of my new apartment that still does not feel like home, repeating the words with every footfall.

After about ten minutes, I realize I have moved sideways from my desk to the center of the room.

I rush back to my notes, put a red star next to the slide. Feeling the information click into place, I grin.

Back yard coyote - Newton, pa Janis williams

Administrative assistant for Student affairs

Back yard bobcat - Newton, pa Janis williams

Administrative assistant for Student affairs

Alaskan moose - north pole, AK Janis williams

Administrative assistant for Student affairs

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