Fall 2017: The Health Humanities Journal of UNC-Chapel Hill by The Health Humanities Journal of UNC Chapel Hill

the health humanities journal of the university of north carolina at chapel hill

fall 2017 exploring illness, caregiving, and medicine

The Health Humanities Journal

of the University of North Carolina at Chapel Hill mission statement

The Health Humanities Journal of UNC-CH aims to inspire and facilitate interdisciplinary thinking and collaborative work while developing and embodying a variety of ideas that explores the interface between arts and healing. This publication allows for dialogue, meaning-making, and multiple representations of the human body, medicine, and illness. To learn more about the publication or to submit, visit http://hhj.web.unc.edu

disclaimer The Health Humanities Journal of UNC-CH adheres to legal and ethical guidelines set forth by the academic and health communities. All submitters maintain patient privacy and confidentially according to the Health Information and Portability and Accountability Act (HIPAA). The University of North Carolina at Chapel Hill and The Health Humanities Journal of UNC-CH do not endorse or sponsor any of the viewpoints presented in this journal. The opinions presented in this journal are those of the corresponding authors.

sponsors

hhj of unc-ch fall 2017

editorial team Manisha Mishra Editor-in-Chief Majors: Biology and Interdisciplinary Studies Minor: Chemistry Class of 2018 Katie Huber Layout and Design Editor Majors: Anthropology and Interdisciplinary Studies Minor: Biology Class of 2018 Annie Konzelman Art Director Majors: Art History and Comparative Literature Class of 2018 Sophia Shwartz Treasurer Major: Biology Minors: Chemistry and Russian Language and Literature Class of 2018 Yakin Ouederni Marketing Director Majors: Global Studies and Journalism Minor: Arabic Class of 2019

Meredith Dorminey Editor Major: Biology Minors: Chemistry and Neuroscience Class of 2018 Jackie Kenny Editor Major: English Minors: Creative Writing and Comparative Literature Class of 2018 Madison Schaper Editor Major: English Minors: Creative Writing and Writing for the Screen and Stage Class of 2018 Calvin D. Olsen Graduate Editorial Advisor M.A. Candidate in Literature, Medicine, and Culture Jane F. Thrailkill, Ph.D. Faculty Advisor Co-Director, HHIVE Lab Department of English and Comparative Literature

table of contents Editorâ&#x20AC;&#x2122;s Note Manisha Mishra

Advisor's Note Jane F.Thrailkill

The Case of the Missing Glasses

Sophia Brancazio

A Final Manicure

Bret Robinson

Bare Hands Jessica Barnhill

Broken Saleha Rana

Of Natural Causes

Sydney Clarke Bezanson

Blood Rachel Sauls

Cystic Fibrosis Evana Bodiker

The Imposter LaKesha Beasley

Zhenin Racckaz Sophia Shwartz

A Broken Cycle

Emily O'Mara Zalimeni

The Clock KJ Daguerre

Doctor Intertwines Medical Art and Culture

Tori Placentra

Inside Jake Bowling

Empty Eyes Jasmine Sinkhada

From Patient to Survivor

Mounica Boggala

Like Water, Or Blood

Ben Kaplan

Headache Monster Outcasts

Marquis Peacock

Behind the Curtains

Isabella Davis

Dr. Poet Kat Tan cover art: abstract, one by Annie Konzelman

editor's note

Dear Readers, We have officially been an active publication for a full year nowâ&#x20AC;&#x201D; and what an experience it has been. The process of bringing each issue to fruition has continuously been enlightening. We always learn something new each semester and are constantly challenged by the process of maintaining a publication, excited for new opportunities to pop up for involvement, and thinking about new ways to prosper. We are humbled by the interest and the support our community has given us. As we combed through submissions this semester, we couldnâ&#x20AC;&#x2122;t help but recognize the importance of storytelling. A good chunk of the submissions we receive every semester tend to be narratives. This form of writing gives authors the ultimate control in shaping their style, voice, and story. Authors pick and choose the words that they string together, the details that they want to accentuate, the moments that matter most, and what they hope to convey to the readers. They recreate the experience through their own narrative, shaping the beginning, middle, and end as they see fit. Not only do we see the importance of storytelling, but we see the power behind it, too. In a few of the pieces, authors contemplate an unfamiliar position, a dilemma, a newfound realization, or simply what to do next. Storytelling emotionally moves us, drives us to reach out and form bonds with each other, and causes us to pause and think about the impact we have on others. But most importantly, storytelling gives meaning to the human experience. Now, more than ever, we need stories in order to connect us to humanity and to remind us of how diverse yet interconnected we all are.

In this issue, our authors use storytelling in a variety of waysâ&#x20AC;&#x201D; to come to terms with a beloved experiencing illness, to reflect upon a specific clinical encounter, to make sense of a personal journey with disease, or to serve as a reminder of why they pursued a healthcare profession. The stories are gripping, the words are powerful, and the emotions are high. Be attentive and be mindful as you read. I would like to express my gratitude to the people who continue to make this journal a tangible reality. To Jane, thank you for being a wonderful advisor. To our sponsors, thank you for believing and investing in our mission. To the Editorial Team, thank you for your hard work, passion, and dedication. To our authors, thank you for sharing your stories with us. To our readers, thank you for supporting us. May I present to you the Fall 2017 issue of The Health Humanities Journal of UNC-Chapel Hill. Happy reading, Manisha Mishra Editor-in-Chief

advisor's note

Dear Readers, A liberal arts education is a beautiful thing. Creating the time and the space for bright, inquisitive minds to ask big questions, read widely, dive into archives, look to the stars and dig into the geological record, and above all to communicate their thoughts and discoveries: this is certainly one of the great achievements of higher education. Yet sometimes the heady ideas of the classroom and the lab sit uneasily with the quiet burdens of everyday living. Getting sick, or grieving a loss, creates a pause that can feel like an obstacle to academic work. For students whose courses take them into the clinic, the thrill of patient encounters can mingle with queasiness at the frailties they daily encounter. In the midst of our intellectual pursuits, we can be startled at the simple truth that we navigate a turbulent world not as minds floating above the fray but as engaged participants. Our aspiring minds are housed in vulnerable human bodies. Contributors to The Health Humanities Journal of UNC-Chapel Hill give shape and expression to the (too often unremarked) experiences that accompany university life. “Depression is a thief,” writes one contributor. “It steals from you slowly, with such a subtlety that you don’t even notice the way it crumbles you apart.” Another describes feeling like “a professional patient” as she manages the distress and tedium that befall someone with a chronic illness. The reflections and drawings in these pages help us to hear the background hum, giving us subtle instructions about the importance of looking with care, and the rewards of paying attention. From a medical student’s perspective, readers glimpse

9 the imaginative impoverishment of those whose “idea of what a future doctor looks like” can’t quite include being African American. We witness expansions, too. Reflecting on the death of her no-nonsense, pragmatic grandfather, a young woman describes the “sense of wonder and mystery” that she feels thinking back about a memorable day they spent together. In another essay, we meet a troublesome patient who harbors hidden reserves of poetry: “I will speak to you through the flowers,” she tells her hospice aide. This latest edition of this journal is filled with wisdom about the sorrow and the beauty that surrounds us every day. It is astonishing that this publication is completely run by students at UNC-Chapel Hill. The labor of creation and publication happens outside the context of the classroom, yet bears the deep traces of ideas incubated through academic study. The creative work collected here makes a powerful case for the importance of the arts and humanities in the context of human health– very much living up to its double-barreled name, The Health Humanities Journal. With gratitude, Jane F. Thrailkill HHJ Faculty Adviser Co-Director HHIVE Lab

the case of the missing glasses Sophia Brancazio “Where did I put my glasses?” you ask one spring. You need them to watch Days of Our Lives in the evenings. On the coffee table, where they always sit. He hands you your glasses. He thinks nothing of it.

“Where did I put my glasses? How will I see my cards?” you laugh in the summer while playing with family in the yard. He laughs with you while playing his ace. He’ll let you win again with a smile on his face. “I can’t find those darned glasses,” you sigh in the fall. You don’t bother looking for them at all. You can’t quite remember where you saw them last. He frowns when you cannot remember your past. “Do you have my glasses?” you whisper in the winter. He hands you your glasses as he pulls you in closer. He has a back up pair that he keeps with him. He is always prepared. He wants you to enjoy the last of your days as he bundles you up against the cool winter air. “I’ll hold onto these,” he says in the spring. He looks at you. You look at peace. He cleans your glasses, takes them off of your eyes, and he kisses your forehead one last time.

Sophia Brancazio is a fourth-year MD-MPH student from Chapel Hill, NC.

a final manicure Bret Robinson

The deep buzzes of zippers hummed through the air and the noxious odors

of formalin spilled from the royal-blue body bags. I kept my eyes parallel with the floor for a few seconds before looking at the cadaver. And there she lay before us. She was still and pallid, supine in "anatomical position" (a term I could never really appreciate until witnessing it in such permanence). Faint liver spots and freckles on her arms were faded from her embalming procedure. She should have used more sunscreen. Every part of her was greyed and subdued, seemingly artificial. Old white rags wrapped over her face and lap to feign decency. She was a mummy with her dressings removed, but soaking and without a glass barrier. We took a moment before opening the lab manual and beginning the dissection.

I promised my group I would take to the scalpel. I wanted them to force it

into my clutch so I could claim I wasn’t a willing participant. Rotating through the four of us, a cut down the center of the chest; two cuts tracing the lower margins of the ribs; then, my cut.

The flesh sucked the fading warmth from my fingers as I pressed her chest

in an attempt to locate the upper border of her breast plate at the base of her neck. My hand slid the fresh blade across her chest, from the right shoulder to the left, splitting apart her soggy leather skin and scraping across dry bone along the way, exposing the connective tissue and muscle beneath. The metal was cool but not as cool as the layers it slashed through. Pinching her to begin the skinning process, I recoiled. I turned my head away and looked down at my fingertips, now greasy from her fat and the embalming fluids, foreign to her and foreign to me. I stepped away.

“Why don’t I let someone else cut for a bit,” I told the group, then traded

the knife for a textbook. My classmates picked up where I left off, flaying open her breasts and midriff, sawing through bone, rib by rib, and carving through the layers, to expose her heart—not even the size of a navel orange. They scraped away specks of clotted blood and cut out her heart, then passed it to me. I held it in my hands, cold. Now powerless and grey, but once plump and vigorous, soft and elastic for

13 some seventy or eighty years. What did she leave unfinished at the time nature took her body and delivered it to us? I looked away.

A curious teammate standing near the head of the table peeled away

the tatters that concealed the face. She gazed past me. Her face was smeared. She appeared to be gasping in surprise, screaming. Mouth hollow, nose flattened and crooked, eyelids ajar. Her lips were retracted just enough to see the ridges of her remaining teeth. It was a mask of rubbery flesh without a wearer behind it. Nonhuman. Sparse salt-and-pepper hair coated her scalp, eyes, and eyebrows.

My eyes walked the contours of her corpse. Permanent wrinkles near

her underarms led south toward her hands. Hands that held a cup of coffee, that fluttered through pages in books. I was terribly fixated on her stiffened, alabaster hands, paralyzed in a claw-like pose. The backs were totally smooth, but the ridges in her bulging knuckles were exceedingly deep. It seemed impossible that they could have gotten her rings off. Her fingernails still retained some reddish nail polish near the cuticles where the shallow pool of preservatives had not reached. A remnant of her final manicure.

At the tips of her wet finger pads were yellow stains. I didn’t know whether

to follow my urge to reach out to try to comfort her. On her opposite arm, just past her wrist, was a Band-Aid.

My nose and eyes burned.

“Professor, do you have extra rags?” I asked.

“Of course, did you all have a splatter?”

“Uh, yeah, the whole thing’s pretty messy,” I lied.

He pointed me to the rear of the room, a short trek past two more bodies.

I snatched three rags and brought them back to the aluminum cot and laid one over each hand, careful not to dawdle or be scratched as I withdrew my own hands. I kept the third to cover up her gash for when we were finished. After blatantly concealing the hands, I peered around at my teammates. I longed for them to notice and exclaim, “Thank you so much, I couldn’t stand to see her hands either!” But they were silent, outwardly unfazed. I was alone and they were focused on the insides.

I left the room to sit in my thoughts. Stripping from my scrubs, I instantly

regretted forgetting a plastic bag to quarantine them. Formaldehyde stained my nostrils; it tarnished my fingernails and lingered deep in the creases of my hands, somehow having penetrated my nitrile gloves. The dark rings under my eyes felt a bit deeper than before. I blew my dry nose, then washed out my mouth in the water fountain. I scrubbed my hands and arms to my elbows twice in a sink that was much too shallow. My coffee was rendered flavorless against an inescapable stench that marked me with death. * * *

When I returned to my apartment, the carpet seemed browner than usual

and my ivy plant more wilted than it was that morning. My eyes burned with every blink. While reading, my attention meandered away; my dinner lost its allure.

That evening, I called my parents unannounced, hoping to muffle my

haunted mind after writing furiously in my journal had failed. “Does it smell?” they asked. “Did you get dizzy? Did you name it?” I was distracted. “How was it?”

I finally managed to place the words, mentioning her fingernail polish, her

Band-Aid. They went mute, I paused. My vision clouded with grief.

Bret Robinson is a third-year medical student from Monmouth Junction, New Jersey.

bare hands

Jessica Barnhill Bare hands, rotten flesh The softness of your body Pierces my defense

* * * I wrote this haiku as a means of reflecting on how touch can break boundaries in unsuspecting ways. My bare hands sunk into this patient's wound during a cursory examination of his legs. He didn't speak or make eye contact. He didn't flinch when his skin gave way to my touch. Had I looked before I touched his legs, I would have worn gloves. I would have been protected from the harsh reality of his condition, from what his body needed to tell mine.

Jessica Barnhill is a postdoctoral fellow in Integrative Medicine from Durham, North Carolina.

broken Saleha Rana

The depression is a thief. Its crime is constant. It is an outstretch of dexterous fingers that clasp around the throat, shrinking the eyes, robbing the breath. It sneaks up on you in the middle of a smile and tugs the corners of your mouth into a frown. It weighs your ankles as you run forward and surrenders your body to the earth just inches before you reach the finish line. It steals from you slowly, with such a subtlety that you don’t even notice the way it crumbles you apart. On a day that it takes your smile it takes a sliver of your identity. And on a day when it takes your emotion it steals a piece of your heart. “Take this pill,” they say. “Read this book,” they say. “Stay positive,” they say. “Keep pushing,” they say. The solution is so simple when you can’t see the scars with the naked eye. But I can’t say this out loud. And I can’t cry in front of you. And I can’t admit it without a stigma cloaking me in its eerie shadow. So I stay silent. The happiness is a whisper. Its transience is a tragedy. It is an outpouring of warmth that fills the body, lifting the posture, widening the gaze. It trickles down the throat and illuminates the spirit. It softens the edges and basks the day in a yellow effervescence, a glow of richness and of hope that is greatly coveted. It weaves itself so effortlessly and calmly; with such quietness that you sometimes think it’s a mistake, an anomaly. On a day when it quells the hardship, it empowers you to fight. And on a day when it suppresses the demons, It gives you a sense of purpose. “Those pills are working,” they say. “That book taught you well,” they say. “You’re keeping a positive attitude,” they say. “You pushed through it,” they say. The victory is so obvious when you can’t see the complexity of the heartache beneath the surface. But I can’t risk losing this momentary peace. And I can’t tell you that it is harder because I know it will not last. And I can’t admit my pain without bringing you down with me. So I force a smile.

But all the while. I am breaking.

Saleha Rana is a senior from Allentown, Pennsylvania who is majoring in Health Policy and Management.

of natural causes Sydney Clarke Bezanson

He had a good last day. It’s not often we decide how to go. Two doctors told him to stay at the hospital, but he refused. Instead, he went home to watch the Atlanta Braves. He went on his own terms. I wish I could ask, “Did you know it was time?” There’s something about going on a Friday that makes it a little better. Maybe it’s because Friday is both an end and a beginning. But death whispers. You have to lean in to hear it. I’m still trying to make sense of why I sat down that Friday to do the crossword, which I never find time to finish on any normal day. He and my grandmother did it every day at their old house. But unlike my grandmother, who often had better things to do with her time, he would remain at the kitchen table until its completion. Even now I can see him turning pages in the worn Merriam-Webster. As a child I’d sometimes take a break from annoying Kit-Kat — my grandparents’ awful Siamese cat — to see what was taking him so long. The man was thorough in every possible sense of the word. I’m glad that my second-to-last visit with him in August was not, in fact, the last. While I had the best intentions, the Biltmore Estate was no place for a ninetysomething-year-old man. I thought taking him to America’s largest private home would be a nice bonding experience, considering we hadn’t seen each other in months, but I was gravely mistaken. We decided to get lunch after touring the grounds. I went inside to get food at the café, leaving him alone at a picnic table. When I returned, I discovered him on the ground, surrounded by Biltmore staff. Someone told me he had fallen.

19 I suddenly felt dizzy. I invited him to this place. I left him alone to wait. Tears filled my eyes as I considered the very worst. The staff indicated that he needed to see a doctor. I winced, noticing the large gash on his head, but my grandfather didn’t seem to mind. He protested my efforts to get him to a hospital. “I’m fine. Take me home, please,” he said as we drove into downtown Asheville. After checking into the ER, he continued to resist. When one of the nurses asked him what hurt, he replied, “Nothing, I want to go home.” He was no-nonsense. He did what he wanted. As I’m faced with the reality of death, the finality of it, the way it whispers in the wind, I’m left with a sense of wonder and mystery that’s profoundly unlike him. So in his honor, I’ll try not to overthink it. I’ll do my best to say it like it is. If he were here to comment on his own death, he’d probably say something like, “It’s only natural for a person of my age to die,” and that would be it. His explanation would be logical, based purely on what is. The particulars of the unknown are, for the most part, irrelevant to this understanding. He was pragmatic. It is what it is. I’ll remember that.

Sydney Clarke Bezanson is a senior from Mooresville, North Carolina who is majoring in History and Religious Studies and minoring in Geography.

blood Rachel Sauls

It is important to hold it together during appointments.

I am not allowed to cry when my ribcage is inflamed, or when the bone and

cartilage in my jaw is damaged, or when infections ravage my immunocompromised body. If I sit in a paper gown with tears streaming down my face, I am written off as “dramatic” or “feeling down” or any other combination of words that spell out “I don’t believe you.” Nobody says, “This seems to be a rational response to an uncontrollable disease.”

For the most part, I have learned how to hold it together. I have learned to

look up at the fluorescent lights and to pretend I am talking about someone else’s body and not my own when I describe symptoms, side effects, and problems. I have learned to pretend that I am a professional patient instead of a student who spends more time in doctor’s offices than with her best friend. I have learned to convince myself that Cartesian dualism is possible for me each time I loop a protective medical mask around my ears and hand over my tattered health insurance card.

The unfortunate result of this self-taught adaptation is the hundreds of tears

I have cried in phlebotomy chairs, watching my blood zip through tiny tubes and fill up vial after vial. I hold it together for the appointment, but when I am sent away for blood work, everything seems to fall apart. This sudden loss of stoicism always catches the phlebotomist off-guard. “Did… I’m so sorry, did that hurt?” they ask me, shocked that their quick stick with a dainty butterfly needle has caused so much distress, especially since they can tell from the raised bluish mark on the crease in my arm that I am a returning patient who is all too familiar with this ritualized process.

I always shake my head and feel a pang of guilt for worrying them. “You

did a great job,” I assure them through tears, “I’m just overwhelmed.” We watch the vials fill up, they tell me I can stop squeezing my fist, and they release the tight blue elastic band. Neither of us are thinking about the blood, but both of us are watching it, our eyes fixated on all that this moment is draining from us. I unintentionally suck out the energy of the phlebotomist with my sunken eyes and pale face, serving

21 as a living reminder of sickness and mortality, a reminder that all adventures can be cut short and all blood can be drawn up in plastic tubes. I stand up, assuring them that I am capable of maintaining my consciousness, and walk out the door, leaving behind vials of blood and tears and rawness for someone else to shake and label and send off. The gauze bandaged around my elbow reminds me that I am less than I was when I entered, that a part of me has been taken.

They say the body replenishes lost blood at a miraculous speed. They never

say how long it takes to replenish all of the composure I leave behind when my arm is straightened out to be methodically pumped, punctured, and pressed. Perhaps it is a secret I am better off not knowing.

I wipe my damp cheeks on tissues or sleeves and seek to continue on with

a life that I hope is still full of adventure. The replenishing is a slower and more intentional process than the draining, and it is a ritual that I am still learning. So far, it involves collapsing into the arms of friends who love me, baking elaborate cakes for the most minor of occasions, giggling at raindrops that slide down windows too quickly, and pretending my comforter is really a cloud when my medications kick in and I doze off for an involuntary nap.

Unfortunately, by the time I am feeling whole again, I am walking

with labelled stickers to another blood collection lab, prepared to meet the next phlebotomist who will bear witness to my tears. With every crack in my composure I lose a bit more of my â&#x20AC;&#x153;healthy life,â&#x20AC;? a reality that began deteriorating many years ago. If I step back from the tubes, stickers, needles, and gloves, I realize that I am losing everything. My veins gave away ten vials of blood today. What will be left tomorrow?

Rachel Sauls is a sophomore from Durham, North Carolina who is majoring in Global Studies and minoring in Literature, Medicine, and Culture and Medical Anthropology.

cystic fibrosis Evana Bodiker

The ferrous reek of fresh blood, tiny gravel pebbles and dirt in the red moonly wound scraped on the left elbow. Wild spirited, age seven; too headstrong for a helmet. A toy skateboard, the kind of plaything safe enough for driveways until used to roll belly down. Mother bemoans the injury, wrapping and lathering with antibacterial balm. Excoriated skin is an organ too, deep enough in tissue to last decades beyond its pavement genesis as a badge of rough childâ&#x20AC;&#x2122;s play. Wind knocked out of sticky lungs. Defying chronic treatment: mark of a reckless girl disfigures the woman aging through progression though the crater remains from when it was picked off like acne as soon as the face healed. Envy the undying figures in statue gardens â&#x20AC;&#x201C; those with marble dermises, unscarred innards, nonexistent sinuses, lungless and unable to protest the acid rain that erodes the good cells. All the smooth surfaces fingers cannot scratch.

Evana Bodiker is a senior from Concord, North Carolina who is majoring in English and Religious Studies and minoring in Creative Writing.

the imposter LaKesha Beasley

I did not decide to seriously pursue medical school until my senior year of

college. I finally knew what I wanted to do and had a clear plan for how to make it happen. However, I could not shake my old friend, the Other. She loved to magnify my differences and feed my insecurities, especially when it seemed like the odds were stacked against me. I was the first in my family to graduate college and I would be the first to attempt a doctorate degree. Not to mention I had very little exposure to doctors I could relate to. Most of the doctors I encountered were not minorities, but I knew they existed. Needless to say, my feet were stone cold the day before I began my medical school application. I refused to spend any more time second guessing myself, so I decided to take a mental health day.

It was a beautiful Sunday afternoon, the weather was great, and the sun

was illuminating the Panther stadium just right. I was sketching out the Charlotte skyline at the pool when people started to scream. Without much thought, I followed the noise to a quickly growing crowd. Across from the pool, on the other side of the courtyard a drunken man was dancing on the balcony railing. My heart skipped a beat as the manâ&#x20AC;&#x2122;s foot slipped off the railing. Seconds later he regained his balance, laughed it off, and continued to dance. In this moment, the gravity of the situation struck like lightening.

A woman a few feet away from us called the police while another man went

to the management office. Everything after that moved in triple speed. The man slipped and fell off the balcony railing to the ground four stories below. It was a terrifying thing to watch, the way a body can bend and contort, but I could not look away. More screams pierced the air. And there I was: an EMT-Basic and Certified Nurse Assistant, the closest thing to anyone with medical training in the middle of an emergency. I was unsure of what exactly I was qualified to do, but nonetheless, I felt myself running toward the man.

As I approached the motionless man splayed out on the ground, I could

hear him moaning in pain. The smell of alcohol met my nostrils sooner than

25 expected. I remember thinking how distinct the smell of blood mixed with liquor was. My rapid assessment revealed a previously tan torso now decorated with deep hues of purple, red and blue. A nasty gash on his head suggested a traumatic brain injury. The unnatural angle of his leg and the bone piercing through his forearm equaled multiple fractures.

There were already two men kneeling beside the fallen man when I arrived.

They looked at me quizzically before asking why I was there. I could sense the Other creep up from my subconscious, but I suppressed her. I took a deep breath and faked confidence as I informed them that I was trained as an EMT-B and I could help until the paramedics arrived. Still, it took a few more moments for the kneeling men to grant me permission. Lucky for me and the dancing man, the paramedics arrived quickly. As the paramedics took over, I realized I could never be content just watching from the sideline. This revelation strengthened my resolve to complete my application. * * *

It was my first semester of medical school and I was beyond ecstatic to be

back in the Emergency Room learning under an attending physician. It was a slow night, so the attending allowed my classmate and me to interview the patient first. We took turns asking the man questions about his illness, carefully completing the internal checklist of important question we were taught to ask.

The next step was to complete a physical exam. We decided that I would

do the pulmonary and my peer would do the cardiovascular exam. As I began the pulmonary exam, I was interrupted by my classmate who felt that I was not percussing the patientâ&#x20AC;&#x2122;s lungs properly. I smiled and thanked him for his advice. As I auscultated the patientâ&#x20AC;&#x2122;s lungs, I pretended not to hear my classmate try to direct me. He proceeded to remove my earpiece from my ear, then tell me not to forget the middle lobe.

At this point my embarrassment was replaced by frustration; the Other

was becoming stronger. Was it because I am African American? A female? Or did I

26 just have a character flaw that made my peer feel like I was incapable of completing a basic pulmonary exam? I smiled at the patient and hoped he did not sense my growing discontent. Upon completion, I stepped aside so my peer could complete the cardiovascular exam. Instead, my classmate informed the patient the he would do a “proper” pulmonary exam before proceeding to the cardiovascular exam.

Currently, I am in my third year of medical school and I still feel like an

outsider from time to time, particularly when I am second guessed by people simply because I do not fit their established idea of what a future doctor looks like. In the beginning, the Other made me second guess myself, but I’ve learned not to shrink in her presence. Instead I embrace my otherness because becoming confident in my abilities is a vital part of my journey in medicine. There will always be a peer, an attending, or a patient who will view me as different for any number of reason. However, I cannot let that dampen the quality of care I give. At the end of the day, we all share a common goal: to heal and not harm.

LaKesha Beasley is a third-year medical student from Camp Lejeune, North Carolina.

zhenin racckaz

Sophia Shwartz Soviet Union escapade Led to an unplanned pregnancy Resulted in a coat hanger and agony Acquired a grouchy personality Remedied with a new marriage Surprised with infertility Lithuanian divorce Fell into a state of despondency

A permanent state.

Found companionship in a bottle Developed atherosclerosis Ignored it Found gangrene Lost a leg Lost her life

The title of this piece translates to "Eugenia's Story" in Russian. Sophia Shwartz is a senior from Charlotte, North Carolina who is majoring in Biology and minoring in Chemistry and Russian Language and Literature.

a broken cycle Emily O'Mara Zalimeni

Ms. Jones came in with the same complaint. Again. Ms. Jones’ chart was a redundant combination of vaginal yeast infections and urinary tract infections. The specific constellation of symptoms and idiosyncrasies of different physicians’ notes varied, but there was always, somewhere in the note, a side remark: ‘Uncontrolled Diabetes Mellitus. Follow up at next appt.’ Occasionally the connection between her raging high A1C’s and her current pain would be made explicit, but it was never particularly necessary. Ms. Jones was variably on insufficient medications or taking nothing for her illness. There was never a ‘next appt.’ until there was the same complaint, again. Hovering over her name was the reason for today’s visit; predictably and yet disappointingly, it was already labeled a UTI. Ms. Jones looked older than her age and miserable. She was soft-spoken, slow to speak, and slower to warm up to the novice medical student interrogating her about a condition which she had spent more time living with than I had spent studying. She already knew the diagnosis and the cure. She was four days later to treatment than was usual: her car had broken down and she had been stranded at home with the pain growing worse until another transportation method could be arranged with a friend. Ms. Jones quickly dismisses her diabetes; yes, she knows that is what’s causing this, of course. No, she does not want to talk about that right now. She just wants to feel better and then she’ll come back when she’s not in agony from this to discuss that other thing. Please, can we just help her. The pain is horrible and she knows what works to make it go away; it has worked every other time. Ms. Jones experiences her repeated illnesses and her underlying chronic condition as simultaneously connected and unrelated, or not related enough to be actionable. From our brief visit it was clear she had many other stressors--many other pains--in her life. Perhaps anything that was not an immediate crisis was eclipsed by a more proximate one, and she is just struggling to stay afloat. We ordered her the usual medications and wished her relief from pain. I told her I looked forward to seeing her on the other side of this, perhaps in a week or two; perhaps then we could do something about that other thing so this would not happen again. Ms. Jones comes in with the same complaint. Again.

Emily Oâ&#x20AC;&#x2122;Mara Zalimeni is a fourth-year MD-MPH student from Elon, North Carolina.

the clock KJ Daguerre

She lay in a nondescript room in Memorial Hospital that was not fit for her. “Can you fix the clock? It’s crooked, and if I am going to have to eat, poop, and die in this room, I want you to fix that.” “Of course, Mrs. Sanders,” I said, and quickly leveled up the clock and the playing field. Now that she had accepted this unrelenting leukemia, I would do whatever she asked in order to give her some control, of me, at the very least. I had stopped at the nurse’s station before I went in, and the young woman stationed there joked with me, slightly mocking the moribund patient; “She said to me ‘Honey, you go run down and grab us some real coffee at Starbucks, ok?’ Can you believe she thinks I have time?” I gently told the nurse the patient was important and had had quite a career. I warned her not to underestimate Mrs. Sanders. This talk would improve her care for a shift or two. A dying person is suspended above time. Patients’ needs are incongruently juxtaposed with the tight schedules of workers, doctors, nurses, and peripheral staff who are also coping with immense sadness. We try to announce perfunctory reasons for visits and provide neat summaries to make sense of what is not sensible— that death is here, now. The hardest part is going into rooms and just listening to patients’ words, words that are carrying dense, whispering wishes. They often ask me if they will have jobs to do in Heaven and if angels or departed ancestors will accompany them to the spiritual side. I say, “yes,” and “not to worry,” and “everything will be ok.” “I will speak to you through the flowers,” she said.

31 And sitting at the side of her bed, I start to drift now, to face my own limitations of time. I am grateful for the opportunity to fine-tune my flaws and for my own ease in life. Most look happy at the end because their questions have been answered. So straighten up the clock, and pay attention to the time.

KJ Daguerre is from Hartford, Connecticut who is an alumnus of the MPH program.

doctor intertwines medical art and culture Tori Placentra

For Dr. Raj Telhan, the epitome of the meaning of health humanities can be

found in the anatomical sketches of Andreas Vesalius and Frank Netter. Vesalius, a 16th-century anatomist, draws the human form in its entirety, immersed in natural surroundings, encouraging the viewer to see beyond the anatomy to the beauty of the body as a whole. On the other hand, Netter, a 20th-century medical illustrator, depicts a truncated image, faceless and isolated against a white background, separating the body from so much of what it means to be human.

These juxtaposed images were displayed behind Dr. Telhan as he sat, relaxed,

in his well fitted gray suit, surrounded by the walls of books in the HHIVE (Health and Humanities: An Interdisciplinary Venue for Exploration) Lab. The occupants of the room leaned forward in their seats, entranced, as he continued, deftly seaming together the outwardly disparate vocabularies of medicine and the humanities— utilizing technical anatomy and quoting Emerson in the same sentence.

Dr. Telhan says that knitting this seam between the technical (Netter) and

the moral (Vesalius), and “[discovering] how to make the two speak to one another” is essential to placing the “exigencies of medical education” in a human context., Dr. Telhan is especially equipped to merge these intellectual spheres, having studied English at the University of Virginia as an undergraduate and then continuing to earn a dual degree in medicine and creative writing. And it is a merging—a conscious effort that requires practice. The physician and writer, William Carlos Williams, said of this fusion, “When they ask me…how I have for so many years continued an equal interest in medicine and the poem, I reply that they amount for me to nearly the same thing.” Dr. Telhan finds this statement to be “a kind of aspiration” in a world that he says is now hyperspecialized; and though Dr. Telhan readily commends the merits of specialization, he also feels that “the efficiencies it generates come with real costs.”

This deliberate search for a balance can be seen in Dr. Telhan himself and in

33 his writing. When he explains the need for humanities in medicine, he speaks about medical history before clinical data. This is a surprising response from a doctor with extensive medical training. In his beautiful and chilling essay, “Begin Cutting,” Dr. Telhan grapples with humanizing the graphic, but necessary, nature of anatomy lab; every sentence walking the line between Vesalius and Netter. This amalgamation of perspectives was evident even as he delivered his talk in the HHIVE Lab. Three minutes in, his pager went off, he paused to check it, and then continued on about Aristotelian cosmology, as though nothing had happened, as though the two were in no way unrelated.

Dr. Telhan has cultivated the ability to communicate articulately on a broad

spectrum of topics, staying “true to [his] original drives” but learning to improvise along the way. Now an assistant professor in UNC-CH’s Department of Physical Medicine and Rehabilitation, Dr. Telhan is carving his own role as a mentor to doctors in training. In his teaching and clinical practice, and by performing grand rounds, he is finding interdisciplinary spaces in which to discuss the importance of medical humanities. He says “studying the humanities essentially gives us ways of living in the world that are morally and aesthetically richer than they might otherwise be” and places “clinical encounters in a frame beyond the purely medical,” which opens up insights into therapies and treatments that might have otherwise been invisible.

The hope for medical humanities lies in people like Dr. Telhan—an

individual with a strong conviction to intertwine medicine and the humanities. Finding balance between the philosophies embodied in the sketches of Vesalius and Netter will always be “essential in our struggle as patients and physicians to come to terms with the phenomena of conception, aging, illness, suffering, disability, and death,” Dr. Telhan says, and though it requires creativity, “the path…exists—for those who would walk it.”

Tori Placentra is a senior from Boone, North Carolina who is majoring in Chemistry and English.

inside Jake Bowling

—Ever been to one of these before? I glanced over at Mark, relieved that one of us had finally broken the silence. My hands choked the steering wheel at ten and two. —God no. You? —No… We parked in a guest space and walked up the main entranceway to the steely, official-looking building. Two of our classmates, Trent and Scott, were lounging on couches in the spacious, dim lobby. They were both wearing neckties. —You guys made it! —Excuse me, please sign in over here. Mark and I turned to face a tired-looking man sitting behind what appeared to be a reception desk. He glared at us from behind a glass panel. —Driver’s license, please. Make sure these photo ID’s stay on your normal clothes. I stuck a printed badge on my shirt pocket and was starting to sit down next to Scott on the couch when I heard a voice. —Come! A tall, bony woman with cropped blonde hair in pale, grey scrubs urgently waved us over to a hallway that lead into the heart of the building. We got up quickly and followed her through two sets of doors, the second of which required her laminated badge. —Excuse me! I think Trent’s in the bathroom.

The woman in grey, already halfway up the hallway ahead of us, turned around and walked hurriedly back toward the men’s room. —There’s a bathroom he could have used where we’re going! —We don’t have to wait, Scott offered. I’m sure he’ll find us. —We do, she replied. Wouldn’t want anyone to get lost in here. Two minutes that felt like ten passed before Trent emerged. We advanced into a small room filled with medical garb in boxes. A straight red strip of tape ran across the floor at one end of the room. —There are your scrubs. Small, medium, large. Bathrooms for the rest of you are through that door on the right. Change, leave your things in the lockers, and meet me back in here. We did as she said. Back in the supply room, the four of us stood in a row wearing dull-green scrubs that fit variably well. Our leader started handing out supplies. —Hairnet. Shoe covers. Make sure they cover the whole foot. Make sure you stay on this side of the red line. Gowns. Your head goes through there. No, no. You’re not even tied in the back. Let me. Let me. Ok. Are we all good? Let’s go. We followed her through sliding doors opposite the red line into another hallway. I could see two large rooms on either side of me through glass panels. —You all can wait in that one. I don’t know which one the case will be in yet. We walked through more automatic doors into the room on the right. The space was largely empty except for the walls, which were lined with various instruments: labeled glass bottles, knives, tongs, a sink, a camera, a hanging scale. An electrical cord ran from an outlet to a power saw hanging from a hook. Two long, horizontal tables stood at the room’s center. It felt metallic and cold. I paced the perimeter of the room, gloved hands at my sides.

—Dude. Trent was looking at me and laughing. —I know. We were in a rush. Everything she handed me was too small. My hairnet had already ripped open across the front, and my shoe covers had split at the seams and were holding together by threads. —I think it’ll be alright. —Yeah, just hope nothing gets on you man. —Yeah. Suddenly, a different door opened. A girl no older than any of us in black scrubs was wheeling a new table into the room. This one had a canvas bag resting on it. We knew what was inside. She quickly disappeared through the doors we had entered with the rolling table and the bulging bag. No one said a word. A few minutes later she rolled the table back in. This time, she placed it in a particular spot near the center of the room. The girl was pale, with close-cut red hair and piercings up and down both ears. Her face was unmoving as she hurried around, moving tools over to the table and re-situating them around the room’s exterior. —Do you need any help? Scott’s the strongest one here, Mark asked. Startled, she turned and looked at him for a second and then put her head down and continued with her work. After a few more arrangements she stopped what she was doing. We all waited in silence around the table. —30 year old male. History of uncontrolled hypertension. Died in custody last night. Looks like that’s all we’ve got today. A shrill, confident voice had entered the room. We turned to see a short, stocky

37 woman in her mid-thirties strolling into the room with a clipboard in hand. She wore the same scrubs as the red-haired girl. Her casual manner at once broke and heightened the room’s tension. I took my scented lip balm out of my left breast pocket and started rubbing it between my upper lip and nostrils. —I’ll be the pathologist on today’s case. You all are first-year students? —Just started our second year, said Scott. —Wonderful. Wonderful. My third group this week. Any questions before we get started then? Four netted heads stared at each other across the table. The doctor nodded towards her assistant. —Ok, then. The girl leaned to the end of the bag and in one motion pulled a zipper down its length and lay the sides flat. I fought the urge to look away, and instead leaned forward. There was a gasp to my left. I stared at what lay in front of me. Suddenly I understood. There was no one inside.

Jake Bowling is a fourth-year medical student from Atlanta, Georgia.

empty eyes

Jasmine Sinkhada Sometimes I look in the mirror and see empty eyes staring back at me I realize I’m in captivity Of my thoughts, emotions, and this role that I have been assigned to play A doctor Healer? This isn’t where I imagined I would end up I wanted to dance To ache To bleed and to fight All for this dream of mine I wanted to touch a place So sacred and so beyond the realm that any human intelligence could ever touch I wanted freedom I wanted meaning But I feel it all seep away from me As days pass And I realize life isn’t exactly what I’d thought it would be I thought I would be happy Fulfilled is a better term Because I am happy, I suppose But still there are days when I wake up and realize The monotony, never-ending grind Tear stained pillows and sleepless nights Am I selling my soul yet again? Or is this just more captivity that I’m attempting to break free from Is this what I worked so hard all those years for? I just want freedom From the claws of the anxiety that surrounds me All I want is fulfillment from deep within For now, I am imprisoned and attempting to break free As I look at myself in the mirror and see empty eyes staring back at me Jasmine Sinkhada is a second-year medical student from Kathmandu, Nepal.

from patient to survivor Mounica Boggala

I do not remember what it was like to have a head with no hair. I do not

remember what it was like to have a tube up my nose. I do not remember what it was like to be pushed around in a wheelchair. But when I visit the hospital for my annual checkup, where I eagerly wait for my blood lab results and the announcement from my doctor that I am still cancer free, and see small children in the cancer ward, I can’t help but picture myself. But then I tell myself something that I would like to remind all cancer patients and survivors: “God gives his toughest battles to his strongest soldiers.”

When I was a child, I was diagnosed with acute lymphoblastic leukemia.

When I grew old enough to understand what I had suffered through, I remember asking my parents why this had happened to me. They told me that the doctors were incapable of pinpointing one true cause. But, curiosity for the reason behind my illness has only heightened over the years, especially once I came to learn about the several side effects that the chemotherapy can cause even years after treatment. I will have to live with any additional side effects I develop forever.

Although I am currently in remission, I am reminded of my past each and

every day. To think that there is a chance of a relapse is frightening. Considering the progress I’ve made over the past several years, I shouldn’t be concerned for my future, but it’s still not something I can easily overlook. I was left with several scars; one from the insertion of my IV tube, some from bone marrow biopsies, and one from where I had part of my lung removed when I got pneumonia while I was hospitalized. The scars may seem trivial when looking at the bigger picture, but I will always notice them. They remind me of how weak my immune system is from the chemotherapy, and that my body will always be more fragile.

Since my treatment days, I have never stopped dancing. I do get exhausted

more quickly than those I dance with, and I catch myself breathing rapidly after rehearsals. However, I continue to push myself to develop the stamina to dance as much as my fellow teammates. It is hard to adjust to always needing “special” care.

41 While chemo leaves you without cancer, it also leaves you reliving and remembering it. But rather than dwell on the pain I went through, I think of how it made me a warrior and a survivor.

Mounica Boggala is a sophomore from Cary, North Carolina who is majoring in Biology and minoring in Chemistry.

like water, or blood Ben Kaplan

Sam, the interpreter, looks down at his clipboard, and back up at me. “Her

name is Ana,” he explains. “She speaks Spanish.” I nod. That is all he knows, and so it is all I know. He knocks on the door. One, two, three.

Ana is an extremely small woman, with tiny pink sneakers and thin, blue-

jeaned legs below an oversized sweater. The sweater covers a catheter, snaking out of her abdomen through a small, well-healed hole. The fluid is gone. It is time for the catheter to be removed. Her brown eyes widen, her face tightens, she grips the arm of her chair. “Ahora mismo?” Right now?

Ana looks at the doctor, and then at Sam standing beside her. Facing Ana,

the doctor briefly explains the procedure in a string of English phrases that fall gently on my ears. Pinch-and-a-burn. Bit-of-a-tug. Safe sounds. Sounds that I recognize, comforting in their familiarity. Ana is propped on her side, eyes still wide with fear, connected by an unintelligible stream to the man, the doctor, who is somehow about to remove a tube from inside of her.

Ana looks at Sam, whom she has just met. Calmly, clearly, smiling gently,

Sam translates the doctor’s words into Spanish. Ana nods. Her face returns to how it looked before the procedure was first mentioned: eyes no longer wide, jaw more relaxed. Now she understands. The procedure will be brief and simple. She will only feel a sharp pinch and a brief burning sensation when the anesthetic is administered, and then a mostly painless tug as the tube is removed. She smiles at Sam, looks at the doctor, and looks back at Sam again. “Estoy listo.” I’m ready.

The catheter was out in three minutes, and Ana was fully dressed and on

her way in ten. I had worked with interpreters in a clinical setting before, but only for interviews and physical exams; this was my first time observing an interpreter at work during an invasive procedure. After Sam and I left the room to visit the next patient, I asked Sam how it felt to navigate this scenario, to mediate between two people during such an intimate point of physical and emotional contact. How did he find precisely the right words as the procedure evolved so quickly? “For some

43 patients,” he explained, “it’s not even about the words. Sometimes, it’s just about having someone there who speaks your language.”

Pain and suffering are close fellows, but they are not the same. In “The

Nature of Suffering and the Goals of Medicine,” Eric Cassell, a physician and author, suggests that pain becomes suffering when it is unexplained, its source unidentified. Pinches, burns, and aches may be free of suffering if they are understood, labeled, delineated -- but fear and uncertainty can bring forth immense suffering, even in the absence of physical stimuli. A suffering that leaves you shaken, empty, alone. A suffering that clutches heart, mind, and body in two strong fists, twisting your lungs beyond breath, wringing out thoughts like water. Like blood.

Perhaps, then, in that brief moment between the doctor’s words and Sam’s

translation, Ana suffered. A suffering that gripped her body with uncertainty and widened her eyes in fear. A suffering that melted as Sam spoke, turning the unintelligible into an answer, soothing her ears with familiar sounds. Speaking her language.

Shortly after I first met Sam, he explained to me that his job was to be

invisible. A mediator, facilitating communication between two people who are meant to focus on each other, rather than on him. But the interpreter is not invisible. The interpreter has a voice. A voice that is familiar to a stranger. A voice that can soothe suffering on its own. A voice that travels, flows, connects. Like water. Like blood.

Ben Kaplan is a second-year medical student from New York, New York.

headache monster outcasts Marquis Peacock

Twenty-eight electric eels squirm on the other side of my iris beating their bodies against the corner of my eyebrow as I skydive from Sears Tower with four white bricks in a Dora backpack.

Some days the sky cries saltwater taffy. Other days Warhead Sours. Today it makes crĂ¨me brulee on a sidewalk hot enough to curdle egg yolks caught in the cracks, cool enough that black sunglasses shield ant faces.

By now, seven of the eels have died from a cholera outbreak. Five are sight-seeing in the Philippine rice paddy terraces. And fourteen are unconscious after an intense reenactment of the Vietnam War. Agent Orangeâ&#x20AC;&#x2122;s bombs blasted them from behind foliage, swapping crops for desert and Lymphoma

The surviving slimy bodies squirm out of a gash in my forehead beating their bodies against the corner of my brow.

Marquis Peacock is a fourth-year medical student from Goldsboro, North Carolina.

behind the curtains Isabella Davis Outside Spreading laughter With smiling eyes averted Demanding to take the stage Masquerading the malignant illusion of Immortality But the true act festers underneath

Inside Metastatic Invader Stripping away temporality

The sound of hair falling to the ground The sound of tears rolling down pale cheeks The sound of a final breath escaping pursed lips The sound of doctors murmuring, "another hopeless attempt"

Eyes now shut tightly in pain Eyes that once smiled on stage

Isabella Davis is a sophomore from Lillington, North Carolina who is majoring in Biology and minoring in Neuroscience.

dr. poet Kat Tan

One day, I'll tell my daughter I wanted to be a poet so I became a doctor broke the bindings of my textbooks even as my bones groaned under the memory of incisors and arm-twisting they buckled through every exam buckled me down to the reality of healing, that is the itching crawl of tissue and personality knitting themselves back into something whole I'll tell my daughter, Baby, you don't need to cut yourself open just to describe red You don't owe the audience a sacrifice break the bread of your flesh make loaves out of your wrists misting the air in their eagerness to be swallowed Sometimes, making it looks like me unscarred, apparently eyes leaking with light and chemistry atoms fusing to give me energy to make it another night more You don't need to suffer to take suffering away; (though doctors do suffer plenty) it takes maniacal love for reanimation for shadow puppetry, surgical knives sparring with shadows to make them finger-bunnies, to become messiah, to break the bread and eat it too to live every death on your operating table and love every life that left it

Poets linger in condemned stories still smoking around the bones of each window, peer into the haunted cavity hunting for a spark, even in dead cities Doctors give stories a say in their demise and an ear to hear them home, steady hand to sweaty brow companion to the end of the road I wanted to be a doctor, I'll tell my daughter so I became a poet died first and lived later but later crept up on me sooner than sleep so I started studying and wrote a miracle I mean, I wrote a paper and became a miracle I was healing and in doing so â&#x20AC;&#x2039;becoming the enabler of this nasty habit of staying alive of wanting people of choosing today now now now now every now that will come after now I'll tell her medicine made me and poetry gave me a daughter to tell this to

Kat Tan is a junior from Great Neck, New York who is majoring in Bioethics and minoring in Neuroscience and Fiction Writing.