Fall 2018: 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 2018 exploring illness, caregiving, and medicine

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 explore 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 Insurance 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

The Health Humanities Journal of The University of North Carolina at Chapel Hill FALL

2018

EDITORIAL TEAM Emily Long Editor-in-Chief Majors: English & Biology Minor: Medicine, Literature, and Culture Class of 2019 Neha Aggarwal Design and Layout Editor Major: Health Policy and Management Minors: Chemistry & Medicine, Literature, and Culture Class of 2021 Jillian Nguyen Marketing Director Major: Public Relations Minor: Composition, Rhetoric, and Digital Literacy Class of 2020 Alice Peng Art Director Major: Economics Minors: Chemistry & Math Class of 2021 Lisa Samal Treasurer Majors: Biology & Psychology Minor: Medical Anthropology Class of 2019

Shraya Changela Editor Majors: Chemistry & Exercise and Sports Science Class of 2020 Elizabeth Coletti Editor Majors: Chemistry & English Class of 2021 Sanam Kavari Editor Major: Environmental Health Sciences Minors: Medical Anthropology, Chemistry, & Biology Class of 2019 Jillian Shiba Editor Major: Anthropology Minor: Spanish for the Medical Professions Class of 2020 Nicholas Allen Graduate Editorial Adviser M.A. Candidate in Literature, Medicine, and Culture Jane F. Thrailkill, Ph.D. Faculty Adviser Co-Director, HHIVE Lab Department of English and Comparative Literature

TABLE OF CONTENTS Editor’s Note Emily Long

Faculty Adviser's Note

Jane F. Thrailkill Terra Scarlette Beek

To the patient in the blue gown in room 74

The Voice Anonymous

6 8 10 11

Niyanta Patel

Tailbone Alleigh Wiggs

Sexy Eyes Bret Robinson

Perspectives Jasmine Sinkhada

A Portrait of the Artist as a Cell

“To See ”

Tony Asher

Confronting Gender Norms in Today's Society

Vaishnavi Siripurapu

The Helpers KJ Daguerre

A Shrinking World Victoria Alexander

Jamie G.

Vulnerable Populations

Words Between Us Tyra Walker

Vicious Cycle Jasmine Sinkhada

Catatonic Problem in Bed 167

Praveena Somasundaram

Jared Williams

Nervosa Aisha Jitan [cover art by Alice Peng]

EDITOR'S NOTE Dear Readers, As last year’s Health Humanities Journal Editorial Team graduated, many of them going on to perpetuate knowledge learned through their tenure with the HHJ in graduate school, medical school, or through teaching others, a new group of editors, artists, and graphic designers stood waiting in the wings to ensure that the journal’s mission of facilitating interdisciplinary thinking and providing a venue to explore ideas of health, illness, and caregiving on UNC’s campus would continue—and continue it has. For the new Editorial Team and I, this semester has been a season of learning. Together, we have learned how to transform the intimate texts sent to us by talented individuals into a cohesive journal, how to collaborate with authors to make their pieces shine, and how to work together as a true editorial team. It has been an honor to watch a group of uninitiated but eager students morph into a close-knit family of health humanities scholars who take time to listen to each other’s opinions, continually go above and beyond anything I ask of them, and brighten each meeting with camaraderie and laughter. How fitting, then, that as we discovered how to breathe life into a journal, we had the pleasure of reading so many submissions that consider issues pertinent to how medicine is both taught and understood. Medical students recount their first autopsy experience and an eventful night at a homeless shelter, a nurse contemplates how best to deal with burnout, and a range of authors grapple with the chronic lessons intrinsic to dealing with a physical or mental illness. The common thread of learning that binds all of these submissions speaks to how the humanities and social sciences are so vital to our quest of processing and finding meaning within the health care professions.

The Editorial Team and I present the Fall 2018 issue of The Health Humanities Journal of UNC-Chapel Hill to you in the hope that it might serve as a catalyst for learning for you just as it has for us. As you read through its pages, our sincere desire is that you find something that makes you ask questions you never considered, changes the way you conceive of medicine and its provision, or even kindles an inclination to delve deeper into the health humanities. Finally, I would like to express my gratitude to those who continue to come together to make the idea of the Health Humanities Journal a reality. To Dr. Jane Thrailkill, thank you for your unfailing support and insight. To our sponsors, thank you for your faithful investments and for giving us the means to bring our ideas to fruition. To Manisha Mishra and the members of the past Editorial Team, thank you for passing on your knowledge and for serving as an enduring resource. To the current Editorial Team, thank you for the hours of hard work, boundless creativity, and unwavering dedication you have poured into this issue. To our authors, thank you for entrusting us with your stories. And finally, to our readers, thank you for approaching this issue with an open mind and careful consideration. We hope you enjoy the Fall 2018 Health Humanities Journal of UNCChapel Hill. With gratitude, Emily Long Editor-in-Chief

FACULTY ADVISER'S NOTE Dear Readers, Recently I traveled to New York City, to hear Dr. Atul Gawande, a worldrenowned physician, writer, and public health advocate, deliver a lecture at the annual New Yorker Magazine Festival. On an unseasonably warm October day, Dr. Gawande spoke about the trajectory of his career. He said very few words about his medical training; instead, he talked of his time at Oxford University, where he earned a graduate degree in Philosophy, Politics, and Economics. There he met fascinating fellow students from a wide range of fields, including an aspiring journalist named Jacob Weisberg, who dreamed of a new kind of magazine that would be published completely online. He recalled late night conversations about art, ethics, politics, and literature. Takeaway #1: Don’t spend all your time in the library: make friends and hang out. The people you meet will expand your universe. When he returned to the U.S. to train as a physician, his friend Jacob contacted him. Would he be willing to write an article a week for his new magazine, called Slate? As a medical student, Gawande had little time for sleep, much less new writing projects. But he agreed to write the articles, and for five consecutive days he poured his experience working with patients onto the page. The articles caught the eye of an editor for The New Yorker magazine, and soon he became a staff writer for that prestigious publication. Takeaway #2: Before you are 40, say yes to everything. You don’t know what you’re good at yet. Gawande decided to investigate the question, what does it mean to be good at what we do? What makes for a good surgeon, or for good medical care? He talked to patients, to fellow physicians. He learned about the low but persistent

rate of medical mistakes in surgery, such as leaving a gauze pad in a patient, and decided to investigate how other high-stakes, life-or-death fields handle the problem of error. He interviewed fighter pilots, and bridge-builders, and went to their place of employment. He learned that these fields use simple checklists to ensure that crucial steps are taken, and he wrote a book – The Checklist Manifesto – advocating the use of this easy tool in surgery (count the gauze pads before and after!). He partnered with researchers to test the checklist, and they showed that the rate of medical error plummeted. Takeaway #3: Learn from people in other fields. Then partner with them to seek – and test – solutions. Recently, three of the most influential men in the United States have asked Dr. Gawande to serve as CEO of a new venture intended to transform medicine. The Ariadne Project is the brainchild of Jeff Bezos (Amazon), Warren Buffett (Berkshire Hathaway), and his old friend Jacob Weisberg (Slate magazine). Their three goals are simple and wildly ambitious: to 1) improve health outcomes, 2) enhance the medical experience, and 3) reduce costs. Takeaway #4: Solutions to problems often come from surprising collaborations. Embrace interdisciplinarity! The pieces in the Health Humanities Journal reflect different perspectives, fields, and genres, giving a taste of the creative thinking that is essential to practicing medicine in the twenty-first century. All my best, Jane F. Thrailkill HHJ Faculty Adviser Co-Director, HHIVE Lab

To the patient in the blue gown in room 74 Terra Scarlette Beek

To the patient in the blue gown in room 74—

Did you know today would be the day?

Faded blue jeans, a red striped shirt, tossed on the floor, All at once a panic, a flurry of motion— Like a well-coordinated danse macabre. Nurses in blue swirl around the room as white coats converge on a lifeless body…

GRAB the code cart

START the IV line (a 16 gauge at least)

RUN the normal saline

COMFORT…a mother KEEP calm… The beads of sweat incessant— Words shout—“ALL CLEAR!”— And your body lifts into the air. The danse macabre begins again… And now. And now, there is silence. The soft ‘beep, beep’ drags on but the danse is over. Purple manicured nails rest easily on a bed rail, A weary mother caresses a cheek. To the patient in the blue gown in room 74—

Did you know today would be the day

You would learn to live again?

-Terra Scarlette Beek is a Master of Science in Nursing (Family Nurse Practitioner) Candidate from Durham, North Carolina.-

The Voice Anonymous

Dream a little dream about me. Can you dream about anything else? Try. I dare you. If you can’t, I’ll whip up something juicy. One of those dark dreams where all the lights are still on, blinding you through your eyelids. The air conditioning doesn’t work. Sweat coats your body as you drown in the kiddie pool that was once your bed. Back into the throes of sleep, death’s fingers clutch at your ankles. Your muscles clench, and the sweat runs cold. Other people complain about not remembering dreams. You wish you couldn’t. You can’t remember if the dream ever stopped. Splash water on that plaster face. Run fingernails deep into your arms. Place a timid hand on the stove top. Even as skin melts like clumps of cheese and your body loses itself in a bag of bones, the dream continues. You can scream into the mirror, but I don’t care about your safe word. Death can’t keep us apart. Not in your dreams, not in your mind. I own you. I’m in your head, twisting every action into punishment. A perfection that grinds your bones to dust. I feed off the calories in your vomit. I’m the competition that pushes you into a mindless rhythm, the crowd screaming your name, with open arms waiting at the finish line of your race to death. One foot. Now the other. Again. Again. Again. Again! AGAIN!

Our relationship wasn’t always symbiotic. At first, you wouldn’t show any skin. You thought things were chugging along great; you had no need for an upgrade. A few poorly placed words from people who meant the world and you made a wrong turn in the dark. In my business, uncertainty is gold. I put on my best dress for you and slicked my hair back with snake oil. I wrote my pitch on little notecards, practicing in the mirror a couple times before pulling up beside you. You were bursting with potential, like a soft putty with no hand to give it shape. My hands held the promise of greatness, no down payment needed. We achieved incredible feats together. All it took was the right kind of coach. I hardened your mind into a diamond, seeding it with rot that you wouldn’t notice until too late. Later, there were moments where you tried to fight, but my tendrils ran deep. It only takes twenty-one days to make a habit that will last a lifetime. If it’s any consolation, your lifetime looks pretty short. But then. Something feels different today. Something has stirred. Told someone about me, did you? Mm. I’ll make them hate you. It really shouldn’t take much. They’ll figure out you’re not worth fighting for. I’ll be here, waiting for you to learn. Where’s the popcorn?

You have the audacity to try and box me up? Think a couple therapy sessions are enough to muzzle me? I’ve had you on a leash for years. Thought it was bad before? I wasn’t angry then.

Now, life is going to become hell. I’ll tear away any

semblance of confidence. I’ll put circus mirrors in every room. You can’t hide from the grotesque, bulging sac you’ll become as they make you stuff your face with poison. They call this “getting better?” It’s a façade. Your parents will cry every night. They’ll always fear you, tread carefully around the “triggers.” You were supposed to be their light! You were an answered prayer, not this nightmare of

failure. The blaming will rip apart their marriage.

Things are going well? Don’t get cocky. I’ll find my way back into your life. Maybe I’ll send you a

free Healthy Living magazine, or I’ll get all of your friends to start diets.

You’ll come running back once you realize how much smarter, sexier, and better everyone else is.

I’ll be here.

-This piece was composed by an anonymous medical student at the University of North Carolina School of Medicine.-

A Portrait of the Artist as a Cell Niyanta Patel

- ARTIST'S NOTE As both a scientist and an artist, Santiago RamĂłn y Cajal created some of the most beautiful, intricate, and important depictions of the neuron in neuroscience history. His artwork serves as an invasive, impersonal look into the smallest details of the brain. I was inspired to build upon Cajalâ&#x20AC;&#x2122;s artwork in order to make an intimate, personal piece of art showing what a neuron in my own brain might look like - an internal self-portrait. -Niyanta Patel is a sophomore from Nashville, Tennessee, who is pursuing a major in Neuroscience and minors in Chemistry and Creative Writing.-

Tailbone

Alleigh Wiggs I can lay on the floor and stare at the ceiling for two whole minutes. That doesn’t sound like much, but it’s more than it used to be. I’m not sure if it will ever be more than that. When I lay on a thin foam mat during the night class at the local gym, I often think to myself, maybe I should take up running instead of the whole yoga thing. Honestly, it wouldn’t hurt to give up anything that involves lying on the ground. This doesn’t mean I don’t like yoga. In fact, I do, but it just reminds me of the ugly, crooked piece of bone curved at the bottom of my spine. Instead of a nice smooth line, my coccyx juts inward abruptly. The X-ray makes me seem like a dog with its tail curled between its legs. In a sense, I feel like that. So at the end of the yoga class when we attempt to lie peacefully on our backs, I want to skulk out of the room while no one is looking and glance back with big, watery eyes. Two years ago at cheerleading practice, I fell from six feet to the floor while working on a new skill. In the aftermath, I felt frozen in place on the ground. I had heard stories of people who got hurt so badly that their bodies wouldn’t allow them to experience the pain, but I wasn’t convinced. Sure, maybe with childbirth, I imagined. However, in those moments it became easier to understand. The initial impact had left no pain behind, only a feeling that something was off. Then, some discomfort appeared in my hips which grew stronger hour after hour. The next morning in the emergency room, my doctors concluded from the X-rays that there was no abnormality with my coccyx. “It’s just a bruise, it should heal in a week or two.” I was hopeful. This is only two weeks, I thought, I’ll be as good as new. So I happily drove to the pharmacy, picked up a prescription for hydrocodone, and fell asleep a short two hours later. Any rest I got over the next week was credited to pain pills, and any after that to my newfound ability

16 to spring out of bed and twist 180 degrees to land on my other side - while still unconscious. For almost a year, this kept me from adding any extra pressure to my coccyx while I slept. Although I did not process it at first, there had been plenty of reason to panic. The fall had caused the small bones in my coccyx to break free of their placement and bend in towards my stomach. I didn’t learn this until several months later when I went to get a second opinion. My general practitioner took a second set of X-rays, and I saw for the first time an image that will stay in my mind forever - and in the favorites tab on my iCloud. With an uncertain face, she tilted her laptop screen towards me. There my tailbone was, three months after the accident and severely out of shape. "There’s really not much we can do," she said. For months, I visited a chiropractor who adjusted my hips and improved the pain, but the pain never went away. When I sit in bed, I can feel the bones crouched underneath me. Sometimes I fear they might break off and not be a part of me anymore. Sometimes I hope for it. When my doctors say there’s not much they can do, they’re telling the truth. There are very few options available for coccyx injuries. Despite my wishes, removing the coccyx altogether is a rare procedure with limited positive outcomes. Manipulation only results in the bones moving back over time to where the pelvic muscles have fastened them. Having a coccyx injury is incredibly frustrating. No one can see how painful it is, and physicians have so little to offer. Even with those infamous blow up donuts I make my mother buy on every road trip, I can’t seem to find relief. For now, I try to keep comfortable, often by curling up into strange positions so as not to add any extra pressure. Other times by squirming around when I’m sitting or lying down, keeping off of hard surfaces that cause my tailbone to shift. With that in mind, if you’re ever in a yoga class with someone who can’t sit still, it might be me: the girl who can lay on her back for a whole two minutes. -Alleigh Wiggs is a freshman from Hampstead, North Carolina, pursuing a major in Neuroscience.-

Sexy Eyes Bret Robinson

Monday. Same patient as Saturday. “Hey, sexy.” I balk, paralyzed. The room shudders or maybe it’s just me. Her eyes are hollow and menacing. She chuckles as I flee. Tuesday. The patient: “Are you hiding from me, Sexy Eyes?” Snickers from witnesses. Accomplices. Churning, I flee. Wednesday. Patient. I remain in the hallway.

-Bret Robinson is a fourth-year medical student at the University of North Carolina School of Medicine from Princeton, New Jersey.-

Perspectives Jasmine Sinkhada

The euphoria that comes from letting it all out on you is unlike any other. You are the lifeboat I do not have to take care of but that always takes care of me. Yet deep into the abyss of the night there is a hymn like guilt I recite as I twist and turn attempting to be one with the night. It is then that I realize: you're not good for me at all. You are not solving my problems but adding to them instead. (Binge Eating Disorder)

It felt as though my arteries and veins had splintered apart, leaving my body with blood splattered everywhere. Had someone stabbed me? Was I going to faint? Or is this what it feels like when we are confronted with the haunting truth of our very existence? A deep sense of crippling emptiness had incapacitated me. This is it, I said to myself. Before death, we all surround you speaking words of love and admiration that hesitated leaving our tongues all these years. But the minute Life leaves your body, everyone around you will too. The minute you stop breathing, we all go home. Leaving you alone on your deathbed. Leaving you alone to go wherever it is you go. This is where we all end up. (Death of a Patient)

-Jasmine Sinkhada is a third-year medical student at the University of North Carolina School of Medicine from Kathmandu, Nepal.-

"To See"1 Tony Asher 10:00am “Oh wow, I wasn’t expecting that.” “It is a colon, you know.” “Fair point.” I guess an N95 doesn’t filter out the smell of shit. Dr. V, are you going to dissect the bowel, or are you just going to rip it open? Holy shit, that’s the same trashy Walmart knife I used to cut my onions last night. “Do you want to hold the specimen?” “No, thanks.” I’m already covered in blood from when I almost dropped the heart— not trying to add shit to the mix. 5:45am Damn. It’s early. I should brush my teeth— still tasting onions. Oh great, everyone wants breakfast. “Do you want to get breakfast at Weaver Street before I head to the medical examiner?” “Sure! Are you excited?” “Yep.” Hell yes, I’m excited. I want to be a surgeon, remember? 9:30am “Wow, so that’s what a liver looks like.” “Yep! Here’s how it would be oriented if it was in my body! Oh boy, almost dropped it.” You’re so weird. Did you really just take this man’s liver and hold it up to your gown? No wonder you work with dead people all day.

Latin autopsia - to see with one’s own eyes; careful visual examination

21 “So, what made you interested in becoming an autopsy technician?” “I shadowed one in college and fell in love with the job!” “Wow, it’s amazing that you found your calling so early on.” Yikes. Punt to psych. 7:30am “How are y'all feeling?” “I’m psyched.” “I’m worried to be honest.” “Tony?” “Not really— we’ve been working with the cadavers all semester, you know?” Oh come on, what’s another body? 9:00am “Now I’m going to take his brain out. Notice where I make the incision— when he’s lying in that coffin it’ll look like I was never here.” “Ah, that makes sense.” You’ve done this way too many times. Way, way too many times. Holy shit, what is that noise. Oh my god you’re skinning his head. For fuck’s sake lady, he may be dead but he’s not an animal. Be a little gentler. 7:45am “Hi, we’re the medical students from UNC coming to watch the autopsy.” “Ok great, first we’ll take your headshots and print out your guest passes. Smile for the camera.” “Thank you.” Man, my picture looks stupid. 8:45am “Do you want to hold the heart?” “Sure.” Wow, this actually looks like a heart. Wow, it’s cold. I didn’t know hearts were cold. Is my heart cold? Wait. He must have just come out of the refrigerator. Right. He’s dead.

22 8:00am “Alright everyone, time to put on your facemasks. Matthew and Rodney, you’re going to have to wear the headgear because you have facial hair.” Lol. I wish I had a sweater. Why is it so cold down here? Oh, right. Morgue. 8:30am “The first thing we do is obtain some vitreous humor from inside his eye for analysis.” “How do you do that?” “Just like you get any other fluid sample.” Oh my god, you just sucked it right out of his eye with a needle. I didn’t realize eyes deflated like that. “Next, we make our first incision. Where’d my scalpel go?” That was a bit messy. Red. Wow, very red. His muscles actually look like muscles. I didn’t know the deltoid heads were shaped like that. Oh, never mind, you just sliced right through it. “Now, we remove the thoracic wall.” “Do you use a Stryker saw?” “Nope.” What are those? Oh my god, did you get those from Home Depot? I think I see a Home Depot sticker on the side. I think they’re called loppers. Are you sure you weren’t supposed to be a butcher? 8:15am “Everyone ready?” “As ready as I’ll ever be?” Come on y’all, we’ve dissected a cadaver before. 8:16am Wow. He’s dead.

-Tony Asher is a second-year medical student at the University of North Carolina School of Medicine from Charlotte, North Carolina.-

Confronting Gender Norms in Today's Society Vaishnavi Siripurapu

The concept of only two genders is so ingrained in our society through

strict gender-normative marketing and media that challenging this binary is perceived as deviant. Transgenderism challenges traditional gender roles and norms, and as a result, it is very controversial. The controversy surrounding transgenderism fosters aggression and creates a negative stigma. Education about and awareness of transgenderism are some of the most effective solutions to eliminate these damaging misunderstandings.

Harsh gender norms result from gendered language and culture being

imposed upon us as children. If roles are not explicitly taught by our parents, then they are conferred subliminally by society. Products from vitamins to socks are marketed as either “for men” or “for women.” This strict gender-normative environment breeds a strong phobia of those who do not conform to the gender expectations pushed by gendered marketing. Fears of being perceived as too feminine or too masculine breed ideals of hyperfemininity and hypermasculinity. For example, products “for men,” such as deodorant, are marketed with dark colors and intimidating names such as “swagger” or “sport,” whereas deodorant “for women” is marketed with pastel colors and delicate names such as “lilac meadow” and “lavender dream.” Refusal to challenge the gender roles and normative behavior not only affects those who are transgender, but also has wider impacts on society by reinforcing stifling notions of masculinity and femininity and allowing for less freedom of gender expression.

There are various reasons why transgender rights are an important issue

in today’s society. Some people are still debating whether or not transgenderism is a real phenomenon, which distracts from a much larger, more essential conversation: What can we do to provide a more inclusive and supportive society to those who are transgender? Due to the stigma against transgenderism, there is no recent data about how many transgender people there are in America. The United States census only allows for two answers to the question of gender, forcing respondents to choose between male or female and making it impossible

24 to accurately survey how many transgender and gender nonconforming people there are in the United States. The systematic erasure of transgender existence is a result of transphobia in our society. Aside from erasing the voices and existence of transgender people, transphobia also impacts the lives of transgender people by creating a dangerous, violent society in which they must live. Transgender people are more likely to suffer physical and emotional abuse, and we have yet to provide them with the support that they need to eliminate and deal with this mistreatment. According to the Williams Institute, 41% of transgender people have attempted suicide, compared to 1.6% of the general population.1 Twenty-two transgender people have already been killed in 2018.2 According to Beverly Tillery from the Human Rights Council, “There is an increased climate of hate that is, in some cases, being allowed to grow,” and increase the danger and difficulty for transgender people in America.3

The simplified solution to transerasure and transphobia is education,

awareness, and activism. Those who are not transgender must become allies to the transgender community by being aware of and active against transphobia in our society. One way to work towards eliminating transphobia is to be mindful of our speech by referring to transgender people as “transgender” and not “transgendered.” In order to promote the acceptance of all different gender expressions and to promote freedom of gender exploration, it is necessary to challenge the ideas of the gender binary and create accepting spaces for all gender identities. This begins with being open to education on these potentially unfamiliar topics.

Haas, Ann P., Phillip L. Rodgers, and Jodi L. Herman. "Suicide Attempts Among Transgender and Gender Non-Conforming Adults." The Williams Institute (2014): n. pag. Web. 15 Oct. 2015. 2 “Violence Against the Transgender Community in 2018.” Human Rights Campaign, 2018. 3 Astor, Maggie. “Violence Against Transgender People Is on the Rise, Advocates Say.” The New York Times, 9 Nov. 2017. 1

-Vaishnavi Siripurapu is a freshman from Mooresville, North Carolina, pursuing majors in Biology (B.S.) and Women's and Gender Studies and a minor in Medical Anthropology.-

The Helpers KJ Daguerre

I now say goodnight when it is the beginning of the day I wrote 89 when the number in my mind was 67 I meant to say something different I was called after-hours to help a patient with leukemia I had to pull my car off to the side of the road The Policewoman came, To ask why I was there and to correct me I explained that I am a nurse and cannot remember if I am working here or there I turned to my right and saw the looming World Trade Center Memorial The awful twisted steel that has echos of evil—it does not seem right the material is here in the South I began to think of the Firemen’s beating hearts under the weight of their gear Did any of them want to say no to the futile task? I do not think the firemen felt pain with the universe pulverizing them A businessman I know said no to his boss to take the elevator in the Trade Center that never landed; he got out When the plane hit the Pentagon that day, I heard the incoming whistle, the rattle of the window frame within a nanosecond. They called me there, and I said, “I cannot go.” Careful now, we can go on missions that do not need us. Recently, I dialed 9-11…..in error, to get an external line out I thought I was still in the hospital, when I was actually home The Police came again, and I explained twice I was a nurse and somehow got confused I joke about my mind changes in the hope That someone will say “Are you ok? Really ok?” What if the helper needs to depart? Burnout is when we stay seated in the wrong seat, And we obey. -KJ Daguerre completed her Master of Public Health (Occupational Health) at UNC in 2006 and is currently a Malignant Hematology-Oncology Nurse Navigator at the North Carolina Cancer Hospital. She is from Hartford, Connecticut.-

A Shrinking World Victoria Alexander

Coming to college is like exploring a new world Hundreds of paths to take, opportunities offered Research Study abroad Thousands of peers Table after table at involvement fairs— you sign up for countless clubs. You have a plan. Classes, intramurals, jobs, research. And then...

Living with and managing an invisible, chronic illness shrinks your world, and it shrinks you as a person. Having to take into consideration whether or not your body can physically handle working in a lab (and standing up) for hours at a time. Hoping you don’t pass out in Bio 101 because is there anything worse than 500 people seeing you at your worst?

The first time passing out this semester

So, you have to build a new world, one where the possibility exists that a single action you take can be enough to debilitate you for hours or days at a time.

The plan you thought you had is shredded.

A world where you can do everything in your power to keep yourself healthy:

And your world is shrinking.

9 hours of sleep 30 minutes of cardio 3 meals a day

The first migraine

Now, it’s all you can do to get through two classes before you have to go back to your dorm room and sleep for five hours.

And still it isn’t enough, so you pass out twice the next morning. A world that looks a lot different from the world your peers get to live in. A smaller world. A shrinking world.

-Victoria Alexander is a junior from Greensboro, North Carolina, pursuing majors in Global Studies and Interdisciplinary Studies and a minor in Neuroscience.-

Vulnerable Populations Jamie G.

- ARTIST'S NOTE I’ve been focused on my future career in nursing, but I have wanted to make art with social context for a long while now, especially because of my interest in public health and serving disadvantaged people. I’ve been inspired by my experiences serving patients of various backgrounds in school and within the community, and I wanted to bring attention to people who don’t get access to the care they rightfully deserve. As with many social issues and events, our country has forgotten about the people who build the backbone of our society, people who are impacted by its systemic issues and whose own health is put at risk. While this piece of art makes a statement of its own, there is so much more we can do to affect change. -Jamie G. is a student in the UNC School of Nursing from Sanford, North Carolina.-

Words Between Us

Tyra Walker

"Impossible is a word only to be found in the dictionary of fools." -Napoleon

On the whiteboard are words I don't recognize. A wave of panic, like

many that have come today, washes over me, and only in the shivering aftermath does meaning start to materialize: The Napoleonic Period. I squint a little and lean forward. I'm in front; I can see fine. I just hope people mistake my look of confusion for bad eyesight as they filter into the room.

The stragglers come. One, a girl, purple faux-hawk, her face set almost

in a snarl, yet blunted by the competing air of indifference she's trying to exude. Some smile and say, "Morning." I smile. I nod. I peer at my notes, given to me by Dawkins beforehand, to avoid conversation.

I try to ignore the fact that many of these students, whether they hate

history or love it, will have an easier time learning than me. This subject that I could once absorb so naturally.

And my therapist tries to tell me my intelligence hasn't been affected. --

When the first class I've had in two years ends, I pack slowly. Though

memories from high school and freshman year of university help fill in some gaps, it's disheartening to have only understood half the lesson.

I approach Professor Dawkins. "Hi, Amy," she says with a smile.

"Hi," I say, quietly.

Nervous, she speaks, "I hope you enjoyed—I mean I hope you were

able…" she starts to ramble, and the words get lost somewhere in the space between us as my understanding fails.

I put my hand on her shoulder. She tapers off. I breathe. "…Thank

you…" My brain fails to find more words. "Was good," I nod, and then hurry off. -

I'm sitting in a common room, studying. In 20 minutes I've read two

pages of my textbook. The girl with purple hair is nearby, looking at the practice test in consternation. She gets up, comes over to me. "Hey, help me with a question," she demands.

I read for a while. It feels very long. "Helloooo?" I put my finger up. A

couple minutes later, I take her pencil and circle the correct answer. “Finally. S'that right?" I flip to the page in my book with the answer, show her. “You read the book?” She stares at me.

I frown. "I…like…history."

"Pfft. I don't understand the point." She tosses her arm up flippantly and

leans back. I had a speech prepared for this kind of situation, back when I was about to declare my history major at university, two long years ago. Words swirl around my head in a jumble, but like a clogged faucet they cannot find a way out.

All I utter is, "History…past…future…learn."

She chuckles. "Oh, so you learn something about your problems from

assholes who keep fighting over land? Tell me, how's it helped?"

And for some reason, my shred of resolve that I'd carefully started to

rebuild over the past several months breaks. I get up, hastily packing, trying to leave before my eyes are too full of water to hold any more in.

"Hey, what—" She stands up. I push her; she doesn't move very far.

Seeing the surprise on her face, I rush out of the room. She doesn't follow. -

"Amy, it's been days. You have to get out of bed eventually, hon," my

mom calls to me from the kitchen. I think Dawkins will be lenient about my absences. I pull back the covers and stare at pictures still up on the wall. Shani, Lyndsay, Vicky, and me at Danny's Burgers; us at the aquarium, the state fair. We haven't hung out in so long. They used to say I was a big mouth, but they loved me anyway. I suppose I should try and reach out again, but the last outing was so awkward and Lyndsay wouldn't stop crying as Shani was trying to be helpful and reminisce on all the things I used to do, used to say, used to be like.

My ex’s picture is gone. We hadn't been together long enough for him

to feel compelled to stay. Just, "This is too much, Amy. We can still be friends." I haven't talked to him since.

"Hey," my mom peeks in, "You wanna go to the gym? Dr. Katwan says

de-stressing makes communication easier." -

I run a short distance, because it’s been so long. But it feels good, the

explosive energy of muscles that might remember they used to run, a deep-down good burn.

Cooling down, I see her—a purple splash, talking to my mom,

near the front.

"Hey, Amy. Wanna punch a bag?" She's got purple fingerless gloves on. I

don't have the energy to tell her off, so I get down. I've never tried, but punching something does sound nice.

32 -

After, we sit together on a bench. "You like that bag," she says after a long

swig of water. "...Yeah."

The mirth slowly leaves her face. "Never heard of aphasia."

"Yeah...” And I want to talk about all the things that happened since

that day. The stroke, the tests, the uncertainty, never knowing how much of me would return, even with years of help. Quitting debate team. Withdrawing from university. Two years of speech therapy. How shameful it felt to do nothing at home. How hard it was to go back to school. How learning used to be almost effortless. How every conversation, once a joy, now a struggle, was hardly worth it. How my mom was the only person I’d had a semi-decent conversation with in weeks. How I’d tried to drown out my own life by reliving the histories of others. My old life unlivable. The new one, uncharted. And I still can’t figure it out… “A...stroke…” I say.

“Hey,” she’s looking at me, and I realize I’m crying. I get up. “Wait.

You're not leaving this time. Look, I’m sorry ‘bout before. Take a deep breath; we have plenty of time.”

-Tyra Walker is a student in the UNC School of Nursing from Burlington, North Carolina.-

Vicious Cycle Jasmine Sinkhada

torn and defeated at my inability to cease the pain of the infants who shriek and cry in their bassinets for a drug that their bodies were addicted to they pointed fingers at the mothers yet no one saw the guilt the mothers recited in their eyes attesting to their own painful life experiences who is at fault? the vicious cycle of poverty the same vicious cycle that abandons them at a very young age after law enforcement discovers how they are feeding their families the cycle that provides band-aids, but does not care enough to spare a glance at the wound how do we fix it? by looking away? so look away

-Jasmine Sinkhada is a third-year medical student at the University of North Carolina School of Medicine from Kathmandu, Nepal.-

Catatonic

Praveena Somasundaram There was a soft knock. “It’s Saturday.” I know. “Want to visit the Farmer’s Market?” They say I should stay away from that place. Her shoulders sink. This has happened every Saturday for the past few months. Saturday. It was always our favorite day of the week. As children, we held our mothers’ hands and watched as they bought flowers from the Farmer’s Market. With time, we started our own soirees, wearing sun hats and sandals, to pick up bundles of roses every Saturday. Then we would prance around, looking for homes for the roses. Sometimes in the window, sometimes by a desk, and often in the curls of our hair. But then there were Saturdays when I didn’t want Saturdays to exist, and she started to wait for Sunday. Because on Saturday, they keep their grip firm like roots in the garden my mother still keeps. They are like a prison, raising bars in my head and around my body. But only I can see them.

“You can’t just sit in here all day acting like you don’t hear me.” But that’s all I can do now. They control me. For many Saturdays, she waited, leaning against the doorframe of my room. She waited for a reason to stay— a few words, a look in her direction. I couldn’t give it to her. This Saturday, I find solace in the roses sitting on the therapist’s coffee table.

The soft knocks are gone. All I have left are the voices.

-Praveena Somasundaram is a freshman from Oak Ridge, North Carolina, pursuing a major in Chemistry.-

Problem in Bed 167 Jared Williams

I spin around carelessly on a desk chair, surrounded by volunteer med students holding blood pressure cuffs and glucose test strips. This conference room we inhabit most Friday nights is the centerpiece of the second floor of a brick structure housing 300 people who cannot house themselves, and tonight I feel we have made a real difference already. Thirty minutes ago, we showed up and unpacked our supplies in eager anticipation of those in need. Within five minutes of our arrival, Kyle, a regular, was standing in the doorway. Eyes narrowed in faux-suspicion, he asked, “Who are all these new people?” “First year med students,” I replied. “Come get checked out. You’re our first customer!” “Can I have four dollars?” he asked. “No, but I’ll cut you a deal. Tonight the blood pressure check is free.” “You want to at least drive me to the McDonald’s?” “Blood sugar’s on us too.” He was already backing out of the room, gracing us with the final words, “You’re no help! Don’t count on me coming back later!” Soon enough, another frequent visitor named Jamie wandered into the room. “What do I have to do to get a blood pressure check around here?” he grinned. “Katie,” I asked an intrepid-looking first year, “You want to try this out?” “Uh, sure,” she replied, “but I’ve only really done this with an automatic machine.” “Oh my God! I’m going to die tonight!” Jamie was apparently loving every minute of this exchange. Katie performed the check flawlessly and got 250/200.

37 “It’s high, Jamie, really high,” she said. I fumbled my laptop open, tried three alternate passwords for our patient records site before typing the right one, and pulled up his chart as he sat there mutely. “It was normal just a month ago. Has anything changed for you?” I asked. “Well, I ran out of my blood pressure pills a couple weeks ago, and I don’t have a doctor, so I don’t know how to refill them.” “We can get you an appointment at a free clinic in two days, but let me call the doctor in charge of this to make sure we don’t need to do anything tonight. That number is awfully high.” I stepped out into the hallway, dialed Dr. G, our on-call advising physician, and explained the situation. “Do you think he needs to go to urgent care tonight?” I asked. “As long as he hasn’t had any symptoms that indicate this is an extremely acute spike, he should be good to wait until Monday. Ask him about headachesblurredvisiondizzinessnauseashortnessofbreath and you should cover the bases.” “Thanks, Dr. G!” I walked back into the room with a new basically-a-doctor sense of confidence, breezed through the questions, and confirmed the Monday appointment on the basis of his comforting negative responses. “Over the weekend, avoid caffeine, intense exercise, and I-know-you-wouldn’t-do-this-but cocaine or any other drugs.” He exits stage left, and I spin carelessly on the desk chair. Triumphant thoughts race through my head: If we hadn’t been here, he never would have gotten that checked. There’s a very real chance we saved a life tonight, and on top of that, I

38 finally feel like I know what I’m doing a little bit. Three more patients file in, and I direct them to the appropriate med students like I’ve been doing this my whole life. But then another resident of the shelter bursts in, wide-eyed and panting. I ask him, “Can we get you a blood pressure or sugar check?” “Nah man, there’s a problem down the hall. The guy in the bunk next to me has been freaking out all night, and I don’t know what he’s going to do. Can y’all help us?” I look at the other students, and they look back at me. “I guess we can go down there,” Katie says. Katie and I step out into the hall and follow the tide of general commotion down to a room at the end. Shelter residents cluster around a bed in the corner along with a woman in professional clothes. A man lies there: early thirties, close-cropped hair, shelter nametag draped around his neck, tears streaming from his eyes. “It just hurts sometimes. I can’t bear it. I’m thinking about doing terrible things, terrible things.” We gravitate toward the professionally-dressed woman. Katie pulls her aside and says, “We’re med students volunteering here, and we heard from the hall. What’s going on?” “I’m a doctor here giving flu shots. Apparently he’s in a really bad state.” The doctor walks over and leans in toward the patient. “What’s your name, sir?” “You can’t help me. NO ONE CAN HELP ME.” “How long have you been feeling like this?” Through tears he howls, “My whole life! The hospital couldn’t help me.

39 My family couldn’t help me either. The world is just a blackness. It’s all so dark. And the pain never leaves.” I stand dumbfounded beside Katie. The doctor asks, “Do you ever have thoughts of hurting yourself or anyone else?” “I don’t want to hurt anyone, but I’m in pain in my head all the time. I just want it all to end.” A member of the shelter staff arrives in the room. “An ambulance is on the way. Everyone go back to bed.” “It’s ok now,” the doctor tells us, “The emergency room will handle it from here. Thanks for coming in and checking on him with me. I’ll stay with him until they arrive.” I stand there mute and barely manage a nod. He’ll go to the emergency room, get some short-acting medications to calm him down, and stay the night if he’s lucky. Where he’ll go after that is anyone’s guess. Staying here any longer just feels like spectating, so Katie and I walk back to the conference room, and I sit back down in the desk chair. “What happened in there? Did you guys take care of the problem?”

-Jared Williams is a second-year medical student at the University of North Carolina School of Medicine from Greenville, North Carolina.-

Nervosa Aisha Jitan

I. Nervosa I didn’t know My diagnosis Until now. I thought I knew myself. I am a manifestation of my inner being. I am a woman—powerful, beautiful, intellectual. And I am a product of an oppressive society— A society that preached to me You are not good enough. You are not skinny enough. You are not beautiful enough. Enough, Enough, Enough— Label me how you’d like to But I will fight. Until I am that face on the magazine Until I am that surreal beauty on the screen Until all that is left of me Are bones. II. DIAGNOSIS: ANOREXIA NERVOSA Tears rush down my face, And I feel them shoving Their sacred fists Down my dysfunctional throat. Singing their gospel hymn: We are here to cure you, Oh, this is your kingdom come.

ANOREXIA NERVOSA You’re empty. We must fill you. Have you learned nothing? From your mother? From your doctor? From the magazines? The fluorescent screens? You’re not good enough. What have those years of institutions done for you? ANOREXIA NERVOSA Nervous, are you? We thought so. We knew so. We take a while to formulate These names—haven’t you noticed? ANOREXIA NERVOSA First, you should try Eating more. Then, talking less. After a while, we’ll ask you to stop. Thinking and breathing will become Secondary. But until then, you just— Succumb. This is your kingdom come.

III. And so I earnestly endeavor to listen. I try to accept that I am the problem. I must be solved because they say this problem is engulfing me, consuming me, destroying me, but perhaps I am not the problem. Perhaps you need to be exposed to more: You’re eating an apple and throwing away the core You’re eating a watermelon and spitting out the seeds You’re picking flowers but abandoning the weeds. I am not the problem. Before you diagnose the dying flower with phytotoxicity, I ask that you please do check for weedsFlowers tend to become engulfed, consumed, destroyed, By the abrasive weeds in their environment They tend to succumb—Oh tell me now, is this their kingdom come?

-Aisha Jitan is a junior from Holmdel, New Jersey, pursuing majors in Global Studies and Chemistry.-