The Health Humanities Journal FALL 2020 | 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 the following website: http://hhj.web.unc.edu.
DISCL AIMER 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 Carolina Parents Council
The Health Humanities Journal of The University of North Carolina at Chapel Hill
FALL 2020
Editorial Team Elizabeth Coletti Editor-in-Chief Major: Chemistry; English Class of 2021
Anna Covington Editor Major: Neuroscience Class of 2021
Maia Sichitiu Design and Layout Editor Major: English Class of 2022
Olivia Delborne Editor Major: Psychology Class of 2022
Alice Peng Art Director Major: Economics Class of 2021
Rhea Jayaswal Editor Major: Pre-nutrition Class of 2023
Malik Tiedt Treasurer Major: Medical Anthropology Class of 2023
Noah Ashenafi Editor Major: Biology Class of 2023
Austin Hopkins Graduate Editor M.D. Candidate M.A. Candidate in Literature, Medicine, and Culture
Serenity Bennett Editor Major: Biology Class of 2023
Jane F. Thrailkill, Ph.D. Faculty Adviser Co-Director, HHIVE Lab Department of English and Comparative Literature
Lydia Weinberger Marketing Director Majors: Political Science; Studio Art Class of 2021
Table of Contents Elizabeth Coletti
Editor’s Note
4
Johanna Evans
Unwelcome Guest
7
Jessica Rohde
Dancing in the Storm
8
Katie Regittko
Patient Perpetrator
9
Alexander Benedict
this dull circle of porcelain
13
Madiha Bhatti
Ostomy
14
Fariha Rahman
An Incomplete Loss
18
Hanna Tischer
The Screen Turned Black
20
Clare Landis
The Next Page
23
Megan Swartzfager
We All Have Headaches, Sweetie
24
Tyler Clay
Net Carbs
28
Hazel Milla
Obsessions, Compulsions
31
Patrick KaperBarcelata
Making Mom Happy
32
Mili Dave
The Ultrasound: A Palliative Remedy
34
Lucas Thornton
A Family History
35
Lilian Manning
Creating Simulacra
39
COVER ART by Alice Peng
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Editor’s Note Dear Readers, When we released the Spring 2020 issue of the Health Humanities Journal in early April of this year, I said that the field of the health humanities seemed even more important now than usual. The intervening months, far from settling down, have only proven that assertion again and again. We collectively face a global pandemic that is not only casting our awareness of physical health and death into sharp relief, but also affecting mental wellness as we contend with the burdens of grief, isolation, and anxiety for the present and future, all the while trying to find ways to express our experiences and show empathy to those both near and far from us. I know you, as well as I, have probably gotten tired of hearing the word “unprecedented,” but unfortunately I must apply it again because I don’t know how else to describe the way the Fall 2020 semester has unfolded. Thankfully, the contributors to this edition of the journal have not run out of words in the same way. The production of the journal this semester was certainly different than it has been in years past, but I was nevertheless impressed and humbled by the array of work submitted for consideration. The willingness to confront painful topics, share vulnerable experiences, and craft stories that use imagination to delve into meaningful and relevant issues never ceases to surprise me. In this volume, artists turn to imagery to express the weight of anxiety and depression, poets grieve their friends and family members, students explain lifelong struggles with eating disorders and migraines, and children care for their parents as best they can. Most significantly, a common thread the Editorial Staff and I began noticing in the pieces selected was attention placed on care of loved ones. This appeared in working through grief with family members, bridging barriers of understanding with partners and friends, sharing the burdens of parents’ illnesses, and empathizing with patients with the same intensity as a close relative. Even in this difficult time in the world, when it is easiest to hide away and hope for life to return to normal, what proves most imperative is our readiness to care for others even when we feel ill-equipped. One medical student describes a son repeating “I love you” to his dying father and wonders, “Was he making up for the times he hadn’t said it or squeezing in all the times he wouldn’t be able to?” It seems to me that the reports of giving and receiving care in these works are
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nothing less than a litany of “I love you�s. In spite of the circumstances, in spite of all hardships, we show our love for those around us and seek healing in the endeavor. I am deeply grateful to the members of the Editorial Staff. Even though we have been unable to meet in person, it has been an important part of my week to hear your thoughts and celebrate your work as we constructed this issue of the journal. Special thanks to those who helped in the continuation of the Walker Percy Prize and in the production of our new Health Humanities Podcast, which features readings and interviews with past authors published in the journal and is available on our website and most large podcast platforms. Thanks also goes to Dr. Jane Thrailkill and Dr. Kym Weed for their support and guidance, and to our sponsors, particularly Honors Carolina, the Department of Social Medicine, and the Carolina Parents Council, whose generous continued support has allowed us to maintain production of the physical journal as well as expand onto virtual platforms, enabling us to bring the work of the published authors and artists to a greater audience within the UNC-Chapel Hill community and beyond. Finally, thank you to our contributors for your insight and trust sharing your poems, stories, and art. Thank you for offering us an example for when our own words fall short. The Editorial Staff and I are proud to present the Fall 2020 issue of The Health Humanities Journal of UNC-Chapel Hill. We hope that it serves as an introduction or an opportunity for deepening of your exploration in the field of the health humanities and that it can provide some guiding light in the value and diversity of a creative, personal approach to contending with illness, caregiving, experiences with the medical system, and life in a global pandemic. All my best, Elizabeth Coletti Editor-in-Chief
Unwelcome Guest Johanna Evans She likes to pretend it’ll go away, like it did twice before. It’s simply a visitor overstaying their welcome. Making messes that she’s too tired to clean and keeping her awake with music that’s just a little too loud. Her limbs are becoming as thin and white as the shag carpeting she stumbles over on every trek to the bathroom. For someone so frail, her grip is still tight as we lead her from the bed to the toilet, then the toilet to the couch, and from the couch back to the bed, her own Herculean tasks, not as big, but just as important. My grandpa brings out her jewelry box, a small cedar chest from her own grandmother. She tells me I’m only allowed to wear her diamonds on very special occasions. She gives my dad slides from their summers at the coast, and when he says he doesn’t have anything to view them on, my grandpa comes back with two slide projectors from 1986. She tells us stories from her seventy-odd years of life. She talks about her childhood and how her grandfather smoked so much that the insides of his house turned yellow. My dad argued with her about the worst trouble he ever got into, and she told us about the time she accidentally locked me in the car and had to call the fire department to get me out (and how I slept through the whole thing). And as long as we didn’t mention the empty bottles of Ensure, or the smoothness of her head, or the reason we all drove hundreds of miles to see her, everything was okay.
-Johanna Evans is a sophomore from Cornelius, NC, pursuing majors in Psychology and English with a concentration in Creative Writing.-
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Dancing in the Storm Jessica Rohde
The storm comes from within. Her anxious tears flow over her on her wedding day, washing out one of her happiest moments. An umbrella offers a glimmer of hope that shields her from the worst of the rain. She reaches out and her love stands there with her, offering comfort within the eye of the internal storm. -Jessica Rohde is a senior from Chapel Hill, NC, pursuing a major in Psychology and a minor in Neuroscience.-
Patient Perpetrator
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Katie Regittko The last time I rode in an ambulance rushing to the hospital, a part of me jumped for joy. This time it wasn’t my fault, I thought. People will show their care before judgement for once. There’s an EKG in front of my television set; my dog was back with my roommate. Once again, I didn’t know if that gentle goodbye would be my last to her. But if I died, I remembered in the back of my mind, at least it wasn’t my fault this time. Tiny metal box rushing down the road to the hospital. Texts flooding my inbox. Spray the nitro under the tongue, chew this aspirin. “You’re kind of young for this.” The physical symptoms were almost identical to the times before, but this time without a paired electrolyte imbalance or laxative overdose or extended stretch without intake. Heart racing, chest tightening, pain, and everything else blurred out. I couldn’t see or breathe, but a part of my dying heart swelled as I thought again, this wasn’t my fault. For once. When you present to a hospital after taking boxes of laxatives, you’re
10 perceived to be suicidal from the start. Scream until the nurses stare that this is what you did to try to survive, but no matter what, in the flowchart of biomedicine, pill overdose = suicide attempt. Cue elopement risk measures. No phones, items, or visitors allowed. Cue patient sitter. Multiple sets of eyes on your every breath. Cue drug tests. You must have lied about not taking anything else. Cue involuntary 72-hour psychiatric hold. At least. When you enter a hospital after taking boxes of laxatives, you are a waste of resources. For there are people who need bags of fluids and electrolytes, care of doctors and nurses, EKGs and vitals all night who didn’t choose this fate. People who were scared and surprised when this happened. When you enter a hospital after taking boxes of laxatives, you are an oddity. Nurses cannot wrap their heads around it. Doctors’ eyes widen when they read the chart. Wait until they see how long their kind have tried to help. On
11 paper, you are incorrigible. In person, you are exhausting. No one is more tired than you. Having an eating disorder is having to explain your “why” in an emergency. Why does a stroke victim go into hypertensive crisis? After six years, I don’t even know why I take laxatives. I think a random spike in blood pressure is as close of a metaphor as anything I’ve come up with so far. When someone’s blood pressure spikes unexpectedly while watching television, they reach for a beta blocker. When I sit on the couch and the number of eating disorder thoughts skyrocket off the charts in my brain, I reach for laxatives and push away food. I am holding this illness and its blame at the same time. I am holding this guilt and the concern of others on these tired shoulders. How can I heal while assuring everyone I’m okay? I’m not. I’m searching for a breath to feel scared and angry and sad, but this isn’t about me anymore. Illness is a group effort, and I’ve been elected the leader without my consent. This is waiting until rock bottom to reach out for help, or not sleeping until your labs come back, or opting to die on your bathroom floor rather than step foot in a hospital for fear of incarceration in a psychiatric facility at the drop of a “danger to oneself” label. It’s finding yourself imprisoned with no autonomy as an adult, all because you aren’t very good at eating. Society handed me these behaviors on a silver platter and didn’t mention that the dining table was behind two locked doors and that I’d have to show my empty plate to the nurse before leaving.
12 Healing shouldn’t be this hard. You cannot incarcerate the body without incarcerating the mind. I visit a friend in the hospital and can’t walk to her room without looking over my shoulder for my police escort. I’ve embraced the fifth amendment in my medical interactions knowing that incriminating myself is more harmful than telling this illness’s truth. I can’t tell a friend about urges without waiting for red and blue lights out my window and a “wellness check.” Medicalized and then criminalized—I shouldn’t have to recover from my recovery. When I went to the hospital most recently, a part of me jumped for joy. Because when you have a blameless illness, you deserve care. You don’t have to fear that what is on the back of the next doctor’s clipboard are the papers that will send you to the next bed available across the state, handcuffed on a two-hour ride in the back of a police car. When you have a blameless illness, you get fundraisers and flowers and prayers in service and PSAs. People check in. They buy you meals and make sure you’re going to your appointments. A patient, 20, presents to the ER with chest pain, numbness, dizziness, abnormal EKG, and tachycardia. One question decides everything that happens next: are they to blame?
-Katie Regittko is a junior from Carrboro, NC, pursuing a major in Sociology and minors in Medical Anthropology and Health & Society.-
this dull circle of porcelain
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Alexander Benedict Content Warning: Graphic depiction of bulimia stuttering can you hold my hair back lifting the flimsy plastic seat collecting short black hair behind your ears over ridges of your spine pushing my fingers through your roots gently the tile floor is cold against our knees against our eyes whispering the reeds give way to wind and give the wind away the reeds give way to wind and give the wind away teeth rattling shoving middle and forefinger through your throat shaking skin molting puking into this dull circle of porcelain this surrogate altar filling with clumps of oatmeal fruit loop purĂŠe and splintered gerund phrases this is an act of forgetting marinara and half-digested word fragments this is an act of remembering stomach acid coating pink gums shedding shoulders swaying squeezing my wrist slumping over the faux-marble sink washing your face pouring out a half-cap of Listerine tilting your jaw to fluorescence gurgling spitting out the remaining taste of your insides into this circle of dull porcelain reciting the reeds give way to wind and give the wind away the reeds give way to wind and give the wind a way
A. R. Ammons, Small Song, https://allpoetry.com/Small-Song
-Alexander Benedict is a sophomore transfer student from Carrboro, NC, pursuing a major in English and Comparative Literature and a minor in German.-
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Ostomy
Madiha Bhatti Scrubs were out of the question. Instead I drew wide black wings over my eyes and painted my lips bright pink and slid on nice fitted pants. I respect death enough to dress up when I expect she’ll be paying a visit. She had a particularly tenacious customer today. JT had “life is rough” tattooed on his right arm and “death is easy” on his left. He did not make it easy. I started the day asking for morphine. I looked into the attending’s eyes and insisted, “He is dying. His body is an open sore and he can’t tell us he’s hurting. You can see the pain in his eyes.” She conceded to a small dose of oxycodone. Less than 20 minutes later JT’s heart gave up. He was shocked with 200 volts of electricity four times over the course of two hours, and it wasn’t until the nurse noticed a tear leak out of his glassy eye that she pushed some fentanyl. The bitter side of my thoughts turned towards the man in the picture I’d taped to the end of the bed. Handsome, the center of a large and beautiful family, gazing into the lens as if to say that he was aware of the riches that surrounded him. That was the man who had decided that he would squeeze every minute out of this life, even if it meant that he would leave it in a ball of flames. Are you happy now, JT? So goddamn stubborn. You dragged me into your violent end. I had to crack your ribs for the miniscule possibility that you could be with your children again. It was a small voice. I was overwhelmingly focused on the suffering of the swollen, starved, oozing body in the bed. “Baby, baby” I cooed, stroking his matted fro. “Just hold on a little longer. They’re coming to say goodbye and then we’ll let you go. You are so loved, JT. I’m sorry, I’m sorry we’re hurting you.” I wasn’t expecting any of his children to be among the visitors. But suddenly there was Ross, 18 years old, handsome and whole. His shoulders were stiff, defensive. I only had to put my hand on his arm and he wilted. There are two sounds from the day that I can’t forget. One is Ross’s cracked
15 voice as he spoke to his father. “Daddy, I love you I love you I love you. You have been the best dad. I love you I love you I love you.” Was he making up for the times he hadn’t said it or squeezing in all the times he wouldn’t be able to? The second sound was the wail of JT’s mother. Mabel was sitting in the car, unsure if she could bear seeing her 40-year-old unresponsive son. When I told her he wouldn’t survive the day she screamed right into the phone. For two minutes I listened to a stranger’s raw agony, the desperate cry of a mother outliving her son. She pleaded with God. In many cultures the bereaving are not left alone in the weeks following death. The pain is too crushing, too everywhere, and community members take turns simply being present for it, holding up one small corner of anguish day after day until the left-behind can tolerate stretches of being alone without drowning. It was this instinct that kept drawing me back into room 15. That and my own personal stock in the grief. At one point it was just me and Ross. A spontaneous speech fell from my lips. “I was here when his heart stopped. For two minutes I was his heart. I need to tell you that I was strong. That it was my privilege. That knowing how much you all loved him makes me wish I could have met the man who was worthy of it.” I was crying and relieved that it wasn’t contrived. I told his family that I had come into his room every day and talked to him. Encouraged him, prayed for him, listed off their names. I said that through everything the one thing he was still able to do was shake his head no. That his entire will was contained in that no. He was letting us all know that we were not the ones he wanted. The love I had tried to give him in their absence was paltry in comparison. I lied to them, I think. Or at least said things I didn’t entirely believe. I said he was calmer with them around than he had been all morning—he had
16 perhaps been waiting for them. I really wanted to believe that. I almost did. But I also knew that he had been loaded with sedatives before they arrived. This has been my to-and-fro with death. Sometimes I see a spirit trying to escape its dying vessel onto something better, us selfishly grabbing it by the ankle until its pull onward becomes too great. Sometimes I feel the spirit has already been extinguished, that we were trading goodbyes with a husk. At some point Ross mentioned their last meeting together. “He said he was coming right home.” The most disingenuous thing slipped from my mouth. “He’s going to a different home.” I bit down on my tongue. I’m writing all this now out of a sense of pride and reckoning. Pride for how careless I was with my heart when it came to this stranger. I grieved harder than I have for deaths that were much closer to me. A writer friend told me that she had been so consumed with an idea she was writing about that she felt like it was living outside of her body, that she was sure everyone could see it, like an ostomy bag. That’s what mourning JT became for me. I ran toward fear and pain so that a man would not spend his last week of life in the overwhelming company of cold hands. The reckoning is that I used this man’s death to feed my aliveness. I celebrated the fact that I, unlike my colleagues, openly wept in the call room. Their business-as-usual attitudes horrified me to the point that I welcomed the pain. I perhaps deluded myself into thinking that JT needed me. In truth I need him. Learning the details of his life kept me from the cardboard fate that awaits anyone who turns a life into lab values. I was dying in that call room as he was dying in that bed. We kept each other’s hearts beating.
-Madiha Bhatti is a fourth year medical student from Highpoint, NC, expecting to obtain her MD in 2021.-
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An Incomplete Loss Fariha Rahman
I silence my cell phone periodically to curb my addiction to my phone screen. One of the many goals I had for 2020. Because my cell phone was silent, I missed twelve calls, forcing the individual on the other end to call non-traditionally. I answered the ancient landline to hear crying, no, sobbing. Hello?! No one was answering. I checked the caller ID. It was from New York, which meant family. Alarmed, I started yelling. Hello! What’s wrong?! Hello! The peripheral crying increased in intensity, while the person on the phone was mumbling something. As I continued to scream, the landline disconnected suddenly. I ran to get my cell phone, realizing the missed calls were from my cousin. When I was about to dial again, I received a text.
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He’s dead. My stomach dropped, like that ride at the fair where they take you all the way to the top, and then suddenly you drop. The tears were streaming down my cheeks, fearing how many more people will I lose in the coming weeks? I cried harder when I could not attend his funeral due to quarantine. A few days later, I was on a video call, watching my uncle’s service on my computer screen. I should have been there personally. Instead, I could only internally scream, receive directions from others to grieve, and remember my uncle through conversations that resurfaced some precious memories. Like my cell phone that I silenced periodically, I stopped feeling any emotion temporarily. The loss felt so incomplete, especially given it was a pandemic that took a loved one from me.
-Fariha Rahman is a senior from Raleigh, NC, pursuing a major in Health Policy & Management from the Gillings School of Global Public Health and minors in Biology and Chemistry.-
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The Screen Turned Black Hanna Tischer
The scratchy couch oozes the smell of home. Sweat builds between your hand and the remote as you flip through the channels. You pick something about weddings, or a big crazy family, or maybe something about both. The sound of the TV drones on as you eat the last of the salt and vinegar chips from the bag that you only opened this morning. You push your fingers into the corners. The small chip-bits crumble against the pad of your index finger. You suck the dry and salty dust off your hand. Your fingers shine with saliva as you put them back in the bag for another helping. By the time the screen turns black and counts down from five, you debate getting up. Once you do, the backs of your bare thighs are red. You look down and see a weird speckled pattern across them and do some acrobatics to try to get a better look. With your hand on the coffee table and your left foot on the couch you realize that you’re not actually bruised. The couch stitching imprinted on your thigh. You walk five steps into your kitchen. The tile is cool and sticky. You grab the fudge-striped cookies from the cabinet and walk back to the couch. Before you sit you rub your feet against the carpet, depositing the pieces of rice your feet picked up from your kitchen floor. A loud bang from the construction outside grabs your attention. You look out and see the sky. Its blueness matches the label of the empty Blue Moon bottle on the coffee table. The view of a single cloud makes you almost feel a light spring breeze on your skin. You think about crawling into your bedroom and pulling on a pair of shorts over your underwear, putting on a clean shirt, taking the elevator down, and walking through the double doors that lead from the small lobby to outside. But then you think about how much effort that would all take. You think about how many door handles and
21 buttons you’d have to press. You think about how you couldn’t see anyone once you actually got out there. You think about how you couldn’t walk into that ice cream store three doors over. You think about how if you saw a neighbor’s dog, you wouldn’t be allowed to pet it. Then you think about how the couch has shaped itself around you like a mother hugging a very fragile child. Then you look back to the screen. And then you don’t think anymore. The screen turns black again. The light outside is starting to disappear. The sliver of sky between the roof of the apartment across the street and the top of your window has turned orange. You think about how beautiful it must be from the backyard of the house you grew up in. But that only makes you think about your parents asking you to come home. Which is not something you want. They’re nice and the food there is good, but at least here this apartment is all yours. The couch you got from your parents, the table you took out of someone’s trash on Fairfax, and the swirly chair you stole from your dorm room. They make this apartment feel like yours. Ever since your mom moved your bookshelf into the living room and replaced your sheets with a newer and pinker set, your room at home hasn’t felt like yours. But you also know you should go home. The food here is starting to dwindle, and you’re sick of having rice every night. But you don’t know what to do, so you go back to the television. Mary fights with Juliet over Anthony for the sixth time, even though you’ve shouted at her that Anthony isn’t good enough. You stick the last of the fudge stripes into your mouth and let the cheap chocolate melt on your tongue. Anthony’s engaged to Mary now, even though Juliet’s pregnant. You laugh at their lives and are thankful and selfrighteous that you are nothing like them. But then they all dance together in a nightclub and two make out with strangers. And you wish you could go to a nightclub and make out with strangers. Not that you would, but you would like to be able to.
22 The screen turns black again. This time “Season 2” comes on the screen. You look down at your dirty shirt. You feel the oil built between your eyebrows. Your knees click as you stretch them over the small table. The room is full of dirty dishes and stale clothes. You turn off the TV. As you muster the courage to clean, you check your phone: “The Long Grim Road Ahead,” “U.S. Service Member Dies,” “12-year-old Belgian girl becomes Europe’s Youngest Known Coronavirus Death,” “Not Enough Tests,” “U.S. Now Leads World in Confirmed Coronavirus Cases,” “White House Projects 100,000 to 240,000 U.S. Coronavirus Deaths,” “Face Mask Shortage.” You google when this will end: June. You google how to prevent it: wash hands, exercise, use hand sanitizer, wear a mask, don’t go outside, support your healthcare workers. The world is under attack. You can’t see it. You can’t know if you have it. And you know you’ll probably be fine. You know that. But you don’t know if your job is coming back. And you don’t know when you’ll be able to go to the store again without being afraid. And you don’t know when walking into your neighbors’ house will be allowed. You just want to fast-forward through this part of your life. But you can’t, so you go back to the couch and start season two.
-Hanna Tischer is a junior from Davidson, NC, pursuing majors in Computer Science and English.-
The Next Page
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Clare Landis We sit turning pages One day to the next Over and over Until it becomes so easy We forget what we’re doing, why we’re doing it And how difficult it can be to turn the page Sometimes our pages stick The ink bleeds And our brains become massive weights in our heads Our grey matter turns into a lump of fear and despair Her brain became a weight But she tried to turn the page like everyone else Her pages stuck, her ink ran off So she fought She fought with love and words and hope and kindness She fought with big pills and small pills and infusions and electric shocks She fought so hard to turn her next page But she had a massive weight in her head She fought anyway Until there was no next page
In loving memory of all of those who lost their lives to suicide. According to the World Health Organization, there is one suicide attempt every 1–2 seconds and a death by suicide every 20 seconds.1 National suicide hotline: 800-273-8255 1. José Manoel Bertolote and Alexandra Fleischmann, “Suicide and psychiatric diagnosis: A worldwide perspective,” World Psychiatry 1, no. 3 (2002): 181–185. -Clare Landis is a junior from Charlotte, NC, pursuing majors in Business and Psychology.-
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We All Have Headaches, Sweetie Megan Swartzfager “If migraine patients have a common and legitimate second complaint besides their migraines, it is that they have not been listened to by physicians. Looked at, investigated, drugged, charged, but not listened to.” — Oliver Sacks, Migraine
My first migraine hit me like a bus during my tenth-grade theater class. I must be coming down with the flu or something. Nothing but severe viral infection could explain the pain in my head—explosive at first, then throbbing and all-consuming, sucking sensation out of the rest of my body—or the sudden intense nausea I felt. By the end of the school day, I knew nothing but pain. A pop quiz that day would likely have gone completely unanswered. I couldn’t remember if I had eaten lunch (I hadn’t—I found my bagged peanut butter sandwich squished at the bottom of my backpack that evening) or what my homework was or which friend I was supposed to meet for tacos that weekend or if it was actually Italian food we would be eating. Fortunately, I was only fifteen years old and therefore not expected to drive myself or my four younger siblings to and from school. I don’t know if I could have fit a key into the ignition of a car, and I certainly know that I shouldn’t have. I rode in silence in the passenger seat of my dad’s car and took my temperature as soon as I got home. No fever. What’s wrong with me? I thought I must have been dying. As incomprehensible as my nascent chronic migraine was to me that first day, I had no idea that this pain would also be illegible to friends and doctors alike. I grew up, as many children do, only being allowed to stay home from school if I had a fever. So, for three days of migraines for which I did not yet have a name, I persevered. When I finally explained my pain to my mom, a former migraineur herself, she made an appointment with a local nurse practitioner who diagnosed me vaguely with “chronic headaches” and wrote a prescription for gabapentin, an anticonvulsant used to treat postherpetic neuralgia (a complication of shingles) and off-label to treat neuropathic pain and a host of other issues from anxiety
25 disorders to alcohol withdrawal. Though I noticed some reduction in pain that I would later be told was occipital neuralgia—caused by inflammation of the nerves in the scalp—my migraines were as fierce as ever.1 When I showed up at school complaining to friends of what I believed was a migraine, I was told that if I really had a migraine, I wouldn’t be functional enough to go to school. I had worked hard to push through pain that, to me, was more real than anything else. My healthcare provider had done what she thought was best. I was sure if that wasn’t working, it must somehow be my fault. Not wanting to be a bad patient, I had to deal with the pain, so I did. Hearing doubt from people I cared about, however, made me question if my pain was real at all. Maybe everyone feels like this. Maybe I’m making this up. If the medication isn’t working, maybe the pain is all in my head in more ways than one. Eventually, I would see a neurologist who, after CT scans and blood tests to rule out a variety of potentially life-threatening pathologies, diagnosed me with chronic migraine. He told me to try yoga and stop drinking coffee. I did not believe these interventions would work—and perhaps that is why they did not—but I tried them anyway. I did not seek medical help again until my sophomore year of college when my life was covered over with the fog of migraine. There were days when I felt better than others, but there were almost no days when my head did not really hurt. I slept little, ate less, and struggled to sit through my classes. After a particularly grueling day in which I had to leave class to sit in a dark bathroom and gather strength to make it until the end of the day, I decided I needed a doctor. I skipped class and made an appointment with student health. To my pleasant surprise, the doctor who saw me had previously worked in a neurology clinic. I was certain this woman would finally understand and validate my pain. “I have headaches sometimes, too, sweetie. It’s just something we all have to deal with,” she said before I left her office with no recommendations for treatment and a fire in my stomach. I knew this pain in a way that was more real than anything
26 else in my life. Why couldn’t anyone else see that I was suffering? Another trip to a neurologist and I had a prescription for a newly approved migraine prevention medication: a monthly injection that I administered myself— in panting breaths and cold sweats due to my fear of needles—once a month. It worked beyond my wildest dreams. My near-daily debilitating migraines were reduced to a few moderate bouts per month. The medication was free for a year. Then I learned that it would cost several thousands of dollars for the next year, even with my insurance. I went cold turkey, and the fear was almost as debilitating as the migraines themselves. My migraines were never as frequent as they were before this medication, but for many months I panicked every time my vision blurred momentarily or I smelled something I wasn’t sure was really there, both previously signs that I would soon be bedridden by a migraine that could last multiple days. I have migraines occasionally now. One or two a month. Just enough to remind me that I haven’t escaped the invisible illness that has followed me my whole adult life—an illness to which no one but me can bear full witness. My chronic migraine is woven into the fiber of my being. It has made me a critical asker-of-many-questions when it comes to biomedicine, as I now want evidence that interventions will work. It has made me more empathetic, gentler, and more sensitive to the pain of others. But my new relative absence of pain brings with it the same uncertainty and doubt that I saw and heard on the faces and in the voices of friends and doctors for years. Now I wonder, were they ever really that bad? Did I dream my migraines to disguise other pains? Am I a liar?
27
1. Gabapentin has been shown to have little or no efficacy in migraine prophylaxis. See Mattias Linde, Wim M Mulleners, Edward P Chronicle, and Douglas C McCrory, “Gabapentin or pregabalin for the prophylaxis of episodic migraines in adults,� Cochrane Database of Systematic Reviews 6, (2013): CD010609, https://doi. org/10.1002/14651858.CD010609
-Megan Swartzfager is a first year grad student from Oxford, MS, pursuing an English MA in Literature, Medicine, and Culture.-
28
Net Carbs Tyler Clay
I don’t think you quite understand my role here. I understand your confusion; honestly, it makes a lot of sense, seeing as I am clothed in the same logo-emblazoned, sweat-wicking sport polo that your executive weight loss physician wears on a daily basis, and yes, the shirt is tucked into a pair of standard grey slacks, which, I understand, give off some semblance of professionalism and knowledge of medically related things despite not having a degree to my name, but the wardrobe I can explain, because as you see I am the only male employed here other than the doctor himself while the rest of the staff, as you and every other power-napping, hypermasculine CEO on my patient list have not-so-discreetly made yourself aware, are women of varying heights but unvarying bust size, made all-the-more obvious by our dress code, which grants me this performance-professional combo while puzzlingly denying even the phlebotomist a reprieve from heels, and your confusion is likely heightened because I am, of course, holding a bright red medical chart with your name on it, and I am, as always, holding two syringes (one testosterone, one vitamin B12, each of which will soon be emptied into your asscheek and stomach fat, respectively); you see the testosterone (that’s the one I give from behind, pants at your ankles, hands supporting your weight on the table because the glute muscles must be relaxed for it to go in without pain, the thick juice of vitality that I silently 18-gauge into your hairy ass—silently of course because I am comparatively young and full of vitality and you personally choose to express embarrassment of your ectopic masculinity with stoicism unlike the others who do so by poking fun at themselves or by droning on about the weather or that one guy who takes his gun out of his back pocket before pulling down his trousers) and the vitamin B12 (that’s the one that you have been told burns fat, and look how gloriously neon red the liquid is, you can almost convincingly smell the
29 calories smoke away in a chemical blaze), but it’s not even these injections or my wardrobe that I imagine really gives you the wrong impression about my role in your Health Optimization Plan©—what must truly have led you to disclose that horrible news to me is how inextricably integrated into your daily routine I have become, the hour-by-hour meal planning that I provide to you, the HIPAA-protected messages that I must contractually answer any given minute of the day through our trademarked iPhone app, you know the messages: “how many more carbs can I have today?” (none), “are beans keto?” (no), “its my wife’s birthday i had cake, sorry” (understandable, pack jerky before parties like we talked about!), but of course I already knew you had cake, as I have access to your food logs through the app, a strange diary written in net carbs eaten and ounces of water drunk, meals skipped for work and meals binged for better reasons, steps taken and days spent sleeping by a hospital bed, a picture of your life in which I get to fill in the missing pieces, the meals I think were eaten with your family, the romantic dinners with your wife, the after-hours drinks with your employees, the after-hours drinks alone, all of this narrated by your occasional commentary when you choose to make notes—“it was my birthday,” “friend in town, sorry,” “got bad news, fell off the wagon”—and then on top of all of this, you see me so often, weekly for your injections, our secret passing off of vitality, and after those, I ask you how your week was, about any unforeseen complications in the strict diet devoid of carbs mandated for you, and maybe it is that, the weekly venting about how hard it is to balance the diet with your business, your children, your friends, and of course everything going on with your wife, maybe it is those brief moments between the injections and your weighin that made you think that I am the right person to whom you should reveal the results of your wife’s biopsy, her prognosis, the wrong kind of weight, the kind that can’t be removed like your belt before hopping on the scale, weight that can’t slough off with fewer carbs or nutritional labels or the right type of
30 snacking, something an injection won’t fix or prevent, so yeah, maybe there was a bit of silence before I could figure out what to say to you, to just say I’m so sorry and then without skipping a beat to tell you to hop on the scale, taking everything out of your pockets first, wringing almost every last drop of weight from your body before submitting to my judgement of the life you lived that week, disciplined or not, that’s all in the number; that there is my job: to look at the number and to tell you what to do to make it lower when you see me again in seven days, when I will greet you once again and ask, “How was your week?” even though I already know.
-Tyler Clay is a third year medical student in the UNC School of Medicine from Concord, NC.-
31
Obsessions, Compulsions Hazel Milla
When you asked why I bought you a tub mat I said I was worried about you because that’s easier to say than the whole truth: that I lie awake every night wondering when your strong, well body will sicken or when one of us will slip in the shower and crack her head open and bleed to death and that I regularly envision it happening because my mind would rather force sights on me than let me daydream. And it’s easier to say I have to scrub three times to feel clean and I have to check the doors just to be sure— not that I envision grime swallowing my fingers, constricting, digging under my skin not that I see people coming in the night behind my closed eyelids to hurt you, to make me face your injury, your death, and my mourning. And all I’ve ever done is prepare myself because I’ve guilt-tripped myself enough times to feel the weight of every possibility on my spine eased only by a third scrub (I can’t tell you why only that it is, only that I need to check one more time).
-Hazel Milla is a senior from Chapel Hill, NC, pursuing a major in Neuroscience and a minor in Creative Writing.-
32
Making Mom Happy Patrick Kaper-Barcelata
I know my mom is sad. I can tell because whenever she’s sad, she orders Gourmet Kingdom for me and Sal and goes to bed early. I think she’s not hungry because she eats pills instead. We’ve been having a lot of Gourmet Kingdom lately. Sal doesn’t really like Gourmet Kingdom, but I tell him not to tell Mom that. Honestly, I’m kind of tired of Gourmet Kingdom too, but I keep my mouth shut. Sal complains a lot. He doesn’t know how to tie his shoes, and sometimes Mom stays in bed in the mornings, so I have to do it. Problem is, I’m not really good at tying shoes either. This morning I tied Sal’s shoes together as a prank, but he took it like a wussy and started crying. Mom came downstairs, pushed past me, and gave Sal a hug, even though I’m the one always tying his shoes. “Listen Dan, you have to look out for your little brother. There’s enough we have to deal with,” Mom told me. I thought Mom would be mad, but when I looked at her she seemed focused on something else, like she had forgotten something. I thought a lot about her eyes at school today. Ms. Scholes told me I seemed distracted. I think I messed up. I think I mess up a lot. I came up with a plan at school to make Mom happy. Mom always laughs at the movie Little Rascals. She thinks it’s funny when kids sing. “Okay, then you sing the part ‘O is for the only One I see,’” I said to Sal as we were getting off the bus. “I don’t really want to sing, Dan,” said Sal. “I’ll let you use my iPod,” I said. Sal smiled big. “Deal.”
33 We tiptoed into Mom’s room; she was still asleep. Sal had to put his hand over his mouth because he’s a loud breather. I flipped on the light and Mom groaned, “No, don’t do that.” “L is for the way you Look at me,” I started singing. Mom sat up and rubbed her eyes. I nodded at Sal and he jumped out from behind me. “O is for the only One I see.” Mom started smiling. It was working. I started moving my hands around. “V is Very Very extra-ordinary.” “E is Even—” Sal stopped. I looked back at Sal, meeting his wide eyes with my own. “I forget,” Sal mouthed to me, his cheeks flushed. My mouth went dry. I couldn’t believe it. My plan was crumbling right in front of me. Then Mom made a noise. It sounded like she was crying. Me and Sal both turned to her. But Mom was actually smiling, and then she started to laugh. She threw back her head and started laughing really loud. I started to laugh, too. Then Sal laughed. “Come here,” Mom said, patting on her bed as she wiped her eyes. Sal and I jumped up and Mom gave us both a hug. “Are you happy?” I asked Mom. “Yeah, baby,” Mom said softly as she reached for the glass of water beside her bed. I knew it would work. She opened up her pills and swallowed two.
-Patrick Kaper-Barcelata is a sophomore from Radnor, PA, pursuing majors in Global Studies and Sociology and a minor in Philosophy, Politics, and Economics (PPE).-
34
The Ultrasound: A Palliative Remedy Mili Dave A soft knock on the door Turning the steel handle with purpose, yet hesitant We file into the darkened room Illuminated by the glow of a screen Waiting to display the image That simply cannot be expressed by emotion There you lay, vulnerable Sheathed from the jarring inevitable by the delicate paper gown The probe positioned Set to navigate the folds of hopeful maternity You scour the stagnant screen with a glimmer in your eyes The probe was meticulously recast Deep down we all knew the truth Bound by a collective humanity The one that lets technology convey what we can never say An inky mass Was all that was left Of a life, of a love, of a dream never materialized Medicines prescribed and regimens outlined An infallible concoction to bury the scars and pangs As the probe shuts off with a definitive click So does the trace of a glimmer in your eyes You gaze down to the gown Swathing the body longing for motherhood The prescription is lacking, you say What of my heart? But we slip out the door and leave it ajar On to cure the next with our art We navigate the day reveling in this precision-based care But do we realize, a palliative remedy is all we can fare?
-Mili Dave is a junior from Cary, NC, pursuing majors in Biology and Chemistry and a minor in Medical Anthropology.-
A Family History
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Lucas Thorton Your father is a sick man, but he will never admit it because admitting it would mean he’s weak and weakness scares him. Remember that time in the brewery? You were young then, nine or ten. He sat down beside you while the waiter snaked his way over. “What would you like, sir?” He ordered, and, after asking what kind of beer they had on tap, he glanced down and noticed the waiter, the male waiter, wearing a polka-dotted skirt. Your father kept his mouth shut. That was until he had four of those specialty stouts. They were locally brewed, and they tasted like chocolate milk, but they were also 14%. The polka-dotted waiter approached. “Anything else for you, sir?” He glanced down again. The waiter was still wearing it. “Do they make you wear that thing here?” He pointed to the skirt. “No,” the waiter said, “I have a closet full of them. I like skirts. I’ve always liked them.” He couldn’t help but laugh as you looked away in embarrassment. A few other patrons turned their heads, wanting to know what was so funny. They would have never guessed a grown man was having a drunken laugh at the expense of a polka-dotted waiter who probably wasn’t even out of college. The waiter ignored him and retreated back into the kitchen. When he returned with the bill, he tossed it onto the table and darted toward the outdoor garden. Your father left a tip and placed it under one of his glasses. It totaled $2.35. The meal was close to seventy. Your father is an angry man, but the reason he got a good laugh out of the waiter is because he thought the guy was weak. For the longest time,
36 he thought you were weak. You grew out of it though. Age came around, putting meat on your bones and hair on your chin. You even played baseball during your sophomore year of high school so you could prove to your father that the scrawny, sports-hating kid of five years ago was as good as dead. Remember that dinner after your team won their first game? You, his only son, had finally pushed aside weakness. Never mind how you missed every fly-ball that was hit in your direction. Dinner was over. Your father sat beside you with a bottle of rum in front of him. There was only a quarter of it left. When you sat down for dinner, half remained. He grabbed your shoulder and pulled you close. His breath, faintly sweet, warmed your cheek. “Listen,” your father said, “think of it like this.” He hiccupped and placed three fingers on his mouth. “It’s kinda like this, you know, you’re not gonna win every time.” He burped, and his cheeks puffed up like a bullfrog. “Listen, I only win a third of the time.” He poured two-seconds’-worth of rum into a glass tumbler. “You gotta have something to depend on during the 66% of the time you’re losing.” He gulped it down. “This is nice to have.” He shook the bottle and poured one-second’s-worth of rum into the tumbler. “Drink.” You knocked it back, real smooth. One gulp, down the hatch. A little burst of Caribbean sunshine exploded in your mouth, warming the back of your throat. He was proud and you were scared. As you sat the tumbler back
37 on the table, he smiled while you wondered what the future could bring. Your father is a fragile man, but he’s strong enough to pretend he’s otherwise. Remember that Christmas party? It was recent, so you should. You had just completed your first semester of college. For the first time in your life, you made a D. In fact, you made two D’s, one in biology and one in chemistry. Next semester would be different. You would stop drinking so much. Maybe you would even tell your father to stop drinking so much. He got you into this mess in the first place. But things weren’t all bad. Your father still thought you were strong. You even made his opinion of you skyrocket after you joined the same fraternity he belonged to. There wasn’t a weak bone in your body. He said something to that effect when he fell off the porch at the party. He’d had five mistletoe martinis and he was leaning against the railing when he went over. Luckily, the drop wasn’t high, and, luckily, only the two of you were around to witness it. You raced down the steps and found him facefirst in a dead rose bush. He groaned. You untangled him and helped him to the steps. After he sat down, you asked if he needed a band-aid or anything. The thorns had lashed his face. Blood trickled down his forehead. “I just need your shirt-tail,” he said. You untucked your shirt and stepped closer to him. He grabbed it and began to press the fabric against his face. “I’ll stop bleeding in a minute.” The minute dragged on, and the bleeding didn’t stop. “Trust me, I’ll stop.” The shirt-tail of your white dress shirt turned red. “I don’t want to go back in and seem weak.” You kept standing there, knowing full well what happened to your
38 father. You paid enough attention in biology to understand how ethyl alcohol cajoles the cerebellum into sluggishness with a burst of neurotransmitters. You also understand how one day his heart may give out. Excessive alcohol consumption has that effect, but you don’t know why. You missed that lecture. “Go get me another drink.” In this matter, you had no choice. You are a strong son and you must obey your father even though you desperately wish that neither of you would take another drink ever again. But that is a wish and nothing more. You could do nothing except to tuck your shirt-tail in and walk up the steps, even though the blood had soaked into your underwear.
-Lucas Thornton is a junior from Teachey, NC, pursuing majors in English and Philosophy and a minor in Creative Writing. -
Creating Simulacra
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Lilian Manning
Depression is the face in the sky, the overbearing presence of dread or fear, an uncomfortableness that can’t be attributed to any reason. I painted three responses to this existential dread, partially influenced by absurdism: the belief that life is purposeless, but the purposelessness should be embraced, not feared. One person sits on the edge of a building and bears the weight of the face alone. The second person stands against the building and disguises themselves in smoke. The final person has accepted the depression, the dread, the face, the unknown, and embraced it. They stand in the eye of the almighty oppressor, and accepting that view of the world appears to create a happier disposition within them. Personally, I do not know if that is true. Yet.
-Lilian Manning is a first year student from Dayton, OH, pursuing a major in English and Comparative Literature and a minor in Asian Studies.-
