Ars Literarium | Special Issue by Rutgers New Jersey Medical School

S p e c i a l Is s u e | | Wi n t e r & S p r i n g 2 0 2 1

A R S L I T E R A R I UM

I CAN’T BREATHE

Pandemic & Prejudice

A R S L I T E R A R I UM

I Ca n’ t B r eat h e

Pandemic & Prejudice s p e c i a l i s s u e // w i n t e r & s p r i n g 2 0 2 1

A R S LI T ER A R I UM Ars Literarium seeks to express the medical narrative through the creative voices of the members of the Rutgers Biomedical Health Sciences Campus in Newark, NJ. The journal provides an outlet for members of the community who spend endless hours managing the stresses and responsibilities of patient care to find peace through creative expression. Transforming memories or emotions from an intense day spent with patients into words or visual art allows for a stronger, healthier connection to the self and a deeper appreciation of the patient perspective. The journal is published annually by the Healthcare Foundation Center for Humanism and Medicine at Rutgers New Jersey Medical School. For information, inquiries, and submissions, please email us at: arslit@njms.rutgers.edu.

council members Editors-In-Chief

Nandini Mishra, MS-1 Sarah Shoeb, MS-1

Manasa Ayyala, MD Director of the Healthcare Foundation Center for Humanism and Medicine, Rutgers New Jersey Medical School Tanya Norment Program Administrator of the Healthcare Foundation Center for Humanism and Medicine, Rutgers New Jersey Medical School

Editors

Danielle Lee, MS-1 / Graphic Design Kajol Patel, MS-1 / Graphic Design Ryan Jin, MS-1 / Art Editor Bianca Yugar, MS-1 / Art Editor Halle Sarkodie, MS-1 / Literary Editor Hector Lisboa, MS-1 / Literary Editor Taylor Anthony, MS-1 / Literary Editor

Faculty Advisors

Beth A. Pletcher, MD Associate Professor of Pediatrics and Medicine, Rutgers New Jersey Medical School Andrew Berman, MD Professor of Medicine, Rutgers New Jersey Medical School

Ars Literarium’s annual publication is possible due to the support of The Healthcare Foundation Center for Humanism and Medicine at Rutgers New Jersey Medical School.

acknowledgements

With special appreciation and gratitude to The Healthcare Foundation of New Jersey for their generous support. Thank you to Tanya Norment, Dr. Pletcher, and Dr. Berman for their advice, mentorship, and guidance throughout the year.

welcome to the covid-19 special issue of ars literarium As we write for this issue of Ars Literarium, the Covid-19 crisis is still very much with us. Although there is a lull in new cases and hospitalizations in NJ are back to the levels of mid-March, we are still dealing with the physical and psychological fallout of the pandemic and bracing for a new onslaught as summer fades into fall and winter. And Covid-19 has revealed another, equally devastating illness – the cancer of prejudice, both overt and implicit, that poisons American society and divides us as a nation. When you open this magazine, you will have the opportunity to peer into the hearts and minds of future physicians – some of whom have been on the front lines, helping to care for Covid patients. These are the young men and women who will take care of you and your loved ones, and thousands of others like you. In some ways, they are like most other young medical professionals: eager to apply the skills and knowledge they have spent so many years acquiring to make lives better and cure disease. In another respect, however, the young physicians shaped by Rutgers New Jersey Medical School are a group set apart, a group that has been infused with the concept of marrying humanism with medicine. The Healthcare Foundation Center for Humanism in Medicine at Rutgers NJ Medical School was founded to do just that. We at HFNJ like to say that humanism is in our DNA - and it is. Our roots go back well over a century when Newark Beth Israel Medical Center was founded to provide a home for Jewish doctors to practice their profession. It was a time when Jewish doctors, and doctors of color, were barred from the staff of other area hospitals because of anti-Semitism and racial prejudice. And so Newark Beth Israel was born with the mission of providing quality care to all. The hospital was committed to demonstrating the utmost sensitivity to the life situations and diversity of background of both its patients and caregivers, and not surprisingly became the first hospital in greater Newark to admit African Americans on staff. A hundred years later, when the hospital was sold to Barnabas Health, HFNJ was created with the proceeds of that sale. Over time, we at the Healthcare Foundation have learned many things. Above all else, we have learned that healthcare goes much beyond fighting disease and infirmity. It is first and foremost about people. It is about helping people stay well in both body and mind. And it is about helping those faced with chronic and life-threatening situations maintain their hopes and dreams, and their connections to their families, their community, their work, and their dignity. It is about healing in the truest sense of the word. But it is not only patients and their families who need understanding and healing. In this time of the Covid-19 epidemic, it has become abundantly clear that physicians and other medical professionals need that as well. The incidence of stress - and even suicide - among healthcare workers has been too high for too long, but Covid-19 has underscored for us all the extremely difficult conditions under which they work. This remarkable publication will give you some insight into the struggles, hopes, and dreams faced by the new generation of medical professionals. That they are heroes has been acknowledged by all these past several months. It is our hope that writing will be cathartic for them and further eye-opening for us all. We must always keep in mind they that are at the heart and soul of the healing process. We are eternally grateful. Marsha Atkind Executive Director/CEO The Healthcare Foundation of New Jersey August 2020

table of contents

pandemic life Self Isolation / Danielle Lee 7 Soap and Water / Tiffany Y. Chen 8 The Air We Share / Dr. Diane P. Calello 9 What Did I Forget / Silvio Giraldo 10 A Virtual Mishap / Silvio Giraldo 10 Flight of Twenty Twenty / Grace An 11 Leave Me Alone / Macsu Hill 12 Natural Dejection / Yash Shah 13 Hang In There! / Sandhya Shankar 14 2020 / Rohit Mukherjee 15

racial injustice

I Still Can’t Breathe / Sheena Zanjani Racism in the Midst of a Pandemic / Dr. Beth A. Pletcher Newark Voices / Dr. Beth A. Pletcher Untitled #2 / Dr. Dustin Cummings What We’ve Become / Benjamin Mathers We Too Are America / Oriana Culbert When Will Change Come? / Macsu Hill I Am / Melissa K. Warren My Skin Is Not a Weapon / Midhat Rehman Hanging on a Tree / Anonymous Nutshell / Todd L. Friedman A Criminal by Another Name / Victor A. Mensah Black Innocence / Regina Bruce My Vote Cannot Be Bought / Benjamin Mathers Enough Apologies / Joanne Beese 2020 Visions / Donte Jefferson Siblings / Jennifer Hernandez

17 18 18 20 21 22 23 23 24 25 26 27 28 29 30 31 32

from the wards The Real Superheroes / Nivetha Srinivasan 34 The Doctor Will See You Now / Dr. Danilo Bacic Lima 35 4/21/2020 / Dr. Danilo Bacic Lima 36 Kindness / Dr. Tina Jih 37 COVID-19: Can We Think of All The People? / Allyson Bontempo 38 War Zone / Anoush Kalachian 39 On Covid-19, From a Faceless Resident / Dr. Willy Roque & Dr. Raluchukwu Attah 40 An Anatomic Sense of Identity / Sonia Bhala 42 COVID and AIDS, Personal Reflections / Dr. Laura Rees Willett 43 Fahrenheit 2020 / Dr. Jeremy S. Grayson 47

hope There Is Light / Silvio Giraldo 49 Together, We Are an Ocean / Dr. Janet Cai 50 Untitled / Melvin M. Makil 52 Harmoniousness / Frances Ruff 52 Musings of a Vaccine / Jeff Ho 53 Rise / Kopal Bansal 54

pa n d e mi c l i f e

pandemic life

Self Isolation Linocut, Ink on Paper

Danielle Lee MD Class of 2024 Rutgers New Jersey Medical School 7

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Soap and Water Acrylic and Pencil on Paper

Tiffany Y. Chen MD Class of 2023 Rutgers New Jersey Medical School 8

pandemic life

The Air We Share You fear the air we share Cross the street because I’m over there And that virus is everywhere Buy supplies so you’ll have some spare Buy up masks that you will not wear So concerned for your own welfare Unfair. While the curtained bays fill up with souls The vast unknowable toll Of the patients who die alone Wear your dang mask and #stayhome So many lives not even known And the numbers have every day grown But the problem is not really here Hasn’t reached anyone in your sphere And you think it will all disappear So you say that you just don’t care Change your mind as if in midair You want someone to cut your hair Got a great deal on cheap airfare Walk around as your face is bare And all I can do is glare Which makes you spit and swear About that virus from “over there” In the air we share.

Diane P. Calello, MD Professor of Emergency Medicine Rutgers New Jersey Medical School 9

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What Did I Forget? Phone, Keys, Wallet, I’m all set Running out the house Crap! Forgot my mask again!

A Virtual Mishap There once was a class in the middle of their zoom lecture, The professor was speaking about different cell structures. When suddenly the professor muted their mic, And the students giggled with delight. To see the professor had dropped his dentures!

Silvio Giraldo Masters Student in Biomedical Sciences Rutgers School of Graduate Studies 10

pandemic life

Flight of Twenty Twenty Shouts, cheers, clanging of pots and pans Symbolize both 19:00 and gratitude for the front line Confusion, frustration, shouts of anger Quarantine and protests, advocate for Black Lives Matter A set of eyes greet me in the hallway I see you, but need more time to process your new face Whose voice calls me behind the mask? Election draws near, who hides truth behind a mask? Smells of hand sanitizer and bleach, the smell of clean Sticky residue remains on my skin, no more touching Fires burn, apocalyptic orange sky, feel the heat Tropical storms and historic hurricanes, nature only intensifies School canceled, work canceled, life canceled, time is indifferent 24 hours a day spent at home, but let’s move Internationalism, fans join the fight, Parasite gets the win Global pandemic, another global race for a cure Responsibility to dispel false rumors and care for the sick Virtual goodbyes to grandfathers in the ICU Students step up with childcare, online tutoring, fresh groceries, blood donations People stay engaged with virtual concerts, operas, and museums Society opens up, but pause, reassess, and stay safe Call for change, call for the flight of twenty twenty Pandemic of COVID-19, learn Pandemic of racism and social injustice, rise Pandemic of climate change, unite The next pandemic awaits Will the flight be different then?

Grace An MD Class of 2021 Rutgers New Jersey Medical School 11

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Leave Me Alone What day is today I woke up this morning with a heavy heart The demands of the world are weighing me down I see hopelessness sneaking up and taking joy away from us I cannot breathe because everything around me is polluted Leave me alone, just for a second I feel like I am a pizza, and everyone is demanding a slice The demands of life are becoming burdensome I need strength to get through every second of the day We are battling COVID-19, racism, sexism, and the likes I need to hold on to hope in these dire times Leave me alone, just for a moment

Macsu Hill, PhD, MPH, CHES Program Manager Rutgers School of Nursing 12

pandemic life

Natural Dejection Chalk

Yash Shah MD Class of 2022 Rutgers New Jersey Medical School 13

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Hang In There! Digital

Sandhya Shankar Masters Student in Biochemical Sciences Rutgers Biomedical and Health Sciences 14

pandemic life

2020 It seems as if it was yesterday, when one’s breath had not been constrained by the notion of invisible fear, Shrouded in corners, individuals clamor at the sight of a cough, A reality that in any other conjecture of time, had been simply a nuisance. But in today’s world, such garnered fear, nest in one’s mind, In isolation, like our very vessels confined to four walls, mandated to acclimate to the era we live in. Although the prospect of death remains viscerally apparent, one wonders of, the days which preceded, Identity, had formed within the roots of routine, 16 ounces of coffee, 24 minute drive, glaring above a blue surface for 8 hours, With the chance of having a serendipitous conversation somewhere along the way. It is the routine I crave, simply. Monotony had a fine tune to my ear, when its sound had not been colored by imminent despair. As our finances dwindle, in tandem, with our livelihood, I look forward to welcome routine into my existence once again, but now, with a barrier to what came before and what has transpired, A barrier that divides two separate worlds, One of which embodies the fantasy of routine and overlooks the presence of fear, Another embedded in strife, differentiation, and embracing the very fragility of our breath. While considering this fabric of division, restricting each passing moment, I pose to you an inquiry, What would change if such division had been hollow? Would the civic unrest, vanish? or Has this unprecedented time revealed that division embed the very pillars of which this country had been built upon?

Rohit Mukherjee Graduate Student of Urban Public Health Rutgers School of Public Health 15

r a ci a l i nj ust i ce

racial injustice

I Still Can’t Breathe Marker on Paper

Sheena Zanjani Pre-Medical Scholar Rutgers Biomedical and Health Sciences 17

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Racism in the Midst of a Pandemic To say these past few months have been challenging for us as a nation, perhaps even more so for those of us involved in frontline healthcare, is most certainly an understatement. However, as we have had to drastically change routines, consider risks to our own health as well as the health of our loved ones, all while trying to make sense of the chaos - something far more startling has emerged. The tragic death of George Floyd has forced us to face an even more insidious threat to our health and survival as a society, that of systemic, pervasive racism. The past few days I have been trying to come to terms with some shocking realizations about my own behaviors and perceptions, and I am frankly ashamed. Despite having trained and practiced in underserved and needy communities for more than 30 years including, Chicago, Los Angeles, New Haven CT and Newark NJ, I am embarrassed to realize how uninformed I am about racism and its impact on others. It is not enough to say that I provide care to people who have no other place to go, feeling satisfied that I may provide a “safety net” for my

Newark Voices Photographs

Beth A. Pletcher, MD Associate Professor of Pediatrics and Medicine Rutgers New Jersey Medical School

disenfranchised and under-served patients. What have I done to lift them up, change their circumstances, or level the playing field? I am ashamed that from my position of privilege, being a white woman raised in an affluent suburb of Chicago, that I have failed to be introspective enough to truly grasp how ignorant I am about this critical social issue. As I look back on my life I am ashamed for all the times I have remained silent - silent when someone told a racist joke, a colleague spoke disrespectfully about a patient whose circumstances led them to make poor decisions, or I didn’t come forward to support and defend a colleague who was being dismissed or not listened to, merely because of the color of their skin. I am ashamed that I have not actively fought side by side with others to force our elected leaders to push forward with meaningful, substantive reform as opposed to placing a band aid on the massive hemorrhage that we recognize as institutional racism. I am ashamed that I have not educated myself about racism, nor recognized that I too am racist. I don’t believe I am intentionally or malignantly racist, but

racial injustice

my ignorance as well as my failure to speak up, act and learn, force me to acknowledge that I am indeed racist. The good news is now that I have made a diagnosis, I can develop a treatment strategy and there may be hope for me to become a better person. Fortunately my friends, co-workers and students have offered to help me educate myself about the roots of racism and steps I can take toward becoming less racist. There are small things that I can do in my patient interactions by reframing how I perceive their circumstances, by listening even more carefully, asking better questions, and consciously refocusing the lens through which I view my patients and their families. I can work within both medical and non-medical organizations to push for long overdue, critical, lasting and yes, perhaps, even radical reforms to reduce and eliminate the disparities and level the playing field, so that someday social determinants of health will merely be a historic notion and not an ever-present, horrifying reality. I can actively support under-represented minorities in medicine so that they are promoted into positions of power so they can become the guiding lights and agents for change that we so desperately need. I can

speak up respectfully but firmly when I see injustice, witness racist acts, or hear racist comments. Most of all, I can and must hold myself accountable for my actions or inactions. We as a nation and as individuals must do better.

Beth A. Pletcher, MD Associate Professor of Pediatrics and Medicine Rutgers New Jersey Medical School

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Untitled #2 Night descends upon a once anointed nation Its founding covenant blind to rank and station Native heirs exiled to the edge of omission Rugged continent tamed to brutal submission Untold black lives stolen in an empire’s scramble Yolked in servitude beneath a false preamble Men wage war to sustain liberty’s creation Rooted injustice rots a fragile foundation Serf and scion journey from the kingdoms of yore Finding sanctuary upon a teeming shore Civilization of every race and people Equal prayers whispered underneath dome and steeple Where temples of new wealth and gleaming spire abound The unanswered history seeps through faulted ground Time’s passage buries whip, chain and iron collar Replaced by bonds of coin and almighty dollar An unending race toward fleeting prosperity Such unequal fates clothed in blind temerity People of color struggle in these lands claimed free Our bodies crushed under cudgel and bended knee A colossus finds its bravery contested Souls of the disenfranchised remain unrested A mythos steeped in abundance and creation Lacking the will to face its creeping stagnation Standing at a precipice of its own making Lofty ideals threatened, its unity breaking They who found life anew, an old world in their wake Will build a new future unbound by past mistake The mold recast, a bold republic forged as kin Heals the endeavor, imperfect in origin

Dustin Cummings, MD, MPH Assistant Professor of Surgery Rutgers New Jersey Medical School 20

racial injustice

What We’ve Become Blood and Acrylic on Newspaper

Benjamin Mathers Level 3 Accelerated BSN Student Rutgers School of Nursing 21

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We Too Are America Digital

Oriana Culbert MPH Class of 2022 Rutgers School of Public Health 22

racial injustice

When Will Change Come? Why is the world in chaos? When will we embrace the gift of life? Why do some people support unjust actions? We are all created in His image and likeness. I am disappointed in us. When will change come? Why are we in a state of chaos? When will we start to treat each other with respect? Why are we still judging some people because of their race? May love be reflected through our actions. I am disappointed in us. When will change come?

Macsu Hill, PhD, MPH, CHES Program Manager Rutgers School of Nursing

I Am You say, I am a piece of property because of the color of my skin I look into the mirror and see a masterpiece a child of “I am who I am” You strip away my birth right. A human being I am You take away my liberties, and say I am less than a man My people have been treated terribly, but you may not agree I will never let your hatred reflect what becomes of me As I look down on the earth, my people I see; Promise, Hope, Love I AM

Melissa K. Warren Mental Health Clinician Rutgers New Jersey Medical School 23

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My Skin Is Not a Weapon I stand here With glass beneath my feet And tears pouring from my eyes Trying to convince you That I am worthy Of being able to live Without fearing for my life This color on my skin is not a weapon It is soft, fragile and human What will it take for you to see That you and I fall from the same tree This colored skin of mine won’t hurt you The way its hurt me

Midhat Rehman Class of 2020 Rutgers School of Public Health 24

racial injustice

Hanging on a Tree You left me bleeding Dead, dying, dismembered You left me there that day, hanging by a rope You asked for my allegiance My loyalty, my labor, my life But you left me there that day, hanging without any hope I called for you to see me Did you see me? You turned away hurriedly But did you see me? You put me in chains and dragged me along Branded me with your iron fist; left your signature in my scars As I gasped for air, you grasped my neck. Did you not see me? You speak of freedom and liberty Of happiness and prosperity. And bear false witness that you may be the “fittest” in your hierarchy. You have taught the masses what? To hate, to hurt, to hide You have left us hanging, left our love to die. A young man was murdered in plain sight Yet, we are slow to see A young woman cried out in the dead of night But, we are slow to listen A child shot to death at your hands Your hands thirst for more blood. But we are slow to stop you. You left us there, by that tree Slipping into your car and driving away. Far, far away from here. Just because you can. We hang today. We’ve been hanging for a long time. The tree has been weeping since, with no end to her tears. She weeps for the beautiful body that you stole but prays for the soul you’ll never conquer. You left him hanging on that tree The tree of your so-called liberty And justice for all that no one sees. But did you see him?

Anonymous MPH Student Rutgers School of Public Health 25

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Nutshell Digital

Todd L. Friedman Rutgers University Behavior Health Care 26

racial injustice

A Criminal by Another Name Where I come from death isn’t too unusual. An overpoliced inner city with too much gang violence. People from my city only seemed to pass away abruptly and my situation was no different. I was 16 years old when I walked in on my father’s lifeless body on his bedroom floor. He had a stroke in the middle of the night. People are often surprised when I tell my story, but, to me, growing up in the inner city without a father figure was pretty common. At 16 I was alone in a country to which I was but a stranger only 5 years prior. Through sheer force of will, I went from an at-risk youth in the inner city to a high school graduate on a full scholarship to college; at least that’s how the story looks from the outside. The truth is, I had a lot of help. Help in the form of teachers who took a personal interest in my success and mentors who moved mountains to make sure I was on the right track. I met my first mentor who helped me get back on track and work towards a college education and beyond. These days I proudly walk the same streets I used to walk as a teenager, this time in a shirt and tie and a white coat. I tell you this story because for everyone with my story there are hundreds- if not thousands- who never get that same chance. One of the joys of attending medical school in your hometown is the ability to recognize your patients because you used to play soccer with their child, or they used to be your Sunday School teacher. As we are in the field of meeting people sometimes at their worst, inevitably these meetings aren’t always so rosy. During one of my psychiatry overnight shifts, I met one of the most excellent residents I ever worked with. It was a slow night, so we had a lot of time to chat and get to know each other. Towards the end of the night we had a new admission. A 16-year-old black boy from a juvenile detention center. Something about the patient’s last name sounded familiar; it was an African

last name and I grabbed onto the small chance I might know the patient. He was being sent from a juvenile detention center for attacking a security guard and attempted suicide. The only past psychiatric diagnosis in his file was Conduct Disorder. I asked my resident if the patient also has an associated anxiety or mood disorder? His response was “who cares, he’s a criminal”. I didn’t think too much about that answer as we quickly found out he was in Juvenile detention for murder so yes that was a factually correct statement, so we moved on to see him. When I walked into the room, now his name didn’t only sound familiar, he also looked familiar. During the interview I discovered the reason his name sounded familiar was because I knew that name. I didn’t know him personally, but I knew of him. I used to run track and field with his brother in high school. His brother was gunned down on the way from practice my senior year; a case of mistake in identity. These stories though sad, weren’t too uncommon in my city. A promising young man, gone and never to be heard from again. I was quiet for a long time, holding back tears because to me he wasn’t a criminal. He was a little black boy growing up without a father and a mother who, due to circumstances, was unable to be present. He was me without a mentor. I was him in every foreseeable way except he was in handcuffs and I was in a white coat. Same story, different endings with the only difference being that someone came in and showed me that I could be something other than a gangster. He wasn’t so lucky.

Victor A. Mensah MD Class of 2021 Rutgers Robert Wood Johnson Medical School 27

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Black Innocence DAUGHTER I am 5 years old. I play with my brothers. We work together. We use blocks. Suddenly, there’s a change. My mother is gone. My father seems distant. He looks at me. I don’t recognize his face.

He seems ANGRY.

I try to cheer him up. I say count to 10. He looks at my brothers.

He seems SAD.

I am confused. Our castle, it’s falling! FATHER My children were playing today. They were building a castle so high. It was a beautiful sight. They can’t go outside. Life is so different now. This is their kingdom now. That is when it happened. I saw a reflection of myself. It lasted 8 minutes and 46 seconds. I struggled to breathe. I survived. AGAIN. My reflection did not. I look at my children. My daughter comes up to me. I watch her eyes. I see her mother. I cry for my wife. She could not breathe. A victim of a villain I could not see. I watch my sons play. They are only three and building a throne. They woke up Black. A color that absorbs so much pain. My body aches. My chest pains. I can’t breathe. They will lose their innocence today.

Their kingdom is falling.

Regina Bruce Class of 2021 Rutgers Graduate School of Biomedical Sciences 28

racial injustice

My Vote Cannot Be Bought Sharpie on Paper

Benjamin Mathers Level 3 Accelerated BSN Student Rutgers School of Nursing 29

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Enough Apologies I can’t apologize enough The words we use are empty Like giving Tupperware to the starving The problem unsolved, you widen the divide The divide between those who have too much And those who have nothing at all I can’t apologize enough The language has no resonance We are lip syncing to songs in our head As people chant for justice, there is silence The silence of the offended, those entitled to be so And for those that chant, it is deafening I can’t apologize enough I have to answer for guilt with action The pain of shame is nothing compared to the lives deprived Sorry is the sorriest of the things we have to offer So change regret into reformation, And don’t be sorry, but be better.

Joanne Beese Mental Health Specialist Rutgers University Behavioral Health Care 30

racial injustice

2020 Visions Man 2020 been on some bullshit all year nonstop First we lost Kobe, Gigi, Bill Withers and lost pops Corona got on lock fast food lines wrapped around the block Curfew about 8:00 gotta wear a mask when I shop Bill Gates tryna give out shots Acting like a doc when we know he’s not And at the same time black people still getting killed by the cops Tell it like it is, gotta call a spade a spade Cops started off catching slaves Didn’t need you to patrol but said color folks need control So now your job is saved 13th amendment say prisoners are slave No wonder why you want to put me in a cell or a grave Wise man told me something that really didn’t seem obvious to me Cops don’t work for us they protect and serve the property And whatever value that it has That’s why if I’m in a nice car riding past In suburbs, I’ll get pulled over fast Ask me questions like who I am, and what I’m doing around You live around here? Ain’t you from the other side of town Just because my skin tone dark brown Somehow my presence make the prices of the houses go down?

Donte Jefferson Specialist IV Rutgers Day School 31

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Siblings Photograph

Jennifer Hernandez, RN, BSN Registered Nurse Rutgers University Behavioral Health Care 32

fr om t h e wa r ds

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The Real Superheroes Digital

Nivetha Srinivasan MD Class of 2023 Rutgers New Jersey Medical School 34

from the wards

The Doctor Will See You Now I saw you for the first time when you came to clinic after being discharged from the hospital. Your visible anxiety dissipated and turned into a timid smile when I greeted you in Spanish. “Hola, señor, yo me llamo Dr. Lima.” I open up your chart, copy and paste a little bit from the previous notes (but not too much, I’m trying to impress my preceptors,) set up all my template “smart phrases,” speak in imperfect Spanish, type in English, think in Portuguese. I don’t look up as you hand me ten prescription bottles you pull out of a tattered Shop Rite bag. I don’t look up as you hand me your blood pressure readings written on a stained sheet of loose notebook paper. I focus on the task at hand. I scroll through your notes: pulmonary says “possible cryptogenic organizing pneumonia.” Not really sure what that means, but I guess I’ll sound really smart if I just throw that on my presentation. You suddenly turn to me and say “just give me lots of refills, doctor. I’ll need them when they send me back to Honduras.” I look up, and for the first time, I actually see you. The nervousness in your eyes. The visible anxiety. The fear. You had received the deportation orders, after 29 years in this country. You were a mason. Your hands had built this country. And now it was removing you, tearing you down, without a thought. I thought back to my own navigation of the complex immigration system. The anxiety, the fear. And I was a doctor, had a good lawyer, spoke the language, and had collected all the bits and pieces, forms, stamps, receipts, and tax returns. The cards were impossibly stacked against you. What chance did you have? To you, a deportation to Honduras was, for all intents and purposes, a death sentence. I guess there was no point in starting you on any of my little intern medications, or filling out my newest healthcare maintenance template. I give you a 90-day supply of breathing treatments and heart failure pills. I make sure you are seen, that you are ACTUALLY seen, one last time before your ultimate departure. From this country? Maybe from this world. I think about you sometimes and wonder if you have anyone taking care of you. It was a privilege to be your doctor, and to see you.

Danilo Bacic Lima, MD PGY-2, Internal Medicine Rutgers New Jersey Medical School 35

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4/21/2020 We met yesterday, when I helped the young soldiers flip you on your stomach to help you breathe. Today, you died. When we broke the news to your loving wife, she asked for just one thing: an opportunity to see you one last time, to say her final goodbye. Our amazing nurses made you presentable for your final date with your wife. I methodically gowned up and entered the room, and as your wife and children began to wail, the N95, surgical mask, and face shield hid my tears. I only met an intubated version of you. A shell of the man you seemed to be. And yet I served as the officiant at your last minute wake. Your wife cried the entire call. “You are and will always be the love of my life, mi amor. I’ll never forget how handsome you looked on our wedding day. I will fight for our children and never give up.” We are trained on how break bad news and hold difficult conversations during a normal grieving process. We are not trained on how to help a wailing wife and teenage kids deal with loss over the internet when all they get is a short virtual wake. “I want to tell you that my colleague made sure to tell your papa how much you guys loved him.” They seemed to find some comfort in those words.

Danilo Bacic Lima, MD PGY-2, Internal Medicine Rutgers New Jersey Medical School 36

from the wards

Kindness Photograph

Tina Jih, MD Hospitalist & Instructor Rutgers Robert Wood Johnson Medical School 37

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COVID-19: Can We Think of All The People? Can we abandon the notion that death is the only important metric of COVID-19? Instead, can we think of all the people? Can we think of the people who have indeed survived COVID-19 but who have nevertheless endured physical health problems as a result? Fever. Chills. Cough. Shortness of breath. Difficulty breathing. Fatigue. Muscle or body aches. Headache. Loss of taste or smell. Sore throat. Congestion. Runny nose. Nausea. Vomiting. Diarrhea. Can we think about the uncertainty and fear that is inevitably experienced from a positive test result, uncertainty and fear of what will happen next? Can we appreciate their suffering? Can we think of the people who have indeed survived COVID-19 but who nevertheless had to be admitted to the ICU? Can we think about the uncertainty and fear that is inevitably experienced from being admitted to the ICU, uncertainty and fear of what will happen next? Can we think of the looming question: “Will I live or will I die?” Can we think of the psychological trauma that may haunt them even after recovery and discharge? Can we appreciate their suffering? Can we think of the people who have indeed survived COVID-19 but who nevertheless had to be put on a ventilator or were intubated? Can we think of the powerlessness and loss of control that is inevitably experienced from not being able to do something so basic as breathe on one’s own? Can we think about the uncertainty and fear that is inevitably experienced, uncertainty and fear of what will happen next? Can we think of the looming question: “Will I live or will I die?” Can we think of the psychological trauma that may haunt them even after recovery and discharge? Can we appreciate their suffering? Can we not only think of these people but of how they had to endure these experiences in the hospital alone, without their loved ones by their side? Can we appreciate their suffering? Can we think of all the loved ones of the 1.15 million people globally who have met their untimely end from COVID-19? Can we appreciate their suffering? Can we think of all the people? Can we appreciate… suffering? Or, have we come to a time where a person’s life only matters once it’s been lost?

Allyson Bontempo Doctoral Student Rutgers School of Communication & Information 38

from the wards

War Zone “Armed for battle?” asked the nurse standing across from me as we watched each other don personal protective equipment. It took me 15 minutes to plan my tasks and don 8 pieces of PPE before seeing just 1 patient; there were still 3 more. Last week I had volunteered to float to the orthopedic floor before finding out about its transformation into a COVID unit. As I attempted to take a deep breath through the muggy mask, I looked around through the foggy face shield at my dear colleagues gearing up and the manager giving out directions. Yes, I was armed for battle. We were fighting a war with the unseen enemy invisible to the naked eye, the little devil in the shape of a spiky ball, yet we know it’s here. I didn’t sign up for this… Or did I? Unknowingly, I had indeed. As I read the Nurses Pledge during the pinning ceremony years ago, serving on the frontlines of a pandemic is not exactly what I pictured. This illness has restructured the role of nursing. The next day, my calves burned as I recalled the previous shift where I’d functioned as a nurse, aide, respiratory therapist, as well as housekeeper, increasing my own exposure to this deadly virus in order to reduce the exposure of multiple colleagues. Almost every workday, one of my loving family members would urge me to call out of work. Tempting, but a sense of duty nudged at me.

a nurse, causing my colleagues to be exposed all the more to make up for losing me. In an attempt to justify my dilemma, a friend says, “Please don’t feel that way. You did your part at the hospital, now you’re doing your part by staying home.” To the nurse: Every day, you live and leave a legacy; you live in the legacy of the heroes before you, and you leave a legacy for those to follow you. When you suit up with your PPE armor and prepare for war with the unseen viral enemy, remember what it is that you do: you do nursing. You care for the sickest of the sick, which is not only a science but an art; an art that requires training and dedication, and an almost superhuman foresight. Your training and zeal have culminated for such a time as this, for it is the human life for which we do business. Have courage, take heart, and pray (see Holy Bible, 2 Corinthians 1:9).

Today is Day 6 of my mild symptoms (sore throat, runny nose, anosmia, ageusia) and my dad’s result comes back “detected” for SARS-CoV-2 RNA. According to the employee self-monitoring program, I need to call out sick for the next 14 days. I can’t help but feel like I’m abandoning my duty, leaving 4 patients without

Anoush Kalachian, RN Doctor of Nursing Practice Student Rutgers School of Nursing 39

ars literarium / special issue / winter & spring 2021

On Covid-19, From a Faceless Resident Willy Roque, MD PGY-3, Department of Medicine Rutgers New Jersey Medical School

Raluchukwu Attah PGY-2, Department of Medicine Rutgers New Jersey Medical School

The virus came in like a thief in the night and stole so many lives from their families. Being a black resident in an inner-city hospital in Newark, New Jersey taking care of the most vulnerable population, African Americans, affected by the deadly virus took an emotional toll on me and a lot of my colleagues. It was heart wrenching seeing people who look like family and remind you of your loved ones die in numbers.

others to do the same. Residents and fellows from different specialties volunteering to help the medical inpatient teams. People offering to give up their days off/vacation time even though they were burnt out and had had a rough year so far. Everyone willing and ready to do whatever it took to make the work environment more favorable and efficient. I have witnessed the amazing efforts that have been made by everybody involved in trying to provide quality care across the board.

I had a particular patient who reminded me of my father in many more ways than one. I was rooting for his recovery and was very happy when he had less oxygen requirements. But that victory did not last for long. I walked into one of my night shifts with him going into a cardiac arrest and not responding to CPR and pressor. With so much pain and defeat I knew I had to make that phone call to his wife at 2 a.m. to break the devastating news to her. Hearing her wail and laugh hysterically from the shock of the news broke me. I spent the rest of that night in a daze while caring for the countless other patients that needed my attention. I went home and all I could think about was him. What if that were my father? Who will be next? When will this end? Will we ever find a cure? How many more lives will be lost to this evil virus? They were many more losses like him throughout my time in the ICU. Although COVID 19 brought so much loss and pain, I cannot but help to also see the unity it brought amongst my colleagues, patients’ and their families through the shared sadness. I saw husbands who had been estranged from their wives and kids come together and set aside their differences to make the best decision for their loved ones. Families remain together within the confines of their homes, and those who are fighting with each other, are in this fight together. If anything, this journey has proven that everyone has given 101% of themselves, and continues to motivate

But unfortunately, that's only one side of the coin. When I gaze into the eyes of a dying patient, draped in protective gear, allowing only my eyes to see through the shield, they don't know me, and they’re forced to leave their future in the hands of a faceless figure, a stranger who can’t even look at them face to face. They are terrified of crossing the threshold. They know exactly why they came, but every one of them is hoping for a cure. They spend their extensive days in agony, unsure as to the outcome of their dire state, able only to Facetime with relatives and friends, which surely isn’t enough. When did technology manage to replace the gentle touch, the soothing voice, the hug? The virus is ruthless. I know everyone tells us how heroic our actions are. Every day I travel to work I am proud of myself and my continued noble act. I know that I must endure and win. I wish to make it easier for my patients every day, but sometimes it’s hard to know how. Sometimes I feel that I am on the verge of failure, and that I will simply sink into the abyss as I am surrounded with so much despair. My loved ones are constantly running through my mind, as I often wonder what my fate will be. I thank God, as day after day goes by and I remain untouched by the virus. Still, it's incredibly difficult to endure such testing times in my position.

from the wards It is hardly a physician’s place to provide care in these circumstances, given that the studies aren’t extensive enough in telling us what is best. Normally, we practice evidence-based medicine, but COVID 19 hit us so fast and hard that there isn’t enough evidence for most practices. As good as our intentions are, all we can do is hope that they succeed. Still, death surrounds me. People are dying day after day. One by one, they die and I am without the power to prevent it. I do try, I try my very best, but every day the virus wins a few more battles in this lengthy war. Simply, when he finds a suitable ground, he attacks and thinks not of the consequences but of himself. What of myself? What of my being and how it affects me? But it is not just death that drives me. There are many situations that I can talk about that have hit me hard, and show why I will never look at things the same way again. As I previously mentioned, many fighters still remain on our side, and the public sure recognizes that with undying support. Firefighters, Police Officers, News Reporters, Vendors, and Teachers all as one. These are all beautiful and noble occupations. But it seems to me that often, and quite unfairly, employees who work on hygiene in hospitals are very much neglected. After meeting a woman working in that specific area, my mind has been changed forever. 24/04/2020 She was an elderly woman from Honduras who works in the hospital. It was difficult to converse fluently, but I noticed that she had trouble putting on protective equipment, so I offered her help in Spanish. I also do it with the families of patients who are at risk because most of them do not speak English, or speak very little. This makes our work even more problematic due to insufficient and clear communication. After I offered my services, I guessed that she was around 60 years old, so I was confused as to why she had not stayed within the comforts of her home. She replied that she had to work because of her family. She was scared to death but as a mother, she must first think about their existence before her own. She told me that she faces tremendous amounts of fear every

day, which makes the job even more stressful than it already is. That was when I finally understood. She was in the same boat as myself, despite being much older, and she's on the front line. She is surely another hero among us. I watched her as she hurried back and forth, ensuring that the hallway remained clean for those who hadn’t the time to make room. It was entirely inspiring to see someone devote themselves to a greater cause, knowing fully well that, as time passes by, more and more people will die of this great virus, and she is just as at risk of this fate than the majority of people. If I am to be honest, I contemplate her mentality more often than some would think. What sort of mentality towards life, and people as a whole, does somebody have to obtain to relentlessly work as she did, to block out the fear of contracting the virus, and simply continue with her business. It was extraordinary to ponder. It wasn’t done halfheartedly either. Even with the knowledge of COVID 19, this lady took her time, still retaining the level of professionalism and focus that would normally be at play during a typical work day. If only the rest of the country could see her in action, then they too, just as I am to this day, would be truly inspired. Her family must be very proud of the work she is doing. As many would see her job as insignificant, an ignorant view of the average worker, then surely this account of this heroine will change your view. These people are the unsung heroes that are rarely spoken of, the people who need our support now, more than ever. It’s not just the doctors, and the nurses who deserve our praise, but the people who keep those facilities clean. The people who allow those with medical expertise to work in a comfortable and clean environment. That is where we need to be as a planet. Simply supportive of everyone.

ars literarium / special issue / winter & spring 2021

An Anatomic Sense of Identity Who are we At our core? Every course, every organ system, every religion, every culture, every patient, every “cell” even Tells me differently I turn on the television A vain attempt at avoiding the question As stories of protests Remind me that some still try to reduce us To not even the number of melanocytes But rather the sheer amount of melanin granules in our skin As though a simple histological slide Could even begin to explore the depths of who we are Some think more, and try harder – they say who we are is in Our brain, our heart, our breath I ask you, my cadaver, Who lies before me Your heart no longer beats Your mind does not light up our fMRI machine Even as we peel your skin and fascia away And see a version of you That even you yourself wouldn’t be able to recognize in the mirror You remain unapologetically you You are you Without the skin Without the beating heart Without the functioning brain You are you And of that, at least, I am positively sure So when I ask you who I am When I don’t know Will you share with me The secrets of where I should cut To find our anatomic sense of identity Sonia Bhala MD Class of 2023 Rutgers Robert Wood Johnson Medical School 42

from the wards

COVID and AIDS, Personal Reflections A New Infection Changes Medicine and the World, Again Laura Rees Willett, MD, FACP Professor of Medicine, Division of Education Associate Program Director, Internal Medicine Rutgers Robert Wood Johnson Medical School As a medical student and internal medicine resident, I had the experience of caring for AIDS patients at the beginning of the AIDS epidemic. Now towards the end of my career, in my role as an associate program director and hospitalist attending, I am caring for COVID patients at the beginning of the COVID pandemic. What follows are my personal thoughts on some similarities and differences regarding these experiences. First, some historical context AIDS was first described in 1981. In 1983-84, the HIV virus was identified but no blood test was available. By the end of 1984, more than 7,000 cases of clinical AIDS had been identified in the US, probably the “tip of the iceberg” in terms of infected persons, and more than half of those patients had already died. In 1985, a reasonably accurate antibody blood test became available. By the early 1990s, AIDS became the most common cause of death for US men aged 25-44, and it remained so for over a decade. After more than a decade of randomized-controlled trials of multiple medications, highly-effective therapy became available in the late 1990s. Since then, indications for this treatment have expanded to include everyone identified as having been exposed to the virus. This changed AIDS from a disease which was uniformly fatal, usually within weeks to maybe 1-2 years after presentation, to a chronic disease which can be controlled. Many of my medical school classmates were among those who died of AIDS in the 1980s and 1990s, before effective therapy was available. Many attempts at creating a useful vaccine against HIV have not yet borne fruit. COVID was first described in December 2019, with the virus being identified and fairly accurate viral testing becoming available shortly thereafter. Within a very short time, well over a million persons world-wide were identified as having been infected, again likely the “tip

of the iceberg”, with about 2% of those identified having died. In April 2020, a randomized controlled trial of remdesivir (not yet published) has reportedly shown promising clinical activity against the virus. We are obviously very early in our journey with this virus, so the timeline for other proven treatments, vaccines, etc. is unknown. My recollections on my personal experiences with these viruses will be grouped into several themes: concerns and uncertainties about transmission; types of persons most affected; effect on physician families; effect on physician training; use of unproven therapeutics; and public reaction and stigma. Concerns and uncertainties about transmission With any new infectious agent, there will obviously be uncertainty about how exactly the disease spreads. That has definitely been true of both HIV and COVID. In both cases, the greatest fear and uncertainty has surrounded the importance (or lack of importance) of the role of fomites, e.g. potentially infected objects, in the transmission of these diseases. In the case of AIDS, it was clear early on that the disease was spread in a way similar to hepatitis B, with mostly blood-borne and sexual transmission. Hepatitis B can also spread non-sexually in households, probably on fomites or food, so there was understandable concern that this could be true for AIDS as well. This resulted in fear about hugging someone with AIDS, sitting in a restaurant with or using a napkin used by someone with AIDS, etc. It took years of good public health research to show, that although virus could be found in fluids like tears or saliva, that these fears regarding fomites were not well-founded. During my time as a medical student and resident, we did many more procedures than students or medicine residents do now. In fact on some days during my VA rotations, students and residents were the only people in

ars literarium / special issue / winter & spring 2021 the hospital drawing blood on patients. Consequently, we experienced many more needlesticks than current internal medicine trainees. Needlesticks had been shown early on to carry a risk of AIDS transmission. I heard of residents and attending physicians in other programs who refused to care for patients with AIDS out of concern for their personal safety, and I remember viewing such physicians with contempt. Coronaviruses, of which COVID is one, have long been thought to be transmitted mostly by respiratory droplets about the size of a blood cell. There is good randomized-controlled trial data regarding another droplet-transmitted illness, influenza, showing that plain surgical masks are as effective in protecting healthcare workers as much more expensive and uncomfortable N95 masks. I therefore push back against some of the public health authorities who say that wearing a mask doesn’t protect the wearer. If COVID transmits mostly in droplets like influenza, which it probably does, a simple surgical mask should protect the wearer. By obsessively washing our hands after touching any potentially-contaminated surface and covering our bodies with multiple layers of gowns, shields, etc., we are all behaving as though fomites are very important in the transmission of COVID. We are therefore not hugging our patients, not thoroughly examining them, and not holding hands of the dying. If we are honest, we need to admit we have no idea whether or not these restrictions are needed. Hopefully, we will soon have the strong public health research to know one way or the other. Types of persons most affected This is one of the aspects which is most different in my experience of the two viruses. Early in my experience with AIDS, the bulk of the patients I saw were previously-healthy men in their 20s and 30s. The hospitals in which I served as a medical student (San Francisco) and resident (Boston) neighbored large gay communities. Ever since COVID hit my hospital in New Jersey, unbidden memories of the faces of these long-dead young men have been flooding my mind. I performed my first lumbar puncture, in 1981 as a third-year medical student, on a wealthy 35-year-old with a headache; he died a couple of weeks later of an “unexplained” fungal meningitis. I remember arranging a home discharge of a remarkably upbeat 25-year-old man with AIDS and unrelenting Cryptosporidia diarrhea. He literally brought home a U-Haul of intravenous fluids

so he could receive 13 liters a day of total parenteral nutrition at home, in the hopes that he could spend his last month or two of life there rather than tethered to a hospital bed. Most sadly, I remember a lively, flirtatious 20-year-old who I first cared for following a kidney transplant donated by his apparently-healthy brother. Unbeknownst to anyone, the brother was infected with HIV (there was no testing available yet), and the kidney infected my patient. I cared for him again less than a year later as he was dying, ravaged by multiple infections and AIDS dementia. The legions of previously-well young men dying in our ICU of overwhelming Pneumocystis pneumonia are nameless and faceless in my memory now, there were so many of them. On any overnight shift during my residency, I would expect to admit 2-3 such patients, many of whom quickly required intubation. Many families found out that their “perfectly-healthy” son was dying and found out that he was gay at the same moment. Obviously, women and children were not immune from the disease. I vividly remember one of my first female clinic patients with AIDS. “Jewell” was a single mother in her 30s who found out that she had the virus when her second child became sick and died of AIDS at the age of 6 months. She had probably been infected by a drug-using sexual partner. There was no effective therapy yet available, so I watched her rapidly diminish from an active, hard-working person to a skeletal patient hardly able to move. About 6 months before she died, she made the wrenching decision to have her healthy 4-year-old daughter adopted by and live with her best friend. Jewell herself was too weak to care for her anymore, and the daughter’s father was not a responsible person. Clearly anyone of any age can contract and die of COVID. The consequences of COVID infection tend to be more severe in the elderly and ill, especially those with obesity, diabetes, and cardiovascular disease. As a result, the vast majority of the people now dying of COVID are older than 50. Most of these deaths are among people who were active and productive before getting sick. For some small portion, a COVID pneumonia may offer a quick release from something as distressing as slowly progressive neurologic degeneration. No less of a physician than Sir William Osler called pneumonia the “old man’s friend”. He was expressing his observation that, in an already-compromised person, pneumonia often results in a fairly quick and

from the wards painless death. For our fellows and residents working in intensive care units, it can be overwhelming to care for a seemingly endless stream of intubated COVID patients, many of whom are young or middle-aged, and most of whom will die. Even medical floor patients with COVID seem to experience outcomes far more severe than those of our usual floor patients. On a recent teaching service week, I took care of 22 people with COVID. One month later, 6 of those patients have died, 3 of whom had severe pre-COVID neurologic disability. Among the survivors, many are still not back to their baseline from before this infection. Recovery from this virus appears to take a very long time. Effect on physician families Obviously, most physicians have families and want to keep them safe. This is one of the major stressors of healthcare workers caring for COVID patients. We worry about bringing home this virus, especially if we have vulnerable family members. As mentioned above, it is likely that simple precautions likely wearing a surgical mask with anyone who might have COVID (which is essentially everyone right now) and washing hands before and after patient interactions (which we should be doing anyway) will prevent most transmission. We don’t know that for sure yet, so there is a lot of anxiety. Because my family and I shared this anxiety, I chose to live in temporary dormitory housing during my first round of COVID hospital service. Interestingly, I also had occasion to worry about bringing AIDS home to my family in 1984, back when AIDS really was a death sentence. I was a resident working in an emergency room which served a lot of AIDS patients. After doing a procedure, I disposed of the needle in a sharps container. It turned out that someone had previously disposed of a very large needle in that container incorrectly, so that the tip was pointing straight up and out of the container. As I put my hand down towards the container, I sustained a large deep needlestick into my hand. There was no way to know whether that needle had been in a patient with the virus, but if it had, I had just sustained a high-risk exposure. No blood test for virus or antibody was available at that time, so it was impossible to monitor me to see if I had contracted HIV. I had just recently married, and discussed with my husband whether we should live separately for a couple of years (no one was sure yet that

sharing a household was safe). My husband refused to consider that. In essence he was saying that, if I was going to die young, so was he. Effect on physician education Obviously, AIDS came onto the scene during a different era of medical education, when residents and students usually “ran the show” regarding patient care, with often a very minimal amount of senior physician oversight. It is interesting, looking back with my 2020 brain, that there were no medical students in 1983 protesting the fact that we were all drawing blood and doing many invasive procedures on patients, and thereby risking our lives if we happened to stick ourselves. With the current COVID situation, I believe all US medical schools completely pulled their students out of direct clinical contact. From an educational standpoint, this is disastrous – you can’t learn to take care of patients remotely. Certainly once the acute personal protective equipment (PPE) shortage is relieved, I hope that all medical schools will restore vigorous clinical education to their students. The other education issue, more subtle and perhaps more applicable to residency education, is that over-exposure to one clinical entity may lead to under-exposure to other important clinical entities. This definitely happened during the early AIDS era. During my residency, I would estimate that at least a quarter of my hospitalized patients had AIDS. This of necessity decreased my clinical exposure to other illnesses I needed to learn about such as bleeding disorders, valvular heart disease, etc. Some residency programs had an even more skewed experience than mine, with about a half of their patients having AIDS, leading to a lack of attractiveness of those programs to highly-qualified medical students. It is too early in the COVID era to know if this illness will have a similar effect on medical education over the long term. Certainly it has skewed exposure over the short term, as our hospitals have been inundated with large numbers of COVID patients and our resident and attending physicians have stepped up to serve them. All physicians will need to learn a lot about COVID, as it will be with us for a while (Physicians who thought in 1983 that they would avoid treating AIDS patients turned out to be wrong, not just morally but factually). Those of us with input into medical education need to ensure that our learners have enough experience with COVID patients to learn how

ars literarium / special issue / winter & spring 2021 to care for them, but not so much that they don’t learn enough about other important topics. Use of unproven therapeutics It is natural for very ill patients and families dealing with a new and poorly-characterized infection to reach in panic for any treatment that seems to promise to help them. Doctors should have the ability to be more rational about this, and to adhere to our oath to “first do no harm”. The thing that has shocked me the most about the COVID epidemic, in distinction to the early era of AIDS, is how many highly-regarded physicians have disregarded this ethos and have made multiple unproven therapies the “standard of care” at their institutions. I have seen hydroxychloroquine, highdose steroids, other powerful immunosuppressants, and immune plasma all used in the absence of rigorous data and not in a trial setting, so that we as a profession will have no idea whether these therapies are useful. There are good theoretical reasons to think that each of these therapies might benefit patients, and equally good theoretical reasons to think that each of these therapies might harm patients. Until there are good studies showing that a drug provides a net benefit, we may well be doing more harm than good. Thank goodness Dr. Fauci, who came to prominence as an early AIDS researcher and stood up for evidence then, has maintained his stance that therapies and vaccines should be subjected to randomized controlled trials before we use them on patients across the board. In my opinion, all of us should follow his lead. Public reaction and stigma One thing that has been much more salutary about the COVID epidemic than the early AIDS epidemic is the public reaction. In the 1980s and 1990s, hospitals certainly did not celebrate their “healthcare heroes” for taking care of AIDS patients. Many national figures stated publicly that AIDS was God’s punishment for persons who had gay sex or used drugs. I remember being asked by well-meaning people why I would risk myself in order to take care of “people like that”. There was a terrible stigma attached to patients with AIDS, regardless of the way an individual patient contracted the illness. A whole generation of patients with hemophilia died young, shunned by society other than their families. I remember an older man dying in the hospital of AIDS which he had contracted from a transfusion during coronary bypass surgery. His family was so

frightened by his illness that they never came to see him and wouldn’t take him home. No nursing homes would accept any patients with AIDS, so he was stuck in the hospital until he died alone a few months after admission. Fear and stigma often go hand-in-hand. During the 1980s, an elderly patient who was a retired nurse remarked to me that, similar to the case with AIDS, her family had suffered enormous stigma and isolation during her childhood because her mother was dying of tuberculosis. So far, there has been great public fear but minimal public stigma regarding COVID. My hope is that good public health research will find that very simple interventions such as everyone in the population wearing a surgical mask will prevent most infections. That would help diminish the fear and might prevent the stigma. I think we will look back at this early time in the COVID era and think that one of our biggest mistakes was in barring visitors from coming into our hospitals. To have so many patients facing severe illness and death almost without family support strikes me as terribly cruel, especially since it is likely that simple interventions like universal masking, if enforced, could protect patients and healthcare workers alike. Looking forward We don’t know yet, of course, how COVID will play out. Will most infections turn out to have been asymptomatic, so maybe we are closer to “done with the dying” than we think? Will general population mask use and hand washing lead to a tolerably low level of community transmission? (I hope so) Will infection turn out NOT to confer long-lasting immunity, so that natural herd immunity is impossible and vaccine development extremely difficult? (I certainly hope not) With COVID having more severe effects in populations with less than average social power, such as obese, elderly, poor, and non-white persons, will a stigma around the disease develop? Will our public health systems be better prepared for the next pandemic? Time will tell – and, in time, our current trainees will share their early COVID experiences when the “next big thing” comes around.

from the wards

Fahrenheit 2020 All I see are matches, And cinders when I roam, Out of the comfort of my cave, The place I call home.

Miles away from my life, I finally hear her voice, She’s begging and pleading, For me to make the right choice.

The horse waiting outside, Onto it I climb, Inside’s filled with embers To ignite the thoughts in my mind.

“Stop setting yourself on fire, To keep others warm; For when you are ashes, You’ve lost your control.”

I turn toward the East, Look back to the West, The trot turns to a gallop, Towards the ones I love best.

I’ve donned all my armor, Inside still not safe, And for the rest of the battalion, War assumes a slow pace.

I strip off my armor, And crawl through the door, Exhausted but living, And believing once more.

Reinforcements are shackled, By messages fraught and loud, And the pitch of my cries, They don’t make a sound.

“Stop setting yourself on fire, To keep others warm; For when you are ashes, You’ve lost your control.”

“Surrender’s not easy,” Not in my blood..... “No war ends in victory” Though we think it should....

War isn’t for thinkers, They will surely die, While waiting for their leaders, To hear the last baby cry.

And I’ll stop setting myself on fire, To keep others warm; I will not be ashes, I’ll keep my control.

Jeremy S. Grayson, MD Associate Professor of Anesthesiology and Pediatrics Rutgers Robert Wood Johnson Medical School 47

hope

There Is Light Darkness, empty void so bitter and cold. Inundating the hearts of those who hate, Slithers through the body; like viscous paint. Those folks most disturbed, with dark thoughts untold Their minds wandering in a pool of mold. How did they learn, was it taught or just fate? Coming into this world so pure so great! How can you teach to hate another soul? We are all the same, regardless of skin. Black or white, man or woman we are one Together we build what has been undone. To learn from our past and do what is right We must unite and find the good within. Where there is hate, there is love…There is Light!

Silvio Giraldo Masters Student in Biomedical Sciences Rutgers School of Graduate Studies 49

ars literarium / special issue / winter & spring 2021

Together, We Are an Ocean Acrylic and Luminescent Paint on Canvas

Janet Cai, MD Resident, Internal Medicine Rutgers Robert Wood Johnson Medical School 50

hope

“Individually, we are one drop. Together, we are an ocean.”

–Ryunosuke Satoro

Together, the individual cells, lamellae, and glands featured in these paintings contribute to a complete functioning body. There is a kind of beauty about the individuality and unity simultaneously exhibited; as physicians, nurses, social workers, and other healthcare personnel, we are individuals ultimately working towards a common goal. We must also remain cognizant of other perspectives; sometimes, learning to see a situation in a different light can help us provide the best individualized care for each patient and family. In a time of abundant uncertainty, these concepts have come to the forefront - with little prior evidence to guide us, a multidisciplinary approach is paramount to providing the best possible outcomes.

ars literarium / special issue / winter & spring 2021

Untitled A battle we thought but a war had begun Life as we know it is no longer fun Sheltered at home with no place to go Unable to see those we love those we know An invisible enemy that we all ought to fear Our soldiers are fighting without proper gear Shields are on shortage, ammunition unknown Civilians are dying; the worst part alone Six feet apart we flatten the curve Giving our army their best chance to serve Because united we stand divided we fall We are all in this together; for one and for all

Melvin M. Makil, PharmD, MBA Oncology Pharmacist Rutgers Robert Wood Johnson Medical School

Harmoniousness “Help Us, Lord!”; Is my fervent prayer. “Anguish and Chaos have inherited the land!” Rage makes me come undone, when the Media’s mixed messages invade my ill-constructed Peace. Melancholy thoughts are whirling dervishes in my Head, Objectionable events make me wish Hate were Dead. Nervous laughter to offset the quiet Room’s tension, when I stated quite boldly: “Ignorance is King” - did I fail to mention? Optimism is the Mother of Hope; so United we stand and divided we fall, when Sanity can be found, Nowhere at all. Negative thoughts should be banned, from renting a room in your mind, so End how you start, then Start a new end, Sanity can be restored if we could all just be kind.

Frances Ruff Secretarial Assistant Rutgers Navy ROTC 52

hope

Musings of a Vaccine As we nurse our wounds and tend to the sick Change our routines and habits We search for the end to this nightmare Which had destroyed our lives We look to a vaccine, promising to cure us, To take away our pain and give us hope We look to a future, where everything is normal, Where sanity is restored to our lives But will the vaccine heal our scarred bodies? Heal the blood we have spilled fighting a silent killer? Or will it feed the divisions we have faced The greed and hatred which has risen, Lying dormant until now? Will it heal the lies we have been fed At which we had latched hungrily After being starved into compliance. Will its mass production benefit us, If all we have left is a dying memory Of what once was And no inkling Of what’s next? Will this vaccine bring back All the lives we lost, the hopes that were dashed? Or will the needle only remind us, Of the pain we have suffered At the hands of ourselves? As we receive promises Of a vaccine that can cure all We must ask ourselves What is there left to fix?

Jeff Ho Intern Rutgers Environmental and Occupational Health Sciences Institute 53

ars literarium / special issue / winter & spring 2021

Rise When all is said and done, When the war against COVID-19 is won, We’ll leave our houses and raise our hands up to the skies, We’ll hug and laugh and be with one another, Pure joy will fill the hearts of every mother and father, sister and brother, And we will rise up again, We will find joy where there once was pain, So although, right now, life can really get you down, Keep pushing and have faith that it’ll turn around, We will rise, we will rise up once more, With a newfound perspective, much wiser and stronger than before.

Kopal Bansal Masters Student in Biochemical Sciences Rutgers Biomedical and Health Sciences 54

hope

Front Cover: Wear a Mask (Digital) Danielle Lee / MD Class of 2024 Rutgers New Jersey Medical School

Back Cover: A Year to Remember (Digital) Nivetha Srinivasan / MD Class of 2023 Rutgers New Jersey Medical School