Ars Literarium Volume 1 by Rutgers New Jersey Medical School

VOLUME 1

ARS LITERARIUM

THE LITERARY JOURNAL OF RUTGERS NJMS AND HEALTH PROFESSIONS SCHOOLS

VOLUME 1, 2016

A NOTE OF THE EDITORS

In our first few months of medical school we learned that there is little in medicine that does not involve narrative features. The education, the clinical training, and the research are all in some way infused with the receiving, telling, or creating of stories. We began our medical training by learning about the science of human anatomy, physiology, pathology, and beyond. And while we continue to tighten our grasp on the science of medicine, we have come to realize that there is an equally important art of medicine. This art is interwoven with the narratives of others, and it allows us to see patients as more than mere bodies to heal. Narratives allow us to learn, to find meaning in experiences, and to make connections with ourselves and with others. In this 06

first volume of Ars Literarium, some of those stories that would otherwise be lost are presented here to preserve the lessons that they can teach, and the feelings that they evoke in the authors and in others. The art of medicine is also an indispensable part of being a competent physician, not only in the many nuances of clinical reasoning, but also in working with patients and the challenges that brings. The ability to reflect, learn from the perspectives of others and collectively grow through art has become for some of us a way of reasoning and working through the vicissitudes of our own lives. Some of the writing pieces shared in Ars Literarium are both cathartic, and an eloquent reminder that words themselves heal.

Within these pages, you will see the artists within all of us (or perhaps just 40-or-so of us.) We hope that you will find the stories within worth celebrating, and their lessons empowering. There are many perspectives represented by these stories, as many different kinds of people carry these experiences with them. Physicians, nurses, patients, public health professionals, and healthcare providers all share different sides of one experience that we hope to vivify with these stories. So take a look inside, and find how everyone involved in the vocation have found a means to balance and a space to heal.

ARS LITERARIUM EDITORIAL BOARD 07

TABLE OF CONTENTS

EVAN SPIVACK

Who Are You?

JONATHAN LIM

The Unwanted Patient

NATALIE SMITH

The Drawer

MICHELLE CORDOVI

Shame With a Side of Toast

CELESTINE ODENIGBO

An Ode to My Soulmate; A Sageâ&#x20AC;&#x2122;s Poem

SANJILA ISLAM

Study Area

TOVA GERBER

This Sky

MEMORY NDANGA

If only I could

BETH A. PLETCHER

Rebuilding NYC

ANONYMOUS

Hospitali ya Mkoa

MONICA MALONEY

For You

PETER NIELSON

Wail

BETH A. PLETCHER

Heartless

EMANUEL GOLDMAN

Departure

PETER REZKALLA

Photography series

NEEL SANGAL

Face to Face

PETER SHUPPER

White Out; Passion Puddle

SHARON GONZALES

Unexpected

HOA PHAM

Somea(nta)gonizing poems

MARGARET MORALE

Love is

EUNJUNG LILIANA KIM

Shadows; Reality

MYRON PULIER

The Exam 09

“Who are you?” the woman in the bed demands A reply, but the answer does not satisfy Again, she demands “Who are you?”

How did you get here, to this place? Standing by the bed of a withered, hospital-gowned old woman Her eyes at once accusing, questioning Looking past the white coat and stethoscope Not the first who has stopped by today Nor likely the last One in a never-ending parade: “Who are you?”

What, really, are you doing here? Why are you here? To feel a pulse? To listen to a murmuring heart? To order yet another test? To draw yet a few more drops of blood? Really—what can you do for me? “Who are you?”

WHO AR E YOU?

Lying in the over-warm, under-lit room Her world confined between two bedrails She peers out from a sea of white Pillows, sheets, blankets Resigned, turning her head away, She utters from dry lips “Who are you?”

EVAN SPIVACK, DDS PROFESSOR, PEDIATRIC DENTISTRY, RSDM

THE UNWANTED PATIENT IN THE STYLE OF WILLIAM CARLOS WILLIAMS, M.D.

This is just to say I have examined the patient that was in room 5 about whom you were probably complaining during lunch Trust me she was human so sweet and so ill.

JONATHAN LIM NJMS â&#x20AC;&#x2DC;17

THE DRAWER NATALIE SMITH NJMS ‘17

Sweat slowly gathered at the base of Angela’s neck as she waited in the tiled room, and it bothered her that her hair was damp. She grimaced as her father’s voice boomed in her head, “Horses sweat, men perspire, and women…” Women were supposed to glisten or glow or something ridiculous. Everything was decorated in light pink and blue. In her exhaustion, she forgot to look before she sat down, but now she saw that she sat in a plastic chair that was baby boy blue. Always superstitious, she shifted herself over to a pink one. The TV propped up in the corner was not loud enough to hear, and the subtitles were large enough to cover half the screen. Angela never understood the point of providing subtitles to a TV show when they came two minutes after the words had actually been said. In the meantime, they ruined the show for everyone who could hear. She looked around her to find some wood to knock on but had to content

herself with apologizing silently so that God would not curse her with a deaf baby. What was worse: a deaf baby or a blind one? A deaf one would be eerily quiet like a child from a horror film. She shuddered at the thought. In truth, she did not know how she felt about the life inside her. It was what she had wanted, had planned for all her life. She wanted to be a mother of three girls like her mother and grandmother before her. She closed her eyes softly. Three generations of three girls. She could feel the tiny dark curls of hair running through her fingers. She could kiss the tiny perfect toes. Her vision was shattered by the dream from the night before. It had been a recurring nightmare from her childhood she had all but forgotten. Some details were so vivid it seemed like a memory. She first had the dream when she was eight. There was a house open to visitors. Above, the sky was a claustrophobic Belgian grey. The cloud cover was so dominant it erased color from the scene. It pressed down like a dense fog, made it hard to breathe. The monochromatic house loomed

large. Angela felt the crunch of gravel beneath her feet as she approached the front door. She was aware that her cousin was beside her, and her mother and aunt were somewhere near. Then, in the mysterious way of dreams, the house suddenly disappeared. She and her cousin were in a dark closet now. In the small space, a naked light bulb shone on a small table with a single drawer. It was a plain, undecorated table made of dark wood. Maybe that is what made it remarkable. All those old houses were crammed with antiques—even in the bathrooms—and here was the most insignificant table. Her cousin screamed and ran away. A spider had dropped down from the ceiling and scared her away. She was the one who had taught Angela not to be afraid of the dark. Now Angela was alone in the closet, and she carefully opened the table drawer and hid a picture she had made inside. Then she was in the car with her family, pulling away from the strange house. She felt like she was missing something important. She felt an ache in her chest where it used to belong. She wanted to turn back and retrieve the drawing, but it was too late. The table had it now, locked away in a mildewed closet,

hidden behind the fog, never to be found again. The doctor came in to get Angela and apologized for the heat. He was a large man with an olive complexion and kind dark eyes, and she immediately relaxed in his presence. The translucent jelly felt cold and strange on her stomach. The doctor turned off the lights, and the room became loud with the whooshing sound of her baby’s heartbeat. She watched the doctor’s face instead of the screen. He smiled at her as he moved the probe around, “Everything is looking good. That’s the head there. Let me see if I can get a good profile view.” Angela kept her eyes fixed on the doctor. He did not seem worried. In the reflection of his glasses, the baby’s face came in and out of view. There was a tiny hand, clenched into a fist. The doctor asked, “Would you like to know the sex?” She managed a smile and lied, “I just want it to be healthy.” “You’re doing everything right,” he reassured her, “Don’t stay out in this heat though. Drink plenty of water.” He handed her some ultrasound photos to hang on the fridge. She shook his bear paw of a hand, and he left her to change.

She looked down at her swollen belly as she dressed and scowled at it. Did her husband still find her attractive? There had been such desire in his eyes the night they met at the embassy. He had seen her in her dark blue gown standing by the fireplace. His first words to her were, “You are the woman I am going to marry.” She had believed in fate. Now he met her gaze less often, spoke to her less, touched her less. She looked at herself in the skinny exam room mirror. She was barely showing. He thought of her differently now, because she was a mother. Now, boy or girl, this child made her a mother. She left the exam room, made a follow-up appointment at the front desk, and walked towards the elevators. As she watched the elevator doors close, she resisted tears and felt them burn behind her eyelids. She thought of the drawing she had left behind in that table drawer in that lonely, spiderfilled closet. It had been a drawing of a home.

THE DRAWER - N. SMITH NJMS ‘17

Thursday morning paved the way for a labyrinth of emotions that I didn’t care to feel that day. Breakfast with girlfriends weeping over unfulfilling lovers, hungry bank accounts, thirsty social lives, and other reapings of what they’ve sown. I listen as I swallow my own Breakfast, that is. My comforting smile hides all of the wasted hours I’ve spent on my couch and all of the people I didn’t feel like making time for. Two dollar lipstick and unwashed jeans my attire of choice to match my lazy lust For dreams of success without action For orgasms without background noise And for books that don’t steal so much time . Books that I like with a little wear and tear signs that I’ve used them and abused them without so much as the care to read them whole. Worn and torn by a girl who rips the world to shreds tapes together all of the pieces and says, you’re mine, I love you. I continue eating my omelet.

SHAME WITH A SIDE OF TOAST

MICHELLE CORDOVI DOCTORATE OF PHYSICAL THERAPY (DPT) SCHOOL OF HEALTH RELATED PROFESSIONS (SHRP) ‘18

AN ODE TO MY SOULMATE A shout-out to my Best Friend and my Worst Enemy, My Reward and my Retribution, My Monica and my Jezebel, The one who tells me ‘as it is’ and not ‘as I want it to be,’ My Love, my Life, my Delilah. The one who chained Hercules and turned my Mighty Roar into a mere whimper! Mother to my Princess, A Happy Birthday to you my love. May fortitude, wisdom and love continue to shine through you. Obi’m in my next life, I will still seek you out. Thank you for all you are and more!

A SAGE’S POEM In the ages of old, When men were men, A prayer was sent, To Allah above, By ‘a mother to be,’ For a son to bear, Lo and behold! A bill was payed, and was called Nabil!

CELESTINE ODENIGBO, MD. PGY4, INTERNAL MEDICINE/PEDIATRICS RUTGERS NJMS

STUDY AREA SANJILA ISLAM NJMS ;18 24 22

THIS SKY Just a couple more hours lying in the sun, staring at the clouds like prizes we’ve won. Bluer and deeper than any pool I’ve seen, whitest of fluff fills cotton-candy dreams. Just a couple more minutes lying in the heat, skin needs to tan on these sandaled feet. Paper and books fly in the breeze, carelessly we watch them away with ease. Just a couple more seconds out in the rays, we say to the little ones as they run and play. They rub the sunscreen from their face, a protection our love cannot replace. Just a couple more moments under this sky, before I find myself above it high. Going back to the place where I began, when the blue was my inviting friend. When these freckles and spots didn’t know my face, when I didn’t think I’d have to leave this place. When the white clouds were made of dreams, before they deflated to bags of steam. Just one more moment under this sky, then I must, reluctantly, say goodbye. I’ll do what I wish on a summery day, to swim in the blue and float with it away.

TOVA GERBER GRADUATE SCHOOL OF BIOMEDICAL SCIENCES 24

CLASS OF 2020

MEMORY NDANGA SCHOOL OF HEALTH RELATED PROFESSIONS

I heard them say there is nothing else they can do They told you to prepare for the worst They suggested all they knew how to They even went above and beyond their training And yet somehow you still feel like they failed you If only I could have one more idea, just one more fling of hope I would smile and install hope in you I still believe you can still fight-there is always hope

IF ONLY I COULD ONLY

If only I could take the pain away, I would switch places with you So you did not have to suffer Maybe if life was really fair, things like this would not have happened to someone like you If I could really turn back, I would have really watched and prepared myself And maybe, just maybe I would have all the answers for a day such as this Somehow deep inside, I see ties of sorrow Ties of frustration and anger You ask yourself why me? If only I could answer, I would tell you it’s not your fault I would tell you of the many that have been in your shoes The many that have had it worse than where you are right now But wait what if the only thing I could tell you Is to hold on to hope Hold on to faith, miracles do happen If only I could, I would tell you to believe God stills heals , he hears, he answers He might just be the one you haven’t tried The only one you haven’t called on If only I could, I would pray that you lean and trust in his healing power 26

REBUILDING NYC BETH A. PLETCHER, MD ASSOCIATE PROFESSOR OF PEDIATRICS AND MEDICINE RUTGERS NJMS 28

HOSPITALI YA MKOA

They were distant boulders not headstones. My eyes had tricked me as I awoke from napping and glanced across a field of maize as we drove northward to Kondoa. A herd of cows grazed along the roadside. Death too soon was common in Dodoma. A day-old baby breathed desperately during Tuesday and died from sepsis on Wednesday. An unwatched mother of another newborn was hemorrhaging. A child nearly obtunded with malaria was brought to the hospital only after herbal remedies had failed, after too many days had passed. A healthy newborn baby slept peacefully atop a gurney as stillborn twins wrapped in a shuka rested on the shelf below. If a baby cries at birth and thrives, and his mother survives to provide milk, they may grow to be among the privileged young boys who herd cows, as others till the maize field. Milk from the udder could be taken whenever they grow hungry.

ANONYMOUS AUTHOR

A DAYOLD BABY BREATHED DESPERATELY DURING TUESDAY 31

FOR YOU

WAIL

MONICA MALONEY

PETER NIELSON

GRADUATE SCHOOL OF BIOMEDICAL

NJMS ’19

SCIENCES (GSBS) ’16

Feet face north, greet with anticipation the undulating waves that ask to be met before ceremonially cresting. The waxing moon creates a silver streak of fire across the rippled surface, igniting a path to the horizon. She inhales, lifts head, like a needle on a compass, shaky, then steady while wind whips her flaxen hair in floating tendrils round her upturned face.

pulse point relaxation of thick muscle and tendon. Under skin surface, a steady current of energy emerges and synergizes with the power of the white foamtrimmed, navy blue ocean before her. She contemplates in muted study, the path, so displayed before her upturned face and forward facing feet.

And the screaming and the screaming of sirens, interrupts yet another moment; sadness about a made up paper company, before that, a song sung with a friend, a conversation earlier. Those sirens were blaring, maybe towards the end of someone’s life. Yet, I have paused my own screaming. No one can hear my screams, day after day, dollar after thousand of dollar. No one cares about my crying, our screams. Most people don’t even care about the screaming in the street, but I do. Those screams matter-most screaming matters. You have to listen deeper. The screaming in the streets here is normal, but let’s not forget that our own reason for screaming, for wailing at all hours of the night, is to learn to care for the screams you can’t yet hear.

She massages the space between thumb and forefinger

LESS HEARTLESS We kids called him “Heartless Hansen”, but we never said it to his face. The Hansens lived at the corner of our sort of circular subdivision in suburban Chicago. There was a two block straightaway leading into our neighborhood which was connected to the “circle”, so that we actually lived in a lollipop-shaped cluster of homes. Within the 32 houses lived mostly families with young children as well as a few older couples whose children were grown and out of the house. Mr. and Mrs. Hansen were the exception. They were childless. They also rarely came to neighborhood events or interacted with the rest of us. We knew them only because they seemed obsessed with their yard. Except in the winter when snow and ice kept us confined, or at least confined to our own yards, where we built snow forts and made battalions of snow angels, we were in perpetual motion around the neighborhood. At the first sign of spring, my friends and I hopped on our bikes after pumping up tires that had gotten soft over the winter months. We sped down the hill toward the Hansen’s house, careening around the corner and making the loop time after time, the breeze cooling our damp foreheads despite the sun’s earnest efforts to overheat us.

BETH A. PLETCHER, MD ASSOCIATE PROFESSOR OF PEDIATRICS AND MEDICINE 34

RUTGERS NEW JERSEY MEDICAL SCHOOL

Summers were filled with bike riding, tree climbing, picnics and swimming. We would be out of the house all day and our parents never worried where we were or when we’d be home. We had no cell phones and were certainly unable to text our whereabouts. It was an exhilarating and carefree existence. As we sailed around the circle (sometimes making it around the entire loop “no handed”), we would call out to our neighbors and friends, waving and shouting as we shot by. Sometimes we’d stop to chat with the adults or kids, and even lend a hand if there was yard work to be done. The exception, again, was the Hansens. During almost every trip we made around the circle Mr. and Mrs. Hansen would be outside tending to their yard. Bear-like Mr. Hansen meticulously trimmed the shrubs and maintained the lawn’s immaculate condition while petite Mrs. Hansen concentrated on dismissing weeds from the flower beds. In front of their house stood a sturdy red maple that blazed with color each fall. In stark contrast to their rather plain home, this maple tree became a breath-taking autumn sentinel that maintained its vigil until winter cruelly stripped away its leaves. Every once in a while we’d forget ourselves and call out to the Hansens, too, but Heartless never looked up or stopped what he was doing. Mrs. Hansen might flap her hand in return, 36

but never called out to us. Most of the time we rode by in silence. Although there were not any NO TRESPASSING signs in their yard, we knew we were not welcome. Not a single one of us ever set foot on the Hansens’ property. When it came time to go door to door “Trick or Treating” or selling magazines for fundraising events, all of us skipped the Hansen house. We knew they would not welcome our intrusion and we chose not to disturb this grouchy old couple. Looking back, the Hansens probably weren’t all that old. They both had full heads of salt and pepper hair and were, perhaps, in their mid-fifties. Even at Christmas time, as the neighbors went from door to door singing traditional carols and gradually adding reinforcements, the Hansen’s doorbell remained unrung. On these nights their house was always dark, with no lights on and no signs of life. Strange how they were away every year for the Brenwood Estates caroling and holiday celebration. On a cold December afternoon when I was about 12, I was lagging behind the jolly carolers, trying to awaken my slumbering toes and rewrap my red woolen scarf. As I stomped my feet and rushed to catch up, I was startled to see, out of the corner of my eye, a fluttering of the curtain that stretched

across the Hansens’ front window beyond the leafless maple. The crowd forged past the Hansen home enroute to the O’Gormans, but I took a closer look and was shocked to catch a glimpse of Mrs. Hansen’s head. Perhaps it was my imagination, but I thought she saw me too. She glanced away quite abruptly and gently reset the drape’s edge. I began to wonder if the Hansens had been pretending all these years to not be home so we would bypass them and not force them to listen to our joyous songs. At the after-party while sipping hot chocolate and thawing my frozen digits, I briefly considered what I had seen. Surely the Hansens couldn’t be that antisocial; perhaps they didn’t celebrate Christmas or maybe they were atheists. Why would anyone pretend year after year to not be home? While it was a mystery to me, I never breathed a word to anyone about what I had seen – not even my best buddy Cathy. The Hansens’ house backed up to the house inhabited by the O’Gorman clan, a boisterous Catholic family of nine with an in-ground pool out back. On the rare occasion when my friend Cathy and I were invited to the O’Gormans to swim, we had a splendid time splashing and cavorting in the pool. During these summer pool excursions, the Hansens retreated into their home, abandoning their

garden tools and barricading themselves inside. Soon after, we’d hear the rumble of their window air-conditioner as they shut out the sound of our laughter. Once when we were playing a lively game of softball over at the O’Gormans a fly ball sailed into the Hansens’ yard while Mr. Hansen was working along side the house. Frankie O’Gorman dashed toward the Hansen’s yard, abruptly pulling up, teetering at the boundary between the O’Gorman’s crabgrass laden lawn and the lush grass carpet that was the Hansens’ pride. Frankie called - “Hey Mr. Hansen! Could you please throw us the softball over there?” Statue-like, Mr. Hansen just stared back. He made no move toward the errant ball laying a mere 20 feet from where he stood. Instead, he shook his head, grumbled to himself, and returned to trimming the shrubs. This was the moment when Mr. Hansen was forever dubbed “Heartless Hansen”. After college in California I returned to Chicago to attend medical school. During the many hours in the anatomy lab, I occasionally considered what it means to be heartless. Our amazing muscular cadaver, Boris, gave us an incredible gift, permitting us to dissect and explore the nerves, tendons, ligaments and muscles of his now pickled self. While we never learned his true identity, we did determine he had died quite suddenly of a heart 37

attack at the age of 42. When we opened his chest we uncovered Boris’ fist-sized heart bearing the signature of an infarction. His weakened ventricular wall did not allow him, apparently, to survive his first massive coronary event. In retrospect, this first glimpse of a human heart inspired me to become a cardiologist. As we four lab partners explored the inner workings of the human body, we had to remove Boris’ heart to identify all the connections and anatomic structures. Removing his heart from his chest and placing it on the table beside his left arm, I was reminded of the word heartless. Boris was currently “heartless”, yet he had generously donated his body in order for students to learn. My thoughts returned momentarily to Brenwood Estates and “Heartless Hansen”. The final day of anatomy class the four of us paused for a moment around our cadaver friend to consider the gift he gave us in his death. We replaced, as best we could, his various parts and organs; I gently slid his damaged heart back into his chest. My fourth year of medical school I came home one week-end to visit my parents. I hadn’t lived in Brenwood since leaving for college, but the neighborhood looked much the same. Heading back to Chicago to prepare for an elective in oncology, I passed by the Hansens’ home. Out of 38

habit I stole a look at the solemn brick structure and was surprised to see Mr. Hansen standing by the red maple tree in his front yard. The storm the night before had taken its toll; a direct lightening strike had split the maple tree in half. Mr. Hansen, now with a full head of white hair, stood stiffly staring down at the broken tree. I knew his wife had died very recently. I slowed down and slid over to the side of the road. While I did not have the nerve to pull up on his driveway, I found myself exiting the car and striding up the walkway. I paused momentarily, taking account of the fact that, at the age of 24, I was “trespassing” for the first time on the Hansens’ property. However, Mr. Hansen’s obvious torment prompted me to continue my journey. He didn’t see me until I was about 15 feet from the fallen tree. His sad eyes met mine and I tried a tentative smile out on him. I said, “Mr. Hansen, you probably don’t remember me, but I am Beth, Faye and Joe’s daughter from down the way.” He nodded silently and I filled the void. “I see your tree took a direct hit last night in the storm. Is there anything I can do for you?” Mr. Hansen replied, “Irene and I planted this tree the day we found out she was pregnant. We were newlyweds and, although the tree was pretty flimsy, it nearly cost me a month’s wages.” I was still

reeling from the news that the Hansens had a child, when he surprised me by inviting me into his house. Immediately I thought of several polite excuses to allow me to depart without raising suspicion. However, the truth was that I was really not in a hurry, and could afford to spend a few minutes with Mr. Hansen. I had come this far into his yard, so why not go into his home? I told him I would be happy to visit for a while and followed him up the two cement steps into his house. Entering the living room I took in the 1950s décor and the sofas with clear plastic covers. Since I doubted they had many visitors, if any, I could surmise why the furniture retained its veil of newness. I gently lowered myself onto the gold brocade loveseat as Mr. Hansen took refuge in the matching chair. He seemed ill-at-ease and finally gave me a half-smile. “Beth,” he said as if reading my mind, “Irene and I hardly had any company, but she really loved this living room suite.” I nodded now, not knowing what to say myself. Mr. Hansen, though, found his voice and continued. “Your parents tell me you are in medical school. They are so proud of you.” I was shocked my parents had any communication with this bristly man. “Irene passed away eight months ago from cancer.” He paused, “It was pretty bad there at

the end.” I found my voice, “Yes. Mr. Hansen, my parents told me about Irene and I am very sorry for your loss.” That phrase – very sorry for your loss - that I say reflexively to patients who reveal a death in the family, rang hollow now in this more intimate setting. Mr. Hansen, though, seemed not to notice my momentary hesitation and he began to tell me of Irene’s five year battle with metastatic ovarian cancer. Several times that afternoon his eyes welled up with tears and he dabbed them away with his handkerchief. He asked about the most current treatments for ovarian cancer and wondered aloud if they shouldn’t have gone for an experimental protocol available only at Memorial Sloan Kettering Hospital in New York. He was incredibly knowledgeable about his wife’s condition, the prognosis, therapies, as well as the unwanted side effects. We drank tea out of Irene’s lovely bone china cups and he told me more about their life together before cancer. He said, “Irene and I always planned to have 2 or 3 children. We were both onlies and wanted to have a real family. A few months after we moved here, Irene found out she was expecting. That was when we ran out and bought that maple sapling. Then she miscarried at about five months. The doctors told us it was a little girl. Irene named her Hope. We 39

never really had a proper burial for her. They said it would be better if we let the hospital take care of her remains. For Irene and me, that little maple was our hope for a family.” By this time I was choked up and could only reach out and pat his hand. Although I anticipated that he might pull away at my touch, “Heartless Hansen” let me squeeze his callused paw. He went on to explain that Irene had suffered three more miscarriages before the doctor declared it too dangerous for her to try to carry another pregnancy. They had even looked into adoption, but by then they were judged to be “too old” by the agencies. So they resigned themselves to life with just each other. At one point, Mr. Hansen declared, “I used to watch you kids riding your bikes around the circle and sometimes wondered what it would be like to see my son or daughter zipping along like that. For Irene it was a different story, you see it was hard for her to be around children here in Brenwood. Watching you grow up and seeing the changes from year to year was a reminder of what we never had. Truth be told, even if we never saw or heard you kids, that darn maple tree was a reminder of what we had lost. I swear Irene had something to do with that tree being hit last night by lightning!” 40

After a while Mr. Hansen pulled out their ivory leather-bound wedding album and we sat side by side looking at the photos. They looked so young and happy that day, surrounded by friends and family. He asked me to call him Bill, indicating that I was too old to still be calling him Mr. Hansen. I learned Bill had no family left; his parents and in-laws were long gone, there were no nieces or nephews, only cousins who lived in Florida and Texas who rarely called. I discovered he had been in the service during World War II and he met Irene on a blind date. They had settled in Brenwood because of the large lots and excellent school system. He asked me what it was like growing up here, and I assured him it had been a perfectly wonderful childhood. I explained that my neighbor friend Cathy, who I first met at age three, was still my best friend, despite the fact that she was living in California. I told him how I had decided to become a cardiologist and was in the process of applying for residency. When we parted that day I gave him a hug and my address in Chicago, promising to keep in touch. I vowed to myself to write to Bill at least once a year. That December I sent him the first of many Christmas cards. During the final year of my cardiology fellowship at the University of Chicago, Mr. Hansen’s name

unexpectedly appeared on the list of patients coming in that day for cardiac catheterization. I found him sitting in the waiting room, perched precariously on the edge of his chair. He smiled broadly as I crossed the room to greet him. I said, “Bill, why didn’t you tell me you were coming here for a procedure? I would have made sure you got the VIP treatment!” He said, “My doctor sent me here and told me I’d be in good hands. I didn’t want to bother you, but was pretty sure this is where you worked.” “Not only do I work here, but I am going to assist Dr. Quintana today. I will be there during your procedure as long as it is okay with you. However, since you are here on official business, I’m going to have to call you Mr. Hansen.” He reached out and grabbed my hands. “It would mean the world to me to have you there. Truthfully, I have never been so scared in my whole life. As much as I miss my dear Irene, I’m not quite ready to join her.” When I explained to Dr. Quintana that our third patient was my former neighbor, he gave me approval to assist. I obtained the consent from Mr. Hansen and gathered his medical history. He had

been having angina for several months already and depended on nitroglycerin to ease the gripping chest pain. He was no longer able to keep up with the yard work, and had had to hire a landscaper to do the job. Naturally the landscaper didn’t quite live up to his standards, but he said he had learned to live with some imperfection. We carefully reviewed the risks and benefits of the procedure, and once again I reassured him that he was going to do fine. I explained that if a narrowing or blockage in a coronary artery was identified, we might recommend placement of a stent (a small metal coil) to keep the artery open, or possibly bypass surgery. Mr. Hansen looked small and frightened on the table, a far cry from the hulk of a man I recalled from my childhood. As I prepped his groin, cleansing it with antiseptic, we chatted about the neighborhood, how folks were buying older homes, knocking them down and replacing them with McMansions. Soon the catheter was snaking its way up his femoral artery, appearing quite suddenly in the atrium of his heart. The flash of dye shot through the coronary arteries, quickly dissipating into his bloodstream. In that instant, as I stared at the screen, it dawned on me that I was visualizing “Heartless Hansen’s” heart. His tight grip on my right hand brought my mind back to the task at hand. Fortunately, Mr. Hansen had only 41

a partial blockage and a stent was promptly placed to ensure a steady supply of oxygen to his hungry myocardium. He was discharged that day and vowed to get back to his yard work as soon as he recovered from the procedure. Two months later I paid a visit to my parents and, feeling a burst of energy, decided to stroll down to see Bill. As I took in the crisp fall air and the changing landscape in Brenwood Estates, I saw a flash of red at the bottom of the hill. When I drew closer to the Hansen home I discovered a small yet determined red maple standing proudly where the old maple tree had been. I sped up the walk and rang the doorbell. Bill pulled the door open and registered his surprise at my unexpected appearance. “It’s such a lovely autumn day.” I said, “Would you like to join me on a leisurely walk around the circle?” He donned a light jacket and we began our Brenwood trek. I smiled at him as we started down the driveway, pointing to his tree and saying, “I guess you really missed that red maple after all.” He sheepishly explained that he planted it on the one year anniversary of Irene’s passing, and seeing it no longer brought him sorrow, only joy. “You see,” he said, “Irene and I nurtured and loved that 42

first maple tree like it was our child. So when I see that tree I think of my lovely wife and remember the sparkle in her eye the day we planted it. Just so you know though, if another bolt of lightening wipes out maple number two, I am going to take it as a sign that Irene wants me to find another way to honor her memory.” At this he chuckled and shook his head. We walked on that day, enjoying the breeze and our relative solitude. We didn’t comment on the evolution taking place in our neighborhood, although I secretly longed for the smaller, simpler homes of my youth. We walked on, lost in our own thoughts, yet keeping pace with each other. I thought of Irene and what she had missed by allowing herself to become frozen in her grief. In his attempt to protect her, Bill too, had lost out on some wonderful relationships. At the end of our journey I gave Bill another hug, sensing an ease in his embrace that I never felt before. As I turned to walk back up the hill, I glanced back for just a moment and saw him with his shock of white hair standing by the firey red maple, right hand in his pocket and left poised in the air. Mr. Hansen waved good-bye and called out, “Give my best to your parents, Beth.” Waving and jogging up the hill I wondered what my childhood friends would say if they learned that Mr. Hansen wasn’t heartless after all.

HEARTLESS - BETH A. PLETCHER, MD

DEPARTURE Who will miss me when I’m gone to tour the prisms of the spheres, to Asia, Mars, and Jupiter? For is the infinite no more than labyrinth to trap my years? The endless bound’ries summon like a knowing ghost of Elsinore. Thus I fear that my undoing, written in the void of time, is there for all to read but me. And who will miss me, knowing all about the prisoners of space, how the infinite comes round full circle, whose zenith is a spot? I never should have left my place, they’ll think, not knowing that the tide will rise at evening, that a tot must seek its mother, that a man may sometime die, and that I can’t hide from travel, even when I go.

BY EMANUEL GOLDMAN, PHD PROFESSOR OF MICROBIOLOGY, BIOCHEMISTRY & MOLECULAR GENETICS RUTGERS NEW JERSEY MEDICAL SCHOOL

RED STOOL This title means something completely different in a hospital. PETER REZKALLA 46

NJMS â&#x20AC;&#x2DC;19

DID YOU BRING THE PADDLE? I thought you did... PETER REZKALLA 48

NJMS â&#x20AC;&#x2DC;19

GOTHAM. Jk, it is Rockefeller Center underneath the Christmas Tree. PETER REZKALLA 50

NJMS â&#x20AC;&#x2DC;19

KRAWEN Newark PETER REZKALLA 52

NJMS â&#x20AC;&#x2DC;19

NEEL SANGAL NJMS ‘19

FACE

What is this dreadful irony? Why must this be the only path? Please, deliver me from myself. My dire thoughts make me faithless. The beast- no, my friend- beckons to me with his kind eyes, wise countenance, and strong ivory tusk. My duality has become my torture. Light and dark pull through my head. The bright is marred by death, the black brightened by a glorious ray of life. I waver between past and present. The present and future have merged with my past. As a child in the wilderness, I formed a tight bond with the forest. My mother was nature and my soul became one with the jungle. Delving deeply into the tangled brush, I would become attached to creatures large and small. I rode on the backs of elephants, sparred with hippos, and danced with wolves. I was completely alone, but with the beasts was my home. There was especially one, Tantanuga, the elephant. He was my dearest companion. Characterized by a grievously sharp wound from the misguided aim of a deadly

poacher, he exemplified the traits of life. I loved him and he loved me. Anger overcame me whenever I saw it and I vowed to avenge the murderous cut. As I grew older in the jungle, I yearned to spend more time with my own race. I left my companions and traveled through the jungle until I came upon a quiet village. Although the villagers were wary of me at first, my deep knowledge of the wilds eventually gained their respect. A few years after my assimilation into the village, I bore a son. Although I had never been happier, I soon realized I had no means to provide for the child. Just as I had, my son was forced to live off of the jungle. Flitting through the brush, aglow with unadulterated happiness, my young son was my guiding light of the jungle, the reminder of base. His dark hair fell in tight ringlets about his carapace like a trickling waterfall, a cocoon of angelic virtue. His deep brown eyes told stories about lands far away, searching, for a new frontiers. He woke to the rising sun, rising the sun as he woke. But my son’s rustic painting

soon faded. From the strong and glowing, he dimmed to sickly and insignificant. The local people said the spirits had taken him. But I knew better as my time in the wilderness taught me much about the maladies of the body. With my son, however, I was proven powerless to stop the hungry tide of the sinister monster. I was nothing, a broken soul without my son. He was the sun to my sea of black.

famed, glorious Western countries. I turned to the underground, agonized and tormented. I finally found something. A foot long ivory tusk was worth enough to pay for the treatment. I could have my son back!

I traveled long and far through the drought, famine, and deaths that had ravaged my country until I reached a widely renowned care center. I described my son’s

Jumping with joy, harpoon in hand, I ventured into the jungle. With my superior tracking skills, I soon came upon the tracks of a large, powerful elephant. I tracked carefully, giving no hint of my arrival. Coming upon the back of the elephant, the beast flipped his head and I came face to face with a grievous wound, the wound of Tantanuga. I had my harpoon raised, poised and sharpened for the kill.

weakness and his impending doom. The evidence was conclusive. My dear child had been the dupe of the dengue. Without immediate care he would become a fatality of the dreadful curse. However, in my country, there was no wonderful nationalized healthcare like there was in the great Western countries and I could not pay for treatment. I was shattered. I tried to look for work. Here though, there was no wonderful jobs bill like there was in the

But what is this dreadful irony? Oh why must this be the only path? Please, deliver me from myself. The beast, no wait, my friend, beckons to me. His kind eyes, his wise countenance, and his strong ivory tusk beckon to me, calling me. My duality has become my torture. Loyalty and duty pull through my head, the bright side marred by the death of my friend, the absence of light brightened by the bright ray of the possibility of life for my son. 55

WHITE OUT PETER SHUPPER, MD RESIDENT PHYSICIAN DEPARTMENT OF PHYSICAL MEDICINE AND 56

REHABILITATION

PASSION PUDDLE PETER SHUPPER, MD RESIDENT PHYSICIAN DEPARTMENT OF PHYSICAL MEDICINE AND 58

REHABILITATION

SHARON GONZALES MD CLINICAL ASSISTANT PROFESSOR DEPARTMENT OF RADIOLOGY, UH

UNEXPECTED Unexpected Just when you thought You were numb to all the pain and joy, Your heart locked away safe and protected So you could never feel again, Somethingâ&#x20AC;¦ Unexpected penetrates to your heart Sensations twist deep in your chest Steal your breath and spread through your bones. Passion waiting deep within a soul ignored That was sleeping is jolted awake Just to remind you What it is To feel again. You are powerless To stop the wave of emotion That envelops and consumes you. You are overwhelmed, and in awe you feel Vulnerable and unprotected Senses sharpened Alive. Unexpected.

SOMEA(NTA)GONIZING POEMS- A TRIBUTE TO AUTONOMIC PHARMACOLOGY HOA PHAM NJMS ‘18

EPINEPHRINE Born above the kidneys, epinephrine, child of terror, placing all in equal agony, direct through muscle and vein. A physic for asthma and heart failure, drastic, and for sudden suffering anaphylactic. Constricts the vessels to slow the song of local anesthetic, and its numb prolong. (But when endogenous, do not forget, vasodilation it does beget.) Beware, lest your heart skip a beat and die or brain bleed and catecholamines sigh. NOREPINEPHRINE A kinder kin, norepinephrine, but I need a clue to know why my heart slows when you spare 2. Is it worth the trouble though, when you choke the vessels, starve the brain, and make the kidneys writhe in pain?

DOPAMINE Tortures the first to arrive on scene: , victims of dopamine— 1 1 yet there is redemption for this sin as a surrogate for norepinephrine. DOBUTAMINE Opposing isomers in balance, receptors have no chance. Double double-butamine, lame pun. Besides—it favors 1. PHENYLEPHRINE Phenylephrine, connoisseur of the finest, shall we serve you 1, Your Highness? With fancy fennel and fragrant roses, this stew will surely flush out noses. I see you savor with widened eye, once red and sleepy, now white and live. BRIMONIDINE AND CLONIDINE

Two siblings who for 2 preen, brimonidine and fair clonidine. Both do make glaucoma smolder (with former softer on beholder). ISOPROTERENOL AND ALBUTEROL Isoproterenol, greedy for -all, eager to clear your breath, though some prefer albuterol— gentler on the heart, ‘tis true, you who settle for just 2. TERBUTALINE When you must pause in long labor to see yourself pregnant with promise, to recall the distant reason for the sweat and the sighs and the throes, to fear the work, of this be sure: terbutaline will bring you succor. AMPHETAMINE I know I cannot turn back time to stand on the bank of my Heraclitean river and laugh at my reflection, but at least I can flip the flow of norepinephrine with amphetamine, unfettered.

so great, now sells norepinephrine in the corner. COCAINE Amphetamine’s sleazy cousin, peddling powder that’ll “take away the pain, guaranteed,” cocaine, uptake blocker, winning the same game. EPHEDRINE Chimera, a macabre mix of terror child and time turner. Behold—ephedrine. No longer shall your urine spill against your will, nor pressure fall to levels that kill. Found in plants and supplements, if your heart be sick, have some sense! PHENTOLAMINE That shadow the townspeople shuddered to report, the one that stole their vigor when they stood, the one that quickened their pulse, the one that came to save the dying horde, that phantom phentolamine, antagonizing receptors until daybreak.

METHYLPHENIDATE Methylphenidate, like amphetamine but safer, mate. also known as Ritalin— rid me of din!

PRAZOSIN You make the pressure drop without palpitations the phantom wrought. Prazosin, so full of win, you block 1— yet many have reason to curse, for epinephrine’s role you reverse, and your first impression’s not nice to mention, for it triggers orthostatic hypotension.

TYRAMINE Tyrants, so mean, end up like tyramine— crumbled tyrosine, what had been seen

TAMSULOSIN Ambitious, cutthroat, more so than prazosin, they say, filching the spot of 1A— tamsulosin transformed the field, 63

made old men before it prostrate, piss their pants, and yield. PROPRANOLOL Off a byway off the map, near a dune named Beta-12, there is a shop that claims to sell “propranolol and propranolol accessories,” just like that guy on TV. A shade spies a violet vase and, perplexed, runs to weep the burden off its chest of a heartbreak long thought forgotten since they were children on the block. TIMOLOL (a tribute to e e cummings) timothy goofed at me oh my lolling the way to timolol sky his headache’s gone(who knows why?) deprive the schlemm, caress the eye it’s because i was kissed(and now he feels) the alpha to omega must be real be one with me and we’ll two be antagonists in our tragedy

RESERPINE Slither over here, come to reserpine. Let me catch you, catecholamine. You’ll be thrown out in the wake of me, rotting in your varicosity. O—what was that smell, dopamine? ...no need to shake and make a scene... BOTULINUM TOXIN A batch of Botox will botch the release of acetylcholine from a vesicle yearning to unite with Mama Membrane. Muscles will have respite in cerebral palsy—delight. BLACK WIDOW SPIDER VENOM Unleash your wrath, black widow queen, make them bleed acetylcholine until they cry and cramp.

METOPROLOL Please let us, who cannot maintain our sugar nor breath freely, but are tame, moor tonight in 2 harbor. You can have the other one for yourself, metoprolol, keeper of the metropolis. We have wandered for a year, glucagoners seeking another way the fear of our terror children to allay. LABETALOL Your mind is so scattered, its offspring so labile: labetalol will save us all from its fickle fruit— as a -blocker (plus 1) to boot. 65

LOVE IS Patient, kind, and does not fail, A battlefield, an open door, A lie, a dream, a fairytale, Who could ask for more? Blind, deaf, dumb, and cannot smell, An art, a drug, a joy, a game, Amazing, awful, stupid, swell, Nothing and the same. Some say you fall in head first, While others say it slowly grows. It might just be a mix of both; No one really knows. Lasts forever, never dies, Gone in the twinkling of an eye, Never falters, boasts, or lies, Makes you laugh and cry. What is fiction, what is fact, Nobody seems to know what’s true, It’s not a feeling but an act, In all things you do. Looking after someone’s needs, Or doing someone else’s chore, It’s all about the quiet deeds To those you care for. The quintessential mystery, The stuff of poems, songs, and more, The greatest gift in history, Love makes a life worth living for.

MARGARET MORALES RUTGERS GRADUATE SCHOOL OF BIOMEDICAL SCIENCES, ‘16 66

EUNJUNG LILIANA KIM, MD PGY4 - INFECTIOUS DISEASE FELLOW RUTGERS NJMS

SHADOWS Heart pounding in the neck Mydriasis and xerostomia Overloaded with caffeine Heavy eyelids, sitting in a chair In this world of black and white Where numbers rule Colorless world Cannot free an empty vessel With no war, no peace Routine stole the joy of healing Defining light vs darkness Leisure calls my name Sitting in a chair again Fighting endless questions Putting in peace upcoming shadows In this world where numbers always rule

REALITY In the vast collection of confusion Neurons are fighting in collusion Between reality and dream Lost in the void of medicine No distinction is set Only obsessed inept Fighting with the meaning of life and death Playing God in an awkward coat with oath Beeping sounds of machines Within the symphony of dripping caffeine Strangely understood All this violent action is for good Pounding headache, shaking hands Growling stomach and a sleepless head Light is seen beyond each death In the gap between breaths

Just before the exam was to start Ezra realized he had studied wrong. Ezra was a detail person, a bottom-up person, not analytical. Theories, abstractions, and concepts struck him as too vague and often too wrong for any practical use and he avoided them. He’d always done well with his photographic memory, attention to detail, and ability to concentrate, observe, and listen. That had gotten him through school despite his father’s dying, his mother’s anemia and constant coughing, the poverty, having to take any job he could so that he could get to homework and studying only when his classmates were already deep into sleeping-off their heavy dates, their football practice, their drinking bouts and their emotional upheavals. He managed to keep his scholarships to Boston Latin and Harvard and to graduate from the Long Island College of Medicine. But now he was sunk and the family was sunk with him.

THE EXAM

The debts they had run up for Ezra to become a doctor were crushing. His mother was out of money for her medicine and her arthritis had become much worse. His sister Esther had put off her first semester at Boston College in order to work two jobs and keep the family from being evicted so that Ezra could get his medical license, get a job as a doctor and make enough to support the family and let her start college herself. Everything depended on Ezra’s passing the licensure exam this first time. There was no way they could survive another year waiting for a second try, a year during which Ezra would almost certainly be drafted as a private and be sent off to the trenches in Europe. But Ezra had studied wrong and there was no way he would pass. Ezra realized his mistake when he was reviewing the exam study guide that, over the previous few weeks,

had become even more frayed and dog-eared than when he had bought it third-hand from a Long Island College of Medicine graduate who had failed his third exam attempt and was giving up medicine to go into the family business. Ezra could picture the diagram for each disease and read-off the signs and symptoms listed for the diagnosis. Just to make doubly sure, he reviewed the book as he was coming up the elevator to 5-North in Flower-Fifth Avenue Hospital on the way to the room of the patient he was to assess for the licensing examination. This time instead of flipping directly to the disease section, Ezra for the first time glanced at the introduction. Ezra never did that kind of thing... he would go right for the guts and skip the generalities, the redundant overview, historical perspective and flowery acknowledgment of the contributions of previous writers and editors that add to the weight of so many medical tomes. Unfortunately, in this case the introduction held the key to passing the exam. The advice in the introduction was succinct and clearly accurate. The book’s author pointed out that knowledge of facts and ability to parrot lists of signs and symptoms of each common illness is not enough to make one a competent physician. Professionalism goes deeper. Being able to spout facts is certainly necessary to convince the examiners of an aspiring doctor’s having prepared himself through study, and it is easy to tell whether a candidate is deficient in that regard; but what the examiners really look for is evidence that the examinee takes a systematic approach to making a diagnosis. They are not impressed when someone simply jumps to a conclusion, perhaps by a lucky guess. What they want to see is that the physician follows a clear logical trail, one with well-defined branches, so that if a dead-end is encountered, the 71

doctor can back up and continue on an alternative route until the patient’s actual improvement indicates that treatment is on the right track. The advice in the booklet concerned the clinical portion of the licensing exam where one assesses a volunteer patient and then discusses the case with a pair of examiners. After a candidate has taken the patient’s history and performed a physical, he should back-track, as the book says, ask further questions systematically and then tell the examiners what the diagnosis is and how he arrived at it. The book’s introduction then suggested memorizing Appendix 3, an outline of just how to make a diagnosis in wellorganized manner that would impress, or at least satisfy, the licensure examiners. Ezra had never read Appendix 3. He tried to flip the book open to that outline, but it was too late. As the elevator doors opened on 5-North Ezra was immediately cordially greeted by Drs. Hamblin and Murtry, who expressed confidence that Ezra could deal with his patient quickly enough to enable them all to catch the lecture down in the auditorium by Professor Robinson, an authority on Penicillin, a new drug that promised to revolutionize treatment of infection. Ezra knew his outlines cold for every particular disease they were likely to throw at him. As long as he knew which disease he was dealing with he could go through that outline methodically, talking about etiology, initial symptoms, progression, manifestation in each body system (gastrointestinal, cardiorespiratory, nervous, genitourinary, etc.) and then list treatments in order of preference. All he had to do was to picture the page with that information and recite it almost verbatim to Drs. Hamblin and Murtry while mentioning how the information from the patient’s history and physical corresponds to the diagnosis. That would work if he knew the diagnosis; 72

but if he was presented with an atypical case he would come across as floundering haphazardly until he hit on the right answer. He would, of course, eventually come up with a correct diagnosis—in medical school he did at least as well as anyone else with this—but it would not look systematic, not the kind of approach the examiners want to see. The patient was a kindly-looking elderly gentleman, alert and friendly, thin to the point of emaciation and apparently comfortable except when he would move his legs or his right arm which seemed to cause him some pain. Dr. Hamblin thanked the patient for volunteering to participate in the licensure examination for new physicians and introduced Ezra as the doctor being tested. Under the watchful eyes of the examiners, Ezra proceeded to ask what brought the patient to the hospital, which symptom came first and when and how the problems had progressed. The answers were confusing. Nearly every part of the patient’s body seemed to have been affected by something at one time or other, making it doubtful that a single illness was to blame and raising the suspicion that the patient was not producing facts reliably.

Ezra noticed a slight discoloration over the patient’s breastbone. Maybe it was just a shadow or a reflection. As he leaned down for a closer look, the patient whispered into his ear, “Systemic lupus erythematosus.” The systemic lupus erythematosus page popped up in Ezra’s mind. He completed the physical exam quickly, efficiently and purposefully, like a bloodhound on a scent. He resumed taking history again, this time systematically, following the book line by line. The patient had an atypical case, but everything fit. Ezra thanked the patient sincerely and led the admiring examiners out of the room as they thanked him for passing the licensure examination in time for Professor Robinson’s lecture.

Usually, if a diagnosis does not spring to mind within the first ten seconds of encountering a patient, it’s going to be a long struggle before the disease gets reeled in, if ever. It was time to backtrack and follow an alternative route in history-taking, but Ezra had not laid down such a structure. Ordinarily when encountering such an impasse he would just start asking all sorts of questions based on hunches, but that would be anything but systematic. Ezra decided to avoid the issue by jumping ahead to the physical exam in the hope that he might pick up some vital clue, some rare but pathognomonic sign that would show the diagnosis. At least this would give him time to think up some way to seem methodical. Drs. Hamblin and Murtry glanced at each other.

MYRON PULIER, MD CLINICAL ASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRY RUTGERS NEW JERSEY MEDICAL SCHOOL

In acknowledgment of The Healthcare Foundation Center for Humanism and Medicine at NJMS Dorian J. Wilson, MD, Director Center of Humanism Michael Cacoilo, Humanism Fellow, NJMS ‘17 Tanya Norment, Program Administrator

Faculty Advisor Beth A. Pletcher, MD, Associate Professor of NJMS Pediatrics & Genetics

Editors Melissa Chavarria, GSBS ‘16 Harry Hurley, NJMS ‘18 Sanjila Islam, NJMS ‘18 Belinda Shao, NJMS ‘18 Khoa Tran, NJMS ‘18 Cover Design Belinda Shao Creative Design Nancy Cheng

For information, inquiries, and submissions, please email us at Ars.literarium@gmail.com 74