W I N T E R 2 0 1 8 - 2 0 1 9 • I S S U E 2 literary amwa A G A L L E R Y O F W R I T I N G

editorial board

E l i z a L o C h i n , M . D . , M . P . H . E x e c u t i v e D i r e c t o r , A M W A

L i n d a C l e v e r , M . D . P r e s i d e n t , R E N E W

C r i s t i n a D e n i s e G o L i t e r a r y A M W A C o - L e a d J . D . C a n d i d a t e , D u k e U n i v e r s i t y S c h o o l o f L a w

A n j u G o e l , M . D . , M . P . H . L i t e r a r y A M W A C o - L e a d P h y s i c i a n a t H e a l D e p u t y H e a l t h O f f i c e r ( I n t e r i m ) , S a n L u i s O b i s p o C o u n t y

P r e e t i J o h n , M . D . , M . B . B . , M . P . H . , F . A . C . S . C l i n i c a l A s s i s t a n t P r o f e s s o r , U n i v e r s i t y o f M a r y l a n d S c h o o l o f M e d i c i n e

M o n i q u e M u n M . D . C a n d i d a t e , W a y n e S t a t e U n i v e r s i t y S c h o o l o f M e d i c i n e

E m i l y T r a n s u e , M . D . , M . H . A . S e n i o r M e d i c a l D i r e c t o r , C o o r d i n a t e d C a r e C l i n i c a l A s s o c i a t e P r o f e s s o r , U n i v e r s i t y o f W a s h i n g t o n S c h o o l o f M e d i c i n e

T a n a W e l c h , P h . D . , M . F . A . A s s i s s t a n t P r o f e s s o r , F l o r i d a S t a t e U n i v e r s i t y C o l l e g e o f M e d i c i n e advisory board

R i t a C h a r o n , M . D . , P h . D . P r o f e s s o r o f M e d i c i n e a t C o l u m b i a U n i v e r s i t y M e d i c a l C e n t e r E x e c u t i v e D i r e c t o r , P r o g r a m i n N a r r a t i v e M e d i c i n e , C o l u m b i a U n i v e r s i t y

E l i z a L o C h i n , M . D . , M . P . H . E x e c u t i v e D i r e c t o r , A m e r i c a n M e d i c a l W o m e n ’ s A s s o c i a t i o n ( A M W A )

L i n d a C l e v e r , M . D . P r e s i d e n t , R E N E W

S a r a h C u t r o n a , M . D . , M . P . H . A s s o c i a t e P r o f e s s o r o f M e d i c i n e , U n i v e r s i t y o f M a s s a c h u s e t t s

G a y a t r i D e v i , M . D . , M . S . D i r e c t o r , N e w Y o r k M e m o r y a n d H e a l t h y A g i n g S e r v i c e s C l i n i c a l A s s o c i a t e P r o f e s s o r , N e w Y o r k U n i v e r s i t y S c h o o l o f M e d i c i n e

C r i s t i n a D e n i s e G o L i t e r a r y A M W A C o - L e a d J . D . C a n d i d a t e , D u k e U n i v e r s i t y S c h o o l o f L a w

A n j u G o e l , M . D . , M . P . H . P h y s i c i a n a t H e a l D e p u t y H e a l t h O f f i c e r ( I n t e r i m ) , S a n L u i s O b i s p o C o u n t y L i t e r a r y A M W A C o - L e a d

S u z a n n e L e o n a r d H a r r i s o n , M D , F A A F P , F A M W A A M W A P r e s i d e n t P r o f e s s o r o f F a m i l y M e d i c i n e & R u r a l H e a l t h E d u c a t i o n D i r e c t o r , F a m i l y M e d i c i n e F l o r i d a S t a t e U n i v e r s i t y C o l l e g e o f M e d i c i n e

advisory board

C l a u d i a M o r r i s e y - C o n l o n , M . D . U . S . G o v e r n m e n t L e a d , U S A I D

A u d r e y S h a f e r , M . D . P r o f e s s o r o f A n e s t h e s i o l o g y , P e r i o p t i v e , a n d P a i n M e d i c i n e , S t a n f o r d U n i v e r s i t y S c h o o l o f M e d i c i n e A n e s t h e s i o l o g i s t , V e t e r a n A f f a i r s P a l o A l t o H e a l t h C a r e S y s t e m D i r e c t o r , M e d i c i n e a n d t h e M u s e , S t a n f o r d C e n t e r o f B i o e t h i c s

R e n d a S o y l e m e z W e i n e r , M . D . , M . P . H . D i r e c t o r , M e d i c a l O p t i m i z a t i o n P r o g r a m C e n t e r f o r H e a l t h c a r e O r g a n i z a t i o n a n d I m p l e m e n t a t i o n R e s e a r c h E d i t h N o u r s e R o g e r s M e m o r i a l V A H o s p i t a l A s s o c i a t e P r o f e s s o r o f M e d i c i n e , B o s t o n U n i v e r s i t y S c h o o l o f M e d i c i n e

contents

6 Against Medical Advice 18 Hiding Spots

By Rosey Lee Pen Name of Atlanta-based Physician By Alyssa Brown Mayo Clinic Graduate School of Biomedical Sciences and University of Louisville School of Medicine

12 broken hands 21 Forces of Nature

By Erin McConnell, M.D. By Chelsea Life Ohio State University Florida State University College of Wexner Medical Center Medicine

13 The Phoenix Effect: Turning 23 Still Human Vulnerability Into Resilience By Elise Miller, M.D. By Hope Ferdowsian, M.D., M.P.H., FACP, FACPM University of New Mexico School of Medicine

contents

25 Gimme Shelter 36 Waiting for Godot

By Emilie Transue University of Pittsburgh School of By Alyssa Brown Medicine Mayo Clinic Graduate School of Biomedical Sciences and University of Louisville School of Medicine

31 The Day My Daughter 41 Building a Community: My Coming- Smelled Like Someone Else of-Age as a Future Physician By Alissa Frame By Pooja Suguna Yesentharao Boston University School of Medicine Johns Hopkins School of Medicine

34 When the White Coat 44 What I Can Do Becomes a Hospital Gown By Kaci McCleary By Michelle Lee University of Pittsburgh School of Medicine

l i t e r a r y a m w a | 6 against medical advice BY ALYSSA BROWN

In rural Kentucky for surgery acknowledge me. The room was rotation, we usually had relaxed call dark, and the voices speaking quietly nights at home. We rarely stayed inside had the unmistakable tinge of late on call nights or got called back fear. in to the hospital on surgery rotation in this sleepy town. If we were on I started to piece together the call for the night, we would text the story. The patient was an 81-year- attending before we left at 5pm to old male in acute renal failure, which see if anything was happening. I is not normally a surgical problem. texted the attending when we He had appeared in the ED eight finished afternoon lectures. He days prior with a small bowel responded with only a room obstruction. He refused surgery to number. I went to the room and relieve the obstruction and left asked the patient inside if she had against medical advice. He returned seen the attending yet. She looked to the ER that afternoon with worried and said no… was she fulminant renal failure and getting surgery? I apologized and persistent small bowel obstruction. skittered out of the room. He had not passed stool in those eight days. Many patients look sick, The attending had texted me the but he looked close to death. He was wrong number, but I could hear his thin and lying limp in the bed with a voice floating down the hallway. I far away look in his eyes. His followed the voice and silently slid children were gathered around him. into the correct patient’s room. The attending briefly turned his head to The attending spoke to the l i t e r a r y a m w a | 7 patient and family, using words like operative team. I could tell the “urgent,” “tonight,” and “chances of attending was tense but also excited, making it through an operation.” as was I. He loved the complicated Then his phone rang. He said he big cases, even though I could tell he would see them after the operation, was growing tired of call and and he turned and ducked out of the working so hard at around 60 years room, clomping off down the hall of age. He loved his patients, and he with me trailing a few lengths loved ICU care, but late at night, he behind. would sometimes mutter that he was getting too old for nights like this. I knew the gravity of the situation and the length of the night ahead, There was a palpable tension that and I was glad I had hidden a Kind night, like a pit in my stomach. It felt bar in the pocket of my white coat. different than getting called in late As we sat in the lounge, I started to for an appendix or cholecystectomy. peel off the wrapper and pick at Usually, the anesthesia team was pieces of it. As if knowing that my joking or playing music when I came mouth was full of granola bar, the in to set out my gloves and gown. attending turned and began to ask Tonight, the room was utter chaos. what fluids were most appropriate They had intubated the patient and for the patient. I gave the incorrect feces came out the endotracheal answer of lactated ringers, and he tube. Feces was everywhere. It began to berate me for picking the covered the patient’s neck and chest. fluid that would kill the patient. It was splashed all over the floor and When being pimped about a patient, over the shoe-coverless feet of the it always seems as though the anesthesia team. I stood paralyzed. patient isn’t real, even though they I did not know this could even are usually on the table in front of happen. me or someone I just visited. It feels as though they are a practice The attending brushed past me question, not a living and breathing and jumped into action. “Come on, human being. we need to get him open,” He said, “Clean him up so I can throw a Just as suddenly as he started central line in that IJ.“ The patient asking me questions, his phone rang, was cleaned and the central line was “OR is ready for you.” We skittered inserted, but the anesthesiologist down the stairs to join the rest of the questioned its sterility. The surgeon l i t e r a r y a m w a | 8 threw back, “This patient needs a We found a small perforation and central line now, and if it gets the obstruction. We squeezed the infected, so be it. He is going to be bowel like a tube of toothpaste, lucky as hell to make it off this damn decompressing the bowel. The table.” surgeon reached for the pool suction as he cut a hole into the stomach. I The surgeon’s first assist stepped watched it fill the large tower it was into the OR. She had been called in connected to with turbid dark fecal from her 40 year work anniversary material. I kept thinking, this dinner. I offered congratulations, patient is going to feel so much but she brushed me off, saying that better when we get all of this feces this case was more important than out of him. her dinner. I stepped up to the table as I had done many times before. The surgeon removed the suction Immediately, the first assist scolded and asked the anesthesiologist for me to re-scrub. I was annoyed. I numbers−ABG, base excess, and how was sure I had not touched anything, fast the fluids were running. I did but I also knew better than to not really know what many of those question her. She was a stern older meant, but I knew the surgeon was woman. She had been around the not happy. He put a G-tube in the block and ate medical students for stomach and he began to work on lunch. closing the perforation. After putting in one line of staples, he I ripped off my gown and gloves handed me the stapler and told me and ran back out of the OR to to run it across the next portion of rescrub. I did not want to miss bowel. I did as I had done many anything. I came back in just as the times before. He did not like the abdomen was fully opened. It was way I stapled across the bowel, and distended and grey. It did not look he asked, “are you sure the bowel is like a “happy bowel.” The surgeon completely closed with a stable line told me to follow his hands. We like that?” I muttered yes. He did began to run the bowel. I was not not seem to agree but moved on, keeping up with him and I kept saying, “We need to get the hell out tripping over my hands, which I am of this abdomen.” He placed the sure he noticed, but thankfully did bowel back inside the abdominal not comment on, besides an cavity. Usually, he talked a lot in the occasional glare across the table. OR, especially when we were closing, l i t e r a r y a m w a | 9 but tonight all we could hear was the not, for the life of me, spell beeping of the monitors and the cholecystectomy in my sleep- snap of the stapler closing the deprived state. We took one last patient’s abdomen. I felt the pit in long look into the ICU, bed 27, then my stomach slightly relax after I walked silently down the long knew the patient was closed and hallway back to the locker rooms. would make it out of the operating He told me that he expected me to room. hand off the patient in the morning to the other students. I nodded with We moved the patient out of the the silent knowledge both of us OR and into the ICU. It was now would barely sleep in the meager midnight. I could see the quiet hours between now and the sunrise. darkness of rural Kentucky outside. I wrote a brief note to my friend who The attending looked exhausted, and would inherit this patient, and I told we both stood there just staring at her I would meet her in front of bed the patient. Occasionally, the 27 in the morning. I was too attending fiddled with the arterial invested in seeing how this turned line and the machine connected to out. When I tried to fall asleep that it. He instructed me that I needed to night, I kept thinking that I might not know how this machine worked by see his name on the patient list in morning. the morning because he had not I knew it was already going to be a made it through the night. late night and early morning, and there was no way I was going to look A few hours later, I was back in anything up when I got home. I the ICU. His name was on the list! He nodded though, wiping my bleary had made it through the night. I felt eyes. hopeful that he had tricked death into letting him survive this episode. We continued to stare silently at But I soon realized how naïve this the patient for an hour at least. I sentiment was. Later that morning, kept wondering what we were there was a commotion outside looking for. Maybe he was looking room 27. One of the nurses for a sign of which way the scale announced that the patient was between life and death would tilt. about to code and we needed to call We eventually stepped outside the the attending.” I told her I knew ICU room and finished his notes. He where he was. I half jogged down the kept snapping at me because I could hall towards the ORs. I knew he was l i t e r a r y a m w a | 1 0 going to do a cholecystectomy in OR basic sense, that’s true, but it served 7, and it was going to happen very as no comfort to me in that moment. soon. I wanted to catch him before he was scrubbed. I still had some I first wrote about this experience hope that he could do something to a year later. The patient still remains save this patient. etched in my mind, and the memory of that night and day remain fresh. I caught him right before he walked After some time, the memory has into the OR. Slightly out of breath, I lost its sharp edges, like a rock rushed to tell him that the patient gently being smoothed by the flow of was about to code in the ICU. What a river. This is still one of my darkest he said next shocked me: “It was moments of third year, but there going to happen sooner or later. I’m were moments of light. There were not surprised.” I fumbled for words miracles and deaths. This was not as he headed into OR 7. I was too the first or last death I bore witness stunned by his reaction to properly to that year. I have come to form my own. appreciate that the surgeon and family made the correct decision to I turned and strode back towards let the man die peacefully. I could the ICU. The only people the family not see through my naïve hope that knew were me, a lowly medical the patient would always make it student, and the attending. I wanted through, at the time. I was so him to be there to talk to the family frustrated that I felt like the and support them through what was attending was ignoring a clearly going to be a traumatic experience if acutely ill patient at the moments he coded. I felt angry and frustrated before his death. It became clear and guilty that I could not do though. They let him die with anything to help. The surgeon dignity. They did not make the futile arrived. He glided towards the chaos decision to shatter his ribs while outside the room. He parted the trying to pump his heart forward knot of people outside and talked to towards more life. While “do not the family. He came over later and resuscitate”, is not everyone’s plainly told me that the family was choice, in this case, it gave the going to let him go peacefully. He patient a chance to say goodbye. I said, “He died by his own hand. He like to think that he understood his didn’t want surgery until it was too decision and the hand he had been late to help.” I guess in the most dealt. At that point in the year, I did l i t e r a r y a m w a | 1 1 not yet understand the power of choosing peaceful death. Even though these these memories can be painful to hold onto, I do not want to forget him, but I want to remember that he chose, and maybe going against medical advice wasn’t always a bad thing. l i t e r a r y a m w a | 1 2 broken hands BY ERIN MCCONNELL, M.D.

ulcerations weep between like interdigital islands floating amidst compromised flesh

sheets of tissue peel off in strips enough to fund a graft or Christmas

erythema creeps towards dorsal patches of xerosis

where water becomes fire the epidermis erodes cracks and fissures l i t e r a r y a m w a | 1 3

the phoenix effect: turning vulnerability into resilience

BY HOPE FERDOWSIAN, M.D., M.P.H., FACP, FACPM

The following essay relates to Dr. Ferdowsian's book, Phoenix Zones: Where Strength Is Born and Resilience Lives (The University of Chicago Press, 2018).

As physicians, we are asked to curiosity, but by a desire to curb turn toward, rather than away from, violence and suffering. Early in my vulnerability and suffering. It is our life, my parents spoke often of human duty, but it is not without a cost. Our rights violations around the world. patients’ pain can vicariously However, the stories they shared did transform into our own. The not fully imprint upon me until I was sleepless nights, despair alternating nine years old and crawled up on my with anger, numbness, and anguish mother’s built-in bookshelves where I can all become ours, piling on top of found a shiny red book entitled A Cry an ache we may already carry. from the Heart. As I opened the book and turned its pages, I read about an

Iranian child who was burned to Our patients’ shared lives are also death because of his religion. A few a priceless gift to us. Their hope, years later, I met members of my courage, and resilience can too father’s extended family that were become ours—lessons in healing we also detained by the same cruel might not have realized we needed. regime. Though my father’s family They are lessons I have tried to escaped, that tortured child’s image heed. remains singed in my brain.

I knew as a child that I wanted to Those early experiences eventually become a doctor. My interest in led me to others who would medicine was not driven by scientific

l i t e r a r y a m w a | 1 4 surprisingly fuel my hope and medical community. In his hospital, optimism. Their gift of hope came at he mentors a variety of colleagues. a poignant time—when I realized I He has reunited with his family, and had been chasing violence my entire —as he did before fleeing to America career, absorbing the sadness and —he continues to pursue interests nightmares along the way. outside medicine. Although he still wrestles at times with the violence Almost thirty years after I he endured, he has risen in a free discovered that bright red book on and open society. He has also my mother’s bookshelf, I walked become a dear friend. toward the glass door of my clinic waiting room. There, I saw a man In Doc, I discerned a phenomenon with a slight build and dark, graying I had repeatedly observed in many hair. As I introduced myself, he patients and torture survivors I met reached out his hand for mine and over the years. They appeared to then carefully released it. He was an defy their seen and unseen injuries established expert in a rare field of and thrive even after indescribable medicine, a man I call “Doc.” trauma, much like the mythical Phoenix who rises from the ashes of Doc is also a torture survivor from her previous form. Within some Iran. He was targeted after vocally circles of medicine, this opposing the government’s transformation is called the Phoenix persecution of his colleagues. During Effect. our first visit together, I was tasked with listening to his story and The Phoenix Effect is a metaphor completing a forensic examination for how we can heal ourselves as for his asylum attorney. I wrote a well as the world around us. Over medical report substantiating Doc’s time, the legend of the Phoenix has claims of torture, and I later learned evolved. Most forms of the myth that he would not be forced to return reflect a basic story: after hundreds to a nation that posed a grave threat of years, when the old Phoenix feels to his life—a country he still loves and her death approaching, she begins o dreams of. collect fragrant plant life to build a

nest in a sacred tree. In the better- Today, after a long personal known tradition, the sun heats the struggle and quest for asylum, Doc is nest and ignites the Phoenix. From an active member of the American

l i t e r a r y a m w a | 1 5 the ashes, a new Phoenix arises. In suffering. But by witnessing literature, the Phoenix has come to resilience, we can also extract key represent an enduring sense of lessons we need to prevent suffering redemption and recovery. and help others suffer less. As healers, teachers, citizens, and Stories like Doc’s led me to what I leaders, we can use these lessons to call Phoenix Zones—places where help turn vulnerability into individuals can heal and thrive. They resilience. also hold lessons for how we can heal as a society. Phoenix Zones are As healers, we can begin by bound by core principles including recognizing principles that foster respect for dignity, freedom, and resilience as the biological needs sovereignty, and a commitment to they are. Research literature shows compassion and justice. Though that treating individuals with dignity often considered lofty ideals, these matters significantly throughout principles are actually biological their lives. Not surprisingly, needs we share with other animals. researchers have found that respect They are the basis for the Phoenix for the intrinsic value of each Effect, which hinges on whether our individual fosters wellbeing, even vulnerabilities are nourished or after severe violence or while dying. exploited. As Doc and others have Likewise, empiric evidence supports taught me, the Phoenix does not rise the therapeutic effects of respect for alone. Resilience is not solely autonomy, compassion, and justice— determined by the best or worst of all of which form the basis for our lives. Like vulnerability, it is a trauma-informed care, a treatment biological phenomenon influenced framework that addresses all types by the world we live in. of trauma, including unjust societal constructs and abuses of power. In our roles as physicians, we carry the burden and privilege of Several collective authorities such seeing patients through some of as the American Medical Association their most difficult and vulnerable and the World Health Organization moments. As a result, we must also have already issued guidelines confront our own vulnerabilities, highlighting the importance of including our relative powerlessness working collaboratively with to conquer disease, disorder, and governments, healthcare l i t e r a r y a m w a | 1 6

organizations, and the public to is where I met Doc, and where many meet society’s health needs through students and residents sat in on a framework of justice. Though asylum evaluations with me. Today, sometimes difficult, our professional they are physicians who organize roles also require that we consider human rights conferences, help shut how our own personal and down immigration detention institutional biases interfere with centers, and serve children who have our ability to deliver just, equitable survived physical and sexual abuse. care to people regardless of their They are creating Phoenix Zones. race, ethnicity, gender, orientation, ability, or financial means. Like many of us, my former Fortunately, there are already students and residents realize that national initiatives, conferences, and they are physician citizens who can curricula dedicated to recognizing magnify their voices through letters and resolving unconscious bias, to the editor, opinion editorials, making it easier to confront articles, and testimony on local and prejudices that interfere with national issues. Just as Doc did, they empathic and just care. remind me that we must move beyond our traditional professional Physician educators can have an roles to help address the ills within exponential impact in this regard. society—through the healthcare There are many opportunities to organizations we work for, the introduce critical principles like professional societies we belong to, respect for freedom, compassion, the media organizations we speak and justice in education and training. with, and the civil society we live in. Students and trainees are hungry for In each of these areas, we have an these lessons. I often reflect on my opportunity to ensure that policies own time as a medical resident when and reforms reflect principles that I wondered if I had chosen the right nourish vulnerabilities and foster field. At a critical time in my training, resilience—the Phoenix Effect— my mentors helped me form a clinic among individuals and within for the evaluation of asylum seekers, society. reassuring me that I could merge my interests in medicine and justice. I frequently recall the child from A That clinic still exists today, more Cry from the Heart and the many than a decade after its inception. It survivors I’ve met throughout my

l i t e r a r y a m w a | 1 7 medical career. Their stories and the myth of the Phoenix offer a powerful example of how we can rewrite our personal and collective narratives. The Phoenix Effect reminds me that together, we can reimagine our future, much like Doc has. He and others have taught me how violence can be defeated. In the zones of the Phoenix, we are capable of strength, resilience, and growth. Each zone can produce momentum for the next —where the wounded rise, and where great care is given to creating peace for those who have been hurt or borne witness to their pain. And, with hope and action, their dispersion offers space to avoid the creation of harm in the first place—a world in which every child can feel safe. l i t e r a r y a m w a | 1 8 hiding spots BY ROSEY LEE

“Where have you been?” I asked. Click Clack It was 6:52 a.m. and my voice Click echoed in the quiet corridor of the Clack hospital’s rehab wing. I fought to contain my emotions, but I found I felt empowered with each step I some deliverance in the echo’s took. dramatic effect. Something had told me I’d find Chad stood 20 feet ahead of me, him in Mrs. Wilson’s room, so I in the doorway of his mother’s room. stopped by on my way to work. We He glanced at me, his eyes widening were supposed to have met there briefly. I became aware of the last evening, but he never showed up piercing click-clack of my four-inch and didn’t answer my calls the entire stiletto heels on the shiny vinyl floor night. Chad visited his mom almost as I barreled toward him. every day. Not wanting to alarm her, I didn’t mention my concern. A charming grin spread across his face. What might have been an I couldn’t sleep all night. I feared innocuous gesture under different something terrible had happened to circumstances further transformed him. We’d finally gotten engaged but my relief into anger. I pivoted and I wondered if we’d make it to our walked away before he could answer wedding. I spiraled down a path of the question. It didn’t matter what what-ifs, imagining everything from answer he gave. I wouldn’t believe cheating to foul play, but deep down him anyway. I suspected he was fine, physically at l i t e r a r y a m w a | 1 9 least. Chad had never disappeared admitting to myself that using them before. It only took one time to get might reflect a larger problem. my attention. Chad’s email account was chaotic. Click Usually meticulous and organized, Clack he hadn’t arranged his read Click messages into folders in months. Clack Even when his mom was rushed to the hospital last month with a heart I scurried to the adjacent Imaging attack, Chad checked email and Center. Approaching the rear responded to urgent messages in the entrance of my office suite, I quickly waiting room. But he hadn’t opened removed my heels and exchanged any messages or taken any meetings them for the quiet ballet flats I for the past two days. always kept in my bag. I planned to skip radiology case conference and I pored over Chad’s calendar and needed to avoid announcing my noticed weekly evening arrival to my colleagues who were appointments labeled “Mary” during already gathering for the daily the time Chad had told me he was at meeting. I felt so small at my natural the gym. The same address was five-foot height. As I sneaked down listed as the location for each the hallway, a sense of humiliation at appointment. the morning’s events weighed on me. I slid into a cluttered storage room My hands trembled. and nestled with my iPad in a Contemplating the purpose of these battered faux leather chair among meet-ups, I took three deep breaths the other cast-off furniture. and said the Serenity Prayer. Then I said it again—slower this time, the I’d never felt inclined to check end of each line punctuated with an Chad’s phone or email in the two increasingly intense breath. years we’d been together. But I needed information, and Chad’s I Googled the address and was email account and calendar were stunned to discover that it wasn’t a easy to access. We had exchanged hotel or some random woman’s email passwords after our home. It was a mental health facility. engagement, but I felt nauseated

l i t e r a r y a m w a | 2 0

Chad and I had talked about our looked defeated, like he was about to health histories, including his bouts collapse under the weight of what he of depression. His symptoms had was hiding. been managed with counseling, but he’d stopped going after his longtime “It’s gonna be okay,” I said. therapist moved away last year. Now I realized he wasn’t coping as well as He lowered his hands from his I thought. eyes and sighed. “Yeah, Mom just went to physical therapy. The doctor I was overcome with guilt that I’d says she’s coming along on the missed the signs, including ghosting cardiac rehab program,” he said. He me last night and taking a week off picked up the magazine beside him work last month with no real and pretended to peruse the pages. explanation. Tears poured down my face as I played everything over in “No, I mean you,” I said. I grabbed my head. I cried the tears I was too his hand and sat next to him. afraid to cry the night before and too angry to cry this morning. I cried Chad sat erect in the chair and imagining the pain that had driven tensed, bracing for an argument. He Chad to isolate himself from the tried to pull his hand away, but I people who loved him the most. I wouldn’t let go. I expected him to cried from the relief that I hadn’t lost look up at me, but he avoided eye him to someone else. I cried because contact. I wanted to fix this for Chad, even though I knew I couldn’t. I rubbed his hand gently. “It’s okay if you need space. I just need you to The rehab wing was busy when I tell me,” I said. returned. A mixture of footsteps, talking, and elevator bells muffled He relaxed. Then he squeezed my the click-clack of my heels as I hand. “Thank you, babe,” Chad said. approached the room for the second He closed his eyes and laid his head time that morning. Chad didn’t hear on my shoulder. me when I walked up. I stood in the doorway and watched him. His body slumped in the chair beside the bed. His hands covered his eyes. He l i t e r a r y a m w a | 2 1 forces of nature BY CHELSEA LIFE

One woman faces discrimination, staring up at her glass ceiling. She knows the odds are up against her; the prospect leaves her reeling.

Another struggles to balance it all- care for her kids, finish the manuscript on time. She clutches onto her third cup of coffee, convincing herself she can meet that deadline.

A girl marches in Washington, making her voice heard. She holds up her sign and shouts for equal rights- the freedoms all women deserve! l i t e r a r y a m w a | 2 2 continued from the previous page

A woman rings the bell in a hospital, celebrating her improved condition. She knew she could beat cancer, and here she is, rejoicing in her newfound remission.

Throughout our endeavors, we question ourselves, “Am I equipped to handle this strife?” We push ourselves forward, trudging ahead, seeking the most we can get from life.

Sisters, we are strong, unstoppable forces of nature. Let us join hands and stand together! United, we will forge our future. l i t e r a r y a m w a | 2 3 still human BY ELISE MILLER, M.D.

Mauve fingernails picked absently The patient studied the pen at invisible fuzz on her jeans. Her intently, twisting, turning, and wrist bangles jingled as she worked; ultimately setting it aside. The pick, scratch, rub, repeat. notepad was flipped through, turned over, and pushed away. She smiled Her blue eyes smiled up at me at me and winked from across the from behind thick-framed glasses. “I table. remember you,” she said when the doctor introduced me. “Ironic,” I It was time to discuss the thought, given that this patient was patient’s test results. Her doctor here for evaluation of memory loss. handed out graphs, one to each While my words and smile said daughter and one to the patient. I “likewise,” I was trying to place this hadn’t seen the graph prior to 80-year-old woman in the sea of entering the room, and I was elderly patients I had seen in the last surprised by the steeply negative month as a medical student on my line before me. Every category on geriatrics rotation. her cognitive testing was marked as severely below average. Two daughters accompanied the woman. The older daughter reached The younger daughter began for the free notepads and pens at the vigorously writing on a notepad. The center of the table and handed one doctor said, “You don’t have to of each to her mother. “Here, Mom,” worry, we are going to go over this she said. “We are at an important thoroughly and give you copies of all meeting, and we are going to take of our notes and instructions to take notes.” home.” l i t e r a r y a m w a | 2 4

The doctor thoroughly went again from across the table, like she through each category on the graph was playing a game and having a with the daughters and the patient. lovely time. Like perhaps this was all She explained what terms like a joke, and she was just tricking “visual-spatial reasoning,” everyone into thinking she was "processing speed," and “delayed losing it. That’s when I placed her. I recognition memory” meant. At the remembered that wink from a few end of her commentary, she paused weeks prior when I was shadowing and looked directly into the patient’s in the same clinic. During her eyes. cognitive testing, whenever the questions became tricky, she would “What this means,” she said look back at me, smile and wink. gently, “is that you have dementia.” People often develop coping The younger daughter again mechanisms, whether conscious of wrote vigorously, head down over them or not. This gesture seemed to her notepad. The older daughter be our patient’s way of smoothing simply nodded a few beats and the ruffles in this new world in which looked at the shredded tissue she’d she lived: disguising her disease, been wringing in her hands. compensating for her deficiencies, and diffusing the tension when The patient pushed her glasses people looked at her with concern. back up the bridge of her nose with While the gesture in itself was the tip of her mauve fingernail, meaningless, it was the most looked at her doctor, and smiled. meaningful thing she was able to say.

Her younger daughter glanced up I’m still human. from her notepad, skeptically stared at her smiling mother, and finally spoke. “Are you alright with that, Mom?”

“Alright with what?” her mother replied.

She smiled and winked at me l i t e r a r y a m w a | 2 5

gimme shelter BYALYSSA BROWN

“It’s just a shot away, it’s just a this because she thought I should shot away,” blared the music in the probably just get some sleep and OR. Music makes the OR feel enjoy my weekend. I got a text from special, magical. There was a flurry her at 8pm, and it said, “Seems like a of hands and spurts of blood, but I’ll quiet night, so unless something start at the beginning of the story. I changes, let’s meet at 8am to hate to say that there is something round.” I decided to go to bed early exciting about getting called in to in case something came in. the hospital in the middle of the night. Logically, I know that means At 1 am, I sat straight up in bed; something bad is happening to my phone was playing a loud jangling someone else, but it makes my heart tone. I didn’t recognize the number, beat a little faster and my adrenaline but I went ahead and picked it up rush. I had been following a surgeon after rubbing some of the crust out at Baptist Hospital all Saturday. We of my eyes. “We have a case. You didn’t have any cases so we both don’t have to come in, but if you do, went home to rest at 3pm. We come through the ED, and I’ll prop agreed that she would call me if the door open so you can get up to anything came in. She always rolled the lounge. Be here ASAP if you’re her eyes when I asked her to do coming, this case needs to go fast.” l i t e r a r y a m w a | 2 6

I quickly woke out of the fog. Before chair, covered in a blanket fresh I even responded, I was pulling on a from the warmer. She was reviewing pair of scrubs. I grabbed a pair of the patient’s chart. I handed her the diet cokes and a granola bar before diet coke that she didn’t remember half-jogging out the door. that she needed. She was scrolling back and forth through a CT scan. It was pouring rain and there was She told me to throw my stuff in her a chance of the roads flooding that locker and look at the CT. I wadded night. I didn’t think about it as I tore up my white coat and crammed it down the road, probably a little too into the top of the locker and fast. My mind kept rifling through hurried back out. Without turning, the possibilities of the case. She she said, “What do you think of this hadn’t revealed any details, but I CT?” My brain was still foggy with knew that it probably wasn’t an sleep, so I wasn’t sure what I was appendix, which is usually not a looking at, but it looked like there middle of the night emergency was a lot of bright contrast sitting in operation. It was definitely not the peritoneum, which I knew wasn’t trauma because it was at Baptist good. She began to fill in the details Hospital and they didn’t handle to add color to the black and white traumas. I thought maybe a CT scan. The patient was a 75- year- gallbladder, but that can usually wait old female who fainted after dinner until the morning as well. I whipped that afternoon. By that night, a CT my car into the ED parking lot. I scan had been done in the walked into the front door of the ED Emergency Department, and blood and past all of the security and staff, was visible in the abdomen. and shimmied through a door into Radiology reported a possible splenic the staff elevator. It always shocks artery aneurysm that had burst. me how much you can get away with That’s when the surgeon had gotten in a hospital if you have a white coat called. It was her turn to try to make on! I slid through the propped open this patient better. door on the second floor to get into the PACU and down the hall to the She looked at me, and said, “We lounge. I took a deep breath before are going to get in there, get out, and walking into the lounge. pray that we can patch it up enough for her to make it through the I found the surgeon curled in a night.” As if on cue, the intercom l i t e r a r y a m w a | 2 7 screeched to life and said, “We’re on the table. ready for you.” The surgery floor always seems to be so full of life Before I got too deep into these during the day, but at night, it almost thoughts, the surgeon called for a seems haunted. There are empty blade and traced it down the middle beds, empty carts, and you can only of the patient’s abdomen. The hear your own breath and suction was shoved into the fresh sometimes the hum of a rogue wound as we went. Blood began to machine. We walked down the hall run down the sides of the drape. towards the OR. I had seen her work When we could finally see the her magic before, but not on a case abdomen open before us, there was like this. She was usually bubbly and dark red, firm blood pooling talkative as we strolled to the OR, throughout. Everything and but tonight she was quiet. She knew everyone was at the ready. Hands that the odds were not in her favor. seemed to just know exactly where She was the last chance to save this to go. Nothing was fumbled. There woman. was a steadiness to the surgeon’s voice, with urgency but without We scrubbed in, which is a harshness. The aneurysm of the process that we can never quite vessel was hiding within the yellow speed up. The patient was moved clumps of fat. It stubbornly did not into the room seamlessly. The want to give away its position. The gloves and gowns seemed to appear surgeon began to pack the abdomen on the surgeon, like a quick costume with Raytecs. She was shoving them change, and everything seemed to down into the crevices and cracks of quicken. The surgeon strode over to the abdomen to soak up any extra the table and stepped up onto two bleeding. We would leave them step stools. As I stepped up to the there. The patient would be closed table, my mind began to wander. I another day., but for today, she thought to myself that this could be would leave the operating room with my grandmother, or someone else’s. a new vacuum sealed abdomen. The It is easy once the face is covered to surgeon asked for lab values. The not think of these more emotional anesthesiologist recited them to her, details of the patient. It is easy to and I could see her begin to frown keep distance when they are just a even from under the mask. They did case or just an anonymous patient not sound good, but we had done all

l i t e r a r y a m w a | 2 8 awe could do for the night. The as I made my way back to the nurses would keep pushing fluids hospital. I was already tense about and blood products after surgery. seeing the patient. I wandered through to the OR lounge where the We stepped out of the OR and surgeon was still staring at the CT peeled off our blood-covered gowns. from the night before and some new I looked down and realized that lab results. I could tell. from her blood covered my clogs because, as expression that it was not looking usual, I had forgotten to put on shoe good. She didn’t turn to me when covers. It was 3am. One of the she said, “We’re taking her back to nurses brought us back down to the OR.” She stood and quickly earth: the roads were flooding and paced down the hall, I didn’t ask we needed to be careful on the drive where we were going because I home. We agreed to meet back at knew she did not want to be 7am to round and check on the bothered. patient. The surgeon decided to crash at the hospital, and I decided Eventually, we ended up in the to try to make it home on the family room of the ICU. About five flooded roads. I was exhausted. I family members were standing there was also worried that the patient clutching coffee and speaking in would not make it to the morning. hushed whispers. They quieted She was in a precarious state, and I more when we appeared. The was not sure if we could pull her surgeon said, “We are happy she back from that cliff ledge. The rain made it through the night, but she is was hard and pulsing. The roads going to need another operation this were thickly covered in water. On morning to keep her alive. I cannot the way home, the interstate started promise anything. Her chances are to flood, but I kept plodding forward not good, but we will do the best we to steal a few hours of sleep before can.” Somehow, the family did not heading back to the hospital. I came look surprised, or maybe they were in and kicked off my clogs and fell still in a state of shock from the asleep in my scrubs. night before and hadn’t yet absorbed this new information. The sleep came quickly, but the alarm came quicker. In the morning, We moved out of the room, and the rain had slowed but not stopped the surgeon began to assemble the l i t e r a r y a m w a | 2 9 team. She listed them like a batting the song seemed to get louder as the order—her surgical partner, a two surgeons worked together to fix hematologist, a critical care this. I cannot quite describe how specialist, anesthesiologist, and a magical this moment was. There are first assistant. The patient was full sometimes indescribable moments of tubes, hoses, and wires, so it was in the OR that don’t seem quite real difficult to move her to the OR floor. −a suspended disbelief, where We crammed into the elevator and miracles seem to appear out of the hoped that nothing bad would ether. I thought for a second, there happen on the way there. Once in is no way that she isn’t going to the OR, there was a flurry of activity. make it off the table, not with the Things were going to go quickly feeling that was that was filling the again. The critical nature was room. The room collectively sighed weighing heavily in the room, but as the surgeons began to navigate everyone there knew that it was a the patient back from the brink. The Hail Mary, and this team was the bleeding was controlled, and final chance the woman had to live. everything was working perfectly. There is nothing quite like a surgeon Before I knew it, the case was over. in a critical case. There is nothing The bubble of magic had burst, and wasted in their movements or the patient had survived another words. The team worked like a hour. As we all began to strip off our machine. It was like everyone knew masks and gowns, someone pointed what the other would do before they out that it was an all female team. I did it. The wound vacuum came off, tried to hold back the feeling that the staples were removed, the that might have been the reason that abdomen was opened again. It everything went so well. There were seemed as though time stood still. It leaders, but it was a group effort was only 8am. rather than a single person who saved this patient’s life, at least for a “The floods is threat'ning, My very while longer. life today, Gimme, gimme shelter, Or I'm gonna fade away,” wailed Mick After the surgery, we continued Jagger. It sounded like someone had to make rounds, but kept coming turned up the volume. I could see back to the patient. We kept the surgeon clipping vessels and wandering by her room to talk to her saving this woman on the table as family and update ourselves on how l i t e r a r y a m w a | 3 0 she was doing. By the afternoon, she I could tell she was grappling with continued stabilize. She was not what she could have done awake or out of the woods, but her differently. She didn’t blame the lab values and vital signs were other team members. She assumed becoming more normal. This was full responsibility. my last day on the rotation. I finally went home. Losing a patient hurts more than it maybe should. I had lost other I woke up Monday and started my patients during my third year of first day of a pediatrics rotation. I medical school. I thought by this kept thinking about the weekend point that I would be able to distance patient, though, and I was worried. myself or maybe it would hurt less, How was she doing? I was afraid to but it never has. Writing this, it still ask. I was afraid to hear that she had hurts when I think about her. Maybe passed. I thought of texting the that’s a good thing. surgeon, but I did not want to bother her after an arduous weekend.

That night, I went to grab a beer with friends after work. I heard my phone buzz, but I didn’t think much of it. I finally checked, and it was from the surgeon. My heart dropped into my toes. I was afraid to open it. I knew before reading it what it would most likely say. It said, “She went into pulseless electrical activity this afternoon, and we never got her back.” I responded that I was sorry, and I knew she had done all she possibly could. She had given it her all. She responded, “thank you.” For one of my first times during third year, I felt like the physician had the same feelings about the patient’s death as I did. We were both hurting. l i t e r a r y a m w a | 3 1 the day my daughter smelled like someone else BY ALISSA FRAME

WINNER OF THE 2018 LINDA BRODSKY MEMORIAL ESSAY CONTEST

I decided to quit the day I realized my interest in my dissertation my daughter smelled like someone project had faded long before I even else. It was my first day back after knew I was pregnant, and how the maternity leave from the Boston students and postdocs who sealed University School of Medicine, my decision to join my advisor’s lab where I had finished two years of were leaving or already gone. I medical school and two years of would explain that I couldn’t leave a graduate research. I expected to daughter I loved to do something I spend four more years in the barely liked. I would remind him how MD/PhD program - two in the lab little clinical experience I had and and two in clinical rotations. how removed I felt, two years into my graduate research, from a future I stayed up that night to wait for as a practicing physician. I would my husband to come home after a remind him how, as an intern, he long shift. He was an internal often left the house before our medicine intern, a glimpse of my daughter woke up and got home future, and I needed his advice. I after she had fallen asleep. How thought about what I would say, how much harder would that be when I would ease him into the into the she was old enough to really know conversation. I would tell him how him, want him, ask for him? How l i t e r a r y a m w a | 3 2 much harder would it be when I tuition check that eclipsed my traded the flexibility of research monthly stipend. The nagging fear training for the rigidity of clinical that an MD/PhD program cannot be rotations and residency- when I was completed during daycare hours. The the one missing everything? And I possibility that I would miss out on would tell him how she smelled like four years of snuggles only to find out someone else when I picked her up that I didn’t want to be a doctor, after from daycare. I wanted her to smell all. like me. But there were reasons to keep We sat down. I took a breath, going, too. There was the obvious thought about where to begin. “I affection the daycare teachers had want to quit.” for our daughter. The payback obligation I had incurred over four After several weeks, we made a years of tuition and stipend paid out plan. I would give it my best effort by our privately funded program. for two months, to make sure that The fear that our daughter would my decision wasn’t made rashly look at my decision as evidence that during a transition that is difficult she has to choose between a career for mothers in any career path. If I and a family. The values I held that still wanted to quit after two months, had driven me to pursue medicine in I would change labs, to make sure the first place. that my decision wasn’t based simply on a poor fit. If I still wanted to quit After several weeks, we made a after changing labs, I would drop out plan. would give it my best effort for of the graduate program and return two months, to make sure that my to the clinical rotations in an MD- decision wasn’t made rashly during a only track. If I still wanted quit then, transition that is difficult for I would. mothers in any career path. If I still wanted to quit after two months, I Our conversation stretched out would change labs, to make sure my over days. It grew to include not only decision wasn't based simply on a me and my husband but also our poor fit. If I still wanted to quit after support system- our families, our changing labs, I would drop out of friends and peers, our mentors and the graduate program and return to role models. More reasons to quit the clinical rotations in an MD-only surfaced. There was the daycare track. If I still wanted quit then, I l i t e r a r y a m w a | 3 3 would. bond with my husband despite his challenging schedule and I realized Two months later, I had a difficult that my return to medical school and conversation with my advisor. He residency wouldn’t destroy my understood immediately and made a relationship with her. call to a professor whose research field and lab environment were a far I recently returned to the lab after better fit, and I switched into his lab another maternity leave. I smiled as I the next day. In the following weeks, handed my second daughter to the I found a project I was passionate woman who had cared for my first, about. I was genuinely excited to and then I cried in the car on my way drop my daughter off each morning to the medical campus. I spent the and head into the lab. I found myself day catching up with colleagues and talking about my research with my making research plans with my family and friends, something I had advisor while I counted the minutes never done in my original lab. I until I could leave. I smiled again began to draw connections between when I picked my daughter up that my research and the clinical work I evening, and then I kissed her head. wanted to do when I graduated. She smelled like someone else, but I didn’t mind. That was two years ago. As the two months passed, my commitment to the program and to a career in medicine strengthened. My daughter began walking, talking, running, and singing, and every day she reaffirmed that a demanding career and a happy family are not mutually exclusive goals. She came home from daycare with songs I didn’t recognize and games I didn’t know, and I was thankful that she was learning more than I could teach her. She told me that she loved her teachers and friends and I was happy she had a community beyond our family. She formed an intense and adorable l i t e r a r y a m w a | 3 4

when the white coat became a hospital gown

BY MICHELLE LEE PLACING SECOND IN THE 2018 LINDA BRODSKY ESSAY CONTEST

It was a beautiful fall evening in might as well have been a hundred New York when I was told I should miles away. My mind was blank and leave medical school. I was a well- could not gain traction past the fact appearing 25-year-old, but the tell- that I would miss school. I was near tale symptoms I had been brushing the end of my second year of off for months finally imploded. I still medical school, and incredulously remember trembling behind a white asked what of my plans to meet up curtain as a patient in my own with friends and study a few days school’s emergency room, in pure later. When he brought up the fact disbelief as the doctor informed me that he wasn’t sure when I would be of my diagnosis. Ironically, I had just able to return, I completely lost it. studied the diagnosis for a medical school exam earlier that year, but I I resisted giving up my white coat was genuinely shocked to as long as I could. With scheduling experience the illness firsthand. accommodations around treatment and appointments, I was able to Thus, began the single most finish the year’s exams only a few transformative year of my medical weeks after my classmates. Although training—the year I became a my dean and doctors were uneasy, I patient. I could tell the doctor felt soldiered on. I’m still high- sorry as he patted my arm, but he functioning, I kept saying, and

l i t e r a r y a m w a | 3 5 objectively, I was. But running myself myself into trouble pretending to be into the ground far past my physical one. and mental limits, rather than accept my disability, ended up prolonging While I made an excellent my healing process and eventually recovery during my leave, I also necessitating a longer than intended became frustrated with medication medical leave. side effects, delays, and knowledge gap between doctor and patient. I had preferred to hide behind a Even though I was a medical student white coat and throw myself into and should have known better, I still helping others for as long as I could got pill esophagitis, an avoidable than to face my diagnosis. I feared medication side effect. I also the depression that would follow if I developed the utmost respect for left school, which certainly did social workers, who smoothed over happen and was not pleasant. I had the practical and socioeconomic always believed that you could aspects of my health insurance and achieve and overcome anything with said “the right thing” more often pure will and hard-work. I was the than my doctor did. girl who was the first in my family to graduate college, worked 3 jobs and After my leave, I was able to put got into an Ivy League medical on my white coat in good health, school. I was the girl with 10 indebted to my treatment team. My research publications. I was the girl rueful dissatisfaction with medical who developed De Quervain’s advances and healthcare system tendonitis from repetitive hand made me run head-first into all that movements during countless late had to be lived for, just as before, but nights and weekends of research. this time more wisely and strategically. This naiveté about hard work led me to learn the hard way that our Unwittingly traversing the five bodies did have a physical and stages of grief through my recovery mental limit, and that medicine was gave me a mental steeliness that my not advanced enough to bring us younger, more excitable self didn’t back on track from certain diseases have. I was smart before, but now I fast enough, or at all. I was not was wise. Although I didn’t see at the superwoman, and I was getting time, that year made me the doctor I l i t e r a r y a m w a | 3 6 needed to become. I also realized further questions if they think of that patient advocacy and long-term them later. care were extremely important to me. Looking back, I’m extremely grateful that I had these lessons as a Living with a temporary disability nascent yet-to-be formed doctor. gave me the courage to be assertive Though painful, these very same life and excel in crises. I didn’t hesitate experiences helped develop an to speak up loudly anymore and ask additional skillset in leadership, questions anymore. I was surprised community advocacy, and patient to be able to reach patients, education I wouldn’t have otherwise. sometimes better than fellows, and It made me into the woman I am address their frustrations with today, and the physician I will be misdiagnoses and delays, because I tomorrow, and I wouldn’t have it any too was acutely aware of the other way. practical issues in medicine.

Doctors were not infallible—they are overworked, make mistakes, and a small delay can disrupt a patient’s work or school week tremendously. Part of this dissatisfaction fueled my desire to get a certificate in business leadership and decision to get a joint MBA in the future so I could learn how to improve the inefficiency of our healthcare system.

Feeling strongly about clear doctor-patient communication, I also became a stronger community health and patient advocate. With each and every patient I sit with, I always make sure they understand their diagnosis and medications, and I encourage them to write any l i t e r a r y a m w a | 3 7

waiting for godot BY EMILIE TRANSUE

FROM THE 2018 LINDA BRODSKY MEMORIAL JOURNAL

Words whispered to me in the quiet “I am a patient. I have been of confidence: hospitalized during medical school for wanting to kill myself.” “I’ve been repeatedly misgendered. There’s nowhere to indicate my “I am afraid of being stopped by the preferred pronouns to our police. I worry about waking up to administration. I feel this place is a the shooting of my sisters and hostile learning environment.” brothers on TV.”

“I have to repeatedly ask for my “I can’t breathe. I want to accommodations. I have to demonstrate my anger with protests, repeatedly explain my health status with change.” and why I have decided not to undergo intensive surgery right now “I am tired. I need to take online to ‘fix myself’.” classes, research months, and time off. My passion for patient care is “I have had to independently not strong enough to outweigh the orchestrate an elaborate system of dread of this place.” childcare to cover the three times of day I am expected to be on the wards." l i t e r a r y a m w a | 3 8

Things lectured to me in our “Women in medicine should get academic halls: married to a man who makes money”, said the Chair of the “Suck it up”, said the director of our Department of Medicine. “This way Internal Medicine rotation at you can spend more time at home Medical Education Grand Rounds. and relieve your guilt of being a “That’s my viewpoint on wellness.” career woman.”

“Those protests are damaging to “It pains me to think of students out your reputation”, said the anesthesia there suffering”, said the Chair of the attending. “You should be careful of Curriculum Committee. “It pains me having such photos of yourself.” to think we don’t know about it.”

“Don’t wear your Black Lives Matter Things we have said in response: Pin”, said the Human Resources Department. “Don’t wear your “But, this learning climate is hurting LGBTQ Pride Pins. Too political, we us. The traditions of medicine are don’t want to make anyone capitalist, heterosexist, patriarchal, uncomfortable.” and racist. This culture assertively promotes obedience to authority, “Mandatory group sessions would conservatism, and assimilation. We also make me want to kill myself”, see our patients and our hearts said the director of our Internal being burdened by these Medicine rotation at Medical oppressions. Is that not suffering?” Education Grand Rounds. Wait. Said the Vice Dean. Wait for “An applicant asked me about the when the curriculum is changing. mental health support for our trainees”, complained the psychiatry Wait. Said the Advisory Dean. Wait Program Director. “I think twice until you have completed your about an applicant who asks me that studies. kind of thing.” Wait. Said the Assistant Dean for Student Affairs. Wait until you are really a doctor. l i t e r a r y a m w a | 3 9

Wait. Said the Associate Dean for because I am systematically Faculty Affairs. Wait until you are an forgetting my own. I must re-learn attending with authority. Wait. They to practice empathy because my said. shameful emotional vulnerability is hidden deep within. I am losing the Wait. ability to honor the humanity in others because I am killing it within "For years now I have heard the word myself. 'Wait!'It rings in the ear of every Negro with piercing familiarity. This And yet, 'Wait' has almost always meant 'Never.'" I have touched humans Who Still Rise. Things said in a group debriefing session: I have cried with humans who have invited me to heal within their grief. “I can learn to wait. I will learn to justify the time between now and I have read Roxane Gay write then, between now and that time brokenly about working to love her when I might have the power to abused body and passionate soul. I make a difference.” have seen Angela Davis tell her stories of collectives, feminism, and Staring at my residency application, activism. I said: I have heard Bryan Stevenson call to Maybe medicine isn’t the place for keep the drums beating for justice. I me. It has placed a hundred ton anvil have visited the grave of Dr. Martin on my bursting soul. I am losing the Luther King Jr. and he said to me: love of learning, the love of service. I am losing the ability to care for our We must use time creatively, in the communities because in this ivory knowledge that the time is always tower, I am transforming myself out ripe to do right. Now is the time to of belonging. I am no longer the make real the promise of democracy brother or sister of patients, I am the and transform our pending national overseer and auctioneer of health. I elegy into a creative psalm of must learn “cultural competency” brotherhood. Now is the time to lift l i t e r a r y a m w a | 4 0

our national policy from the quicksand of racial injustice to the solid rock of human dignity.

On September 15, 2017, I submitted my residency application. For I deserve better.

My classmates deserve better.

Our communities deserve better.

We all deserve the solid rock of human dignity. Now.

l i t e r a r y a m w a | 4 1

building a community: my coming-of-age as a future physician BY POOJA SUGU NA YESANTHAR

FROM THE 2018 LINDA BRODSKY MEMORIAL JOURNAL

Joshua* leans back onto the sterile would encapsulate my own love and examination table, his skin damp frustration with a career in with perspiration and his cotton medicine. I entered medical school shirt sticking to his sweaty ribcage. with a penchant for surgery. I spent The cloth pulls itself from his skin to much of my undergraduate and billow outwards with each gust of air graduate career working with my from the fan I had set up in the hands, first while completing my corner, revealing emaciated arms Bachelor’s in Biomedical Engineering which clench into fists as he slowly and then while doing my Master’s in pulls up his shirt. A couple of Statistics. Thus when I was awarded minutes later, it is over: the stitches this research fellowship, I was and his feeding tube are removed, beyond excited to join the surgical and after three weeks in the ICU, he team in the OR, the clinic, and in the can finally eat food again. To a research lab. normal person, feeding through a tube would be unimaginable. To him, At the intersection of cancer, it is life. critical care medicine, and thoracic My research fellowship in surgery, my research project focused thoracic surgery was supposed to be on long-term pneumonectomy a highlight of my medical school outcomes. This is how I met Joshua. research career, but little did I know He suffered from such an advanced that my interaction with Joshua case of mesothelioma that an

*The patient's name was changed for privacy reasons. l i t e r a r y a m w a | 4 2

extrapleural pneumonectomy was happy that the lymph nodes and indicated. At the time I had already margins were clear, and we had gone through a year of medical seemed to have completely excised school, but practicing clinical the disease. However, my feelings of interviews with standardized immense joy and accomplishment patients or patients in the were shattered when I talked to the ambulatory primary care clinic I patient after surgery and found out worked at did not completely that he could barely live the life he prepare me for working with had. He was largely confined to patients like Joshua, who were in sitting, and he could no longer live such advanced stages of disease. I the life he had so enjoyed. was taken aback at how disease had ripped apart not only these patients’ Alongside the emotions I had to lungs, but also their lives, their come to terms with when working families, and their entire identities. with such sick patients, I also had to Standing in the OR as we cut out struggle with the realization that the their lungs, I could not help but department was heavily male- wonder what else we were cutting dominated. There were no female out: their ability to run after their surgeons in the department, and grandkids in the park, their ability to there was only one female resident. I go on that skiing trip, or their desire had been in such situations before, to even take those few extra steps to as the only girl in my Math Honor the mail box. Society in high school, then again as the only girl on my senior design In a medical anthropology class I team for my capstone engineering took during undergrad, we learned class during undergrad. However, it about the distinction between a still was a shock when, upon “disease” and an “illness,” where the expressing concern that I did not latter involves more than just feel confident taking patient pathophysiological processes and histories because I did not know how also incorporates the patient’s life to read chest x-rays, I was told that I circumstances. While working with just had to “chat with the patient and these patients I became acutely look pretty.” aware of the distinction between these two terms. After the first These experiences eroded the procedure I felt incredibly proud and layers of confidence and certainty I l i t e r a r y a m w a | 4 3 had built up since high school: I was serve advanced or end- stage sure that I wanted to be a surgeon patients, and how to come to terms after watching a cesarean section in with less-than-ideal clinical the 10th grade. The raw emotions outcomes. My team even consisted that came with being a surgeon, of physicians who were not directly however, truly shook me to my core. present– from Dr. Paul Kalanithi, the How was I supposed to uphold my author of When Breath Becomes Air, I promise to heal my patients when learned that as a physician part of life after surgery is only half the life our job is not to always promise they used to have? How was I patients for their health, but to help supposed to go through another patients come to terms with changes stage of life where I was one of the in their lives brought about by few women in the field? disease and to help them find meaning in their lives even after an As a child, my tennis coach told illness. me that though tennis seems like an individual sport, I always had a team. As I have entered my second year of medical school, I have realized Despite my experiences during that my healthcare team expands my research fellowship last summer, every day: a community that I can my decision to make a commitment not only rely on, but also contribute to serving patients for a lifetime to, creating a continuum of support came when I realized that, like my and commitment to serving people tennis coach said, I had a team in and promoting patient health. medicine to support me. I sought advice from the female resident in the department, as well as other female physicians who I looked up to, on how to assert myself as a female medical student. I was taught how to respectfully but confidently communicate with my colleagues and my patients. My team also consisted of my surgical team – the attendings, residents, and nurses– who I talked to about how to best l i t e r a r y a m w a | 4 4

what i can do BY KACI MCCLEARY

FROM THE 2018 LINDA BRODSKY MEMORIAL JOURNAL

It wasn’t the long nights spent What finally got to me was the coating whiteboards in culture of wards. In the pressure- unpronounceable drug names, cooker of hospital medicine, simple hoping to at least recognize them on annoyances became crushing threats the morning’s test. It wasn’t the to my dignity and control. Gone inbox bulging with student loan were the didactic days of watching emails, seemingly. It wasn’t the lectures online, replaced by cold, morning I learned my classmate had sunless morning rounds that seemed committed suicide, although I can no designed to clash with my natural longer drive up that parking ramp circadian rhythm. Committing to without imagining him jumping off. It anything in advance became more wasn’t the message about a second dependent on prayer than planning, classmate’s suicide that brought us as we never knew our schedules all together while, somehow, until the first day of each rotation. I simultaneously pulling us apart. It wanted desperately to help my wasn’t even the day we learned of a overburdened residents, but being a third student...I knew what it would team player actually means getting say before I opened the email. Failing out of the way when teaching takes tests, missing meetings, dozing off in as long as doing it themselves. I’d class; all the standard struggles come to clinics excited to finally seemed surmountable when learn through experience, yet my considered in isolation. notes were non- billable, my physical l i t e r a r y a m w a | 4 5 exams had to be repeated, and my been a little better than the last—a time felt less valuable than the nitrile difficult but steady climb up to the gloves we burned through on edge of the emotional setback rounds. Every interaction became a known as clerkships. Especially in stinging reminder of how little we the first six months, the thought of knew. quitting was my constant companion. It was not a daydream, a There is a certain Ivory Tower pleasant stroll into escapism when a romanticism to studying through the surgery dragged on and on; it was a night in the early years. We’re doing nightmare. To carry on felt this for a purpose; for our patients, impossible, but to quit? I couldn’t we persevere. The cause is noble and bear the thought of giving up on my we are proud to make the sacrifices patients and myself. it asks of us. But in clinics, when even bathroom breaks are doled out As I struggled to choose between by superiors, the sacrifices were no my goals and my mental health, I had longer mine to make. Suddenly, I the fortune of rotating with a few wasn’t staying late for the good of people who were working to solve the patient; I am there because I the exact problems I was facing. need a good evaluation. When I Their simple acknowledgement of the stand by the operating table for toxic culture in medicine allowed me hours, it is not out of concern for the to step back and reassess my situation: certainly, at that moment I person in front of me, but rather to felt powerless, but it wouldn’t always meet my attending’s expectations. be that way. As a doctor, I would be All choice had been smothered by in a position to advocate for change. obligation, and I brimmed with Even as a medical student, I started resentment. It felt like being in high finding ways to fight back against the school again. strict, emotionless culture of the wards by talking about doctors living After being bullied throughout my with mental illness. formative years, severe depression and anxiety have been constant With a few other students, I companions. I struggle not only to be helped found a chapter of the the best possible version of myself National Alliance on Mental Illness and live an authentic life, but to have (NAMI) at our school. Wellness, while the self-confidence to believe that I important, was not enough for us; deserve happiness. Each year had l i t e r a r y a m w a | 4 6 failure, and struggle as a common ground for medical professionals to support each other. Additionally, I started a personal project collecting stories of physician and medical student struggles with mental illness and suicidality. I stopped wasting energy railing against what I couldn’t control, and channeled it towards what I could.

Confidence trickled back in with every rotation I passed, until finally I hit my stride in advanced clerkships. There were so many other healthcare careers I could have chosen, so many other things I could have done with my life... but once I was back in my specific field of interest, neurology, the endless questioning seemed almost silly: Can I do this? Should I do this? Of course! I love medicine; the current system of practice is my primary frustration. Part of wisdom is accepting that there are things I cannot change, while maintaining the desire to change what I can. Today, what I can change is still small, and control over how I use my time is limited, but it will continue to improve with training. By focusing on what I can do rather than what I can’t do, I have found both day-to- day satisfaction and the patience to continue working for the practice of medicine I love.