Cleveland Clinic Lerner College of Medicine 2016 of Case Western Reserve University Table of Contents

Dean’s Introduction 3 Touching and Examining 23 James B. Young, MD Kaitlin Keenan, CCLCM Executive Dean of Cleveland Clinic Lerner College of Medicine This White Coat I Wear 24 Editor’s Introduction 4 Elizabeth Shay, CCLCM No Longer Broken 5 Louisiana Swamp: Don’t get lost in Appledene Osbourne, CCLCM a Louisiana swamp 25 Shaker Lakes: Fall season at Shaker Lakes 6 Datta Sudarshana, CCLCM Datta Sudarshana, CCLCM Words 26 A Cleveland Story 7 Radhika Rastogi, CCLCM Rebecca Achey, CCLCM Skipping Stones 27 A Job 8 Mike LaBarbera, CCLCM Yuanjia Zhu, CCLCM Details You Won’t Find in An Operative Report 28 Moon My Lovely Friend 9 Jessica Jones, CCLCM Datta Sudarshana, CCLCM Trapezing 29 City at Night 9 Katie Daley Rachel Elkin, CCLCM Impersonations 30 My father’s doctors 10 Katie Daley Kathleen Quinn, MD, CCLCM Faculty Hey Doc 31 Nymphaeaceae 11 Katie Daley Mike LaBarbera, CCLCM Mary Katie Gets Diagnosed with Cancer 32 Word Medicine 12 Katie Daley Jordan Gales, CCLCM Flip It 33 To the one that gives me strength 13 Stephen Raithel, CCLCM Nemat Sharaf, CCLCM Shaker Fall Trees: Sunlight through fall trees 34 Waiting 13 Datta Sudarshana, CCLCM Heart Nemat Sharaf, CCLCM Seizure: A Differential Diagnosis 35 Anne Runkle | CCLCM Class of 2017 Yellow Eyes to Remember Me 14 Jessica Jones, CCLCM Daniel Firl, CCLCM Waves 36 The Sacredness of Standing Shoulder Nemat Sharaf, CCLCM to Shoulder with Death 15 Soccer as Self-flagellation? 37 Brian A. Shields, M. Div., Staff Chaplain Daniel Sexton, CCLCM What is the color of your faith? 15 Why? 38 Radhika Rastogi, CCLCM Elizabeth Shay, CCLCM Editors-in-Chief: Josephine Volovetz and Stephen Raithel On the Day We Met 16 On Approach 39 Kate Ituarte, CCLCM Stuart Zeltzer, CCLCM Issue No 6 Co-Editors: Rachel Elkin, Rebecca Achey, Karen Fang, Alexander Chaitoff, Tulsi Patel, 2016 Constructs 17 Our Cages 40 Datta Sudarshana, Beau Hilton, Kaitlin Keenan, Christina Snider, Emily Zhang Bob Sun, CCLCM Joseph Abraham, CCLCM Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Chateaubriand Shenanigans 18 Losing the Love of Your Life 41 James Witten, CCLCM Stethos Logo designed by Medrano Design (www.medranodesign.com) Brian A. Shields, M. Div., Staff Chaplain Context 19 Layers 42 Kate Ituarte, CCLCM Radhika Rastogi, CCLCM All copyrights for individual articles revert to the appropriate authors. The Good Teacher 20 Things that enter by way of silence (after Mark Strand) 43 Richard A. Prayson, MD, MEd Jessica Jones, CCLCM The opinions expressed within this journal are solely those of the authors, and do not necessarily reflect the views A Babe Once More 21 On Kindness and Compassion 44 of the Cleveland Clinic Lerner College of Medicine. Elizabeth Shay, CCLCM Johanna Goldfarb, MD, CCLCM Faculty New Growth 22 Imperial Palace 46 Mike LaBarbera, CCLCM Front Cover Artwork Michael LaBarbera, CCLCM Integration Josephine Volovetz | CCLCM, Class of 2019 INTRODUCTION | Dean’s INTRODUCTION | Editor’s

The cover art for this year features a skeleton hand engaged in to the sixth issue of It’s Time for a Time Out Welcome writing—it acknowledges our anatomical and medical expertise while Stethos, the medical humanities James B. Young, M.D. reminding us that it is the human stories in medicine which are so Professor of Medicine & Executive Dean journal of the Cleveland Clinic Lerner critical to our work. In the words of the famous doctor and poet Cleveland Clinic Lerner College of Medicine of Case Western Reserve University College of Medicine. William Carlos Williams, “But the haunted news I get from some obscure patient’s eyes is not trivial. It is profound.” This year’s issue We have reluctantly admitted medical professional burnout we So it is time for a Time Out. is filled with such profound stories from our patients, stories haunted at that mistakes made by our are hearing so much about? It And to that point, here comes times, but also joyous, both tragic and triumphant. profession are killing us – or is a real problem, but it always STETHOS 6th Edition - 2016. rather, our patients. It has been has been present. It seems, Once again ably assembled Many of the stories this year focused on a sense of place: a patient suggested that hospital errors, however, the difficulty is getting by CCLCM Editors-in-Chief(s) with a life story inextricably rooted in Cleveland, another story about for example, are the third leading worse. Some reports suggest Josephine Volovetz and Stephen the ability of place to assume the power of metaphor and transport us cause of death in the United that nearly half of physician Raithel, with co-Editors Elkin, away from the mundane, and other reflections about what it means States with hospital safety scores caregivers have symptoms Achey, Fang, Chaitoff, Patel, to devote ourselves to places of healing. Many of the photographs in only slowly improving. One suggesting burnout, which is Sudarshana, Hilton, Keenan, this year’s issue show us beauty can be found in places both near and initiative to address the problem significantly higher than that Snider, and Zhang. The far, providing a reminder that profundity lies in the particulars of color, is mandating a “Time Out” be noted in the general population. extraordinary photography, texture, shadow, light, which can also be said for the details of our done before any interventional There was seemingly more poetry, reflective writing, and patients’ stories. procedure is begun. Labeled the burnout reported by physicians narrative stories re-energize me This year’s “A Different View” section features several pieces by Universal Protocol the procedure who are “first responders” – that and help with my own personal Katie Daley, a Cleveland based poet who reflects in her writings was initially focused on surgical is, those in primary care and burnout. The contributions tell about the personal nature of illness of body and mind. Her writing is suites in order to prevent emergency medicine settings. me great things about what compassionate and insightful as it focuses on the human narrative that wrong site surgery, which is an Of course there is a differential we do and the resilience of our must remain central to our medical encounters. egregious error that can have degree of resilience in any own caregiving team. There is significant consequences. When population and so it is with bountiful joy in my heart when I We hope you enjoy this issue of Stethos. It was our great pleasure done correctly, I believe it is an healthcare professionals. How look at what has been done, once to review the works, and as always, we look forward to your future effective preventive medicine might we address the challenge again, with STETHOS. Please submissions! practice. The concept is to step and increase our own resilience? enjoy it, swallow it, and help back and have the team (led by I believe that embracing the yourself heal with it. Take a time Warm regards, the captain of the ship which is arts and humanities broadly out. Reflect on your part in this The Editors usually the surgeon in the case and individually will help us complex system – what it means of the operating room) go over understand the nuances of to you, your patients, your family, all particulars of the procedure professional challenge and friends and loved ones. planned for any patient. purpose. Yes, it is a hard and …and consider contributing to frustrating profession at times. So what might time outs have to next year’s edition. Help yourself, But the rewards far outweigh any do with us outside of the hospital me and the team! pain caused by the challenges. or clinic? And what about

3 4 No Longer Broken Appledene Osbourne, CCLCM | Class of 2018

We want to be physicians that revealed the renal mass, arm immobilized while working because we want to heal the a nephrectomy was thought to to control her pain and other sick. For me, this meant treating be curative. But two years later, symptoms that were increasingly illness and promoting health. a surveillance scan and biopsy limiting her ability to perceive Furthermore, we all want to revealed disease recurrence. At her own remaining existence. relieve “pain and suffering,” and this point the destiny of her life She needed pain medications in many of us, including myself, as dictated by cancer became quantities sufficient enough to would like to believe that if we inescapable. She had metastatic numb her discomfort yet leave treat the pain, then we treat disease and had to come to terms her with enough mental facility the suffering. Spending time with the fact that this is how to get through her days. She with patients at the end of life her life would end. Still, there needed other agents to treat the has redefined my perspective. was more to be done. Novel nausea that was brought on both I have come to appreciate the agents could avert her fate for by her disease and the very pain less frequently mentioned role some time – the masses shrank, medications we gave. There of the physician – that is, to but side effects followed. The was no simple recipe for any of relieve suffering. Very often, masses inevitably regrew and this. Her medications had to this takes us to the bedside of a the side effects worsened. She be constantly adjusted and our dying patient where delivering told me no one wanted to give treatment plan further refined to care can become complicated, up. She was switched to a then reflect new realities. and can create conflicts. It’s new immunotherapy that had complicated because the patient, produced remarkable results in Still, she was dying. How would the physician, and the family will some percentage of patients. Yet she spend her remaining days? often deliberate about the use of another promise betrayed. There She wanted to lessen hospital life-sustaining interventions that was no escaping her progressive admissions and preferably may only serve to delay death. decline and certainly no denying eliminate them altogether. There is the potential for conflict the truth in the scans. She wanted her care needs when delaying death appears managed by a team of dedicated to be at the expense of relieving I met her at the time of an professionals so she could “die in suffering. I would argue that if admission for progressively dignity,” which were her words. we begin to acknowledge our role worsening dyspnea in the setting She eventually opted for hospice. to relieve suffering as much as of a recent thoracentesis, which At first, this was a word she both we acknowledge our role to treat provided only a brief respite. mistrusted and feared – a signal physical pain and illness earlier During this hospitalization, she to give up. Together, she and on in the treatment process, our felt a snap in her arm while her family eventually concluded patients may suffer less. turning in bed. The x-ray that this was in fact modern unveiled the expected pathologic medicine’s last opportunity to One particular patient encounter fracture. Surgical repair was fulfill a promise to her – to relieve that has re-shaped my outlook a consideration, but she was suffering. “No more fixing,” she involved a patient with metastatic tired of being broken. There had said. We all realized that renal cell carcinoma. New and was a remarkable strength to she was no longer broken, but advanced medicine, particularly her usually faint voice when dying. She went on to spend her in the new age of treatments, she said, “No more fixing.” last days surrounded by family. I had bought her several additional Still, she couldn’t decide. She would like to think we finally kept years. Yet at each stage, the sought advice from her children our promise to her. Shaker Lakes: Fall season at Shaker Lakes initial promise of improvement but they were either reluctant Datta Sudarshana | Class of 2019 was betrayed by inevitable or unable to give any. We relapse. When her hematuria recommended against surgery first brought about the CT scan and offered instead to leave the

5 6 A Cleveland Story Rebecca Achey, CCLCM | Class of 2018

There was something in the way family to pack up her identity, And she said to me, “I’d rather she talked about it that made supplant her volition and ship her die than be taken up out of this the move to Georgia seem like down to Georgia. place.” She fixed me with a bone- an insurmountable insult; a dry eye and a perfunctory wrap tear in the fabric of her story It wasn’t so much that she didn’t of an arthritic knuckle on texture- that rendered her adrift. She want to go. It was that her soul less desk. “I’d rather die than be had entrenched roots along the had sojourned so long on this taken up out of this place.” sidewalk splits of Cleveland great lake, among the tumultuous Hidden with the silence of the streets. She had extended winters and mercurial summers, next few seconds, I scheduled a branches to brush the cement of that her life harmonized with follow-up appointment. city living. Her life’s intricacies Cleveland’s accent, and with played out among the friends and Cleveland’s accent alone. Her Later, I came to find family she harbored within the story’s inflection reflected East out that her family framework of her Cleveland story. Cleveland. Her office visit’s had moved her down to Georgia, “Her soul had grown deep…” intonation pitched and yawed Cleveland story until the encroaching disability with the waves of follow up care and all, for the very and instability of aging sufficiently and consultant orders placed at last time. alarmed her remaining Southern the Clinic.

A job CLE Yuanjia Zhu, CCLCM | Class of 2017 7 8 Moon, My Lovely Friend Datta Sudarshana, CCLCM | Class of 2019 My father’s doctors Kathleen Quinn, MD | CCLCM Faculty

Alone, you shine ever so bright Among the stars, punched like a hole in the celestial fabric. My father was a survivor. He was to go to the hospital when confronted My parents remember Dr. S Neglected by creatures who slumber, proud to tell you all the obstacles he by family members. At Dartmouth taking the time to sit close to my Cursed by those who cannot. had overcome in his life, including Hitchcock, the diagnosis of father, giving him his undivided a harsh childhood in which he went pancreatic cancer was quickly made attention and steady eye contact Lonesome, illuminated through another’s light out to work at age 11 and severe with an endoscopic placement of a and methodically exploring all Dragged around daily by forces unseen learning disabilities causing delays stent and an oncology consult. the options. Intermittently, Dr. S. in his reading and spelling, which reached out to touch my father’s Every night you rise with a different visage The physicians who were involved prevented him from achieving a arm, reinforcing the sense of Do you ever wish to be free? with his care had very different styles four year high school diploma. He connection. of communication, leaving very relished recounting how he had different lasting impressions. The hospice team was at my parent’s surmounted these barriers. He sat home the next day—first the hospice next to the smartest girl in his middle Dr. L, the hospitalist, deftly nurse, then the hospice physician, school classes, and his grades went orchestrated the hospital stay and Dr. D. Always a man of action, my up. They eventually married, giving had detailed conversations with father had chosen to stop eating and him the stable, supportive family life my parents about the diagnosis, drinking to accelerate the inevitable. he had not had in childhood. He left treatment options, and prognosis. He could not tolerate the prospect high school early to enlist in the Navy He listened carefully to my father’s of a prolonged period of weakness in World War II and after serving declaration that he would refuse and helplessness. The hospice nurse on a mine sweeper in the Pacific, active treatment and wished to also swung into action enumerating was awarded a “war diploma.” go home to die. Dr. L respected the comfort care options to be put My parents formed an inseparable these statements, saying to both into place as needed. My parents team for over sixty years—he was my parents and their children that felt relieved to know there was a the brawn who used his physical as a physician, he was familiar path forward, and my father began strength and energy to hold down with the stoicism of farm folks who to eat again. Later in the day Dr. D two jobs while she kept the books for understood the cycle of life. arrived to confirm and reinforce the his growing landscaping business. Long after the oncology consult, my treatment plan. He prided himself on being an astute parents talked with disdain about observer of human behavior, regaling the young oncologist who breezed After Dr. D left, my father perked the family at dinner time about the into my father’s hospital room in up and warned, “Watch out for her lives and foibles of his customers. fashionable clothes, which appeared [Dr. D]. Did you see how she looked My parents lived frugally, growing out of place in rugged New England around the house?” Indeed, three most of their own food, including farm country. She rapidly talked at months after my father’s death, sheep for meat as well as wool. my parents about active treatment Dr. D called my office to indicate she They avoided debt by paying for options, including surgical exploration was interested in buying my parent’s purchases, such as a car, in cash. and chemotherapy. By their account, home, which was now for sale. My father’s proudest accomplishment she never explored my father’s My father died as he had lived—on was paying for both of his children wishes or goals for treatment. Even his own terms and with “no regrets.” to go to Cornell. He saw education in his weakened state after much He died December 31, 2008 at as a way they would not have to weight loss, my father pulled himself home in his own bed without pain. earn their living by physical labor, up and stated emphatically to his as he had to do. He often spoke wife, “Get me out of here.” The My family is grateful to each of of his good health as a necessity consultation ended abruptly, and his physicians (and nurses) who to accomplish these goals, and he discharge plans were set in motion participated in his care. Although rarely saw doctors. He was still by Dr. L. each was competent in their medical chopping and stacking wood, as well knowledge, each physician is now The same night, back at his farm, as studying spelling words to improve primarily remembered for how they my father was visited by his longtime his reading into his eighties, proud of navigated the complex task of patient primary care physician, Dr. S., who his strength and perseverance. communication, empathy, and spent over an hour with my father City at Night professionalism in end of life care. Everything changed in October reviewing the hospital findings and Rachel Elkin, CCLCM | Class of 2016 2008, the week of his eighty-second confirming that my father understood How do you want to be remembered birthday, when he became jaundiced. both the treatment options and the by your patients and their families? He insisted on having his birthday consequences of his decisions. party at home and only acquiesced

9 10 Word Medicine Jordan Gales, CCLCM | Class of 2017

Seven minutes. That is all I have with you. Seven That night, instead of the slurred curses I had grown minutes to find what pill, what test, what service I accustomed to, I heard him say through sobs “life is can render. Just seven minutes, to find where I can shit, it is suffering and pain.” poke, prod, and pierce. If you had heard him say it too doc, his voice so honest, you would have taken it for truth too. How long does it take to reach the heart of the problem? When will I know when I get there? Maybe “I never told anyone that” it’s these words: I don’t think I was meant to be happy. I hear these “I have never told anyone that.” voices and know they are not real. I won’t repeat what they say. They tell me the voices are really just me. It’s not the suffering of this present moment. Not I’d rather believe they weren’t. That is the worst part, the gripping anxiety or the paralysis I feel, each day, knowing a part of me is so terrible to say those things. when my emotions overwhelm me. “I never told anyone that” It’s not the guilt I feel when I can’t take care of my daughter, or the frustration I face when I act in ways I Seven minutes is gone. Not one more to give. You know I shouldn’t. leave. Until our next seven minutes, I can only wonder what will precede when I hear you say It’s the future loss that hurts the deepest. The idea that not only is the present moment lost, but also the “I never told anyone that” future.

“I have never told anyone that”

My daddy came home drunk again. My mom and brothers had assumed their hiding places for the night, having learned where it was safe to ride out his inebriation.

Nymphaeaceae Water lilies in bloom at Kinkaku-Ji, Japan Mike LaBarbera, CCLCM | Class of 2019

11 12 To the one that gives me strength Nemat Sharaf, CCLCM | Class of 2018 Yellow Eyes to Remember Me Daniel Firl, CCLCM | Class of 2018

I felt your Love as the sweetest song that touched every note of my heart “I’m in a death spiral to hell doc,” perform a cursory exam and review on the shoulder. The attending told your melody danced through my being Pat tells me. We both knew his of systems fully conscious of a clinic me after, “It’s not so much what where you sang into the depths of my soul decompensated cirrhosis was full of other patients. He is a good you say but how you say it, and the worsening; he was having 5L of candidate I think to myself, sober patient wants to hear you and see ascitic fluid removed by paracentesis since discovering his cirrhosis, that you’re there with them.” For every 3 days, and his MELD was otherwise healthy, completed whatever reason this piece of advice increasing almost weekly, 22, addiction counseling as requested, has stuck more than most. Before 26, 28 but not high enough to compliant on his medication, and speaking to Pat again I focus my eyes receive a donor organ. He was strong family supports to help him on his and declare without doubt or just discharged from the hospital through. As I prepare to leave the hesitation, “But we’re here as a team following a variceal bleed that room I shake his hand, a courtesy for you, all of us for you, and I can probably should have killed him. since, in my head, I am already promise we’ll do everything in our Instead he was resuscitated by a organizing my presentation to the power to keep you here.” skilled intensivist only to develop attending. But then I am stuck. “It is scary and I have people I don’t spontaneous bacterial peritonitis and His hand is still wrapped tightly want to leave,” he says as he looks spend two weeks septic in the ICU. around mine and his eyes locked around at his wife and daughter He described the most fantastic into mine and I am dragged from before turning to me and locking hallucinations and waking up with my intellectual sanctuary as tears my eyes into his again. “But now flapping tremor and truly losing drape his cheeks. I feel a shaking, I know why God sent me here to himself. distantly familiar sensation as my see you today, you care and not I found myself retreated from the soul is stirred from a cave deep everyone cares, so thank you.” moment, trying to imagine this within, rising to meet his. In that moment, a therapy was lost concept of self, of not knowing “I’m in a death spiral to hell doc, I delivered, maybe not pharmacological those around me or what was being know there’s going to be some other and certainly not mechanical, but I done to me; I am frightened before event and I am not going to make it connected with this patient in a way I fall back into the beige clinic this time.” I’ve rarely experienced, and we were room. Pat’s family is there with I know what Pat wants me to say, both certainly changed as him, a wife clearly overwhelmed but I can’t bring myself to lie to a result. into introspection and fear and a him. He is, in a way, right after all; I found out a month later Pat had daughter grasping out for control. Waiting any further insult to his liver would died before receiving transplant. He Knowledge is her weapon and likely be catastrophic. I settle for developed pneumonia during an she needs ammunition. I answer what seems at the time only a half admission for encephalopathy. I Photo taken around Doan Brook. her questions on the process I love to swing from tires in the measure. “I know this has to be sometimes wonder if I overpromised of evaluation and listing, being very overwhelming and there’s so or underdelivered, did I do everything summer, and it gave me joy to called for transplant, the surgical see this swing in limbo through much information coming at you in my power? In the end those eyes, procedure and complications, and everything is dark and scary brilliantly icteric and filled with tears a cold Cleveland winter. The post-operative length of stay absence of people encircling the and only getting worse...” I start. brought me back to a piece of myself. and immunosuppression. She is swing with their laughter and In my head I am stumbling through Those yellow eyes forced me to truly modestly calmed with this infusion play reflected a natural shift in a poorly choreographed version see a patient lost and wasted by a of information but Pat is absent. the environment to a more calm of what I’ve had modeled for me medical practice meant to smoothly and reflective state. I felt joy During our discussion I see him before. transition patients from cog to cog as thinking about how each state of looking out the window and I I think back on one of the first efficiently as possible. Even though I being provided texture, meaning, wonder what he’s thinking? Why liver transplant cases I assisted on. failed Pat, I think about how grateful and importance to the other. isn’t he paying attention? I am I am to have truly seen him as a frustrated before I wonder how lucid The patient was paralyzed by fear, unable to consent to proceed with patient, even if briefly, and to have Nemat Sharaf, CCLCM he is, he has had encephalopathy in the opportunity to see yellow eyes Class of 2018 the past and he has been scattered induction of anesthesia. I observed the transplant attending go to this every day in my chosen practice and today. I return to my task and know I am in the right place. collect the data needed to present patient and calm him with what him to our selection committee. I seemed a magical phrase and hand

13 14 The Sacredness of Standing Shoulder to On the Day We Met Kate Ituarte, CCLCM | Class of 2019

Shoulder with Death Brian A. Shields, M. Div. | Staff Chaplain On the day we met you were writhing in bed, unable On the day we met your fingers were blue and your As chaplains, we have the privilege to stand shoulder-to-shoulder with Death. to communicate or lift your head. You were covered eyes were a bright green hue. You glanced up at me We don’t run from it in fresh sores and scabs, reminders of your present and pretended to see, but all that was there was a Rather, we’re called to it. horrors and past jabs. You were wasted and thin, blank stare. You moaned and groaned and tapped When a patient dies connected to life through a single pin. I could see your head and feet to a fleeting beat, and though Family present you and touch you, but I could not teach you or the infection had taken its toll it could not take your At the bedside, in the hallway, on the unit reach you. soul. We go there On the day we met you were screaming and clawing On the day we met you were seizing uncontrolled, We don’t turn away at the air, pleading with the man upstairs. There never to awaken, your story untold. Your brother From the raw, real, relevant emotions, stories were bats in your hair, flying everywhere, why could found you lying on the floor while your mother came And loss no one see them, why did no one care? He sat running through the open door. Does he have a We are chaplains who stand shoulder-to-shoulder with death. faithfully by your side and cooing softly to ease your history of seizures in the past? No, not a one, it all fright, he tried to help you see the light. happened so fast.

On the day we met you were yellow as a pear and On the day we met your arms were open wide, you curled up like a hibernating bear. You pretended to could barely breathe and could no longer hide. Not be asleep, but I know you were measuring time with even two and with more left to do, your mother held every machine beep. Your mother was stroking your you in place as tears streamed down your face. With dreaded hair and your father was pacing here and too little energy to fight doctors outright, you held there. You knew your parents were denying your onto life with all of fate that your liver would be too late. your might.

On the day we met you were in a deep sleep, can The day we met is one I’ll never forget and one I bet you give me a thumbs up or wiggle your feet? With you never knew we met. eyelids lifted your gaze never shifted, no response to pain and no new gain. Locked in I fear, only able to hear, with nothing left to heal we wait for time’s reveal.

What is the color of your faith? Something about the colors of the candle holders made me think of the ways in which people are faithful and degree of vulnerability that often underlies that faith. Radhika Rastogi, CCLCM | Class of 2020

15 16 Story Slam Spotlight! Chateaubriand Shenanigans James Witten, CCLCM | Class of 2019 It was an average day in the changed and woah… was that it? days, except I overheard someone spring of my junior year, and I And I kind of leaned around the talking in casual conversation was with a few guys from my side of her and saw like the entire about how the now accepted way Constructs fraternity at the freshman dining shank of a cow on the plate, and to do the Heimlich was “five and hall near the Cornell University of course you couldn’t swallow that five”- five back slaps followed by Bob Sun, CCLCM | Class of 2019 intramural softball fields. We had much cow without chewing girl! five stomach thrusts. And this sent just beaten Chi Phi in softball by a new wave of psychic pain over Henry Heimlich, whose eponymous like 20-2, and we were having the presumed ineptitude of my On the corner of 113th and but fundamentally it’s built as a maneuver has saved countless an average talk about the load pharynx evacuating technique. Amsterdam, in Manhattan, there monument to an ideal, and there’s lives, is a Cornell undergraduate bearing capacity of our fraternity is a cathedral. It’s the seat of something magical about that. That and medical school alumnus. I’m For the next couple months, in roof in anticipation of a brother- the Episcopal diocese of New people—that we, collectively—are sure he sat many times in the same those tortuous hours between run above ground pool installation, York, and its official name is able to look up once in a while tables, eating the same dinners attempting to sleep and when I heard a little noise at about The following works by Bob the Cathedral Church of Saint from our pain and our struggle and and contemplating vectors of force actual respite from the mind’s nape level, that had an attention- Sun ‘19, Kate Ituarte ‘19, John, but everyone calls it St. our work to work on something so required for external ejection of ruminations, I would recount those grabbing characteristic to it. Myself and James Witten ‘19 are John the Divine, or, if you live in much bigger than us. visceral contents. Perhaps Henry’s breath-stopping seconds. I could and my six co-conspirators stopped the neighborhood, simply “the harrowing encounters with the very feel the strangulation of doubt and some of the pieces performed I used to go to St. John the Divine our calculations and listened as, at Cathedral.” It happens to be the same insipid Cornell cow meat lead regret, fear and inadequacy. “What at the inaugural Story Slam: a lot, to be consciously caught up barely above a whisper, a clearly largest cathedral in the world, full him to his discovery, we may never if’s” flooded my thoughts. The next in the metaphor. I didn’t go inside, freshman, very bashful girl said: Medical Student Edition. This stop, because this is New York, know. morning, I would be so mad at I didn’t sit in a pew, I didn’t pray, event, organized by Josie so there are no caveats to our “hiiii, ummm, I’mm sorry to bother myself—“I hadn’t failed!” I would I wasn’t there to do any of those I asked her if she was still choking superlatives. On its north side is you but, uh, my friend…uh,... I think, “Stop worrying about what Volovetz ‘19, Anna Faris ‘19, things. For one, I couldn’t—the and she shook her head no, and St. Luke’s, which is decidedly not think she might be choking…” could have happened, stop thinking and University Track student, functional part of the cathedral I said “Say something!” and she a cathedral—certainly not literally When a moment strikes, one never about what didn’t happen! You was closed, since I usually went whispered “Thank you” with her Brenna Brown ‘18, was held and not even metaphorically—it’s a truly expects it to look and feel the acted, it worked, and this freshman at night, coming from many head kind of down staring at her on September 28, 2015 at the hospital that, besides being the last way it does, but still I had to ask… can go on to eat thousands more hours in the library or a late shift vanquished foe. I looked around refuge of underage drunks, does “Are you serious?” meals (hopefully with sufficient Market Garden Brewery. Story volunteering in the hospital ER. I the cafeteria and maybe 30% of brisk business as one of the city’s mastication).” Slam: Medical Student Edition sat just outside the closed doors, With freshman in her eyes she the people were definitely staring 15 level 1 trauma centers. Across But I still sometimes continue is a forum in which medical on the ground, under the pointed nodded the affirmative. at me, but it was so quiet and the the street is the dorm I lived in my to sweat it out and think about arch of the entrance. I think, in I jumped up from the low bench I whole thing had happened so fast students can creatively freshman year of college. that day, and it used to scare architectural terms, that space is was on, ran over to the high table that I wasn’t really sure what to do share their perspectives me to think about medicine and I’ve always thought there was called a portal. It wasn’t actually directly behind me, and saw that so I said, “good” and went back to the opportunities that I’ll have to and experiences with other something fascinating about a portal to anywhere (except the for sure this girl was choking. Just my table and sat down, and all my intervene and both succeed and members of the Cleveland places like churches—museums locked doors behind me), and I to make sure she was choking, friends started saying things, but fail, and how those instances might and preserved archeologic didn’t actually retreat to some I asked, “Are you choking?” To one thing I’ll never forget was one medical community. This haunt me. But I also think about sites too, perhaps—places place of peace and quiet—I which she nodded fearfully. Her of my best friends said, “Wow nice year’s event featured a group how the experience was so novel are so consciously, concretely mean, I could still see and hear chair was tall and metal backed, job… that was awesome dude, I and scary that of course it will stick of performing students from constructed for a purpose that is the ambulances taking gunshot and she was sitting a little bit thought you were going to make in my head, but it might become so both the College and University so removed from the mundane. victims next door—but it was below chest level, and dear lord her stand up to do the Heimlich… commonplace that it doesn’t dwell It’s built to the impossible, the really all those things, in metaphor. I didn’t know what I was doing, I that was crazy.” Tracks of the medical school. with me -- I can take the learning irrational. I mean, the Empire And I did actually look up, at just wrapped my arms around her And time kind of slowed, and my points from these events and leave State Building is gorgeous, but the sculpture, and masonry, and and bear hugged her and the seat, stomach dropped, and I was like the emotional angst behind. I’m that’s a veneer over something craft. I looked up at the ideal, at and the metal was kind of in my dear lord I should have made her sure the times I fail will linger very functional. Of course, the the metaphor that I had, in that face, but I just was thrusting with stand up, what was I doing? forever, but I’m also sure that I cathedral also serves the functions moment, become a part of. my fists like I think I had seen in When we got back to the fraternity and everyone going into medicine of housing the congregation, a movie or lifeguard training that my buddies retold the story several right now are the kind of people disseminating political views, etc., one summer I had trained to be times and there was a lot of who have to intervene when we a lifeguard, but was too young discussion about the horrors of the are asked to and that this action to actually lifeguard because my Cornell steak, and the merits of could never be fully displaced parents thought it would be a good our fraternity chef being much less by apprehensions or the mental idea, but that was like 8 years ago, murderous by comparison, and I gravitas of failure. and maybe the guidelines have mostly kept to myself the next few

17 18 Kate Ituarte, CCLCM | Class of 2019 Context The Good Teacher Richard A. Prayson, MD, MEd | CCLCM Faculty

Preface My goal with this piece is to showcase the parallelism that exists in the thoughts of patients and doctors while highlighting the nuances and subtleties in the differences that do exist. In this performance piece, the patient What makes for a good teacher? reflection, however, the analogy the lab, problems in their personal Certainly, much has been written seems perfect. life, updates on what was going and the doctor will each tell their own story while simultaneously telling the story of the other. The patient on the subject- papers, thought on with the kids. I recall sitting in I first met my friend, a teacher and doctor have distinct points of view and yet, together, they tell a cohesive story. Although cliché at times, pieces, books, commentaries. The her office as we informally chatted. among other things, 26 years ago. ultimately, this piece is meant to demonstrate that we are all far more alike than we are different. passing of a good friend often Our sessions were punctuated by I was a second year pathology presents you with an opportunity to these intermittent interruptions resident and she was one of four reflect on that person and what she from those needing something doctors running a laboratory. All Patient: Well, it all started about Patient: Cold, calm, technical. hours in a day- what I could do or he has done and accomplished from her. What initially seemed four of these individuals were a year ago. I hadn’t- And underneath the stoic with more time- and how her or his life impacted from my perspective to be irritating wonderful people in their own Doctor: Even finished my presentation, I could tell the others, all in the name of trying disruptions of our conversation Patient: Is endless! For the first way. Most of our time as residents morning coffee. I was a resident doctor was trying to be- to make some meaning or to give shifted at some point to time in my life, I get to do exactly in training in that laboratory was purpose to what is otherwise a sad observations of a master at work, working 80 hours a week- Doctor: Warm and empathetic, what I want, what truly makes spent with two of these individuals, occasion. It does not erase the of the power of being selflessly Patient: It’s like two full time but without giving- me happy. I’ve never known this my friend being one of these. As feelings of loss but in looking for there for others in the moment. kind of freedom from- a learner, by the time one gets jobs, you know, working and Patient: False hope. Hope-what a a legacy, however small or grand, She addressed each of these to residency training, one has planning a wedding. I wasn’t- double edged sword. We need it Doctor: Fear-paralyzing fear. I’d you can go on knowing that that interruptions warmly, personally been subjected to hundreds, Doctor: Sleeping, I never had to get us through each and every never given bad news before. individual’s life had meaning, and with a smile. And yes, she perhaps thousands of teachers, time to eat and I hadn’t seen my day-hope just knowing that- Of course, I had watched other continues to have meaning and often apologized to me afterwards a trail going all the way back to people do it, and when you’re that the life you lead, in a similar for the interruption as well. family in days. I thought it’d be Doctor: This will never get easier kindergarten for me. Experience standing there you think about fashion, has the chance to be different- but that I will find peace- makes one somewhat savvy at She liked to talk and she meaningful in a positive way. The all the ways you could do it discerning certain things in a admittedly talked with certain Patient: I thought I was different, Patient: Because that’s all I have recent passing of such a person differently- learning environment. Admittedly, alacrity. She was always moving I thought it couldn’t happen to left. Hope will betray me unless has provided reason for me to the relative importance of these and her speech seemed to move in me. How do you tell- I hope Patient: But, honestly, I wouldn’t pause for a few moments (perhaps have changed anything because it things varies from learner to learner step. You had to keep up. There Doctor: Someone they’re going more than a few moments, to be Doctor: For acceptance. but I do believe there are certain was no slacking. She enjoyed got me here. My only wish is that honest) and reflect on this person’s to die soon? That the life they’ve Acceptance that not everything is characteristics that number from talking about her family and the I had- life, or at least the snippets of it planned isn’t going to happen? in my control and that it doesn’t among these things that form the things she liked to do. She was I was blessed to have shared. In But worst of all, what if- mean that I am- Doctor: Appreciated what I have. core of good teaching. The first willing to share with you her my reflections, I found myself I know it’s selfish to think about of these is sincerity. She always experiences, both in the science Patient: They were wrong? Patient: A failure. What have I rummaging around the subject of yourself when someone else is seemed sincere, even when I world and in that world which Doctors are human too, right? really done with my life? I did what makes for a good teacher, suffering but I kept thinking this daresay she did not sometimes feel exists outside of the science world, Can’t they be wrong? What if I all the things you’re supposed since I believe teaching was one of could be- like being sincere. Sincerity can as a subtle reminder that such a was the exception- to do, like go to school and eat the many things she did well. Patient: Me. It happened to me. be a hard thing to maintain when world does in fact exist, should Doctor: But that’s not true. As vegetables, but did I really do- If only you knew how long it took A famous quote on the subject trudging through the daily routine, exist and needs to be given its physicians, we know there are Doctor: Everything I could? me to finally accept it. To process of teaching proffers that “A good sometimes interfacing with people proper due. She clearly loved her things worse than death. There That’s the question we must it. That day- teacher is like a candle – it who might be anything but. She family. She smiled and laughed are lives not worth living. Can ask ourselves. That’s how we consumes itself to light the way for was always truthful – knowing and yes, sometimes worried when you imagine- learn-that’s how we get up every Doctor: Everything changed. others.” (Mustafa Kemal Ataturk). what she knew and unselfishly she talked of them and told stories That day, I felt the full weight of Patient: Not teaching your kids to morning and face ourselves in the At first glance and perhaps sharing and knowing what she did about them. But underlying the responsibility and- ride a bike? Not taking them to a mirror. We make- interpreting this on the concrete not know and willing to admit that stories was a clear sense of what side of things, the sentiment seems and partner with you to remedy was really important in life. baseball game or to Disneyland? Patient: Choices every moment of Patient: It crushed me. The a bit trite or too simple or cute. that. She was always available. Not seeing them graduate high overwhelming disbelief, the anger, She had the smallest office of the every day. The beauty of it all is And then there is the whole issue I remember many an excursion school or move them into their the sadness, the injustice of it all. staff people in that laboratory; that I get to choose how I spend of what happens when the candle with her into the lab to check college dorms? I’d give- But then I remembered- the chair’s office easily was eight the rest of my- is used up? Does the flame go this out or figure that out. There times larger than the closet she Doctor: Anything-anything-to not Doctor: Time. I’m always Doctor: The good outweighs the out? Does a good teacher only was a constant steady stream occupied. One could barely fit have that happen to me. In that obsessing over not having enough bad. It has to. This world is not have so much “wax” to burn and of individuals in her office with in a desk, a guest chair and one moment I was- fair-it is not balanced and it never then burns no more? On further questions about things going on in time- how there’s not enough bookcase into the room. It was will be- but- Patient: It’s worth it. 19 20 The Good Teacher cont. the only office she had for as long been much easier to adopt the In working with her on projects, as I knew her, excepting at the “one size fits all” approach. She she was the epitome of a good end when she moved into a large created for herself, in an easy and collaborator. She always pulled office in a newly built building with unobtrusive way, a persona of her weight and honestly often an extremely high vaulted ceiling, credibility, real, not fabricated. times, more than her weight. She which she thought was funny. listened. She was committed. She Papers were piled everywhere – Fortunately for her, some of her followed through. She knew how on the desk and on the bookcase accomplishments and skills were to get things done and she did behind the guest chair. They recognized and appreciated by them. were not neatly arranged and to others, something that not all In reflecting back on my any observer had a haphazard good teachers are blessed to interactions and observations of appearance, ostensibly disordered. experience. She won the Institute’s this person over the years, I do And yet, the appropriate papers resident teaching award. She believe she was a good teacher, a could be retrieved when needed, was entrusted with overseeing the consummate teacher. Much I have papers that had likely sat in their Problem Based Learning (PBL) learned from working with her and spot for years before again seeing Program for the medical school watching her in action, initially as the light of day. One certainly program, a huge and important a resident I training and later as a should not have judged the person part of the curriculum for year 1 colleague. Some small part of her by her surroundings. and 2 students. Many students, when at the time of graduation are will hopefully go on every time I During her career, she was asked about what part of their 5 try and do something the way she frequently invited to speak in a year curriculum they found most would have done it. She was, in number of venues - in the medical useful, state that it was the PBL Ataturk’s words, a big candle that school, department, hospital and experience. She served as Vice burned brightly and gave off much at national meetings. She was Chair of Education for the Institute, light and bequeathed sparks that well respected in her field. She responsible for overseeing all of the kindled many a flame in other really knew her craft and she had a myriad educational activities of the candles that continue to burn. way to make it all seem so simple Institute, ranging from overseeing And that is what makes for a good and clear for the novice, when in a medical technology school and teacher. Many thanks, Gerri. reality little in medicine is. She the weekly Grand Round series to was able to pitch her presentations coordinating continuing medical to her audience, caring to know to education activities. There were whom she was speaking and giving many more things she did that I do thought to making the necessary not even know about. adjustments, when it would have

A Babe Once More Elizabeth Shay, CCLCM | Class of 2020

And now I’m a babe again Creeping, crawling, walking uncertainly… Falling. Learning new words: Hepatosplenomegaly and borborygmi. New Growth New movements: I’m A budding tree in Shaker Lakes Palpating and percussing Mike LaBarbera, CCLCM | Class of 2019 For I... am a medical student.

21 22 Touching and Examining Kaitlin Keenan, CCLCM | Class of 2020

The difference between touching was a sacred part of the doctor- the opportunity to learn about his and examining seemed arbitrary patient interaction, and that not journey and inspiration. He spoke to me when I started medical only was it clinically significant, about balancing his career and school. When I started learning but it was expected. Armed with duties as a physician with his love the techniques for physical this idea, I returned to clinic and of writing and humanities. We diagnosis, I felt very uncomfortable. practiced laying hands on my learned about the ways in which he To me, the medical novice, I patients. I was fortunate, my chose positions which allowed him could not appreciate what there patients and preceptor were willing time to write, and it was inspiring was to be gained from touching to learn with me. After hearing to hear how hard Dr. Verghese a patient. I firmly believed that the philosophies of Dr. Verghese, worked so he could cultivate his everything of clinical significance I felt like my white coat fit better. passion for humanities. Having could be obtained from the patient When I asked my patients to get listened to many of his talks interview. I sat comfortably on the examination table, they before this meeting, I had certain across from the standardized obliged. I found myself hesitating expectations about how this man This White Coat I Wear patients in our communication less, instead opting to cover my would speak. He exceeded these Elizabeth Shay, CCLCM | Class of 2020 skills sessions, knowing that I bases and use every technique I expectations. The lessons I learned was safe behind my open ended had in my arsenal. The difference from his videos were merely If not for this white coat questions and statements of between touching and examining snapshots of his philosophy. As we I wear, empathy. Interviewing patients finally clicked. Touching had asked more questions, Dr. Verghese With trepidation and fear, came very quickly to me, which always seemed like an intrusion, answered with authenticity, Its shoulders weighing me down only increased my resentment and in a way it was. I lacked patience, and passion. The idea With the expectations towards the physical exam. Week confidence in my own abilities of meeting a personal hero can Of those that have walked before, after week, I struggled to practice and feared how my incompetence be daunting, but I felt even more Whose arms outstretched the exam techniques, I failed to would make the patient feel. I inspired after listening to Dr. see their clinical value, I pulled bumbled and stumbled and flashed Verghese. He did not romanticize Beckon me to grab the baton away from my patients. My my most apologetic smiles. But the work that his career takes. He Of medical knowledge and skill, physician advisor listened patiently in examining, I could connect with did not placate us with clichés or Which I reach for uncertainly… when I lamented my struggle with my patients and collect valuable soundbites. He did speak about touching patients, gently correcting clinical information. I am grateful his personal experiences, the If not for this white coat I wear, me: examining, not touching. She for the messages Dr. Verghese lessons he has learned, and his It would have been absurd suggested I investigate the work of has shared with the world, and I hopes for the future of medicine. For me to ask you Dr. Abraham Verghese. am incredibly grateful that I was I am grateful for people like Dr. To disrobe yourself, fortunate enough to meet him. Verghese who have created a space Dr. Verghese had recorded a series for humanities in medicine and for To lay bare your life’s story of videos teaching some of the key Dr. Verghese visited Cleveland and words-both written and spoken- In the creases and calluses of your skin. elements of the physical exam, and Case Western Reserve University that help bring doctors and patients I devoured them. “Who was this to speak as the F. Joseph Callahan and people together. man?” Distinguished Lecturer. Before speaking to the greater Cleveland Examining patients is an essential I wondered and, with the help area, Dr. Verghese met with part of our profession and it is of Google, found recordings of medical trainees in various stages important to keep this ritual alive some of his previous talks. In of their careers. Medical students as we move into the technological one, he talked about the ritual up through Chief Residents age of medicine. It is my hope of the physical exam. What gathered to ask questions and learn that by communicating our shared resonated the most with me more from this physician writer. experiences, we can appreciate was his explanation of patients’ Dr. Verghese is an advocate and the examination for what it is— expectations. Dr. Verghese champion of the humanities in gathering information and fostering explained to me and thousands medicine, in addition to his role as connection. Clearly, much more of others that the physical exam a physician and teacher. We had than just touching.

23 24 Words Radhika Rastogi, CCLCM | Class of 2020

Atelectesis (Ah-te-lek-te-sis) Propanalol

I try the word out, rolling it -alol around on my tongue, feeling it on my lips. It’s become a Must be a beta blocker. The process and progression and familiar feeling these past few growing familiarity with talk about symptoms and months, the trial of medical medicines manifests most in presentations with specificity vocabulary. Often, I’ll skim over Longitudinal Clinic, as I look and precision. Their care is the word at first, and then return through the list before knocking strengthened by their words. to it, taking in the spelling and more confidently on the exam A lump is no longer a lump; it piecing it apart, pulling together room door. I try to remember the is benign or malignant. That the meaning and the sound. brand names of the medicines, world of difference is held within ask the patient if they’re taking their words. Each word I learn feels like a Zoloft instead of asking about step away from the patient, sertraline. But my words get I am working to reconcile these increasing the distance between in the way, and I ask about disparate roles our words can us. My understanding of health sertraline instead. play. Do they distance or do and disease becomes more they unite? Are they intellectual intellectual; I look to mechanistic Using medical vocabulary is a or experiential? Do these explanations of the narrative the measurable metric of growth. dichotomies truly exist, are patient relates, convinced that It shows in the fluency of oral they part of my induction into defects in molecular pathways presentations, the deeper medicine? In the meanwhile, I can explain away their pain. Their engagement with primary continue stumbling, trying to find experiences become codified literature, the analysis of patient my words, their words, in jargon and abbreviations, cases. Each word I learn feels our words. understood by their providers yet like a step towards an inner detached from their own words. sanctum of intellectualism I remain unconvinced that the and professionalism. Within charts reflect patient experiences, this sanctum lies clarity of worried that our vocabulary communication, in which is reductive, homogenizing providers can discuss disease Louisiana Swamp: Don’t get lost in a Louisiana swamp… experiences that are necessarily Datta Sudarshana, CCLCM | Class of 2019 personal.

And yet, it’s intoxicating.

25 26 Details You Won’t Find in An Operative Report Jessica Jones, CCLCM | Class of 2017

The operative report is four pages deck to the patient’s detriment, the operative report was filed. A buzz long. As a fourth-year medical physician is acquitted. And in these from my white-coat pocket signals student, I’ve learned to skim cases, the juries of family members a text, and I can’t help my grin quickly for the most pertinent will all too often find themselves when I see the surgeon’s name information, the details needed guilty. blinking on my phone screen. to formulate the plan for the day A few minutes. Thinking of you. or the facts I may need to recite For family, time is a currency, Smiling now, I allow my fingertips during rounds. often one that does not appreciate to graze lightly along the right side 14-year-old female with a large value until there is almost none of my skull. Hidden to the human right-sided subdural hematoma left to spend. Here, a few minutes eye, it is not difficult to find the causing significant right-to-left inevitably become very specific subtle indentation. shift with preoperative signs of minutes—the slight delay in calling By the nature of our profession, brainstem compression. an ambulance, the difficulties with physicians run the risk of becoming Drawing a deep breath, I continue directions en route to the hospital. “fiery-weather friends,” characters through the report, unconsciously Ghosts that float above tears in the that appear from the mist only filling in details as I read. waiting room, who will accompany when the storm descends. In Date: November 1. the family home if the patient does truth, my surgeon was there for not. There were family members in the each of these awful moments: in waiting room who hadn’t had the However, in this case, the final the emergency department, the opportunity to change out of their lines of the operative report paint operating room, the I.C.U., and Halloween costumes. a happy ending: The patient onward. was transferred to the intensive Typically I fully discuss all But I don’t think of those moments care unit in stable but guarded risks, benefits, alternatives, often. Instead, I remember the condition. and expectations of the surgery minutes my surgeon invested with the family but, under these At this point, the passing of time that are not documented in the circumstances, I felt the patient’s changes. The fleeting seconds in operative report or anywhere else life would be in jeopardy if the moment of crisis suddenly in the medical record. there was a delay by even a few become hours that turn into days Letters that he sent during my minutes. that turn into weeks that turn recovery and my transition back into months of painstakingly I wonder if the surgeon realizes to school. Words that forced me slow progress. Here, time is best how closely his considerations to take a step back to see where delineated by the reaction that would parallel those of the family I was coming from and where I accompanies each milestone. In members outside. wanted to go. Messages of pride the beginning, the tiniest step when I succeeded and words of A few minutes. forward is a momentous victory: encouragement when I didn’t. For physicians, time is a luxury, opening the eyes, lifting a finger, Skipping Stones I remember having dinner at his forming the basic constraints that managing a smile. As time passes, River-bed skipping stones at Cleveland Metroparks house when I was home from characterize the task at hand. If however, the paragon of “a full Mike LaBarbera, CCLCM | Class of 2019 college, his speech at an award the time is enough, the surgeon recovery” reveals itself as a naïve ceremony my senior year, the will work slowly and meticulously, deceit, and patients and their surprise dance at my wedding. taking care to document each step. families may be forced to reconcile If the time is small, the surgeon what once was to what is now. For my surgeon, minutes in the operating room were a non-existent may instead work quickly, forgoing At this point, I wonder, Where luxury. For the physician who formalities in order to complete the is the surgeon’s voice? It was so became my friend, they were an task at hand. assured in the operative report. opportunity to make an impact that I simply poured Betadine solution Where is it now to offer guidance no one will fully appreciate but me. over the skull and quickly draped and direction to the life saved? And for me, they were and are a it out. It depends on the surgeon. gift. However, if the time is too little, The date is now October 31, 2015. forbidding success by rigging the It’s been thirteen years since that 27 28 Impersonations Featured Artist: Katie Daley A Different View | for my brother Walter, 1954-1975

About Katie Daley: You used to do a pretty good L.B.J., ranch voice, Texas, the caw-caw of Boston and Bobby Kennedy, Aunt Mary Kelly, Katie Daley and her inner quintet of characters hit the road on a regular basis to bring her one-woman show of poetic monologues to even our grandparents rasping at each other while making love. It was easier that way, wasn't it? various venues around the USA and Canada. She has won two individual artist fellowships from the Ohio Arts Council, and her work Easier to be inside your old ward mate Miss B's throat has been published in a variety of magazines and anthologies, including Seneca Review, Puckerbrush Review, Art Crimes and After the as she wavered down the hallway in her scuffed-up slippers, Bell: Contemporary American Prose about School. She produced Full Blast Alive: Voices from the Ruby Side, a CD of her show, as well as three chapbooks: Red Hot Mangoes and Voodoo Juice, Coyote at the Wheel and Venus and the Hitchhikers. She is also a member warbling and singing out against people with whom of Drifters Inn, a band that marries spoken word with music. Their first CD, Zaggin' Like a Vagabond, came out in 2013. As a teaching she had once been in the world. It was far better artist, she offers poetry writing as a way to build trust with ourselves and community with others. In this capacity, she has been part of to argue with her vacant relatives while entertaining your own. When you were home on a weekend pass the Devising Healthy Communities (DHC) project at CCF Lerner College of Medicine since 2012, working with Lerner medical students you would steer us into our bedrooms, pat us on our heads and members of the Cleveland Sight Center to create poems about health and well being. and say, in the rainfall voice of a nurse on duty,

Are we feeling a little anxious today? Maybe we should sit in our room until we feel better, hmmmm? Far more simple Trapezing to be the nurse than you, schizophrenic brother of mine, for my father whom none of us could bear to sit with or love for very long. Life was more fluent when you could punch the garage windows When I wake the tumors until your hands bled, when you could come marching are glommed to your spine and you paralyzed from the nipples down. I hear birds through the backyard, fist raised, your voice husky nibbling under the sill of clouds and crooning a perfect Bob Dylan, It's allright, Ma, our daily sun has sunk behind, I'm only bleeding. Ma was in the kitchen and she wasn't pecking your freckles from the white loam weeping, but she gasped your name, as if to herself. of your Irish skin. I know what this means, She said I was too young for this and sent me to bed, so I stood at the upstairs window and caught the red rhythm how I’ve got to get up and roll you from bedrail to bedrail, south potato hip of ambulance light as it swung across me, watched them to north potato belly, wipe the forest floor tuck you in and take you away. And it was easier there than here, from your buttocks and make you wasn't it, easier to play piano in the day room and hunch yourself again. But I’ve already seen your shoulders like Nixon, gruff up your face and jiggle the bedsore sky across your tailbone, your jowls, Let me say this about that...I love my oh my red-yellow smear of twilight, your death dear dog Checkers and my wife Pat. Better Richard Nixon meandering among tree limbs while your leg twitches under the sheet than Walter Daley, kinder to laugh at you as a buffoon tyrant and your hands drift upwards than to ignore you, easier to make all the crazy people love you as if groping for the bar of a trapeze than to come home. It's better that you're dead now, isn't it, or the outstretched arms better dead and gone than singing those sad songs you wrote, better now than when you looked around and saw that nobody of some invisible trapezist was listening, you at last in your own throat, us drifting down come to yank you out by your roots and carry you there some whining highway, the baby grand stretched out in front of you like the hood of a car that won't start. You knew who you were, so did I, whatever was left of you, white fingers praying to black keys, foot twitching on stuck pedal. Which is why you finally decided to leave and why I still plumb the world for your fingerprints or anything that could be construed as a keenness for staying.

29 30 Hey Doc Mary Katie Gets Diagnosed with Cancer for Dr. Scott Krupkin in thanks

Hey, Doc—I can walk again Oooooo, I could walk on water Despite the fact that she hospital and brought home. After surfed her spasms of labor in Look—no limp, no wince, no hobble And do the jig across hot coals doesn’t have a job, Mary wears she fills out the tedious patient the company of an annoyed, For a little while longer now When you talk like that a business suit and starched information forms, including the inconvenienced man in a white I can pretend I’m not gonna Tell it to me again, Doc white shirt to all her doctor one asking her religion, to which lab coat who insisted he knew Grow old and die Say that thing about me having the pulse of an athlete appointments. As she waits she replies “nature” or “none of best. It always amazes them that You know I don't have much money for her blood tests and CAT your business,” she works on her she was feisty enough to fight I know you don’t like your patients But you make me feel like a million bucks scans, she sits with her legs poems instead of leafing through off the nurse each time the Man To get all melodramatic When you put it that way pressed together, leafing through People, which never fails to ordered, “Give her some gas.” But let’s face it, Doc Giving me back my stride and pride and so on You made me young again Women’s Day and People. awaken a great hopelessness in In between her caterwauls of A few stretches here, a few corrections there Hey Doc, you looking around Though she’s very obedient, she her. She detests waiting rooms, agony, she’d had the chutzpah to And I’m damn near Olympian Like the rest of us for meaning? rankles visibly when authority their carpets grimy with dread instruct her sworn Do-No-Harmer For the cost of this little poem figures call her name. “Mary? and their muffled, flat-screen to let her breathe, push, give life. Just get out your eagle eyes and watch me skulk Mary! Wake up,” they urge broadcasts of The Young and When the nurse calls, “Mary?” Wow! You gotta be the funnest, smartest Like a dying woman into your office her when the colonoscopy is the Restless. Oh, the bleary they both tremble. At the same Most eagle-eyed doctor I've ever met Then cavort like a kangaroo on the way out complete, and even under the stares, trembling hands, and moment, they remember their You noticed the crooked way I stand Bouncing through the parking lot influence of medicine’s best feel- wiggling legs of her waiting room underwater journey into this And told me, If you want your foot to stop hurting, This liver of mine light as a feather good anesthesia, she manages compatriots. Oh, the lifelong wait blaring, fluorescent world. They I suggest you stop holding yourself that way My feet all decked out with wings to scowl. This is because when to be seen, the lifelong terror hear again the muffled sounds she was born, the birth certificate of being found out. To lessen Yes, Doc That's what I call meaning, Doc of battle that accompanied their clerks at the hospital had her own terror, she vows to call Anything you say, Doc That's what I call fulfilling your purpose trepidatious swim into the fray. pestered her parents to come up her physician “man” or “Doc” ‘Cause my liver doesn’t hurt anymore either There's just no way to keep this one They both shudder to think that with something for the record, when she delays him with her You put your smart, elephant-ear hand there To yourself this is still a fray, that there might but the parents drew a complete questions. And knocked a few times to hear still be a man in white throwing blank. Finally, under duress, they If anybody was home Having noticed each other in the a tantrum at the end of the next I was home, Doc sputtered “Mary,” after Mary’s waiting room, Mary and Katie tunnel. In solidarity, Katie rises Especially when you called with the blood test results mother. Each time she hears sit as far apart as possible. They at the same time as Mary and To tell me that, Biochemically speaking her name called, she feels like assume they have nothing in follows her into the examination You're a very healthy woman a duplicate, a fraud, the kind of common, but of course, they’ve room. person who draws a blank. forgotten. They each had a A poet, Katie wears fringe vests mother who loved giving birth, and bell bottoms and brings and they each were yanked her Synonym Finder to all her into the world by a substitute doctor appointments. She has doctor who knew nothing about no regard for authority and has delivering life from emissaries been called “Katie” ever since the who are in an utterly conscious day she was bundled out of the state. Each had a mother who

31 32 Flip It Stephen Raithel, CCLCM | Class of 2018

Raul slapped the table, laughing hand we played. In the beginning, in surprise. “You sure you never and whooping. “Ace! Flip it!” whoever played the highest card played before?” He handed me We were playing cards, sitting would win, but certain cards were the pile of cards on the table around a long fold out table, like apparently off-limits, like the Jack in congratulations and several the kind in high school cafeterias of Spades or the Three of Clubs. cards from his own hand. Carlos with round plastic stools attached. Then the object was to form pairs handed me half the deck and Raul wore a black Grateful Dead of matching cards so that the echoed Raul’s approval in his t-shirt, the one with a skeleton Four of Diamonds followed the characteristically taciturn manner: in three-quarters profile adorned Four of Hearts. Success was first “Good.” The next hand, I made with a laurel of roses. He had a signified by picking up more cards, the same play, but now Raul solitary silver tooth that gleamed but later in the game having a clucked in disapproval, telling me as he laughed. His curly hair was full hand of cards was the sign of to give all my cards to Carlos, who thinning. failure. The rapid succession of apparently had won the afternoon. “C’mon c’mon c’mon baby, it’s each new contradicting rule was I congratulated Carlos for winning time to flip it!” Still laughing, Raul dizzying, but I would nod in feigned the game, and his heavy profile whacked Carlos on his sizeable understanding to Raul as he lightened as he grinned. The back. Carlos, unsure of exactly passionately corrected me. Carlos moment was touching in its own what he was supposed to flip, sat with an impassivity that was way, to watch Carlos engaged with or how, blinked at me. He was only betrayed by a hand slightly something other than his terrifying a boulder of a man, wearing a shaking as he tried to guess which delusions, to listen to Raul hospital robe that stretched and card would be permissible to play. argue with us instead of himself fell short of covering his stained The two men (whose names as he sat alone in his hospital undershirt. His pants were have been changed for this story) room. The world, if cruel, was pinstriped blue and white, his feet suffered from schizophrenia for offering reprieve. As Carlos and enwrapped by bandages over old nearly all of their adult lives. Raul ambled back towards their socks. Not finding any clues as to Carlos lived with his parents, respective rooms, I was left with what Raul wanted from either us, I but had become increasingly the afterglow of the day, puzzling shrugged at Carlos to say sorry. withdrawn, spending his days the metaphor of the moment. How Raul pounded the table now, silver peering between the blinds in his bizarre it was to play a game that tooth flashing in a moment of basement, ducking behind the wall felt like it had changing rules, how anger, “Flip. It.” He reached toward and crossing himself every few strange to feel my logic disconnect the upturned Ace of Diamonds in minutes. Raul was from a group from that of those around me. the middle of the table between home where he had stopped taking How troubling to not know order us, and with great ceremony held his medications and had become from its antithesis, to not know it on its edge with one finger, then increasingly irascible, talking when loss masqueraded as victory. turned it face down. He pulled the more feverishly to himself. Each I found my white coat where I had pile of cards toward himself, and day I helped interview Raul and left it folded over a chair in the said to me, “Your turn, hombre.” Carlos, seeing how they tolerated corner of the room, and I buttoned I had been on the inpatient their new medications, learning it back on. The TV room had Shaker Fall Trees: Sunlight through fall trees how they felt about long-acting psychiatry ward for over a week, emptied by now, and so I put the Datta Sudarshana, CCLCM | Class of 2019 and I was spending the afternoon injectable formulations, probing the cards away and turned the lights in the TV room, where patients phenomenological world of each off. Walking to the end of the usually had group therapy sessions. as it collided with the so-called hallway, leaving the ward for the But therapy was over for the day “therapeutic milieu” that the locked day, I punched in the security code and Raul was now teaching Carlos ward provided. But this afternoon, and waited for the locked door and me how to play the game we were simply playing Flip It. to click open. As the door was he invented: Flip It. The game Picking a card at random from closing behind me, Raul’s voice seemed simple at first, except Raul my hand, I laid it down on the carried from one of the rooms: “No, kept changing the rules with every table and Raul’s eyes widened no, no. Flip it!”

33 34 Seizure: A Differential Diagnosis Jessica Jones, CCLCM | Class of 2017

He’s six years old, Admitted last night Because his arms were shaking. EEG confirms the answer, cut and dry: seizure.

Now his father’s shouts echo down the hallway, Impressive since he’s on the phone. What on earth does my boy’s health have to do with The emperor of Rome??

His mother is crying now, and she pleads, Please, don’t take him from me! “Ma’am, I need to take him to the MRI. He’ll be back.” But you told me! You said seizure!

Hours have passed, the chaos calmed. Mom and dad are both on board. Staring at the clock as they wait for the MRI read, Too tired to explain to the child why they’re afraid.

Suddenly, the haphazard chorus of toddling feet from the hallway, Followed shortly by an ecstatic giggle: Peter! His baby sister is here to visit. Peter tries to be brave as he explains to her: Seizure. His sister’s forehead creases deeply with confusion. She clambers up onto the bed with him and takes his hand. Looking at the nurse and then back at him, she says, See her? But I came to see you.

Waves This picture of a fallen tree was taken around Doan brook. It provided an appreciation of the intricacies, function, and beauty of nature in its many forms. Nemat Sharaf, CCLCM | Class of 2018

35 36 Soccer as Self-flagellation? Daniel Sexton, CCLCM | Class of 2018

When I began to write about my by determining the number of games Roger Federer [2], a beauty that Soccer as Self-flagellation? cont. experience on the CCLCM indoor we’ve played and subtracting zero is universal and linked to “human soccer team, I worried that a from it. Until recently, I’ve remained beings’ reconciliation with the fact significant degree of rhetorical stoic in the face of constant defeat. of having a body.” These moments been taking myself WAY too seriously. I deftness would be required to create On my college baseball team, I of joy punctuate the otherwise brutal had subconsciously brought the stress something that didn’t resemble contributed over 70 losses to our progression of each game but are of my coursework—the disorientation of the reassuring speech my mother record-breaking 228 game losing overshadowed by the five goals the transitioning between clinical rotations, the gave me after I failed to make the streak, a streak that (coincidentally) other team scores while we stand feeling of inferiority at being the lowest in Why? Washoe County Little League All-Star ended the year after I graduated [1]. with our jaws agape. I don’t want the medical hierarchy, the struggle to prove I Team. Thankfully, this will probably Needless to say, I can handle losing. to downplay the athleticism of my learned something in the last two years—to Elizabeth Shay, CCLCM | Class of 2020 not be the case, as my profound But recently, amidst the impending teammates, but all the kinetic beauty what was meant to be an outlet for it. And ineptitude on the soccer field leaves burnout all too many third year in the world cannot make up for the with this realization, a new feeling emerged: You had everything, no room whatsoever for words of medical students experience, after feelings that stem from being made freedom. The wonderful freedom that exists The looks, the charm, the life encouragement or comfort. an exquisitely odious rout, I found to look utterly foolish. in, every now and again, being okay with That many pined for, yearned for… myself asking the question, “What do looking slightly ridiculous, slightly simple, And yet you gave it all away, I decided to try out indoor soccer in It became obvious that I experienced slightly—dare I say—silly. I gain from doing this?” One lonely, dreary autumn day. February of my second year, mere very little concrete benefit from my months from Step 1. My classmate— For many people, assuredness of a time with the Brosencephalons. I wish I could say I immediately applied who for confidentiality’s sake will job well-done often soothes the sting But several games ago, I discovered this new mentality to my life in the clinic. You had it all hereby be referred to as “the Female of defeat, validating their decision something that I could take away Third year is a dream come true for some And yet you had nothing, Messi” (FM)—put a team together to play in the first place. Sadly, “a from my abject failure on the but a debilitating slog for others, and at this For in a moment you decided that for the same reasons myself and job well-done” cannot in seriousness soccer field, something that would point I consider myself a member of the Everything others joined it: a deep longing for be said of any performance I’ve put undoubtedly make Mama Sexton latter camp. Regardless, there are many Was of no consequence, the camaraderie of team sports, forth on the soccer field. My utility on proud. Roughly five minutes into things I look forward to, with my expanding Just a bag full of broken feathers the thrill of competition, and the the soccer field is exhausted by 30 the game, I was passed the ball and responsibility for the care of my patients Useless, empty, deceiving. regeneration of our atrophied lower seconds into the game, on average. started to dribble across midfield. For chief among them. And the ability to let limbs. Of course, if I had my choice At this point in the game, the some strange reason, the defenders my punctilious façade down when needed You held the balance of sports to play with my classmates, opposing team realizes that my large were staying back somewhat, as if will surely aid me in the future, whether I And weighed your life, soccer would be near the bottom frame and uncanny agility cannot they thought any aggressive move need to inform my pediatric patient that I And found it wanting do indeed know the Pokémon he’s talking of the list. Although I have some come close to compensating for my by them would cause me to juke Of something, many things, everything… experience on the soccer field, my tragically feckless ball-handling. them out of their boots. I knew about, or confide in my post-surgical patient that, yes, everybody farts (some of us with storied career is less than inspiring. Although I reportedly have had the that they would certainly remain in You left us nothing It consists of four years of play in the requisite coordination to walk on my their boots, thoroughly un-juked, aplomb). Medicine is hard enough as it is, so it never helps to be reminded that I too But shattered dreams and broken hearts, High Sierra Soccer League starting own two feet for over 25 years, any but was surprised that a woman on A life unlived, potential unfulfilled. as a 6-year-old wherein I possessed attempt to use my feet for kicking the sidelines was also privy to this am just as human as my patients. And now we look up a Cro-Magnon desire to do nothing or dribbling causes my motor skills information. She shouted, “Don’t With tear-stained faces and empty arms, but kick the ball hard, had a stunning to regress to an intrauterine stage of worry about him! He has no skill!” References And wonder proclivity for falling down just to get development. I’ve learned to become Oof. 1. Mark Saxon, "Caltech Win Is One for the Why? muddy, and played on one team we a very good obstacle, but obstacles Record Book,” ESPN.com, February 9, 2013. named after my dog (the “DJ Dogs”). cannot score goals. I felt the familiar vague GI distress 2. David Foster Wallace, “Roger Federer as Religious Experience - Tennis,” The New York So when the FM asked me to join her that accompanied me through While I may never obtain the Times, August 20, 2006, sec. Sports / Play team, the Brosencephalons, I agreed, most of my days in middle school. satisfaction of a job well done, I Magazine albeit with some reservations. Humiliation. Shame. Awkwardness. have been able to do so vicariously. Granted, she spoke the truth. We Since that time, I am sad to report For example, the FM was a walk-on all knew it was the truth. I simply that the Brosencephalons currently starter on an NCAA Division I soccer thought it was unnecessary to lay claim to the worst record in team. At least once per game, she broadcast it to the entire facility. the league for two years running. scores a goal or makes a pass that But as I recovered from the visceral Thankfully, I’ve lost count of the exemplifies the “kinetic beauty” that discomfort my wounded ego number of losses we’ve accrued, the late David Foster Wallace defined foisted upon me, I realized I had although it could be easily calculated when describing tennis legend

37 38 Note from the Editors: The following poem was misattributed last year, and so with apologies to the author, we reprint “Our Cages” in this year’s issue.

Our Cages Joseph Abraham, CCLCM Class of 2019

I graced a casino the other day. Walking down the aisles, I wondered whether I had entered a different space. It seemed a prison, With slot-sized cells. Expressions of resignation Permeated the inmates’ faces. On them, I could see each eye’s luggage From the previous day, month, year of life’s travels, Such was the light. The optical sirens forcibly captivating Victim after victim. Comforting them in rare moments of doubt, “Don’t worry. The darkness can’t reach you here. It’s too bright.” And I felt that they weren’t really gambling their money. No, this was a Russian roulette with their lives But everyone knows the house always wins. In that moment I feared for them, for me. For what makes a prisoner are the bars. And I don’t know what bars surround me. On Approach Yet I’m sure they’re there, Big things are coming to CLE Trafficking me to a path unknown, Stuart Zeltzer, CCLCM | Class of 2016 When I simply yearn to be free.

39 40 Losing the Love of Your Life Brian A. Shields, M. Div. | Staff Chaplain

Shedding tears for a love so dear She and I have been together through thick and thin Now I’m with her at life’s long end. “There’s nothing more we can do,” Proclaims the medical team I clutch my chest as my heart explodes A love that’s lost So true, so bold. I think I might die Right here with her So many years with her My love, my one, my wife.

Tears drop as blood pumps through my body I’m so worn out My own life feels shoddy I’m NOT ready to say goodbye I scream “GODDAMNIT!!!” As I stammer and cry I can’t believe this My soul is in pain Layers Can you see this? The depth of the mountains became clear as the mist and rays of light cast filled out the valleys and cast shadows on the peaks, creating shades of yellow and orange and red I hadn’t seen before. Radhika Rastogi, CCLCM | Class of 2020

41 42 Things that enter by way of silence Jessica Jones, CCLCM | Class of 2017 On Kindness and Compassion Johanna Goldfarb, MD | CCLCM Faculty

First, the illness This essay was written for the this time. I want to make a plea compassion returns and increases Creeping forward to disturb graduating pediatric residents for your adoption of kindness as with each year. It is speculated that last year. your approach through life. As you this is because physicians, just like The quiet health continue to refine your craft, I urge everyone else, invariably experience After some thought, it became Health that had once been truth you to choose kindness, every time. personal loss. We share experiences clear to me that what I wanted to Until blemished It is an attitude that is yours to with our patients…and become talk to you about was Kindness: choose in almost every interaction more empathetic. attention to kindness as young Then, the inquiry with everyone you come in contact physicians leaving training, When we discussed professionalism Reaching hesitantly to find with. Most importantly, this applies throughout your practice; and, during these past few years, I asked to patients and their families, but The promised answer always, KINDNESS. each of you to speak of a time also to colleagues, nurses, work Trust in our knowledge, our tools when you were most proud, and Your paths to training at the assistants, the custodian who invariably your stories were about Praying we will slay the beast Cleveland Clinic have varied. cleans the floors, the phlebotomist, stepping up and seeing the human Each of you has come to the end the guard in the parking garage, a need of a child or of a family. Then, the fear of training, by your own unique life partner, your family – and, of Sometimes you told a story about Facing the realm of the unknown routes. Some of you came course, to yourselves. a colleague. These stories were, directly, from college to medical Their maladies George Saunders, a popular writer, in fact, all about human kindness. school and straight to training Monsters in a mirror, raging, untamed notes that we almost all develop Some examples include the time while others previously practiced Worst of all: Unnamed kindness as we age, likely because when unexpected personal needs medicine in various settings. the longer we live, the more pain arose, and a colleague rose to Some of you are from Ohio; some we experience in our own lives, and cover for you, even though it was Then, the hope from nearby states; some of you the more compassion is nurtured. not clear if or when you could pay Finding that precipitous moment—perhaps less than a moment have traveled from far away; and He reminds us to not wait for old back the call. Or when you learned, some have family in a war torn Our promise age, however, and urges us to seek after caring for an infant and now country. Some of you always have The name. The answer. it: always, now, today, everyday.1 being on a different rotation, that lived in democratic states and The weapon that will silence fear This message is perhaps most the family of that 23 week gestation some have experienced variable important for young physicians who infant still considered you the personal freedoms. Despite these will lead the practice of medicine baby’s doctor, as you had shown Then, the grief (so much worse than fear) significantly different paths, we and pediatrics into the future. them such caring and expertise Seeing the monster (now real, now named) now have shared the last 3 years and they wanted to know what in this place. The attending staff Studies of American physicians Our solution (our promise!) you thought about next choices. have watched each of you grow show that compassion, a close The weaker of the two opponents Or the family that wanted, you, and learn. You have been entrusted relative of kindness, tends to Powerless to quiet the beast “their” resident present when life with the care of children, children fade during house staff training, support was to be removed. I recall we have cared for together these reaching very low levels by the a resident early in my own career as Quick, the brave rebellion last years. At this stage you end of training. Notably, NOT all a staff physician who taught me an Screaming from the bedside each have earned the right to young physicians lose compassion important lesson in professionalism. independent practice. You have during training…and you as The battle cries of our best defenses As we made rounds together, this spent many hours by the bedside of individuals and as a group are Falling on deaf ears resident seemed to know everyone sick children, and have learned to good examples of the ability to And we, the heroes, silenced we passed in the hall, from the independently evaluate each child maintain compassion despite long custodian to the ward secretary. each day and especially at night. hours, hard work, and sometimes They each returned her hello with Now, the breathless gamble You have manned and “womanned” frustrations related to patients, much warmth. I learned from her Fading as the beast grows stronger the wards through weekends and work conditions, and fatigue. an important lesson in kindness. holidays. You have learned to In part, this may be due to the Voices of patient and family and doctor She taught me about remembering recognize who is sick and when support of the friendship that I Vying for a final say to pay attention to all who support to ask for help, the first skill of a know this group shares. And often forgotten until the final roll of the die my practice, on each unit: not just senior physician. I expect that you But even among those physicians my fellow physicians and nurses, have seen much kindness, but also most negatively affected by but everyone. I have tried to some “not-kindness” practiced over training, it appears that as we age, maintain this practice.

43 44 On Kindness and Compassion cont.

We go into medicine enjoying our in a way that fosters kindness. remember this, the importance of work with people and wanting to A recent study at Mayo Clinic respect between us, the importance help others, and most often our suggests that one important factor of kindness, then your practice patients make kindness easy. But in physician engagement is how will be gratifying and often joyful, sometimes we may find ourselves we relate to those above us. When even in times that are hard or sad. in situations which make us feel we are treated with respect, we Having shared these last years uncomfortable or where it may be are more engaged, and more likely together, we are connected to each more difficult to open ourselves to be creative and innovative.2 As of you. The desire to be physicians up to kindness. For example, the trainees you have little control, but (healers, teachers), to care for patient may come from a culture as you take on leadership roles children and to put the needs of that I do not understand and has in the future, remember these children first, both in our medical values that seem at odds with what lessons. practice and in our worlds, will I know, or has an illness I do not always bind us. Some of you have Life will be full of times of understand and may doubt exists, developed deep friendships here. happiness (like tonight!) but or the family is angry, or is not Maintain these and honor them, also times of challenges, losses hearing me, or is annoying, or…. nurture them. and pain. I wish you all much Each of these situations provides happiness, today and always, but I Remember also to be kind to a chance to ask: why it is that a know that it is not always possible. yourselves. There often are huge particular child, parent, or other So I also wish you resilience, for expectations for physicians and you makes me feel so uncomfortable, those times when you are not will meet these best if you have so angry, so annoyed? If we learn being heard, when life brings been true to yourself, if you have to respond with kindness and sadness. May you be resilient in been kind and compassionate with respect, we almost invariably will the face of loss, pain, stress, and your own needs as well. learn something about the other disappointment. that can help to care for the child When we remember to be kind and family at hand. Sometimes we We are blessed with work that with ourselves we can better give also will learn something valuable is the best antidote for stress, as selflessly to our patients. about ourselves. crazy as that may seem at first. Imperial Palace The Tokyo Imperial Palace in Spring How could a stressful practice be References: For another way to think about the antidote for stress? If you have 1. George Saunders. Congratulations by Mike LaBarbera, CCLCM | Class of 2019 this, consider each interaction the way. Random house, 2014. maintained a practice of kindness between our self and others. Martin 2. Lister ED, Ledbetter TG, Warren, AM. and respect for others then you will Buber, a philosopher of the last The engaged physician. Mayo clinic more than likely find gratification century, has noted that there are proceedings. 90:425-7, 2015. in your work. Compassion is the basically two ways a person can ability to experience what the interact with another person. In other is experiencing (to put on an “I – It” interaction, the person their shoes so to speak), but to initiating the interaction feels then be able to step back, take superior to the other person and off those shoes, put your own We gratefully acknowledge the financial contributions of the many individuals is looking down on that person. In shoes back on and figure out who have helped to make this issue of Stethos possible. an “I- Thou” interaction there is what is to be done to help, to respect between the two, and each make it better. Sometimes there is equal, regardless of standing in We also would like to extend our thanks to the Cleveland Clinic Center for Medical Art and Photography will be a cure or a treatment and life, jobs held, wealth, age, sex, for their assistance and vision with Stethos’s layout and design. sometimes – just comfort, just race, or any other consideration. listening, nothing more than being In this interaction respect leads to If you would like to help support future issues of Stethos, please visit http://giving.ccf.org/goto/Stethos. there. Hippocrates described this compassion, leads to kindness. You Your assistance is sincerely appreciated. as the physician’s creed: “To cure will not hurt another person you sometimes, to relieve pain and to respect as you respect yourself. comfort always.” These interactions Undoubtedly, there will be times at between human beings are the work when we cannot control our highest form of giving, they are environment or our engagement. “I Thou” interactions and they It can be difficult to be present are extremely gratifying. It you

45 46 2016

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