Rubor: Reflections on Medicine from the Wasatch Front: 2019 (Issue 7)

Postcard to My Dermatologist (Front Cover) - Phoebe Draper; On Being a Different Man p.4 - Luke Mirabelli; Triplets p.5 - Anne Vinsel; Holes p.6 - Stephen Mossbarger; Tree of Hippocrates p.7 - Michael Bishop; Balance p.8 - Kevin Rodriguez; Mourning's Glory p.8 - Lindsey Wright; Team 1 p.9 - Lillian Boettcher; A Joke a Day p.10 - Christian Schmutz; Snoop p.12 - Ali Etman; Rules for Attending Withdrawing Care Conferences p.13 - Dannen Wright; The Gift p.14 - David K. Twitchell; Differential Diagnosis: Climate Change p.15 - Adam Kessel; "Worlds Apart" p.16 - Jorgen Madsen; PICU Rambling p.17 - Tyler Brown MD, Kajsa Vlasic; What's Worse p.17 - Julie Kilpatrick; Bye Bye Baby: Mom's Perspective p.17 - Anna Shvartsur; Who Heals the Healer? p.18 - Jenna Tiller; Mooring p.19 Hunter Wright; Step 1 p.19 Anonymous; To Astra in Clinic 6 p.20 - Dannen Wright; The Words We Use: Observations from Psych Rotation p.20 - Anna Shvartsur; Windows p.21 - Jordan Peacock; Hospital Tourism, Benjamin Drum p.22 - MD, PhD; Nirvana, Awais Riaz p.23 - MD, PhD; Of Patients and People p.24 - Ben Berger p.25 - Magpie Wisdom, Romany Redman, MD; NPO p.26 - Amy N. Cowan, MD; Author Biographies, p.28; Jack's Mountain - Serena Fang (Back Cover)

RUBOR Issue 7 | 2019 Reflections on Medicine from the Wasatch Front University of Utah School of Medicine PUBLISHER Program in Medical Ethics and Humanities University of Utah School of Medicine SPONSORS University of Utah School of Medicine Office of Admissions University of Utah Eccles Health Sciences Library Associated Students of the University of Utah University of Utah Health Office of Health Equity and Inclusion rubor.med.utah.edu R UBOR at the University of Utah School of Medicine 2018-2019 Editor-in-Chief Kajsa Vlasic Co-Editors Lillian Boettcher Serena Fang Phoebe Draper Content Editors Poetry: Amanda Walker, Hunter Wright Prose: Anna Brandes, Leslie Denson, Allie Kroes, Sabina Imanbekova Imagery: Michael Kennedy-Yoon, Allison Chang, Gina Allyn Review Staff Allison Chang, Sabina Imanbekova, Anna Brandes, Curtis Sudbury, Julia Moncur, Gina Allyn, Caitlin Indart, Nick Pappas, Allie Kroes Faculty Advisor Susan Sample, PhD, MFA 1 Dear Readers, Thank you for picking up the 2019 edition of Rubor: Reflections on Medicine from the Wasatch Front. This year's publication includes some powerful and thoughtful visual and literary works that explore current pressing themes related to medicine. This past November I interviewed Dr. Rafael Campo, current poetry editor of JAMA. As an editor of Rubor and a proponent for the medical arts and humanities, his words resonated with me: When we think about the humanities, we think about morality. We think about ethics. We think about power dynamics. Who gets to tell the story? . . . that's the joy of this work - being people together - and by presenting myself as a fellow human. I hope that models a different way of being in medicine. We're not just robots, we're not just technicians, we're not just in our white coats in disguise. We're people. All of us. With these thoughts in mind, I am so grateful for the opportunity to bear witness and share this collection of the seventh edition of Rubor. Dr. Campo's words remind me of how important a humanities publication is to our medical community at the University of Utah. Whether we are students, providers, professors, patients, or family members, we are united in our humanity. We share in the experience of making mistakes and celebrating successes, as well as lives and histories that extend far beyond the hospital campus. This amounts to different perspectives and stories worth sharing. Many different themes present within our published work this year. Multiple authors explore memorable interactions with patients, from the arena of pediatrics in "To Astra in Clinic 6," to end-of-life experiences in "Triplets" and "What's Worse." Sacrifice and the ripple effects on families of working in healthcare are beautifully conveyed in the poems "Balance" and "Who Heals the Healer?" We can chuckle together over humorous hospital moments in the cartoons of "A Joke A Day." "Differential Diagnosis: Climate Change" speaks to the far-reaching environmental implications of the medical system, a perspective that resonates with current conservation efforts of the Utah open lands. "Snoop" is a poignant response to racist comments experienced as a student doctor in the operating room, and at a school attempting to diversify its student population. I implore you to think critically and reflect on the voices present in this publication. I'm so grateful to the artists and authors for sharing their experiences with us. I owe incredible thanks to our 2019 team of content editors and review staff for helping us select our pieces for this publication; Dr. Susan Sample for her never-ending guidance and support; Dr. Gretchen Case for her continuous advice through the publication process; the Program in Medical Ethics and Humanities for providing the primary funding and support for this publication; Kristy Martin at Sheridan Printing; and my amazing co-editors - Lily Boettcher, Phoebe Draper and Serena Fang. Rubor has filled a vital space in my heart as a medical student these past four years and I am so grateful to everyone I have had a chance to work with. Thank you for giving me this opportunity. I will miss this more than you can imagine. With warm wishes, Kajsa Vlasic Editor-in-Chief, 2018-2019 P.S. If you'd like to read my entire interview with Dr. Campo, you can find it on our website. 2 Table of Contents Postcard to My Dermatologist, Phoebe Draper........................................................................................ Front Cover On Being a Different Man, Luke Mirabelli............................................................................................................................ 4 Triplets, Anne Vinsel......................................................................................................................................................................... 5 Holes, Stephen Mossbarger........................................................................................................................................................ 6 Tree of Hippocrates, Michael Bishop...................................................................................................................................... 7 Balance, Kevin Rodriguez............................................................................................................................................................. 8 Mourning's Glory, Lindsey Wright............................................................................................................................................ 8 Team 1, Lillian Boettcher.............................................................................................................................................................. 9 A Joke a Day, Christian Schmutz............................................................................................................................................10 Snoop, Ali Etman..............................................................................................................................................................................12 Rules for Attending Withdrawing Care Conferences, Dannen Wright....................................................................13 The Gift, David K. Twitchell.........................................................................................................................................................14 Differential Diagnosis: Climate Change, Adam Kessel....................................................................................................15 "Worlds Apart," Jorgen Madsen............................................................................................................................................. 16 PICU Rambling, Tyler Brown, MD and Kajsa Vlasic........................................................................................................17 What's Worse, Julie Kilpatrick................................................................................................................................................... 17 Bye Bye Baby: Mom's Perspective, Anna Shvartsur....................................................................................................... 17 Who Heals the Healer?, Jenna Tiller .....................................................................................................................................18 Mooring, Hunter Wright..............................................................................................................................................................19 Step 1, Anonymous...................................................................................................................................................................... 19 To Astra in Clinic 6, Dannen Wright..................................................................................................................................... 20 The Words We Use: Observations from Psych Rotation, Anna Shvartsur............................................................ 20 Windows, Jordan Peacock...........................................................................................................................................................21 Hospital Tourism, Benjamin Drum, MD, PhD................................................................................................................... 22 Nirvana, Awais Riaz, MD, PhD................................................................................................................................................ 23 Of Patients and People, Ben Berger...................................................................................................................................... 24 Magpie Wisdom, Romany Redman, MD........................................................................................................................... 25 NPO, Amy N. Cowan, MD........................................................................................................................................................ 26 Author Biographies...................................................................................................................................................................... 28 Jack's Mountain, Serena Fang............................................................................................................................... Back Cover Each year, we receive many more submissions than we have space for print. Visit rubor.med.utah.edu to view the comprehensive collection. In addition, explore our website to view past issues of Rubor (2013 - 2018), writing and artwork published online on a rolling basis, instructions on how to submit your own work, and information on arts and humanities events and projects at the University of Utah School of Medicine. 3 On Being a Different Man | Luke Mirabelli What does it mean to be a man? Growing up with my mom and older sister just two doors down from my Nonna, we were "the Italian-Catholics" of our neighborhood, our home in the unlikely setting of Salt Lake City, Utah. Given these circumstances and being surrounded by a community of hyper-quintessential-go-camping-everysummer-rigid-gender-role-nuclear families, I found myself asking this question of manhood often. And while being raised in this world of women has always brought me immense pride, I would constantly struggle to find an answer to my seemingly simple question. The shatter of glass has always been that sound for me,that visceral grasp, tug, and wring of cochlea that gives me a moment of sad before I snap back to the reality of a clumsy accident or drunken slip of hand. For this, I thank a man. That man who calls himself "dad," who would throw and smash through fury and shatter, shatter as mom sobbed, shatter as my sister and I hid and plugged our ringing ears to suppress this distressed, dissonant orchestra. Is this what it means to be a man? A boy grows up when he finds himself caring for his only parent. I was nine, numbed by a din of disbelief as mom's "just a lump" went from mammography, to malignancy, and to curative double mastectomy in a matter of two weeks. And despite my mom-a former dietitian and lactation specialist-feeling the weight of an absence of what she felt defined her career and her womanhood, she never failed to be present for my sister and me. And when playground banter brought callous, casual remarks of having just a mom, I'd think if only you knew. Is this what it means to be a man? It was a dark time as a third-year medical student on the Oncology service, but Dr. B brought light I will never forget. Her presence was stern, yet reasonable. Her face was encased by large lenses over drooped eyes that had seen too much, yet she retained the most moving ability to be wholly present with her patients. Her hand shake was not simply a "hello," but a caress of comradery, a statement of "I am here and here for you." Her exam was not solely an objective maneuver, but a massaging away of the misery of malignancy. The way she used her hands, her touch to ail and hope with patients, was mesmerizing. She was a human, being fully present with another human. She was light through grim predicament. Is this what it means to be a man? As a fourth-year medical student rotating on general medicine wards, Dr. C showed me that mindfulness and emotion-cultivating it, naming it, sitting with it-can be another of medicine's curing prescriptions. The subjectivity of emotion discomforts physicians and trainees alike, yet Dr. C took every opportunity to embrace it. Her genuine, heartfelt finesse to addressing the suffering grounded me. "I feel like there's so much love in this room," shes aid to a family as their loved one knocked on death's door. And I could feel this phrase, see it ripple through the water of a room slowed by sorrow, and see it bring closure and peace. I know that moment was meant for family, but that ripple passed through and changed me too. Is this what it means to be a man? I'm a man, a different man because of women. These women who show up and stay when others leave, who touch and humanize when others ail, who uplift and embrace emotion and grow. I'm a man because of women who gave and showed me nothing short of the world. And if I can emulate even an ounce of these women, that is a different man worth being. 4 Triplets | Anne Vinsel When I am dying I will breathe in triplets Until I don't. I will die on the third beat and then there will be a long rest while a sweet-faced nurse turns off my machine and consoles my visitors. If my dog is there, I hope they let him curl into the crook of my knees as I lie on my side. Just like at home. I hope it will comfort him, and I hope he pulls off a deep, mournful wail when I stop. I suppose I may be home, but I see myself in a hospital room with butter yellow walls and dust motes dancing in the air. Rhythmic hiss of respirator, keeping good time for a machine designed by a white guy. I would like to avoid agonal breathing and also shitting myself or extended choking. These are not crowd-pleasers. I would like to be given Soldiers' Joy, Sweet morphine, so my hands will be on top of the sheets, calm. If I can, I will sit bolt upright in the bed, and stare at the ceiling tiles, with an ecstatic expression on my face, eyes wide and serene, surprised mouth, O. Might as well give people something to talk about. And a little hope. I would like my dog at my funeral, please. Silver-framed if he is not permitted in person. He drinks in triplets, messy like last breaths, until he doesn't. He will whine and pace, I think, and he will mourn me more than some others. ________ A poet asked me if I had seen people die, which got me thinking about how people die in hospitals. This poem is what came out of that exchange. I began thinking how I might arrange my own death if I were conscious and hospitalized, picking and choosing from deaths I had seen. I once had a lovely Newfoundland with impeccable manners (she would "lie down" but not "lay down," to one dog sitter's surprise), whose only piece of gaucherie was that she drank water in triplets, slurping loudly and leaving half of it on the floor. Death in hospitals reminds me of that-as refined as you're motivated to be, the structure of the place elicits crude and rude behavior. 5 Holes | Stephen Mossbarger as in the tatted walls of Canyon de Chelly exhaling and, perhaps, inhaling there must be some, like flutes angling just so, that multiply the desert wind the music Laotze said might not seem perfect uttering 10,000 things just so you left one with the void you created vanishing slowly from the solid world the many kinds of vanishings how I listened for your laughter or anything particular thus suddenly hearing it aloud! I remember how the painted wall of sand made stone like flesh was seen as if sipping into those rows of mouths just so the portions of my own breaths draw into the apertures for the hearts of notes - countless types of silence, jellyfish in sound - extend into both listener and singer both singer and singer both listener and listener ________ My beloved spouse died of an accidental self-overdose of methadone, prescribed for the palliation of fibromyalgia pain, possibly because of confusion induced by other normatively prescribed opioid drugs accompanying that prescription. In these times in which opioids are rightly under scrutiny, I hope that nevertheless we all will remember that for extreme pain, sometimes such drugs enable sufferers from such maladies as fibromyalgia and other forms of "invisible injury" to continue to live mobile and productive lives - and to demand wise and humane compromises that take this factor into consideration. 6 Tree of Hippocrates | Michael Bishop Throughout my time so far in medical school, I have experienced a wide variety of thoughts, feelings, and emotions, many wonderful, some not so much. I have labored to learn many difficult concepts, and I've been grateful to grasp the rare simple ones without too much difficulty. I have interacted with peers, mentors, professors, and administrators, each with a unique place in the picture and a different role to play in this ever-expanding universe of medicine. I have even been able to catch an elusive glance of life beyond medicine, when I make an effort to do so, and see that there is so much more to each of these people. There is more to a physician than the white coat and prescription pad. There is more to patients than disease. It's easy to convince myself that I know this is true, but I find myself being struck, time and again, with this realization, especially when I have the opportunity to get to know those I interact with on a more personal level. My portrayal of the Tree of Hippocrates, a symbol of medical teaching and learning, made of over 1,100 pieces of walnut and poplar, stacked in 74 unique layers, is intended to evoke the idea that medicine is learned, taught, and practiced in layers, and that individuality is essential in forming a truly successful team. Each piece of the artwork was individually measured, cut, placed, and glued into a specific location, and it takes them all working together to make the picture of the tree take life. Likewise, we all bring our unique talents, strengths, opinions, and goals, and only when working together in harmony can we visualize the layers and depth that transform our contributions into a work of art in medicine. 7 Balance | Kevin Rodriguez Smiling, laughter, and chuckling out of breath as two little feet rub against my beard This is it I am happy Loud sounds warp me out of a memory, confusion, heavy eyes and an aching body remains in bed It's still dark outside I was happy Scrubs on and face washed, with your hand on the doorknob you're ready to walk out the door I wonder if those two little feet are.... Sleeping I'll come home early and play with those little piggies tonight I promise Walk to the car, no, lets jog. Speed through traffic and arrive at the refiner's fire, Pre-round, round, present your plan and get mocked... feel shame. Authoritative voices reiterate "study more, improve, be smarter, this is what's most important!" They're wrong Look outside and realize that time has beaten you once again, The absence of light taunts and sneaks words into your mind "You are late again" Rush home and arrive at familiarity, forgiveness and love. Walk to the front door, no, lets run. Maybe it's not too late. Lights are out, I wonder if... little feet? Sleeping Somewhere in between wishes and memories I'll still play with you tonight, I promise Mourning's Glory | Lindsey Wright Will you rain for me? Will you cry the fertile tears of heaven, as I weep less fruitful ones. Will you show me love in your sorrow. Teach me growth in the times that storm. Give me reassurance as the weaker parts of me are washed away. 8 Team 1 | Lillian Boettcher A composite of a dozen of my patients from my inpatient wards medicine team. Clay sculpture, 2019. 9 A Joke a Day | Christian Schmutz These comics are part of a larger collection, which can be viewed online at rubor.med.utah.edu You can also find the artist on Instagram and Facebook (@stethojoke) 10 11 Snoop | Ali Etman "You know who you remind me of, Ali," the plastic surgeon standing opposite me in the operating room said. "Snoop Dogg. You sound just like him." Is he serious? Am I the only one who heard what he just said? My mind raced. I was dumbfounded, but as a brown man living in Salt Lake City, I had had worse things said to me. I convinced myself he didn't deserve a response. Just let it go, I told myself. He's just an ignorant white guy. He proceeded to call me "Snoop" for the next five hours, with the occasional "brotha" thrown in the mix. My cheeks grew visibly more flushed with each insult. By this point, I had to say something, but I couldn't. I held my tongue, afraid my rage-fueled retaliation would make me out to be an "overly sensitive millennial." Throughout all of this, I tried to read his eyes. Was this his way of trying to relate? I soon realized that despite the surgical gown and mask I wore, the surgeon only saw brown skin and dark eyes staring back at him. There was nothing I could say. He had already assigned me a label and was treating me accordingly. The rest of the case was a blur. I asked the team if they were okay with me stepping out to grab a quick bite to eat. But that was a lie. I was fasting for the month of Ramadan and knew that I still had a few hours before sunset. I used to believe I knew how to thrive in white spaces, but there are days where no Oscarworthy performance is enough. The clean-cut, charismatic routine I have woven into my being is at times exhausting, but I feel like it is something I must do, constantly contorting myself when necessary to fit into the tiny box of acceptable brown people. After all, it was my ability to navigate white spaces that led me to areas such as the OR in the first place. But despite my best efforts, I have no control over how I'm perceived. There's no onoff switch for my brownness that could have shielded me from the words of that plastic surgeon. Words that I've heard far too often, burning like a thousand tiny papercuts, slowly wearing down the soul and creating a corrosive environment of self-doubt. This is how I move through medicine: a trapezist walking the tightrope of white spaces. If I lose focus, even just for a second, I risk falling. 12 Rules for Attending Withdrawing Care Conferences | Dannen Wright 1. Under no circumstances note how the patient's temples are grey with the same advancing pattern of color change as your father's or how a strong man, just like your dad is, too, has been made powerless by his heart that always gave unconditional love. 2. Do not observe how his son clutches and wrings his baseball cap, just like the ones your brother always wears. Grant invisibility to his tears. 3. Forget that his wife, not unlike your own mother, does not cry. 4. Praise his daughter for saving his life with CPR, allowing the family time to say goodbye. 5. Zone out when the attending eulogizes the patient, remarking on how he is an incredible fighter, but his body was not up to this final match. 6. Use plain, straightforward language as you explain how and when he will die. 7. Reassure them he does not feel pain, but they should nevertheless hold his hand and tell him they love him and that they'll be okay even though you can't fathom that being true if this were your father. 8. Every time you sense tears welling in your eyes, imagine anything (i.e., the monotony of the reading you have to complete tonight, what you're going to eat for lunch), anything to prevent you from crying. This is not your moment. 9. As best you can, shut out the wailing emanating from the family conference room you exited seconds ago. 10. Craft a list of personal rules intellectualizing the situation to prevent you from breaking down in fear of knowing your family is not immune to this situation. 11. Walk to the next patient room. 13 The Gift | David K. Twitchell Oh, the decision it must have been To take the road less travelled; Perhaps defying the wishes of remaining kin To serve a cause much higher. Mortal death could not end The desire to teach and show A group of eager students The human body they must know. Along a lifetime of medicine Will bless the lives of scores. In search of healing from grief and pain Come the patients who enter the doors. Remarkable the impact one choice can have To awe, perplex, inspire. The knowledge which will result Will serve a cause much higher! Takes a special person To let others know them to the core; Having them feel their beloved organs Which promote life no more. Head to toe and back to front The body is slowly transformed From its original purpose So its students can be informed. Amazing is the opportunity Our donor to us has given To learn, to feel, to touch, to know. Our thirst for knowledge he has driven! New appreciation has filled our souls For the intricacies of the human body Where structure determines function And proteins serve as antibody. Kidneys, muscles, and the bones of the body Have taught us all so much. Of the many ways of learning One of the best is by touch. Surely, words cannot express The debt of gratitude we feel! The gift one gave we must profess Enables us to serve a cause much higher! 14 Differential Diagnosis: Climate Change | Adam Kessel This "stethoscope" highlights the prodigious amount of medical waste produced by the healthcare system: nearly 7,000 tons of medical waste per day, amounting to roughly 3% of the total U.S greenhouse gas emissions. It was created from expired/clean medical waste. I chose to create a stethoscope for its symbolism in healthcare. The stethoscope has become an elemental component of medical providers. It is a crucial diagnostic tool that has become nearly an extension of a healthcare provider's body. The amazing part of this tool is its sustainability. A healthcare professional only really needs one or two stethoscopes throughout their career to care for their unending stream of patients. Patient livelihood is not put to harm, but environmental consciousness is preserved. The stethoscope is a paragon for the sustainability in medical tools that can be attained. 15 "Worlds Apart" | Jorgen Madsen "I see the same skies through brown eyes that you see through blue. But we're worlds apart, worlds apart. And you see the same stars through your window that I see through mine. But we're worlds apart, worlds apart. And the mocking bird sings, in the old y'ander tree, twadiladee dee dah, dee dee dee." i Jorgen uses abandoned books as his medium to create 3D representations of stories. This piece is from Aventures of Huckleberry Finn, which was read to him as a child. i. "Worlds Apart" from the Broadway musical Big River. Roger Miller and William Hauptman, 1985. 16 PICU Rambling | Tyler Brown, MD and Kajsa Vlasic Roses are red, Some babies are blue, Especially those with Tetralogy, In the CICU. A poem written on a whim by a senior resident and sub-intern on a busy spring Tuesday in the PICU. What's Worse | Julie Kilpatrick I'm not as sad about your dying. I'm not as moved by your pain, your struggle Your anoxic brain, your limp limbs, your artificial breaths I'm not as sad about the soccer games you won't play, the first kiss you won't have The heartbreak you may have been spared I'm not as sad because you are no longer suffering. But your dad Your dad who sits by your lifeless side with his head in his hands Your dad who is trying to remember how to breathe Your dad who wishes you would just wake up, or that all of this is a terrible dream Your dad who is worrying over what he did wrong, what more he could have done Your dad who may be questioning his ability to go on, let alone support your Mom Your dad who doesn't know how he'll survive tomorrow because you didn't survive today. Bye Bye Baby: Mom's Perspective | Anna Shvartsur Bye sweet baby Bye bye Or would it be better to wait out this trial? Birth you completely Have you live for the littlest while? Months and months more of mutual agony To have you suffer outside of me? No, I'm sorry There's no need to make you cry baby Bye sweet baby Bye bye 17 Who Heals the Healer? | Jenna Tiller My wife and I got into an argument last night. I slept on the couch. I hate that. I missed holding her close and breathing in the smell of her hair. I woke up this morning and it was clear there was still an awkward tension in the air. I kissed her on the cheek and told her I loved her. She grudgingly said it back. I know what she wants. She wants me to be able to stay home. To really sit down and talk through all of our "issues". I can't. Time is not on my side and I must go to work. I tiptoe into my son Milo's room while he sleeps in his crib. He has the softest skin and he sucks his tiny thumb just like I had done. I kiss his forehead; I try not to wake him up. My heart was stolen the day he was born. I hope he remembers and misses me while I am away. I should want to stay home and be with Milo. I should want to stay and talk with my wife. There is a part of me that knows this, and halfheartedly wants to want it. I pretend this doesn't get to me, all the things I "should" feel, do, and be. I almost believe it. I click my seatbelt and drive into work. Rain on the road makes the asphalt reflect the bright city lights. I can't help but feel at home when I pull up to the hospital in the dark early hours. The automatic glass doors of the hospital part, and I step into another dimension. Not one where my mother is going through chemo, or my wife is less than satisfied with our marriage, and I see my son so infrequently. Not one where my depression cripples my confidence. I step out of MY world. I become what THEY need. As I throw my white coat over my light green scrubs and lace up my sneakers... I become invisible to the human heart. I am a symbol of strength. I offer hope. I heal. Even though I am less than whole. "Dr. Tiller, your patient is ready in pre-op". And I go. I heal. I listen, teach, explain, and reassure. I cut, plate, suture, and cast. I do not cry, stress, show my pain, or hurt. With my white coat I must be invincible, and invisible. I am the healer. But who will heal me? 18 Mooring | Hunter Wright The guilt I carry Drags at me like a Sea anchor in a storm. More weight flows in and My scuppers are not enough. Perhaps, then, I founder. You come-an ocean in your eyes And mouth ringed with earth, the Sky upon your brow. Mortality Pressing upon you all creation within You, screaming culpability because your Insensibility. Because you filled the Mortal needle. And lay in stupor Next to her choking warmth Her machine is left for you but Her dislodged intangible presses -A weight I could not bear. Your confession dribbles, but Walking, we leave it behind. Sharing knowledge of what Has been together I see lengthening Back behind us-tightening- The bowed tails of Our guilt flying, Pulling us straight against The stiffening breeze. Step 1 | Anonymous 19 To Astra in Clinic 6 | Dannen Wright Coloring, exclaiming of Mickey, identical blonde hair to her nearby sisters, the cotton leggings of girlhood, she sits with legs askew in the unlearned way of children. But her boots belie her position. Bright sunshine yellow, securing the center around which the waiting room revolves. I sense the sublime; she carries the potential. Does she feel the weight? I seek ways to imbue them with magic. Perfect shine providing protection from snow, sleet, and society alike. But my incantations are too late. Scratches here and there catch the fluorescent light. Yet, the rubber still reflects casting a halo of joy, their armor unencumbered by adult perceptions, opinions With gratitude to a newfound star, I rise and leave. The Words We Use: Observations from Psych Rotation | Anna Shvartsur This one's loquacious Someone else - in melancholy's grip Beware of the beguiling They'll slither into your own narcissism Is that a pejorative? This man does want to live! 20 Windows | Jordan Peacock In this composition, we see the truth in the cliche"beauty is in the eye of the beholder." While the irises are undoubtedly captivating, the title of the piece calls attention to the light that passes through the pupil and informs the eye of the events unfolding before it. Each of these eyes belongs to a future physician who will be challenged to use the light entering to make difficult diagnostic decisions. However, as the variety in the texture and color of the irises suggest, each of the eyes will have unique experiences and challenges throughout their life.This digital composition was created for the Layers of Medicine course and depicts the irises of twenty-five of the members of the School of Medicine class of 2021. 21 Hospital Tourism | Benjamin Drum, MD, PhD Our ICU has over 100 beds. You'll take care of the sickest patients here. At night, there is only one fellow so you get to run the floor. We walk down the ward as if an ancient castle, admiring the fluorescence. Our main floors are single rooms... mostly. We have in-person interpreters for Spanish and Somali. Resident assistants do all the scut work for you. We peer past the curtains as an elderly man struggles to stand with a walker. The ED is a level one trauma center. You'll get tons of procedures there. I've done 5 LPs already. We smile through body odors and GI bleeds. We have tremendous patient volume. We are a resident run hospital, no competition with fellows. The fellows are actually really good about teaching us. Patients try to maneuver around our group as we pile into an elevator. Morning report has breakfast. Noon conference has lunch except on Thursdays. Sometimes attendings bring food when you are post-call. Our elevator opens, full of suits. The family will catch the next one. We have computers in our call rooms so you can put in orders without leaving. We have cell phones instead of pagers. We have really insanely good health-care. We exit, falling over each other to hold the elevator doors open for our host. This is the all-comers hospital. This is the tertiary referral center. This is the quaternary referral center. We ponder retirement benefits. We have a really nice resident lounge. We have a really nice allergy-free garden. We have a really nice donor wall. If I ever get sick, I would choose this hospital. 22 Nirvana | Awais Riaz, MD, PhD I walked with them for miles Listening to their stories Till I realized that they were just lost souls At that moment of clarity I saw them disappear into the fog The fog of illusions Illusions of love and happiness and hope and God I stopped and let them go ahead I had reached my destination I closed my eyes and reached out to grab Nirvana But nothing I open my eyes and realized That the illusion of clarity was gone And I was just as lost as everyone else But even worse Now I was all alone Photograph by Awais Riaz, MD, PhD taken in Montana in 2013. 23 Of Patients and People | Ben Berger I didn't know if I should wake him or let him slumber on, further into the quiet, golden morning. I hovered in the doorway, pausing for a long moment I took a slow, meandering inventory of a life, manifest in objects around his room. A well-worn watch resting on a floral arm chair, untidy piles of books and receipts, an armoire with a door cracked open to reveal rows of folded sweaters and shirts, and photos, obscured by dust, but proving that a life, vibrant with people and places had existed before Mark had been stricken with his illness. It saddened me to think of the hospital room where he spent so much of his precious, waning time. Where rubbery beds and cold metal instruments could be wheeled in and out, interchanged, as easily as a person could be. Where the ubiquity of thin gowns and all things disposable threatened to bleach out the rich, complex dyes that so uniquely colored the fabrics of his life. The cold jargon that littered his chart among hastily composed notes and litanies of numbers seemed to be a betrayal, reducing the man who had created homes from wood and nails, who explored religions like museums, learning and leaving, and whose life, garnished by the innumerable idiosyncrasies that bestow our ineffable humanity upon us, was inextricably woven among those who knew him, into categories in an electronic form. I wished that all of the white coats and blue scrubs who whirled by "the CHF in 315" could have stood there with me in his home and known that Mark was more than pathology and a job to be done, more than the next patient. 24 Magpie Wisdom | Romany Redman, MD Up in the hills on a fine spring day Blown amongst the tree tops I met not a chickadee, not a wren But a magpie Lover of death And Joyful Singer All in one We began a-talking As I, lover of joy Yet singeing of death, Made the unlikely but matched foil For this ying yang colored Raiment of a bird He hopped on one foot Then jumped down to the grass Shot his tail up towards the shadows And began a-chatting fast Bibbling babbling Quicker than I could Clap along Finally a pause A deep breath And, I thought, a chance for me To share my two cents of worthlessness But no, began again the magpie With that old wive's diddy Surely you've stumbled across it While nestled in aproned lap of yore It goes like this Said the robin to the sparrow I would really like to know Why these anxious human beings rush about and worry so Said the sparrow to the robin Friend, I think that it must be They have no Heavenly Father Such as cares for you and me i And yes! There lie a premise I could pounce on Fueled by a clever chill of the north wind I dared reproach the magpie And exclaimed... But I have a secret garden! So secret that even I Barely know of its existence For the garden dare not step forth In the confines of these four dimensions Ever the rationalist The magpie glanced at the Weather formed mountain majesties And down towards the barren gravel Beneath his feet He sparred... Growth in a garden Often holds signs often symptoms Leaves blossom, vines reach towards the light And roots, though less visible, are massive Even more massive when invisible to begin with And how massive might roots grow When torn out I watched the trees sway in the wind Jealous and an admiring spectator Of worldly-unworldly feats For never willI let roots down so far as to Withstand the accidental sigh Of a calm south breeze For every chance for bloom Means staying in one place Means indebtedness to the earth and air And sunshine bestowed upon that Pocket of geography Indebtedness Pain in brutal storm Reason enough to forego The spring glory of petals And cotyledons unfolding Yet the best of growth occurs in spite of us In spite of occurrences What seems an empty hole In fact a vast expanse Filled with everything but emptiness And spreading so far as to shame the big bang For the laws of conservation of energy or matter Matter not when it comes to my secret garden A brisk gust from the valley below Ruffled the magpie's feathers From his dusky throat Sang three clear notes of joy And he was gone You have wings, but I have roots, I cried after him Roots, I cried I cried And it began to rain i. Cheney, Elizabeth. "Overheard in An Orchard."1859. 25 NPO | Amy N. Cowan, MD Bearded. Pungent. Sour smelling clothes stuck in places well beyond the expiration date. "If you people don't give me some god damn graham crackers right now I'm leaving!" His voice carries across the room, down the hall to the nurse's station. "You're here for an amputation, sir. Your surgery is scheduled in less than two hours." My delivery is flat and matter-of-fact. "I don't care about surgery! You've been starving me to death for two days and I want something to eat! NOW." He is definite. "After I eat, then I'll go to surgery," he argues, as if to bargain. Education regarding the risks of aspiration while intubated is delivered. Anesthesia is the bad cop, while I play the innocent messenger from internal medicine. "God damn you people! I'm hungry!" The grey beard streaked with tobacco stain, an hombre look gone completely wrong, bobs up and down. Whiskers sprouting from an edentulous mouth. Profanities are slung around the room. The neatly groomed third-year medical student cringes as the patient pulls the sheets over his head. A clear signal he is done with us. Having obviously failed with my educational inservice on aspiration risks, I opt for a more practical approach. "Sir, where exactly would you go if you don't get the surgery?" I'm cautiously curious. No response. I fill the space and remind him his foot is dead and the amputation with vascular surgery would be life saving. Crickets. I wait shifting my weight from one high heeled shoe to the other. In one fell swoop, like a bird of prey about to pluck its dinner, he rips off the covers. I lean backwards away from the bed while still maintaining my balance. He looks up at me from the tiny island of a hospital bed. For all his big talk he's a frail old man losing more than a limb, he's losing his agency. "Ma'am," his voice is softer, almost quiet. I lean in towards the bed to hear better. Careful not to get too close. "I'll go home and take care of it myself." "How?" my voice cracks. "Well, I'll just pretend like I'm an animal in a trap. I'll take my buck knife and saw through the muscles and then the bone." He makes gashes though the air with his hand wrapped around an imaginary knife. Knowing what landed him an extended stay on 2-East, I believe him. Having recently been discharged from the hospital after being treated for a diabetic foot infection, he's back not three weeks later. The wound vac carefully placed by the podiatrists to suck out drainage and encourage the crater in his foot to remember how to heal made it all of four days. Having fired the home health nurse at the front door, he removed the wound vac himself since "It really didn't work anyway." Then with fishing line he sutured "that son of a bitch shut." His foot is now a black crater of oozing pus. I stare at the man in front of me demanding to break his NPO status. Our gazes lock. Who will blink first in this no-guns-on-campus, gun slingers show down. I give the universal signal to the team we're done here. In my most commanding of voices bark out the following orders. 26 "You aren't eating anything until after your surgery. Those are your orders and I expect you to follow them." In my most confident, respectable, "That's doctor, lady doctor, to you" turn on your heels and exit stage right, I head for the door. The sheets are now back covering his head. "You know what you are?" says the taunting voice from behind sheets. "What's that?" I freeze. "You're just a bunch of Republicans!" And with that the OR calls for my patient. On my own rounds the following day I notice his name on a different floor. He's now followed exclusively by the surgeons, medicine benched to the sideline. I pop my head into his room. "Well, what the hell do you want?" he bellows from the bed. He is supposed to be working with physical therapy and I'm a distraction. "I knew they were starving you to death so I just wanted to make sure you got something to eat." I'm genuine, maybe he can tell. "Yeah, I got dinner last night and breakfast this morning." He's less edgy, not exactly kind, just not hollering through sheets. Another pause. We stare at each other. He's lost a leg, but he's already learning how to transfer, pivot and, most importantly, he's regaining his independence. I smile as I turn to go. "See you later, alligator," I call. "In awhile, crocodile," he responds. And just like that we patch it up. 27 Author and Artist Biographies Ben Berger, UUSOM '21 studied molecular biology at the University of Utah and hopes to someday practice in internal medicine. His interests include classic literature, state politics, chips and salsa, and his girlfriend's tripod pittie, Biscuit. Michael Bishop, UUSOM ‘21 spent two years in France as a missionary, graduated with a degree in neuroscience from BYU, and worked in Washington, DC for a year as a student researcher. He loves Nutella, reading, and spending time with his family. Lillian Boettcher, UUSOM '20 is originally from Oklahoma and graduated from Yale with a degree in American Studies, with focuses in architecture and sculpture. She loves letterpress cards, the National Parks, and breakfast sandwiches. Amy Cowan, MD is a full-time hospitalist and educator at the Salt Lake VA Medical Center. She loves tackling tough topics and impolite subjects through improv on the wards and group discussions. She enjoys rock climbing, dead lifting and bringing waffle bar to work. Phoebe Draper, UUSOM '21 has a B.A in painting from Brown University and hopes to one day take Frida Kahlo to lunch. Ben Drum, MD, PhD is an intern in the Internal Medicine-Pediatrics residency at the University of Utah. He completed medical school at the University of Washington. He enjoys the outdoors, playing music, writing (of course), and hanging out with his wife and dog. Ali Etman, UUSOM '20 has his heart set on Family Medicine. He enjoys basketball, indulging his sweet tooth and sharing his story through spoken word, children's books, rap, and short stories. Serena Fang, UUSOM ‘21 spent her undergraduate years in St. Louis at Washington University studying psychology, neuroscience and philosophy. Outside of medicine her interests include charcuterie boards, silk scarves, and lo-fi hip-hop. Adam Kessel, UUSOM '22 received his undergraduate degree in Biomedical Engineering at the University of Utah. He enjoys trail running, backcountry skiing, mountain biking, and pretty much anything that involves getting outdoors. Julie Kilpatrick, UUSOM '20 is originally from Florida and earned undergraduate degrees in Boston and Salt Lake City. Her interests include baking, petting all of the dogs, and adventuring in the great outdoors. Jorgen Madsen, UUSOM '19 will begin his residency in Med/Peds at the University of Cincinnati and Cincinnati Children's Hospital. He is interested in LGBT health and is one of the founders of Utah's first free PrEP clinic. He enjoys unicycling, theater and hiking. Luke Mirabelli, UUSOM '19 holds a Biology B.S. and Italian B.A. from Loyola University Chicago. He will soon begin a combined Medicine/Psychiatry residency at the University of Kansas. He enjoys cooking and eating with his family, sharing a bottle of wine with friends, and skiing Snowbird. Stephen Mossbarger is an Honors Program alumnus of the University of Utah, 1991, major emphasis in "Intellectual Traditions of the West," minoring in English Literature, and a University employee since 1989, currently in the Eccles Health Sciences Library. His interests include amateur comparative global culture studies (cosmology, ethics, psychology, and mysticism), science and technology, and the evolution and application of individual and species rights. 28 Jordan Peacock, UUSOM '21 is from Kaysville, UT and studied neuroscience and chemistry at Brigham Young University. He enjoys visiting new cities, scuba diving, and building campfires. Romany Redman, MD is a third-year combined Internal Medicine-Pediatrics resident at the University of Utah. She has a bachelor's degree in Russian Language and Literature and played fiddle in one of the first Siberian Irish pub bands before moving back stateside for medical school. Awais Riaz, MD, PhD is an epileptologist who has been with the Department of Neurology, University of Utah, since 2004. He claims that the best part of his job is being a small group facilitator for the "Layers of Medicine" course. When not engaged in clinical work, he enjoys reading, writing and taking pictures. Kevin Rodriguez Amenero, UUSOM '19 has a B.S. in Exercise Science and will be moving to Denver for his general surgery residency. He is originally from Peru and is heavily involved with the Hispanic community. He is also an avid rock climber, and a loving father and husband. Christian Schmutz, UUSOM '20 has been performing improv comedy for seven years and is currently in the cast of "Improv Broadway" in Provo. Anna Shvartsur, UUSOM '20 plans on pursuing psychiatry. She studied microbiology, immunology and genetics as an undergraduate at UCLA. She likes swimming, sand volleyball, playing the ukulele and eating dessert. Jenna Marie Tiller, UUSOM '22 has a B.S. in Psychology with an interest in interpersonal relations. She enjoys adventures outdoors, hiking the red rock of southern Utah, and skiing and snowboarding throughout the Wasatch Front. David Twitchell, UUSOM '22 holds a B.A. in Latin American Studies from Brigham Young University. He is passionate about serving others and enjoys traveling as well as hiking and rock climbing with his wife and two dogs. Anne Vinsel worked at University Hospital in Graduate Medical Education doing medical writing and surgical photography for 16 years, and now does freelance medical writing while working on a novel and writing other fiction. She enjoys spending time with her pit bull rescue dog, Dr. Miranda Bailey, who is an active, wiggly couch potato, and as strong and determined as her namesake, as well as being the only dog Anne has ever had who loves kale. Kajsa Vlasic, UUSOM '19 earned a B.A. in English from the University of Utah and will be moving to Philadelphia to begin her pediatrics residency this summer. Things she will miss most about Utah: quick weekend trips to the desert, powder skiing her favorite chutes at Alta, getting lost at the King's English and drinking wine with friends on sunny afternoons at East Liberty Tap House. Dannen Wright, UUSOM '19 holds a B.S. in Biology with minors in Psychology and Art History, which she will employ as a psychiatry resident at UNC Chapel Hill this June. In her spare time, you can find her devouring books or emulating the Barefoot Contessa by making dinner (with dessert!) for her friends. Hunter Wright, UUSOM ‘21 has a B.A. in Ancient Greek and Latin literature. He enjoys heavy metal objects and singing along to Disney songs with his daughter. Lindsey Nae Wright, UUSOM '22 completed her undergraduate degree at the University of Utah in Medical Anthropology and minored in Pediatric Research. In her free time, she enjoys traveling, hiking, and practicing yoga. She loves to sample fancy cheese and drink coffee.