Voices from the Wards (2022): A Collection of 55-Word Stories from the School of Medicine Class of 2022 at the University of Utah

Front Cover - Nicolette Jessen; You Are Irreplaceable - Derek Woodruff; Just a Pap Smear - Lindsey Wright; Mudblood - Anthony Mills; Suction - Nicolette Jessen; I Don't Speak Spanish - Sarah Childs; Interview - Anonymous; The Laugh - Sam Simister; Will you be my doctor? - Samantha Derzon; Why Plastic Surgery? - Emily M. Graham; Days - Shreya Sreekantaswamy; You Will Lose - Derek Woodruff; A Smile - John Sanchez; No Heartbeat - Samantha Derzon; Night - Abbie Luman; Roller Coaster - Amanda Truong; How Catatonic - Jenna Tiller; IUFD - Intrauterine Fetal Demise - Sarah Kinsey; Slow Down - Sarah Childs; Red Lipstick - Nicolette Jessen; Ouch! - Daniel Brandley; So What Now? - Elzard H. Sikkema; Time of Death - Kassie Amann; Day of Discharge - Jackson Richards; ER - Harneet Dhillon; SICU - Abbie Luman; The Sub-I's Patient - Shreya Sreekantaswamy; ICU Handoff - Nicolette Jessen; Duality - Sophie Janes; 2 Weeks' Notice - Kassie Amann; Home - Harneet Dhillon; You Are Not Alone - Derek Woodruff; It's a Race - Sarah Childs; Coffee, please - Sophie Janes; Surgery Clerkship - Gina Allyn; Valentine's Day - Kassie Amann; Rainbow Pin - Sarah Kinsey; Laughing With You - Naveen Rathi; Happiness… - Shreya Sreekantaswamy; I'm Decompensating - Sarah Kinsey; Another Night - Abbie Luman; Medicine on Pause - Elzard H. Sikkema

VOICES FROM THE WARDS A COLLECTION FROM THE CLASS OF 2022 THE UNIVERSITY OF UTAH SCHOOL OF MEDICINE Cover Photograph: “Sunrise Over Ogden” Nicolette Jessen Layout and Editing: Sarah Kinsey VOICES FROM THE WARDS We are proud to present this collection of 55word stories written by the University of Utah School of Medicine Class of 2022, inspired by the 55-word story project at the University of Virginia School of Medicine and first adopted by the members of the Utah Gold Humanism Chapter class of 2019, Dr. Kajsa Vlasic, and Dr. Dannen Wright. Editors Sarah Kinsey ‘22, Jackson Richards ‘22, and Elzard Sikkema ‘23 Thank you to Dr. Gretchen Case, Dr. Tiffany Glasgow, the Utah Gold Humanism chapter faculty advisors, as well as Shawnee Johnson, our chapter staff advisor, for helping us bring this project to print. An additional thank you to our classmates at the University of Utah School of Medicine for contributing their stories. Dear Reader, Contained within these pages are stories of joy and grief, triumph and loss, camaraderie and isolation. Written by graduating medical students, these 55-word narratives are reflections on their clinical experiences during the 3rd and 4th years of medical school. The transition from preclinical to clinical training can be overwhelming and bring with it a variety of unexpected thoughts, feelings, and experiences. Our purpose in sharing these stories is two-fold. First, it provides a space for graduating students to share in a way that allows others to bear witness to what they have been through. Second (and we argue, more importantly) by distributing these booklets to medical students beginning their third year, we hope to provide emotional support and connection about that which leaves us feeling vulnerable. Designed to fit in a white coat or scrub pocket, this booklet can serve as a reminder that you are not alone. We were thrilled by the abundance and variety of our classmates’ brave, authentic contributions. And we are delighted to be able to bring each and every one of them to you. There is one student whose unique contribution deserves a special acknowledgment. Upon learning the purpose of our project, Derek Woodruff took it upon himself to draft a twopage letter communicating his thoughts, feelings and the things he wished he had known prior to starting his clinical years. Though it did not conform to our intended 55-word format, we knew after reading it that we could not deprive our readers of the insight, wisdom, humility, and authenticity it held. As such, we have included excerpts of Derek’s letter and grouped the stories according to its themes, which we feel adds a sort of literary harmony we would not have achieved otherwise. We hope this publication serves as a reminder of the unassailable humanity in all of us – our mutual yet distinct vulnerability and resilience. Though we aim not to be prescriptive in this publication, we wish to offer this singular piece of advice: When you find yourself in a patient room and you’re not sure what to do or say next, slow down and remember first to be a human with another human. Thank you for writing. Thank you for reading. Sarah Kinsey, Jackson Richards, & Elzard Sikkema Table of Contents You Are Irreplaceable Just a Pap Smear Mudblood Suction I Don’t Speak Spanish Interview The Laugh Will you be my doctor? Why Plastic Surgery? Days You Will Lose A Smile No Heartbeat Night Roller Coaster How Catatonic IUFD – Intrauterine Fetal Demise Slow Down Red Lipstick Ouch! So What Now? Time of Death Day of Discharge ER SICU The Sub-I’s Patient 1 3 3 4 4 5 5 6 6 7 8 9 9 10 10 11 11 12 12 13 13 14 14 15 15 16 ICU Handoff Duality 2 Weeks’ Notice Home 16 17 17 18 You Are Not Alone It’s a Race Coffee, please Surgery Clerkship Valentine’s Day Rainbow Pin Laughing With You Happiness… I’m Decompensating Another Night Medicine on Pause 19 20 20 21 21 22 23 23 24 24 25 You Are Irreplaceable From third year through residency, your clinical training will consistently challenge your belief in yourself. Relegated to menial tasks, being ignored/overlooked, and constant evaluations make it hard to feel anything other than insignificant. When you add in the solitary nature of various medical settings, constant fluctuation, high-stress environments, and the natural competitiveness of most medical professionals, you have a recipe for depression and anxiety. An antidote to this feeling is remembering for your patients that you are the doctor. Patients will remember you and the medical team for years to come. So even when you don't believe in yourself, you can lean on the fact that your patients trust you. Additionally, in the third year, you will have a gift that you will never again have: time. You have the time to sit and be with patients, to listen to their needs, to their worries, to their fears that no one else has. Take time to sit and be with the people that you treat. Their courage will inspire you, their circumstances will humble you, and most of all, you will remember that you are no different from them. This gift of time and your presence makes you a vital team member. Yet, you are more than your medical career. Your personality, interests, and life are not defined by what 1 happens in the clinical environment. You are more than your job, more than your grades, your specialty, more than where you go to residency, you are more than a salary, more than STEP scores, and you are more than a doctor. There will honestly be moments when you feel your entire life is being swallowed by medicine, but in those moments, commit to continuing to do the things that make you, you. When you get the chance, put down the books and go out with friends, play video games, dance, sing, go skiing, walk outside, or play your instrument. You will find that the more your commitment is to your wellbeing, the more you will have to give to others. Now lastly, if there is ever a time, as there was for me, that you begin to think that maybe everything feels like it is too much, a time when your mental, physical, spiritual, or emotional health is at the breaking point. Please remember this: You are infinitely more important than a job. You are worthy of respect, you are worthy of happiness, and you are worthy of success. Give yourself permission to do whatever you need to do to put your wellbeing before anything else. Derek Woodruff 2 Just a Pap Smear Lindsey Wright The speculum was lubed. Then, “I was raped once. Please hurry.” “She doesn’t have to do this,” said the attending protectively. “I don’t have to do this,” I said, heart in my throat. “I want the student to do this,” said the woman with determination. “You are powerful,” said the attending to the crying woman. Mudblood Anthony Mills You were in DIC. Too pale to be alive. Too adept with that teenage eyeroll to be actively dying. Blood bank keeps running out. Nationwide shortages. 5L blood now at bedside. Your exact type. Umpteenth negative HIV test days before. On dual-antiretroviral prophylaxis. Nonetheless--unusable. I wished I could give you my dirty gay blood. 3 Suction Nicolette Jessen Back is aching, can’t see anything. The surgeon holds the suction in front of me. Now is my time to shine, I grab it. Hand is slapped, I am yelled at. “How dare you grab my suction, who do you think you are, definitely not qualified to be here!” I was warned about this surgeon. I Don’t Speak Spanish Sarah Childs Buenos Dias, I say. Behind me enter three residents A wall of masculine competency and intimidation “You’re healing as we expected” She doesn’t understand them. They leave. I place my hand on her arm. She places her hand on my hand. I smile. She smiles. I leave. I need to learn how to speak Spanish. 4 Interview Anonymous During the Adverse Childhood Events lecture my heart is racing. For every category, I can think about an example. Like the time my father was arrested for drunk driving with me in the car. As a walking statistical guarantee of failure, I sit down for dream residency interviews, proudly giving those ACEs the middle finger. The Laugh Sam Simister They need a heart biopsy; They are full of fears. So, during the procedure, I held their hand, and requested Britney Spears. I’ll never forget the laugh. As they left, I found a card, full of words that they had thought. And though they had no answers, it said that kindness had meant a lot. 5 Will you be my doctor? Samantha Derzon Patient struggling from COVID long-hauler syndrome. Symptoms of fatigue, numbness, and weakness to name a few. Been difficult to find help. I go into her room and she begins her story. I am listening and listening without interruption. Patient showing relief turns and asks, “Will you be my doctor?” Listening can be the best medicine. Why Plastic Surgery? Emily M. Graham The heart still beats in the burn victim without a face, and in the child with mangled hands. Wondering, “What will be my place as I move forward?” Alive to await social death, They need saving too. Normalizing form, restoring function, gives hope to those with stigmatized bodies, lost identities, and unseen wounds. Life anew. 6 Days Shreya Sreekantaswamy There are some days where you feel – Useless. Stupid. Like you’re just getting in the way. And then there are days Where a patient tells you, “You are going to be a great doctor.” Days where you feel Valued. Days where you feel Like you helped. And it’s those days That make all the difference. 7 You Will Lose I know, I know, this is not a happy sentiment. Yet, I feel that it is essential to know that for many third-year medical students, clinical training is the first time in their lives that they will lose. Let's be absolutely clear, in the next year, you can expect to: mess up presentations, feel tired most of the time, forget basic information, get lost in a stairwell, mix up patients, and not eat lunch. You may even find yourself passing out in an operating room, crying in a bathroom stall, watching a patient pass, standing in shock when a patient that reminds you of someone receives terrible news, becoming a hypochondriac, seeing the effects of abuse, neglect, violence, or anger. I know I did. You may even begin to question why you or anyone goes into medicine in the first place. It is a sobering realization to recognize that ultimately, we all lose in a way, in that we all will die. Yet, I have come to find that life and medicine are not so much about losing or winning. It is about living and choosing. Medicine for me is simply helping others live and choose the best options for the time they have left. Derek Woodruff 8 A Smile John Sanchez Sleeping soundly on her hospital bed, a smile on her face. Her husband, awake and diligent, betrayed her illness. She could not eat. He was not smiling. Three days later: Mouth agape with vomitus at the corners of her mouth. A tube through her nose providing nutrition. She was no longer smiling. Neither was I. No Heartbeat Samantha Derzon Parents checking in on growing baby. Recent accident caused some worry. Scan with doppler to no end. Bring in the ultrasound for the final scan. “I’m sorry to say there is no heartbeat.” Silence suddenly fills the room. Then sobs of inconsolable heartbreak. Nothing to do but hold her hand. I feel helpless and numb. 9 Night Abbie Luman Last night I dreamt of his chest underneath my hands. Good rhythm, good depth! One cannula placed into the groin, one ounce of hope against the impending death of a young man. He’s not a candidate for ECMO. I take my N95 off as we walk out of the room, sweat dripping down my back. Roller Coaster Amanda Truong Admitted for A-fib, cheerful 90-year-old Anticoagulate overnight, heart rate controlled Discharge summary signed, then rapid response Right MCA stroke, my heart drops Emergent thrombectomy, in ICU Function restored, she has made it through New hemorrhage overnight, no more we can do Home on hospice, wait, actually, funeral These ups and downs are taking a toll 10 How Catatonic Jenna Tiller They say eyes sparkle… Sapphire, a halo of sky. “How are you, Suzanne?” Your lips roll, summoning a response. None comes. Your eyes lock mine, saying, “I’m still in here. Tell them.” I clasp your hand. You hold on. Emptiness forms in my gut as I watch your spark dim. “Hopefully, more ECT will help.” IUFD – Intrauterine Fetal Demise Sarah Kinsey “It’s been a while since she felt baby move” “Safest to push…” “The tissues will have begun to degrade” “Gentle traction” nothing could have prepared me to hold that floppy, grey, not-cold, yet distinctly not-warm form Numb in the aftermath – worry they think I’m heartless In the car, I cry so hard I can’t breathe 11 Slow Down Sarah Childs It’s 0631. Nurse: “She wants to speak to the team” Chief: “We don’t have time to talk right now” Patient: [she mumbles something through her trach] Chief: “I’m sorry, ma’am, I can’t understand you” He lifts up her gown to press on her belly. She tries again. He’s gone. She’s frustrated. I’m appalled. It’s 0632. Red Lipstick Nicolette Jessen Admitted at 38 weeks with sepsis, now s/p PLTCS 2/2 NRFHT. Still fevering on broad-spectrum coverage, but she looks beautiful breastfeeding and applying red lipstick. Fast forward, she has received over 120 blood products and her family decides to let her go. I was the last person to see her “well,” did I miss something? 12 Ouch! Daniel Brandley Ouch! I pull my finger away. Annoyance. Realization, then fear. The surgeon says everything will be fine. I leave the patient, caring for myself. Worried, I pass by waiting family. I think of her. The disease, unknowns. Unexpected exposure, forced empathy. Test results provide relief. Their reality remains unchanged. Harmful medicine? I think of her. So What Now? Elzard H. Sikkema 59-year-old with chest pain. Started on heparin but troponins and EKG are negative. Light-headed, tachycardic, hypotensive. Imaging shows rapid abdominal bleed. But bleed tamponades and the exact source cannot be identified. All workup is negative. Patient stabilizes and can be discharged. “But what happens now? Will this happen again? I am only 59 years old.” 13 Time of Death Kassie Amann When she died her arms were wrapped around the LUCAS machine in a heartbreakingly empty hug. An hour earlier, her EKG was normal, then PEA, now flat. The blanket I brought to warm her was lifted over her head, a burial shroud. The only people who knew she was gone were the strangers around her. Day of Discharge Jackson Richards A patient eager to leave. Manic symptoms stabilized but insight remains poor. Can no longer justify inpatient commitment. Family? Too difficult, even dangerous to live with them. Residential? Disqualified. All bridges burned. Disposition? Return to homelessness (and meth use). His sister pleads, “What can I do to change the system?” I have the same question. 14 ER Harneet Dhillon There was an accident. Meet us at the hospital. Where is she? She’s in room 11. It’s going to be fine. You’re going to be fine. It hurts, it won’t stop hurting. This medication is not working. Can you give her more? No, we can’t. Why? She’s still in pain. We can't. It keeps hurting. SICU Abbie Luman Bed 6 now has a tracheostomy. Yesterday he moved his left foot, his nurse said. I walk to his bedside and call out his name. No verbal response or foot twitches for me. The day he arrived to the SICU his voice was full. He told me about his wife, his drinking, his abdominal pain. 15 The Sub-I’s Patient Shreya Sreekantaswamy Cardiology Sub-I. Senior is out. 80 yo M. HFrEF. Gurgling because of the fluid on his lungs. “I appreciate you.” He’s my favorite patient. And I’m worried that he’s getting worse because he’s my patient. Because I don’t know what to do. I run into the cardiology fellow. She asks, “How’s everything?” I start crying. ICU Handoff Nicolette Jessen This is a 28-yo female G1P0 admitted at 32 weeks for ovarian torsion, s/p partial bowel resection and oophorectomy. This surgery was complicated by a crash C-Section for absent fetal heart tones. The husband knows that the baby didn’t make it, but the patient is still waking up from anesthesia and doesn’t know this yet. 16 Duality Sophie Janes White, heroin, easy delivery. Her fourth. My first. Grateful tears. We wait for the laboring mother in the next room. Beautiful tracings. She speaks no English. 10 cm. Her first. My second. A baby boy is born. Silence. Two hours of compressions. I squeeze her hand but can offer no help. This can’t be fair. 2 Weeks’ Notice Kassie Amann I remember seeing the last question scribbled in his notebook— “How long do I have left?” His belly was tight with cancer. Months, maybe. Then he got chemo and fought fevers. Tears rolling, he decided he didn’t want his daughter to see him in pain. He went home. The answer to his question—two weeks. 17 Home Harneet Dhillon I never wanted to come back. I know, but you’re sick. I feel fine. You have a fever. But I don’t want to be here. Your WBC is elevated. I don’t like it here. But these labs show that… I don’t care about the labs. I know this is hard. I want to go home. 18 You Are Not Alone I often think back to a call room during my 24-hour surgery call. The room was a cramped space with furniture from every decade since the ‘70s haphazardly shoved together. It was around 2 am, and I had about an hour to sleep. As I lay on the double bunk, I began to think of all the students who had come into that room. Literally, thousands of other clueless medical students, like myself, had passed this test. If they could do it, so could I, and so can you. I promise you that whatever you are going through, realize that someone has been through it before and trust that you can do it now. Now, I will not diminish the challenges that face our current health care system. A pandemic, political division, and decreased public trust pose their challenges. Yet, I have seen how my classmates, mentors, and friends have stepped up. They have battled through personal health challenges; they have faced divorce, cancer, death, and loss with grace and strength that could be nothing less than inspiring. I have seen them comfort each other and commit to positive change. I feel that the best days are ahead because I am surrounded by some of the best people I have ever met. Rely on your friends and colleagues. They will always be there for you. Derek Woodruff 19 It’s a Race Sarah Childs Where did my intern go? We’re running down the stairs. I hope I don’t roll my ankle in these shoes! There he is! We walk into the room. I’m the last to enter. My Chief has just finished saying something. She leaves. The rest of the residents follow. I leave. Where did my intern go? Coffee, please Sophie Janes It was third year And I was on the sidelines. Then an intern bought me coffee. I didn’t even ask! I loved the feeling of being seen. I didn’t realize how much I yearned for inclusion. When it’s finally my turn, I’ll buy coffee for my students, so they know they’re part of my team. 20 Surgery Clerkship Gina Allyn Surgery, first day. Actually, going well! It’s hot... Lightheaded. Oh no. Step back too late. 1000 years later. “Call the anesthesiologist!” Rapid response. “It’s OK honey… but… you’re going to have a scar.” and concussion. and broken nose. Don’t worry, I got one day off. Acute Stress Disorder for rest of Surgery. Step back sooner. Valentine’s Day Kassie Amann To me, there is always significance in hearts—The heart balloon floating past on a hike, the smiling heart sticker on the floor of the heart transplant patient’s room, the heart-shaped clay “thank you” token from my patient’s wife, the heart rocks found on a New York beach, the heart on my white coat’s sleeve. 21 Rainbow Pin Sarah Kinsey Gay Not Gay Neither Both Bi Worry about being too outspoken too in-your-face don’t shove it down my throat Worry I don’t use my voice when I should too straight-passing I put on the rainbow pin it drives connection with some patients disconnection with others feel: pride, exposed, judged, like a fraud wear it anyway 22 Laughing With You Naveen Rathi “Rate, rhythm, axis…” I try to be systematic All of these p-waves are inverted The patient likely has significant atrial pathology The fellow looks over my shoulder, I hear a giggle The EKG leaves my hands “It’s upside down” I make another attempt, red face, 20th year of school, sometimes as silly as the 2nd Happiness… Shreya Sreekantaswamy 50 yo M. Metastatic Prostate Cancer. “Sir, I’m sorry.” His eyes tear up. “It’s too soon.” He wants to go smoke outside. But there’s no staff to go with him. He says smoking makes him happy. He says he will leave AMA. He signs the paperwork. He’s gone. I’m left thinking: What makes me happy? 23 I’m Decompensating Sarah Kinsey Home exhausted 2 ½ hours till bed hospital food for dinner no time for exercise need to study, need sleep more Don’t want to do this all over again tomorrow Depression settles in A sleepy cat on my chest purring, “stay in bed, you’re warm and safe here. Where no one can yell at you.” Another Night Abbie Luman Last night I dreamt of the coronaries drifting from the aorta. From the root at the base to the apex of the heart. Antegrade and retrograde flow. Cardioplegia and controlled cardiac arrest. The unthinkable, your heart, now exposed to air for our eyes and hands. Emptied of blood just a moment ago… it beats again. 24 Medicine on Pause Elzard H. Sikkema In the hospital all day, my partner ill each night. “I think it’s time to go to the ED.” In the hospital all day, my partner’s hospital room each night. “I think we need to consult Oncology and Surgery.” In the hospital all day, chemotherapy, surgery. Medical training on pause, classmates bringing dinner every night. 25 Your Stories 26 27