August 2020

Coming Full Circle: An Interview with Patricia Watson, MD

By Sarah Elmer, M2, and Thomas Nguyen, M2

If there is ever a feeling such as déjà vu, it must lie in the dim hour before the sky breaks open to welcome the day. As we log onto Zoom to begin the interview, there is a feeling of newness wrapped in layers of routine. By now, we have been conducting faculty interviews for several issues of The Synapse, but each one is unique. We imagine our guest for the day, Dr. Patricia Watson—Practice of Medicine (PoM) 1 and 2 co-course director, psychiatrist, and head of the Department of Humanities in the College of Medicine—must feel something similar. She was once in our shoes, being interviewed to become a student in Texas A&M College of Medicine’s charter class. Things have come full circle, and now, she is being interviewed as a faculty member in the College of Medicine.

Watson described her experience as a member of the Texas A&M College of Medicine charter class using a single word: interesting. “Over half of us had not graduated from college yet because we were getting accepted early,” Watson said. “There were only 32 people in our class. We were constantly being written about and having our pictures taken. If you think it was hard to get into the class, it would be harder to get out, because they wanted everyone to graduate. One poor guy got sick and probably should have taken a leave of absence, but they just nursed him along.” 

There was a lot of added pressure being in the first class of A&M medical students, Watson recounted. “There was a pressure because you didn’t want to let down A&M,” Watson said. “All of us were A&M students, so we had a great commitment to A&M, and to get into the first class was clearly an honor. The fear about how [our level of success] would impact the school was second to how it would impact us long-term. Ultimately, it was a very good experience. Sometimes it was stressful, but because we were so close, it really made a huge difference. When we took our boards, everyone else in the room was a UT student, and we were the only A&M students. Our school actually scored the highest on the boards that year, which was a proud accomplishment for us.” 

Before entering medical school, Watson did not understand the complexity behind medical school accreditation and its seriousness. “I think we were a bit naive coming in because we didn’t think about what could happen, especially with accreditation and LCME [Liaison Committee on Medical Education],” Watson said. “In the middle of our first year, a rumor went around that we weren’t going to get accredited.” 

In the end, the school received full accreditation from the LCME but not without some bumps along the way. “Our first dean left, and the second dean didn’t like us,” Watson said. “It brought us closer together, and nowadays we can pick up pretty easily where we left off because sometimes it felt like it was us against them.” 

During her first year of medical school, Watson met classmate Mark Sicilio for the first time, not realizing that they would later become teaching colleagues at the College of Medicine as her career came full circle. “Dr. Sicilio is the same as he was then,” Watson said. “He was quieter then, because he was, like any good medical student, studying. Overall, he was very much then as he is now. Dr. Sicilio is addicted to coffee now, and I was there when we had his first cup. Before that, he would have Postum or instant coffee. I joke that if I give a patient a drug and their face looks like his face did when he had his first cup of coffee, they’re not getting the drug again.” 

One of Watson’s other classmates was Susan Rudd, who is now Dr. Susan Rudd Bailey, the current president of the American Medical Association (AMA). “She may have been the first student admitted to the medical school, and she could have easily gone elsewhere,” Watson said. “She was my roommate during residency at the Mayo Clinic, and even then [in medical school], she was in the AMA. She was one of our med student representatives. She would come in after being on call and would sigh and say, ‘I have to go to Hawaii this weekend,’ and I would joke ‘Oh, you poor thing!’ We have stayed in touch all of these years. She has an allergy practice in Fort Worth and a family. She has worked really hard and deserves this. I think she will do a really good job. She is keen on patient care and is keen on physicians being addressed in the mix. It has always been a passion of hers.”

Choosing Psychiatry

Watson decided on a career in psychiatry late in medical school. “My mother had depression, so I wanted to steer clear of psychiatry, but when I got onto the clerkships, I became interested in the impact of illness on the patient and his or her family,” Watson said. She noted that on rotations, she often saw “a whole lot of chronic illness but not a whole lot of people getting over it.” Many people would come into the hospital with depression or psychosis, and unlike many other patients, they would recover. “You would see the phoenix rising from the flames,” Watson said.

Watson was also fascinated with the problem-solving in psychiatry. “There was never an algorithm to follow. There was a point when you had to use your brain and figure out what to do. That is what hooked me.”

The idea of entering psychiatry did pose some challenges, however. “One thing that initially turned me off was the idea that psychiatrists were eccentric and didn’t get medicine. But when I started doing electives in psychiatry in clerkships, I realized they were rock-steady and caring people, and they had to know so much medicine.” This, Watson said, is because “many patients will have a significant illness not related to psychiatric illness, and others will have psychiatric symptoms related to a significant illness that is misdiagnosed or mistreated.”

Another challenge for Watson was the stigma in psychiatry. “My parents didn’t want me to be a psychiatrist. They wanted me to be ‘a doctor.’ When you said you were going to be a psychiatrist, folks would push back and say you need to be a ‘fill in the blank.’” The stigma has gotten better throughout the years, but “it is not entirely better,” Watson said. “Many clinicians don’t value psychiatry until they need a psychiatrist for an illness or treatment, but we are now coming into our time. People now realize how common mental illness is.”

Applying to residency positions was not nearly as stressful for Watson’s class as it is for current medical students. “Back then, STEP 1 was not crucial. You had to pass, but if you had paid attention in school, you would pass,” Watson said. “It was to weed out people that couldn’t function as an intern or first-year resident. So, we didn’t have that worry. The focus was on making sure that we passed our classes, but we didn’t worry about boards at all. That’s an additional stressor that current medical students have.”

When Watson and her classmates were choosing where to apply to residency, many chose to apply to the Mayo Clinic, given the strong relationship that the COM students had with faculty who were Mayo graduates. “Back then, you only applied to maybe five residencies because you couldn’t do it online,” Watson said. “Programs would look at your grades, but really it was recommendations from your professors. About 10% of our class ended up at the Mayo Clinic because quite a few Mayo people were at Scott and White [then the main clinical teaching facility for the Texas A&M College of Medicine] then, and they wrote us great recommendations. There was no one who wanted to go to Mayo that didn’t go to Mayo. You just wanted to make sure your professors didn’t think you were an idiot.”

During Watson’s first year of residency, eight months were spent rotating with psychiatry, but the other four months were spent rotating with internal medicine in the hospital. “We didn’t wear white coats at Mayo unless you thought that someone might throw up on you,” Watson said. “You’d round, and most of your day was spent researching the syndromes that patients had. You would have to go to the library and search through the stacks. The immediacy of information that you guys have now is amazing.” 

Among the many memories that Watson has of her time at Mayo, one that has stayed with her was the level of respect that everyone in the hospital had for one another. “Everyone was very respectful of each other. There were TV shows that would show horrible hospitals. But it was not like that at Mayo,” Watson said. “You had to be unfailingly polite, and demeanor was valued. In psychiatry, you never knew who you were going to see. There was one space called the Intensive Psychotherapy Center, where we did intensive therapy for a week with couples. This was where people literally were coming in for the world-famous Mayo Clinic.”

“The Daring Way”

Watson was at Mayo for two years. She then married and moved to Houston, where she and her husband both had residency positions at UT Health Science Center Houston. After graduating, she went into private practice near the medical center in Houston. “We did a lot of work with inpatient substance use disorders, bread and butter psychiatric stuff, depression and mania. At that point, I was doing both inpatient and outpatient psychiatry.”

After she had been practicing for about 25 years, Watson stumbled upon the work of Dr. Brené Brown, a professor at the University of Houston known for her work on courage, vulnerability, shame, and empathy. Brown has a certification program called “The Daring Way” that provides training on courage-building, shame resilience, and vulnerability. Watson could see many of these themes were relevant to her medical practice and so became motivated to get certified in “The Daring Way.” “So many of the things that can lead to burnout are what we cultivate in pre-medical students, medical students, and residents. And I could see the progression of that. Doctors would try shaming techniques to get people to do things. Their relationships were breaking up because they weren’t taking care of themselves,” Watson said.

Watson began focusing on physician burnout and thought if she could work with residents and medical students, she might be able to change things. She went to Scott and White in Round Rock because it had residents there. She called Dr. Sicilio to ask him what it was like working at Scott and White, and he said, “It’s great, but if you want to get involved with med students, you need to come to the med school.” Watson came and interviewed at A&M, and the interim dean at the time, Dr. Paul Ogden, was one of her former classmates. “He said, ‘You don’t have to convince me, you have to convince the vice dean,’ who was a vascular surgeon. It was remarkably easy to convince her.” “So, that’s how I came to Texas A&M,” Watson explained.

Originally, Watson was just going to be helping with Becoming a Physician (BAP), a course focusing on professionalism, ethics, and communication skills. But the day she came to observe and help, the person in charge of BAP unexpectedly stepped down, and Watson was asked if she could take over. “I want aspiring medical professionals to be more shame-resilient, and when the universe offers the opportunity up to you on a platter, can you say no?” Watson said, adding, “It was a baptism by fire, and I’ve been here for a little over five years now.” 

Now a full-time faculty member and department head at the College of Medicine, Watson said there are still things she misses about clinical practice. “I had to give up my relationship with patients, but I love it when I can get into a room with students and have that conversation, getting straight to the bottom line of taking care of patients. I have to remind myself that in touching one class of medical students, I am probably touching hundreds of thousands of patients.”

The Future of the Practice of Medicine (PoM)

A major part of the PoM 1 and 2 courses are the OSCEs (objective structured clinical examinations), which give first-year medical students the opportunity to develop and refine their history-taking and physical exam skills before entering clerkships. One notable OSCE, the sexual history one, which M1s have during the fall of their first year, was started shortly after Watson arrived at A&M. “The person in charge of the clinical skills course at the time wanted to do the sexual abuse OSCE because no one ever gets this clinical training, yet it is so important. She said, ‘They don’t know medicine right now, but they do know people.’”

The feedback on this OSCE has not always been positive, though. “The first year we did the sexual assault OSCE, one of the attendings said we should just do the bread and butter stuff, like headaches, for OSCEs, but I told him that sexual assault is part of the bread and butter of medicine,” Watson said. Students now in clerkships have told Watson that it has helped, because this topic does come up, no matter what specialty one practices in.

Another notable OSCE during M1 year happens in the spring of the first year and regards a patient who has Parkinson’s. In it, students must combine basic-science knowledge from anatomy and neuroscience, the clinical skill of doing a neurological exam, and the communication skills needed to calm an upset patient. “This is actually one of our former employee’s mom’s stories. It is a pretty big OSCE for students because you are trying to deal with someone who is upset, without throwing another doctor under the bus, and you also have to break bad news,” Watson said.

Admittedly, M1 year can be stressful, but there is a method to its design. “We want things to sneak up on you gradually,” Watson said. “By the end of PoM 2, we want you to walk into an OSCE without the fear that it is an OSCE. By semester 3, we want you to be so comfortable taking a history and doing a physical that you are confident walking into clerkships.”

Watson said that although the PoM 1 and 2 courses will keep evolving, they most likely will still have the same OSCEs that they do now. “You will have a thousand times to do a headache evaluation, but I don’t know anyone who wants to get rid of the chance for you to get yelled at by a patient and learn how to handle it properly.”

For medical students, having a faculty member who once was in our very same shoes makes it easier to trust in the process. For Watson, her career has come full circle. “There is no day that passes that I don’t learn something now that I’m teaching. Sometimes it’s something LCME-related. Sometimes it’s something that students tell me.” In medicine, teaching and learning are inextricably linked, and physicians are nothing if not curious. A path of lifelong learning led Watson back to A&M, and we’re lucky to have her as a teacher and mentor.

Fireworks Salute to Healthcare Heroes on the Front Lines Battling COVID-19

By Xin Wu, MD, MS

A Hero in the Face of the Disaster

By Claudia Serrano, M2

This piece was written in early May 2020, weeks after COVID-19 was declared a pandemic by the World Health Organization.

As of early May 2020, over a hundred and fifty physicians have perished in Italy, having contracted the coronavirus. With over four million cases across the globe, countless physicians are now being called to step up and bear the weight of infection while the rest of the world hides away at home, safe and protected.  

It was Italy where we first saw how this virus was going to change history forever. One physician, as early as February 20, 2020, saw the incomprehensible impact in his ICU clinic in the region of Lombardy, Italy, and narrowed down the insanity to one question: How are coronavirus patients presenting, and what are their outcomes? Seeing death after death, he was determined to find the trends and dedicated the following three months of his life to recording and publishing this information in order to warn the world. It was this physician in Lombardy who allowed us to see what was to come and what treatments were even going to be possible. This is the story of Giacomo Graselli, MD. 

Italy was the first Western country where the novel disease was diagnosed. Therefore, there were cases that presented even five weeks before the pandemic was declared, but these cases were improperly diagnosed for weeks. Once they were identified, though, the death rate was high. The coronavirus has a much higher mortality rate in older individuals, and Italy has one of the world’s oldest populations. For comparison, the United States’ population percentage over the age of 65 is a mere 16%, compared to Italy’s 23%, as of last year’s census.  

As an associate professor in the Department of Pathophysiology and Transplantation at the University of Milan, Graselli felt an academic obligation to record and study the real-time cases in his ICU. On February 21, his first patient was diagnosed in his small town of Lombardy, a town of 50,000 just south of Milan. Within 24 hours of the first case, thirty-five new patients were diagnosed. There was an exponential spread of the disease within just two weeks. Soon, 40% of the total emergency room patients needed hospital admission for viral pneumonia and some form of respiratory failure. These values were much higher than those reported in the studies coming out of China at the time, and Italian doctors were shocked and unprepared for this influx of admissions. Graselli saw the disorganization and realized that his entire hospital system needed a redesign promptly. Meanwhile, physicians across the world read his reports that were being published, listening and waiting to see if their countries would see their first cases as the United Nations warned.  

All of a sudden, 500 ICU beds were occupied, with each patient in need of constant mechanical ventilation. Graselli had to act swiftly and create new guidelines for the disaster. He worked with his colleagues to contact local hospitals with infectious disease units to create isolation cohorts of quarantined patients. All elective surgeries at the hospitals were halted, leaving operating rooms open for emergency surgeries. New protocols for ICU patients and healthcare staff were developed. In the first few days of the epidemic, 10% of the positive swabs came from healthcare workers because they were unaware of the spread of the disease. After implementing proper personal protective equipment, these numbers were brought down to nearly zero infected health care workers.  

Dr. Graselli was not only a leader for his country but for the world. I have no doubt that physicians will continue to pore over his published cases in the coming months and use his action plans as a model for what to do in every resurgence of this pandemic. As a future practicing physician, I can only hope to one day be as cool-headed in the face of disaster as he was.  

For Further Information: Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA.​ 2020;323(16):1574–1581. doi:10.1001/jama.2020.5394

Will I Ever Be Ready?

By Alexander Le, BS

Le is currently doing an MPH through the MD Plus Program and will be an M1 next year.

The New Normal

By Tiffany Rudzitis, M2

I woke up as the captain announced we would be landing soon. Only 6 hours ago, I had been in a foreign country where I spent my spring break practicing my skills as a medical student and providing free healthcare to the underserved residents of Lima, Peru. This experience was life-changing, and I was more pumped up than ever to tackle the rest of the second semester of medical school. To top it all off, once the semester ended, I would be spending my summer break in Cancun, Mexico, for the wedding of my dreams and marrying my best friend. Little did I know that when I walked off that plane, I would be walking into a new world, and everything I knew was about to get flipped upside down. 

Within the next few days, we received word that due to the COVID-19 pandemic, classes would be temporarily moved online, and the campus would be closed. At this point, everything was unknown, and questions soared. Would we get to continue with our medical careers? How would I find a quiet place to study? How would we continue with classes that require patient contact? These questions even poured into my personal life as well. Would my family be okay? Would I still be able to get married? Would I get to see my classmates again? With the unknown looming over our heads, it was hard to focus on studying things like the circulatory system.

Medical school is difficult enough, and when I finally thought I was getting into a rhythm of study habits, the pandemic changed it up. I was no longer able to go to class, ask my professors questions, or even have a quiet place to take exams. With the ever-changing reality of being a medical student in this pandemic, I realized the parallel it has with a career in medicine. This pandemic made it more apparent than ever that becoming a physician means being resilient and adjusting to adversity. Physicians are working hours and hours in constant contact with this fatal virus and moving out of their homes to protect their families as they serve the medical community. As difficult as it may be, I realized that being a medical student at this time is a gift and an opportunity to learn how to deal with adversity.

While I may have had to reschedule my wedding and might not see some of my classmates until graduation, I have learned to adapt to the situation. I learned how to study in a noisy household, perform OSCEs online, and continue to adjust as things change daily because of the pandemic. This is a growing period for everyone, but a time to build our character and learn to become better future physicians. My experience in the face of this adversity has confirmed that a career in medicine is my calling. This is just the beginning of a career filled will adversity and resilience, but one that will be more rewarding than I can ever imagine. 

I’m Just a Medical Student

By Megan Emiliani, M2

Over spring break, I went on a medical mission trip to Peru. Our trip leaders were constantly checking for updates from the Texas A&M study abroad office, and our trip was still good to go. While we were there, we would get so busy treating patients during the day that no one was on their phones checking social media or messages from family. However, every night at dinner, we would come together and share news about what was happening in the United States. First, I got news that our classes would be online for the next week or two. Then, I got news that the Houston Livestock Show and Rodeo had been cancelled. When I finally heard that the NBA cancelled the rest of the season and churches were closing for the time being, I knew this pandemic was growing to a greater proportion than I could have ever imagined.

Despite all this news, our trip was never cancelled. We made it through the whole trip, and I returned safely to Texas. Two days after we left to return home, the border to Peru closed. If we had left just two days later, we would have been stuck in Peru. I was astonished at the time frame everything happened in.

Once I returned to Texas, my family wanted me to stay in Houston with them, so I’ve been here at my parents’ house with my brother and two sisters ever since spring break. I’ve enjoyed being able to spend time with them, but I haven’t been able to neglect the responsibility I have to my medical education. It has been a struggle to concentrate on schoolwork when I don’t have my usual routine while living in a house full of people who I love having fun with.

Early on in this time of quarantine, I would sit here thinking, “What is the point of sitting here studying and stressing out about exams all the time? Why am I putting so much effort into this? After returning from this medical mission trip where I was actively providing so much care to people, I now feel useless. I’m just a medical student.”

One morning, I was lying in bed drinking coffee and watching the news with my mom. They were doing a story on the physicians and nurses working in ICUs treating patients with COVID-19. The thing I noticed about these healthcare providers is that they looked exhausted and seemed to never have a chance to slow down. However, I also noticed that they looked optimistic. They work tirelessly, put their health at a higher risk, and even give up hugging their families. Yet they love and care for patients with all they have in order to comfort them in times of distress and celebrate with them in times of joy. Seeing how these healthcare heroes have impacted their patients is nothing short of inspiring to me.

I now see that there is purpose in what I am doing. While I wish I could be helping on the front lines, my place is here, in my home, learning more about medicine. I am already growing as a future physician so that one day I can fight alongside the healthcare providers out there today and defend my patients to the best of my ability.  

Even though our roles may seem small right now, medical students are doing their part by continuing their medical education, even from home. Thank you to the physicians on the front lines for motivating us and giving us hope.

A Germaphobe’s Back-to-School Guide for Staying Physically and Emotionally Healthy

By Jordan Garcia, M4

1. Ease back into human interactions slowly. Start by letting your significant other back into the house and introducing yourself to your newborn child.

2. If you spot a face-toucher in class, be it a student, professor, or LCME representative, refrain from calling out their madness overtly. Maintain your professionalism by building a parachute hand sanitizer (see #3), and sling-shot it discreetly to the face-toucher.

3. To build an emergency parachute hand sanitizer, tie a surgical mask to a travel-size bottle of Germ-X.

4. Write down all theoretical COVID symptoms on a notecard. Scrub hands for the length of time it takes to read said notecard aloud twice from beginning to end.

5. Stop harboring negative emotions. If necessary, work with a therapist until you no longer feel swells of abandonment and rage at the mention of the name “Lysol.”

6. When you see someone on campus not wearing a face mask, quickly lie down on the ground and elevate your legs to maintain blood flow to the brain.

7. Keep a flare gun on your person at all times. If you find yourself in a bathroom with no paper towels to open the door with, send out a distress signal.

8. Protect yourself and others by personally conducting temperature checks on everyone in the building at least once per hour.

9. Avoid contact with anyone who has an intact cough reflex.

Connecting in the Time of Corona

By Sreeya Cherlo, M2

Thirty-Seven Minutes

By Olivia Adams Moharer, M4

“Medical Alert. Code Blue. Medical Alert. Code Blue.” 

A mundane announcement, of an imminent arrest,

which pierced my ears,

trickled down to two hands, to ten fingers,

whose tips, ashamedly now, longed for CPR.

To compress the chest

of an anonymous Lazarus

To bring someone, 

Anyone, 

back to life. 

My moment came.

To be cast as the hero portrayed on the screen

when someone grabbed my arm,

and led me to a dying patient,

now, right in front of me.

I jumped to help; I gowned; I gloved.

Little did I know,

I would be compounding Death’s desire 

to steal away Life.

With the first compression, 

a snapping so horrid struck my hands, 

rolled up my spine and still rings in my ears

like a bell that pierces and portends instead of celebrates or cheers.

The cinematic appeal abandoned as the curtain closed.

No one warns you of the assault on the senses—

the battery of beating a beat-less heart.

No one warns you of how quickly the hero

becomes the accomplice, if not the villain, in the same story.

The sights, the sounds, the smells, the sensations—

They inhabit the darkest fraction of my memories, still.

How my arms pumped like pistons, 

pushing past every snap, every spew

Each beat expelling more of his soul.

Until that someone grabbed my arm. 

I felt the weight of dozens of eyes.

My numb arms lifted off of the mangled frame.

A ringing, so deafening, pervaded the room;

it drew out like the straight line on the monitor.

All the while, 

He wasn’t even my patient;

I knew nothing about him.

Yet,

Death left me standing covered in a strange man’s blood.

No one warns you of when medicine is not enough

and when all the right steps still fail. 

So why rage against Death in a pyrrhic fight

when a victory could lie with dignity?

These hands long to go back,

to those thirty-seven minutes,

and guide his heart, gently, into that good night.

Resilience

By Helen Chen, M3

This year was a year of firsts.

First of many board exams 

First experience of rounding on patients

First time living in a big city without my support system nearby

First time living in the midst of a pandemic

Even with all these first-time experiences, I realized how constant life is 

Behind every storm, there is a silver lining

Behind every burned forest, new life grows

And when life starts to feel overwhelming, and self-doubt starts to creep in,

I try to find the light in my current storm.

To All My Mentors

By Brianna Covin, M3

To all my mentors:

Thank you for always believing in me, even if I never believed in myself. Thank you for seeing past my many flaws and frequent mistakes. Thank you for the constant encouragement and for reminding me that failures are OK. 

Because of you, I am even closer to a dream I once thought unattainable. 

The high school girl who

once broke a hospital door during an EMT rotation, 

got attacked by an elderly patient with dementia,

was so overcome with excitement during her first ambulance call that she ran past the patient, 

spent two EMT rotations pretending to hear breath and bowel sounds, only to find out later that the stethoscope was on the bell setting,

decided, while watching her first surgery, that she was going to try her absolute hardest to become a doctor.

The college girl who

canceled an EMT job interview because she doubted herself too much,

cried over learning MATLAB,

cried over learning organic chemistry,

stress ate an entire box of cinnamon sticks before an anatomy exam she started studying for a little too late,

almost didn’t submit an application to a medical school because she still doubted herself

is now halfway through medical school 

and assists in the very surgeries that drew her to become a doctor. 

Because of you, the words of those who doubted me are powerless. 

Because of you, I know what a great doctor looks like, and I cannot wait to become a doctor, one day soon, just like you. 

Initial Impression of Med School

By Ksenia Vlassova, M1

US Route 75 Exit 285—Ross Avenue

By Erin Sigler, M4

It was sometime in the late summer of 2015 when I first made my way on what would become my daily commute. I headed out of the suburbs, hopped on US 75, exited toward downtown Dallas via Exit 285, and took a right turn onto Ross Avenue. I was headed to a job interview.

It would be several months until I started my job—my first job after finishing my MBA, my first grown-up-feeling job. To say I was nervous would be an understatement. I spent my days delving through rows and rows of data, learning the intricacies of Excel, and seeing how data fit into measuring healthcare operational outcomes. The learning curve was steeper than I imagined. 

When I left for a new opportunity, I realized how much I was leaving with. I had not just learned how to be an analyst. The experience showed me my weaknesses, and it showed me my strengths. It taught me the value of communication. It showed me the importance of teamwork and collaboration with colleagues. It taught me the value of asking for help. Years later, I would find that my time spent working on Ross Avenue would remind me of how far I have come.

It was sometime in the summer of 2018 when I first made my way on what would become my new commute. I headed out of the suburbs, hopped on US 75, exited toward downtown Dallas via Exit 285, and took a left turn onto Ross Avenue. I was headed to Baylor University Medical Center for the start of my second year of medical school. 

I have made this trip many times over the last couple of years. Most days I make the trip without much thought to my time spent working down the road. On other occasions, a quick look in the rearview mirror after turning left toward the hospital has served as a reminder of how far I have come and how appreciative I am to be where I am today. As I head into my last year of medical school, I hope to enjoy my time left as a student, knowing that I will be onto the next part of my journey before I know it. 

It is very easy for us as students to spend time looking forward, planning for next the stages of training. It takes work to stay in the moment and enjoy where we are, whether in the hospital with patients or at home with loved ones. Every so often, though, it is worth taking a look back, and reminding ourselves that where we are today is because of the roads we traveled along the way. 

eight minutes and forty-six seconds

for George Floyd

By Thomas Nguyen, M2

the time it takes for a school bus, the sticky color

of sunlight, to snake around a neighborhood, pause 

for dreary-eyed children tired from an evening

of kickball. the time for me, groggy-eyed in the mornings, 

to walk, unbothered, from the parking lot to school. 

in that time, your voice falling out of focus

like a distant rain, & then gone, irrevocable.

all for cigarettes & a twenty-dollar bill.

it’s August now. the leaves have unfurled

& I’m alone in a void of my thoughts.

I can’t stop seeing the careless look in his eyes 

as he towered over you, the same indifference

I give to the pigeons cooing on power lines, fish eyeing 

the mouth of a shimmering hook. or how, neck

pinned, you called for your mom. tonight, 

the wind is a hollow breath in your absence, 

the lake folding into itself like a memory. 

I know there is no right way to wish things back, 

& this story will repeat itself with each scab 

I peel, blood pooling like a ditch, the words

I can’t breathe assembling on the shore, 

just before the wash of the sea takes them back.

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thank you:

A special thanks to ... 

Karen Wakefield, PhD, RN, for being our faculty editor, and Barbara Gastel, MD, MPH, for serving as editorial mentor.

 The Synapse is sponsored by the Department of Humanities in Medicine at the Texas A&M University College of Medicine.