June 2015

A Memoir
By Nicole Lew, M2

"This woman must live," Noah declared. "You don't know what this woman means to me. How she saved my life. She is the reason I am alive today. She will not die. God will not allow her to die like this."

The attending pursed her lips; I wondered how she would treat Noah's denial and grief.

"It doesn't look good. We encourage prayer, and faith helps in the process. But we want you to prepare yourself because she is not doing well. She might have a few days."

Noah's jaw shook and his lip pressed into a line—not angry but resolute. "She will not die. God will save her."

I sat silently, not knowing whether to put a comforting hand on his shoulder or to look away from the awkward glare of the situation.

We left the conference room, and I stood in the hallway as Noah went in to be with his wife.

Three days later, I was back in their wing, listening to another patient's case, when I heard a wail—a howling from the end of the wing.

It was Noah. Blessing had died. His sobs resonated through the wing. There was a brief pause as everyone—nurses, doctors, clueless students—stopped to interpret the hollow howl, to see if it was another psych patient out of control or a family member goofing off. And then we saw a group of young African men huddled at the end of the hall. And I knew it was the little Ugandan family I had come to love.

Then, as if in slow motion, nurses, doctors and students turned away and began to work again. It was another day in Critical Care for them. But for me, a friend had died. I still think of their family today and wonder what Noah said to God that day. And I think of how, for that family, it wasn't just another day.

Some names and identifying details have been changed to protect the privacy of individuals.

The Brave One
By Anna Shamsnia, M2

I think it was the first time that I saw him that weak and helpless. I had been in medical school for almost six months learning about the doctor-patient relationship and how it is important to pay attention to the patient's pain. No amount of science classes or tests or even BAP discussions had prepared me for this moment. I was there to be strong for my mom. I almost believed that being in medical school had made me stronger, but the moment I walked into the recovery room and saw him in pain—screaming and asking for the pain to stop—I fell apart. I had no control! I lost it!  He was screaming and I was crying. My mom was the strong one. I knew that over the last ten years my dad’s back pain slowly wore him down, both physically and mentally. But he never showed it. Now that he had undergone surgery to fix the source his pain, it was finally over. All I could do was cry. I almost forgot that the surgery was successful; seeing him in pain was preoccupying me, and I wanted it to stop.

My Angel
By Suneet Flora, M2

“He has acute myeloid leukemia.” This is what my brother texted me while I was  in my cell biology class to tell me my 29-year-old cousin had cancer. Shock, fear, then anger came over me in a rush of emotions. I had not seen him in three years, and the fear of not ever seeing him again made me go numb. Months went by, and I was only able to talk to him through the chat on a game we played. He did not leave the hospital for six months, and I couldn’t imagine what he may look like now after chemo. Being a true Sikh, he had long hair that he would tie in a turban and a long beard. This is the only way I have ever known him to look. That summer my dad went to see my cousin and showed me pictures when he returned. My cousin had scruff and close to no hair on his head. Seeing this person who was unrecognizable to me brought me to tears. Then all of a sudden there was hope. A bone marrow donor was found and this was the possible cure. Weeks later the hope was smashed when the donor withdrew from going through the donation process. This happened three times. I felt helpless and clueless because I knew nothing about his treatment and did not know what I could do to help. I felt anger towards those who gave us hope and then backed out from potentially saving my cousin’s life. The family dynamic was changing in a way I did not understand. It was a time for us to lean on each other and for open communication, but instead there were secrets about the treatment and his condition, which angered me even more. Nine months after his diagnosis, his condition was worsening. An unplanned round of chemotherapy was now necessary because no bone marrow donor was found that would donate as planned. His immune system wasn’t able to handle it anymore and infection was eating through his skin and to his bone. All of a sudden I stopped hearing from him. He had asked to see my brother. Within a few days my brother was on a plane heading to England to see my dying cousin. I knew then that things were not looking good. My brother had been in the air for only a few hours when at 10:30 pm we got the phone call that my cousin had passed away. My brother was too late.  It was my junior year and my MCAT was the next week. Now I had a sense of guilt. I knew I would not be able to go to the funeral because it was in England. I knew I should’ve talked to him more and made more of an effort. Was he angry that I didn’t play the game enough so we could talk more? Would he think I was selfish for not missing school and rescheduling my MCAT to be at the funeral? A conversation we had before his diagnosis came to my mind. He told me how proud he was of me and how he knew I would be a great physician. When I got accepted into medical school all I wanted to do was tell him that I did it. Every day since I think about him and hope I am making him proud.

Abruptio
By Dr. Katie Fuller, Family Medicine

Tiny flutter in my hand,
The sweetness of your perfection,
Ten perfect fingers
Ten perfect toes
Your mother’s button nose
Who lies bleeding on the table.
You fit into my palm
Too perfectly for this world.
The bassinet became your deathbed,
The warm blanket a shroud,
And now I,
Your deliverer,
Am delivering your eulogy instead.
To know death before life
Is a tragedy 
And a blessing - 
Which one is greater,
I do not know.
I carry your death in my body
And your body in my hand
As your mother carried you
Those weeks too few.
Your heartbeat, faint,
And now still,
Is seared into my soul
And now forever I will know
The grief of knowing you.

Siri, Do I Have Cancer?
By Anand Jayanti, M2

As the medical profession matures and the democratization of technology matures even faster, health care providers find themselves at odds with services like WebMD and the increasingly "omniscient" patient—"Does this rash mean I'm schizophrenic? I read it on Yahoo Answers." 

Needless to say, this knowledge is often incomplete and misinformed—for now—but we can easily envision a world in which technology-aided diagnosis will transcend even the physician's ability. With the iWatch taking your vitals and Kickstarter projects aimed at keeping the doctor away better than the apple ever could, it doesn't take H.G. Wells to see that world coming. And with 3-D printed hip replacement schematics available as torrents on Pirate Bay, indeed that world seems closer than we may imagine.

So how are we best placed to guide both our patients and ourselves through this transition? The times really call on us to decide what it is about us that is irreplaceable, rather than dig our heels like Luddites and pretend the world is still flat. No doubt there was a generation of doctors that trusted their own intuitions more than the first MRI machines, too.

Perhaps one place to start is the ever-receding role of the doctor as a guide. Countless studies show patients increasingly dissatisfied with the shrinking time allotted with their physician during visits. The only people less happy with this seem to be the physicians themselves. Both parties appear to have evolved a rather simple understanding that patients show up when they're not feeling well. Dr. Abraham Maslow (of Hierarchy of Needs fame) was the first psychologist to refer to his patients as "clients," and in his approach he endeavored not just to treat the ill in a person's life but promote the good and healthy. This may sound like marketing, but the difference is as cavernous as the relationship someone has with their doctor vs. with their personal trainer. With the knowledge we are empowered with, not only in medicine, but in nutrition and fitness and mental health, we are enabled to make even starker improvements in people's lives than a trainer or mystic without ever writing on that little square pad, and the future might just call on us to make that change.

Sunscreen
By David Harmon, M2

I sat down in my undersized chair next to my translator, an American doctor’s daughter in her mid-teens, and observed the family as they got situated. The two children were young, neither older than 15. Both were dressed in jeans with long-sleeved shirts covering their arms. I thought to myself, “It’s hot outside; that must be unbearable.”

Both children were wearing glasses, but I could see only the sides of their faces where the frames of their glasses hugged their ears. Each child had her own hat, pulled low over her eyes, so much so that I was unable to see the eyes. I looked down at their hands; large patches of sunburn covered their intensely fair skin.

I asked again, in my limited Spanish, for their papers from triage which contained their chief complaints and vitals. My vision blurred out everything on the page except one word, underlined, on both the children’s papers: Sunscreen. Other words—headaches, glasses—started to come into my visual focus after a few more seconds. Such a simple request in contrast to the multi-symptom syndromes and chronic pain cases which consumed the majority of our time in our small church clinic in Lima.

After a few questions through my translator about medical history and potential causes of their headaches, I started my physical exam on each child. I asked to see the back of their hands. Small raised specks covered the reddened backs of their hands—an early sign of sun poisoning. I proceeded to an ocular examination, asking each of them to read the eye chart I had available—both were nearly blind even with their glasses. I told my translator I needed to have a look in their eyes and if they could please remove their glasses. As the older child took off her glasses, our eyes met for the first time during the examination. My eyes were met by her red, melanin-deficient irises. When the light of my otoscope shone into her eyes, the entire eye glowed red from the amount of light entry. After the brief exam, I noticed her blinking and rubbing her eyes as she returned the glasses to her face.

After completing the physical exam on both children, I asked a few more follow-up questions, revealing that sunlight was abrasive to their eyes. I was immediately thankful that our eye clinic in the floor below had a plethora of sunglasses. I told the sisters I could give them sunglasses for their eyes, better prescriptions for their vision, and ibuprofen for their intermittent headaches. Sunscreen. The first item noted in their immediate “needs,” yet the only problem I was unsure I could solve.

I excused myself from the room and walked down the humid, hazy hallway to our rudimentary pharmacy. I asked every staff person in the room if we had sunscreen anywhere. My plea was only met with blank stares or “no clue” responses. I looked through every bin, container, and hygiene packet we had. Nothing. I was slightly irritated. We were equipped to treat parasites, fungi, bacterial infections, acid reflux, migraines, and even diabetes. Yet we lacked something so simple.

I focused. I mentally rehearsed the list of other medical personnel on my floor. “Who would have sunscreen with them right now?” It came to me. I ran to the examining room across from the pharmacy and asked my colleague if I could speak to her a moment. I first asked if she had sunscreen. “Yes, of course.” I stumbled over my next words, “Could I ... I need ... I’ll buy you another ... but my patients really need this. Can I have it?” Being one of the nicest individuals in our crew, she was more than willing to help and retrieved a small, almost full 7-ounce bottle of sunscreen from her backpack. I thanked her and ran back to my room.

I apologized for my 10-minute absence, but the patients hardly seemed to notice my apology as their faces lit up when I set the small tube down on the table in front of them. You would have thought I had just performed neurosurgery gratis for this humble family. After I explained application instructions and told them to take extra care of their hands—the most exposed piece of skin on their bodies—I asked them the fateful question, which sometimes pales in comparison to a complex medical diagnosis for which we can’t provide treatment or a difficult lifestyle adaptation as a result of a congenital malformation: “Is there anything else I can do for you?” My translator relayed their response: “No, this is wonderful.” 

As I left the family at the eye clinic with an extra note to ensure they received two pairs of sunglasses each, something inside me moved. There will be difficult and dreary days as I continue to progress in my medical education. I will have complex cases, and hopefully I will provide good solutions for each. But one thing I must remember, there is no way to know a patient’s entire life in a 15-minute visit—there is no way to fully understand the mental battles, depression, and discrimination one may face with a chronic disease or congenital disorder. Doing my absolute best, even by providing something as simple as sunscreen, can help a struggling patient realize that, yes, there is someone who truly cares about me.

M1
By V.T. Alexander

Oh, how time flies by
Has it really been one year?
Summer is so near

M1 has been great
With an interesting tank and
A calendar too

Neuro is now done
Cadaver Ball has been fun
M0s have come

THANK YOU

To our amazing faculty mentors: Barbara Gastel, Mary Elizabeth Herring, Gül Russell, & AJ Stramaski

Faculty Editor: Karen Wakefield